Tag: pubmed

J Robot Surg. 2026 Jun 9;20(1):582. doi: 10.1007/s11701-026-03486-3.

ABSTRACT

Robotic colorectal surgery has emerged as an alternative to laparoscopy, offering technical advantages particularly in complex procedures such as rectal surgery. However, its adoption is influenced by the learning curve, which remains incompletely characterized according to tumor location. Cumulative sum (CUSUM) analysis provides an objective method to assess surgical learning curves. A retrospective analysis of 60 consecutive patients undergoing robotic colorectal surgery was performed. The learning curve was evaluated using CUSUM analysis of total operative time. Patients were stratified according to tumor location into right colon (n = 23), sigmoid colon (n = 16), and rectum (n = 21). Perioperative outcomes, including operative time, console time, and postoperative complications, were compared among groups. Non-parametric tests and proportion analyses were used, with statistical significance set at p < 0.05. Operative time was significantly longer in rectal surgery compared to right colon and sigmoid procedures (median: 205.0 vs 145.0 vs 175.0 min; p = 0.000306). Similarly, console time was higher in the rectal group (180.0 vs 127.5 vs 154.0 min; p = 0.000215). No significant differences were observed in postoperative complication rates among groups (p = 0.191). CUSUM analysis identified inflection points at case 6 for right colon, case 5 for sigmoid colon, and case 8 for rectal surgery, indicating a more prolonged learning curve for rectal procedures. The learning curve in robotic colorectal surgery depends on tumor location. Right colectomies show a faster acquisition of technical skills, whereas rectal surgery requires a greater number of cases to achieve stabilization of operative performance. Likewise, procedural safety is maintained during the learning phase, reaching a stable point on the curve after approximately 20 cases, in agreement with the global literature.

PMID:42260235 | DOI:10.1007/s11701-026-03486-3

Theory Biosci. 2026 Jun 9;145(3):28. doi: 10.1007/s12064-026-00480-z.

ABSTRACT

The classification of plant varieties is a key task in plant breeding and variety registration. Red fescue (Festuca rubra L.), a widely cultivated grass species, includes numerous closely related varieties, making automated classification a challenging multi-class problem. This study aimed to develop and evaluate a multilayer perceptron (MLP) neural network combined with a subset-based decision framework for accurate classification of red fescue varieties and recognition of previously unseen varieties. The study analyzed 76 varieties described by seven morphological features. To address the complexity of the multi-class problem, the dataset was divided into multiple subsets and the effectiveness of different partitioning strategies was evaluated. A confidence-based and majority-based decision rule (majority ratio ≥ 0.9 and mean Softmax confidence ≥ 0.8) was introduced to improve the reliability of final predictions and enable open set recognition. The model was evaluated using accuracy, precision, F1 score, and recall. The most optimal solution was to divide the dataset into 15 subsets, with the first subset containing six varieties and the remaining subsets containing five varieties each. This approach provided the best balance between predictive performance and decision consistency, enabling correct classification of known varieties and stable detection of unknown samples. Combining MLP neural networks with strategic subset division and confidence-driven decision rules offers a robust solution to high-dimensional, multi-class classification challenges in plant variety recognition. The model’s ability to recognize new varieties is crucial for its practical application, ensuring the algorithm’s flexibility. This is particularly useful in agriculture and horticulture, where new varieties are bred over the years.

PMID:42260232 | DOI:10.1007/s12064-026-00480-z

Hormones (Athens). 2026 Jun 8. doi: 10.1007/s42000-026-00794-z. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to comprehensively investigate the independent associations between a wide array of novel metabolic indices and the prevalence of circadian syndrome (CircS), as well as to explore, within a cross‑sectional framework, whether the C‑reactive protein triglyceride glucose index (CTI) shows statistical associations consistent with mediation.

METHODS: A cross‑sectional analysis was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave, involving 6,507 participants aged ≥ 45 years. Multivariable logistic regression, restricted cubic splines, and mediation analyses were employed to assess associations, non‑linearity, and indirect effects (cross‑sectionally consistent with mediation).

RESULTS: In fully adjusted models, multiple metabolic indices – including dynapenic abdominal obesity, frailty, TyG‑related indices, and the cardiometabolic index (CMI) – showed significant positive associations with CircS prevalence (all P < 0.001), while CCR was inversely associated. Restricted cubic spline analyses revealed significant non‑linear relationships for all indices (log‑likelihood ratio test P < 0.001). Mediation analysis indicated that CTI had a statistically significant indirect effect (cross‑sectionally consistent with mediation), with the proportion of the total effect statistically attributable to CTI ranging from 20.8% to 86.5%.

CONCLUSION: This large‑scale cross‑sectional study identified significant, often non‑linear, associations between multiple novel metabolic indices and CircS. CTI, a composite marker of inflammation and metabolism, showed a substantial indirect effect cross‑sectionally consistent with mediation in these associations. These hypothesis‑generating findings highlight the potential importance of the “metabolic‑inflammatory” axis in relation to CircS and offer epidemiological clues for early identification and risk stratification. Prospective studies are needed to assess temporality and causality.

PMID:42260226 | DOI:10.1007/s42000-026-00794-z

Hormones (Athens). 2026 Jun 8. doi: 10.1007/s42000-026-00798-9. Online ahead of print.

ABSTRACT

PURPOSE: Pheochromocytomas and paragangliomas (PPGLs) can trigger major cardiovascular events (MACEs) due to unpredictable release of catecholamines. The aim of this systematic review and meta-analysis was to determine prognostic factors associated with MACEs in PPGLs patients.

METHODS: A literature search was conducted in PubMed and the Cochrane Library from January 1980 to March 2026. Assessment of clinical, laboratory, imaging, histological, and genetic parameters was performed on the pooled data.

RESULTS: Nine retrospective cohort studies involving 1566 patients with PPGL were included. MACEs were observed in 302 patients [pooled estimate of 21% (95% CI 14-29%)], 95 of those having Takotsubo syndrome [pooled estimate 39% (95% CI 23-54%)]. Tumor necrosis/hemorrhage and diabetes were associated with increased risk of MACEs [71% (95% CI 25-115%, p < 0.001) and 56% (95% CI 2-109%, p = 0.02), respectively]; additional predictors of MACES were dyspnea and chest pain [5-fold (95% CI 3.3-7.4, p < 0.001) and 2.7-fold (95% CI 1.5-4, p < 0.001) increased risk of MACEs]. Patients with MACEs had an average maximum diastolic blood pressure increase of 19.3 mmHg (95% CI 2.5-36mmHg, p = 0.02) and 9.4 mm larger tumor size (95% CI 1.2-17.56, p = 0.02) than those without. No significant associations between age, adrenergic-noradrenergic phenotype, metastatic disease, familial PPGLs, and MACEs were found.

CONCLUSION: This is, to the best of our knowledge, the first meta-analysis of cohort studies of catecholamine-induced MACEs in patients with PPGL. 21% of PPGL cases developed MACEs. Necrosis/hemorrhage, dyspnea, chest pain, and diabetes were associated with an increased likelihood of development of MACEs. However, these results should be interpreted with caution due to statistical and methodological heterogeneity.

PMID:42260224 | DOI:10.1007/s42000-026-00798-9

Int J Colorectal Dis. 2026 Jun 8. doi: 10.1007/s00384-026-05168-w. Online ahead of print.

ABSTRACT

PURPOSE: The global rise in early-onset colorectal cancer (EOCRC) is a growing concern, particularly in low-resource settings. However, comprehensive data from Ethiopia are limited.

AIM: This study aimed to describe the clinicopathological profile and proportional hospital-based representation of EOCRC at Ethiopia’s largest tertiary referral center.

METHODS: We conducted a retrospective cross-sectional analysis of 630 histologically confirmed colorectal cancer (CRC) cases diagnosed at Tikur Anbessa Specialized Hospital between January 2019 and September 2024. EOCRC was defined as a diagnosis before the age of 50 years and late-onset CRC (LOCRC) as a diagnosis at the age of 50 years or older. Data on demographics, tumor location, histology, differentiation grade, and TNM stage were also extracted. Descriptive statistics, chi-square tests, and binary logistic regression were used for the analysis.

RESULTS: Of the 630 CRC cases, 292 (46.3%) were EOCRC (mean age 36.1 years, SD 7.9). Rectal tumors were significantly more common in EOCRC (31.2% vs. 22.5%, p = 0.012), as were poorly differentiated/undifferentiated tumors (21.9% vs. 13.0%, p = 0.003). Metastasis at diagnosis was less frequent in the EOCRC group (27.4% vs. 66.3%, p < 0.001). Multivariable analysis identified rectal location (adjusted odds ratio (AOR) = 1.60, 95% confidence interval (CI) 1.11-2.30) and poor differentiation (AOR = 1.94, 95% CI 1.25-3.00) as independent predictors of EOCRC, while metastasis was inversely associated (AOR = 0.20, 95% CI 0.14-0.29).

CONCLUSION: In this hospital-based sample, EOCRC constitutes a substantial proportion of CRC cases, with distinct clinicopathological features, including rectal predilection and aggressive histology. These findings highlight the need for heightened clinical suspicion in younger adults while acknowledging the influence of Ethiopia’s young population structure on the observed proportions.

PMID:42260223 | DOI:10.1007/s00384-026-05168-w

Int Urol Nephrol. 2026 Jun 9. doi: 10.1007/s11255-026-05232-y. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera, and Mei, to assess their discrimination, calibration, and clinical utility in a contemporary cohort.

PATIENTS AND METHODS: We retrospectively reviewed patients undergoing surgery for cT1 renal masses at our institution. The primary endpoint was pathological upstaging to pT3a. Model performance was evaluated using the Area Under the Curve (AUC) for discrimination and the Brier Score for overall accuracy. Calibration was assessed using parametric and nonparametric Loess-smoothed curves. Clinical utility was quantified using Standardized Decision Curve Analysis.

RESULTS: The institutional upstaging rate was 17.1% (19/111), and clear cell histology predominated (77.5%). Nocera (AUC = 0.736) and Barra (AUC = 0.733) had higher point estimates of discriminative ability than Mei (AUC = 0.677), but the differences were not significant. All models descriptively overestimated absolute risk. However, Mei demonstrated the highest absolute calibration stability, whereas the Nocera model showed significant global unreliability (U = 0.052, p = 0.021). The Barra model achieved the lowest overall error (Brier Score = 0.122) and the highest clinical net benefit within the decisive 8%-18% decision window, although the overall accuracy differences were not statistically significant.

CONCLUSION: All nomograms are useful risk-stratification adjuncts, but wide confidence intervals and low event counts mean these findings are exploratory. No single model is definitively superior. Nocera and Barra are effective for relative risk-ranking, while Mei provides superior absolute precision for patient counseling.

PMID:42260216 | DOI:10.1007/s11255-026-05232-y

Clin Oral Investig. 2026 Jun 9;30(7):284. doi: 10.1007/s00784-026-06972-y.

ABSTRACT

OBJECTIVE: This retrospective pragmatic study aimed to evaluate and compare the healing outcomes of the multisonic GentleWave irrigation system with conventional syringe-needle irrigation used for non-surgical endodontic treatment.

METHODS: The study included 46 teeth that underwent nonsurgical endodontic treatment using two different irrigation protocols: (1) GentleWave irrigation system, and (2) Conventional syringe-needle irrigation, with a minimum follow-up of 1 year. Preoperative and follow-up data from treatment records, including clinical signs and symptoms, periapical radiographs, and cone-beam computed tomography (CBCT) images when available, were collected. Two independent evaluators scored the radiographs and CBCT scans based on the 2D periapical index (PAI) and 3D CBCT-PAI index, respectively. Based on clinical data and radiographic evaluation, treatment outcomes were categorized as healed, healing, or diseased. The success rate was assessed using both strict and loose criteria. Statistical analyses included Fisher’s exact tests, and Wilcoxon rank-sum tests, where appropriate. The significance level was set at 0.05.

RESULTS: Based on the periapical index and clinical evaluation, both the GentleWave and conventional groups exhibited comparable percentages of healed cases, corresponding to success rates of 69% and 70%, respectively (strict criteria). Using loose criteria, the success rate based on periapical imaging was 96% for conventional and 85% for GW groups. No statistically significant difference in healing outcomes/success rate was observed between the groups on both periapical radiograph and CBCT interpretation. Male sex, negative pulp vitality, presence of pre-operative periapical radiolucency (PARL), and absence of pre-operative symptoms were associated with reduced healing in the Conventional group. Pre-operative PARL and non-surgical root canal retreatment were associated with reduced healing in the GW group.

CONCLUSION: There were no differences in success rates or healing outcomes of endodontic treatment between the GentleWave irrigation system and conventional syringe-needle irrigation at 12-month follow-up. The presence of pre-operative PARL was significantly correlated with reduced success in both groups.

CLINICAL RELEVANCE: This study highlights similar success rates and healing outcomes for endodontic treatment with the GentleWave irrigation system compared to conventional syringe-needle irrigation at 12 months follow-up.

PMID:42260197 | DOI:10.1007/s00784-026-06972-y

Commun Biol. 2026 Jun 8. doi: 10.1038/s42003-026-10420-8. Online ahead of print.

ABSTRACT

The rapid expansion of single-cell RNA sequencing (scRNA-seq) has made accurate cell type annotation a critical bottleneck for biological discovery. Existing computational methods are often limited by reference data dependency, while emerging single Large Language Model (LLM) approaches are susceptible to model-specific biases and provide insufficient uncertainty quantification. To address these limitations, we introduce mLLMCelltype, a framework that harnesses collective intelligence-the emergent problem-solving capacity arising when multiple independent agents interact through structured deliberation to produce solutions exceeding individual capabilities-of multiple LLMs through an iterative deliberation process. Across 49 diverse datasets, our framework achieves a mean accuracy of 77.2%, a 15.7-percentage-point improvement over the best-performing single-LLM baseline (61.5%). The consensus mechanism demonstrates high robustness to noisy input and generalizes to datasets released after the LLMs’ training. By providing transparent reasoning chains and robust consensus-based confidence metrics, mLLMCelltype minimizes manual annotation effort and enables reliable interpretation of complex cellular landscapes. The framework is available as an open-source package and an accessible web server.

PMID:42260142 | DOI:10.1038/s42003-026-10420-8

Sci Rep. 2026 Jun 8. doi: 10.1038/s41598-026-56729-6. Online ahead of print.

ABSTRACT

The clustering of unhealthy movement behaviours is highly prevalent among adolescents and significantly impacts both health and academic outcomes. While evidence linking 24-hour Movement Guidelines to general academic outcomes is substantial, research specifically on arithmetic fluency remains limited. This cross-sectional study analysed 578 Spanish adolescents (aged 11-15 years) to quantify compliance with physical activity, screen time, and sleep recommendations and to explore the role of physical fitness in this relationship. Results revealed alarmingly low adherence: only 1% of adolescents meet all three health recommendations, while nearly half meet none. Results demonstrate a threshold effect, showing that adolescents who follow at least two guidelines achieve modest but significant higher scores in arithmetic fluency (B = 7.81, η²_p = .015, p = .005). Notably, this academic advantage is statistically accounted for by higher levels of cardiorespiratory fitness, which is consistent with a mediating role in all comparisons (B from 0.88 to 2.43; all 95% CI exclude zero), whereas muscular fitness does not. Findings suggest promoting combined healthy habits may be more effective for cognitive development than targeting single behaviours. Integrating movement-based strategies into school environments could enhance potentially arithmetic fluency success by fostering the cardiorespiratory health necessary for optimal arithmetic learning.

PMID:42260090 | DOI:10.1038/s41598-026-56729-6

Sci Rep. 2026 Jun 8. doi: 10.1038/s41598-026-56786-x. Online ahead of print.

ABSTRACT

The use of probiotics for preventing necrotizing enterocolitis (NEC) in preterm infants remains controversial. Specifically, whether the outcomes of infants with NEC are associated with prior probiotic administration remains unknown. This study aimed to examine the association between early supplementation with mixed-species probiotics and the timing of NEC onset as well as clinical outcomes in preterm infants who subsequently developed NEC. This retrospective study enrolled 216 preterm infants (gestational age < 35 weeks) diagnosed with stage II/III NEC from two hospitals in China. The patients were divided into a probiotics group and a nonprobiotics group. The timing of NEC onset, disease characteristics (intestinal perforation, surgery, mortality), and the occurrence of other preterm comorbidities were compared between the two groups. Among the infants who developed NEC, the median age at onset was observed to be later in the probiotic-exposed group compared with the unexposed group (22.5 days vs. 12 days). The probiotics group had a shorter duration of fasting after NEC onset (p < 0.05). However, no statistically significant differences were observed between the groups in terms of rates of surgery, intestinal perforation, mortality, shock, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), or extrauterine growth restriction (EUGR). Among infants who developed NEC, early mixed-species probiotic exposure was associated with later NEC onset. This association should be interpreted cautiously because probiotic exposure was non-protocolized and time-dependent. No clear evidence was observed for an association with reduced disease severity or lower rates of major complications, including surgery, bowel perforation, or mortality. These associational findings are exploratory and require further investigation.

PMID:42260078 | DOI:10.1038/s41598-026-56786-x