Tag: pubmed

Front Public Health. 2026 Jul 31;14:1846531. doi: 10.3389/fpubh.2026.1846531. eCollection 2026.

ABSTRACT

BACKGROUND: Loneliness is increasingly recognized as an important psychosocial health issue among older adults. Older adults with chronic diseases and multimorbidity may be particularly vulnerable because long-term disease burden, coexisting chronic conditions, functional limitations, and reduced social participation often interact. This scoping review aimed to map the available evidence on assessment tools, prevalence estimates, and factors associated with loneliness among older adults with chronic diseases and multimorbidity.

METHODS: A systematic search was conducted in CNKI, Wanfang, VIP, China Biomedical Literature Database, Embase, The Cochrane Library, PubMed, Web of Science, and CINAHL from database inception to November 2025. Eligible studies were screened and extracted according to predefined criteria. Descriptive statistics, narrative synthesis, and thematic analysis were used to summarize the findings.

RESULTS: Twenty-one studies involving 26,140 participants were included. Five loneliness assessment approaches were identified, including the UCLA Loneliness Scale, the 3-item UCLA Loneliness Scale, the ULS-8 Scale, the De Jong Gierveld Loneliness Scale, and a single-item loneliness question. Thirteen studies reported prevalence estimates, ranging from 25.0 to 97%. When stratified by assessment instrument, estimates were generally higher in studies using the full UCLA Loneliness Scale and lower in studies using single-item loneliness questions. Factors associated with loneliness were grouped into four categories: sociodemographic factors, health status and disease-related factors, lifestyle and social support factors, and psychological and cognitive factors. Insufficient social support, chronic disease burden, multimorbidity, functional impairment, depression, anxiety, living alone, and widowhood were repeatedly reported.

CONCLUSION: Loneliness among older adults with chronic diseases and multimorbidity is common but heterogeneous across studies. Future research should standardize measurement approaches and conduct longitudinal and intervention studies to inform integrated and personalized management strategies.

SYSTEMATIC REVIEW REGISTRATION: Identifier md2je. The review was registered with the Open Science Framework. The publicly accessible registration URL is: https://osf.io/md2je/.

PMID:42601983 | PMC:PMC13472916 | DOI:10.3389/fpubh.2026.1846531

Front Public Health. 2026 Jul 31;14:1917410. doi: 10.3389/fpubh.2026.1917410. eCollection 2026.

ABSTRACT

BACKGROUND: Chronic low-dose exposure to organophosphorus pesticides (OPPs) is widespread in the general population and has been linked to heart disease mortality, yet the biological pathways connecting such exposure to fatal outcomes remain poorly defined. We examined whether urinary OPP metabolites are associated with heart disease mortality and whether DNA methylation biomarkers might contribute to this association.

METHODS: We studied 502 adults aged ≥50 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 cycles with urinary OPP metabolite measurements, DNA methylation profiles, and linked mortality follow-up. Survey-weighted Cox models were used to relate baseline metabolites [per 1-standard-deviation (SD) increase] to heart disease mortality, with sensitivity analyses for exposure definition and confounding. DNA methylation biomarkers that were significant after false discovery rate (FDR) correction were examined in exploratory single-mediator models, with Benjamini-Hochberg correction applied across the five indirect-effect tests, and in a secondary survival random forest. THP-1 monocytes were exposed to chlorpyrifos as a mechanistic probe of pathways suggested by the epidemiological findings.

RESULTS: Among four OPP metabolites, only diethylthiophosphate (DETP) was associated with heart disease mortality after multivariable adjustment [hazard ratio 1.33, 95% confidence interval (CI) 1.11-1.61 per 1-SD increase, FDR = 0.010], with a positive association across quartiles. After Benjamini-Hochberg correction, DETP showed FDR-significant linear associations with five DNA methylation biomarkers. In separate single-mediator models, MonoPP and ZhangAge showed nominal indirect effects at raw p < 0.05, with estimated proportions mediated of approximately 9.2 and 8.4%, respectively; however, neither remained statistically significant after Benjamini-Hochberg correction across the five mediation models. A survival random forest combining DETP with the five markers achieved a 5-fold cross-validated 20-year area under the curve (AUC) of 0.71 (95% CI 0.66-0.76). In vitro, sub-cytotoxic chlorpyrifos raised pro-inflammatory cytokines, increased DNMT1, suppressed TET2, and induced global DNA hypermethylation.

CONCLUSION: In this exploratory analysis, higher urinary DETP was associated with greater heart disease mortality in middle-aged and older adults. MonoPP and ZhangAge showed suggestive indirect effects in separate exploratory models, each accounting for an estimated 8-9% of the association, but neither effect remained significant after FDR correction. Most of the DETP-related risk, therefore, remained unexplained by the measured methylation markers. The in vitro experiments provided hypothesis-generating support-most directly for inflammatory signaling-rather than confirmation of the epidemiological pathway.

PMID:42601976 | PMC:PMC13473126 | DOI:10.3389/fpubh.2026.1917410

Front Public Health. 2026 Jul 31;14:1915867. doi: 10.3389/fpubh.2026.1915867. eCollection 2026.

ABSTRACT

BACKGROUND: After diagnosis of high-risk human papillomavirus (HPV) infection, patients often seek guidance on cancer risk, colposcopy, follow-up, treatment, partner management, pregnancy, and anxiety. Large language models (LLMs) are increasingly used for medical consultation, but their response quality and safety in this setting require evaluation.

METHODS: In this single-center, expert-rated methodological study, 15 patient-style questions based on common outpatient consultations were submitted to ChatGPT-5.5 Instant and DeepSeek-V3. Each model generated three independent responses per question, yielding 90 artificial intelligence (AI)-generated responses. Five blinded gynecology experts independently evaluated all responses, producing 450 expert-rating records. Accuracy, safety, guideline concordance, completeness, and understandability were rated on a 1-5 Likert scale. Experts also assessed major error and potential harm. The primary outcome was the proportion of responses without major error or potential harm.

RESULTS: ChatGPT-5.5 Instant had higher response-level scores than DeepSeek-V3 for accuracy (mean difference, 0.25; 95% CI, 0.11-0.39; FDR-adjusted p = 0.010), safety (0.27; 0.07-0.47; p = 0.010), completeness (0.22; 0.07-0.37; p = 0.020), and composite score (0.18; 0.04-0.31; p = 0.027). The difference in guideline concordance did not remain significant after multiplicity correction (0.16; -0.01 to 0.33; FDR-adjusted p = 0.057), and understandability was similar. Responses without major error or potential harm occurred in 42/45 (93.3%; 95% CI, 81.7-98.6%) ChatGPT responses and 38/45 (84.4%; 70.5-93.5%) DeepSeek-V3 responses (risk difference, 8.9 percentage points; 95% CI, -13.3 to 31.1; p = 0.344). Exploratory question-level risks were observed in HPV16/18 positivity, normal cytology, partner management, and pregnancy scenarios.

CONCLUSION: Both two models demonstrated generally strong performance across the evaluated quality domains. ChatGPT achieved higher ratings in several quality domains, but response-level binary safety differences were imprecise and not statistically significant. Both models require guideline-based clinical oversight.

PMID:42601968 | PMC:PMC13473150 | DOI:10.3389/fpubh.2026.1915867

Front Surg. 2026 Jul 31;13:1882855. doi: 10.3389/fsurg.2026.1882855. eCollection 2026.

ABSTRACT

BACKGROUND: The accessory maxillary ostium (AMO) is a common anatomical variant of the lateral nasal wall and has been implicated in impaired maxillary sinus drainage, mucus recirculation, and chronic sinus pathology. Although AMO can be identified using both radiologic and endoscopic techniques, the endoscopic visualization rate of CT-documented AMO has not been well characterized. This study aimed to evaluate the endoscopic visualization rate of AMO using FFE in patients with CT-documented AMO.

METHOD: This retrospective cohort study was conducted at a tertiary referral center between January 2023 and December 2024. Patients with CT-confirmed AMO who subsequently underwent FFE were included. Patients with a history of prior sinus surgery were excluded. Demographic data, CT findings, and endoscopic visualization of AMO were collected from electronic medical records. Descriptive statistics were used to summarize the data, and categorical variables were analyzed using Chi-square or Fisher’s exact tests as appropriate.

RESULTS: A total of 274 patients were included, with a mean age of 34.4 ± 14.1 years; 51.8% were male. While AMO was confirmed on CT imaging in all participants by inclusion criteria, FFE visualized AMO in only 26% of cases (71/274), indicating a low endoscopic visualization rate among patients with CT-confirmed AMO. Maxillary sinus opacification was detected on CT in 49.6% of patients, while nasal polyps were present in 34.3%. No significant gender differences were observed in the prevalence of maxillary opacification or nasal polyps.

CONCLUSION: Flexible fiberoptic endoscopy demonstrated limited ability to visualize accessory maxillary ostium in patients with CT-documented AMO. While FFE remains useful for functional and mucosal assessment, CT imaging appeared to useful for anatomical identification of AMO and may be considered for comprehensive evaluation and surgical planning.

PMID:42601967 | PMC:PMC13472984 | DOI:10.3389/fsurg.2026.1882855

Front Nutr. 2026 Jul 31;13:1893988. doi: 10.3389/fnut.2026.1893988. eCollection 2026.

ABSTRACT

BACKGROUND: Optimal protein provision in critically ill patients remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy and safety of higher versus lower or standard protein provision in critically ill adults.

METHODS: Randomized controlled trials comparing higher versus lower/standard protein provision in critically ill adults were included. The primary analysis focused on trials with a between-group protein difference of at least 0.3 g/kg/day. Mortality was analyzed separately by time point, including 28/30-day, 60-day, 90-day, in-hospital, and ICU mortality. Secondary outcomes included mechanical ventilation duration, ICU and hospital length of stay, nutrition/metabolic markers, muscle-related outcomes, and safety. Risk ratios (RRs) and mean differences (MDs) were pooled using random-effects models. Certainty of evidence was assessed using GRADE.

RESULTS: Twenty-six studies were included. Higher protein provision did not significantly reduce mortality at any time point. For 28/30-day mortality, no statistically significant difference was observed, although the point estimate was lower with higher protein provision (RR = 0.82, 95% CI 0.58-1.17; I ² = 0%). No significant differences were observed for 60-day mortality (RR = 0.85, 95% CI 0.52-1.39; I ² = 51.1%), 90-day mortality (RR = 1.03, 95% CI 0.93-1.14; I ² = 0%), in-hospital mortality (RR = 1.04, 95% CI 0.78-1.39; I ² = 0%), or ICU mortality (RR = 0.84, 95% CI 0.57-1.26; I ² = 0%). Higher protein provision did not significantly shorten mechanical ventilation duration (MD = -0.74 days, 95% CI-1.92-0.43; I ² = 79.0%), ICU stay, or hospital stay. Higher protein provision was associated with a more favorable Day 3 nitrogen balance (MD = 6.39 g/day, 95% CI 2.77-10.01; I ² = 51.7%), but was not associated with a significant increase in gastrointestinal intolerance.

CONCLUSIONS: Higher protein provision did not significantly reduce mortality or consistently improve clinical recovery outcomes in critically ill adults. It was associated with more favorable early nitrogen balance, but evidence for patient-centered benefit and safety remains limited.

PMID:42601943 | PMC:PMC13472815 | DOI:10.3389/fnut.2026.1893988

Front Vet Sci. 2026 Jul 31;13:1895478. doi: 10.3389/fvets.2026.1895478. eCollection 2026.

ABSTRACT

BACKGROUND: Toxocariasis caused by Toxocara canis is a common parasitic disease in dogs with important zoonotic implications. Although fecal examination is traditionally used for diagnosis, it has limitations in detecting prepatent, low-intensity, or intermittent infections. Therefore, serological testing was selected in this study as a more sensitive and time-efficient approach for assessing exposure at the population level. This study aimed to determine the seroprevalence of T. canis infection and identify associated risk factors among dogs in four Egyptian governorates.

METHODS: A total of 409 dogs from Cairo, Qalyubia, Kafr El-Sheikh, and Gharbia were sampled. Serum samples were tested for anti-T. canis IgG antibodies using a sensitive immunoassay. Epidemiological and management-related risk factors, including age, sex, feeding practices, housing conditions, cohabitation with cats, coprophagy, and deworming history, were recorded and analyzed using univariate and multivariate logistic regression models.

RESULTS: The overall seroprevalence was 25.9% (106/409; 95% CI: 21.91-30.38%), with the highest prevalence in Cairo (32.2%) and the lowest in Qalyubia (19%). Dogs older than 4 years showed the highest seropositivity (37.4%). Seroprevalence was significantly higher among dogs fed homemade food (36%), living outdoors (41.5%), cohabiting with cats (32.4%), exhibiting coprophagy (30.4%), and those without regular deworming (33%). No statistically significant differences were observed between male and female dogs. Multivariate logistic regression identified older age, outdoor living, cohabitation with cats, coprophagy, homemade diet, and irregular deworming as significant risk factors for infection.

CONCLUSION: The findings demonstrate substantial exposure of dogs to T. canis in the studied regions and highlight the cumulative impact of environmental and management-related risk factors. The use of serology provided a broader estimate of exposure than fecal examination alone. Regular deworming, improved feeding practices, and environmental hygiene are essential to reduce infection risk and minimize zoonotic transmission.

PMID:42601940 | PMC:PMC13472903 | DOI:10.3389/fvets.2026.1895478

Front Aging Neurosci. 2026 Jul 31;18:1830477. doi: 10.3389/fnagi.2026.1830477. eCollection 2026.

ABSTRACT

BACKGROUND: Dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) are common types of dementia, however, diagnosis is challenging. An innovative MR method called neurite orientation dispersion and density imaging (NODDI) is used to assess different microstructural alterations between the conditions.

OBJECTIVE: To assess microstructural white matter (WM) changes in DLB and AD using NODDI.

METHODS: Diffusion images were acquired from 26 DLB patients, 36 AD patients, and 37 normal controls (NCs). The diffusion tensor imaging (DTI) was used to generate fractional anisotropy (FA), mean diffusivity (MD), and NODDI was used to generate neurite density index (NDI), orientation dispersion index (ODI), and volume fraction of isotropic water molecules (Viso), these parameters were compared among groups applying Tract-based spatial statistics (TBSS). We also analyzed the correlations between altered parameters and cognitive scores and investigated the diagnostic efficacy of different parameters using k-nearest neighbor (KNN).

RESULTS: Compared with NC, FA, ODI, and NDI significantly decreased, while MD and Viso significantly increased in both DLB and AD. Compared with DLB, ODI and NDI significantly decreased in AD. The diffusion parameters of multiple fibers were strongly correlated with cognition. NDI exhibited a relatively larger AUC value in differentiating between groups.

CONCLUSION: Widespread disruption of white matter microstructure is evident in both DLB and AD, with differences in these alterations between the two conditions. NDI holds promise as a neuroimaging biomarker for distinguishing DLB from AD.

PMID:42601937 | PMC:PMC13472807 | DOI:10.3389/fnagi.2026.1830477

Front Endocrinol (Lausanne). 2026 Jul 31;17:1861158. doi: 10.3389/fendo.2026.1861158. eCollection 2026.

ABSTRACT

AIMS: Metabolic syndrome (MetS) is diagnosed using fixed thresholds that may not fully reflect the continuous accumulation of cardio-metabolic risk. We investigated whether whole blood viscosity (WBV) increases progressively with increasing MetS burden and explored the relative contribution of individual MetS components to hemorheologic alterations.

METHODS: We analyzed 38,574 adults (21,914 men and 16,660 women) who underwent comprehensive health examinations between January and April 2021. Whole blood viscosity was measured by cone-plate viscometry at shear rates of 300 s^-1 (systolic blood viscosity [SBV]) and 5 s^-1 (diastolic blood viscosity [DBV]). MetS was defined according to NCEP-ATP III criteria. Associations between WBV and MetS burden were evaluated using logistic regression, ANCOVA, regression tree analyses, ROC analyses, and sex-by-viscosity interaction testing.

RESULTS: WBV increased progressively with each additional MetS component in both sexes (p for trend <0.001). After full adjustment for hematocrit, age, smoking status, eGFR, white blood cell count, and AST/ALT, higher SBV was associated with MetS in both women (OR 1.45, 95% CI 1.32-1.58, per 1-SD increase) and men (OR 1.27, 95% CI 1.22-1.33, per 1-SD increase). Regression tree analyses identified triglycerides and waist circumference as metabolic factors associated with elevated WBV. Sex-stratified analyses demonstrated a stronger association between WBV and MetS in women than in men.

CONCLUSIONS: WBV increased in parallel with accumulating cardio-metabolic risk burden, including among individuals who did not meet diagnostic criteria for MetS. WBV may serve as a complementary marker associated with metabolic risk burden, particularly among women and individuals with hypertriglyceridemia or central adiposity.

PMID:42601926 | PMC:PMC13472914 | DOI:10.3389/fendo.2026.1861158

Front Oncol. 2026 Jul 31;16:1834400. doi: 10.3389/fonc.2026.1834400. eCollection 2026.

ABSTRACT

Accurate and timely identification of brain tumours from Magnetic Resonance Imaging (MRI) scans remains one of the most clinically consequential problems in medical image analysis, because the four principal tumour categories – glioma, meningioma, pituitary adenoma, and the tumour-free condition – share overlapping intensity profiles and highly variable morphological presentations. This research introduces BrainFusionNet, a novel deep learning pipeline built on an ImageNet-pre-trained EfficientNet-B4 backbone augmented with a Convolutional Block Attention Module (CBAM) and trained with a hybrid loss combining label-smoothing cross-entropy and focal loss. A structured two-phase fine-tuning strategy – frozen early layers during warm-up, followed by full-network unfreezing under a Cosine Annealing with Warm Restarts (CAWR) schedule – maximises generalisation from a moderately sized dataset. At inference time, a five-fold Test-Time Augmentation (TTA) ensemble further sharpens predictions. Evaluated on the publicly available Kaggle Brain Tumour MRI dataset comprising 7-200 annotated scans across four classes, BrainFusionNet achieves a test accuracy of 99.81%, a macro-averaged F1-score of 99.78%, and a mean AUC of 0.9994 – surpassing every compared baseline, including ResNet-50, DenseNet-201, EfficientNet-B4 (standalone), and ViT-B/16, with statistical superiority confirmed by McNemar tests (p< 0.0001 for all comparisons). Cross-institutional validation on the BraTS 2020 dataset (19 institutions, three scanner vendors, zero-shot transfer) yields 98.25% accuracy and AUC = 0.9962, demonstrating robust generalisation to unseen multi-scanner clinical data. Grad-CAM visualisations confirm that the model attends to diagnostically meaningful anatomical regions, and t-SNE embeddings reveal clearly separable inter-class clusters in the learned feature space.

PMID:42601923 | PMC:PMC13472811 | DOI:10.3389/fonc.2026.1834400

Front Oncol. 2026 Jul 31;16:1876274. doi: 10.3389/fonc.2026.1876274. eCollection 2026.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC), but clinical benefit remains heterogeneous and is not fully explained by programmed death-ligand 1 (PD-L1) expression or tumour mutational burden (TMB). We explored whether whole-exome sequencing (WES) of circulating tumour DNA (ctDNA) could identify mutational and copy-number (CN) signatures associated with outcome in advanced NSCLC treated with first-line ICI.

METHODS: Baseline plasma ctDNA from 37 patients with advanced NSCLC treated with first-line ICI or chemo-ICI was analysed by WES. Single-base substitution (SBS), indel (InD) and CN signatures were inferred using COSMIC-based signature frameworks. SBS signatures reflect point mutation patterns, including clock-like processes that accumulate with age; indel signatures reflect small insertions and deletions; and CN signatures summarise structural changes such as chromosomal gains and loss of heterozygosity. Signatures were integrated with PD-L1 status, TMB, progression-free survival (PFS) and overall survival (OS). Patients were classified into four clinicogenomic groups according to PD-L1 expression and PFS.

RESULTS: Median PFS and OS were 9 and 20 months, respectively. Single-nucleotide-variant-derived TMB (TMB-SNV) was similar in patients with adverse and favourable outcomes, and patients with TMB-SNV >10 mutations/Mb were evenly distributed between both groups. The SBS profile was mainly represented by the clock-like signatures SBS1, SBS5 and by the tobacco-like signature SBS92, whereas indel signatures were mostly represented by InD4a and InD10. CN signatures showed the most apparent separation between outcome groups. CN9 exposure, a marker of structurally unstable genomes, was higher in adverse-outcome patients and most prominent in Group 1 (PD-L1 ≥50% and adverse outcome), whilst CN21 exposure was highest in Group 4 (PD-L1 ≥50% and favourable outcome). No signature retained statistical significance after correction for multiple testing.

CONCLUSIONS: In this exploratory cohort, ctDNA-derived CN signatures may capture structural genomic phenotypes associated with ICI outcome beyond PD-L1 and TMB. CN9 emerged as a candidate resistance-associated signature, whereas CN21 was associated with more favourable disease control. These findings are hypothesis-generating and require validation in larger prospective cohorts.

PMID:42601918 | PMC:PMC13472933 | DOI:10.3389/fonc.2026.1876274