Tag: pubmed

Hong Kong Med J. 2026 Jun 18. doi: 10.12809/hkmj2513308. Online ahead of print.

ABSTRACT

INTRODUCTION: We conducted a study to linguistically translate and psychometrically validate a translated and culturally adapted Chinese version of the European 3-item benign prostatic hyperplasia (BPH) screening tool (TOOL), then assess its diagnostic accuracy for identifying BPH with a prostate volume above 40 mL.

METHODS: The study was conducted in two phases. The first phase involved a rigorous translation process performed by skilled multilingual translators using forward and backward translation techniques. The second phase focused on psychometric validation and was conducted in urology units across our hospital network.

RESULTS: Sixty-six male patients of Chinese ethnicity, aged 18 to 90 years, who presented with lower urinary tract symptoms for at least 4 weeks were recruited. The study evaluated the TOOL’s reliability, internal consistency, and validity, including convergent, concurrent, and criterion validity. Statistical analyses demonstrated strong internal consistency (Cronbach’s alpha=0.890) and substantial test-retest reliability (intra-class correlation coefficient=0.715). The screening tool demonstrated moderate to strong correlations with both the International Prostate Symptom Score and prostate volume, supporting its validity. Furthermore, responsiveness analysis showed significant reductions in TOOL scores after surgery. The combination of the screening tool (cut-off: ≥3) and prostate-specific antigen level (cut-off: >2.35 μg/L) exhibited high sensitivity and specificity for detecting prostate volume above 40 mL (sensitivity: 92%, specificity: 73%; area under the receiver operating characteristic curve=0.842).

CONCLUSION: These findings support the reliability and validity of the TOOL as a culturally adapted instrument for evaluating lower urinary tract symptoms in Chinese-speaking populations. Its use may improve the management of BPH.

PMID:42312411 | DOI:10.12809/hkmj2513308

Haematologica. 2026 Jun 18. doi: 10.3324/haematol.2026.300790. Online ahead of print.

ABSTRACT

Adults with primary central nervous system lymphoma (PCNSL) who are ineligible for consolidative whole-brain radiotherapy (WBRT) or autologous stem-cell transplantation (ASCT) due to advanced age, comorbidities, or impaired performance status have limited treatment options. Lenalidomide is active in relapsed PCNSL, but prospective data on its use as maintenance are limited. We conducted a multicenter phase II trial of lenalidomide maintenance in adults with PCNSL who achieved at least a partial response after 2-6 cycles of methotrexate- and rituximab-based chemoimmunotherapy and were not candidates for WBRT or ASCT. Lenalidomide 15 mg was given orally on days 1-21 of 28-day cycles for up to 12 cycles or until progression or toxicity. The primary endpoint was 2-year progression-free survival (PFS) from maintenance initiation. Thirty-one patients were enrolled (median age 72 years); 30 received lenalidomide with a median of 11 cycles, and 50% completed all 12. At a median follow-up of 20.7 months, the 2-year PFS was 58.8% (95% CI, 43.4-79.8%), exceeding the pre-specified alternative threshold of 55%, although the formal one-sample log-rank test did not reach statistical significance (p = 0.084). The 2-year overall survival was 83.9%. Grade 3-4 neutropenia occurred in 53.3%, whereas most non-hematologic adverse events were grade 1-2. Treatment was discontinued for toxicity in 13%; one grade 5 pneumonia occurred, and no thromboembolic events were observed. These findings suggest that lenalidomide maintenance is feasible and potentially beneficial in consolidation-ineligible PCNSL patients, though the hypothesis-generating nature of this single-arm study warrants confirmation in randomized comparative trials.

PMID:42312406 | DOI:10.3324/haematol.2026.300790

Haematologica. 2026 Jun 18. doi: 10.3324/haematol.2025.300090. Online ahead of print.

ABSTRACT

This study aimed to evaluate the prognostic significance of FDG-PET/CT-derived biomarkers, including volumetric and dissemination metrics, in newly diagnosed multiple myeloma (NDMM). A total of 146 NDMM patients who underwent baseline FDG-PET/CT before any treatment between 2014 and 2022 at two institutions were retrospectively analyzed. Metabolic tumor burden was quantified using total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG), while spatial dissemination was assessed by the maximal interlesional distance (Dmax), defined as the greatest threedimensional Euclidean distance between lesion centroids. Lesions were segmented semi-automatically using LIFEx software with a 41% SUVmax threshold and a minimum SUV of 2.5. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method, and optimal cutoffs were determined using maximally selected rank statistics. Among PET-derived parameters, TMTV and Dmax were significantly associated with PFS and OS and retained independent prognostic value after adjustment for clinical and biological prognostic factors. In multivariate analysis performed in separate models due to collinearity, TMTV > 18.6 cm³ (PFS: HR = 2.17, p = 0.003; OS: HR = 2.23, p = 0.04) and Dmax > 23.2 cm (PFS: HR = 1.89, p = 0.01; OS: HR = 2.69, p = 0.01) remained independent prognostic factors. Dmax represents an independent PET-derived biomarker reflecting spatial disease dissemination in NDMM. The combined evaluation of dissemination and volumetric parameters may improve baseline risk stratification, providing a more comprehensive assessment of disease biology and potentially guiding therapeutic decisions in multiple myeloma.

PMID:42312402 | DOI:10.3324/haematol.2025.300090

Circ Cardiovasc Interv. 2026 Jun 18:e016573. doi: 10.1161/CIRCINTERVENTIONS.126.016573. Online ahead of print.

ABSTRACT

BACKGROUND: Recent observational studies have suggested that early treatment (<12 hours from diagnosis) of intermediate risk pulmonary embolism (PE) with catheter-based therapies may reduce morbidity and mortality. However, the effect of early versus late mechanical thrombectomy on acute pulmonary hemodynamics and right ventricular mechanics is less well defined.

METHODS: Patients enrolled in SYMPHONY-PE were divided into one of 2 groups based on the time from baseline CT pulmonary angiography to mechanical thrombectomy: Early <12 hours versus late ≥12 hours. The primary safety end point was the rate of major adverse events within 48 hours, as adjudicated by an academic independent safety board. The primary efficacy end point was the core-lab assessed mean change in right ventricle-to-left ventricle ratio from baseline to 48 hours.

RESULTS: Early thrombectomy was performed in 44% (48/109) of patients and was associated with a larger reduction, approaching statistical significance, in right ventricle-to-left ventricle ratio (0.52±0.50 versus 0.37±0.34; P=0.071). Mean pulmonary artery pressure decreased significantly more in patients receiving early thrombectomy (8.6±5.2 versus 5.8±5.0 mm Hg; P=0.006). The major adverse events rate was similar (P=0.431) between groups, and there were no mortalities. The differences in efficacy outcomes were greatest in higher-risk patients per the Composite Pulmonary Embolism Shock score.

CONCLUSIONS: Early mechanical thrombectomy was associated with larger reductions in right ventricle-to-left ventricle ratio and mean pulmonary artery pressure, with no significant differences in safety event rates compared with patients who underwent late thrombectomy. Randomized trials are needed to test these associations.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06062329.

PMID:42312382 | DOI:10.1161/CIRCINTERVENTIONS.126.016573

Ren Fail. 2026 Dec;48(1):2685354. doi: 10.1080/0886022X.2026.2685354. Epub 2026 Jun 18.

ABSTRACT

The atherogenic index of plasma (AIP) is a lipid-based marker of cardiovascular risk, yet its prognostic value for severe acute kidney injury (AKI) in critically ill patients with cardiovascular disease (CVD) remains uncertain. This retrospective study analyzed 5,872 patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with external validation in the eICU Collaborative Research Database (eICU-CRD). The primary outcome was stage 3 AKI, and secondary outcomes included renal replacement therapy (RRT) and length of stay. Stage 3 AKI was observed in 20.7% of patients, with the incidence increasing across AIP quartiles (Q1-Q4: 15.9-26.8%), and 5.3% of patients requiring RRT (Q1-Q4: 2.6-10.9%). High AIP was associated with stage 3 AKI (adjusted OR = 1.35; 95% CI: 1.11-1.64), RRT (OR = 1.95; 95% CI: 1.33-2.87), longer hospital LOS (β = 3.58; p < 0.001) and ICU LOS (β = 1.14; p < 0.001). Restricted cubic splines revealed linear associations between AIP and both renal outcomes (stage 3 AKI and RRT). Mediation analysis indicated that stage 3 AKI mediated 12.6% of the association between the AIP and in-hospital mortality. The predictive models achieved AUCs of 0.916 for RRT and 0.727 for stage 3 AKI. These associations with renal outcomes were robust, as confirmed by entropy balancing and external validation in the eICU-CRD. Elevated AIP is a robust, externally validated predictor of stage 3 AKI and RRT, with substantial predictive accuracy for RRT. Furthermore, it appears to influence in-hospital mortality partially through renal injury, warranting confirmation in future prospective studies.

PMID:42312375 | DOI:10.1080/0886022X.2026.2685354

J Alzheimers Dis. 2026 Jun 18:13872877261457126. doi: 10.1177/13872877261457126. Online ahead of print.

ABSTRACT

BackgroundIn cerebral small vessel disease (CSVD), the burden of white matter hyperintensities (WMH) does not fully account for cognitive impairment, suggesting the involvement of intermediary mechanisms.ObjectiveWe investigated whether a gray matter atrophy network acts as the key mediator linking topologically specific (deep) WMH to multidomain cognitive dysfunction.MethodsIn this retrospective study, 260 patients with CSVD (62 cognitively normal, 125 with mild impairment, 73 with dementia) were included. Cognitive status was assessed neuropsychologically. 3.0 T MRI identified an atrophy network. We then conducted pre-specified mediation analyses and a primary confirmatory analysis using structural equation modeling (SEM) to test whether this atrophy network mediated the effect of deep WMH on cognitive performance.ResultsA 41-region atrophy network was identified, primarily involving the medial temporal lobe and thalamus, that was significantly associated with cognitive status. The final SEM demonstrated excellent fit, showing that higher deep WMH burden was associated with greater network atrophy (β = 0.145, p < 0.05), which in turn was strongly associated with poorer executive function (β = -0.64, p < 0.001) and memory (β = -0.572, p < 0.001). The direct effect of WMH on cognition was not statistically significant in the model.ConclusionsOur findings suggest that in CSVD, a unified network of gray matter atrophy acts as a powerful statistical mediator in the effect of deep white matter injury on cognitive decline. This atrophy pattern may represent a more direct biomarker of the neurodegenerative process underlying cognitive impairment than WMH burden alone.

PMID:42312368 | DOI:10.1177/13872877261457126

J Neurosurg Anesthesiol. 2026 Jun 19. doi: 10.1097/ANA.0000000000001128. Online ahead of print.

ABSTRACT

Hemodynamic stability and timely neurological assessment are critical components of anesthetic management in intracranial neurosurgery. This systematic review and meta-analysis were prospectively registered in PROSPERO (CRD420251274560, registered December 28, 2025) and evaluated the efficacy and hemodynamic stability of remimazolam versus propofol as hypnotic agents in patients undergoing these procedures. PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing remimazolam with propofol in patients undergoing intracranial neurosurgical procedures. The outcomes evaluated were heart rate (HR), mean arterial pressure (MAP), hypotension incidence, recovery characteristics, and adverse events. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. We included 7 RCTs, comprising 770 patients. Remimazolam was associated with a significantly shorter recovery time compared with propofol (MD: -1.74 min; 95% CI: -3.40 to -0.08; P=0.040; I2=48.7%). There were no significant differences between groups in anesthesia duration (MD: -3.31 min; 95% CI: -9.40 to 2.78; P=0.286; I2=0%), HR (MD: -1.79 bpm; 95% CI: -8.97 to 5.39; P=0.625; I2=97.5%), MAP (MD: -2.54 mm Hg; 95% CI: -6.09 to 1.00; P=0.160; I²=29.5%), and incidence of hypotension (RR: 0.56; 95% CI: 0.26-1.22; P=0.143; I2=72.4%). In conclusion, in patients undergoing intracranial neurosurgery, remimazolam use was associated with shorter recovery time and a hemodynamic profile similar to that of propofol.

PMID:42312365 | DOI:10.1097/ANA.0000000000001128

Trop Doct. 2026 Jun 18:494755261459846. doi: 10.1177/00494755261459846. Online ahead of print.

ABSTRACT

BackgroundAccurate and timely Gram stain interpretation of positively flagged blood culture bottles is crucial for early detection of bloodstream infections and initiation of empirical therapy. However, resin and charcoal particles in culture media may interfere with smear clarity.MethodsA prospective study was conducted on 100 positive blood culture samples. Four smear preparation techniques – conventional, water wash, blood film, and drop and rest – were applied. These were assessed for diagnostic agreement with final culture results and graded for resin/charcoal interference. Kappa (κ) statistics measured concordance.ResultsThe blood film method showed the highest agreement with culture Gram stains (63%, κ = 0.26), followed by conventional (62%, κ = 0.24), drop and rest (61%, κ = 0.22), and water wash (59%, κ = 0.18). It also had the least particle interference and the most deposit-free smears (29/100).ConclusionThe blood film method offers superior diagnostic clarity and is recommended.

PMID:42312347 | DOI:10.1177/00494755261459846

Glob Health Action. 2026 Dec;19(1):2686564. doi: 10.1080/16549716.2026.2686564. Epub 2026 Jun 18.

ABSTRACT

BACKGROUND: Cesarean section is a lifesaving obstetric intervention when medically indicated; however, its utilization remains unequal across sub-Saharan Africa (SSA). Although the World Health Organization recommends cesarean section rates of 10-15%, access remains insufficient in many low-resource settings and excessive in others. Understanding geographic patterns and drivers is essential for maternal health planning.

OBJECTIVE(S): To examine the spatial variation and determinants of cesarean section delivery across SSA.

METHODS: We conducted a cross-sectional analysis using Demographic and Health Survey data (2015-2024) from 201,481 weighted samples across 28 SSA countries. Spatial autocorrelation and hotspot patterns were assessed using Global Moran’s I and Getis-Ord Gi* statistics. Spatial regression models, including ordinary least squares, spatial lag, spatial error, geographically weighted regression, and multiscale geographically weighted regression, were fitted. Model performance was compared using corrected Akaike Information Criterion and adjusted R².

RESULTS: Cesarean section delivery showed significant spatial clustering (Moran’s I = 0.18, z = 43.3, p < 0.01). Hotspot areas were identified in Uganda, Rwanda, Burundi, Kenya, Tanzania, Malawi, South Africa, Lesotho, Gabon, Ghana, and Senegal, while cold spots were observed in Ethiopia, Madagascar, Angola, Nigeria, Guinea, Cote d’Ivoire, Sierra Leone, Liberia, and Mauritania. Previous cesarean delivery, maternal age ≥35 years, pregnancy spacing behavior, and health insurance coverage were significant spatial predictors.

CONCLUSION: Cesarean section utilization in SSA exhibits substantial geographic inequality driven by context-specific determinants. Spatially targeted maternal health policies, improved referral systems, and equitable financing mechanisms are needed to optimize access to medically indicated cesarean delivery while minimizing unnecessary procedures.

PMID:42312320 | DOI:10.1080/16549716.2026.2686564

Int J Chron Obstruct Pulmon Dis. 2026 Jun 12;21:616277. doi: 10.2147/COPD.S616277. eCollection 2026.

ABSTRACT

INTRODUCTION: Patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often suffer from malnutrition, and traditional assessment methods struggle to fully capture muscle loss. The value of total pectoralis major area (tPMA) measured by CT remains to be determined. This study aimed to investigate the relationship between tPMA and malnutrition in patients with AECOPD and its diagnostic value.

METHODS: A total of 123 patients with AECOPD were enrolled (35 in the malnutrition group and 88 in the non-malnutrition group). Clinical and imaging parameters were compared between the two groups. Logistic regression analysis was used to assess the independent association between tPMA and malnutrition, and ROC curves were employed to evaluate its diagnostic performance when used alone or in combination with albumin (ALB) or total protein (TP). Spearman correlation analysis was used to examine the relationship between tPMA and other nutritional and disease severity indicators.

RESULTS: tPMA levels were significantly lower in the malnourished group than in the non-malnourished group (P < 0.01). tPMA was a protective factor against malnutrition in patients with AECOPD (OR = 0.998, P < 0.001); this association remained statistically significant after adjusting for confounding factors (P < 0.05). The AUC of tPMA for the standalone diagnosis of malnutrition was 0.770; when combined with ALB or TP, the AUC increased to 0.901 and 0.916, respectively (P < 0.05). tPMA was positively correlated with nutritional indicators and negatively correlated with the NRS2002 and CAT (P < 0.05).

DISCUSSION: tPMA is an independent associated factor against malnutrition in patients with AECOPD; when combined with ALB or TP, it significantly improves diagnostic performance and can serve as an objective adjunctive assessment indicator.

PMID:42312314 | PMC:PMC13271148 | DOI:10.2147/COPD.S616277