Tag: pubmed

Zhonghua Fu Chan Ke Za Zhi. 2026 Apr 25;61(4):289-304. doi: 10.3760/cma.j.cn112141-20250905-00411.

ABSTRACT

Objective: To evaluate the screening efficiency of gene DNA methylation testing, p16 staining, human papillomavirus (HPV) genotyping, and liquid-based cytology (LBC), and their combined strategies in self-collected high-risk HPV (HR-HPV) positive individuals. Methods: This study analyzed a subset of data from a free self-sampling cervical cancer screening program conducted in Baise, Guangxi Zhuang Autonomous Region (from May 2023 to April 2024). HR-HPV positive self-collected cases with complete data and quality control were included. Using the triage strategy recommended by the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management guideline and the Chinese cervical cancer screening guideline [ie, HPV16/18 positivity and (or) LBC of atypical squamous cell of undetermined significance (ASCUS) or worse] as reference standard, the sensitivity, specificity, colposcopy referral rate, and the number needed to colposcopy (NNC) of various secondary triage approaches were assessed. Results: (1) A total of 777 HR-HPV positive women with complete data were analyzed. (2) Methylation positivity was significantly higher in high-risk group HPV16/18 (20.5%, 25/122) and high-intermediate-risk group HPV31/33/35/45/52/58 (17.2%, 66/381) than that in the low-risk group HPV39/51/56/59/66/68 (9.6%, 26/371; χ²=8.85 and χ²=7.59, P=0.003 and P=0.006). (3) Methylation positivity of cervical intraepithelial neoplasia (CIN)Ⅲ and cervical cancer cases (67.5%, 27/40) was significantly higher than CINⅠ cases (12.9%, 31/240), and CINⅡ cases (16.4%, 12/73), with statistically significant differences (P<0.05). The p16 positivity increased with lesion severity in all pairwise comparisons (P≤0.005 after correction). (4) When the guideline-recommended triage strategy [HPV16/18 positivity and (or) LBC≥ASCUS] was applied to this study population, using colposcopy-directed biopsy pathology as the reference standard, the sensitivity and specificity for detecting CINⅡ⁺ and CINⅢ⁺ were 69.03%, 65.21%, and 95.00%, 63.23%, respectively; the colposcopy referral rate was 39.77% (309/777), and NNC was 3.96 for CINⅡ⁺ and 8.13 for CINⅢ⁺. (5) Methylation performance: for CINⅡ⁺, sensitivity was 34.51% and specificity was 88.25%; for CINⅢ⁺, sensitivity was 67.50% and specificity was 87.79%. (6) p16 performance: the sensitivity for detecting CINⅡ⁺ and CINⅢ⁺ were 72.57% and 92.50%, respectively, which did not differ significantly from the guideline-recommended strategy (all P>0.05), whereas the specificity for CINⅡ⁺ and CINⅢ⁺ were 68.67% and 65.60%, respectively, similar to the guideline-recommended strategy (all P>0.05). The colposcopy referral rate was lower with p16 testing alone compared with the guideline-recommended strategy [37.32% (290/777) vs 39.77%; P>0.05]. (7) Combined strategy 3a achieved a sensitivity of 63.72% for detecting CINⅡ⁺, which was similar to the guideline-recommended strategy (P=0.109), and a sensitivity of 95.00% for detecting CINⅢ⁺, identical to that of the guideline-recommended strategy. The specificity of strategy 3a for CINⅡ⁺and CINⅢ⁺ were 70.18% and 68.52%, respectively, both significantly higher than those of the guideline-recommended strategy (χ²=9.75 and 12.56, all P<0.01). The colposcopy referral rate for strategy 3a was significantly lower than that of the guideline-recommended strategy [34.75% (270/777) vs 39.77%; P<0.001], with corresponding NNC of 3.75 for CINⅡ⁺ and 7.11 for CINⅢ⁺. Strategy 5a showed a sensitivity of 64.60% for detecting CINⅡ⁺, which was not significantly different from that of the guideline-recommended strategy (64.60% vs 69.03%; χ²=3.20, P=0.074), and a sensitivity of 95.00% for CINⅢ⁺, identical to that of the guideline-recommended strategy. The specificity of strategy 5a for CINⅡ⁺ and CINⅢ⁺ were 75.30% and 73.00%, respectively, both significantly higher than the guideline-recommended strategy (both P<0.001). NNC for strategy 5a was 3.25 for CINⅡ⁺ and 6.24 for CINⅢ⁺, both lower than those of the guideline-recommended strategy (3.96 and 8.13, respectively). The colposcopy referral rate for strategy 5a was also significantly lower than that of the guideline-recommended strategy [30.50% (237/777) vs 39.77%; χ²=70.01, P<0.001]. Conclusions: Among self-collected, high-risk HPV-positive individuals, combined triage strategies that integrate HPV genotyping with cytology, p16 staining and methylation testing, specifically strategy 3a and 5a, offer comparable sensitivity with superior specificity and lower referral rates versus co-testing for detecting CINⅡ⁺ and CINⅢ⁺.

PMID:42045780 | DOI:10.3760/cma.j.cn112141-20250905-00411

BioDrugs. 2026 Apr 27. doi: 10.1007/s40259-026-00779-9. Online ahead of print.

ABSTRACT

BACKGROUND: Only a minority of patients with advanced gastric cancer (GC) or esophagogastric junction (EGJ) adenocarcinoma derive durable benefit from anti-programmed cell death 1 (PD-1) therapy. However, reliable biomarkers for real-world clinical decision-making remain limited.

OBJECTIVE: To identify tumor site-specific genomic alterations associated with outcomes of nivolumab monotherapy in a nationwide real-world cohort.

METHODS: We conducted a retrospective nationwide analysis using Japan’s Center for Cancer Genomics and Advanced Therapeutics (C-CAT) registry, including patients with GC and EGJ cancer adenocarcinoma treated with nivolumab monotherapy (July 2019-April 2024). Primary endpoints were time to treatment failure (TTF) and overall survival (OS), defined as the interval from nivolumab initiation to death from any cause; objective response rate (ORR) was secondary. Gene-level alteration indicators were derived from vendor-reported tumor-only panel calls across multiple platforms and filtered for clonal hematopoiesis of indeterminate potential (CHIP)-like variants (variant allele frequency < 0.05). Multivariable models adjusted for age and sex were fitted separately for GC and EGJ cancer. Variant pathogenicity was based on available panel annotations; therefore, gene-level results should be interpreted as exploratory findings.

RESULTS: Among 798 patients with GC and 114 patients with EGJ cancer adenocarcinoma, median TTF/OS/ORR were 3.98 months/20.2 months/11.7% in GC and 4.80 months/24.7 months/14.9% in EGJ cancer adenocarcinoma. In GC, ASXL1 mutation remained independently associated with longer TTF (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.37-0.94) after adjustment and CHIP filtering. For OS, microsatellite instability-high [MSI-H] (HR 0.16, 95% CI 0.04-0.70) and FANCG (HR 0.37, 95% CI 0.16-0.87) were associated with longer OS, whereas CDH1 (HR 1.51, 95% CI 1.10-2.05) was associated with shorter OS. In EGJ cancer adenocarcinoma, NTRK1 mutation correlated with longer TTF (HR 0.31, 95% CI 0.10-0.98) and MUTYH with shorter OS (HR 5.68, 95% CI 2.04-15.81), both exploratory.

CONCLUSIONS: In this large Japanese real-world cohort, genomic associations with nivolumab outcomes differed by tumor site. In gastric cancer, ASXL1 mutation was associated with prolonged treatment benefit under PD-1 blockade, while CDH1 and FANCG showed exploratory associations with OS. These findings warrant further validation in prospective and platform-controlled analyses.

PMID:42045774 | DOI:10.1007/s40259-026-00779-9

J Imaging Inform Med. 2026 Apr 27. doi: 10.1007/s10278-026-01966-4. Online ahead of print.

ABSTRACT

Lumbar intervertebral disc degeneration (LIDD) is a leading cause of low back pain, with subtle and variable imaging features that challenge early diagnosis. This study aimed to develop and validate a rigorous MRI-based radiomics ensemble model for disc-level LIDD discrimination, using the patient as the primary sampling unit, with explicit statistical correction for the non-independence of multiple lumbar discs from the same patient. This retrospective single-center study enrolled 122 subjects (102 LIDD patients and 20 healthy controls), contributing a total of 610 lumbar discs. Regions of interest (ROIs) of intervertebral discs were manually segmented on fat-suppressed T2-weighted imaging (FS-T2WI) sequences, and 1409 Image Biomarker Standardization Initiative (IBSI)-compliant radiomic features were extracted. To account for within-patient clustering of discs, multi-step feature selection was performed in the patient-level split training set, including Generalized Estimating Equations (GEE), Benjamini-Hochberg FDR correction, Spearman correlation-based redundancy removal, and L1-regularized logistic regression. Three base classifiers (logistic regression (LR), random forest (RF), radial basis function SVM) and a soft-voting ensemble model were trained with patient-level fivefold group cross-validation to avoid data leakage. Model performance for disc-level LIDD diagnosis was evaluated via AUC, accuracy, sensitivity, and specificity in an independent patient-level test set, with SHapley Additive exPlanations (SHAP) for model interpretability. A compact, reproducible radiomic signature was derived from the final selected features. All models achieved excellent diagnostic performance in the independent test set: RF (AUC = 0.966, 95% CI: 0.937-0.988), SVM (AUC = 0.974, 95% CI: 0.949-0.992), and LR (AUC = 0.974, 95% CI: 0.949-0.992). The soft-voting ensemble model achieved the best discrimination with an AUC of 0.976 (95% CI: 0.954-0.992), along with balanced sensitivity (88%) and specificity (96%). SHAP analysis identified key intensity- and texture-based radiomic features driving model predictions. The MRI-based radiomics ensemble model, built with rigorous statistical correction for within-patient clustering of discs and patient-level validation, enables accurate and interpretable disc-level LIDD discrimination. This model shows strong promise for assisting the early detection and objective diagnosis of LIDD in clinical practice.

PMID:42045763 | DOI:10.1007/s10278-026-01966-4

Optom Vis Sci. 2026 Apr;103(4):e70049. doi: 10.1002/ovs2.70049.

ABSTRACT

PURPOSE: To analyze trends in malpractice payments made on behalf of U.S. optometrists from 1996 to 2023 using National Practitioner Data Bank (NPDB) data, and to assess whether state-level scope-of-practice expansions are associated with increased liability risk.

METHODS: Publicly available NPDB data were reviewed for malpractice payments involving optometrists between 1996 and 2023. Variables included number and value of payments, provider age, patient demographics, geographic distribution, and allegation category. Nationwide trends were analyzed using the Mann-Kendall test; pre- and post-scope expansion comparisons in 11 states were evaluated using the Mann-Whitney rank-sum test. All monetary values were inflation adjusted to 2023 U.S. dollars.

RESULTS: A total of 1040 malpractice payments were recorded (mean 38.5 cases/year). Mean payment was $220,918 (SD $311,395; range $300-$2.95 million). The average provider age was 43 years; 56% of patients were >50 years old. ‘Failure to diagnose’ accounted for 40% of primary allegations. Inflation-adjusted total payments demonstrated a significant upward trend (p = 0.008) that became nonsignificant after excluding 2021-2023 (p = 0.15). No significant change in annual case numbers was observed (p = 0.28). Among 11 states with expanded optometric authority, no statistically significant increase in malpractice cases occurred post-expansion except in Indiana (p = 0.049). Expanded-scope states mirrored national trends in both payment frequency and amount.

CONCLUSIONS: Malpractice payments involving optometrists remain infrequent and financially modest compared with other health professions, with most claims arising from diagnostic rather than procedural issues. There is no evidence that expanding optometric privileges, including lasers, injections, or oral medications, has increased malpractice risk. Advances in education, technology, and interprofessional collaboration likely underpin this stability. Ongoing monitoring of NPDB data will help ensure that optometry’s growing clinical role continues to align with patient safety and professional accountability.

PMID:42045747 | DOI:10.1002/ovs2.70049

Insights Imaging. 2026 Apr 27;17(1):122. doi: 10.1186/s13244-026-02291-8.

ABSTRACT

OBJECTIVES: To prospectively evaluate the correlation between the attenuation imaging (ATI) parameter and hepatic steatosis in overweight (OW)/obese (OB) children, and to establish normal ATI reference values from a prospectively enrolled cohort of healthy children.

MATERIALS AND METHODS: A total of 653 prospectively enrolled children were categorized into OW, OB, and normal control groups based on body mass index (BMI). Ultrasonographic hepatic steatosis grading and ATI measurements were independently assessed by two radiologists. Hepatic steatosis was graded visually as none, mild, moderate, or severe.

RESULTS: The final study cohort consisted of 97 OW, 292 OB, and 264 control children. Median attenuation coefficient obtained with ATI for normal control group, OW group, and OB group were 0.51, 0.54, and 0.64 dB/cm/MHz, respectively. Statistically significant differences in ATI values were observed among all three groups (all p < 0.001). In the combined OW/OB subgroup, ATI values demonstrated a significant weak to strong positive correlation with age, height, weight, BMI, skin-to-liver distance, serum alanine aminotransferase, aspartate aminotransferase, triglycerides, and uric acid (all p < 0.05). Additionally, ATI values increased stepwise with the severity of hepatic steatosis and showed a statistically significant positive correlation with steatosis grade, with higher grades corresponding to greater ATI values (η² = 0.626, p < 0.001).

CONCLUSIONS: ATI values exhibit a significant stepwise increase across healthy, OW, and OB pediatric cohorts, and correlate with anthropometric/metabolic profiles and ultrasonographic steatosis severity. This evidence positions ATI as a non-invasive tool to grade severity and monitor treatment response in metabolic-associated steatotic liver disease.

CRITICAL RELEVANCE STATEMENT: ATI shows significant increases across pediatric weight groups, correlating with metabolic profiles and steatosis severity, positioning it as a non-invasive metabolic-associated steatotic liver disease assessment tool.

KEY POINTS: The ATI value increased significantly in a stepwise manner from healthy controls to OW and OB children, confirming its sensitivity to fat-related liver changes. ATI correlates significantly with most metabolic and anthropometric parameters in OW and OB children, suggesting its utility in reflecting metabolic status. ATI values increase progressively with hepatic steatosis severity and show a strong positive correlation with ultrasonographic steatosis grade.

PMID:42045745 | DOI:10.1186/s13244-026-02291-8

Zhonghua Wei Chang Wai Ke Za Zhi. 2026 Apr 25;29(4):510-517. doi: 10.3760/cma.j.cn441530-20251129-00455.

ABSTRACT

Objective: To investigate the surgical safety and oncological efficacy of minimally invasive surgery (MIS) for primary gastric gastrointestinal stromal tumors (GISTs) with a maximum diameter of ≤5 cm. Methods: A retrospective cohort study was conducted. The inclusion criteria were as follows: patients undergoing radical local resection via MIS, pathologically confirmed primary gastric GISTs, maximum tumor diameter ≤5 cm, and complete available clinicopathological data, adjuvant therapy information and follow-up records. The exclusion criteria included multiple GISTs, a history of other malignant tumors, and distant metastasis or local invasion detected preoperatively or intraoperatively. Clinical data of 517 patients with gastric GISTs who underwent radical surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2018 to December 2024 were retrospectively collected. All patients were divided into four groups according to surgical approaches: laparoscopic surgery group (Lap group, n=411), robotic surgery group (Robot group, n=9), endoscopic surgery group (Endo group, n=44), and laparoscopic-endoscopic cooperative surgery group (LECS group, n=53). Partial gastrectomy was performed in the Lap, Robot and LECS groups, while endoscopic submucosal dissection was the only surgical method in the Endo group. The Lap group was further subdivided into the favorable anatomical location subgroup (Lap-F group, e.g., anterior wall, greater curvature) and the unfavorable anatomical location subgroup (Lap-C group, e.g., posterior wall, lesser curvature, cardia, pylorus) based on tumor location. The LECS group was divided into the laparoscopy-dominated resection subgroup (LECS-L group) and the endoscopy-dominated resection subgroup (LECS-E group) according to the resection modality. Perioperative outcomes and follow-up data of patients in different groups were observed and analyzed. Results: Among all the patients, 227(43.9%) were male , with a median age of 62.5 (55.0, 68.0) years. There were 105 cases with tumor diameter ≤2.0 cm and 412 cases with 2.1-5.0 cm. According to postoperative pathological risk stratification, 98 cases were very low-risk, 368 low-risk, 36 moderate-risk and 15 high-risk. Baseline data comparison showed no statistically significant differences in gender, age and mitotic count among the Lap, Robot, Endo and LECS groups (all P>0.05), while significant differences were found in tumor growth direction, tumor diameter and pathological risk grade (all P<0.001). No statistically significant baseline differences were observed between the Lap-F and Lap-C groups, nor between the LECS-L and LECS-E groups (all P>0.05). All surgeries were successfully completed in the four groups. R0 resection was achieved in all patients of the Lap, Robot and LECS groups, while the surgical margin could not be evaluated in the Endo group. The average operation time of the four groups was (91.4±40.8) minutes, (104.8±28.8) minutes, (60.2±40.5) minutes and (141.7±19.4) minutes, the numbers of patients with intraoperative blood loss ≤50 ml in each group were 356, 7, 44, and 46, respectively. The median time to resuming liquid diet was 4.0 (3.0,4.0) days, 4.0 (3.0,6.0) days, 3.0 (2.0,3.0) days and 4.0 (4.0,5.0) days, and the median postoperative hospital stay was 6.0 (5.0,7.0) days, 6.0 (5.0,8.5) days, 4.0 (4.0,6.0) days and 7.0 (5.0,8.0) days in the four groups, respectively. Intraoperative complications occurred in 13 cases of the Lap group (all with intraoperative bleeding, blood loss >200 ml), 1 case of intraoperative perforation in the Endo group, 1 case of intraoperative bleeding in the LECS group, and no intraoperative complications in the Robot group. Postoperative complications were observed in 17 cases of the Lap group, including 5 cases of gastroparesis, 10 cases of pulmonary infection, 1 case of pancreatic fistula and 1 case of incision bleeding; no relevant postoperative complications were found in the other three groups. Subgroup analysis revealed that the operation time in the Lap-F group was significantly shorter than that in the Lap-C group [(79.3±39.0) minutes vs. (98.1±40.4) minutes, t=-4.566, P<0.001], with no statistically significant differences in other intraoperative and postoperative outcomes (all P>0.05). No statistically significant differences were found in all intraoperative and postoperative indicators between the LECS-L and LECS-E groups (all P>0.05). The median follow-up duration of all patients was 34 (19, 53) months, and no tumor recurrence, metastasis or death was observed in any patient during the follow-up period. Conclusion: Laparoscopic surgery, robotic laparoscopic surgery, endoscopic surgery and laparoscopic-endoscopic cooperative surgery all yield excellent surgical safety and oncological efficacy in the treatment of gastric GISTs with a maximum diameter of ≤5 cm. Tumor anatomical location has a certain impact on the operation time of laparoscopic surgery, but no significant effect on surgical safety and efficacy. In laparoscopic- endoscopic cooperative surgery, both endoscopy-dominated and laparoscopy-dominated tumor resection achieve comparable surgical safety and therapeutic efficacy.

PMID:42045716 | DOI:10.3760/cma.j.cn441530-20251129-00455

Zhonghua Wei Chang Wai Ke Za Zhi. 2026 Apr 25;29(4):484-491. doi: 10.3760/cma.j.cn441530-20260110-00026.

ABSTRACT

Objective: To investigate the efficacy and safety of mFOLFOXIRI combined with bevacizumab plus cytoreductive surgery (CRS) in patients with resectable peritoneal metastasis of colorectal cancer (CRC). Methods: A single-center, prospective randomized controlled design was conducted. Inclusion criteria: confirmed synchronous or metachronous peritoneal metastasis of CRC, aged >18 years, adequate organ function and tolerance to chemotherapy, resectable peritoneal lesions with peritoneal cancer index (PCI) <20, Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1, and tolerance to CRS. Exclusion criteria: intolerance or inefficacy to oxaliplatin, distant unresectable metastasis, emergency surgery, active malignancy, history of thromboembolism, pregnancy or lactation, and other severe comorbidities. Between August 2022 and December 2024, eligible patients with resectable peritoneal metastasis of CRC treated at the Sixth Affiliated Hospital, Sun Yat-sen University were enrolled and randomly assigned at a 1:1 ratio to the neoadjuvant therapy group (mFOLFOXIRI plus bevacizumab followed by CRS) or the direct CRS group. The primary endpoint was the 1-year progression-free survival rate. Secondary endpoints included the response to neoadjuvant therapy, completeness of cytoreduction (CC) score, length of postoperative hospital stay, and postoperative complications. Results: A total of 53 patients who underwent surgery were included, with 19 in the neoadjuvant therapy group and 34 in the direct CRS group. There were no statistically significant differences between the two groups in age, sex, BMI, primary tumor location, pathological type, pattern of peritoneal metastasis (synchronous/metachronous), extraperitoneal metastasis, history of prior systemic therapy, baseline radiological PCI score, or tumor markers (CEA, CA19-9, CA125) (all P>0.05). In the neoadjuvant therapy group, post-treatment radiological PCI score was significantly lower than baseline [M(Q₁,Q₃): 6.0 (4.0, 12.0) vs. 8.0 (5.0, 12.0), Z=-3.086, P=0.002], and CEA was significantly reduced [3.9 (2.8, 7.3) μg/L vs. 7.7 (4.1, 16.1) μg/L, Z=-2.809, P=0.005]. Hemoglobin and albumin levels were also decreased [107.0 (97.5, 117.0) g/L vs. 134.0 (118.0, 140.5) g/L, Z=-3.019, P=0.003;35.9 (34.9, 39.3) g/L vs. 40.0 (37.3, 42.9) g/L, Z=-2.213, P=0.027], with all differences statistically significant (all P<0.05). CA19-9 and CA125 showed a downward trend, but the differences were not statistically significant (all P>0.05). There were no significant between-group differences in CC grade (proportion of CC 0-1: 17/19 vs. 88.2% [30/34]), length of postoperative hospital stay [10.0 (7.0, 13.0) days vs. 13.0 (9.3, 14.0) days], or incidence of severe postoperative complications (8/19 vs. 38.2%[13/34]) (all P>0.05). The proportion of 1-year progression-free survival in the neoadjuvant therapy group was 10/19, which was higher than that in the direct CRS group (29.4%), but the difference was not statistically significant (χ²=2.797, P=0.096). Conclusion: Neoadjuvant therapy with mFOLFOXIRI plus bevacizumab can reduce peritoneal tumor burden without increasing surgical risk, and may improve progression-free survival. However, due to the small sample size and short follow-up duration, long-term benefits need to be confirmed by further follow-up.

PMID:42045712 | DOI:10.3760/cma.j.cn441530-20260110-00026

Aesthetic Plast Surg. 2026 Apr 27. doi: 10.1007/s00266-026-05847-7. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: The nasal tip plays a central role in facial aesthetics, and achieving long-term tip stability is a key objective in rhinoplasty. This study compared postoperative tip stability between structural rhinoplasty using a strut graft (SG) and preservation rhinoplasty with an underlay Pitanguy ligament graft (PLG).

METHOD: Eighty-six primary rhinoplasty candidates were enrolled and divided into two groups of 43. One group received structural rhinoplasty with strut graft, while the other underwent preservation rhinoplasty with an underlay PLG. Nasal tip rotation and projection were measured using 3D soft tissue scans before surgery and at 3, 6, and 9 months postoperatively.

RESULTS: Time significantly affected tip projection (P = 0.001) with both groups showing a downward trend, but no significant differences were observed between techniques at 3, 6, or 9 months (P > 0.05). Tip rotation showed a similar pattern; no significant differences between techniques at any time point. Repeated measures ANOVA confirmed a significant effect of time on rotation (P = 0.001) without a significant time-by-group interaction (P = 0.285).

CONCLUSION: Both structural rhinoplasty with SG and preservation rhinoplasty with underlay PLG yield similar outcomes in maintaining tip projection and rotation over 9 months. Time-dependent reductions were observed, but no statistically significant differences existed between techniques.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42045684 | DOI:10.1007/s00266-026-05847-7

AIDS Behav. 2026 Apr 28. doi: 10.1007/s10461-026-05145-y. Online ahead of print.

ABSTRACT

Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being relates to ART adherence among youth with HIV (YWH), including those using oral or LAI-based regimens. We analyzed baseline data from YWH aged 18-29 years in the United States enrolled between 2023 and 2025 in a randomized controlled trial addressing HIV care barriers, mental health, and substance use. Oral ART adherence was measured using a validated scale, with high adherence defined as a score ≥ 80%. For participants on LAI-ART, high adherence was defined as having no missed or delayed injection visits. We assessed the associations between financial well-being (i.e., unmet subsistence needs, overall financial situation, and mobile technology vulnerability) and adherence using descriptive statistics and adjusted prevalence ratios (PRs) estimated with log-Poisson models with robust standard errors. Among 201 participants, the median age was 27 years. Most (89.1%, n = 179) used oral ART, while 10.0% (n = 20) received LAI-ART. High adherence was achieved by 69.8% of oral ART users and 90% of LAI-ART users. Participants who reported they could “barely get by” financially had significantly lower adherence compared to those living comfortably (RR 0.70, 95% CI 0.52-0.95). Greater unmet subsistence needs were also associated with reduced adherence (RR 0.85, 95% CI 0.73-0.99). Financial well-being was linked to adherence among YWH using both oral and LAI-ART. Efforts to reduce financial hardship may support improved HIV treatment outcomes.

PMID:42045638 | DOI:10.1007/s10461-026-05145-y

Arch Gynecol Obstet. 2026 Apr 27;313(1):176. doi: 10.1007/s00404-026-08431-1.

ABSTRACT

INTRODUCTION: Cervical cerclage is an acceptable procedure in women with cervical insufficiency and is known to be effective in the prevention of preterm delivery. However, limited data exist regarding long-term health outcomes among offspring exposed to cerclage during pregnancy. Since the presence of a foreign body during pregnancy may change the vaginal microbiome, we aimed to study whether a cervical cerclage is associated with long-term infectious morbidity of the offspring.

STUDY DESIGN: A retrospective population-based cohort study was performed at a tertiary medical center, including all singleton deliveries between the years 1991-2021. Long-term infectious morbidity was compared among offspring after pregnancies with and without cervical cerclage. The diagnoses of infectious morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan-Meier survival curve was utilized to evaluate the cumulative incidence. A Cox proportional hazards model was used to control for confounders.

RESULTS: Out of 356,356 offspring included in the analysis, 0.4% (n = 1416) were following pregnancies with cervical cerclage. Unadjusted analyses demonstrated no significant difference in total infectious morbidity between the groups (OR 1.0, 95% CI 0.9-1.1; p = 0.369, Table 1). Kaplan-Meier analysis showed no difference in cumulative incidence (log-rank test P-value = 0.19, Fig. 1). In the primary analysis, cerclage was not associated with long-term infectious morbidity. However, in a secondary model, after adjustment for confounders including gestational age, obesity and diabetes, cerclage exposure was associated with a modest reduction in the risk of long-term infectious morbidity (adjusted HR 0.9, 95% CI 0.87-0.99, p = 0.036).

CONCLUSION: In this large population-based cohort, cervical cerclage was not associated with increased long-term infectious morbidity in offspring. A modest association with reduced infectious morbidity was observed after adjustment for confounding factors. These findings should be interpreted cautiously given the observational design and potential residual confounding.

PMID:42045628 | DOI:10.1007/s00404-026-08431-1