Tag: pubmed

Eur J Nucl Med Mol Imaging. 2026 May 16. doi: 10.1007/s00259-026-07918-y. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the feasibility of non-invasively identifying bone marrow involvement (BMI) in follicular lymphoma (FL) using baseline ¹⁸F-FDG PET/CT combined with multidimensional feature fusion, and to compare the impact of different bone marrow volume-of-interest (VOI) frameworks on model performance.

METHODS: This retrospective study included 187 patients with newly diagnosed FL, 93 of whom had BMI. Based on baseline ¹⁸F-FDG PET/CT, two bone marrow VOI frameworks were constructed: a pelvic VOI framework and a spine-pelvis VOI framework. Clinical features, conventional imaging features, radiomic features, and deep learning features were extracted. A hierarchical feature screening strategy was employed: clinical and conventional imaging features were screened using univariate logistic regression, Spearman’s correlation analysis, and multivariate logistic regression, whereas high-dimensional radiomic and deep learning features were screened using LASSO regression combined with the Boruta algorithm. Based on the selected features, six different modelling schemes were developed. The optimal scheme was selected using the area under the receiver operating characteristic curve (AUC) in the independent validation set as the primary metric. Under the optimal scheme, the performance of seven machine learning models-logistic regression (LR), support vector machine (SVM), gradient boosting machine (GBM), neural network (NN), random forest (RF), k-nearest neighbours (KNN), and adaptive boosting (AdaBoost)-was further compared. SHAP analysis was used to interpret the key features of the final model and the direction of their contributions.

RESULTS: Compared with the non-BMI group, the BMI group was more likely to present with widespread regional lymph node involvement, B symptoms, larger lymph node lesions, as well as lower Hb, higher LDH, lower Apo A, lower eGFR, and higher β2-MG levels (all P < 0.05). Under both VOI frameworks, the BMI group exhibited higher bone marrow FDG uptake intensity and metabolic burden, as reflected by higher values of conventional PET/CT features, including SUVmean, Standard Deviation (PET), RMS, 25th Percentile Value, Median, 75th Percentile Value, TLG, Glycolysis Q2-Q4, SAM, and SUVpeak (all P < 0.05). Multivariate logistic regression analysis indicated that regional lymph node involvement and β2-MG consistently remained independent predictors across both VOI frameworks, whereas SUVmean retained statistical significance only within the pelvic VOI framework. A comparison of six modelling schemes revealed that the scheme integrating the spine-pelvis VOI framework with clinical features, conventional imaging features, and radiomic features performed best. Under this scheme, the GBM model achieved the best overall performance on the independent validation set (AUC = 0.906, Accuracy = 0.877, Precision = 0.926, Sensitivity = 0.833, Specificity = 0.926, F1 score = 0.877). SHAP analysis revealed that, in addition to LNr (≥ 5) and β2-MG, first-order statistical features such as PET-Orig-FO-IQR, as well as texture features derived from wavelet/LBP transformations-including PET-Wav-HLL-NGTDM-Strength, PET-Wav-HLL-GLRLM-SRHGLE, CT-LBP3D-m1-GLCM-MCC, and PET-LBP3D-m2-GLSZM-SAHGLE-also made significant contributions. These findings suggest that BMI-associated imaging phenotypes are characterised not only by increased bone marrow metabolism but also by remodelling of the grey-level distribution and spatial heterogeneity within the bone marrow.

CONCLUSION: Bone marrow involvement in follicular lymphoma is associated with higher tumour burden and altered metabolic heterogeneity within the bone marrow. A PET/CT-based radiomic-clinical model showed good performance for non-invasive BMI prediction, and the spine-pelvis VOI framework outperformed the pelvic VOI framework alone. The final GBM model may provide a feasible imaging biomarker for complementary baseline assessment of BMI in FL.

PMID:42142271 | DOI:10.1007/s00259-026-07918-y

Metabolomics. 2026 May 16;22(3):74. doi: 10.1007/s11306-026-02457-x.

ABSTRACT

INTRODUCTION: We present a simple test to assess whether a metabolomics dataset is fit-for-purpose. Current qualitycontrol approaches do not directly evaluate the ability to recover biologically meaningful perturbations.

OBJECTIVES: To evaluate whether known drug-induced metabolic perturbations can serve as internal benchmarks fordataset quality.

METHODS: In a study (the TROMBOLOME study, unrelated to allopurinol therapy), 1,000 serum samples were analyzedwith one targeted and two untargeted metabo lomics panels. Samples were classified as allopurinol-positive (N=19)using detection of allopurinol analytical targets. Endogenous metabolite markers of allopurinol therapy wereevaluated based on hypotheses derived from the literature. Statistical evaluation was performed using Mann-Whitney U-tests.

RESULTS: The hypothesis of upregulation was supported for xanthine, orotate, and orotidine (p < 0.0001) inallopurinol-positive cases (N = 19). These findings demonstrate repro ducibility of well-characterized metabolicperturbations within the dataset.

CONCLUSION: In the absence of external quality assessment schemes for untargeted metabolomics, such benchmarkscould provide a practical way to evaluate whether datasets are suitable for downstream biological interpretation.The proposed targeted exposomics approach complements traditional QC metrics by assessing biologicalrecoverability.

PMID:42142266 | DOI:10.1007/s11306-026-02457-x

Support Care Cancer. 2026 May 16;34(6):546. doi: 10.1007/s00520-026-10786-9.

ABSTRACT

BACKGROUND: The Multinational Association for Supportive Care in Cancer (MASCC) Risk Index is the most widely used tool for stratifying febrile neutropenic cancer patients as low or high risk for serious complications. Studies evaluating its discriminative performance have relied predominantly on sensitivity, specificity, receiver operating characteristic (ROC) curves, and c-statistics-metrics that are mathematically elegant but have limited direct utility in clinical decision-making at the bedside.

METHODS: Sensitivity and specificity data from Rivest et al. [13], the original Klastersky et al. derivation study [3], and the Zheng et al. meta-analysis [10] were used to calculate positive and negative likelihood ratios. Posttest probabilities were derived using Bayesian updating (pretest odds × LR = posttest odds), with a cohort pretest probability of complications of 35%. Likelihood ratios for procalcitonin (Ahn et al.) were applied sequentially to demonstrate the compounding of independent predictors.

RESULTS: Applying Rivest et al. data in the inverted framing (i.e., predicting complication presence), a MASCC score > 21 yields a posttest probability of neutropenic complications of approximately 22%, and MASCC < 21 yields 65%. When procalcitonin ≥ 0.5 ng/mL is added to a high-risk MASCC score, the posttest probability rises to 85%; when procalcitonin is negative in a low-risk patient, it falls to 11%. Likelihood ratios varied meaningfully across Klastersky, Rivest, and Zheng (LR + range: 1.98-4.00; LR – range: 0.29-0.51), reflecting heterogeneity in populations, outcome definitions, and study settings.

CONCLUSIONS: Unlike sensitivity/specificity and predictive values, LRs are relatively independent of outcome prevalence, making them more transportable across clinical settings, though they are not immune to population and spectrum effects, stopping at sensitivity, specificity, ROC curves, and mathematical completeness but clinical incompleteness. Clinicians, who are the end-users of these tools, deserve the metric that speaks their language: the updated probability that this patient, in front of them, will experience harm.

PMID:42142265 | DOI:10.1007/s00520-026-10786-9

Metabolomics. 2026 May 16;22(3):76. doi: 10.1007/s11306-026-02455-z.

ABSTRACT

BACKGROUND: At the end of lactation (mammary involution), dynamic changes in milk components occur in all mammals. The time to reach complete cessation varies among taxa and species. The involution of cows, sheep, and goats (Bovidae) has been reported, but limited information is available on giraffes.

OBJECTIVES: Characterise organic acids and amino acids in the milk of giraffes at involution.

METHODS: Milk was obtained from five giraffes. A LC-MS/MS metabolomics approach was followed, and statistical analysis of the data was done using MetaboAnalyst 6.0.

RESULTS: There were 38 organic acids and 45 amino acids measured in the giraffe milk. The organic acids indicate a decrease in Krebs cycle intermediates. Lower citrate levels are associated with lower lactose levels, indicating reduced osmotic regulation. Lower uracil and orotic acid indicate decreased pyrimidine synthesis and eventual nucleotide synthesis. Increased amino acid content is not devoted to protein synthesis, but to other functions, specifically as antioxidants, redox buffering, and cytoprotection. Increased histidine, serine and methionine promote protein degradation and one-carbon metabolism. Lysine catabolites lead to decreased levels of energy metabolites and to stress adaptation. Aromatic amino acids modulate the supply of immune and neuroactive metabolites.

CONCLUSIONS: During involution, the regulation of organic acids suggests reduced Krebs cycle activity, indicating a transition from high biosynthetic to catabolic activity. Likewise, amino acids have other functions, specifically antioxidant, redox-buffering, and cytoprotection.

PMID:42142263 | DOI:10.1007/s11306-026-02455-z

Support Care Cancer. 2026 May 16;34(6):545. doi: 10.1007/s00520-026-10753-4.

ABSTRACT

PURPOSE: While physical activity, sedentary behavior, and sleep have individually been linked to long-term outcomes in cancer survivors, few studies have evaluated their synergistic effects across a full 24-h period. This study aimed to examine the association between adherence to the Canadian 24-Hour Movement Guidelines and mortality risk in a nationally representative sample of US cancer survivors.

METHODS: Data from 2551 cancer survivors participating in the 2007-2018 National Health and Nutrition Examination Survey were analyzed. Adherence to the 24-Hour Movement Guidelines for aerobic physical activity, sedentary behavior, and sleep was summed to categorize participants into four groups. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cancer-specific mortality.

RESULTS: The proportions of participants meeting no, one, two, and three guidelines were 14.4%, 38.6%, 34.4%, and 12.6%, respectively. Over a median follow-up of 70 months, 617 deaths occurred, of which 261 were attributed to cancer. Compared to those meeting no guideline, HRs (95% CIs) for those meeting one, two, and all three guidelines were 0.72 (0.55-0.95), 0.59 (0.43-0.81), and 0.55 (0.38-0.81), respectively, for all-cause mortality, and 0.47 (0.29-0.76), 0.53 (0.33-0.85), and 0.22 (0.10-0.49), respectively, for cancer-specific mortality. Subgroup analysis showed that the association between cumulative adherence to the guidelines and all-cause mortality was stronger among individuals with a body mass index ≥ 30 kg/m².

CONCLUSIONS: Greater integrated adherence to the 24-h movement guidelines was associated with a progressive reduction in mortality risk among US cancer survivors, especially those with obesity.

PMID:42142261 | DOI:10.1007/s00520-026-10753-4

BJS Open. 2026 May 12;10(3):zrag022. doi: 10.1093/bjsopen/zrag022.

ABSTRACT

BACKGROUND: Long-term bowel dysfunction can impact a significant proportion of patients following anterior resection. The aim of this study was to assess the efficacy of transanal irrigation (TAI) to treat low anterior resection syndrome.

METHODS: Adults (≥ 18 years) with major low anterior resection syndrome (score > 30) at least 12 months after low anterior resection were enrolled at four European centres. Eligible patients were randomized 1 : 1 using block randomization to the TAI group or best supportive care group. The primary endpoint was the feasibility of TAI measured by treatment adherence or switch of therapy. Secondary endpoints included bowel function, quality of life and study-specific patient satisfaction questions. Outcome evaluators and the statistical team were blinded to allocation, whereas participants and caregivers were unblinded.

RESULTS: Forty-one patients were randomized, of which 40 (19 TAI; 21 best supportive care) completed follow-up; 1 patient in the TAI group was excluded due to fistula surgery. At 12 months, low anterior resection syndrome (median 3 (range 0-39) versus 36 (2-42); P < 0.001) and Wexner scores (median 0 (0-15) versus 13 (4-20); P < 0.001) were significantly lower in the TAI group compared with the control group. The Measure Yourself Medical Outcome Profile score was lower in the TAI group after 3 months (median 2 (0-11) versus 11 (7-12); P < 0.001). In addition, patients in the TAI group achieved higher Memorial Sloan Kettering Cancer Center Bowel Function Instrument scores after 12 months (median 89 (37-90) versus 39 (28-61); P < 0.001). Adherence was high, with 15 (75%) maintaining daily irrigation, and patient satisfaction measures favoured TAI. Two mild procedure-related adverse events (tenesmus, dizziness) were reported.

CONCLUSIONS: This randomized clinical feasibility study confirms that TAI is feasible and has high acceptability for patients. It leads to better functional outcomes and improvements in quality of life compared with the best supportive care for patients with low anterior resection syndrome.

REGISTRATION NUMBER: NCT05920681 (http://www.clinicaltrials.gov).

PMID:42141911 | DOI:10.1093/bjsopen/zrag022

Eur J Cardiovasc Nurs. 2026 May 16:zvag130. doi: 10.1093/eurjcn/zvag130. Online ahead of print.

ABSTRACT

Missing data are common in cardiovascular nursing and allied health research, especially in longitudinal studies. Common problems associated with missing data are reduced sample size, reduced statistical power and precision, and potentially biased results. There are several design strategies that can help minimize missing data including minimizing unnecessary items and incorporating reminders. It is important to understand common types of missingness, including item nonresponse, item-level missingness, wave nonresponse, and structural missingness, and to understand common mechanisms of missingness, including missing completely at random, missing at random, and missing not at random. This methods paper provides worked examples to illustrate several of these design and methodological considerations.

PMID:42141903 | DOI:10.1093/eurjcn/zvag130

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2500672.

ABSTRACT

BACKGROUNDVaccinations against COVID-19 were integrated into routine care in Germany in April 2023. However, evidence of the impact of seasonal vaccination remains limited.AIMTo assess the clinical and economic impact of COVID-19 vaccination in routine care during the early SARS-CoV-2-endemic phase in Germany.METHODSA retrospective cohort study using statutory health insurance data from two German federal states (Saxony and Thuringia), covering over 3 million individuals, was conducted. Adults aged ≥ 18 years vaccinated against COVID-19 between 1 September and 30 November 2023 were matched 1:1 with unvaccinated individuals using propensity scores. Outcomes during the 4-month follow-up included occurrence of SARS-CoV-2 infection, long COVID, other respiratory infections, hospitalisations, mortality, healthcare costs and indirect costs caused by sick leave. Rate and hazard ratios (RR, HR) with 95% confidence intervals (CI) were calculated. Sensitivity analyses tested robustness.RESULTSA total of 146,132 individuals (73,066 per group) were matched. COVID-19 vaccination was associated with reduced rates of long COVID (RR: 0.43; 95% CI: 0.26-0.70), respiratory infections (RR: 0.91; 95% CI: 0.87-0.95) and COVID-19-related hospitalisations (RR: 0.41; 95% CI: 0.31-0.54). All-cause mortality was 25% lower among COVID-19-vaccinated individuals (HR: 0.76; 95% CI: 0.70-0.82). Healthcare costs were lower in the vaccinated cohort, particularly for inpatient care, e.g. EUR 1 million savings in COVID-19-related hospitalisations. Indirect costs caused by sick leave were also reduced by EUR 1.3 million.CONCLUSIONSeasonal COVID-19 vaccinations in routine care settings were associated with substantial clinical and economic benefits. These real-world findings support continued implementation of national immunisation recommendations during the endemic phase of SARS-CoV-2 circulation.

PMID:42141891 | DOI:10.2807/1560-7917.ES.2026.31.15.2500672

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2500919.

ABSTRACT

BACKGROUNDA surge in pertussis occurred in the Netherlands in 2023-24. Infant vaccination uptake decreased from 95% in 2011 to ca 86% in 2024. Maternal vaccination was introduced in 2019, with uptake ca 70%.AIMTo describe pertussis epidemiological trends in the Netherlands.METHODSWe conducted a retrospective study using pertussis notification data from 2012 to 2024 and estimated infant and maternal vaccine effectiveness (VE) with the screening method.RESULTSDuring the COVID-19 pandemic, pertussis notifications dropped from ca 6,000 in 2013-19 to 79 in 2021 (incidence ca 35 to < 0.01/100,000 population). Notifications surged from May 2023, peaking in March 2024, resulting in 18,208 notifications in 2024 (102/100,000). Notifications and hospitalisations in 2024 were highest among infants aged 0-5 months (573 and 304/100,000) followed by infants aged 6-11 months (446 and 92/100,000). Annually, 0-2 deaths were reported; in 2023-24, 10 deaths were reported (6 infants, 4 ≥ 60-year-olds). In 2024, 83% of mothers of notified infants aged 0-2 months were unvaccinated. In 2020-24, maternal VE against pertussis in infants aged 0-2 months was 91%. In 2012-24 primary series VE was 98% at age 1, 92% at age 3, 92% post-booster at age 5, and 71% at age 9 years.CONCLUSIONLow population immunity after 2 years of reduced circulation likely contributed to the highest pertussis incidence ever recorded in the Netherlands, posing a particular threat to unprotected infants. Maternal and infant VE are high, underscoring the public health priority of enhancing vaccination uptake.

PMID:42141889 | DOI:10.2807/1560-7917.ES.2026.31.15.2500919

Euro Surveill. 2026 Apr;31(15). doi: 10.2807/1560-7917.ES.2026.31.15.2600288.

ABSTRACT

An unusually large outbreak of invasive meningococcal disease affecting young adults occurred in South East England between 13 and 18 March 2026, with 21 confirmed cases including two fatalities. Thirteen cases were university students and 19 had attended the same nightclub over a 3-day period. The outbreak strain was a distinct genome within the previously seen type B: P1.12-1,16-183: F1-5: ST-485 (cc41/44). Over 13,000 chemoprophylaxis doses and 11,000 meningococcal B vaccinations were provided to possible contacts.

PMID:42141888 | DOI:10.2807/1560-7917.ES.2026.31.15.2600288