Tag: pubmed

Sci Rep. 2026 Jul 2. doi: 10.1038/s41598-026-59783-2. Online ahead of print.

ABSTRACT

Urinary incontinence, coital incontinence, dyspareunia, and sexual dysfunction are clinical conditions that can result from this condition. Treatment options include conservative and surgical approaches. The gold standard in surgery is mid-urethral sling procedures. The aim of this study is to compare the effects of the commonly used conventional transobturator tape (TOT) and retropubic transobturator tape (TOTRP) techniques on female sexual function and to evaluate possible differences, particularly regarding dyspareunia. A total of 108 sexually active women with stress urinary incontinence who underwent conventional TOT (n = 54) or TOTRP (n = 54) surgery between January 2023 and January 2025 were included in the study. Women aged 18-60 years who presented to the clinic for stress urinary incontinence between January 2023 and January 2025, were sexually active, underwent TOT or TOTRP surgery, and had a minimum of 6 months postoperatively were included in the study. The FSFI questionnaire data and demographic characteristics of patients in this group, as routinely collected in our practice, were retrieved from the hospital database and patient files. Data analysis and statistics were performed using jamovi software (version 2.6.44). No significant differences were found between the demographic and clinical characteristics of the two groups included in the study. A significant increase in postoperative FSFI scores was observed in both groups compared to the preoperative period. No significant difference was found between TOT and TOTRP in terms of total FSFI scores. However, when FSFI subscales were examined, a significant improvement in dyspareunia scores was observed only in the TOTRP group in the postoperative period (p < 0.001). No significant change in dyspareunia was observed in the conventional TOT group. Postoperative coital incontinence decreased significantly in both groups. Conventional TOT and TOTRP techniques provide a general improvement in female sexual function after SUI surgery. Although there is no significant superiority between the techniques in terms of total sexual function scores, improvement in dyspareunia scores was observed in the TOTRP group; however, direct superiority over conventional TOT could not be established. Prospective, randomized, long-term follow-up studies are needed to confirm these findings.

PMID:42393323 | DOI:10.1038/s41598-026-59783-2

J Neurooncol. 2026 Jul 3;178(3):87. doi: 10.1007/s11060-026-05692-3.

ABSTRACT

BACKGROUND: Brain metastases from renal cell carcinoma (RCC) are uncommon but clinically consequential. We evaluated survival, intracranial failure, lesion-level local failure, and MRI volumetric response after Gamma Knife radiosurgery (GKRS), including associations with systemic therapy exposure.

METHODS: We retrospectively identified patients treated with GKRS for intracranial RCC metastases (2001-2025). Systemic therapy exposure (TKI and/or immunotherapy) was captured time-agnostically. Overall survival (OS) and patient-level intracranial treatment failure were analyzed using Kaplan-Meier/Cox models. Lesion-level treatment failure was analyzed using clustered generalized estimating equations (GEE). Six-month volumetric response was assessed using an epsilon-stabilized log volume ratio ln{(V_6m+ϵ)/(V_GKRS+ϵ)}, ε = 0.01.

RESULTS: Thirty-four patients (87 lesions) were treated; 22 deaths occurred. Overall survival was numerically longer among patients who received systemic therapy compared with those who did not, although this did not reach statistical significance (log-rank p = 0.058). In a parsimonious adjusted Cox model, TKI exposure was associated with improved OS (aHR 0.191; 95% CI 0.062-0.593; p = 0.004), as was higher KPS (HR 0.37 per 10-point increase; 95% CI 0.21-0.63; p < 0.001). Ten patient-level intracranial treatment failure events occurred, without significant differences by systemic therapy exposure. At the lesion level, 15/87 lesions failed; postoperative cavities had higher failure than intact lesions (71.4% vs. 12.5%; p = 0.001) and remained associated with failure after clustered adjustment (OR 9.92; 95% CI 1.44-68.27; p = 0.020). Dmax was not correlated with 6-month log volume ratio (ρ=-0.075; p = 0.535), but poorer 6-month volumetric response was associated with subsequent lesion failure (p = 0.0023; clustered OR 2.84; 95% CI 1.16-6.96; p = 0.023).

CONCLUSIONS: In RCC brain metastases treated with GKRS, postoperative cavities showed a higher observed rate of local failure than intact lesions, although this finding should be interpreted cautiously given the small number of cavity targets. While Dmax was not associated with early volumetric change, early 6-month volumetric trajectory was associated with subsequent local failure, suggesting a pragmatic imaging marker for risk-adapted surveillance and salvage planning. Systemic therapy exposure, particularly TKIs, was associated with OS in adjusted analysis, whereas intracranial treatment failure did not differ by systemic exposure in this cohort.

PMID:42393321 | DOI:10.1007/s11060-026-05692-3

Dysphagia. 2026 Jul 3. doi: 10.1007/s00455-026-10975-y. Online ahead of print.

ABSTRACT

Swallowing activities have been increasingly recognized as relevant to cognitive function, yet the physiological pathways linking these functions to the brain remain incompletely understood. One proposed mechanism involves changes in cerebral blood flow. This study examined whether a standardized oral exercise program could alter prefrontal cerebral blood flow, measured by near-infrared spectroscopy. This single-center prospective study enrolled 52 healthy adults (mean age 33.1 ± 10.4 years; 67.3% female). Participants performed a 12-min exercise protocol consisting of 15 guided tasks classified into neck and shoulder relaxation, swallowing muscle strengthening, and vocalization practice. Cerebral hemodynamic responses were recorded continuously with a head-mounted dual-wavelength spectrophotometer. Hemoglobin difference (HbD), defined as oxygenated minus deoxygenated hemoglobin (HbO₂ – HbR), was used as a surrogate marker of blood flow, and task-related changes (ΔHbD) were calculated relative to baseline. Category-level effects were evaluated with Bonferroni correction, and task-wise comparisons were treated as exploratory and adjusted using Benjamini-Hochberg false discovery rate correction. Swallowing muscle strengthening tasks demonstrated a significant category-level increase in ΔHbD (0.34 ± 0.96 µM; p = 0.01), whereas the other exercise categories did not show significant overall effects after correction. In exploratory task-wise analyses, tongue protrusion (p = 0.0098, q = 0.049), lateral tongue movements (p = 0.0003, q = 0.0045), and chewing and swallowing action (p = 0.0095, q = 0.049) remained statistically significant after false discovery rate adjustment. No differences were observed by age or sex. In summary, swallowing-related oral exercises were associated with acute increases in prefrontal cerebral blood flow. These results suggest a possible physiological link between oral motor activity and cerebral perfusion, which warrants further investigation in larger and more diverse populations.

PMID:42393301 | DOI:10.1007/s00455-026-10975-y

Eye (Lond). 2026 Jul 2. doi: 10.1038/s41433-026-04698-5. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate DR prevalence, risk factors, and undiagnosed disease in the Thessaloniki Eye Study.

DESIGN: Cross-sectional, population-based study.

SETTING: Community examinations and home visits in Thessaloniki, Greece.

PARTICIPANTS: Adults aged 60 years or older; 2468 with gradable fundus data or fundus examination were analysed.

EXPOSURES: Self-reported diabetes mellitus (DM), demographics, ocular/systemic history, and lifestyle factors.

MAIN OUTCOMES AND MEASURES: DR prevalence/severity graded from fundus photographs using a modified Airlie House system; clinically significant macular oedema (CSMO), vision-threatening retinopathy (VTR), and DR risk factors.

RESULTS: Among 2468 participants, DR prevalence was 6.9% (170/2468; 95% CI, 6.0%-8.0%). Among 352 participants with self-reported diabetes, 31.0% (109/352; 95% CI, 26.4%-36.0%) had DR; mild, moderate, severe non-proliferative DR, and proliferative DR were observed in 13.6%, 7.1%, 7.4%, and 2.8%, respectively. CSMO and VTR were present in 6.5% and 11.9%, respectively. Increased DR risk was associated with male gender (OR = 2.64), insulin therapy (OR = 4.87), and longer antihyperglycaemic treatment duration (OR = 1.05/year). Lower DR risk was associated with older age (OR = 0.87/year), regular alcohol intake (OR = 0.39), and migraines with aura (OR = 0.11). Among participants with DR, 73.9% were unaware of their diagnosis.

CONCLUSIONS: DR affected nearly one-third of participants with diabetes, and most DR cases were undiagnosed. These findings support improved DR screening and education in older Greek adults.

PMID:42393291 | DOI:10.1038/s41433-026-04698-5

Sci Rep. 2026 Jul 2. doi: 10.1038/s41598-026-60065-0. Online ahead of print.

ABSTRACT

This study aims to evaluate the impact of two dose reconstruction techniques, standard and composite, on gamma passing rates (GPRs) during pre-treatment quality assurance of large-field pelvic RapidArc plans using the Octavius 4D system with a 1500 2D ionization chamber array. The investigation focuses on quantifying the effect of reconstruction methodology across varying gamma criteria and normalization modes. Ten large-field pelvic RapidArc verification plans for pelvic radiotherapy cases were analysed using both standard reconstructions based on a single measurement and composite reconstructions generated by merging two longitudinally shifted measurements in the Octavius 4D system. Measurements were performed on a Varian TrueBeam linac using 6 MV beams, and dose comparisons were conducted in verisoft software. The composite reconstruction was generated by merging two longitudinally shifted measurements to extend the detector’s effective field of view. Gamma analyses were performed under both global and local normalization at multiple criteria (1 mm/2%, 2 mm/2%, 2 mm/3%, 3 mm/2%, and 3 mm/3%). Statistical significance between reconstruction methods was assessed using paired tests (p < 0.05). Under global normalization, 3D GPRs exceeded 95% for all criteria, with negligible differences (< ±2%) between standard and composite reconstructions (p > 0.05). Local normalization exhibited greater sensitivity, showing up to -11.6% lower GPRs for the composite method at the most stringent criterion (1 mm/2%), though these differences diminished (<2%) at 3 mm/3%. Composite reconstructions consistently produced volumetric and transverse-plane GPRs that were comparable to or higher than those from single-plane analyses, confirming stable dose agreement across planes. The composite reconstruction method provides dosimetric accuracy equivalent to the standard approach while enabling full-field verification for large field pelvic RapidArc fields. Its use significantly enhances QA efficiency without compromising clinical reliability. For standard practice, composite reconstruction combined with global normalization and 3 mm/3% gamma criteria offers an optimal balance between accuracy and practicality in large-field pre-treatment QA.

PMID:42393290 | DOI:10.1038/s41598-026-60065-0

Int Ophthalmol. 2026 Jul 2;46(1):275. doi: 10.1007/s10792-026-04151-2.

ABSTRACT

PURPOSE: To evaluate the postoperative visual and refractive outcomes of cataract surgery following blunt ocular trauma over a ten-year period and to investigate the impact of timing of surgical intervention, and preoperative clinical findings on the final visual prognosis.

METHODS: This study included 92 patients who underwent cataract surgery secondary to blunt ocular trauma at a single-center tertiary care hospital between January 2015 and January 2025. Demographic characteristics, cataract types, lens status, timing of surgery, preoperative and postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), associated ocular findings, surgical complications, and same-session intraocular lens (IOL) implantation were analyzed.

RESULTS: The mean age of the patients was 54.7 ± 18.4 years, and 66.3% were male. The most common cataract types were mature cataract (50%) and cortical cataract (28.3%). Mean preoperative BCVA improved significantly to a mean best-achieved postoperative BCVA of 0.39 ± 0.50 logMAR. The mean postoperative spherical equivalent was – 1.11 ± 2.02 D. Complications were observed in 29.3% of patients intraoperatively and 35.9% postoperatively. No statistically significant associations were found between postoperative BCVA, SE, or astigmatism and lens status, cataract type, iris integrity, or timing of IOL implantation (p > 0.05).

CONCLUSION: Cataract surgery secondary to blunt ocular trauma can result in significant visual improvement when appropriately managed; however, the risk of intraoperative and postoperative complications remains considerable. Therefore, individualized surgical planning is essential for optimizing outcomes in these patients.

PMID:42393286 | DOI:10.1007/s10792-026-04151-2

Surg Oncol. 2026 Jun 30;67:102490. doi: 10.1016/j.suronc.2026.102490. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Peritoneal metastasis (PM) of gastric cancer (GC) is frequently resistant to systemic chemotherapy, which leads to a poor prognosis. This study was designed to compare the safety and tolerability of hyperthermic intraperitoneal chemotherapy (HIPEC) with recombinant mutant human tumor necrosis factor-α (rmhTNF) versus paclitaxel after radical surgery for GC.

METHODS: Patients with locally advanced or metastatic GC who underwent surgical exploration at the Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University were prospectively enrolled and randomly assigned to three groups. All patients received HIPEC on the 1st and 3rd postoperative day. The HIPEC regimens were as follows: rmhTNF (Group A), paclitaxel (Group B), and rmhTNF + paclitaxel (Group C).

RESULTS: A total of 30 patients were enrolled in this study, with 10 patients each in groups A, B and C. There were no statistically significant differences in postoperative first activity, gastrointestinal function recovery, catheter removal, and length of hospital stay (P > 0.05). Postoperative complications, including abdominal distension, discomfort, anastomotic leakage, myelosuppression, infection, and fever, did not demonstrate statistically significant differences among the three groups (P > 0.05). Similarly, no statistically significant differences were observed in hematology, liver and kidney function, and postoperative coagulation function among the three groups of patients before surgery, after the first HIPEC treatment, before the second HIPEC treatment, and after the second HIPEC treatment (P > 0.05). After a median follow-up of 14 months, a total of 10 patients (34.5%) experienced recurrence.

CONCLUSION: The safety and tolerability of rmhTNF for HIPEC in GC were confirmed. Additionally, rmhTNF did not impede gastrointestinal recovery or increase postoperative complication rates.

PMID:42391679 | DOI:10.1016/j.suronc.2026.102490

Injury. 2026 Jun 30;57(8):113477. doi: 10.1016/j.injury.2026.113477. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses are central to trauma care in both peacetime and conflict, where training and expertise directly affect patient outcomes. Cooperative training between healthcare professionals from opposing communities is rare in regions of ongoing violence, yet may be a powerful mechanism for strengthening regional trauma systems and advancing health diplomacy. Operating Together is a binational initiative that brings Palestinian and Israeli trauma providers together for joint training. This study describes the establishment of a regional Advanced Trauma Care for Nurses (ATCN) program serving both Israeli and Palestinian communities, evaluates course effectiveness, and health‑diplomacy attitudes.

METHODS: Between January 1 and December 31, 2025, six ATCN providers and two ATCN instructor courses were conducted. Participants completed anonymous questionnaires assessing satisfaction, perceived clinical relevance, and attitudes toward Palestinian-Israeli health cooperation. Descriptive statistics summarized responses, and comparisons used independent‑samples t tests and Fisher’s exact tests (significance p < 0.05).

RESULTS: Of 52 participants, 36 completed the study (50% Israeli, 50% Palestinian). Participants reported high course satisfaction (M = 8.44/10) and perceived educational impact (M = 4.39/5). Most (94.4%) expressed interest in maintaining professional contact. The belief that cooperation improves patient care is strongly correlated with positive health‑diplomacy attitudes (rs =.74, p < .001). Palestinian nurses reported significantly higher scores regarding the role of health cooperation in conflict resolution and mutual understanding (both p = .006). Male participants had higher health‑diplomacy index scores than female participants (p = .004).

CONCLUSION: In the context of ongoing conflict, joint ATCN courses for Palestinian and Israeli nurses were associated with high educational satisfaction and strong support for continued professional cooperation. Participants perceived binational training as beneficial for trauma care and contributing to a more positive climate. Joint trauma nursing education may provide a promising platform for strengthening trauma systems and advancing health diplomacy in conflict‑affected settings.

LEVEL OF EVIDENCE: Prognostic and epidemiological; Level II-III (educational intervention).

PMID:42391665 | DOI:10.1016/j.injury.2026.113477

J Med Internet Res. 2026 Jul 2;28:e84262. doi: 10.2196/84262.

ABSTRACT

BACKGROUND: Knee osteoarthritis is a heterogeneous condition characterized by chronic pain, stiffness, and fatigue that fluctuate rapidly over time. Traditional clinical assessments provide only static diagnoses of disease severity, failing to capture the dynamic, day-to-day symptom variability that impacts patient quality of life. While wearable technologies offer the potential for continuous, high-frequency monitoring, previous reviews have examined general technological interventions for knee osteoarthritis management, yet they lack a specific synthesis of technologies for symptom monitoring.

OBJECTIVE: This study aims to synthesize current research on sensor technologies used for the continuous monitoring of knee osteoarthritis symptoms in free-living or simulated daily environments. Specifically, the review seeks to (1) map sensor modalities to specific symptom domains (biomechanical, physiological, and behavioral); (2) evaluate the alignment between objective sensor metrics and patient-reported outcome measures; and (3) identify gaps in current monitoring paradigms.

METHODS: A systematic literature search was conducted across PubMed, Embase, Web of Science, and IEEE Xplore. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility criteria included studies involving participants with knee osteoarthritis using wearable or portable sensors capable of continuous monitoring (eg, inertial measurement units and electrocardiography) and assessing clinical symptoms (eg, pain, fatigue, and stiffness). Studies relying solely on stationary laboratory equipment (eg, force plates) without a portable component were excluded to ensure relevance to real-world applicability. Data regarding sensor types, sampling frequencies, monitored symptoms, and the statistical association between objective features and subjective symptom severity (key findings) were extracted.

RESULTS: A total of 16 studies met the inclusion criteria. The summary constructed from the results revealed a distinct technological saturation: the majority of studies (n=6) used inertial measurement units to quantify biomechanical deficits (eg, gait asymmetry and range of motion), which showed robust correlations with functional limitations. In contrast, there was a notable scarcity of research using physiological sensors (eg, electrocardiography and bioimpedance) to monitor systemic symptoms. Crucially, findings highlighted a significant discrepancy between subjective and objective data, particularly in sleep monitoring, where poor self-reported sleep quality predicted pain exacerbations despite stable objective actigraphy metrics. Furthermore, most systems operated as passive data loggers, with a lack of integration into active feedback loops.

CONCLUSIONS: Unlike previous reviews focused solely on biomechanics, this study innovatively maps the use of sensors across a multidimensional symptom spectrum, revealing a critical gap in the monitoring of fatigue and physiological stress. The findings suggest that current sensor applications are limited by a lack of integration with subjective patient experiences. Real-world implementation requires a hybrid monitoring paradigm that combines the ecological validity of wearable sensors with the clinical relevance of patient-reported outcomes. This approach paves the way for digital phenotyping and active feedback systems, offering a personalized strategy for managing the complex symptom burden of knee osteoarthritis.

PMID:42391637 | DOI:10.2196/84262

J Med Internet Res. 2026 Jul 2;28:e86808. doi: 10.2196/86808.

ABSTRACT

BACKGROUND: Patients with gastrointestinal cancers experience a broad range of symptoms, including anxiety, pain, and reduced quality of life. Although immersive virtual reality (IVR) has emerged as a potential intervention, its efficacy specifically in patients with gastrointestinal cancer remains unclear.

OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the effects of IVR on symptom management in patients with gastrointestinal cancer.

METHODS: Twelve databases and 1 gray literature source were searched from inception to April 30, 2026. RCTs comparing IVR interventions to routine care or nonimmersive alternatives for symptom management in adults (≥18 years) with gastrointestinal cancer were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. The evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Random-effects meta-analyses were performed for primary outcomes (anxiety, pain, quality of life) and secondary outcomes (knowledge, length of stay, vital signs, safety). Heterogeneity was explored using subgroup analyses and meta-regression.

RESULTS: Fourteen RCTs were included, comprising individuals (N=837) with colorectal, liver, esophageal, gastric, pancreatic, and biliary tract cancers. IVR interventions-including immersive scenes, interactive games, anatomical models, and cognitive behavioral modules-were primarily delivered during perioperative and chemotherapy periods. Meta-analysis showed that IVR significantly reduced anxiety (standardized mean difference [SMD] -0.58, 95% CI -0.95 to -0.20; P=.01; 95% prediction interval [PI] -1.36 to 0.21) and pain (SMD -0.75, 95% CI -1.48 to -0.03; P=.04; 95% PI -2.21 to 0.71). Subgroup analysis revealed that the anxiolytic effect was more pronounced when IVR was administered during active treatment and when single sessions lasted ≥20 minutes. Hospital stay was significantly shorter in the IVR group (mean difference -4.11 days, 95% CI -7.39 to -0.82; P=.03; 95% PI -13.82 to 5.60 days). No significant effects were detected for quality of life, knowledge acquisition, or vital signs. The evidence certainty was moderate to very low, with common limitations including risk of bias and imprecision.

CONCLUSIONS: This meta-analysis provides evidence that IVR is an effective nonpharmacological adjunct for symptom management in patients with gastrointestinal cancer, significantly reducing anxiety and pain when implemented during active treatment for at least 20 minutes. However, these findings should be interpreted with caution due to moderate to high heterogeneity, substantial risk of bias in the included studies, and low to very low GRADE evidence certainty. While the 95% CIs indicate a statistically significant average effect, the wide 95% PIs suggest that the true effect in future clinical settings may vary considerably, ranging from marked benefit to negligible impact. These results support the integration of IVR into perioperative and chemotherapy care pathways while underscoring the need for larger, more rigorously designed trials to establish definitive conclusions.

PMID:42391636 | DOI:10.2196/86808