Tag: pubmed

Diagn Interv Imaging. 2026 Aug 11:S2211-5684(26)00139-7. doi: 10.1016/j.diii.2026.08.001. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to compare the image quality and lesion detection between ultra-low dose (ULD) chest-abdomen-pelvis computed tomography (CAP-CT) reconstructed with a deep-learning image reconstruction (DLR) algorithm, and standard-dose CT (STD-CT) in cancer follow-up.

MATERIALS AND METHODS: A total of 106 patients undergoing CAP-CT for the follow-up of cancer were prospectively included. Each patient underwent both STD-CT and ULD-CT acquisitions. ULD-CT images were reconstructed using two DLR levels (Smooth/Smoother). Dosimetric indicators, objective image quality, subjective image quality, and lesion detection were compared. Agreement between protocols and readers was assessed using Gwet’s AC1 or AC2 coefficients.

RESULTS: ULD-CT significantly reduced radiation exposure, with a mean CTDI_vol reduction of -71.5% and dose-length product reduction of -71.5% (P < 0.05). Minor but statistically significant differences in HU values were observed between STD-CT and ULD-CT across most tissues. For all organs or tissues, image noise was significantly higher with ULD-CT-Smooth than with STD-CT (P < 0.001), and with ULD-CT-Smoother than with STD-CT, except for dorsal vertebra (P = 0.39) and trachea (P = 0.26). For all organs or tissues, image noise was significantly lower with the Smoother DLR level than with Smooth DLR level (P < 0.001). Agreement between STD-CT and ULD-CT regarding lesion detection was almost perfect for thoracic, abdominal, and bone lesions. Detection of infracentimetric hepatic was lower with ULD-CT, whereas detection of larger lesions (≥ 10 mm) remained similar. Subjective image quality was lower with ULD-CT, with moderate inter-reader agreement, and lower diagnostic confidence than with STD-CT. One of the two readers considered that 19%-24% of ULD-CT examinations were uninterpretable.

CONCLUSION: ULD-CT with DLR offers substantial radiation dose reduction but resulted in poorer image quality and lower detection of small low-contrast abdominal lesions compared with STD-CT. Although lesion detection remained equivalent for thoracic and skeletal lesions, the high proportion of suboptimal or uninterpretable examinations may limit routine use of ULD protocols in cancer follow-up.

PMID:42580928 | DOI:10.1016/j.diii.2026.08.001

Med Dosim. 2026 Aug 11:S0958-3947(26)00056-7. doi: 10.1016/j.meddos.2026.07.003. Online ahead of print.

ABSTRACT

To develop and rigorously validate a deep learning framework for CT-free positron emission tomography (PET) attenuation correction in non-small cell lung cancer (NSCLC), with a comprehensive assessment of both quantitative and physical integrity to establish a proof-of-concept for its technical feasibility. A U-Net was trained on a multi-center dataset of 100 NSCLC patients to synthesize attenuation-corrected (AC) from nonattenuation-corrected (NAC) PET data. The framework’s performance was evaluated on an independent 30-patient test set. The multi-faceted validation protocol included global image fidelity (peak signal-to-noise ratio [PSNR], structural similarity index measure [SSIM]), quantitative lesion integrity (SUV_max/SUV_mean bias, dice similarity coefficient [DSC]), and fundamental physical characteristics (contrast recovery, spatial resolution). Bland-Altman analysis and paired statistical tests were used. The framework generated images with state-of-the-art global fidelity (PSNR: 36.2 dB; SSIM: 0.967). For lesion-specific analysis, the model introduced a negligible and statistically insignificant mean bias in both SUV_max (+0.72%;p=0.067). While SUV_mean showed a statistically significant difference due to per-patient aggregation, the absolute bias remained clinically negligible (-1.23%;p=0.005). Spatial accuracy was excellent (mean DSC: 0.89). Critically, physical performance was preserved, with 99.2% contrast recovery and no significant degradation in spatial resolution. Deep learning-based attenuation correction synthesis is a highly promising proof-of-concept for CT-less thoracic PET. By demonstrating quantitative fidelity and preserved image-derived physical characteristics, this work establishes a foundational step toward a prospective emission-only workflow, which has the future potential to enhance patient safety by eliminating CT-associated radiation dose.

PMID:42580920 | DOI:10.1016/j.meddos.2026.07.003

ISA Trans. 2026 Aug 4:S0019-0578(26)00399-X. doi: 10.1016/j.isatra.2026.08.005. Online ahead of print.

ABSTRACT

This paper constructs a safety-critical and resource-efficient synchronization control framework for multi-weighted directed networks with an adaptive intermittent event-triggered mechanism. First, the adaptive control gains are rigorously proven to remain bounded for practical feasibility. Second, a unified event-triggering condition with an internal dynamic variable is designed to integrate synchronization errors and safety margins, so that synchronization and safety requirements are handled within a single triggering logic. Third, safety is enforced as a hard constraint via an input-to-state safe barrier function and quadratic programming, providing a unified method to manage both safety and synchronization objectives. This framework guarantees asymptotic synchronization, state invariance within a safe set, and exclusion of Zeno behavior. A numerical example of a collaborative sensor network is provided to illustrate the theoretical findings.

PMID:42580904 | DOI:10.1016/j.isatra.2026.08.005

Inj Prev. 2026 Aug 11:ip-2025-046093. doi: 10.1136/ip-2025-046093. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescents represent a high-risk group for road traffic injuries, particularly in rapidly motorising cities in India. This study aimed to document the travel patterns and understand the road safety knowledge, practices and safety perceptions of adolescents during their school commutes in Delhi, India.

METHODS: A cross-sectional survey was conducted with students from four public schools. Schools were selected based on proximity to high-crash road segments, and all eligible students were invited to participate. A questionnaire was administered via the Research Electronic Data Capture (REDCap) tool within the school premises between December 2023 and February 2024. Descriptive statistics were used to summarise participant characteristics and outcomes, and χ² tests were used to assess associations between various factors and adolescent road safety knowledge.

RESULTS: A total of 4789 adolescents aged 10-19 participated in the survey. Household vehicle ownership was 66%, with 85% owning motorised two-wheelers. Walking was the predominant mode of transport (77% males, 38% females), followed by cycling and public bus. The prevalence of helmet and seatbelt use was low among those who travelled on motorised two-wheelers and cars, respectively. Most participants reported feeling safe (males 70%, females 65%), yet many also reported fears of crashes, speeding vehicles, robbery and harassment. Knowledge of road safety signage was poor.

DISCUSSION AND CONCLUSIONS: The results highlight the urgent need for interventions that combine education, infrastructure improvements, enforcement and gender-sensitive approaches. Strengthening institutional mechanisms and leveraging school-based platforms can help embed adolescent-friendly road safety planning in India’s broader road injury prevention agenda.

PMID:42580880 | DOI:10.1136/ip-2025-046093

Emerg Med J. 2026 Aug 11:emermed-2026-215992. doi: 10.1136/emermed-2026-215992. Online ahead of print.

ABSTRACT

BACKGROUND: Electric-scooters (e-scooters) are popular worldwide although there are concerns about their regulation and safety. Since 2019, 59 deaths have been reported in the UK involving e-scooters; 10 under 18 years old. In the UK riding privately owned e-scooters is illegal unless on private land. We reviewed e-scooter injuries in patients presenting to Emergency Departments of three UK Paediatric Major Trauma Centres.

METHODS: This was a retrospective observational study of e-scooter-related injuries in patients under 16 years-old from January 2019 to December 2024 at Alder Hey Children’s Hospital (AH), Sheffield Children’s Hospital (SCH) and Royal Manchester Children’s Hospital (RMCH). Patients were identified via electronic triage records and cross-referenced with trauma lists. At RMCH, a change in software limited data collection to 2023-2024. Descriptive statistics were used with 95% CIs for key proportions.

RESULTS: 477 patients presented with increasing incidence over the 6 year period. Median age was 12 years (IQR 10-13), with a male predominance (64.4%). Most injuries occurred to the rider (94.8%) and ≥80% were private e-scooters. 2.5% occurred on private land.Most common injuries were limb (40.6% lower, 36.2% upper), head (24.1%), and facial (18.4%) injuries. 10.4% of head injuries had an Abbreviated Injury Scale (AIS) score of 3 or 4, indicating major trauma necessitating imaging, hospital admission, and surgical intervention. Of the most seriously injured (AIS 3 or 4), 48% were from a collision with a motor vehicle or stationary object. Only 1.8% were wearing a helmet; 13.4% were admitted and 6.9% required surgery. Most injured children (74%) lived in the most deprived areas (Index of Multiple Deprivation (IMD) 1/2).

CONCLUSION: E-scooter related injuries are rising. Limb, head and facial injuries were most common, with head injuries being most severe, this has serious life-changing implications for families and significant impact on healthcare resources. There is a need for greater public awareness, clear public health messaging and review of government legislation to prevent further injuries and deaths.

PMID:42580879 | DOI:10.1136/emermed-2026-215992

Eur J Hosp Pharm. 2026 Aug 11:ejhpharm-2025-004887. doi: 10.1136/ejhpharm-2025-004887. Online ahead of print.

ABSTRACT

OBJECTIVES: Intravenous immunoglobulin (IVIG) is a high-cost therapy that is widely used in paediatric care for its immunomodulatory effects. However, inappropriate prescribing contributes to resource waste and potential harm. This study aimed to evaluate the impact of clinical pharmacist-led supervision on the rational use of IVIG in a paediatric hospital setting.

METHODS: A retrospective cross-sectional study was conducted at a paediatric hospital, comparing two 6 month periods: before and after the implementation of a clinical pharmacist-driven prescribing protocol. A total of 248 paediatric patients were systematically selected and assessed for IVIG indication appropriateness, dosing accuracy, and corticosteroid pre-treatment. Statistical analyses were performed to compare clinical variables across the two periods.

RESULTS: Following clinical pharmacist intervention, the proportion of appropriate IVIG prescriptions significantly increased from 49.2% to 66.9% (p<0.001), and the number of vials used decreased from 837 to 451. Dosing improvements led to the saving of 199 vials, equating to approximately £15,694 in cost savings. Among patients with immune thrombocytopenic purpura (ITP), the rate of corticosteroid use, as the first-line therapy prior to IVIG administration, increased from 10.5 to 33.3%. Although IVIG use increased in certain departments, its administration became more evidence-based and targeted to appropriate indications.

CONCLUSION: Clinical pharmacist-led supervision significantly improved the appropriateness of IVIG use in paediatric patients, reduced unnecessary dosing, and contributed to substantial cost savings, underscoring the critical role of clinical pharmacists in optimising high-cost medication use. Further prospective studies are recommended to assess long-term clinical outcomes of such interventions.

PMID:42580873 | DOI:10.1136/ejhpharm-2025-004887

AJNR Am J Neuroradiol. 2026 Aug 11:ajnr.A9577. doi: 10.3174/ajnr.A9577. Online ahead of print.

ABSTRACT

PURPOSE: This systematic review and meta-analysis aimed to synthesize evidence on baseline and procedural neuroimaging markers associated with futile recanalization in posterior circulation stroke.

DATA SOURCES: A systematic search was conducted across PubMed, Scopus, Web of Science, and Embase from inception through April 2025.

STUDY SELECTION: Studies evaluating neuroimaging predictors of futile recanalization in patients with posterior circulation stroke who achieved successful recanalization (mTICI ≥2b) after endovascular treatment were included.

DATA ANALYSIS: Risk of bias was assessed using PROBAST. Random-effects meta-analysis was performed for imaging parameters reported in two or more studies. Heterogeneity was assessed using I² statistics, and leave-one-out sensitivity analyses were conducted.

DATA SYNTHESIS: Twelve studies comprising 3,521 patients met the inclusion criteria. Meta-analysis of five studies demonstrated that higher PC-ASPECTS scores were significantly associated with reduced odds of futile recanalization (pooled OR = 0.72, 95% CI: 0.60-0.86; I² = 74.8%). The BATMAN collateral score showed a non-significant general direction toward lower futile recanalization with higher scores (OR = 0.81; 95% CI: 0.57-1.14; I² = 51.8%). Additional imaging predictors identified across studies included PMT score, PC-CS, PComA patency, CBF <35% volume, and cerebral circulation time. Perfusion metrics such as hypoperfusion intensity ratio and core volume did not independently predict futile recanalization.

LIMITATIONS: The current study has several limitations. A small number of included studies (mostly retrospective with limited sample sizes), high heterogeneity (I² = 74.8% for PC-ASPECTS), varying definitions of functional outcome, differing covariates in multivariable models with possible residual confounding, and wide variation in study size/design. Furthermore, we were unable to perform reliable formal subgroup analyses, and publication-bias assessments due to only five eligible studies for PC-ASPECTS and two for BATMAN, necessitating reliance on qualitative assessment and leave-one-out sensitivity analyses while leaving publication bias and small-study effects unexcluded.

CONCLUSION: PC-ASPECTS is a robust imaging predictor of futile recanalization in posterior circulation stroke. Location-based and collateral-based imaging parameters demonstrate greater prognostic value than volumetric thresholds in this territory. Integration of multiple imaging parameters into composite scores may enhance predictive accuracy and guide patient selection.

PMID:42580864 | DOI:10.3174/ajnr.A9577

Open Heart. 2026 Aug 11;13(2):e004250. doi: 10.1136/openhrt-2026-004250.

ABSTRACT

BACKGROUND: Catheter-directed thrombolysis (CDT) has emerged as a reperfusion strategy for intermediate-risk and high-risk pulmonary embolism (PE), potentially improving thrombus resolution while reducing bleeding risk compared with systemic thrombolysis. However, evidence comparing CDT with anticoagulation alone remains inconsistent.

OBJECTIVE: To evaluate the efficacy and safety of CDT compared with anticoagulation alone in intermediate-risk and high-risk PE.

METHODS: A systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Cochrane Library, Epistemonikos and ProQuest were searched through 8 May 2026. Randomised and observational studies comparing CDT with anticoagulation alone were included. Primary outcomes were all-cause mortality and major bleeding. Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences with 95% CIs.

RESULTS: 18 studies involving 16 126 patients were included. CDT was associated with a lower risk of all-cause mortality compared with anticoagulation alone (RR 0.41, 95% CI 0.32 to 0.54; p<0.0001; I²=0%). No statistically significant difference was observed in major bleeding (RR 1.78, 95% CI 0.85 to 3.71; p=0.1259; I²=51.3%), and trim-and-fill analysis yielded a similarly non-significant result (adjusted RR 0.84, 95% CI 0.39 to 1.79). CDT and anticoagulation alone showed comparable outcomes for PE-related mortality, intracranial haemorrhage, delta right ventricle (RV)/left ventricle (LV) ratio, delta Thrombus Burden Score or systolic pulmonary artery pressure. Meta-regression identified that a greater baseline RV/LV ratio was associated with attenuation of the observed mortality benefit.

CONCLUSIONS: CDT was associated with lower all-cause mortality compared with anticoagulant alone in intermediate-risk and high-risk PE without a statistically significant increase in intracranial haemorrhage. Larger adequately powered randomised trials are needed to define the role of CDT in acute PE.

PROSPERO REGISTRATION NUMBER: CRD420261373193.

PMID:42580844 | DOI:10.1136/openhrt-2026-004250

BMJ Open. 2026 Aug 11;16(8):e118941. doi: 10.1136/bmjopen-2026-118941.

ABSTRACT

OBJECTIVES: Inappropriate and broad-spectrum antibiotic use contributes to antimicrobial resistance (AMR) and higher healthcare costs. In Saudi Arabia, despite ongoing antimicrobial stewardship efforts, comprehensive real-world evidence on antibiotic prescribing patterns remains limited. This study aimed to evaluate antibiotic prescribing among insured (Daman) beneficiaries in Saudi Arabia and benchmark against international standards.

DESIGN: Retrospective analysis of deidentified health insurance claims from the National Platform for Health and Insurance Exchange Services (NPHIES), covering 1 November 2023-31 October 2024.

SETTING: Antibiotic prescriptions were identified within claims and linked to diagnostic codes using the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) to determine clinical indications for use.

PARTICIPANTS: Among 4.02 million claimants, 8.3 million antibiotic prescriptions were identified.

PRIMARY AND SECONDARY OUTCOME MEASURES: Antibiotic claims were mapped to the Saudi Food and Drug Authority (SFDA) drug list. Hospital antibiotic consumption was expressed as defined daily doses (DDD) per 100 patient-days for five selected inpatient antibiotics, whereas overall antibiotic consumption (in both community and hospital settings) was expressed as DDD per 1000 insured persons per day. Treatment duration, prescriber specialty and patient demographics were measured. Appropriateness of antimicrobial prescribing for respiratory tract infections was assessed using Healthcare Effectiveness Data and Information Set (HEDIS) metrics.

RESULTS: Age-stratified and sex-stratified antibiotic prescription rates showed disproportionately high use in male infants (509.6 prescriptions per 1000) and older males (641.9 prescriptions per 1000). General practitioners accounted for 80% of prescriptions. Broad-spectrum beta-lactams, particularly amoxicillin-clavulanate, predominated. Overall antibiotic consumption was 11.63 DDD per 1000 insured persons per day, comparable to European Surveillance of Antimicrobial Consumption Network (ESAC-Net) outpatient benchmarks. Mean treatment durations ranged 8-14 days, exceeding global stewardship recommendations. HEDIS indicators revealed overprescribing, particularly for upper respiratory tract infections.

CONCLUSIONS: This is the first claim-based analysis of antibiotic prescribing patterns among Daman beneficiaries in Saudi Arabia. Decision support systems, artificial intelligence-driven audits and targeted education could optimise prescribing, reduce AMR and inform policy.

PMID:42580838 | DOI:10.1136/bmjopen-2026-118941

BMJ Open. 2026 Aug 11;16(8):e118613. doi: 10.1136/bmjopen-2026-118613.

ABSTRACT

INTRODUCTION: Suicide is a major public health concern and one of the leading causes of death among young people globally. Unemployment has been associated with an increased risk of suicide and suicidal behaviour through its effects on mental health, financial security and social well-being. In sub-Saharan Africa (SSA), high levels of youth unemployment, poverty and limited access to mental healthcare may further increase vulnerability to suicidal behaviour. This systematic review aims to synthesise evidence on the prevalence, associated factors and methods of suicide and suicidal behaviours among unemployed youth in SSA.

METHODS AND ANALYSIS: The review will be conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Eligible studies will focus on unemployed youth aged 15-35 years residing in SSA countries and report on suicide, suicidal ideation, suicide attempts or completed suicide. Electronic databases, including PubMed, Web of Science, EBSCOhost, Scopus, ProQuest and Sabinet African Journals, will be searched using a comprehensive search strategy supplemented by backward and forward citation searching. Three reviewers will independently screen studies, extract data and assess methodological quality using appropriate critical appraisal tools. Prevalence estimates will be pooled using random-effects meta-analysis where appropriate. Associated factors will be synthesised narratively and organised according to the socioecological framework.

ETHICS AND DISSEMINATION: Ethical approval is not required as the review will use data from published studies and publicly available sources. Findings will be disseminated through publication in a peer-reviewed journal, conference presentations and engagement with relevant stakeholders. The review is expected to provide evidence to inform suicide prevention strategies, mental health interventions and employment-related policies targeting unemployed youth in SSA.

PROSPERO REGISTRATION NUMBER: CRD42025642679.

PMID:42580836 | DOI:10.1136/bmjopen-2026-118613