Tag: pubmed

J Plast Reconstr Aesthet Surg. 2026 Mar 16;116:215-222. doi: 10.1016/j.bjps.2026.03.009. Online ahead of print.

ABSTRACT

INTRODUCTION: Assessing the ability of AI chatbots to provide information consistent with clinical guidelines is essential for evaluating the accuracy of the information that patients may receive. We evaluated the ability of three widely used chatbots to reference and respond to clinical questions in alignment with the American Society of Plastic Surgeons’ (ASPS) clinical guidelines.

METHODS: Evidence-based clinical practice guidelines from ASPS and the American Association of Plastic Surgeons (AAPS) were used to develop prompts for ChatGPT-4, Meta Llama 3.1, and Microsoft Copilot. Reviewers determined if the chatbots’ answer aligned with the ASPS guidelines. Any reference to ASPS by the chatbots was recorded. Descriptive statistics were used for data analysis.

RESULTS: Forty-nine total recommendations from five clinical guidelines were included: reduction mammoplasty, autologous breast reconstruction, breast-implant associated anaplastic large cell lymphoma, eyelid surgery, and reconstruction after skin cancer. Copilot cited ASPS recommendations most frequently (Copilot: 67.3%, Llama: 34.7%, ChatGPT: 16.3%; p<0.0001) and had the highest rate of ASPS- and AAPS-aligned responses (Copilot: 79.6%, Llama: 73.5%, ChatGPT: 69.4%; p>0.05). Among the misaligned responses, neutral responses were most common with no significant differences among the chatbots (Copilot: 60%, Llama: 69.2%, ChatGPT: 40%; p=0.62).

CONCLUSION: In our study, up to 30% of chatbot responses did not align with ASPS and AAPS guidance. These results indicate a need for advocacy from plastic surgery societies regarding patient reliance on AI chatbots and training AI models specific to the specialty.

PMID:41985209 | DOI:10.1016/j.bjps.2026.03.009

Epilepsy Behav. 2026 Apr 14;180:111044. doi: 10.1016/j.yebeh.2026.111044. Online ahead of print.

ABSTRACT

BACKGROUND: Intractable epilepsy with partial-onset seizures (POS), affecting more than 20% of individuals with epilepsy, is one of the most common neurological conditions worldwide. Perampanel (PER), an antiepileptic drug (AED), is widely used in the treatment of refractory POS. However, the optimal dose of PER remains undetermined. This network meta-analysis (NMA) aims to determine the optimal dose of PER by comparing and ranking the outcomes acquired from eligible randomized, double-blind, placebo-controlled trials, quantitatively analyzing the data.

METHODS: Electronic databases such as Embase, MEDLINE, CENTRAL, and ClinicalTrials.gov were searched from database inception through May 30, 2024. This NMA includes and synthesizes data from four eligible randomized controlled trials and compares outcomes from four fixed doses of PER (i.e. 12 mg, 8 mg, 4 mg, and 2 mg) along with placebo (PBO). The outcomes assessed include the 50% responder rate, seizure-free rate, dropout rate due to treatment-emergent adverse events (TEAEs), retention rate, and the incidence of TEAEs and serious TEAEs (sTEAEs), using a modified intention-to-treat (MITT) approach. Two reviewers independently screened studies, extracted data from eligible studies and assessed the risk of bias (ROB) using the Cochrane ROB tool 2.0. Pairwise meta-analysis (PMA) and NMA were conducted using a random-effects model with ADDIS v1.16.8 software. The odds ratio (OR) and 95% confidence interval (CI) were calculated for PMA, and OR and 95% credible intervals (CrI) for NMA for dichotomous outcomes. Statistical heterogeneity and sensitivity analyses were performed, and inconsistencies were assessed using the node-split and inconsistency models. We evaluated the quality of evidence and strength of recommendations for clinical practice using the GRADE approach. This prospective study protocol is registered with PROSPERO (registration number: CRD42021247514).

FINDINGS: A total of 281 citations were initially identified from the databases and manual searches, with 4 studies involving 2187 participants ultimately included in the systematic review and NMA. All included trials were assessed as having a low ROB according to the revised Cochrane ROB tool 2.0. The ORs and CrIs for the 50% responder rate showed that PER 12 mg compared to PER 4 mg, PER 2 mg, and PBO ranged from 1.96 (1.12 to 3.21) to 2.78 (1.74 to 4.08). For PER 8 mg, the ORs and CrIs compared to PER 4 mg, PER 2 mg, and PBO ranged from 1.66 (1.01 to 2.67) to 2.33 (1.57 to 3.39). For the seizure-free rate, the ORs and CrIs of PER 4 mg, PER 8 mg, and PER 12 mg compared to PBO ranged from 4.21 (1.18 to 15.35) to 5.90 (1.88 to 22.06), respectively. For TEAEs, the ORs and CrIs for PER 12 mg compared to PER 4 mg, PER 2 mg, and PBO ranged from 2.26 (1.30 to 4.00) to 3.07 (1.86 to 4.82). No significant differences were found in the incidence of sTEAEs across all intervention groups. The ORs and CrIs for the dropout rate showed that PER 12 mg compared to PER 8 mg, PBO, and PER 4 mg ranged from 2.16 (1.22 to 4.06) to 5.00 (2.26 to 14.19), and for PER 8 mg compared to PBO and PER 4 mg, the ORs and CrIs ranged from 2.31 (1.24 to 4.58) to 2.38 (1.06 to 6.22). For the retention rate, the ORs and CrIs of PER 12 mg compared to PER 4 mg, PBO, and PER 8 mg ranged from 0.43 (0.24 to 0.69) to 0.65 (0.43 to 0.97). The overall quality of evidence was deemed high. A strong recommendation is made to prioritize PER 8 mg as the first-line treatment, with PER 12 mg as a secondary option for refractory epilepsy with POS.

INTERPRETATION: PER is safe and effective for the treatment of intractable epilepsy with POS. This NMA, which provides high-quality evidence, strongly recommends PER 8 mg as the first-line treatment option, with PER 12 mg as the second choice when necessary. These recommendations are likely applicable to the majority of patients with intractable epilepsy with POS; however, they may not apply to all patients, particularly those with unique clinical characteristics or in specific clinical circumstances.

PMID:41985208 | DOI:10.1016/j.yebeh.2026.111044

Epilepsy Behav. 2026 Apr 14;180:111051. doi: 10.1016/j.yebeh.2026.111051. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to assess feasibility of a remotely delivered physical activity intervention in adults with epilepsy.

METHODS: Adults with epilepsy and at least one seizure in the prior six months were randomized 2:1 to either a physical activity intervention or a healthy living education control arm. The intervention group received a 12-week program led by a trained health coach aimed to progressively increase daily steps while the control group received biweekly telephone education on healthy living. Sustainability was assessed at 12 weeks post-intervention. Daily steps and activity intensity were continuously measured by a Garmin Forerunner 45.

RESULTS: A total of 21 participants were randomized (15 intervention; 6 control), and 17 completed the full study (14; 3). There was high retention (93%), attendance (80%), and acceptability in the intervention group. While the proportion of the intervention group who strictly adhered to their daily step goal was low (26.67%; 95% CI 0.076 – 0.581), there was a significant increase in mean daily steps (3495 (95% CI 2,170-4,821) to 5591(4,271-6,911), p < 0.001) and mean daily moderate-to-vigorous intensity activity minutes (17.98 (5.55-30.41) to 30.11 (17.93-42.28), p < 0.001) in the intervention group compared to the control group. Both measures remained elevated at follow-up (4,758 (3,437-6,079) and 35.26 (23.03-47.49), respectively) while the control group showed no statistically significant changes over time.

CONCLUSION: A remotely delivered daily steps-based physical activity intervention is feasible for people with epilepsy and shows promising immediate and sustainable effects on physical activity behaviors.

PMID:41985206 | DOI:10.1016/j.yebeh.2026.111051

Epilepsy Behav. 2026 Apr 14;180:111052. doi: 10.1016/j.yebeh.2026.111052. Online ahead of print.

ABSTRACT

BACKGROUND: Self-limited epilepsy with centrotemporal spikes (SeLECTS) is the most common focal epilepsy syndrome in childhood. Although its clinical course is generally benign, concerns remain regarding potential cognitive effects of both the disease and antiepileptic treatments. This study aimed to evaluate visuospatial abilities and cognitive perception in children newly diagnosed with SeLECTS and to compare the cognitive outcomes of levetiracetam and valproic acid monotherapy.

METHODS: This prospective study included 64 children aged 5-10 years who were newly diagnosed with SeLECTS and initiated on monotherapy with either levetiracetam or valproic acid. Cognitive functions were assessed using the Bender-Gestalt Visual-Motor Perception Test at the baseline and after 6 months of treatment. Test results were compared within and between treatment groups.

RESULTS: Of the 64 children, 38 (59.4%) were male and 26 (40.6%) were female, with a mean age of 8.5 ± 1.7 years. Valproic acid was prescribed to 34 patients (53.1%), and levetiracetam to 30 patients (46.9%). There were no significant differences between the groups in terms of age or sex distribution (p = 0.052 and p = 0.63, respectively). In the levetiracetam group, the mean Bender-Gestalt error percentile score increased from 32.0 ± 25.0 at baseline to 37.3 ± 25.2 at month 6, while in the valproic acid group, the corresponding values were 30.6 ± 21.7 and 30.9 ± 25.4. No statistically significant differences were observed between baseline and 6-month cognitive assessments within or between the two treatment groups (p = 0.30 and p = 0.83).

CONCLUSION: In children newly diagnosed with SeLECTS, neither levetiracetam nor valproic acid monotherapy was associated with significant changes in visuospatial abilities and cognitive perception over a 6-month follow-up period. Further long-term and larger-scale studies are warranted to clarify these findings.

PMID:41985205 | DOI:10.1016/j.yebeh.2026.111052

J Psychosom Res. 2026 Apr 13;207:112675. doi: 10.1016/j.jpsychores.2026.112675. Online ahead of print.

ABSTRACT

OBJECTIVE: The international cardiovascular guidelines emphasise self-care as a key factor for better health management in patients. Self-care incorporated into patient engagement is considered vital for the patient-provider relationship to alleviate the polipharmacological treatment burden. However, several cardiovascular (CV) patients struggle to adhere to recommendations. The present study aims to address this research gap by exploring the adherence and real-world effectiveness in a CV population. From this perspective, our cohort study attempted to determine self-care ability based on the relevance of self-efficacy and quality of life perception in adults with a CV condition.

METHODS: An observational study design was applied based on cohort analysis. A total of 76 patients at different stages of disease severity participated in the study. Two types of patient data were collected: medical data-drawn from clinical records and psychological data-collected through interviews and the following standardised questionnaires: the EuroQol Visual Analogue, Self-Care of Chronic Illness Inventory, Self-Care Self-Efficacy Scale. All clinical data were recorded during the outpatient scheduled follow-up.

RESULTS: Our results evidenced that patients with hypertension and heart failure need greater engagement actions and education support from providers to achieve the goal of medical treatments modelling health behaviour that prioritises monitoring ability over time. CV risk factors were more regulated in the self-care monitoring group than in the heart failure group; in CV diseases, patients with ischemic heart disease seemed more efficient in self-monitoring than those with heart failure. Relevant results were obtained in self-efficacy perception; the comparison between hypercholesterolaemia and heart failure groups resulted in statistical significance, indicating that patients with hypercholesterolaemia perceive a higher ability to achieve positive outcomes for their own health; other patient groups did not seem to perceive high self-efficacy.

CONCLUSION: In chronic diseases, such as cardiological conditions, monitoring ability seems to be a challenging clinical variable; the ability to check signs and symptoms, and actions associated with the complexity of physical signs and multimorbidity could be impacted over time. Our findings suggest that fostering self-efficacy capacity could induce better physical self-monitoring for enhanced well-being and greater self-confidence regarding the management of health-favouring behaviours and lifestyle-modelled changes.

PMID:41985203 | DOI:10.1016/j.jpsychores.2026.112675

J Low Genit Tract Dis. 2026 Apr 17. doi: 10.1097/LGT.0000000000000953. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess changes in high-risk HPV prevalence among Inuit women in Nunavik following the introduction in 2008 among 12-year-old girls of the quadrivalent HPV vaccine program in Quebec.

METHODS: A total of 169 Inuit women aged 25-65 were recruited in Kuujjuaq, Nunavik, between July 2022 and December 2024. Participants self-collected cervico-vaginal samples under nurse supervision. HPV DNA testing was performed using real-time PCR (Cobas 4800), detecting HPV 16, 18, and 12 other high-risk types. Results were compared with historical data from 473 Inuit women (2002-2007), using the same genotypic categories. Age-stratified prevalence ratios (PR) were calculated to assess differences over time and odds ratios (OR) for HPV 16/18 detection by vaccination status.

RESULTS: Among 148 participants with results, overall high-risk HPV prevalence increased from 15.9% pre-vaccination to 22.3% post-vaccination, driven by a significant rise in other high-risk types among women aged 40+ (from 5.8% to 16.4%; PR=2.80, 95% CI: 1.16-6.75). HPV 16/18 prevalence showed a non-statistically significant decline among the 25-29 age group (6.8%-3.3%). Only one vaccinated participant tested positive for HPV 16/18 (OR=0.29, 95% CI: 0.0062-2.54).

CONCLUSIONS: The quadrivalent HPV vaccine has reduced HPV 16/18 prevalence in the targeted younger population. Continued surveillance is warranted, particularly for nonvaccine high-risk types.

PMID:41985196 | DOI:10.1097/LGT.0000000000000953

Am J Phys Med Rehabil. 2026 Apr 10. doi: 10.1097/PHM.0000000000003007. Online ahead of print.

ABSTRACT

OBJECTIVES: Body weight-supported (BWS) walking therapies, lower body positive pressure (LBPP) treadmills or aquatic pool walking could provide a treatment to reduce pain in individuals with knee osteoarthritis (OA). Our objective was to examine the potential benefits of BWS for individuals with knee OA.

DESIGN: Parallel group randomized clinical trial. Forty-nine (n=49) participants, aged>50 with knee OA, randomly assigned to one of three groups: (1)Control (n=16), (2)Aquatic (n=17), and (3)LBPP (n=16). Interventional groups had two 30-minute walking sessions for eight weeks. The control group received no active treatment. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain from baseline to 8 weeks. Secondary outcomes included other KOOS subscales, six-minute walk test (6-MWT), joint kinematics, and serum cytokine concentration.

RESULTS: Forty-one participants completed the trial. Changes in KOOS-Pain from baseline to 8 weeks were statistically significant and clinically relevant in the LBPP group (15.3,95% CI 5.0,25.6). Changes in the other groups were not statistically significant (Aquatic 0.9(95% CI -7.8,9.6); and Control -3.3(95% CI -12.3,5.7). Post-hoc analyses indicated improvements were significantly larger with LBPP. This group improved in 6-MWT(58.9m, 95% CI 26.1,91.7) and most KOOS sub-scales. Improvements in KOOS-Pain at 8 weeks in the LBPP group were associated with increased knee flexion(P=0.02). Only the control group had significant increases in IL-1β(P=0.04) and IL-1RA(P=0.02) concentration at 8 weeks.

CONCLUSIONS: This is the first randomized controlled trial of BWS for knee OA and showed benefits of LBPP treadmill walking. Future, larger studies should assess effect size, sustained benefits and cost-effectiveness.

PMID:41985188 | DOI:10.1097/PHM.0000000000003007

J Am Soc Mass Spectrom. 2026 Apr 15. doi: 10.1021/jasms.6c00035. Online ahead of print.

ABSTRACT

Hydrogen/Deuterium Exchange Mass Spectrometry (HDX-MS) is a unique, rapidly evolving technique that has been widely adopted for the characterization of the higher-order structure of proteins. Numerous statistical tools are available in the literature that can be used to identify statistically significant differences in the deuterium uptake values. Biopharmaceutical comparability studies, however, require evidence that two protein samples are highly similar and therefore necessitate a different statistical approach. Hageman et al. recently introduced an innovative HDX-MS equivalence testing method utilizing univariate two one-sided tests (TOST). The acceptance limits were established by the randomized resampling of eight replicate measurements of a reference protein. However, this approach can introduce a non-negligible level of variability in the acceptance limits when the same data set is reanalyzed. In the present study, we enhance this method by replacing the randomized resampling process with the systematic enumeration of all possible combinations of the reference data set, thus eliminating the resampling-induced variation. Because this approach incorporates all measurements, including replicate combinations with markedly elevated variability, it leads to higher acceptance limits. Therefore, we evaluated three strategies: robust outlier detection, a percentile-based method, and a partitioning approach to establish more stringent criteria and reduce patient risk. By applying the enhanced methods to data sets of three approved infliximab biosimilars and a partially deglycosylated NIST mAb used as a mock candidate biosimilar, we demonstrated correct classification of equivalent and nonequivalent samples, making the enhanced evaluation strategy well suited for regulatory comparability assessment.

PMID:41985126 | DOI:10.1021/jasms.6c00035

JCO Glob Oncol. 2026 Apr;12(4):e2500232. doi: 10.1200/GO-25-00232. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: The Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE)2 trial builds on the foundational STAMPEDE trial, which introduced innovative multiarm treatment protocols for metastatic prostate cancer. This survey assessed Nigeria’s readiness for the STAMPEDE2 trial by evaluating current clinical practices, radiotherapy infrastructure, systemic therapy usage, and imaging capabilities across its six geopolitical zones.

MATERIALS AND METHODS: We mapped the radiotherapy centers and machines currently available (commissioned) and in the Nigerian pipeline. A structured questionnaire comprising 31 questions in six sections was disseminated to clinical and radiation oncologists via Google Forms. The survey ran from July to September 2024, gathering data on radiotherapy availability, systemic therapies, advanced imaging, and readiness for clinical trial participation. Descriptive statistical analysis was conducted using Microsoft Excel. Responses were aggregated from 14 cancer centers across Nigeria, encompassing both public and private facilities.

RESULTS: The survey identified 23 operational radiotherapy machines distributed across 12 centers, with 19 additional facilities in the pipeline. These centers were predominantly located in urban areas such as Lagos and Abuja. Prostate cancer treatment modalities are available; however, access to agents such as abiraterone and enzalutamide was reported in 73% of centers. There is one operational positron emission tomography/computed tomography facility in Nigeria. Clinicians expressed strong interest in participating in trials although some gaps in infrastructure, particularly in rural areas, and limited access to advanced treatments like 177Lu-PSMA-617 were noted.

CONCLUSION: The findings underscore Nigeria’s potential readiness for the STAMPEDE2 trial, other clinical trials, and collaborative research, bolstered by an expanding radiotherapy infrastructure and clinician enthusiasm for advanced therapeutic approaches. Initiatives like the Cancer Health Fund and the National Cancer Access Partnership represent significant steps toward equitable cancer care.

PMID:41985120 | DOI:10.1200/GO-25-00232

JCO Glob Oncol. 2026 Apr;12(4):e2500636. doi: 10.1200/GO-25-00636. Epub 2026 Apr 15.

ABSTRACT

PURPOSE: The incidence of breast cancer is rising in Nigeria, with the majority of women presenting at advanced stages. Although mastectomy is the primary surgical treatment, many women fear mastectomy, leading to delayed presentation. Increasing awareness of and access to breast reconstruction after mastectomy is important to mitigate patient fear and encourage earlier presentation. An understanding of institutional and surgical workforce barriers is needed, yet has not been comprehensively studied nationwide. This study assessed barriers to breast reconstruction from the perspective of surgeons practicing in Nigeria.

METHODS: In April 2024, a questionnaire was distributed to breast, general, and plastic surgeons across all six geopolitical zones in Nigeria via an online messaging platform. Demographics, practice patterns, and perceived barriers to breast reconstruction were collected. Plastic surgeons were further asked about microsurgical experience, training, and equipment. Descriptive statistical analysis was performed using R.

RESULTS: Of the 440 invited, 66 (15.0%) surgeons completed the survey. Respondents were predominantly male (81.8%), consultants or fellows (72.7%), and practicing in public teaching hospitals (83.3%). The majority of general and breast surgeons reported performing fewer than five mastectomies per month, while most plastic surgeons had limited or no reconstruction caseloads. Late stage of patient presentation (84%) and poor referral pathways (75%) were the most frequently cited barriers. Additional clinical and institutional constraints were limited access to radiation therapy (62%), inadequate funding (58%), and perceived insufficient technical skill in reconstructive surgery (44%). High interest (90%) in microsurgical training was reported, although equipment access was inconsistent.

CONCLUSION: Findings highlight the need for strengthened referral systems, improved surgical collaboration, and institutional support for training and infrastructure to expand access to breast reconstruction in Nigeria.

PMID:41985118 | DOI:10.1200/GO-25-00636