Tag: pubmed

BMC Med. 2026 Jul 20. doi: 10.1186/s12916-026-05018-0. Online ahead of print.

ABSTRACT

BACKGROUND: The development of second primary cancers (SPCs) has become an important late effect in gastric cancer (GC) survivors, yet its incidence, risk factors, and clinical implications remain poorly defined. This study aimed to evaluate the long-term risk of SPCs, identify clinical factors associated with SPC occurrence, and describe detection patterns and stage distribution of SPCs during long-term follow-up.

METHODS: Patients with GC who underwent curative-intent radical gastrectomy between 2007 and 2021 were identified from the Multidisciplinary Alliance of Gastric Integrative Studies (MAGIS) cohort. Clinical factors associated with SPC occurrence were selected using LASSO-penalized Cox regression, and exploratory risk-based stratification was performed. Stage distribution was descriptively compared between SPCs detected during asymptomatic surveillance and those diagnosed after symptom onset.

RESULTS: Among 11,027 GC survivors (8,519 men and 2,508 women), 241 (2.19%) developed SPCs during a follow-up of up to 16 years. The cumulative incidence of SPCs was 1.25% (95% CI, 1.03%-1.46%) at 5 years, 2.97% (95% CI, 2.55%-3.39%) at 10 years, and 4.15% (95% CI, 3.40%-4.91%) at 15 years after gastrectomy. The most frequent SPCs were lung (23.2%), colorectal (21.6%), and esophageal (12.9%) cancers, showing marked sex-specific differences: lung cancer predominated in males, whereas cervical cancer was most common in females. Factors associated with SPC occurrence included older age at time of gastrectomy (HR 1.04, 95% CI 1.02-1.05; p < 0.001), chronic HBV/HCV infection (HR 2.15, 95% CI 1.29-3.58; p = 0.003), family history of cancer (HR 1.57, 95% CI 1.16-2.12; p = 0.003), and elevated preoperative systemic inflammation (Log-SIRI; HR 1.86, 95% CI 1.31-2.65; p < 0.001). The derived model stratified patients into low-, intermediate-, and high-risk groups with corresponding 10-year SPC risks of 2.07%, 3.61%, and 4.33%. SPCs detected during asymptomatic surveillance were more frequently diagnosed at stage I than those identified after symptom onset (47.4% vs 17.6%; p < 0.001).

CONCLUSIONS: SPCs represent an important long-term health burden among GC survivors, with distinct sex-specific disease patterns. The exploratory risk-scoring model showed preliminary risk stratification, and SPCs detected during asymptomatic surveillance were more often diagnosed at an earlier stage. These findings support further evaluation of risk-adapted, organ- and sex-specific surveillance strategies in methodologically rigorous studies.

PMID:42477705 | DOI:10.1186/s12916-026-05018-0

BMC Public Health. 2026 Jul 20. doi: 10.1186/s12889-026-28633-1. Online ahead of print.

ABSTRACT

BACKGROUND: Vaccine-preventable diseases (VPDs) continue to impose a significant health and economic burden globally, despite advances in immunization programs. Narrower to the context of Saudi Arabia, the current literature consistently shows that the high vaccination coverage has had the primary impact of reducing disease incidence. Regardless, the broader economic impact of VPDs and the financial benefits of immunization remain important for policy evaluation within Saudi Arabia.

METHODS: This study employed a model-based economic evaluation using a societal perspective in order to carry out an estimation of the economic burden of measles, influenza, and pneumococcal diseases. We utilized the Cost of Illness (COI) approach for the purpose of quantifying direct medical costs and indirect productivity losses. On the other hand, the Value of Statistical Life (VSL) approach helped in the estimation of the monetary value of mortality reduction. A comparative framework analyzed current vaccination coverage against a counterfactual no-vaccination scenario for the calculation of the return on investment (ROI).

RESULTS: The estimated annual economic burden of the three selected VPDs in the absence of vaccination was USD 385 (95% CI: 315-460) million. Immunization programs generated substantial economic benefits, with total benefits estimated at USD 1085 (95% CI: 815-1360) million annually. The calculated ROI was 9.85 (95% CI: 6.8-11.3), essentially an indication that for each dollar invested in vaccination, there was multiple economic returns yielded. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSION: Immunization programs in Saudi Arabia provide significant economic and public health benefits and for this reason, sustained investment in vaccination is fundamentally essential towards the reduction of disease burden, improve population health, and ultimately support long-term economic productivity.

PMID:42477699 | DOI:10.1186/s12889-026-28633-1

BMC Oral Health. 2026 Jul 21. doi: 10.1186/s12903-026-09361-9. Online ahead of print.

ABSTRACT

BACKGROUND: Endodontic treatment is fundamental to preserving teeth affected by pulpal and periapical diseases. Robust evidence on treatment outcomes and their determinants is essential for optimizing clinical practice, yet data from sub-Saharan Africa remain scarce. This study assessed the prevalence, clinical and radiographic outcomes, and determinants of endodontic treatment success and failure among patients treated at Jimma Medical Center (JMC), Ethiopia.

METHODS: An ambispective single-cohort study was conducted among a sample of 404 patients who received endodontic treatment at JMC from September 1, 2025, to November 30, 2025. Data were collected on socio-demographics, preoperative clinical and radiographic characteristics, procedural details, and patient-reported outcomes. Clinical and radiographic success was assessed using the Periapical Index (PAI) and symptom resolution. Logistic regression analyses were performed to identify determinants of treatment outcomes, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated, and statistical significance set at p < 0.05.

RESULTS: The majority of participants were aged 25-44 years (49.6%) and female (55.8%), with an overall treatment success rate of 84.2%. Most teeth were non-vital (96.4%) and presented with symptomatic pulpitis or apical periodontitis. Irrigation was primarily performed with saline (85.2%), and optimal obturation quality was achieved in 90.1% of cases. At follow-up, 84.2% of teeth were classified as successful, defined as absence of symptoms and PAI ≤ 2, while 15.8% failed. The most frequent causes of failure were persistent infection (42.6%) and coronal leakage (41.0%). Patient-reported outcomes indicated high satisfaction, with 89.1% of patients reporting satisfaction and 73.0% reporting complete absence of pain post-treatment. Multivariable logistic regression analysis identified several independent determinants of treatment success. Male patients had 2.86 times higher odds of treatment success than female patients (AOR = 2.86, 95% CI: 1.98-3.53; p < 0.04). Conversely, symptomatic periapical lesions or abscesses were associated with 43% lower odds of treatment success (AOR = 0.57, 95% CI: 0.05-0.86; p < 0.03). Similarly, the use of saline as the primary irrigant was associated with 54% lower odds of treatment success than H₂O₂ alone or saline combined with H₂O₂ (AOR = 0.46, 95% CI: 0.21-0.91; p < 0.04). In addition, a temporary or inadequate coronal seal at treatment completion was associated with 62% lower odds of treatment success than a composite restoration or crown (AOR = 0.38, 95% CI: 0.16-0.88; p < 0.02).

CONCLUSION: Endodontic treatment at JMC demonstrates a high success rate, with most teeth showing favorable clinical, radiographic, and patient-reported outcomes. Male gender, preoperative periapical pathology, type of primary irrigant, and coronal restoration quality were significant determinants of treatment outcome. These findings underscore the importance of meticulous procedural protocols and proper coronal sealing to enhance treatment success.

PMID:42477696 | DOI:10.1186/s12903-026-09361-9

BMC Med Educ. 2026 Jul 20. doi: 10.1186/s12909-026-09925-x. Online ahead of print.

ABSTRACT

BACKGROUND: Nursing assistants (NAs) are a key occupational group that provide daily living care and nursing support across medical and integrated healthcare settings. NAs have been introduced to alleviate nursing shortages and better meet patients’ care needs. In many countries, mandatory pre-employment training programs are tailored to the NAs’ role. However, China lacks a standardized pre-service training program, leading to fragmented content and variable training quality. In response to national policy priorities, this study aims to develop a standardized pre-service training program for NAs in China.

METHODS: A modified Delphi method and the Analytic Hierarchy Process (AHP) were used to establish a competency-based pre-service training program, guided by the Competency Iceberg Model, from June to October 2022. An expert panel (n = 12) from nine tertiary hospitals across eight provinces participated in two rounds of Delphi consultations to reach consensus on program content. Expert agreement was evaluated using consensus levels and Kendall’s W coefficient.

RESULTS: The final training program comprises a three-level framework with three first-level indicators, 25 s-level indicators, and 100 third-level indicators, encompassing both practical care competencies and latent professional competencies. Expert consensus was achieved across all hierarchical indicators. Kendall’s W values for the second- and third-level indicators were 0.222 and 0.179, respectively, both of which were statistically significant (p < 0.001). The AHP results assigned the highest priority to skills (0.50), followed by professionalism (0.25) and knowledge (0.25). Within these domains, practical care skills, including mobility care, sputum management, and latent competencies, including emotional management and communication, received the highest priority weightings. These weightings can provide an evidence-informed rationale for prioritising training content, allocating instructional time, and further guiding practical implementation.

CONCLUSION: This study established a structured, competency-based pre-service training program for NAs by integrating expert consensus with quantitative prioritization. The program provides a holistic framework and evidence-informed basis for developing NAs training and standardizing pre-service training in Chinese healthcare settings. Future research should examine its feasibility, effectiveness, and implementation across diverse clinical contexts.

PMID:42477695 | DOI:10.1186/s12909-026-09925-x

BioData Min. 2026 Jul 20. doi: 10.1186/s13040-026-00584-8. Online ahead of print.

ABSTRACT

The advent of high-throughput sequencing technologies has generated increasingly large and complex genomic datasets, necessitating analytical approaches capable of capturing high-dimensional and potentially nonlinear genetic interactions. This situation has significantly impacted the entire field of Genome-Wide Association Study (GWAS), whose primary goal is the identification of genomic traits and variants that are statistically associated with the risk of a disease. However, traditional GWAS methods may show reduced performance when applied to highly polygenic and nonlinear genetic architectures. Computational strategies from Artificial Intelligence (AI) and, in particular, from machine- and deep-learning may provide a powerful tool to overcome such limitations, especially by capturing nonlinear interactions and complex hidden regularities in large-scale data, which traditional GWAS approaches might overlook. To date, only a few approaches have been introduced and systematically assessed. In this review, we describe the main characteristics and limitations of standard statistical approaches for GWAS, the main uses of AI methods in computational genomics, and recent attempts to leverage AI strategies in GWAS. Particular attention will be devoted to key issues, such as the interpretability of methods and results, and the curse of dimensionality. More specifically, the review presents 30 methods designed to leverage AI in GWAS, as well as presenting a comprehensive set of evaluation metrics for their performance, also providing references to the most frequently used databases, and biobanks. Overall, this work may serve as a starting point for both dry- and wet-lab researchers, aiming to extract deeper insights from genomic data by moving beyond traditional linear additive assumptions, and leveraging large-scale datasets through AI-driven approaches.

PMID:42477691 | DOI:10.1186/s13040-026-00584-8

BMC Musculoskelet Disord. 2026 Jul 20. doi: 10.1186/s12891-026-10257-6. Online ahead of print.

ABSTRACT

BACKGROUND: Hip dysplasia (HD) is a known risk factor for early morbidity in the young adult hip. HD causes a variety of pathologic changes to the hip through an asymmetrical distribution of forces. Periacetabular osteotomy (PAO) is becoming increasingly recognized as a treatment. Labral tears occur frequently in the setting of HD and there still remain questions regarding the best treatment practices for labral pathology. We sought to determine whether intraoperative labral tear size was associated with short-term patient-reported outcomes following concomitant hip arthroscopy and PAO.

METHODS: Seventy-one hips that underwent PAO with concomitant hip arthroscopy at our tertiary care hip center from February 2017 to June 2021 who had PROM follow-up time of more than one year were investigated (88.7% women and 11.3% men with mean patient age of 29.5 years). Labral tear sizes were recorded intraoperatively and sorted into three groups: < 5 mm, 5 – 10 mm, and > 10 mm. HOOS scores were collected pre- and postoperatively and were compared across the three labral tear size groups. The association between labral tear size and postoperative HOOS was evaluated while accounting for preoperative HOOS, age, sex, and BMI. The mean follow-up time was 1.57 years ± 250 days.

RESULTS: Across all patients, the mean preoperative HOOS was 66.9 ± 14.5, and the mean postoperative HOOS was 77.8 ± 16.3. Statistically significant improvement was observed in the <5 mm and 5-10 mm groups (p<0.001) but not in the >10 mm group (p=0.310). Mean postoperative HOOS values in the <5 mm, 5-10mm, and >10 mm labral tear groups were 84.3 ± 13.7, 76.9 ± 16.6, and 69.2 ± 16.1, respectively. Larger labral tear size was associated with worse postoperative HOOS (p=0.004).

CONCLUSION: Among patients undergoing concomitant hip arthroscopy and PAO, larger intraoperative labral tear size was associated with worse short-term postoperative HOOS. However, larger labral tears were also associated with older age and worse markers of intra-articular disease, suggesting that tear size may reflect more advanced disease rather than independently determine outcome.

PMID:42477690 | DOI:10.1186/s12891-026-10257-6

BMC Oral Health. 2026 Jul 20. doi: 10.1186/s12903-026-09362-8. Online ahead of print.

ABSTRACT

BACKGROUND: Augmented reality (AR) visualization projects preoperative virtual three-dimensional (3D) models onto real surgical sites and can provide intuitive intraoperative guidance. This in vitro proof-of-concept study evaluated the feasibility of markerless AR-guided endodontic microsurgery by comparing objective outcomes between AR guidance (ARG) and traditional freehand (FH) procedures on customized 3D-printed mandibular models.

METHODS: Customized 3D dental models with artificial periapical lesions (APLs) were generated from cone beam computed tomography (CBCT) images obtained from one patient. A total of 20 dental models (80 mandibular molars and 160 APLs) were included, with 10 models assigned to the ARG group and 10 to the FH group. Surgical planning was performed on virtual models reconstructed from CBCT images. All procedures were performed by one endodontist with more than 10 years of clinical experience after standardized training in both workflows. Surgical time was recorded during each procedure, and postoperative CBCT images were acquired to evaluate bone window marking errors, osteotomy errors, and root resection angle error.

RESULTS: The ARG group required less time than the FH group across all four molar positions. Median (IQR) surgical times ranged from 3.72 (2.99-5.75) to 5.25 (4.58-6.56) min in the ARG group and from 7.02 (6.60-7.66) to 9.13 (8.28-9.75) min in the FH group (all P < 0.05). The ARG group also yielded lower median (IQR) values for bone window marking, osteotomy, and root-resection angle errors. Several tooth-specific comparisons reached statistical significance (P < 0.05).

CONCLUSIONS: Within the limitations of an in vitro proof-of-concept study, markerless AR guidance was feasible and was associated with improved accuracy and time efficiency during simulated mandibular molar endodontic microsurgery. Further clinical studies are required before routine clinical application.

PMID:42477686 | DOI:10.1186/s12903-026-09362-8

BMC Musculoskelet Disord. 2026 Jul 20. doi: 10.1186/s12891-026-10189-1. Online ahead of print.

ABSTRACT

BACKGROUND: Open reduction and internal fixation (ORIF) using locking plates remains a widely used head-preserving treatment for displaced proximal humerus fractures in adults. While short-term outcomes are well documented, long-term functional performance, complication burden, and implant survivorship beyond 5-years remain poorly defined. This systematic review and meta-analysis aimed to synthesise long-term (≥ 5-years) functional outcomes, complication rates, and reoperation rates following locking plate ORIF for proximal humerus fractures.

METHODS: A protocol-registered (PROSPERO CRD420251156067) systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and the Cochrane Library were searched for English-language randomized and non-randomized clinical studies reporting ≥ 5-year follow-up after ORIF with plate fixation for two-, three-, or four-part proximal humerus fractures in adults. Functional outcomes like Constant-Murley score (CMS), Disabilities of the Arm, Shoulder and Hand Score (DASH), University of California Los Angeles Shoulder Score (UCLA), and Oxford Shoulder Score (OSS), complications, and reoperation rates were extracted. Random-effects meta-analyses were performed, with heterogeneity assessed using the I² statistic. Risk of bias was evaluated using RoB 2 and ROBINS-I, and certainty of evidence was graded using GRADE.

RESULTS: Ten studies met the inclusion criteria, with follow-up ranging from 5 to nearly 15 years. Pooled analyses demonstrated no statistically significant long-term differences in CMS, DASH, or UCLA scores, although the OSS favored ORIF (MD 5.00; 95% CI 1.31-8.69). Long-term complications were common, particularly AVN (5-23%), screw penetration (9-15%), stiffness, and glenohumeral osteoarthritis (5-16%). Meta-analysis suggested reduced risks of complications (RR 0.06), overall reoperation/secondary surgery (RR 0.34; 95% CI 0.13-0.87), implant removal (RR 0.34; 95% CI 0.17-0.67), and revision surgery (RR 0.17; 95% CI 0.07-0.45); however, these estimates should be interpreted cautiously because heterogeneity was substantial to extreme across outcomes. Overall certainty of evidence was very low.

CONCLUSION: Locking plate ORIF for proximal humerus fractures provides acceptable but highly variable long-term functional outcomes, with a considerable burden of late complications and secondary procedures. These findings highlight the importance of careful patient selection, meticulous surgical technique, and long-term follow-up. High-quality prospective studies with standardized outcome reporting are needed to better define the durability of ORIF in this challenging injury.

PMID:42477681 | DOI:10.1186/s12891-026-10189-1

BMC Med Educ. 2026 Jul 20. doi: 10.1186/s12909-026-09967-1. Online ahead of print.

ABSTRACT

BACKGROUND: Medical Student Syndrome (MSS) is a well-recognized phenomenon characterized by transient health anxiety and misinterpretation of benign bodily sensations as symptoms of serious illness. However, it remains underexplored in Yemen, particularly among medical students exposed to clinical training stressors. This study aimed to estimate the prevalence of MSS-like symptoms among medical students at Thamar University, Yemen, identify associated factors, and assess perceived severity and functional impact.

METHODS: A cross-sectional study was conducted among 193 medical students at Thamar University, Yemen. MSS-like symptoms were defined as a self-reported experience consistent with MSS, supported by at least four of five supporting features such as transient and recurrent symptoms with reported normal test results, and short symptom duration. Descriptive statistics were used to summarize participant characteristics and the prevalence of MSS-like symptoms. Bivariable associations were assessed using the chi-square test, and multivariable logistic regression was performed to identify associated factors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05.

RESULTS: The prevalence of MSS-like symptoms based solely on self-reported experience was 71.0% (137/193), while 37.3% (72/193) met the operational definition. Among participants with MSS-like symptoms, 35 (48.6%) reported moderate perceived severity and 54 (75%) reported moderate perceived functional impact on daily activities and academic performance. In multivariable analysis, MSS-like symptoms were associated with being in the fifth academic year (AOR = 2.58, 95% CI: 1.14-5.82, p = 0.022) and having a chronic disease (AOR = 4.68, 95% CI: 2.17-10.09, p < 0.001).

CONCLUSIONS: More than one-third of medical students at Thamar University met the operational MSS like symptoms. These findings suggest that MSS-like symptoms may be associated with academic exposure and individual health context. Integrating mental health support and stress management strategies into medical training may help reduce health-related anxiety and improve student well-being.

PMID:42477675 | DOI:10.1186/s12909-026-09967-1

BMC Public Health. 2026 Jul 20. doi: 10.1186/s12889-026-28621-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Oral lesions are frequent complications of Human Immunodeficiency Virus (HIV) infection, particularly among individuals with advanced immunosuppression. These lesions reduce quality of life and increase vulnerability to secondary infections. This study assessed knowledge, risk factors, and healthcare-seeking behavior related to oral lesions among HIV enrollees in Osun State, Nigeria.

METHODOLOGY: A descriptive cross-sectional study was conducted among 180 HIV-positive adults with clinically confirmed oral lesions attending selected Antiretroviral Therapy (ART) clinics in Osun State, Nigeria. Participants were recruited from three selected ART clinics using complete enumeration. Data were collected using a structured interviewer-administered questionnaire and analysed using SPSS version 20. Descriptive statistics and appropriate bivariate tests were used, with statistical significance set at p < 0.05.

RESULTS: Participants were mostly male (51.7%) and Yoruba (74.4%). Only 56.1% had good knowledge of oral lesions. Common risk factors included poor oral hygiene (56.1%), alcohol use (31.7%), and ART non-adherence. Healthcare-seeking within two weeks of symptoms was low (26.7%). Religion, education, and occupation were significantly associated with care-seeking. Poor oral hygiene and low CD4 counts were significant predictors of oral lesions.

CONCLUSION: Knowledge and prompt care-seeking for oral lesions remain inadequate among HIV enrollees. Integrating oral health education, routine screening, and dental care into HIV treatment services is essential to improve outcomes in this population.

PMID:42477674 | DOI:10.1186/s12889-026-28621-5