Tag: pubmed

JAMA Netw Open. 2026 Jun 1;9(6):e2616370. doi: 10.1001/jamanetworkopen.2026.16370.

ABSTRACT

IMPORTANCE: Due to legal restrictions, many patients pay out of pocket for later abortion care in the US. Knowledge of facility availability, self-pay prices, and state Medicaid acceptance may enable timely access to care.

OBJECTIVE: To estimate quoted self-pay prices and assess state Medicaid acceptance for later abortion care from 23 to 33 weeks of pregnancy duration.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a mystery caller design from November 2024 through April 2025. Contacted US health care facilities (clinics and hospitals) advertised offering abortion care at or after 23 weeks in August 2024.

EXPOSURE: Mystery calls at 2-week pregnancy duration periods advertised for providing care (23, 25, 27, 29, 31, and 33 weeks) to request self-pay prices. Facilities in states permitting Medicaid coverage received additional calls regarding acceptance.

MAIN OUTCOMES AND MEASURES: Facility availability by pregnancy duration, quoted self-pay prices, and reported state Medicaid acceptance.

RESULTS: A total of 130 facilities in 20 states and the District of Columbia advertised providing abortion care at or after 23 weeks of pregnancy (52 clinics, 78 hospitals). The overall response rate for obtaining at least 1 usable quoted self-pay price or range was 60.2% (112 of 186 facilities). Median self-pay prices increased from $3000 at 23 weeks to $17 250 at 33 weeks, with a statistically significant increase of $2541 from 23 to 25 weeks. The number of facilities providing care declined from 130 at 23 weeks to 31 at 25 weeks and 3 at 33 weeks. Among facilities in states with Medicaid coverage, 73 of 105 (69.5%) consistently reported accepting Medicaid; acceptance declined at later pregnancy durations and varied by state.

CONCLUSIONS AND RELEVANCE: In this cross-sectional mystery call study of 130 facilities advertising later abortion care in August 2024, self-pay prices increased with pregnancy duration, while service availability and Medicaid acceptance declined. Improving self-pay price transparency and expanding the availability of later abortion care, especially in states with Medicaid coverage, may facilitate more timely access to care.

PMID:42228367 | DOI:10.1001/jamanetworkopen.2026.16370

JAMA Netw Open. 2026 Jun 1;9(6):e2616375. doi: 10.1001/jamanetworkopen.2026.16375.

ABSTRACT

IMPORTANCE: Statin use has been associated with improved survival in patients with breast cancer, but there are no data on the association between statin use and survival in different intrinsic breast cancer subtypes.

OBJECTIVE: To assess the associations between statin use and survival in patients with early breast cancer of different intrinsic subtypes.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort study of female patients with invasive breast cancer diagnosed in Finland between 1995 and 2013. The cohort was limited to early breast cancer cases with sufficient data for surrogate intrinsic subtyping. All data originated from Finnish national registries. Statistical analyses were performed from September to November 2023.

EXPOSURE: Statin use, statin dose, and blood cholesterol levels before and after diagnosis.

MAIN OUTCOMES AND MEASURES: All-cause and breast cancer-specific mortality during follow-up.

RESULTS: A total of 7389 female patients with early breast cancer were included (median [range] age at diagnosis, 60 [21-102] years). Prediagnostic statin use was not associated with breast cancer-specific or all-cause mortality. Postdiagnostic statin use was associated with lower age-adjusted breast cancer-specific (hazard ratio [HR], 0.68; 95% CI, 0.57-0.82) and all-cause (HR, 0.83; 95% CI, 0.75-0.92) mortality. In a multivariable-adjusted model, statin use was associated with higher breast cancer-specific survival in all hormone receptor-positive subtypes (luminal A-like, luminal B-like [HER2-negative], and luminal B-like [HER2-positive]). All-cause mortality was lower among statin users in patients with hormone positive and triple-negative subtypes. One-year lag-time analysis or adjustment for blood-cholesterol levels after breast cancer diagnosis did not affect the results substantially. While the benefit of statin use was noticed in all statin users regardless of dose intensity, a trend of dose-dependent risk reduction was observed regarding breast cancer-specific mortality.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with early breast cancer, prediagnostic statin use was not associated with higher survival; however, postdiagnostic statin use was associated with lower all-cause and breast cancer-specific mortality among patients with hormone receptor-positive intrinsic subtypes. These findings suggest that statin therapy may improve survival of patients with early hormone receptor-positive subtypes.

PMID:42228366 | DOI:10.1001/jamanetworkopen.2026.16375

Jpn J Radiol. 2026 Jun 2. doi: 10.1007/s11604-026-02020-7. Online ahead of print.

ABSTRACT

PURPOSE: Boron neutron capture therapy (BNCT) dose planning conventionally uses a tumor-to-blood (T/B) ratio derived from the tumor maximum standardized uptake value (SUVmax) of fluorine-18-labeled 4-borono-L-phenylalanine (¹⁸F-BPA) positron emission tomography (PET) (individual model). It remains unclear whether tumor SUVmax or individual model doses predict outcomes in accelerator-based BNCT for head and neck cancer (HNC). We investigated the correlation of ¹⁸F-BPA PET SUVmax and individual model doses with treatment response.

MATERIALS AND METHODS: We retrospectively analyzed 30 patients with HNC treated with accelerator-based BNCT (2020-2021). The Kaplan-Meier method was used for survival analysis. Dose parameters (Dmax, Dmin, and D80%) were calculated using the uniform model (T/B = 2.5) and the individual model (T/B = Tumor SUVmax/Blood-pool SUV). Correlations between tumor SUVmax or dose parameters and best treatment response [complete response (CR) vs. non-CR] were evaluated using the Mann-Whitney U test.

RESULTS: The objective response rate was 90%, and the CR rate was 50%. CR status strongly predicted superior 2 years overall survival, locoregional control, and progression-free survival (all p < 0.05). However, no significant differences were observed between the CR and non-CR groups for tumor SUVmax, uniform model doses, or individual model doses (all p > 0.05).

CONCLUSION: ¹⁸F-BPA PET SUVmax and the conventional individual model did not demonstrate a statistically significant association with CR in patients with HNC after accelerator-based BNCT. These findings question the utility of tumor SUVmax-based dosimetry, suggesting that current models require refinement.

PMID:42228342 | DOI:10.1007/s11604-026-02020-7

Clin Pharmacokinet. 2026 Jun 1. doi: 10.1007/s40262-026-01654-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Cagrilintide is a long-acting amylin agonist under development as monotherapy for weight management and as a fixed-dose combination with the glucagon-like peptide-1 receptor agonist semaglutide (CagriSema) for weight management and treatment of type 2 diabetes. Two studies were conducted to assess the effects of renal or hepatic impairment on pharmacokinetics, safety and tolerability following single doses of cagrilintide.

METHODS: In both studies, adult participants were categorised into four groups on the basis of renal or hepatic function (normal function and mild, moderate or severe impairment) and received a single dose of cagrilintide 0.6 or 0.9 mg, respectively. The primary endpoint was area under the cagrilintide plasma concentration curve from time zero extrapolated to infinity (AUC_0-∞) from baseline (day 1) to day 36 (renal impairment study) or day 39 (hepatic impairment study). Other pharmacokinetic parameters included maximum observed cagrilintide plasma concentration (C_max), time to C_max (t_max) and safety.

RESULTS: The renal impairment study included 33 participants (normal function, n = 14; mild impairment, n = 7; moderate impairment, n = 7; severe impairment, n = 5) and the hepatic impairment study included 32 participants (normal function, n = 14; mild impairment, n = 7; moderate impairment, n = 7; severe impairment, n = 4). In both studies, total cagrilintide exposure (AUC_0-∞), C_max and other pharmacokinetic parameters were similar across groups with no consistent patterns observed with renal or hepatic impairment. Compared with normal renal function, the estimated ratio of the mean AUC_0-∞ was 1.23 (90% confidence interval [CI], 0.91-1.66) in mild impairment, 1.18 (0.87-1.59) in moderate impairment and 1.21 (0.87-1.68) in severe impairment. Compared with normal hepatic function, the estimated ratio of the mean AUC_0-∞ was 0.99 (0.89-1.11) in mild impairment, 1.01 (0.91-1.12) in moderate impairment and 1.11 (0.96-1.30) in severe impairment. Overall, 21 and 16 treatment-emergent adverse events (TEAEs) were reported in 11 and 9 participants in the renal and hepatic studies, respectively. In both studies, no serious TEAEs, TEAEs leading to study withdrawal or deaths were reported. No increase in number of adverse events with increasing renal or hepatic impairment was observed, and no new safety or tolerability findings with cagrilintide were identified with renal or hepatic impairment.

CONCLUSIONS: In these studies, within the limitations of small sample sizes, no clinically relevant differences in cagrilintide pharmacokinetics were observed in participants with renal or hepatic impairment compared with those with normal function, suggesting that dose adjustment is not warranted for these populations. Cagrilintide was well-tolerated and there were no unexpected safety issues.

TRIAL REGISTRATION: Studies are registered at ClinicalTrials.gov (NCT04209049 registered 23 December 2019 and NCT05564104 registered 3 October 2022).

PMID:42228334 | DOI:10.1007/s40262-026-01654-0

Ophthalmic Physiol Opt. 2026 Jun 2. doi: 10.1007/s44402-026-00110-7. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effects of scleral contact lens wear on central corneal thickness, corneal or stromal swelling and intraocular pressure, and to identify factors that may influence these outcomes.

METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the AMSTAR-2 quality assessment tool (registration number PROSPERO CRD420251141392). The PubMed, Web of Science and Scopus databases were searched without language or date restrictions. Eligible studies included prospective, observational, controlled or crossover designs assessing physiological changes during or after scleral contact lens wear. Mean differences with 95% confidence intervals (CIs) were pooled using random- or fixed-effects models. Heterogeneity was quantified using the I-squared statistic, and meta-regressions examined the influence of lens and patient-level factors.

RESULTS: Twenty-two studies, including 830 eyes, were analysed. Scleral contact lens wear produced a small but statistically significant increase in central corneal thickness while the lens was in place (mean difference: 7.93 µm; 95% CI: 4.92-10.95; p < 0.001; I² = 0%) and no significant change after lens removal (mean difference: 1.49 µm; p = 0.34). Corneal or stromal swelling showed a small increase of 0.88% (p < 0.001; I² = 83%), consistent with the small magnitude and variability of these changes across studies. Intraocular pressure after lens removal showed no significant variation (mean difference: 0.38 mmHg; p = 0.27; I² = 78%).

CONCLUSIONS: Scleral contact lens wear induces minimal and largely reversible changes in corneal thickness and intraocular pressure. Daytime wear of modern high-oxygen-permeable lenses appears to be physiologically safe, although selective monitoring remains advisable in high-risk patients.

PMID:42228331 | DOI:10.1007/s44402-026-00110-7

Clin Child Fam Psychol Rev. 2026 Jun 2. doi: 10.1007/s10567-026-00573-7. Online ahead of print.

ABSTRACT

The arrival of a baby and the early years of a child’s life represent a critical period for parents, often marked by increased parental stress that can impact both their well-being and the child’s development. Although parental stress has been widely studied, no systematic review has yet focused specifically on early childhood. To address this gap, we conducted a systematic review synthesizing evidence on factors examined as antecedents of parental stress during the first three years postpartum. Following PRISMA guidelines, we included 108 quantitative studies published in the past 12 years that investigated variables statistically modeled as predictors of parental stress. Key determinants of parental stress were identified at three levels: (1) at the personal level, internalizing symptoms, adverse childhood experiences, and perinatal negative experiences were related to higher stress; (2) at the relational level, marital satisfaction and coparenting quality were associated with lower stress; and (3) at the contextual level, social support from friends and family served as a protective factor of parental stress, while children’s developmental problems served as risk factors. Despite the increasing number of longitudinal studies and the growing inclusion of fathers in research, few studies have focused on participants from social minority groups or from non-Western contexts. These findings may contribute to the development of effective strategies to support families during the early years of parenthood.

PMID:42228327 | DOI:10.1007/s10567-026-00573-7

J Cancer Educ. 2026 Jun 2. doi: 10.1007/s13187-026-02918-w. Online ahead of print.

ABSTRACT

Breast Cancer necessitates effective patient education. Large language models (LLMs) facilitate patient health consultation, yet their generated medical content may contain misleading and unsafe information. Systematic evaluations of mainstream LLMs for breast cancer health guidance are currently lacking. This study evaluated six LLMs’ (ChatGPT-5.4-thinking, Claude-4.6-sonnet, Gemini-3.1-Pro, DeepSeek-V3.2, Doubao-2.2-thinking, and ERNIE 4.5 Turbo) performance in breast cancer consultation via a structured checklist. A set of 61 standardized questions regarding breast cancer was developed based on Google Trends, clinical guidelines, practical experiences, and expert reviews. Responses from each LLM were independently evaluated by three breast cancer experts focusing on quality, accuracy, comprehensiveness, and safety. Besides, four patients independently evaluated the satisfaction and understandability of their selected three questions of interest. This study utilized Bernard’s Global Quality Score (GQS) tool to assess quality. Readability was assessed using the Chinese Resource Platform (CRP). Other indicators were evaluated using self-designed questionnaires. Statistical analyses were performed using RStudio. In expert evaluations, ERNIE 4.5 Turbo had the highest descriptive quality score and was among the top-performing models in safety (Bonferroni-adjusted P < 0.05), while several models performed comparably in comprehensiveness. There was no significant difference in accuracy among the models. ChatGPT-5.4-thinking scored significantly lower in safety, and Doubao-2.2-thinking had significantly lower reading difficulty, required age, and Chinese character count (adjusted P < 0.05). In patient evaluations, ERNIE 4.5 Turbo showed the highest descriptive satisfaction and understandability ratings. Six large language models performed strongly in breast cancer question-answering, with ERNIE 4.5 Turbo ranking highest. However, issues like poor readability and unsafe recommendations remain in answers. Future research should prioritize enhancing patient readability to facilitate AI’s application in precision cancer health education.

PMID:42228312 | DOI:10.1007/s13187-026-02918-w

Ann Biomed Eng. 2026 Jun 2. doi: 10.1007/s10439-026-04187-6. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic regurgitation (AR) alters normal blood flow patterns in the left ventricle (LV), affecting diastolic filling dynamics, and is commonly quantified by the regurgitant fraction (RF). However, conventional diagnostic methods have notable limitations, prompting growing interest in four-dimensional flow magnetic resonance imaging (4D-flow MRI) as a tool for quantitatively assessing AR severity. In parallel, viscous energy dissipation (VED), which captures the energy loss caused by viscous forces within blood flow, provides additional important insight into the hemodynamic burden imposed on the LV by valvular dysfunction.

OBJECTIVE: This study aims to investigate the potential correlation between RF and VED in patients with AR, hypothesizing that higher RF values are associated with increased VED, thereby reflecting greater hemodynamic compromise.

METHODS: This pilot study included 10 patients with diagnosed AR and 9 healthy controls, all of whom underwent standardized cardiac MRI, including 4D-flow MRI. Volumetric blood flow and VED were assessed using validated post-processing techniques. Statistical analyses were conducted to evaluate group differences and explore the correlation between RF and VED.

RESULTS: In healthy controls, LV flow exhibited a typical pattern during diastole and systole, forming a vortex during filling. Severe AR patients displayed disrupted LV flow, with regurgitant jets altering the flow dynamics. Quantitatively, integrated kinetic energy (iKE), vorticity (iVRT), and VED (iVED) were significantly elevated in AR patients compared to controls: iKE (0.003 ± 0.002 J vs. 0.001 ± 0.0004 J, p = 0.019), iVRT (0.304 ± 0.0738 s^-1 vs 0.251 ± 0.0466 s^-1, p = 0.077), and iVED (0.434 ± 0.307 mW vs. 0.166 ± 0.055 mW, p = 0.020). An increase was observed in patients with severe AR compared to controls, iKE rose to (0.005 J vs. 0.001 J), iVRT (0.335 s^-1 vs. 0.233 s^-1), and iVED (0.792 mW vs. 0.174 mW). All three parameters positively correlated with RF: iVRT (R² = 0.175, p = 0.1263; Spearman R = 0.486), iVED (R² = 0.628, p = 0.0038; Spearman R = 0.597), and iKE (R² = 0.601, p = 0.0051; Spearman R = 0.616), indicating that increasing regurgitation severity is associated with greater intraventricular energy and flow disruption.

CONCLUSION: This study quantifies the impact of AR on LV flow dynamics and demonstrates elevated VED in patients with AR. The observed correlation underscores the potential of VED as a complementary metric to RF in evaluating the hemodynamic impact of valvular regurgitation. Further studies with larger cohorts are needed to validate these findings and explore their clinical implications.

PMID:42228301 | DOI:10.1007/s10439-026-04187-6

Health Econ Rev. 2026 Jun 2. doi: 10.1186/s13561-026-00801-4. Online ahead of print.

ABSTRACT

Spain leads the world in organ donation, and the 40th anniversary of its first liver transplant was recently commemorated. Our aim was to evaluate the evolution of the Liver Transplantation (LT) program in Spain over its four decades (1984-2024), examining clinical outcomes and societal economic benefits within a mature transplantation framework. Standardized national data from the Organización Nacional de Trasplantes and the Sociedad Española de Trasplante Hepático were used to reconstruct recipient cohorts by age group. Patient survival was estimated using Kaplan-Meier analysis. An economic evaluation from a societal perspective integrated surgical costs, long-term immunosuppressive therapy, and productivity gains associated with recipients’ participation in the labour market. LT activity increased steadily during the initial expansion of the program and has stabilised at approximately 1,200 procedures per year over the past two decades. Both donor and recipient populations have aged; there are currently more patients over 60 years of age than two decades ago. Survival improved throughout the study period, extending life expectancy despite variations related to underlying disease. From an economic perspective, annual surgical costs remained below €60 million, increasing to €70-90 million when long-term immunosuppressive therapy was included. The economic contribution of surviving recipients to the labour market increased steadily, exceeding €75 million in 2024 and resulting in a positive balance since the early 2010s. Adult recipients generated net economic benefits, whereas paediatric recipients showed delayed but progressively increasing contributions as they entered the workforce. LT in Spain has produced sustained improvements in expected survival while generating substantial societal value, demonstrating that LT is both an effective clinical intervention and a valuable public health investment. The Spanish liver transplantation system may serve as a benchmark for evaluating the sustainability and societal impact of liver transplant programs in other healthcare systems.

PMID:42228276 | DOI:10.1186/s13561-026-00801-4

Mol Cell Biochem. 2026 Jun 2. doi: 10.1007/s11010-026-05588-w. Online ahead of print.

ABSTRACT

Spatial organisation of immune cells reflects a balance between tissue anchoring and migratory compatibility, yet how this balance is structured within inflammatory skin disease remains poorly understood. Spatial transcriptomic analyses defined transit-retention immune organisation across lesional and non-lesional skin in atopic dermatitis (AD) and psoriasis (PsO). A unified transit-retention axis captured contextual immune organisation within leukocyte-rich tissue microenvironments. Non-lesional skin in both diseases exhibited retention-dominant organisation. In contrast, psoriatic lesions showed disruption of retention dominance, accompanied by coordinated alignment of antigen presentation, T cell activation, Th17, and B cell programmes with transit-compatible organisation, a pattern not observed in AD. An independent spatial transcriptomic dataset of psoriatic skin enabled assessment of compartmental specificity and clinical relevance. These analyses identified the epidermis as the primary site of transit-skewed reorganisation, with epidermal transit alignment scaling with disease severity. Extension of the same transcriptional framework to circulating adaptive immune cells using CITE-seq revealed lineage-specific transit-associated features in psoriatic disease. Circulating CD4 T cells and B cells showed stronger transcriptional and protein-level alignment with transit-associated states in PsO and psoriatic arthritis. Together, these analyses reveal transit-skewed adaptive immune organisation as a unifying feature of psoriatic disease.

PMID:42228270 | DOI:10.1007/s11010-026-05588-w