Tag: pubmed

BMC Oral Health. 2026 Jun 29. doi: 10.1186/s12903-026-09106-8. Online ahead of print.

ABSTRACT

BACKGROUND: First permanent molars (FPMs) erupt early and remain exposed to the oral environment for prolonged periods, making them particularly susceptible to dental caries, molar-incisor hypomineralization (MIH), restorative failure, and repeated restorative intervention. When long-term prognosis becomes unfavorable, extraction may represent a biologically appropriate treatment option. Favorable spontaneous eruptive adaptation of the second permanent molar (SPM) has been associated with several radiographic and developmental variables. This retrospective radiographic study evaluated demographic and panoramic radiographic parameters associated with favorable eruption potential of SPMs in children with indicated FPM extraction and investigated whether established radiographic conditions were present at the time extraction decisions were made.

METHODS: Following ethical approval, panoramic radiographs of 500 pediatric patients presenting with extraction-indicated FPMs (n = 712) were retrospectively evaluated. Demographic characteristics, dentition stage, number and location of affected FPMs, and extraction indications were recorded. Radiographic assessment included evaluation of SPM developmental stage according to Demirjian classification, SPM angulation, and presence of a third permanent molar (TPM) germ. Statistical analyses were performed using SPSS version 29.0. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were applied, with statistical significance established at p < 0.05.

RESULTS: The mean age of the study population was 128.39 ± 22.11 months; 54.6% were girls and 45.4% boys. Extensive carious destruction (91.4%), repeated treatment interventions, severe structural breakdown, and MIH-related defects represented the principal indications for extraction. Radiographically, 17.6% of SPMs were classified as Demirjian stage E and 27.4% as stage F. Mesial angulation was observed in 55.2% of cases, while a TPM germ was present in 74.2%. However, only 12.8% of cases (62 patients, 91 teeth) fulfilled all predefined radiographic conditions associated with favorable eruption potential following FPM extraction.

CONCLUSION: Radiographic conditions associated with favorable eruption potential of SPMs were present in only a limited proportion of cases at the time FPM extraction decisions were established. These findings highlight the discrepancy between theoretically favorable developmental timing conditions and the clinical realities of pediatric dental practice, where extraction is frequently necessitated by advanced structural disease. Systematic radiographic evaluation of SPM developmental stage, angulation, and TPM germ presence should therefore be incorporated into individualized treatment planning.

PMID:42366359 | DOI:10.1186/s12903-026-09106-8

BMC Med Imaging. 2026 Jun 28. doi: 10.1186/s12880-026-02534-6. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVE: This single-center retrospective study evaluated the associations of AI-quantified coronary plaque parameters and CT-derived fractional flow reserve (CT-FFR) with major adverse cardiovascular events (MACEs) in patients with coronary artery disease, and derived optimal risk cutoff values for plaque burden.

METHODS: A total of 381 patients who underwent CCTA were consecutively enrolled. MACEs were defined as a composite of all-cause death, myocardial infarction (fatal and nonfatal), heart failure death, malignant arrhythmia, coronary revascularization, and rehospitalization for angina exacerbation. Maximum follow-up was 18 months. Risk cutoff values were derived from receiver operating characteristic analysis. Univariate and multivariate Cox regression, Kaplan-Meier analysis, and five predictive models (plaque model, CT-FFR model, combined model, LASSO-Cox, and Cox survival neural network) were constructed.

RESULTS: Among 381 patients, 67 (17.6%) developed MACEs. All six total plaque parameters showed significant associations with MACEs. In multivariate Cox regression, total noncalcified percent atheroma volume (NCPAV) > 4.68% emerged as the strongest predictor (HR 5.073, 95% CI 2.930-8.786, P < 0.001). Analyzed continuously, each 1-SD increase in total-NCPAV conferred an HR of 1.82 (95% CI 1.54-2.14, P < 0.001). The combined model C-index was 0.750 (95% CI 0.696-0.804; optimism-corrected 0.708), comparable to the plaque model alone (0.744, 95% CI 0.686-0.801; corrected 0.705). The LASSO-Cox and Cox survival neural network models achieved C-indices of 0.747 (95% CI 0.674-0.816) and 0.730 (95% CI 0.628-0.833), respectively. In landmark sensitivity analyses excluding early events, the combined model C-index rose to 0.792, with the likelihood ratio test P value narrowing from 0.117 to 0.061, suggesting a trend toward incremental value for CT-FFR after accounting for potential incorporation bias.

CONCLUSIONS: AI-quantified total noncalcified plaque burden was the strongest predictor of MACEs. The addition of CT-FFR to plaque parameters did not provide a clinically meaningful or statistically significant improvement in overall model performance, including discrimination, model fit, reclassification, or discrimination slope. Although landmark analyses suggested a possible trend toward incremental value after exclusion of early revascularization-driven events, this finding should be considered exploratory and requires further validation. Vessel-specific analyses identified RCA plaque burden as having the greatest prognostic weight among the target vessels; however, this exploratory finding also warrants confirmation in independent cohorts.

PMID:42366355 | DOI:10.1186/s12880-026-02534-6

BMC Emerg Med. 2026 Jun 28. doi: 10.1186/s12873-026-01665-x. Online ahead of print.

ABSTRACT

BACKGROUND: Early recognition of non-invasive ventilation failure in patients with acute respiratory failure in the emergency department is essential to prevent delayed intubation and its associated adverse outcomes. The HACOR score is a pragmatic bedside tool developed to predict non-invasive ventilation failure, most prior investigations have been conducted in intensive care settings and have predominantly relied on single time-point measurements or simple change analyses. In this study, we aimed to evaluate predictive value of early change in the HACOR score for non-invasive ventilation failure in emergency department patients with acute respiratory failure and to examine the temporal nature of this association using Generalized Estimating Equations models.

METHODS: This prospective observational cohort study included 106 adult patients. HACOR, National Early Warning Score, National Early Warning Score 2, and Modified Early Warning Score were calculated immediately before and at 1 h after non-invasive ventilation initiation. ΔHACOR was defined as the difference between 1-hour and baseline HACOR scores. The primary outcome was non-invasive ventilation failure. Discriminative performance was assessed using ROC analysis. Logistic regression was used to evaluate the independent association between ΔHACOR and non-invasive ventilation failure. Generalized estimating equations models were constructed to analyze the time-dependent relationship between HACOR and non-invasive ventilation failure.

RESULTS: Non-invasive ventilation failure occurred in 50.9% of patients. Baseline clinical variables and scores did not significantly discriminate between success and failure groups. In contrast, 1-hour HACOR (AUC = 0.760, 95% CI 0.667-0.854) and ΔHACOR (AUC = 0.798, 95% CI 0.711-0.885) demonstrated significant predictive performance. Patients with ΔHACOR ≥ 0 exhibited a substantially higher failure rate (74.4%) compared to those with ΔHACOR < 0 (34.9%). Each one-point increase in ΔHACOR was independently associated with failure (OR 1.63, 95% CI 1.31-2.03; p < 0.001). In Generalized Estimating Equations analysis, the HACOR × time interaction remained statistically significant across adjusted models, supporting the prognostic value of serial HACOR assessment.

CONCLUSIONS: In emergency department patients receiving non-invasive ventilation, early dynamic changes in HACOR provide superior prognostic information compared with baseline measurements alone. Serial HACOR assessment demonstrated through Generalized Estimating Equations modeling supports potential value of response-guided risk stratification and highlights importance of early reassessment in emergency non-invasive ventilation management.

PMID:42366354 | DOI:10.1186/s12873-026-01665-x

BMC Gastroenterol. 2026 Jun 29. doi: 10.1186/s12876-026-05059-y. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of colorectal cancer (CRC) continues to rise, with colorectal adenoma(CRA) being its primary precancerous lesion. Recent studies suggest that hyperlipidemia may promote adenoma development by influencing cell membrane structure, cholesterol metabolism, and inflammatory responses. However, its independent role in the adenoma stage remains unclear.

OBJECTIVE: To investigate the association between hyperlipidemia and colorectal adenoma(CRA) risk and to evaluate the dose-response relationship based on lipoprotein profile stratification.

METHODS: This single-center retrospective case-control study included 180 patients with colorectal adenoma(CRA) and 80 colonoscopy-negative controls. An additional 80 patients with pathologically confirmed colorectal adenocarcinoma (CRAC) were included as a secondary exploratory comparison group. Demographic characteristics and lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), were collected. Univariate and multivariable unconditional logistic regression analyses were performed to evaluate associations between lipid abnormalities and colorectal adenoma, with adjustment for age, sex, BMI, smoking, alcohol consumption, and family history of colorectal cancer. Variance inflation factors were calculated to assess multicollinearity. Quartile stratification and restricted cubic spline models were used to explore dose-response patterns, and E-value analysis was performed to assess the potential impact of unmeasured confounding.

RESULTS: High TC, high TG, high LDL-C, and low HDL-C were significantly associated with the overall presence of CRA in univariate analysis. After adjustment for potential confounders, these associations remained statistically significant. Quartile stratification showed that higher levels of TC, TG, and LDL-C were associated with progressively higher odds of colorectal adenoma, whereas HDL-C showed an inverse association. The RCS models suggested steeper increases in adenoma odds at higher TC and LDL-C levels, while HDL-C showed an approximately linear inverse association. Although high TG was associated with overall adenoma occurrence, TG levels did not differ significantly across adenoma histological subtypes. Subgroup analyses suggested that smoking, obesity, and family history may modify the associations between dyslipidemia and colorectal adenoma.

CONCLUSION: Hyperlipidemia was independently associated with CRA in this retrospective case-control study. A comprehensive dyslipidemic pattern, characterized by elevated TC, TG, and LDL-C and reduced HDL-C, was observed among patients with CRA. Lipoprotein profiles may serve as accessible clinical indicators for colorectal adenoma risk stratification. However, because of the retrospective case-control design, causal inference and temporal relationships cannot be established, and the possibility of reverse causality should be considered.

PMID:42366352 | DOI:10.1186/s12876-026-05059-y

BMC Oral Health. 2026 Jun 29;26(1):1128. doi: 10.1186/s12903-026-08971-7.

ABSTRACT

BACKGROUND: This study was designed to inspect the effects of vitamin D₃ overdose on the submandibular salivary gland of Albino rats and to investigate the possible protective role of vitamin K₁ after one month, as few studies have addressed its histopathological effects.

METHODS: This study was carried out on 60 adult male Albino rats, and they were divided into three groups. Group I (control): received physiological saline. Group II (vitamin D₃ overdose): received 1 ml/kg/day cholecalciferol (200 IU) for 30 days. Group III (vitamin D₃ + vitamin K₁): received the same vitamin D₃ dose plus vitamin K₁ (15 mg/kg/day) for 30 days. Blood samples were analyzed for baseline and terminal levels of total and ionized calcium. Specimens were examined using Hematoxylin and eosin, alizarin red stain, transmission electron microscopes, and histomorphometric analysis. Statistical analysis was performed using analysis of variance, followed by a post hoc test for pairwise comparisons, and paired t-test for intra-group comparison between baseline and terminal values.

RESULTS: examination of group II revealed pronounced structural alterations, notably acinar atrophy, which was statistically validated by a significant reduction in acinar circumference (p-value = 0.024*), alongside ductal degeneration, vascular congestion, and tissue calcification as detected by alizarin red stain. These histopathological changes correlated with elevated serum calcium levels (p-value = 0.001**). In contrast, co-treatment with vitamin K₁ in group III substantially mitigated these pathological effects, demonstrating preservation of acinar and ductal structures, attenuation of calcific deposits, and partial normalization of serum calcium levels (p-value = 0.004*).

CONCLUSIONS: Chronic administration vitamin D₃ overdose triggered degenerative, inflammatory, and calcific changes in the SMG. Also, co-administration of vitamin K₁ diminished vitamin D₃-induced histopathological changes and hypercalcemia.

PMID:42366346 | DOI:10.1186/s12903-026-08971-7

BMC Womens Health. 2026 Jun 29. doi: 10.1186/s12905-026-04637-2. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical cancer remains a major cause of morbidity and mortality among women in Uganda. Although the Human Papillomavirus (HPV) vaccine is highly effective in preventing cervical cancer, completion of the recommended two-dose schedule remains low, particularly in rural settings. Rukiga District was selected for this study due to persistently low HPV second-dose (HPV2) completion rates compared with national targets. This study assessed health facility-level barriers influencing HPV vaccine completion among adolescent girls aged 9-14 years in rural Uganda.

METHODS: A mixed-methods cross-sectional study was conducted between June and September 2022 in selected Health Centre II (HC II), Health Centre III (HC III), and Health Centre IV (HC IV) facilities in Rukiga District. A household survey involving 292 caregivers of eligible adolescent girls was conducted using systematic random sampling. The primary outcome was completion of the two-dose HPV vaccination schedule (HPV2). Quantitative data were analysed using logistic regression to identify factors associated with vaccine completion. In addition, 21 key informant interviews involving 11 healthcare workers and 10 Village Health Team (VHT) members were conducted and analysed thematically to explore contextual barriers affecting HPV vaccine uptake and completion.

RESULTS: The HPV vaccine completion rate was 23.49%, indicating low coverage. In multivariable analysis, vaccine stock-outs and cold-chain challenges (adjusted odds ratio [AOR] = 1.75, 95% confidence interval [CI]: 1.04-2.93; p = 0.004) and understaffing of healthcare workers (AOR = 1.97, 95% CI: 1.05-3.68; p = 0.006) were the only statistically significant predictors of HPV vaccine completion. Although limited healthcare worker knowledge (AOR = 0.94, 95% CI: 0.70-1.24) and absence of government programmes targeting out-of-school girls (AOR = 0.97, 95% CI: 0.73-1.29) were not statistically significant in the adjusted model, qualitative findings highlighted them as important contextual barriers. Additional challenges identified included weak outreach systems, transportation constraints, misconceptions about HPV vaccination, and limited community awareness.

CONCLUSION: HPV vaccine completion in rural Uganda remains low and is strongly influenced by health system constraints, particularly vaccine supply-chain disruptions and human resource shortages. Strengthening vaccine logistics, improving staffing levels, enhancing healthcare worker capacity, and expanding outreach strategies targeting underserved populations are essential for improving vaccine completion and achieving national immunisation targets.

PMID:42366344 | DOI:10.1186/s12905-026-04637-2

BMC Complement Med Ther. 2026 Jun 29. doi: 10.1186/s12906-026-05447-7. Online ahead of print.

ABSTRACT

BACKGROUND: A recent report showed that Stephania japonica chloroform fraction has potential anticholinesterase and antioxidant activities and is able to improve learning and memory in mice. Therefore, the aim of the present study was to isolate and identify compounds from the chloroform fraction with cholinesterase inhibitory and antioxidant activity that may be useful as new candidates for the treatment of AD.

METHODS: Chromatographic methods were used for isolation of compounds and the isolated compounds were analyzed by spectroscopic methods for structure elucidation. Acetyl- and butyryl-cholinesterase inhibitory activity were evaluated for by Ellman’s method and the antioxidant activity by several in vitro models such as DPPH and hydroxyl radicals scavenging, reducing power, total antioxidant activity, and inhibition of brain lipid peroxidation. The interaction of cholinesterase enzymes and isolated compounds were examined by molecular docking studies.

RESULTS: Bioactivity guided approach led to the isolation of four compounds from the chloroform fraction and identified as aknadinine, aknadilactam, aknadicine and stephisoferuline on the basis of their ¹H-NMR and ¹³C-NMR spectral data. All the compounds were of hasubanan type. They showed significant inhibition against acetylcholinesterase and butyrylcholinesterase, with at least two fold increased affinity for butyrylcholinesterase than acetylcholinesterase. The IC₅₀ values of the alkaloids were in the range of 9.36-14.89 µg/mL against acetylcholinesterase and 3.97-6.66 µg/mL against butyrylcholinesterase. Kinetic analysis revealed that all the four compounds exhibited mixed type of inhibition against both acetylcholinesterase and butyrylcholinesterase. The interaction of compounds with several amino acids of enzymes was supported by molecular docking studies. All the hasubanan alkaloids showed antioxidant activity in all in vitro assays and inhibited peroxidation of brain lipid. The IC₅₀ values of the compounds for scavenging of DPPH and hydroxyl radicals, and lipid peroxidation inhibition were found to be in the range of 5.1-40.91, 10.44-19.41, and 20.60-31.72 µg/mL, respectively.

CONCLUSION: The hasubabanan alkaloids isolated from S. japonica may represent a new class of anti-cholinesterase compounds. The multitargeted activity of hasubanan alkaloids may lead to new candidates for the treatment of AD.

PMID:42366338 | DOI:10.1186/s12906-026-05447-7

Cardiovasc Diabetol. 2026 Jun 28. doi: 10.1186/s12933-026-03270-5. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhagic stroke (HS), including non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), accounts for approximately 30% of all stroke cases and over 40% of stroke-related deaths. With high mortality and disability rates, HS imposes a heavy global health burden. As a core metabolic disorder, insulin resistance (IR) has been proven to be associated with all-cause mortality (ACM) in patients with ischemic stroke in previous studies. Nevertheless, its prognostic value remains unclear in critically ill HS patients admitted to the intensive care unit (ICU). Given the markedly higher mortality and morbidity of HS compared with ischemic stroke, it is essential to explore this association. This study aimed to investigate the correlations between multiple surrogate markers of insulin resistance and all-cause mortality among critically ill HS patients in the ICU setting.

METHODS: Data were extracted from the public eICU-CRD database. Patients with severe HS were identified based on the International Classification of Diseases (ICD)-9/10 diagnostic codes. A total of 1538 ICU-admitted patients with severe HS were enrolled and stratified according to quartiles of various IR surrogate markers. The primary endpoint was in-hospital mortality. Cox regression analysis, Kaplan-Meier survival curves, restricted cubic splines (RCS) and receiver operating characteristic (ROC) curves were adopted for statistical analyses.

RESULTS: Among the 1538 enrolled patients, males accounted for 54.6%, and the overall in-hospital all-cause mortality was 26.59%. Multivariate Cox regression analyses revealed that all IR surrogate markers were significantly correlated with all-cause mortality in severe HS patients. SPISE was negatively correlated with all-cause mortality, while other indicators showed positive correlations. Restricted cubic spline analyses demonstrated non-linear relationships between TyG, SPISE, TG_HDL, METS_IR, TyG_BMI, TyG_RC and mortality. No significant effect modification was observed in interaction analyses. ROC curve analysis indicated that TyG exhibited the highest predictive accuracy.

CONCLUSION: In conclusion, insulin resistance surrogate markers were significantly associated with all-cause mortality in critically ill HS patients. Despite their weak-to-moderate discriminative performance, these indices may serve as auxiliary prognostic references for risk stratification. Clinical application of these indicators is expected to optimize therapeutic strategies and disease progression management. Furthermore, this study enriches current evidence regarding the association between insulin resistance surrogate markers and hemorrhagic stroke, and clarifies their roles in predicting mortality across different stroke subtypes.

PMID:42366337 | DOI:10.1186/s12933-026-03270-5

BMC Geriatr. 2026 Jun 29. doi: 10.1186/s12877-026-07895-9. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a major public health concern among older adults and contribute substantially to disability, reduced quality of life, and increased healthcare burden. Fall prevention-related health literacy practices, reflecting the application of health literacy skills in daily life, may influence an individual’s ability to recognize risk factors and adopt appropriate preventive behaviors. This study aimed to examine factors associated with fall prevention-related health literacy practices among community-dwelling older adults in Northern Thailand.

METHODS: A community-based cross-sectional study was conducted among 415 older adults residing in Chiang Rai Province, Thailand, between February to May 2025. Participants were selected using a multi-stage stratified sampling approach. Data were collected through structured questionnaires assessing sociodemographic characteristics, fear of falling, and fall prevention-related health literacy. Functional mobility was evaluated using the Timed Up and Go (TUG) test. Data were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (IBM Corp., Armonk, NY, USA). Multivariable logistic regression analyses were performed to identify factors independently associated with adequate fall prevention-related health literacy and its subdomains. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

RESULTS: Most participants were female (58.3%), and 61.9% were aged 60-69 years. Overall, 88.70% demonstrated inadequate fall prevention-related health literacy. Housing characteristics (AOR = 3.166, 95% CI: 1.505-6.660) and TUG performance (AOR = 0.352, 95% CI: 0.163-0.761) were significantly associated with adequate fall prevention-related health literacy. Housing characteristics were consistently associated with access (AOR = 1.959, 95% CI: 1.168-3.284), cognitive (AOR = 2.055, 95% CI: 1.203-3.511), communication (AOR = 2.125, 95% CI: 1.233-3.665), and self-management skills (AOR = 1.830, 95% CI: 1.095-3.059). TUG performance was significantly associated with access and cognitive literacy. Additionally, cognitive literacy was significantly associated with marital status and fear of falling, while education level was significantly associated with self-management (AOR = 0.504, 95% CI: 0.296-0.861) and media literacy (AOR = 0.342, 95% CI: 0.211-0.556).

CONCLUSIONS: A substantial proportion of community-dwelling older adults had inadequate fall prevention-related health literacy. Environmental and functional factors were consistently associated with health literacy across multiple domains, with additional associations for marital status, educational attainment, and fear of falling. These findings highlight the need for community-based fall prevention strategies incorporating adapted health communication, environmental modification, mobility assessment, and targeted interventions to strengthen preventive capacity among older adults.

TRIAL REGISTRATION: Not applicable.

PMID:42366333 | DOI:10.1186/s12877-026-07895-9

J Cancer Educ. 2026 Jun 29. doi: 10.1007/s13187-026-02932-y. Online ahead of print.

ABSTRACT

Case-based learning (CBL) is widely used in undergraduate medical education, with demonstrable benefits for students across multiple domains. There is a paucity of data in the post-graduate setting. A robust training program is essential for specialty trainees in medical oncology, yet dedicated educational opportunities are limited by a busy clinical environment. This study aimed to evaluate the feasibility of a post-graduate trainee-led CBL program within a Medical Oncology Department at a major cancer centre in Australia. All eligible participants (3 registrars, 1 clinical fellow, 2 nurse practitioners (NPs), 1 post-graduate student NP) were invited to attend weekly CBL sessions over a 20-week period. Session parameters, such as attendance and duration, were recorded. Feasibility was assessed using 4 of Bowen’s key areas: acceptability, demand, implementation and practicality. A questionnaire was completed by each participant following each session and on conclusion of the program. Researchers performed statistical analysis using Mann-Whitney U tests and conducted thematic analyses on qualitative data. Of 20 scheduled sessions, 14 (70%) ran without cancellation. Attendance rate was 66%, with most absences being attributed to leave. Mean session duration was 61.4 min, with mean preparation time of 24.2 min per participant. Participant perceived value was high (9.1/10) and significantly higher with faculty medical oncologist attendance (9.7 vs. 8.8, p = 0.001). Acceptability scores were excellent (9.4/10). CBL sessions were rated significantly higher than concurrent educational opportunities (9.1 vs. 8.1, p < 0.001). Coding of the qualitative data within participant surveys identified the following themes: CBL sessions (1) stimulated relevant and beneficial discussion, (2) were perceived positively, (3) were negatively affected by other clinical commitments, (4) were enhanced by the presence of a faculty medical oncologist, (5) generated a safe space for collaborative learning, (6) were time-efficient and (7) provided self-study opportunities. A postgraduate, trainee-led CBL program in medical oncology is feasible and was well received at our centre. It offers a promising complement to traditional teaching in a rapidly evolving field where faculty oncologist-led educational opportunities may be limited. Future studies could focus on the potential for virtual implementation to allow for collaboration between centres, to the benefit of rural medical oncology trainees.

PMID:42366331 | DOI:10.1007/s13187-026-02932-y