Tag: pubmed

Updates Surg. 2026 Jun 23. doi: 10.1007/s13304-026-02724-5. Online ahead of print.

ABSTRACT

Robotic liver surgery (RLS) is expanding in recent years. Complication prediction is crucial for postoperative outcomes. Traditional MIS scores are poorly studied in RLS, and conventional statistics often oversimplify the multifactorial and interrelated nature of these complications. This study aimed to evaluate the three-level complexity Institut Mutualiste Montsouris (IMM) classification in RLS and assess its integration into an AI algorithm to predict major complications. We retrospectively analyzed data of patients underwent RLS. Surgical complexity was stratified into grades I (low complexity), II (intermediate), and III (high). The cumulative incidence rate and conditional probability of postoperative complication and risk factors for complication ≥ Clavien-Dindo grade II were assessed. The prediction model was developed by training/testing a machine learning (ML) algorithm after feature selection with uni-multivariate analysis. We calculated the receiver operating characteristic (ROC) curve and model accuracy. We analyzed 1,045 patients who underwent RLS, classifying them into three complexity levels: Grade I (n = 581), Grade II (n = 267), and Grade III (n = 109). Significant differences were observed in intra- and postoperative outcomes across the three grades. Multivariate analysis identified ASA score (HR 2.1, p = 0.02), number of lesions (HR 1.8, p = 0.001), and operative time (OR 1, p = 0.004) as key predictors of complications. Associated with the three-level complexity classification, the Neural Network showed the best performance with AUC (0.653) and a precision of 0.996. Three-level complexity IMM classification is a useful tool in RLS for predicting intra-postoperative outcomes. It can be integrated into the Neural Network algorithm to predict major complications.

PMID:42334817 | DOI:10.1007/s13304-026-02724-5

Updates Surg. 2026 Jun 23. doi: 10.1007/s13304-026-02730-7. Online ahead of print.

ABSTRACT

Self-expandable metal stents (SEMS) are routinely used in malignant colorectal obstruction (MCO) for palliation or as a bridge to surgery. However, the association between treatment intent and complication risk, as well as the potential role of clinical success as an intermediate procedural endpoint, remains unclear. We retrospectively analyzed 413 patients with MCO who underwent SEMS placement between 2014 and 2024. Patients were categorized by therapeutic intent (palliation vs. bridge to surgery), and complication rates were compared. Mediation analysis was performed using the Sobel test, structural equation modeling (SEM), and bootstrap-based causal mediation to assess whether clinical success mediated the relationship between therapeutic purpose and complications. Complications occurred in 60 patients (14.5%). Palliation was associated with a higher complication rate compared to bridging (20.0% vs. 8.0%, p = 0.001). Clinical success showed a statistically significant indirect association in the exploratory mediation analysis Therapeutic intent effects (Sobel p = 0.035). SEM confirmed a positive association between therapeutic purpose and clinical success (standardized β = 0.171, p < 0.001) and a negative association between clinical success and complications (β = – 0.191, p = 0.009). Bootstrap mediation analysis revealed that 13.0% of the total effect was mediated through clinical success (p = 0.031). Therapeutic intent was associated with complication risk after SEMS placement, and clinical success may partially account for this association. However, the modest mediated proportion suggests that complications are likely influenced by multiple additional clinical and procedural factors. Optimizing decompression remains important but should be integrated with careful patient selection and follow-up management, particularly in palliative settings.

PMID:42334812 | DOI:10.1007/s13304-026-02730-7

Ir J Med Sci. 2026 Jun 23. doi: 10.1007/s11845-026-04512-x. Online ahead of print.

ABSTRACT

BACKGROUND: Interest in the use of ChatGPT-4o in scenario-based clinical assessment has increased substantially in recent years. However, studies evaluating ChatGPT-4o in pediatric head trauma scenarios and comparing it with different physician groups remain limited.

AIMS: To evaluate the scenario-based performance of ChatGPT-4o in pediatric head trauma and compare it with that of emergency physicians, neurosurgeons, and pediatricians.

METHODS: This study included 60 pediatric patients who presented between 15 December 2024 and 15 June 2025 and met the inclusion criteria. After clinical follow-up, cases were converted into multiple-choice case scenarios and classified into red, yellow, and green zones according to PECARN. These scenarios were answered by 42 physicians from emergency medicine, neurosurgery, and pediatrics (n=14 per group) and by ChatGPT-4o. Concordance of scenario-based management responses with PECARN recommendations was compared statistically.

RESULTS: Of the 60 cases, 25.0% (n=15) were classified as red zone, 50.0% (n=30) as yellow zone, and 25.0% (n=15) as green zone. ChatGPT-4o showed lower scenario-based performance than all physician groups in red-zone cases. When non-contrast brain CT was accepted as the correct option in the yellow zone, ChatGPT-4o had the lowest overall accuracy (median: 24.50). When observation was accepted as correct, ChatGPT-4o showed the highest accuracy both in the yellow zone (median: 17.00; p=0.001) and overall (median: 35.50; p<0.001). ChatGPT-4o showed the highest accuracy in green-zone cases (median: 8.50).

CONCLUSION: ChatGPT-4o did not demonstrate adequate scenario-based performance in critical pediatric head trauma cases. However, it may have potential as a supportive tool in non-critical case scenarios.

PMID:42334770 | DOI:10.1007/s11845-026-04512-x

Ir J Med Sci. 2026 Jun 23. doi: 10.1007/s11845-026-04510-z. Online ahead of print.

ABSTRACT

BACKGROUND: Oxidative stress and antioxidant balance play critical roles in carcinogenesis, particularly among older adults who experience increased oxidative burden. This study explored the association between the composite dietary antioxidant index (CDAI) and cancer prevalence in the elderly.

METHODS: Data from 4,907 elderly participants were analyzed and categorized into quartiles (Q1-Q4) according to CDAI. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for cancer across quartiles, adjusting for demographic and clinical covariates. Subgroup analyses were performed to evaluate the consistency across subgroups.

RESULTS: Participants with higher CDAI levels were more likely to be male, educated, and have lower diabetes prevalence. The prevalence of cancer increased across CDAI quartiles (19.6% in Q1 to 27.5% in Q4, P < 0.001). In fully adjusted models, Q4 had higher odds of cancer (OR = 1.26, 95% CI 1.02-1.54, P = 0.029). Subgroup analyses indicated stronger associations among women and those with diabetes.

CONCLUSIONS: Unexpectedly, higher CDAI was associated with a greater prevalence of cancer among elderly individuals, suggesting complex, context-dependent effects of dietary antioxidants on cancer prevalence.

PMID:42334769 | DOI:10.1007/s11845-026-04510-z

Intern Emerg Med. 2026 Jun 23. doi: 10.1007/s11739-026-04422-x. Online ahead of print.

ABSTRACT

In recent years, several stakeholders in Italy have suggested a crisis of vocation for Emergency Medicine (EM). This study aimed to verify the accuracy of such claims. We conducted an observational cross-sectional study on data from the Italian national test for residency positions assignments from 2019 to 2025. We analyzed trends in the number of medicine graduates, participants in the national test and available and filled training positions. We then compared EM to other residency programs and four “competitors” considering the ratio among filled and available positions; the absolute and relative variation in available and filled positions; the rate of filled positions over the number of exams’ participants. From 2019 to 2025 training positions grew, while the number of medical school graduates remained stable, the number of candidates decrease and was outnumbered by training positions in 2023-2024. The rate of filled positions in EM dropped from 90% in 2019 to 25% in 2024, then increased to 47% in 2025. Available positions in EM increased from 391 in 2019 to 954 in 2025, at a faster rate than most residency programs. EM absolute filled positions grew from 2022 to 2025, at a faster rate than most competitors. Recent years high rates of unfilled positions in EM is related to the abrupt increase in available positions. Our findings do not confirm a vocational crisis for EM in Italy.

PMID:42334765 | DOI:10.1007/s11739-026-04422-x

Intern Emerg Med. 2026 Jun 23. doi: 10.1007/s11739-026-04398-8. Online ahead of print.

ABSTRACT

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as cornerstone therapies for heart failure with reduced ejection fraction (HFrEF), owing to their cardioprotective and hematologic effects. While their impact on hemoglobin and hematocrit levels is increasingly recognized, the influence of SGLT2 inhibitors on mean platelet volume (MPV), a surrogate marker of platelet activation and cardiovascular risk, remains underexplored in HFrEF patients. While SGLT2 inhibitors’ effects on MPV have been studied in DM, this is the first study examining MPV changes specifically in HFrEF patients with adjustment for diuretic therapy. This retrospective study included 80 HFrEF patients receiving guideline-directed medical therapy to which SGLT2 inhibitors were subsequently added. Baseline and 6-month follow-up data on hematological and biochemical parameters were collected. Exclusion criteria included active infection, malignancy, advanced renal failure, hematologic disorders, and recent transfusions. MPV and platelet counts were analyzed using standardized protocols and equipment. Following 6 months of SGLT2 inhibitor therapy, MPV values decreased significantly (p < 0.05), while platelet counts increased significantly (p < 0.05). Although hemoglobin and hematocrit levels showed upward trends, these changes were not statistically significant. No significant correlation was observed between ΔMPV and ΔPLT. Other biochemical markers remained stable throughout the study period. SGLT2 inhibitor therapy was associated with a significant reduction in MPV and an increase in platelet count among patients with HFrEF. These hematological changes may represent an additional mechanism by which SGLT2 inhibitors exert cardiovascular benefit. However, prospective, randomized trials are needed to validate these findings and explore the clinical significance of MPV modulation in heart failure management.

PMID:42334763 | DOI:10.1007/s11739-026-04398-8

J Racial Ethn Health Disparities. 2026 Jun 23. doi: 10.1007/s40615-026-03080-1. Online ahead of print.

ABSTRACT

Racial and ethnic disparities in diabetes prevalence and outcomes are well documented; however less is known about whether the selection of treatment modality itself differs across racial groups after adjustment for clinical correlates of disease severity. This cross-sectional analysis used National Health and Nutrition Examination Survey (NHANES) data from the 2017-March 2020 and August 2021-August 2023 cycles. The primary analytical sample comprised 1,688 adults aged 18 years and older with physician-confirmed diabetes, after excluding 46 probable Type 1 cases. Treatment modality was categorized as insulin-only, oral medication-only (base outcome), combination therapy, or no medication, based on self-reported use of insulin and oral antidiabetic medications. Survey-weighted multinomial logistic regression adjusted for age, gender, education, income, birthplace, insurance, HbA1c, body mass index (BMI), and self-reported diabetes duration. Race and ethnicity remained a significant overall predictor of treatment modality after full adjustment (joint Wald p = 0.012). Other/Multi-Racial adults had 57% lower relative risk of insulin-only therapy than Non-Hispanic White (NHW) adults (relative risk ratio [RRR] = 0.43, 95% CI: 0.24-0.76, p = 0.005), and Other Hispanic and Other/Multi-Racial adults had lower relative risk of combination therapy (RRR = 0.56, p = 0.034 and RRR = 0.47, p = 0.043, respectively). Non-Hispanic Black (NHB) adults did not differ from NHWs at the population level. HbA1c, diabetes duration, BMI, and insurance status were the strongest predictors of treatment modality. An exploratory race-by-income interaction model produced a non-significant joint test (p = 0.259) and is reported as hypothesis-generating. Differences in modality use persist after adjustments, suggesting that structural and healthcare-system factors may contribute to treatment variation independently of measured clinical and socioeconomic characteristics.

PMID:42334756 | DOI:10.1007/s40615-026-03080-1

Stat Med. 2026 Jul;45(15-17):e70653. doi: 10.1002/sim.70653.

ABSTRACT

Brain image analysis presents significant challenges due to limitations in precision, computational efficiency, and interpretability. Although neural networks have proven effective for modeling complex patterns, they often function as black-box systems, making their predictions difficult to interpret and limiting their clinical utility. To address these challenges, we propose the adaptive spatial key-region identification (ASKRI) framework-a novel method to identify region of interest, which combines adaptive sampling based on Shannon entropy, probability-mean-driven selection, and spatial uncertainty quantified via kriging method. ASKRI integrates block-to-block kriging with statistical inference to interpolate CNN-derived classification performance, significantly reducing the computational burden of exhaustive model training without sacrificing predictive accuracy. Designed for seamless integration with convolutional neural networks (CNNs), ASKRI enhances both the accuracy and interpretability of ROI identification. Its effectiveness is demonstrated using the traumatic brain injury (TRACK-TBI) dataset, where ASKRI reliably identifies spatially consistent and biologically meaningful regions associated with aging. These results underscore the framework’s potential to advance brain image analysis, while offering transparent and resource-efficient diagnostic support in clinical settings.

PMID:42334752 | DOI:10.1002/sim.70653

J Immigr Minor Health. 2026 Jun 23. doi: 10.1007/s10903-026-01945-5. Online ahead of print.

ABSTRACT

Increasing global migration has intensified the need for culturally competent healthcare, particularly in countries with high immigrant populations. This study aimed to examine the effect of intercultural competence training on cultural sensitivity and communication skills among nursing students caring for immigrant patients. This experimental study with a control group was conducted online with 69 first-year nursing students at a public university (33 experimental, 36 control). The intercultural competence training program, delivered via online, included lectures, case-based discussions, and interactive activities over four weeks. Data were collected using the Intercultural Sensitivity Scale (ISS) and the Communication Skills Scale (CSS). Statistical analyses were performed using SPSS version 25. The experimental group demonstrated a statistically significant increase in both ISS and CSS scores following the intervention (p < 0.05), whereas no significant changes were observed in the control group. Intercultural competence training effectively improves cultural sensitivity and communication skills among nursing students. These findings highlight the importance of integrating such training into nursing education to enhance the quality and equity of healthcare for immigrant populations. Further studies with larger samples and long-term follow-up are recommended.

PMID:42334737 | DOI:10.1007/s10903-026-01945-5

Sports Med Open. 2026 Jun 23;12(1):79. doi: 10.1186/s40798-026-01054-5.

ABSTRACT

BACKGROUND: Generalized joint hypermobility (GJH) has been associated with increased risk of second anterior cruciate ligament (ACL) injury. The clinical diagnosis of GJH relies on a binary threshold of positive joint hypermobility tests, based on age and patient sex, which may overlook the degree of hypermobility.

OBJECTIVES: To analyze the association between the number of positive joint hypermobility tests on the Beighton Score and the hazard of second anterior cruciate ligament (ACL) injury in patients who return to sport (RTS) after primary ACL reconstruction, which included secondary, stratified analyses of graft rupture and contralateral ACL injury.

DESIGN: Registry study.

METHODS: Data were extracted in January 2026 from an ACL-rehabilitation-specific registry, Project ACL. Included patients were 15-50 years who underwent primary ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autograft, had a documented Beighton Score, participated in knee-strenuous sports before injury, had RTS, reported second ACL injury or had ≥ 1 year follow-up without second ACL injury after RTS. Multivariable Cox proportional hazard regression was used to estimate the cause-specific hazard ratio (HR) of second ACL injury (measured from RTS) based on the Beighton Score, adjusted for age, return to pre-injury physical activity level or higher, graft choice, knee hyperextension (≥ 10° knee extension), and patient sex, accounting for competing risks.

RESULTS: The analysis included 935 patients (mean age 23.7 ± 7.8 years, 51.4% female), with median Beighton Score of 2 (interquartile range: 4). The median follow-up time was 54.4 months. The cumulative incidence of second ACL injury after RTS was 13.1%. Specifically, the cumulative incidence for graft rupture was 7.4% and 5.7% for contralateral ACL injury. For the primary outcome, each additional positive joint hypermobility test on the Beighton Score was associated with a significantly increased hazard of second ACL injury (adjusted HR: 1.10 (95% CI 1.003-1.22, p = 0.044). For the secondary outcomes, each additional test was associated with an increased hazard of graft rupture (adjusted HR: 1.15, 95% CI 1.01-1.30, p = 0.031), whereas no statistically significant association was observed for contralateral ACL injury.

CONCLUSIONS: The HR of second ACL injury (graft rupture or contralateral ACL injury) after RTS in patients who had undergone primary ACL reconstruction increased by 10%, and by 15% for isolated graft rupture, for each positive joint hypermobility test on the Beighton Score, while no association was observed for contralateral ACL injury.

PMID:42334734 | DOI:10.1186/s40798-026-01054-5