Tag: pubmed

Cureus. 2026 Jun 29;18(6):e111728. doi: 10.7759/cureus.111728. eCollection 2026 Jun.

ABSTRACT

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory form, metabolic dysfunction-associated steatohepatitis (MASH), are strongly linked to obesity, insulin resistance, type 2 diabetes, and progressive liver fibrosis. Dual and triple glucagon-like peptide-1 (GLP-1)-based polyagonists may provide complementary hepatic and metabolic benefits, but their overall efficacy and safety have not been fully established. This systematic review and meta-analysis evaluated randomized controlled trials comparing dual or triple GLP-1-based polyagonists with placebo in adults with MASLD or MASH. PubMed, the Cochrane Central Register of Controlled Trials, ScienceDirect, and Google Scholar were searched from inception through May 19, 2026. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were analyzed as mean differences (MDs), using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Six randomized controlled trials involving 961 participants were included. The included GLP-1-based polyagonists-tirzepatide, survodutide, pemvidutide, retatrutide, and cotadutide-significantly increased MASH resolution or histological improvement without worsening of fibrosis (RR 3.32, 95% CI 2.28-4.84; I² = 20%) and fibrosis improvement without worsening of MASH (RR 1.49, 95% CI 1.15-1.94; I² = 0%). Treatment also produced a greater relative reduction in liver fat content (MD -44.60 percentage points, 95% CI -51.17 to -38.04; I² = 0%) and increased the likelihood of achieving at least a 30% relative reduction in liver fat by magnetic resonance imaging-proton density fat fraction (RR 4.71, 95% CI 3.04-7.30; I² = 22%). Body weight was significantly reduced, although heterogeneity was considerable (MD -9.14 percentage points, 95% CI -17.38 to -0.91; I² = 98%). Nausea, diarrhea, and vomiting were more frequent with polyagonists, but no statistically significant differences were observed in serious adverse events or adverse events leading to treatment discontinuation. In conclusion, dual and triple GLP-1-based polyagonists improve histological and imaging-based hepatic outcomes in MASLD and MASH and may simultaneously address underlying metabolic dysfunction. However, gastrointestinal intolerance, pharmacological heterogeneity, the small number of trials, and limited follow-up warrant cautious interpretation. Larger phase 3 trials are needed to clarify drug-specific efficacy, long-term safety, and effects on liver-related and cardiovascular outcomes.

PMID:42529769 | PMC:PMC13418920 | DOI:10.7759/cureus.111728

EJHaem. 2026 Jul 29;7(4):e70366. doi: 10.1002/jha2.70366. eCollection 2026 Aug.

ABSTRACT

Objectives: To study the predictive and prognostic values of serum erythropoietin levels (sEPO) measured at diagnosis in lower-risk myelodysplastic syndromes. Methods: We analyzed clinical associations and prognosis with sEPO in 672/1610 patients with at least one year of follow-up data in the prospective EUMDS study. Results: sEPO levels increase with WHO subtypes associated with erythroid hypoplasia and poorer risk IPSS-R scores. sEPO is an independent predictor of transfusion free survival and levels < 200 IU/L predict response to ESA. sEPO is not an independent predictor of overall survival. Conclusions: sEPO predicts transfusion free survival and response to ESA. Trial Registration: The EUMDS Registry (ClinicalTrials.gov: Identifier NCT00600860).

PMID:42529759 | PMC:PMC13418852 | DOI:10.1002/jha2.70366

Int J Nurs Stud Adv. 2026 Jul 12;11:100628. doi: 10.1016/j.ijnsa.2026.100628. eCollection 2026 Dec.

ABSTRACT

BACKGROUND: Gerontogeriatric competencies are considered essential for preparing nurses to meet the complex care needs of ageing populations. However, the intention to work with older adults remains comparatively low among nursing professionals, particularly among newly graduated registered nurses (NGRNs).

OBJECTIVE: This study explored the structural relationships between nursing education, gerontogeriatric competencies, ageism, and the intention to work with older adults.

DESIGN: A nationwide cross-sectional study was conducted.

SETTINGS AND PARTICIPANTS: This nationwide cross-sectional study was conducted in Portugal and included NGRNs who had completed their undergraduate nursing degree in the 2021-2022 academic year. The final sample comprised 242 NGRNs from public and private nursing education institutions.

METHODS: An exploratory structural equation modelling approach was used to examine potential relationships among five latent constructs: Nursing Education (NEDU), Gerontogeriatric Competencies (GGC), Hostile Ageism (AAS_HA), Benevolent Ageism (AAS_BA), and Intention to Work with Older Adults (INT_OA). Model estimation followed an iterative refinement process.

RESULTS: Model estimation encountered convergence difficulties, and the full structural framework could not be fully identified. Consequently, global model fit indices could not be obtained, and the results should be interpreted as exploratory structural associations. Among the estimated paths, a statistically significant association was identified between nursing education and gerontogeriatric competencies (b = 0.437, 95% CI [0.31, 0.57], p < 0.0001), while no statistically significant structural associations were observed between competencies or ageism to the intention to work with older adults.

CONCLUSIONS: Nursing education was positively associated with perceived gerontogeriatric competence; however, the intention to work with older adults appears to be shaped by more complex and potentially contextual factors. These findings highlight the need for theoretical refinement and further research using alternative modelling strategies and larger samples.

PMID:42529745 | PMC:PMC13418224 | DOI:10.1016/j.ijnsa.2026.100628

Clin Cosmet Investig Dermatol. 2026 Jul 25;19:617844. doi: 10.2147/CCID.S617844. eCollection 2026.

ABSTRACT

BACKGROUND: Microwave therapy has emerged as a minimally invasive treatment option, but long-term real-world data, particularly from Southeast Asian populations, remain limited.

PURPOSE: To evaluate the effectiveness of microwave therapy and its impact on quality of life (QoL) in patients with axillary hyperhidrosis and bromhidrosis.

PATIENTS AND METHODS: A longitudinal ambispective case series study was conducted on 52 adult patients with axillary hyperhidrosis and bromhidrosis treated with microwave therapy. Treatment efficacy and QoL improvement were assessed at 1 week and at 3, 6, 9, and 12 months post-intervention using the Minor test, Hyperhidrosis Disease Severity Scale (HDSS), Visual Analog Scale (VAS), and Dermatology Life Quality Index (DLQI). Repeated measures were analyzed using mixed-effects models.

RESULTS: At 1 week, the mean area of discoloration decreased markedly from 49.1 cm² to 0.3 cm² in the left axilla, with similar improvement observed in the right axilla. At 12 months, compared with baseline, the model-predicted probability of HDSS grade 4 decreased from 68.2% to 5.7%, while the mean odor score and DLQI score decreased from 6.8 to 3.0 and from 19.5 to 6.5, respectively. Overall satisfaction at 12 months was 66.6%. Statistically significant improvements were observed across the majority of efficacy outcomes (p < 0.05). The most common adverse events were pain and swelling, which were mild and self-limiting, with no serious complications reported.

CONCLUSION: Microwave therapy demonstrated a favorable safety profile and sustained clinical benefits in patients with axillary hyperhidrosis and bromhidrosis over 12 months of follow-up. Although patient satisfaction declined modestly at 12 months, overall treatment outcomes remained favorable.

PMID:42529744 | PMC:PMC13418893 | DOI:10.2147/CCID.S617844

Can J Stat. 2020 Jun;48(2):204-221. doi: 10.1002/cjs.11527. Epub 2019 Dec 11.

ABSTRACT

With a growing interest in using non-representative samples to train prediction models for numerous outcomes it is necessary to account for the sampling design that gives rise to the data in order to assess the generalized predictive utility of a proposed prediction rule. After learning a prediction rule based on a non-uniform sample, it is of interest to estimate the rule’s error rate when applied to unobserved members of the population. Efron (1986) proposed a general class of covariance penalty inflated prediction error estimators that assume the available training data are representative of the target population for which the prediction rule is to be applied. We extend Efron’s estimator to the complex sample context by incorporating Horvitz-Thompson sampling weights and show that it is consistent for the true generalization error rate when applied to the underlying superpopulation. The resulting Horvitz-Thompson-Efron estimator is equivalent to dAIC, a recent extension of Akaike’s information criteria to survey sampling data, but is more widely applicable. The proposed methodology is assessed with simulations and is applied to models predicting renal function obtained from the large-scale National Health and Nutrition Examination Study survey.

PMID:42529736 | PMC:PMC13417605 | DOI:10.1002/cjs.11527

Gastroenterol Hepatol Bed Bench. 2026;19(1):e5. doi: 10.22037/ghfbb.v19i01.3189. Epub 2026 Mar 2.

ABSTRACT

AIM: This study evaluated the prognostic value of Strasberg classification on 30-day bile duct patency and explored relevant clinical and procedural factors.

BACKGROUND: Bile duct injury (BDI) is a serious complication of cholecystectomy that may influence early outcomes after endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: We retrospectively reviewed 33 patients with BDI treated with ERCP at Dr. Moewardi Hospital from January 2023 to May 2025. Data included demographics, laboratory results, cholecystectomy type, timing of diagnosis and repair, and injury severity (minor: A-C; major: D-E). The primary outcome was bile duct patency at 30 days, assessed by imaging and clinical indicators. Statistical analyses included chi-square, Fisher’s exact, Kaplan-Meier survival, and ROC curves.

RESULTS: Patients had a mean age of 45.9 years; 54.5% were female, and 54.5% had laparoscopic cholecystectomy. Minor and major injuries were observed in 51.5% and 48.5%, respectively. 63.6% achieved bile duct patency by day 30. No significant associations were found between demographic, laboratory, procedural variables, and either injury severity or outcomes (all p>0.05). Kaplan-Meier analysis revealed significantly longer patency in minor injuries compared to major injuries (mean 25.88 vs. 20.88 days, p=0.030).

CONCLUSION: This study highlights Strasberg classification as an independent predictor of early bile duct patency after ERCP. Other common clinical factors did not significantly influence outcomes. These findings underscore the importance of Strasberg classification not only for injury assessment but also for guiding early postoperative management and monitoring. Larger prospective studies are needed to confirm these results and to optimize prognostic tools for BDI care.

PMID:42529730 | PMC:PMC13418495 | DOI:10.22037/ghfbb.v19i01.3189

World J Radiol. 2026 Jul 28;18(7):123894. doi: 10.4329/wjr.123894.

ABSTRACT

BACKGROUND: Chronic cardiopulmonary diseases, including chronic obstructive pulmonary disease, interstitial lung disease, and coronary artery disease, represent a major global health burden. Low-dose computed tomography (LDCT) combined with artificial intelligence (AI) quantitative imaging enables the identification of cardiopulmonary imaging abnormalities in asymptomatic individuals.

AIM: To evaluate early risk factors for cardiopulmonary imaging abnormalities in asymptomatic middle-aged and elderly population using single-inspiratory phase LDCT combined with AI-based whole-lung quantitative analysis.

METHODS: A retrospective collection was conducted on 1035 asymptomatic individuals aged ≥ 40 years who underwent routine single-inspiratory-phase LDCT screening at Zhuzhou 331 Hospital in 2025. An AI platform was utilized to automatically extract airway wall area percentage, low-attenuation area percentage, interstitial lung abnormality, and coronary artery calcification score. Based on risk stratification criteria, the population was divided into a high-risk group (n = 689) and a low-risk group (n = 346) and randomly stratified into a training set (n = 724) and a validation set (n = 311) at a 7:3 ratio. Independent sample t-test or χ ² test was applied to analyze between-group differences. Binary logistic regression was used to screen independently associated factors, and a multivariate logistic regression model was constructed after excluding collinear variables using variance inflation factor (VIF < 5), followed by the establishment of a nomogram prediction model. The receiver operating characteristic curve and DeLong test were employed to evaluate model discrimination. The Hosmer-Lemeshow test and calibration curves were used to assess goodness of fit. Decision curve analysis (DCA) was applied to evaluate clinical net benefit, and internal validation was performed using the bootstrap method (1000 resamplings).

RESULTS: Univariate analysis showed that smoking history, abnormal metabolic status, body mass index (BMI), age, and gender were significantly associated with cardiopulmonary imaging-defined high-risk status (P < 0.05), while work style showed a marginal association in univariate analysis (P = 0.043) but did not retain statistical significance in the multivariate model (P = 0.851). After VIF collinearity screening (all VIF < 5) and multivariate logistic regression analysis with forced entry of six candidate variables, smoking history [odds ratio (OR) = 1.968 per level, 95% confidence interval (CI): 1.665-2.325, P < 0.001], abnormal metabolic status (OR = 3.266, 95%CI: 2.259-4.723, P < 0.001), BMI (OR = 1.150 per unit, 95%CI: 1.079-1.226, P < 0.001), and age (OR = 1.028 per year, 95%CI: 1.005-1.052, P = 0.018) were identified as independently associated factors for cardiopulmonary imaging-defined high-risk status, while male gender demonstrated an (inverse) association (OR = 0.427, 95%CI: 0.276-0.660, P < 0.001) after adjustment for smoking and other covariates. The nomogram-based risk stratification model integrating the above five independently associated factors achieved an area under the curve (AUC) of 0.833 (95%CI: 0.787-0.879) in the validation set, significantly outperforming the baseline model containing only age and gender (AUC = 0.647, 95%CI: 0.582-0.712; DeLong test: Delta AUC = 0.186, z = 5.256, P < 0.001). The Hosmer-Lemeshow goodness-of-fit test confirmed satisfactory calibration (training set: χ ² = 10.40, P = 0.238; validation set: χ ² = 6.50, P = 0.591). Calibration curves and DCA demonstrated good agreement and positive clinical net benefit. Bootstrap internal validation (1000 resamples) confirmed model robustness (mean AUC = 0.792, 95%CI: 0.760-0.824).

CONCLUSION: The LDCT-based nomogram model combined with AI quantitative imaging analysis may assist in identifying individuals with cardiopulmonary imaging abnormalities in asymptomatic screening populations, potentially guiding further diagnostic evaluation. Prospective studies are warranted to establish its role in improving clinical outcomes.

PMID:42529724 | PMC:PMC13419150 | DOI:10.4329/wjr.123894

Cureus. 2026 Jun 29;18(6):e111733. doi: 10.7759/cureus.111733. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Anemia continues to pose a significant public health challenge, particularly among women of reproductive age. Despite ongoing nutritional intervention programs and iron supplementation strategies, the burden of anemia remains persistently high. In addition to iron deficiency anemia (IDA), inherited hemoglobin disorders such as β-thalassemia and sickle cell disease are important contributors to anemia. High-performance liquid chromatography (HPLC) has emerged as a reliable and widely used method for the identification of hemoglobin variants and the quantification of hemoglobin A₂ (HbA₂) and hemoglobin F (HbF). The objective of our study was to investigate the range of hemoglobinopathies identified by HPLC and to compare them with routine hematological parameters.

METHODS: Our study was conducted in the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, over 18 months from August 2024 to January 2026. A total of 277 anemic females aged 19-49 years with hemoglobin levels below 11 g/dL were enrolled. Hematological parameters were analyzed using an automated hematology analyzer, while hemoglobin fraction analysis was performed using cation-exchange HPLC. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS: The mean age of participants was 33.2 ± 9.07 years, and the mean hemoglobin level was 9.7 ± 0.95 g/dL. Microcytic hypochromic anemia was the predominant pattern with elevated red cell distribution width (RDW) values indicating anisocytosis. HPLC analysis revealed abnormal hemoglobin patterns in 44% of participants. Sickle cell trait was the most common abnormality (26%), followed by sickle cell disease (11%) and β-thalassemia trait (7%). RDW showed significantly superior discriminative ability for predicting hemoglobinopathies compared to mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH).

CONCLUSION: Hemoglobinopathies were common among anemic women of reproductive age, with sickle cell trait being the predominant abnormality detected on HPLC analysis. Routine hematological parameters showed considerable overlap, whereas RDW demonstrated better discriminatory ability but was insufficient alone. HPLC improved the detection and characterization of hemoglobin variants and may be useful in the targeted evaluation of high-risk populations.

PMID:42529704 | PMC:PMC13418751 | DOI:10.7759/cureus.111733

Front Psychiatry. 2026 Jul 15;17:1890660. doi: 10.3389/fpsyt.2026.1890660. eCollection 2026.

ABSTRACT

INTRODUCTION: Refugees carry a cumulative burden of past trauma and ongoing post-migration stress, yet the mechanisms linking these to mental health functioning remain incompletely understood. Sense of coherence – a salutogenic orientation comprising comprehensibility, manageability, and meaningfulness – may help account for these associations. We tested sense of coherence as a mediator of both associations and compared the relative weight of the two stressor domains.

METHODS: A cross-sectional sample of 151 refugees and asylum seekers in the Netherlands (84.1% with a residence permit) completed the LEC-5, PMLP, SOC-13, and OQ-45.2 in person with research-assistant support across Dutch, English, and Arabic. We conducted multiple regression and three PROCESS Model 4 mediation analyses, including a parallel mediation with sense of coherence and post-migration stress as simultaneous mediators.

RESULTS: Both stressors predicted poorer functioning, with post-migration stress substantially stronger than trauma exposure (b = .40 vs. .17). Sense of coherence was the strongest correlate of functioning (r = -.57) and statistically mediated both cross-sectional associations. In the parallel mediation, sense of coherence and post-migration stress mediated the trauma-functioning association, and the direct effect was no longer statistically significant once both were included. Family-oriented stressors dominated the burden profile: worries about family in the country of origin (78.8%), missing family (73.5%), and uncertainty about the future (70.9%).

DISCUSSION: As a personal-resilience construct shaped by – not insulated from – external conditions, sense of coherence warrants sustained attention in this population.

PMID:42529696 | PMC:PMC13418565 | DOI:10.3389/fpsyt.2026.1890660

Cureus. 2026 Jul 28;18(7):e113549. doi: 10.7759/cureus.113549. eCollection 2026 Jul.

ABSTRACT

BACKGROUND: Major depressive disorder (MDD) and amyotrophic lateral sclerosis (ALS) are usually treated as unrelated, yet depressive symptoms occur in a substantial minority of people with ALS and may appear early. These symptoms are heterogeneous and may reflect syndromal MDD, psychological and functional burden, fatigue, apathy, pseudobulbar affect, frontotemporal involvement, sleep or respiratory disturbance, medication effects, or shared affective vulnerability. A proposed pruning-continuum model suggests both disorders may share vulnerability in microglia-mediated synaptic pruning, with ALS amplified by autophagy and protein-quality-control failure and MDD by RNA-processing, stress, and immune dysregulation. We performed an exploratory secondary transcriptome-wide association study (TWAS)/pathway-integration analysis to test whether predefined nicotinamide mononucleotide (NMN)-nominated pathways map onto this vulnerability.

METHODS: We integrated precomputed S-PrediXcan outputs for MDD and ALS across available brain-relevant tissues. Ten Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were predefined from a prior re-analysis of NMN-associated transcriptional programs in aged mouse metabolic tissues. Mouse-derived candidates were represented by human ortholog symbols before the human TWAS screen. The analysis tested nominated pathways rather than the 35-gene NMN-robust list as a standalone set. Cross-tissue screening used Stouffer Z aggregation, tissue-level Wilcoxon testing, competitive permutation testing, percentile bootstrap intervals, pairwise disease statistics, Levene variance tests, concordance measures, and leave-one-out sensitivity analysis. No analysis was treated as confirmatory or evidence of causal mediation.

RESULTS: MDD showed the strongest Stouffer-based exploratory signal in the synaptic vesicle cycle pathway, with a meta-across-tissue Stouffer Z of 3.41 and a wide bootstrap 95% confidence interval of -0.46 to 7.40. This signal did not survive competitive permutation testing (p = 0.1222) or Wilcoxon testing (p = 0.1926). The strongest tissue-level result occurred in the amygdala (Z = 4.057; nominal Wilcoxon p = 0.0093), although tissue-level permutation testing was not performed in the multi-gene-set run. ALS showed no significant meta-across-tissue enrichment among the 10 nominated pathways but displayed candidate gene-level signals in autophagy, endosomal, and vesicle-related genes, including TBK1 and C9orf72. Exploratory Levene tests indicated variance heterogeneity in the regulation of the actin cytoskeleton, endocytosis, and neuroactive ligand-receptor interaction; the actin cytoskeleton and endocytosis remained significant in pooled global false discovery rate (FDR) analysis. Fourteen genes were influential in at least two focus pathways, including EGF, KNG1, FGF8, RAC1, PAK1, PAK2, RAF1, MAPK1, and FGFR1.

CONCLUSIONS: These findings are hypothesis-generating. MDD and ALS may stress overlapping cellular logistics processes while engaging largely different genes. MDD showed the strongest exploratory pathway-level signal in synaptic vesicle biology, whereas ALS showed candidate gene-level coherence in autophagy and endosomal processes without significant meta-pathway enrichment. NMN/NAD+ repletion is not established as a treatment for MDD, ALS, or their comorbidity. These findings generate hypotheses about NAD+-linked cellular stress pathways for future preclinical and clinical studies.

PMID:42529685 | PMC:PMC13419321 | DOI:10.7759/cureus.113549