Tag: pubmed

Anesth Analg. 2026 Jun 2. doi: 10.1213/ANE.0000000000008107. Online ahead of print.

ABSTRACT

BACKGROUND: Oxytocin is the most widely used uterotonic for postpartum hemorrhage prevention, yet high-quality data comparing bolus versus infusion administration are limited. Given the very high uterine blood flow at term, rapid achievement of uterine tone is critical to minimize blood loss. We hypothesized that bolus administration leads to a greater likelihood of attaining adequate uterine tone at 2 minutes.

METHODS: In this randomized, double-blinded clinical trial, 121 patients undergoing elective cesarean delivery under spinal anesthesia were randomized 1:1 to receive oxytocin by bolus or infusion after cord clamping. Masked study drugs were prepared by the investigational pharmacy to maintain blinding of the anesthesiologist, obstetrician, and study personnel. The primary end point was adequate uterine tone at 2 minutes. Secondary end points included patient satisfaction, time to adequate uterine tone, quantitative blood loss, postpartum hemorrhage (blood loss greater than 1000 mL), and safety measures (heart rate, blood pressure, phenylephrine dose, chest pain, nausea/vomiting, additional uterotonic use, and intensive care unit admission).

RESULTS: Of 121 patients enrolled, 115 were analyzable (6 screen failures received no study drug); 114/115 received oxytocin per protocol. Baseline characteristics were similar between groups. Adequate uterine tone at 2 minutes (primary end point) was similar in bolus (50/60, 83.3%) vs infusion (43/55, 78.2%), P = .483. Patient satisfaction scores were also not significantly different (P = .495) between the two arms, with both the bolus and infusion arms having medians and interquartile range (IQRs) of (10 [IQR 10-10]). Median blood loss was slightly lower with bolus (558 mL [IQR 429-733]) vs infusion (687 mL [IQR 480-826], P = .0438; Hodges-Lehmann estimate of 82 mL [95% confidence interval {CI}, 2-168 mL]). Phenylephrine dosage and rates of postpartum hemorrhage, nausea, and additional uterotonic use were similar between groups (all P > .28). Rates of postpartum hemorrhage, hypotension, phenylephrine use, nausea, and additional uterotonic use were similar.

CONCLUSIONS: There was no statistically significant difference in the frequency of achieving adequate uterine tone at 2 minutes between oxytocin given by infusion or bolus. Although the bolus group demonstrated statistically lower blood loss, the magnitude of this difference was small (upper confidence limit of 168 mL) and is unlikely to be clinically significant. Both methods showed comparable safety profiles.

PMID:42228946 | DOI:10.1213/ANE.0000000000008107

Anesth Analg. 2026 Jun 2. doi: 10.1213/ANE.0000000000007978. Online ahead of print.

ABSTRACT

BACKGROUND: Anesthetic adjuvants used in multimodal analgesia-including intravenous lidocaine, dexmedetomidine, or intrathecal morphine (ITM)-may differentially affect immune responses and metastasis-related pathways in colorectal cancer surgery. Their comparative effects on these pathways remain poorly understood.

METHODS: In this prospective, randomized, patient- and assessor-blinded trial, adults undergoing elective laparoscopic or robotic colorectal cancer resection were allocated to receive intravenous lidocaine, dexmedetomidine, or ITM. The primary outcome was plasma matrix metalloproteinase-9 (MMP-9) concentration at 1 hour postoperatively. Secondary outcomes included other metastasis-promoting biomarkers (MMP-2, VEGF, IL-6), immune cell subsets (T and NK cells), and CD39/CD73 expression on T lymphocytes at 1 hour postoperatively and postoperative day 1. Clinical outcomes-including pain scores, opioid consumption, and complications-were also assessed.

RESULTS: Of the 114 enrolled patients, 109 completed the study and were analyzed (ITM group = 37, DEX group = 34, LIDO group = 38). Overall group × time interaction was significant for MMP-9 (P = .028). At 1 hour, MMP-9 was higher in LIDO group than in the DEX group (difference on the log scale, 0.333; 95% confidence interval [CI], 0.0642-0.601; P = .009) and in the ITM group (0.424; 95% CI, 0.0248-0.823; P = .033). The DEX group was associated with increased CD73+CD8+ T cells compared with the LIDO group (difference on the logit scale: 0.669; 95% CI, 0.000987-1.34; P = .050), and with decreased CD39-CD73-CD8+ T cells compared with the ITM group (-0.695; 95% CI, -1.3 to -0.0908, P = .018) and the LIDO group (-0.645; 95% CI, -1.24 to -0.05, P = .029). The ITM group was associated with lower dynamic pain scores than the other groups. Rescue antiemetic use was less frequent with the DEX group, whereas other adverse events were mild and comparable across groups.

CONCLUSIONS: Anesthetic adjuvants exerted differential effects on perioperative biomarkers and immune profiles relevant to tumor progression. Compared with the other groups, lidocaine was associated with higher MMP-9 levels, dexmedetomidine with relative shifts toward an immunosuppressive T-cell phenotype, and intrathecal morphine with superior analgesia with minimal immune impact. Further studies are warranted to determine whether multimodal analgesia strategies influence long-term oncologic outcomes.

PMID:42228944 | DOI:10.1213/ANE.0000000000007978

J Med Internet Res. 2026 Jun 2;28:e86498. doi: 10.2196/86498.

ABSTRACT

BACKGROUND: Large language models (LLMs) require specialized methodologies to quantify model confidence for safe deployment in health care systems; however, there is a lack of established methods for confidence assessment.

OBJECTIVE: This study aimed to evaluate confidence metrics for multimodal LLMs interpreting ultrasound-based radiology cases and to compare self-reported, consistency-based, and hybrid methods.

METHODS: From a total of 330 quizzes on the Korean Society of Ultrasound in Medicine digital platform, we selected 94 multiple-choice cases. Four multimodal LLMs were evaluated: 3 reasoning models (GPT-5, Claude-4.5-Sonnet, and Gemini-3-Pro) and 1 general model (GPT-4o). Temperature was fixed at 1.0. Multiple confidence metrics were assessed: (1) self-reported metrics generated by LLMs using prompts that elicited direct confidence percentages with answers, including first self-reported confidence and mean self-reported confidence; (2) consistency-based metrics derived from 20 repeated outputs per case, including relative entropy calculated as 1 – H/log2 k (H=Shannon entropy, k=number of answer choices) and majority-vote percentage; and (3) a Top Weighted Score combining response frequency with self-reported confidence. Receiver operating characteristic analysis for discrimination and Spearman correlation between accuracy and each confidence metric was conducted. Additionally, model calibration was assessed using expected calibration error and Brier score. Processing time and token consumption (input, output, and total) were recorded for each application programming interface call to evaluate resource use across models.

RESULTS: Diagnostic accuracy varied across models, with Gemini-3-Pro achieving the highest accuracy (70/94, 74.47%), surpassing the median human accuracy (59%, IQR 40.3%-75%). Top Weighted Score, a hybrid metric combining response frequency and self-reported confidence, was the only metric achieving statistically significant correlations across all 4 models: Gemini-3-Pro (ρ=0.52), GPT-5 (ρ=0.43), Claude-4.5-Sonnet (ρ=0.30), and GPT-4o (ρ=0.22). Receiver operating characteristic analysis revealed that Top Weighted Score demonstrated the highest discriminative ability, with area under the curve values of 0.826 (95% CI 0.731-0.920) for Gemini-3-Pro and 0.767 (95% CI 0.668-0.866) for GPT-5. Top Weighted Score was the only metric achieving statistical significance in GPT-4o. Calibration analysis showed that Top Weighted Score achieved the lowest expected calibration error in GPT-5 (0.098) and Claude-4.5-Sonnet (0.192), while Gemini-3-Pro showed comparable calibration between relative entropy (0.119) and Top Weighted Score (0.122). Resource use analysis demonstrated that reasoning models required substantially longer processing times and higher token consumption compared to general models.

CONCLUSIONS: In multimodal LLMs applied to ultrasound-based radiology cases, hybrid methods (Top Weighted Score) demonstrated significant associations across all evaluated models and appear to serve as more reliable indicators of diagnostic confidence compared to self-reported or consistency-based metrics alone, although the strength of these associations varied across models, and external validation is warranted before broader clinical application. These findings support integrative confidence estimation approaches that incorporate response consistency while highlighting the need for resource-efficient sampling strategies to enable practical clinical deployment.

PMID:42228942 | DOI:10.2196/86498

JMIR Res Protoc. 2026 Jun 2;15:e60583. doi: 10.2196/60583.

ABSTRACT

BACKGROUND: Hispanic adults with type 1 diabetes (T1D) have suboptimal access to continuous glucose monitoring (CGM). Widening access to and increasing uptake of CGM for Hispanic adults with T1D are warranted.

OBJECTIVE: This randomized controlled trial (RCT) will evaluate the feasibility of a federally qualified health center (FQHC) CGM intervention and assess for an intervention signal in patient outcomes.

METHODS: A mixed methods, pragmatic pilot RCT will be used. A total of 30 adult Hispanic patients with T1D will be recruited from 4 FQHC sites allocated to provide the intervention (n=2) or control (n=2) conditions. At intervention sites, participants must be willing to use CGM for 3 months and have a willing adult family member participate in the study. Guided by the socioecological model, our intervention has three levels: (1) individual (culturally sensitive CGM information, motivation, and skills acquisition), (2) family or social networks (integration of the core Hispanic values of familismo and collectivismo to leverage family and peer support for CGM uptake), and (3) health care provider levels with CGM training using Project ECHO (Extension for Community Healthcare Outcomes). Intervention participants (n=15) will receive a culturally sensitive CGM intervention with 4 weekly intervention sessions (coattended by a family member), followed by 7 peer support group sessions over 6 months. Control participants will receive a self-monitoring of blood glucose control condition over a 6-month period. Study feasibility will be assessed in terms of recruitment, enrollment, retention, adherence, study procedures and implementation, and acceptability with mixed methods. We will collect physiological (eg, glycated hemoglobin and CGM metrics) and psychosocial (eg, depression, quality of life, social support, and interpersonal processes of care) outcome data. Feasibility data will be analyzed using content analysis and univariate or bivariate statistics. Linear and generalized linear mixed modeling will assess intervention signals and clinically meaningful differences from baseline to 3 and 6 months.

RESULTS: Funding for this project was secured in September 2022. As of May 2024, recruitment commenced following formative qualitative data collection on the social determinants of health and CGM uptake in Hispanic adults with T1D (N=32). Our community advisory board informed protocol modifications by reviewing qualitative findings, collaborating on related intervention refinement, and advising on cultural sensitivity methods.

CONCLUSIONS: Guided by the socioecological model, our novel FQHC CGM intervention will provide feasibility and outcome data to guide a full-scale RCT. Our intervention model has unique potential to widen CGM access and increase CGM uptake in low-income Hispanic adults with T1D while improving outcomes for this vulnerable population.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06487962; https://clinicaltrials.gov/study/NCT06487962.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/60583.

PMID:42228938 | DOI:10.2196/60583

JMIR Hum Factors. 2026 Jun 2;13:e92145. doi: 10.2196/92145.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) detection tools for intracranial hemorrhage (ICH) are increasingly integrated into radiology workflows. In real-world practice, perceived utility depends not only on diagnostic performance but also on workflow fit, false positive burden, and how clinicians interpret and act on AI outputs.

OBJECTIVE: This study aimed to characterize radiologists’ perceptions of a Food and Drug Administration (FDA)-cleared ICH AI detection tool in a national teleradiology network, including perceived reliability, false positive burden, workflow impact, medicolegal concerns, and self-reported behaviors during routine use.

METHODS: We conducted an anonymous cross-sectional survey of radiologists in a national teleradiology practice who had access to an FDA-cleared ICH AI overlay during noncontrast head computed tomography interpretation. Survey items used a 5-point Likert scale. Results are summarized as agreement proportions (“agree” or “strongly agree”) with 95% CIs. We compared neuroradiologists with non-neuroradiologists using Fisher exact tests. One primary end point was prespecified: agreement that time spent reviewing examinations with false positive AI alerts outweighed the benefits. Remaining subgroup comparisons were treated as exploratory, with false discovery rate control using the Benjamini-Hochberg procedure.

RESULTS: A total of 65 radiologists responded, including 23 (35.4%) neuroradiologists and 42 (64.6%) non-neuroradiologists. Only 18.5% (12/65; 95% CI 10.9%-29.6%) agreed that false-positive alerts were infrequent enough to be acceptable. Agreement that the AI correctly identified most ICH cases was 32.3% (21/65; 95% CI 22.2%-44.4%), and agreement that the AI rarely missed clinically important hemorrhages was 43.1% (28/65; 95% CI 31.8%-55.2%). Trust in AI output was conditional: 50.8% (33/65; 95% CI 38.9%-62.5%) reported trusting the AI when it agreed with their interpretation, whereas 3.1% (2/65; 95% CI 0.8%-10.5%) reported trusting it when it conflicted with their interpretation. Only 10.8% (7/65; 95% CI 5.3%-20.6%) reported reduced overall interpretation time, whereas 33.8% (22/65; 95% CI 23.5%-46.0%) agreed that time spent reviewing false-positive alerts outweighed the benefits. Self-reported reduced scrutiny after an AI-negative result was uncommon (4/65, 6.2%; 95% CI 2.4%-14.8%). In subgroup analysis, neuroradiologists more often endorsed the primary end point than non-neuroradiologists (12/23, 52.2% vs 10/42, 23.8%; unadjusted P=.03), but no exploratory subgroup differences remained statistically significant after false discovery rate correction. Free-text responses emphasized artifact- and calcification-driven false positives, delayed or inconsistent AI availability, consultation burden, and medicolegal concerns.

CONCLUSIONS: In this national teleradiology setting, radiologists reported substantial false positive burden, limited perceived time savings, and strongly conditional trust in an FDA-cleared ICH AI detection tool. Self-reported reduced scrutiny after negative AI outputs was uncommon but present in a minority of cases. These findings support the importance of specificity, interpretability, latency, and workflow-aware implementation when deploying radiology AI tools in practice.

PMID:42228936 | DOI:10.2196/92145

Annu Rev Vis Sci. 2026 Jun 2. doi: 10.1146/annurev-vision-121225-090634. Online ahead of print.

ABSTRACT

Inferring 3D surface structure is one of the most fundamental functions of vision. There are many well-known depth cues, such as shading, texture, and highlights. However, how these cues are extracted from images-and what exactly they tell the brain about 3D shape-is not fully understood. Here, we describe how these seemingly distinct 3D shape cues could share a common currency for the first stages of shape estimation. The key insight is that when patterns such as shading or texture are projected from a 3D object into the 2D retinal image, they are spatially distorted, with profound consequences for local image statistics. The distortions create highly organized patterns of local image orientation (orientation fields) that are systematically related to specific 3D shape properties. Orientation fields can be reliably measured by filter populations and predict both successes and failures of human shape perception across diverse conditions.

PMID:42228868 | DOI:10.1146/annurev-vision-121225-090634

J Pediatr Orthop B. 2026 Jun 2. doi: 10.1097/BPB.0000000000001358. Online ahead of print.

ABSTRACT

This study compares the outcomes of tension-band plates (TBP) correction of angular deformities in patients with Hurler and Morquoio syndromes mucopolysaccharidoses (MPS) to those with idiopathic etiologies. A retrospective analysis of patients aged less than 18 at a single institution who received TBP between 2005 and 2017 for valgus angular deformities was conducted. Inclusion criteria were patients with complete data and MPS or idiopathic etiology. Femoral and tibial deformities were evaluated independently. Postsurgical X-rays were reported at 6-month intervals. Statistical significance was determined by Mann-Whitney and χ2 tests. Twenty-nine patients were included: Hurler syndrome (8), Morquio syndrome (1), and idiopathic (20). Femoral TBP corrections at 1 year were 4.9° (MPS) and 11.2° (idiopathic); total degrees of correction were 7.3° (MPS) and 8.9° (idiopathic). Tibial TBP corrections at 1 year were 5.8° (MPS) and 5.4° (idiopathic); total degrees of correction were 9.1° (MPS) and 6.0° (idiopathic). The average correction rates for femoral TBPs were 4.3°/year (MPS) and 7.3°/year (idiopathic), and tibial TBPs were 4.5°/year (MPS) and 4.6°/year (idiopathic). Full correction was achieved in four of nine (44.4%) MPS patients and 14 of 20 (70%) idiopathic patients, as well as 9 of 22 (40.9%) MPS limbs and 20 of 38 (52.6%) idiopathic limbs. There were no statistically significant differences between groups or by gender. MPS patients with femoral and tibial TBPs experienced comparable correction rates to idiopathic patients, although idiopathic patients corrected slightly faster, consistent with prior literature. This demonstrates that TBP is an effective growth modulation technique for MPS patients despite morphological differences.

PMID:42228852 | DOI:10.1097/BPB.0000000000001358

J Pediatr Orthop B. 2026 Jun 3. doi: 10.1097/BPB.0000000000001357. Online ahead of print.

ABSTRACT

Ponseti treatment of congenital clubfoot utilizes foot abduction bracing to prevent recurrence. In unilateral clubfoot, families have expressed concern about inducing deformity in the uninvolved leg. This study evaluated rotational profiles of uninvolved legs in children with unilateral clubfoot. We retrospectively reviewed 78 children (mean age: 9.5 ± 3.4 years) with unilateral idiopathic clubfoot treated by Ponseti method at a single institution from 2008 to 2025. Motion capture kinematics evaluated hip, tibial, ankle rotation, and foot progression angle (FPA). Physical exam evaluated bimalleolar axis, hip rotation, and thigh-foot angle (TFA). Pedobarographic data evaluated FPA and foot loading. Results compared to normative cohorts of typically developing children using unpaired t-tests (P < 0.05). The uninvolved side demonstrated more kinematic internal ankle rotation (3.9 ± 7.3 vs. 0.9 ± 5.6°; P = 0.0004), more kinematic external hip rotation (-4.4 ± 9.6 vs. 1.2 ± 6.8°; P = 0.0001), less hip internal rotation on exam (47.4 ± 13.2 vs. 57.6 ± 12.3°; P = 0.0001) and more external bimalleolar axis (-19.0 ± 6.8 vs. -16.0 ± 5.9°; P = 0.0091). There was no difference in TFA or FPA. Pedobarographic analysis showed no foot loading or FPA impact. The uninvolved limb in unilateral clubfoot develops statistically significant external hip rotation and increased external bimalleolar axis compared to normative controls, though kinematic tibial internal rotation was not significantly different. However, there was no significant impact on TFA, FPA, or foot loading, indicating that these differences are clinically insignificant. Awareness of these changes is helpful for counseling and reassuring families. This is a level III retrospective case-control study.

PMID:42228848 | DOI:10.1097/BPB.0000000000001357

J Strength Cond Res. 2026 Jun 3. doi: 10.1519/JSC.0000000000005508. Online ahead of print.

ABSTRACT

Mukandi, I, Turner, A, Bishop, C, Beato, M. Neuromuscular and subjective recovery responses to day and night fixtures during congested and noncongested microcycles in professional soccer players. J Strength Cond Res XX(X): 000-000, 2026-This study investigated and compared the impact of day and night fixtures during congested and noncongested microcycles on countermovement jump (CMJ) performance and subjective self-reported measures 40 hours postcompetitive match play in professional soccer players. Twenty-eight players completed CMJ baseline assessment during preseason. Assessment 40 hours postmatch was limited to players who played ≥60 minutes. Baseline measures for subjective self-reported measures were collected 24 hours prematch. Congested microcycles were classified as 3-5 days between fixtures and noncongested microcycles ≥7 days between fixtures. Across all 4 fixture contexts, significant reductions (p < 0.05) with small-to-moderate effects (δ = -0.47 to 0.30) were observed for all CMJ metrics, except for eccentric mean force that showed nonsignificant, trivial effects for congested microcycles and night fixtures. Statistically significant reductions in sleep quality, mood, muscle soreness, and a composite score of all 3 measures were observed for both congested and noncongested microcycles as well as day fixtures (p < 0.05) (δ = -0.59 to 0.11). For night fixtures, nonsignificant changes were observed for sleep quality and mood. No significant differences were observed between day and night fixtures as well as congested and noncongested microcycles for all CMJ metrics. For subjective self-reported measures, significant trivial to small differences with a bias toward night fixtures were observed for muscle soreness, mood, and composite score. No significant differences were observed among the global positioning system metrics between congested and noncongested microcycles. Significant differences were observed between high-speed running and sprint distance between day and night fixtures with a bias toward day fixtures, while nonsignificant differences were found for total distance, distance per minute, accelerations, and decelerations. Monitoring both objective and subjective self-reported measures provides a holistic approach to understanding player fatigue and recovery, allowing for informed decision making in congested periods.

PMID:42228843 | DOI:10.1519/JSC.0000000000005508

Turk Arch Pediatr. 2026 May 21;61(6):531-542. doi: 10.65717/TurkArchPediatr.2026.25353.

ABSTRACT

OBJECTIVE: The aim of the study was to compare the key clinical features and course of SARS-CoV-2 infection between the local population of the Ternopil region and internally displaced persons (IDPs), to analyze the quality of life in both participant groups, and to determine the frequency and symptoms of long COVID.

METHODS: A cross-sectional study was conducted involving children with confirmed COVID-19 from September 2022 to May 2024. Clinical symptoms, COVID-19 severity, 25(OH)D and zinc levels, long COVID symptoms, and quality of life were compared between internally displaced and local populations using structured questionnaires and medical records.

RESULTS: A total of 299 children with COVID-19 were included, consisting of 29 IDPs and 270 local population. Gastrointestinal symptoms were significantly more common among IDPs (P<.0001), while respiratory symptoms and severe fatigue predominated in the local population (P < .0001 and P=.0229, respectively). The IDPs experienced a more severe course of COVID-19 (P=.0141) and had a longer duration of hospital stay (P < .0001). Serum zinc levels were significantly lower in IDPs compared to local population (P=.0229). Assessment of quality of life demonstrated higher total, physical, psychosocial, and school functioning scores among IDPs, indicating a statistically better perceived health status. The overall frequency of long COVID did not differ between groups; however, its distribution varied by age: it was significantly higher in IDPs under 6 years (P=.0062), whereas among children ≥6 years, it was more common in the local population (P=.0092). Age-specific differences in long COVID symptom patterns were also observed between IDPs and local children.

CONCLUSION: This study highlights the need to consider the impact of war, displacement, and chronic stress on the clinical presentation, timeliness of seeking care, and symptom reporting among children with COVID-19. Future efforts should focus on improving access to healthcare, health education, nutritional, and psychosocial support for displaced children to mitigate the combined negative effects of COVID-19 and war.

PMID:42228823 | DOI:10.65717/TurkArchPediatr.2026.25353