Tag: pubmed

JAMA Netw Open. 2026 Jan 2;9(1):e2553974. doi: 10.1001/jamanetworkopen.2025.53974.

ABSTRACT

IMPORTANCE: Burnout is highly prevalent among resident physicians, producing serious personal, professional, and system consequences. While work hour restrictions were implemented to improve patient safety and resident fatigue, the relationship between work hours with burnout and well-being remains unclear.

OBJECTIVE: To evaluate the association of work hours with burnout, stress, and self-perceived competency among residents in high-burnout specialties, and to explore potential demographic and well-being-related moderators.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included responses from a remote survey conducted from February to June 2024 as part of a randomized clinical trial evaluating a well-being intervention among resident physicians. Eligible participants were residents enrolled in high-burnout specialty residency programs (surgery, obstetrics-gynecology, family, internal, and emergency medicine) in the US.

EXPOSURE: Self-reported average weekly work hours and total hours worked in the past week.

MAIN OUTCOME AND MEASURES: Burnout, stress, and self-assessed Accreditation Council for Graduate Medical Education (ACGME) competency milestones, adjusting for demographics.

RESULTS: A total of 540 residents responded (356 cisgender women [66.8%]; 112 Asian [21.1%], 28 Black [5.3%], 355 White [67.0%]). The sample was predominantly in a medical specialty (56%). The mean (SD) number of average hours worked was 65.4 (11.3) and the mean (SD) number of hours worked in the last week was 60.1 (17.4). There was no significant association between burnout and average hours worked (β = 0.05 [95% CI, -0.05 to 0.15]; P = .34) or hours worked last week (β = 0.06 [95% CI, -0.03 to 0.15]; P = .21). However, stress was positively associated with average hours worked (β = 0.17 [95% CI, 0.07 to 0.26]; P = .001) and hours worked last week (β = 0.27 [95% CI, 0.18 to 0.36]; P < .001). Self-assessed ACGME competency milestones were also positively associated with average hours worked (β = 0.14 [95% CI, 0.07 to 0.21]; P < .001) and hours worked last week (β = 0.08 [95% CI, 0.01 to 0.15]; P = .02). Despite exploring a large set of candidate moderators, very few moderators were identified and none survived P value adjustment.

CONCLUSION AND RELEVANCE: In this cross-sectional nationwide study of resident physicians in high-burnout specialties, longer work hours were associated with higher stress and self-perceived competency, but not with burnout. This suggests that work hours alone may not explain high burnout levels in residency; a more comprehensive approach beyond work hour restrictions is needed to support resident well-being in training.

PMID:41533375 | DOI:10.1001/jamanetworkopen.2025.53974

JAMA Dermatol. 2026 Jan 14. doi: 10.1001/jamadermatol.2025.5295. Online ahead of print.

ABSTRACT

IMPORTANCE: ICP-332 is a tyrosine kinase 2 inhibitor currently under investigation for the treatment of atopic dermatitis (AD).

OBJECTIVE: To evaluate the safety and efficacy of ICP-332 for moderate to severe AD.

DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled, phase 2 randomized clinical trial was conducted between February 6 and November 7, 2023, across 19 centers in China. Individuals aged 18 to 75 years who had diagnosis of AD for 1 year or longer and a history of contraindication or inadequate response to topical therapies were included.

INTERVENTION: Participants were randomized 1:1:1 to receive ICP-332 at 80 mg or 120 mg, or placebo orally once daily for 4 weeks. Study participants and personnel were blinded to group assignment.

MAIN OUTCOMES AND MEASURES: The primary outcome was safety. The key efficacy outcome was the percentage change from baseline in Eczema Area and Severity Index (EASI) at week 4. Other outcomes included percentages of patients achieving EASI-75 (a ≥75% improvement in EASI) and Validated Investigator Global Assessment for Atopic Dermatitis score of clear (0) or almost clear (1) with 2 or more points improvement.

RESULTS: This study included 75 patients (mean [SD] age, 37.3 [18.0] years in the ICP-332 groups and 44.5 [17.4] years in the placebo group; 21 women [28%] and 54 men [72%]). Among the 74 patients included in the safety set, 17 of 25 (68%) in the placebo group, 19 of 25 (76%) in the 80-mg ICP-332 group, and 18 of 24 (75%) in the 120-mg ICP-332 group experienced treatment-emergent adverse events, with all events being mild or moderate. The most common adverse event was decreased blood fibrinogen (1 of 25 [4%] in the placebo group, 6 of 25 [44%] in the 80-mg ICP-332 group, and 5 of 24 [21%] in the 120-mg ICP-332 group). Percentage reductions in EASI at week 4 were -78.2% (95% CI, -89.8% to -66.6%) in the 80-mg ICP-332 group, -72.5% (95% CI, -84.3% to -60.7%) in the 120-mg ICP-332 group, and -16.7% (95% CI, -28.7% to -4.6%) for those receiving placebo. Mean differences vs placebo for percentage reductions from baseline at week 4 in EASI were -61.6% (95% CI, -78.4% to -44.7%; P < .001) and -55.8% (95% CI, -72.8% to -38.9%; P < .001) for 80-mg ICP-332 and 120-mg ICP-332, respectively. There was a statistically significant higher EASI-75 response rate with both ICP-332 doses (64.0% for each; difference vs placebo, 56.0%; 95% CI, 34.4%-77.6%; P < .001) than with placebo and a greater percentage of Validated Investigator Global Assessment for Atopic Dermatitis score of 0 or 1 and improvement of 2 or more points at week 4 in the 80-mg ICP-332 group vs placebo (36.0%; difference vs placebo, 32.0%; 95% CI, 11.7%-52.3%; P = .005).

CONCLUSIONS AND RELEVANCE: In this phase 2 randomized clinical trial, ICP-332 demonstrated a favorable safety profile and encouraging efficacy, supporting further development for AD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05702268.

PMID:41533373 | DOI:10.1001/jamadermatol.2025.5295

JAMA Psychiatry. 2026 Jan 14. doi: 10.1001/jamapsychiatry.2025.4106. Online ahead of print.

ABSTRACT

IMPORTANCE: Grief-focused cognitive behavioral therapies (GF-CBTs) are found effective in treating prolonged grief disorder (PGD), but the relative efficacy of different delivery formats is unknown. While evidence for individual GF-CBT (GF-CBT individual) is well established, evidence for group GF-CBT (GF-CBT group) is scarce. However, the group format holds possible advantages in a bereavement context.

OBJECTIVE: To examine whether GF-CBT group is noninferior to GF-CBT individual in reducing PGD symptoms in older adults.

DESIGN, SETTING, AND PARTICIPANTS: Enrollment and data collection for this noninferiority randomized clinical trial took place from April 2021 to May 2025. Participants were randomized 1:1 to GF-CBT group and GF-CBT individual and followed up with until 6 months posttreatment. Recruitment and treatment were done in a naturalistic clinical practice. Participants included older bereaved adults (65 years or older) with clinically relevant levels of PGD, posttraumatic stress disorder (PTSD), depression, and/or anxiety based on established cutoffs on self-report questionnaires. These data were analyzed from June 2025 through August 2025.

INTERVENTIONS: GF-CBT group and GF-CBT individual consisted of 12 weekly sessions (duration: 2 hours vs 1 hour), including the same intervention techniques in the same order (exposure, cognitive restructuring, and behavioral activation).

MAIN OUTCOMES AND MEASURES: Outcomes were measured at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up as the primary end point. The primary outcome was PGD symptoms measured with the Prolonged Grief-13 questionnaire. Secondary outcomes included symptoms of PTSD, depression, anxiety, loneliness, social support, functional impairment, quality of life, and well-being.

RESULTS: Participants (N = 113; mean [SD] age, 71.58 [5.86] years; 92 female [81.4%], 20 male [17.7%], and 1 person [.09%] had missing information on gender) were randomized to GF-CBT group (n = 56) or GF-CBT individual (n = 57). Mixed linear models on the intention-to-treat sample showed that both formats yielded statistically significant large reductions in PGD symptoms over time (GF-CBT group: d = 1.74; GF-CBT individual: d = 1.46). GF-CBT group was noninferior compared with GF-CBT individual (d = 0.09; 95% CI, -0.06 to 0.25) at 6-month follow-up. The noninferiority of GF-CBT group was evidenced for all secondary outcomes. Dropout rates were 23% (GF-CBT group) vs 19% (GF-CBT individual).

CONCLUSIONS AND RELEVANCE: In this study, GF-CBT group was noninferior to GF-CBT individual at 6-month follow-up in reducing PGD symptoms, but also symptoms of PTSD, depression, and anxiety. Both formats had large effects on symptoms over time and appear to be relevant treatment formats for older adults with symptoms of PGD and other disorders post loss.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04694807.

PMID:41533372 | DOI:10.1001/jamapsychiatry.2025.4106

Int J Environ Health Res. 2026 Jan 14:1-9. doi: 10.1080/09603123.2026.2614976. Online ahead of print.

ABSTRACT

CVS prevalence was found to be 76.9%. Females had higher odds of CVS (OR = 1.834, p = 0.028). Each one-unit increase in screen time was associated with higher odds of CVS (OR = 1.340, p = 0.030). Each one-unit increase in screen distance was associated with higher odds of CVS (OR = 2.153, p = 0.004). Each one-unit increase in room illumination was associated with lower odds of CVS (OR = 0.555, p = 0.015). Those who used at least one protective measure had lower odds of CVS (OR = 0.403, p = 0.006). There was no statistically significant relationship between CVS and academic year, screen brightness, or posture.

These findings highlight the need for spreading awareness and promoting targeted interventions to improve eye health.

PMID:41533339 | DOI:10.1080/09603123.2026.2614976

Am J Physiol Cell Physiol. 2026 Jan 14. doi: 10.1152/ajpcell.00845.2025. Online ahead of print.

ABSTRACT

Prostate cancer progression and metastasis is a complex step that is controlled by various molecular and cellular mechanisms. Here, the process of osteomimicry has a vital role in the context of bone metastasis. Osteomimicry phenomenon refers to the ability of cancer cells to acquire bone-like properties, thus enabling them to adapt to and survive in their bone microenvironment. This phenomenon promotes cancer cell and bone microenvironment interactions and contributes directly to tumor survival, growth, and the development of bone metastatic lesions. In this review we discuss the role of different osteomimicry factors in prostate cancer progression and metastasis, highlighting their involvement in each stage of the metastatic cascade. Key factors involved in osteomimicry – such as bone matrix proteins, signaling pathways, and transcriptional regulators – play important roles throughout the various stages of cancer progression. These include the initial development of the tumor, its local invasion into surrounding tissues, entry into the bloodstream (intravasation), spread to other more distant areas (extravasation), and ultimately, colonization and growth in the bone. Gaining a better understanding of how these factors are regulated, interact, and function can shed light on new treatment strategies aimed at targeting osteomimicry to slow down or prevent the progression of prostate cancer and its spread to the bones.

PMID:41533336 | DOI:10.1152/ajpcell.00845.2025

Tissue Eng Regen Med. 2026 Jan 14. doi: 10.1007/s13770-025-00782-1. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) presents significant unmet medical needs with no effective therapeutic options. Current pharmacological treatments provide only symptomatic relief and do not prevent the ongoing neurodegeneration. Cell therapies using mesenchymal stem cells (MSCs) are being widely investigated for its potential in treating AD but remain unverified. This review aimed to evaluate therapeutic effects of MSCs on AD patients through a review of clinical trial literatures.

METHODS: Publications and registered clinical trials from January 2011 to June 2025 were collected from the international databases (ClinicalTrials.gov, PubMed, Web of Science, SCOPUS) using the keywords of “Alzheimer’s disease”, “mesenchymal stem cells”, and “clinical trials”. After initial screening and sorting, 17 clinical trials and 4 related papers were finally selected for in-depth analysis.

RESULTS: The 17 clinical trials were mostly early stages with 4 phase 1 (23.5%), 9 phases 1/2 (52.9%), 3 phase 2 (17.7%), and 1 pilot phase (5.9%). The source of MSCs included allogeneic umbilical cord blood (UCB) in 5 trials (29.4%), autologous adipose tissue in 4 (23.5%), allogeneic umbilical cord (UC) in 3 (17.6%), allogeneic bone marrow (BM) in 3 (17.6%), allogeneic placenta in 1 (5.9%) and 1 unknown (5.9%). Administration routes were primarily intravenous (IV) infusion in 12 trials (70.6%), intracerebroventricular (ICV) infusion via Ommaya reservoir in 3 (17.6%), and stereotactic brain injection (SBI) in 2 (11.8%). Among the 17 clinical trials, outcome data of 7 trials have been reported in 4 clinical papers and 1 clinical results posted in ClincalTrials.gov: 4 trials using UCB MSCs (NEUROSTEM-AD) in 2 papers, 2 trials using BM MSCs (Lomecel-B) in 2 papers and 1 trial using adipose MSCs (AstroStem) in ClinicalTrials.gov. All 5 reports using different cell types, administration routes or dosages claimed the safety of MSCs administration. As for the therapeutic efficacy, 2 reports using Lomecel-B reported meaningful improvement in AD pathophysiology or cognitive functions, while the other 3 reports using NEUROSTEM-AD or AstroStem failed to show statistically significant efficacy.

CONCLUSION: The analysis of 17 clinical trials and 5 relevant clinical outcomes showed that MSCs therapy if feasible and generally safe in AD patients. There are indications of potential therapeutic benefits such as improved cognitive function or quality of life measures in some AD patients. However, its therapeutic efficacy has not been proven definitely due to small size of subjects, variations in dosage, MSCs source, and administration scheme (route, timing, and frequency). Larger subject sizes and well-controlled trials are needed to provide more conclusive evidence.

PMID:41533329 | DOI:10.1007/s13770-025-00782-1

Spine Deform. 2026 Jan 14. doi: 10.1007/s43390-026-01278-1. Online ahead of print.

ABSTRACT

PURPOSE: Osteogenesis Imperfecta (OI) is a rare connective tissue disorder often associated with severe, brace-resistant scoliosis. Posterior spinal fusion (PSF) with pedicle screws can achieve up to 60% coronal correction, while preoperative halo-gravity traction (HGT) may provide additional benefits but carries potential risks. This study evaluated whether HGT offers perioperative or radiographic advantages compared with PSF alone in pediatric OI patients.

METHODS: Thirty-six patients treated between 2002 and 2020 with ≥ 2 years’ follow-up were retrospectively analyzed. Patients were divided into HGT + PSF (N = 19) and PSF-only (N = 17) groups, comparable in baseline characteristics. The primary outcome was coronal correction rate (CR); secondary outcomes included operative time, blood loss, length of stay (LOS), complications (Modified Clavien-Dindo-Sink Classification, MCDS), and loss of correction at follow-up. Statistical comparisons used Mann-Whitney U and Chi-Squared tests (p < 0.05).

RESULTS: Postoperative major and minor curve CR were 60.2% and 66.5% in the HGT + PSF group vs. 55.1% and 37.7% in PSF (p = 0.337 and p = 0.003). At last follow-up, CR was 51.1% and 38.8% for HGT + PSF vs. 44.9% and 25.2% for PSF (p = 0.298 and p = 0.238). Mean blood loss (1235 vs. 1368 mL, p = 0.972), operative time (443 vs. 410 min, p = 0.490), and LOS (12.6 vs. 9.5 days, p = 0.186) were not significantly different. Complications occurred in 57.9% of HGT + PSF vs. 29.4% of PSF patients (p = 0.367), with more major complications in the HGT + PSF group.

CONCLUSIONS: In this cohort, HGT provided only modest additional coronal correction without clear perioperative advantages compared with PSF alone. Given these limited and partly transient effects, its routine use should be considered cautiously and in the context of individual patient characteristics. Larger prospective multicenter studies are needed to clarify the specific clinical scenarios in which preoperative HGT may offer meaningful benefit in the surgical management of OI-related scoliosis.

PMID:41533302 | DOI:10.1007/s43390-026-01278-1

Qual Life Res. 2026 Jan 14;35(2):43. doi: 10.1007/s11136-025-04157-w.

ABSTRACT

PURPOSE: To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR).

METHODS: In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains.

RESULTS: In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 (P < 0.001), and for physical (P < 0.001) and emotional (P < 0.001) disease-related symptoms, as well as treatment side effects (P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 (P < 0.001) and the FKSI-19 (P < 0.001).

CONCLUSIONS: HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

PMID:41533299 | DOI:10.1007/s11136-025-04157-w

Clin Transl Oncol. 2026 Jan 14. doi: 10.1007/s12094-025-04198-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate how the implementation of intensity-modulated/image-guided RT (IMRT/IGRT) with intraprostatic seeds can impact the risk of late gastrointestinal (LGI) and genitourinary (LGU) toxicity in prostate cancer (PCa) patients treated with dose-escalation RT.

MATERIALS /METHODS: Retrospective analysis of a prospective cohort of 1,010 men treated within a risk-adapted, intensification program with a minimum follow-up (FU) of 5 years. The median radiation dose to prostate was 79.5 Gy (IQR: 75.0, 80.3). Short-term ADT (STADT, n = 165) and long-term ADT (LTADT, n = 385) were administered to intermediate- and high-risk patients, respectively. Late toxicities were assessed using the EORTC/RTOG criteria. Kaplan-Meier analysis: to calculate the cumulative incidence of late toxicities; Cox proportional regression model: to estimate hazard ratios (HRs).

RESULTS: Median FU was 116 months (IQR: 88-133). The median RT dose for IMRT/IGRT was 80.0 Gy (IQR 79.1, 81.2) and 78.0 Gy (IQR 73.1, 79.6), (p = 0.001) for those treated with 3DCRT. The 10-year Kaplan-Meier grade ≥ 2 LGI and LGU toxicities were 10% (95% confidence interval [CI] 8-12) and 16% (95% CI 14-18), respectively. The multivariate analysis (MVA) showed that the use of IMRT/IGRT with intraprostatic seeds was a significant protective factor for grade ≥ 2 LGI toxicity (HR: 0.66, 95%CI: 0.46-0.95, p = 0.021), despite the higher radiation dose in the IMRT/IGRT group. However, its impact on decreasing grade ≥ 2 LGU toxicity did not achieve statistically significance (13% vs 18%; p = 0.053, HR 0.88). A prior transurethral resection of the prostate (TURP) (HR 1.98, 95% CI: 1.30-2.59, p = 0.002) and the presence of acute grade ≥ 2 GU complications (HR:1.76, 95% CI: 1.20-2.9, p = 0.003) were associated with a higher incidence of grade ≥ 2 LGU toxicity, while LTADT was significantly associated with a lower risk of GU complications (HR:0.66, 95% CI: 0.46-0.95, p = 0.021).

CONCLUSION: The study confirms that IMRT/IGRT with intraprostatic fiducial markers significantly reduces grade ≥ 2 late GI toxicity, and appears to prevent an increase in GU toxicity rates despite dose escalation.

PMID:41533295 | DOI:10.1007/s12094-025-04198-0

Int J Comput Assist Radiol Surg. 2026 Jan 14. doi: 10.1007/s11548-025-03564-1. Online ahead of print.

ABSTRACT

Purpose Surgical gestures are fundamental components of surgical procedures, encompassing actions such as cutting, suturing, and knot-tying. Gesture recognition plays a pivotal role in the automatic analysis of surgical data. Although recent advancements have improved surgical gesture recognition, much of the existing research relies on simulations or minimally invasive surgery data, failing to capture the complexities of open surgery. In this study, we introduce and employ a new open surgery dataset focused on closing incisions after saphenous vein harvesting. Methods Our goal is to improve gesture recognition accuracy by incorporating tool pose estimation and 3D hand pose predictions of surgeons. We employ MS-TCN++ and LTContext for gesture recognition, and further enhance performance through an ensemble of models using different modalities-video, tool pose, and hand pose data.Results The results reveal that using an ensemble model combining all three modalities provides a substantial improvement over video-only approaches, leading to statistically significant gains across multiple evaluation metrics. We further demonstrate that the model can rely solely on hand and tool poses, completely discarding the video input, while still achieving comparable performance. Additionally, we show that an ensemble model using only hand and tool poses produces results that are either: statistically significantly better than using video alone, or not statistically significantly different.Conclusion This study highlights the effectiveness of integrating multimodal data for surgical gesture recognition. By combining video, hand pose, and tool pose information, our approach achieves higher accuracy and robustness compared to video-only methods. Moreover, the comparable performance of pose-only models suggests a promising, privacy-preserving alternative for surgical data analysis.

PMID:41533294 | DOI:10.1007/s11548-025-03564-1