Tag: pubmed

Ann Ital Chir. 2026 May 27;97(6):1120-1126. doi: 10.62713/aic.4318.

ABSTRACT

AIM: Splenic flexure resection (SFR) is a technically demanding procedure due to the region’s complex vascular anatomy and limited colonic mobility. The orientation of the colonic anastomosis-either isoperistaltic or anisoperistaltic-represents a critical yet understudied technical factor that may influence operative complexity and postoperative recovery. This study aimed to compare short-term outcomes between these two anastomotic configurations.

METHODS: We conducted a retrospective cohort study at a tertiary colorectal center, including consecutive patients who underwent elective SFR for colon cancer between January 2023 and December 2024 (n = 53). Patients were stratified according to the orientation of the side-to-side anastomosis: isoperistaltic (ISO, n = 32) or anisoperistaltic (ANISO, n = 21). Demographic, oncologic, surgical, and postoperative variables were analyzed. Primary endpoints were operative time, gastrointestinal recovery (time to first flatus and first stool), and length of hospital stay. Secondary endpoints included estimated blood loss, conversion rate, 30-day complications, inflammatory markers, analgesic use, costs, and quality of life assessed using the Gastrointestinal Quality of Life Index (GIQLI).

RESULTS: Baseline demographics were largely comparable between groups, although patients in the ANISO group were significantly older (71.4 ± 6.0 vs. 67.8 ± 4.4 years; p = 0.023) and had a slightly lower body mass index (BMI) (25.4 ± 1.4 vs. 26.5 ± 2.3 kg/m²; p = 0.049). Operative time was significantly shorter in the ANISO group (126.5 ± 13.8 vs. 154.8 ± 23.4 minutes; p < 0.001). Gastrointestinal recovery was faster following anisoperistaltic anastomosis, with earlier first flatus (31.7 ± 8.7 vs. 39.3 ± 10.2 hours; p = 0.005), while time to first stool did not differ significantly (51.2 ± 12.5 vs. 55.8 ± 9.0 hours; p = 0.159). Length of hospital stay was comparable (5.2 ± 0.8 vs. 5.6 ± 1.3 days; p = 0.172). Estimated blood loss was significantly lower in the ANISO group (34.6 ± 17.0 vs. 47.6 ± 13.6 mL; p = 0.006). Conversion rate and postoperative complications were comparable between groups (p = 1.000 and p = 0.743 respectively). No differences were observed in inflammatory markers, analgesic use, or costs. GIQLI scores at 30 days were similar between groups (126.9 ± 11.0 vs. 123.0 ± 8.1; p = 0.166).

CONCLUSIONS: Anisoperistaltic anastomosis following splenic flexure resection is safe and effective and is associated with shorter operative time and faster postoperative gastrointestinal recovery without compromising short-term outcomes. The choice of anastomotic orientation may be influenced by intraoperative anatomical conditions and technical factors.

PMID:42304157 | DOI:10.62713/aic.4318

Ann Ital Chir. 2026 Jun 10;97(6):973-982. doi: 10.62713/aic.4495.

ABSTRACT

AIM: Single-photon emission computed tomography/computed tomography (SPECT/CT) technology is a promising imaging tool for the detection of postoperative residual and recurrent lesions in differentiated thyroid cancer (DTC). However, existing studies presented mixed results, and the overall diagnostic efficacy of this technology remains unclear. Therefore, this meta-analysis was conducted to systematically evaluate the diagnostic value of ¹³¹I-SPECT/CT for identifying residual or recurrent disease in patients with DTC.

METHODS: A systematic literature search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library from inception to 4 December 2025. The search strategy incorporated relevant keywords and MeSH terms, such as “differentiated thyroid cancer”, “thyroidectomy”, “SPECT”, “SPECT/CT”, “SPECT-CT”, “metastasis”, “recurrence”, and “residual”. Study selection, data extraction, and risk-of-bias assessment were performed independently by two investigators. The overall diagnostic performance was assessed by calculating the pooled sensitivity (SENS), specificity (SPEC), and summary receiver operating characteristic (SROC) curve. Sensitivity analyses were performed by excluding individual studies to assess the robustness and stability of the pooled results. Subgroup analysis was used to determine the source of heterogeneity.

RESULTS: Six studies involving 800 patients were included. Pooled analysis showed that lesion-level ¹³¹I-SPECT/CT had a pooled SENS of 0.59 (0.33-0.81) and a pooled SPEC of 0.92 (0.85-0.96). The pooled diagnostic odds ratio (DOR) was 18 (3-91), and the area under the curve (AUC) was 0.92. Based on patient-level ¹³¹I-SPECT/CT, the pooled SENS was 0.89 (0.63-0.98), the pooled SPEC was 0.95 (0.70-0.99), and the DOR was 166 (7-4126). The AUC of the SROC curve was 0.97. The overall diagnostic accuracy of ¹³¹I-SPECT/CT was confirmed, regardless of whether it was conducted at the patient or lesion level. To avoid potential patient overlap, we excluded an earlier study for a sensitivity analysis. The results after exclusion remained within reasonable limits, supporting the robustness of the main findings. Subgroup analyses indicated that patient type may be a potential source of heterogeneity in the non-threshold effect. No publication bias was statistically suggested through Deeks’ funnel plot.

CONCLUSIONS: ¹³¹I-SPECT/CT demonstrates efficacy for the targeted detection of postoperative residual and recurrent lesions in DTC, showing high diagnostic accuracy. However, existing evidence is subject to high heterogeneity, and clinical application should be carefully interpreted in combination with the specific characteristics of patients. Future higher-quality studies conducted using unified standards are needed to further verify its clinical value.

PMID:42304154 | DOI:10.62713/aic.4495

Ann Ital Chir. 2026 Jun 10;97(6):1017-1025. doi: 10.62713/aic.4624.

ABSTRACT

AIM: Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfort in patients after heart valve surgery.

METHODS: A single-center, retrospective cohort study was conducted, continuously enrolling patients who underwent heart valve surgery at Affiliated Hospital of Xuzhou Medical University from June 2022 to June 2025. A total of 150 patients were included. The patients were divided into a control group (conventional positioning care, n = 76) and an experimental group (individualized positioning care, n = 74) according to the nursing method received. The primary outcome measures were changes in cardiac function indicators, such as left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after nursing, as well as postoperative comfort scores measured using the Visual Analog Scale for Comfort (VAS-Comfort). Secondary outcomes included postoperative pain scores (Numeric Rating Scale [NRS]), sleep quality (Richards-Campbell Sleep Questionnaire [RCSQ]), pulmonary complications, pressure ulcer incidence, intensive care unit (ICU) length of stay, and postoperative hospital days. Group comparisons were performed using t-test, Mann-Whitney U test, Chi-square test, or Fisher’s exact test. Postoperative NT-proBNP was analyzed using analysis of covariance (ANCOVA), adjusting for baseline levels.

RESULTS: Baseline characteristics were balanced and comparable between the two groups (all p > 0.05). Compared to the control group receiving conventional care, the experimental group receiving individualized positioning care showed more significant improvement in cardiac function: the change in LVEF (ΔLVEF) was significantly higher in the experimental group (0.85 ± 3.98% vs. -3.15 ± 4.20%, p < 0.001); NT-proBNP levels on postoperative day 7 were significantly lower in the experimental group (median: 685.00 pg/mL vs. 1003.50 pg/mL, p < 0.001), and the difference remained statistically significant after adjusting for preoperative values (F = 12.13, p < 0.001). The VAS-Comfort score at 72 h postoperatively was significantly higher in the experimental group (p < 0.001). For secondary outcomes, the experimental group had significantly lower NRS pain scores at 72 h postoperatively (p < 0.001), significantly higher RCSQ sleep scores (69.26 ± 9.87 vs. 59.86 ± 12.02, p < 0.001), a lower incidence of pulmonary complications (9.46% vs. 23.68%, p = 0.019), and significantly shorter ICU stay and postoperative hospital days (both p < 0.001). There were no statistically significant differences between the two groups in the incidence of pressure ulcers or adverse events (p > 0.05).

CONCLUSIONS: Individualized positioning care can significantly promote cardiac function recovery, enhance comfort, and improve clinical outcomes in patients after heart valve surgery without increasing safety risks.

PMID:42304150 | DOI:10.62713/aic.4624

Hypertens Res. 2026 Jun 16. doi: 10.1038/s41440-026-02710-9. Online ahead of print.

ABSTRACT

Management of chronic hypertension in pregnancy remains uncertain, and current guidelines do not address whether the prognostic significance of blood pressure (BP) varies across gestation. To evaluate gestational age-specific associations between maternal BP in the first half of pregnancy and adverse maternal and neonatal outcomes. We conducted a multicenter registry-based cohort study from April 2022 to March 2023 at 65 tertiary referral centers in Japan. A total of 273 women with chronic hypertension and singleton pregnancies were enrolled before 14 weeks’ gestation (median age, 37 years; IQR, 34-40). Systolic and diastolic BP were assessed at three gestational windows (8-9, 10-13, and 14-18 weeks). Aspirin exposure was treated as time-dependent. The primary outcome was a composite of adverse maternal and neonatal events. Cox proportional hazards models and restricted cubic spline analyses were used. Adverse outcomes occurred in 32.6% (89/273). BP-risk associations differed by timing. No association was observed at 8-9 weeks. At 10-13 weeks, risk increased progressively with higher systolic BP, including excess risk in the moderate range (120-134 mmHg) and the highest risk at ≥135 mmHg (HR, 4.11; 95% CI, 1.14-14.82). At 14-18 weeks, a threshold pattern emerged, with increased risk above 140 mmHg (HR, 2.19; 95% CI, 1.40-3.43). Associations were weaker among women who initiated aspirin before 10 weeks, although interaction was not statistically significant. In chronic hypertension, maternal BP during 10-13 weeks of gestation carries heightened prognostic relevance. These findings support gestational age-specific risk assessment and motivate evaluation of early preventive strategies.

PMID:42304127 | DOI:10.1038/s41440-026-02710-9

Pediatr Res. 2026 Jun 16. doi: 10.1038/s41390-026-05184-0. Online ahead of print.

ABSTRACT

BACKGROUND: Infants undergoing therapeutic hypothermia (TH) due to neonatal encephalopathy often require sedation and pain medication. Dexmedetomidine may be a good alternative to morphine as it provides both sedation and analgesia. However, the safety and pharmacokinetics (PK) of dexmedetomidine in this population are not well established.

METHODS: In this Phase II, multicenter, open-label, randomized, safety and PK trial, 48 infants undergoing TH for encephalopathy were randomized to receive dexmedetomidine (25) or morphine (23) using standardized doses. PK parameters of dexmedetomidine in this population were calculated using a nonlinear mixed effects modeling using NONMEM^® 7.5 software.

RESULTS: There were no statistically significant differences between groups in baseline characteristics, hospitalization outcomes and adverse events. A total of 315 dexmedetomidine PK samples using a 1-compartment model with first-order elimination analysis were analyzed. Median clearance and volume of distribution were 0.51 L/kg/h and 0.25 L/kg. Weight, post-menstrual age, maximum liver enzymes, and encephalopathy severity influenced dexmedetomidine PK.

CONCLUSION: The incidence of adverse events and hospitalization outcomes in infants randomized to dexmedetomidine or morphine during hypothermia were similar. Using population PK to model dexmedetomidine, lower clearance and volume of distribution parameters were found in infants undergoing hypothermia compared to previously published parameters in non-cooled infants.

IMPACT: Infants undergoing therapeutic hypothermia for encephalopathy often require drugs to treat pain and for sedation in the intensive care unit. Dexmedetomidine may be a better alternative to opiates since it provides sedation, analgesia, and prevents shivering but does not suppress ventilation. In this randomized, unmasked, safety and PK trial we found no significant differences in short term hospital outcomes and incidence of adverse events in infants receiving dexmedetomidine when compared to infants receiving morphine. The pharmacokinetics of dexmedetomidine in this at-risk population was further established.

PMID:42304121 | DOI:10.1038/s41390-026-05184-0

Sci Rep. 2026 Jun 17. doi: 10.1038/s41598-026-57623-x. Online ahead of print.

ABSTRACT

Prenatal exposure to environmental pollutants, particularly heavy metals and pesticides, is a major public health concern because of its potential association with fetal growth and development. These toxicants can cross the placental barrier and accumulate in fetal tissues. Meconium, the first neonatal feces, is a well-established biomarker of cumulative fetal exposure during late pregnancy. However, evidence regarding sex-specific associations between prenatal pollutant exposure and neonatal outcomes remains limited, particularly in low- and middle-income countries. A cross-sectional study was conducted among 123 full-term newborns in Syria between August and September 2025, including 68 from Damascus and 55 from Latakia. Meconium samples were collected within the first hours after birth, prior to feeding, using sterile contamination-free procedures. Samples were stored at – 20 °C and transported under controlled cold-chain conditions to accredited laboratories. Heavy metals (Pb, Hg, Cd, As, Cr, Ni, Mn, Cu, Se, Tl, Sb) were quantified using atomic absorption spectrophotometry following microwave-assisted acid digestion. Pesticides (diazinon, chlorpyrifos, malathion, DDT/DDE, permethrin) were extracted using organic solvents and analyzed using high-performance liquid chromatography. Statistical analyses were performed using SPSS version 23.0, including sex-stratified multivariate regression models adjusted for maternal and neonatal covariates. All target pollutants were detected in meconium samples, indicating widespread prenatal exposure. Considerable inter-individual variability in pollutant concentrations was observed across all analytes. Sex-specific associations were identified between pollutant levels and neonatal outcomes. Among male newborns, mercury was negatively associated with birth weight, whereas nickel showed a positive association. Diazinon exposure was associated with reduced head circumference. Among female newborns, lead, thallium, and DDT/DDE showed associations with birth weight. In addition, DDT/DDE was associated with head circumference and birth length, whereas permethrin was associated with shorter birth length. Descriptive regional variation in pollutant concentrations was observed between Damascus and Latakia, although these differences were not the primary focus of the present analysis. This study identified widespread prenatal exposure to multiple environmental pollutants and observed sex-specific associations with neonatal outcomes. Meconium biomonitoring represents a useful approach for assessing cumulative fetal exposure during late pregnancy. Given the observational cross-sectional design, these findings should be interpreted cautiously. Some pesticide-related findings require confirmation using more selective analytical methods. Further prospective studies are needed to confirm these associations and better understand the biological mechanisms underlying sex-specific susceptibility.

PMID:42304096 | DOI:10.1038/s41598-026-57623-x

Nat Comput Sci. 2026 Jun 16. doi: 10.1038/s43588-026-01002-z. Online ahead of print.

ABSTRACT

Gene-environment interaction (G×E) analyses play a crucial role in advancing genetic discovery, addressing missing heritability, and facilitating precision medicine. However, existing G×E methods are mostly designed for cross-sectional data, limiting the utility of longitudinal data. Here we propose SAGELD, a scalable and accurate genome-wide G×E method for longitudinal traits that controls for sample relatedness in large-scale datasets. SAGELD uses matrix projection to construct test statistics and the SPA_GRM framework to efficiently control for sample relatedness, achieving 10- to 10,000-fold speedups over existing methods while maintaining greater power than cross-sectional analyses. We evaluated SAGELD through extensive simulations and UK Biobank analyses. Using age and body mass index as environmental exposures, we identified 74 loci with genetic × age interactions and 5 loci with genetic × adiposity interactions in the pooled analysis of longitudinal primary care data and cross-sectional assessment data. These results highlight the advantages of leveraging longitudinal data in G×E analyses.

PMID:42304093 | DOI:10.1038/s43588-026-01002-z

Commun Biol. 2026 Jun 16. doi: 10.1038/s42003-026-10451-1. Online ahead of print.

ABSTRACT

Cell-cell communication (CCC) contributes to bacterial survival and adaptability. Gram-positive bacteria employ secreted peptides to coordinate CCC. While the molecular pathways activated by these peptides are well studied, little is known about how individual cells contribute to initiating the signaling response. To address this question, we used microdroplet arrays to examine the major human pathogen Streptococcus pneumoniae and its TprA/PhrA regulator/peptide CCC system, which promotes colonization and virulence. We measured phrA promoter activity in wild-type (WT) cells and in a phrA deletion mutant, using populations seeded before signaling began. As signaling emerged, we observed heterogeneity in S. pneumoniae signaling within and across microdroplets. Addition of exogenous PhrA increased both the magnitude of signal and the percentage of signaling cells, yet it did not reduce the heterogeneity of signal. When examining whether PhrA peptide produced from WT cells was shared with ΔphrA cells, we found a preference for self-signaling over signaling to neighboring cells. Overall, we developed a platform to quantify cell-cell signaling at the single-cell level and determined that at early stages TprA/PhrA signaling is highly heterogeneous and primarily targets producing cells. We propose that this heterogeneity and its amplification through autoinduction may confer a fitness advantage to the population.

PMID:42304065 | DOI:10.1038/s42003-026-10451-1

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-58469-z. Online ahead of print.

ABSTRACT

To identify psychosocial factors associated with medication adherence among elderly patients with chronic diseases, guided by the Integrated Theory of Health Behavior Change (ITHBC). A cross-sectional survey was conducted among 1,138 community-dwelling adults aged sixty years or older who were receiving long-term treatment for chronic diseases. A structured questionnaire was administered that incorporated validated instruments including the Adherence to Refills and Medications Scale (ARMS), the Medication Literacy Knowledge-Attitudes-Practices (KAP) Scale, the Beliefs about Medicines Questionnaire (BMQ), the Self-efficacy for Appropriate Medication Use Scale (SEAMS), and the Social Support Rating Scale (SSRS). Descriptive statistics, group comparisons, and binary logistic regression were used to examine the psychosocial factors associated with medication adherence. A total of 1,102 valid responses were obtained, yielding a response rate of 96.84%. Among the participants, 46.64% demonstrated good medication adherence. Guided by the ITHBC framework, psychosocial variables were categorized into intention-, capability-, and context-related domains. Logistic regression analysis showed that higher self-efficacy (OR = 0.874, p < 0.001) and higher medication literacy (OR = 0.980, p = 0.020) were associated with lower odds of poor medication adherence, whereas stronger medication concern beliefs (OR = 1.128, p = 0.008) and a history of adverse drug reactions (OR = 0.596, p = 0.035) were associated with poorer adherence. Compared with older adults living with a spouse, those living alone (OR = 3.848, p = 0.003) and those living with children (OR = 3.404, p = 0.004) showed significantly higher odds of poor medication adherence. Medication adherence among older adults with chronic diseases was associated with medication literacy, self-efficacy, social support, and medication beliefs. The ITHBC provided a useful framework for understanding these psychosocial determinants. The findings highlight the importance of multidimensional adherence-support interventions integrating medication education, psychosocial support, and self-management enhancement for older adults with chronic diseases.

PMID:42304063 | DOI:10.1038/s41598-026-58469-z

Sci Rep. 2026 Jun 16. doi: 10.1038/s41598-026-57900-9. Online ahead of print.

ABSTRACT

The domain shift problem induced by variable working conditions severely constrains the cross-domain generalization capability of data-driven fault diagnosis models. Existing methods lack collaborative modeling of the multi-scale time-frequency characteristics of vibration signals at the feature extraction level. They also neglect the constraint guidance of fault physical mechanisms on the feature alignment process at the domain adaptation level. To address these deficiencies, this paper proposes a physics-guided cross-domain adaptation framework-a Hierarchical Hybrid Transformer network with Contrastive Learning (PgHHT-CL). The framework comprises three key designs. At the feature encoding level, a hierarchical hybrid Transformer encoder is constructed. It achieves collaborative extraction of transient impulse components and periodic modulation components in vibration signals through gated interactive fusion of local convolutional branches and global self-attention branches across multiple abstraction levels. At the domain adaptation level, a physics-guided cross-domain contrastive learning strategy leverages the order-invariance relationship between fault characteristic frequencies and rotational frequency from bearing dynamics prior knowledge to constrain the construction of cross-domain positive and negative sample pairs. The feature alignment process is thereby required to satisfy physical consistency beyond statistical distribution matching. At the training optimization level, a joint optimization objective integrates classification loss, cross-domain contrastive loss, and physical consistency loss, with a progressive weight adjustment strategy to ensure stable convergence of multi-task learning. Extensive cross-condition transfer experiments on two public bearing datasets from Case Western Reserve University and Paderborn University show that PgHHT-CL achieves average diagnostic accuracies of 94.94 ± 0.32% and 90.26 ± 0.50%, respectively, attaining the highest mean accuracy across all 18 transfer tasks among the representative state-of-the-art baselines selected for comparison. The framework also exhibits notable robustness under large domain shift and strong noise conditions. Ablation experiments and feature visualization analyses further validate the effectiveness and physical interpretability of the physics-guided strategy and hierarchical hybrid architecture.

PMID:42304057 | DOI:10.1038/s41598-026-57900-9