Tag: pubmed

Surg Endosc. 2026 Aug 3. doi: 10.1007/s00464-026-13194-6. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is technically demanding. We developed a quantitative indocyanine green fluorescence imaging protocol (q-ICG) to assist LDPPHR and evaluated its clinical utility.

METHODS: We retrospectively analyzed 72 patients who underwent LDPPHR between 2019 and 2025. Patients were divided into a q-ICG group (n = 35) and a non-q-ICG group (n = 37). Baseline characteristics and perioperative outcomes were compared between groups.

RESULTS: Baseline characteristics were generally comparable between groups. All procedures were attempted laparoscopically, one required conversion to open surgery, and no 90-day mortality occurred. No Grade C postoperative pancreatic fistula (POPF) occurred. Compared with the non-q-ICG group, the q-ICG group had shorter operative time (P = 0.025), postoperative hospital stays (P < 0.001), and less intraoperative blood loss (P < 0.001). Bile leakage (2.9 vs. 27.0%; P = 0.007) and Grade B POPF rate (2.9 vs. 24.3%; P = 0.014) were also lower in the q-ICG group. The overall POPF rate was numerically lower in the q-ICG group, but this difference did not reach statistical significance (25.7 vs. 45.9%; P = 0.090).

CONCLUSION: q-ICG-assisted LDPPHR was feasible and was associated with improved perioperative efficiency and selected postoperative outcomes. Given the limited sample size and non-randomized design, prospective studies with standardized protocols are warranted to validate these findings.

PMID:42547636 | DOI:10.1007/s00464-026-13194-6

Eur Spine J. 2026 Aug 4. doi: 10.1007/s00586-026-10218-6. Online ahead of print.

ABSTRACT

PURPOSE: Prolonged smartphone use is frequently associated with poor neck posture and the development of Text Neck Syndrome (TNS). This study aimed to compare manual dexterity between university students with and without TNS and to investigate its relationship with neck disability and smartphone use. We hypothesized that university students with TNS would demonstrate significantly lower manual dexterity compared to those without TNS.

METHODS: This cross-sectional study included 280 university students from a public university. Manual dexterity was assessed using the Purdue Pegboard Test (PPT), while neck disability, smartphone addiction, and pain intensity were evaluated using the Neck Disability Index, Smartphone Addiction Scale-Short Version (SAS-SV), and Visual Analogue Scale (VAS), respectively. Group comparisons, correlation analyses, and multivariate regression were performed to examine the relationships between TNS and manual dexterity.

RESULTS: Participants with TNS demonstrated significantly higher neck disability scores compared to those without TNS (p<0.001). Significant impairments were observed only in non-dominant hand dexterity (p=0.025), whereas no significant differences were found in other dexterity parameters (p>0.05). Smartphone usage duration showed statistically significant weak negative correlations with manual dexterity parameters (p<0.05). After adjusting for age, sex, and smartphone usage duration, TNS was independently associated with reduced non-dominant hand dexterity (β=-0.138, p=0.020).

CONCLUSION: TNS is independently associated with non-dominant hand dexterity, particularly in non-dominant hand performance. Although the effect size was small (Cohen’s d = 0.274), these findings provide preliminary evidence of an association between TNS and reduced non-dominant hand dexterity.

PMID:42547610 | DOI:10.1007/s00586-026-10218-6

Diabetologia. 2026 Aug 3. doi: 10.1007/s00125-026-06821-3. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: Diabetic nephropathy is a leading cause of end-stage renal disease, with podocyte loss being a critical event in its progression. However, the dominant molecular mechanism driving podocyte loss remains elusive, hindering targeted therapy. We aimed to identify the key pathways of podocyte failure in human diabetic nephropathy and investigate metformin’s therapeutic potential.

METHODS: We employed an integrative multi-omics approach, including single-nucleus RNA-seq (snRNA-seq) of 156,043 human kidney nuclei from individuals with diabetic nephropathy and healthy control individuals, db/db mouse models of diabetic nephropathy, spatial metabolomics, in vitro podocyte cultures, and targeted urinary metabolomics in individuals with diabetic nephropathy and healthy control individuals.

RESULTS: snRNA-seq identified ferroptosis and fatty acid metabolic dysregulation as the most enriched pathways within podocytes, mechanistically linked to the MAPK14-solute carrier family 7 member 11 (SLC7A11)-glutathione peroxidase 4 (GPX4) axis. In murine diabetic nephropathy models and in vitro, metformin directly inhibited this MAPK14-SLC7A11-GPX4 axis, suppressed podocyte ferroptosis (including restoration of GPX4 and SLC7A11 expression and reduction of p-p38 and lipid peroxidation) and restored compartment-specific renal lipid accumulation as shown by spatial metabolomics. Clinically, we identified and validated a urinary fatty acid signature, with palmitoylcarnitine as a key biomarker (AUC 0.974, calculated from receiver operating characteristic curves), correlating with disease indices including blood glucose, eGFR, serum creatinine and blood urea nitrogen.

CONCLUSIONS/INTERPRETATION: Our study reveals podocyte ferroptosis to be a central pathogenic event in human diabetic nephropathy, repositioning metformin as a direct ferroptosis inhibitor that preserves podocyte integrity via the MAPK14-SLC7A11-GPX4 axis. Furthermore, we provide a high-performance urinary biomarker, offering a direct translational link toward targeted anti-ferroptosis therapies and non-invasive diagnostics for diabetic nephropathy.

PMID:42547585 | DOI:10.1007/s00125-026-06821-3

BJC Rep. 2026 Aug 3;4(1):39. doi: 10.1038/s44276-026-00237-7.

ABSTRACT

BACKGROUND: Recurrent/Metastatic (R/M) ACC is aggressive with few effective treatment options. The role of surgery after chemotherapy remains unclear. Moreover, prognostic factors in R/M ACC are not well defined.

METHODS: R/M ACC patients treated at Princess Margaret Cancer Centre (2002-2019) were retrospectively reviewed. Descriptive statistics were used to summarize clinical characteristics. OS was estimated by Kaplan-Meier method. Cox regression analysis was used to compute prognostic variables.

RESULTS: Among 83 patients with metastatic ACC [36.2% de novo and 63.8% recurrent], 49 (59.0%) received systemic therapy (ST) with which 15 (30.6%) had a partial response (PR) and 8 (16.3%) had stable disease (SD). 9 (18.4%) had surgery after ST (combined therapy group); 6 (66.6%) were rendered disease free with surgery. The median OS was 26 months (20.4-40.5) for entire cohort (f/up 18 months). OS for patients having combined therapy was 31.2 months (21.4-63.3) vs 24.7 months (17.7-35.2), p = 0.48 for patients receiving systemic therapy alone. Being disease free after surgery was associated with better OS [39.6 (24.8-not reached), vs 23.5 months (21.4-not reached), p = 0.02].

CONCLUSIONS: Selected patients with R/M ACC may achieve long term survival with surgery after chemotherapy. These data highlight the potential role for multimodal therapy in managing such patients.

PMID:42547523 | DOI:10.1038/s44276-026-00237-7

Drug Alcohol Depend. 2026 Jul 26;286:113282. doi: 10.1016/j.drugalcdep.2026.113282. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined the change in alcohol crash fatalities among 21-24y/o drivers in Utah in comparison to its contiguous states before (2016) and after (2019) Utah enacted its.05g/dL blood alcohol concentration (BAC) per se law in 2018.

METHODS: Data from the Fatality Analysis Reporting System (FARS) were used. A difference-in-differences (DID) analysis was conducted to compare pre-law (2016) with post-law (2019) crash fatalities across four BAC levels (≥.01, ≥.05, ≥.08, and ≥.15g/dL) between Utah and contiguous states for 21-24y/o drivers involved in alcohol-impaired driving fatal crashes. We also present 11-year trends (2013-23) in alcohol-related crash fatalities per 100 million vehicle miles traveled (VMT) for 21-24y/o drivers.

RESULTS: Of the 820 21-24y/o drivers involved in fatal crashes in Utah and six contiguous states, 371 (45.2%) were alcohol involved. Across 2013-2023, Utah consistently showed lower alcohol-related crash fatality per 100 million VMT across BAC thresholds compared to contiguous states. Following implementation of the.05 BAC law, Utah experienced notable post-policy declines over the 2016-2019 period, particularly among highly impaired drivers. DID models showed statistically significant reductions in crash fatalities for drivers with BAC ≥ .15 in Utah compared to contiguous states (p < .001), while effects at lower BAC levels were directionally protective but not statistically significant.

CONCLUSIONS: Utah’s.05 BAC law was associated with a significant reduction in the most severe alcohol-impaired crashes among young adult drivers, supporting lower BAC limits as an effective population-level injury prevention strategy for this known vulnerable population.

PMID:42546367 | DOI:10.1016/j.drugalcdep.2026.113282

Acta Psychol (Amst). 2026 Aug 3;269:107570. doi: 10.1016/j.actpsy.2026.107570. Online ahead of print.

ABSTRACT

OBJECTIVE: The study aimed to investigate the relationship between university students’ passive use of short-video media and their intuitive eating behaviors.

METHODS: A cross-sectional survey included 1084 university students in Wuhan, Hubei Province, China. Data were collected using general demographic data, the Surveillance Use Scale (SUS), the Intuitive Eating Scale-2 (IES-2), the Consideration of Future Consequence-food (CFC), and the Social Appearance Anxiety Scale (SAAS). A theory-informed serial mediation model and an exploratory eight-node psychological network were estimated.

RESULTS: Higher SUS scores were associated with lower IES-2 scores (total effect = -0.335, 95% CI: -0.489, -0.180). Indirect associations through CFC and SAAS were statistically detectable, but the serial pathway was small. Body-food choice congruence and reliance on hunger and satiety cues had the highest expected influence, whereas future-oriented dietary consequences had the highest bridge expected influence.

CONCLUSION: Higher SUS scores were associated with lower intuitive eating, and the network analysis further highlighted future-oriented dietary cognition and intuitive-eating dimensions. Based on these relevant factors, it is necessary to enhance the attention of society, schools, and families to university students’ dietary health and take effective measures to promote their healthy development.

PMID:42546361 | DOI:10.1016/j.actpsy.2026.107570

Schizophr Res. 2026 Aug 3;297:76-88. doi: 10.1016/j.schres.2026.07.026. Online ahead of print.

ABSTRACT

BACKGROUND: Concerns about haematological toxicity and absolute neutrophil count (ANC) monitoring may limit clozapine use, particularly in multi-ethnic populations where benign ethnic neutropenia (BEN) and lower baseline ANC are common. We characterised baseline ANC distribution, nationality-derived BEN-risk, post-initiation ANC outcomes, and haematological monitoring patterns in a multi-ethnic United Arab Emirates clozapine cohort.

METHODS: We conducted a retrospective cohort study at a tertiary psychiatric hospital in the United Arab Emirates. Adults with documented clozapine administration and at least one post-initiation ANC between 1 January 2018 and 31 July 2024 were included. Nationality-derived BEN-risk, baseline ANC, post-initiation ANC outcomes within a five-band hierarchy, monitoring intensity, and pre-specified sensitivity and exploratory analyses were examined.

RESULTS: Among 239 patients, 179 formed the final study cohort, contributing 284.7 on-clozapine person-years. Overall, 158 patients (88.3%) had no post-initiation ANC <2.0 × 10⁹/L, 16 (8.9%) entered the 1.5-2.0 × 10⁹/L low-ANC monitoring range, 2 (1.1%) reached conventional-threshold neutropenia, 3 (1.7%) reached severe neutropenia, and none reached agranulocytosis range. Five patients (2.8%) met the clinically meaningful ANC <1.5 × 10⁹/L threshold; all were BEN-risk, all had concomitant valproate exposure, and four had concomitant lithium exposure. Baseline ANC was lower in BEN-risk patients and statistically accounted for much of the BEN-risk-to-outcome association in an exploratory analysis.

CONCLUSIONS: Low ANC during clozapine treatment was uncommon and strongly shaped by baseline ANC and BEN-risk context. Baseline ANC-informed and BEN-aware interpretation may reduce unnecessary treatment interruption while preserving haematological safety. BEN-risk was inferred from nationality, not confirmed genetically; all five low-ANC cases received concomitant valproate; associations are observational.

PMID:42546354 | DOI:10.1016/j.schres.2026.07.026

Fam Med. 2026 Aug 3. doi: 10.22454/FamMed.2026.866657. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Competency in clinical documentation is a core entrustable professional activity expected of graduating medical students, and multiple national organizations have established expectations for documentation training and assessment. However, limited guidance exists on how these competencies are operationalized and assessed in clinical settings, and little is known about current educational practices. This study aimed to characterize how family medicine clerkships teach and assess outpatient documentation competency.

METHODS: We conducted a cross-sectional analysis using five documentation-related items embedded in the 2025 Council of Academic Family Medicine Educational Research Alliance clerkship directors survey. The survey was distributed to 174 US and Canadian family medicine clerkship directors. Descriptive statistics summarized the responses.

RESULTS: The response rate was 57.4% (100/174). Most directors (78.7%) rated assessing documentation competency as important or very important. At clerkship entry, 60.2% of students required intermittent prompting, while 32.3% needed repeated direction. Teaching methods varied: 33.3% reported no formal instruction, and only 19.4% used a common rubric. Informal assessment predominated (56.4%), and 8.5% reported no formal process. Regarding accuracy and integrity, 37.6% had no formal evaluation, while 25.8% used direct observation and 22.6% employed standardized patients or simulations.

CONCLUSIONS: Teaching and assessment of outpatient documentation competency in family medicine clerkships are highly variable, with many programs lacking structured approaches. These findings underscore the need for standardized guidelines and curricular integration to ensure that all students achieve competency prior to residency.

PMID:42546339 | DOI:10.22454/FamMed.2026.866657

Fam Med. 2026 Jul 15. doi: 10.22454/FamMed.2026.238874. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: We developed the Mayo Outpatient Precepting Evaluation Tool (MOPET) to assess and improve clinical teaching for family medicine residents. Given the scheduling challenges of peer evaluation, we sought to improve the MOPET’s usefulness by evaluating the reliability of self- and resident-reported teaching behaviors during clinical precepting compared to peer observation.

METHODS: Forty-eight half-day sessions in a family medicine residency clinic were assessed with parallel observer, preceptor, and resident MOPET forms. Interrater reliability was calculated using the κ (kappa) statistic.

RESULTS: Residents reported that preceptors used 14 of 20 teaching behaviors more often than observers. Observers and preceptors significantly agreed on the use of five teaching behaviors, while residents agreed with observers on two teaching behaviors.

CONCLUSIONS: Although self-assessment and resident-based feedback of preceptor teaching behavior may improve practicality, they are less reliable compared to direct peer observation with the validated MOPET.

PMID:42546324 | DOI:10.22454/FamMed.2026.238874

Am J Dermatopathol. 2026 Aug 3. doi: 10.1097/DAD.0000000000003404. Online ahead of print.

ABSTRACT

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that typically progresses slowly and has a favorable initial prognosis; however, the clinical course worsens in advanced stages. The aim of this study was to investigate the levels of programmed death-1 (PD-1), PD-L1, and PD-L2 immunoexpression in the biopsies of patients with MF. Paraffin blocks from biopsies of 82 patients diagnosed with MF between 2019 and 2025 were selected for this study. Early-phase (initial) and later-phase lesion groups, as well as CD4-positive and CD8-positive disease groups were formed based on histological findings. Immunohistochemical staining was performed for PD-1, PD-L1, and PD-L2. Positivity scores were generated for tumor cells, cells in the tumor microenvironment, and combined positivity scores. Immune scores were statistically compared across the lesion phase, CD4‑CD8 positivity status, age, and sex. Of the patients, 56 (68%) had later-phase lesions, 26 (32%) had early-phase lesions, 64 (78%) were CD4-positive, and 18 (22%) were CD8-positive. PD-1, PD-L1, and PD-L2 expression levels are higher in later-phase lesions than in early-phase lesions. The effect size was found to be small to moderate. CD4 or CD8 positivity, age, and sex did not affect PD-1, PD-L1, or PD-L2 levels. Immune checkpoint inhibitors could be beneficial in the management of MF, a disease that is difficult to treat in the advanced stages. Studies with larger patient series, in which evaluation can be performed alongside clinical staging, are needed.

PMID:42546315 | DOI:10.1097/DAD.0000000000003404