Tag: pubmed

Zhonghua Wei Chang Wai Ke Za Zhi. 2026 Apr 25;29(4):510-517. doi: 10.3760/cma.j.cn441530-20251129-00455.

ABSTRACT

Objective: To investigate the surgical safety and oncological efficacy of minimally invasive surgery (MIS) for primary gastric gastrointestinal stromal tumors (GISTs) with a maximum diameter of ≤5 cm. Methods: A retrospective cohort study was conducted. The inclusion criteria were as follows: patients undergoing radical local resection via MIS, pathologically confirmed primary gastric GISTs, maximum tumor diameter ≤5 cm, and complete available clinicopathological data, adjuvant therapy information and follow-up records. The exclusion criteria included multiple GISTs, a history of other malignant tumors, and distant metastasis or local invasion detected preoperatively or intraoperatively. Clinical data of 517 patients with gastric GISTs who underwent radical surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2018 to December 2024 were retrospectively collected. All patients were divided into four groups according to surgical approaches: laparoscopic surgery group (Lap group, n=411), robotic surgery group (Robot group, n=9), endoscopic surgery group (Endo group, n=44), and laparoscopic-endoscopic cooperative surgery group (LECS group, n=53). Partial gastrectomy was performed in the Lap, Robot and LECS groups, while endoscopic submucosal dissection was the only surgical method in the Endo group. The Lap group was further subdivided into the favorable anatomical location subgroup (Lap-F group, e.g., anterior wall, greater curvature) and the unfavorable anatomical location subgroup (Lap-C group, e.g., posterior wall, lesser curvature, cardia, pylorus) based on tumor location. The LECS group was divided into the laparoscopy-dominated resection subgroup (LECS-L group) and the endoscopy-dominated resection subgroup (LECS-E group) according to the resection modality. Perioperative outcomes and follow-up data of patients in different groups were observed and analyzed. Results: Among all the patients, 227(43.9%) were male , with a median age of 62.5 (55.0, 68.0) years. There were 105 cases with tumor diameter ≤2.0 cm and 412 cases with 2.1-5.0 cm. According to postoperative pathological risk stratification, 98 cases were very low-risk, 368 low-risk, 36 moderate-risk and 15 high-risk. Baseline data comparison showed no statistically significant differences in gender, age and mitotic count among the Lap, Robot, Endo and LECS groups (all P>0.05), while significant differences were found in tumor growth direction, tumor diameter and pathological risk grade (all P<0.001). No statistically significant baseline differences were observed between the Lap-F and Lap-C groups, nor between the LECS-L and LECS-E groups (all P>0.05). All surgeries were successfully completed in the four groups. R0 resection was achieved in all patients of the Lap, Robot and LECS groups, while the surgical margin could not be evaluated in the Endo group. The average operation time of the four groups was (91.4±40.8) minutes, (104.8±28.8) minutes, (60.2±40.5) minutes and (141.7±19.4) minutes, the numbers of patients with intraoperative blood loss ≤50 ml in each group were 356, 7, 44, and 46, respectively. The median time to resuming liquid diet was 4.0 (3.0,4.0) days, 4.0 (3.0,6.0) days, 3.0 (2.0,3.0) days and 4.0 (4.0,5.0) days, and the median postoperative hospital stay was 6.0 (5.0,7.0) days, 6.0 (5.0,8.5) days, 4.0 (4.0,6.0) days and 7.0 (5.0,8.0) days in the four groups, respectively. Intraoperative complications occurred in 13 cases of the Lap group (all with intraoperative bleeding, blood loss >200 ml), 1 case of intraoperative perforation in the Endo group, 1 case of intraoperative bleeding in the LECS group, and no intraoperative complications in the Robot group. Postoperative complications were observed in 17 cases of the Lap group, including 5 cases of gastroparesis, 10 cases of pulmonary infection, 1 case of pancreatic fistula and 1 case of incision bleeding; no relevant postoperative complications were found in the other three groups. Subgroup analysis revealed that the operation time in the Lap-F group was significantly shorter than that in the Lap-C group [(79.3±39.0) minutes vs. (98.1±40.4) minutes, t=-4.566, P<0.001], with no statistically significant differences in other intraoperative and postoperative outcomes (all P>0.05). No statistically significant differences were found in all intraoperative and postoperative indicators between the LECS-L and LECS-E groups (all P>0.05). The median follow-up duration of all patients was 34 (19, 53) months, and no tumor recurrence, metastasis or death was observed in any patient during the follow-up period. Conclusion: Laparoscopic surgery, robotic laparoscopic surgery, endoscopic surgery and laparoscopic-endoscopic cooperative surgery all yield excellent surgical safety and oncological efficacy in the treatment of gastric GISTs with a maximum diameter of ≤5 cm. Tumor anatomical location has a certain impact on the operation time of laparoscopic surgery, but no significant effect on surgical safety and efficacy. In laparoscopic- endoscopic cooperative surgery, both endoscopy-dominated and laparoscopy-dominated tumor resection achieve comparable surgical safety and therapeutic efficacy.

PMID:42045716 | DOI:10.3760/cma.j.cn441530-20251129-00455

Zhonghua Wei Chang Wai Ke Za Zhi. 2026 Apr 25;29(4):484-491. doi: 10.3760/cma.j.cn441530-20260110-00026.

ABSTRACT

Objective: To investigate the efficacy and safety of mFOLFOXIRI combined with bevacizumab plus cytoreductive surgery (CRS) in patients with resectable peritoneal metastasis of colorectal cancer (CRC). Methods: A single-center, prospective randomized controlled design was conducted. Inclusion criteria: confirmed synchronous or metachronous peritoneal metastasis of CRC, aged >18 years, adequate organ function and tolerance to chemotherapy, resectable peritoneal lesions with peritoneal cancer index (PCI) <20, Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1, and tolerance to CRS. Exclusion criteria: intolerance or inefficacy to oxaliplatin, distant unresectable metastasis, emergency surgery, active malignancy, history of thromboembolism, pregnancy or lactation, and other severe comorbidities. Between August 2022 and December 2024, eligible patients with resectable peritoneal metastasis of CRC treated at the Sixth Affiliated Hospital, Sun Yat-sen University were enrolled and randomly assigned at a 1:1 ratio to the neoadjuvant therapy group (mFOLFOXIRI plus bevacizumab followed by CRS) or the direct CRS group. The primary endpoint was the 1-year progression-free survival rate. Secondary endpoints included the response to neoadjuvant therapy, completeness of cytoreduction (CC) score, length of postoperative hospital stay, and postoperative complications. Results: A total of 53 patients who underwent surgery were included, with 19 in the neoadjuvant therapy group and 34 in the direct CRS group. There were no statistically significant differences between the two groups in age, sex, BMI, primary tumor location, pathological type, pattern of peritoneal metastasis (synchronous/metachronous), extraperitoneal metastasis, history of prior systemic therapy, baseline radiological PCI score, or tumor markers (CEA, CA19-9, CA125) (all P>0.05). In the neoadjuvant therapy group, post-treatment radiological PCI score was significantly lower than baseline [M(Q₁,Q₃): 6.0 (4.0, 12.0) vs. 8.0 (5.0, 12.0), Z=-3.086, P=0.002], and CEA was significantly reduced [3.9 (2.8, 7.3) μg/L vs. 7.7 (4.1, 16.1) μg/L, Z=-2.809, P=0.005]. Hemoglobin and albumin levels were also decreased [107.0 (97.5, 117.0) g/L vs. 134.0 (118.0, 140.5) g/L, Z=-3.019, P=0.003;35.9 (34.9, 39.3) g/L vs. 40.0 (37.3, 42.9) g/L, Z=-2.213, P=0.027], with all differences statistically significant (all P<0.05). CA19-9 and CA125 showed a downward trend, but the differences were not statistically significant (all P>0.05). There were no significant between-group differences in CC grade (proportion of CC 0-1: 17/19 vs. 88.2% [30/34]), length of postoperative hospital stay [10.0 (7.0, 13.0) days vs. 13.0 (9.3, 14.0) days], or incidence of severe postoperative complications (8/19 vs. 38.2%[13/34]) (all P>0.05). The proportion of 1-year progression-free survival in the neoadjuvant therapy group was 10/19, which was higher than that in the direct CRS group (29.4%), but the difference was not statistically significant (χ²=2.797, P=0.096). Conclusion: Neoadjuvant therapy with mFOLFOXIRI plus bevacizumab can reduce peritoneal tumor burden without increasing surgical risk, and may improve progression-free survival. However, due to the small sample size and short follow-up duration, long-term benefits need to be confirmed by further follow-up.

PMID:42045712 | DOI:10.3760/cma.j.cn441530-20260110-00026

Aesthetic Plast Surg. 2026 Apr 27. doi: 10.1007/s00266-026-05847-7. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: The nasal tip plays a central role in facial aesthetics, and achieving long-term tip stability is a key objective in rhinoplasty. This study compared postoperative tip stability between structural rhinoplasty using a strut graft (SG) and preservation rhinoplasty with an underlay Pitanguy ligament graft (PLG).

METHOD: Eighty-six primary rhinoplasty candidates were enrolled and divided into two groups of 43. One group received structural rhinoplasty with strut graft, while the other underwent preservation rhinoplasty with an underlay PLG. Nasal tip rotation and projection were measured using 3D soft tissue scans before surgery and at 3, 6, and 9 months postoperatively.

RESULTS: Time significantly affected tip projection (P = 0.001) with both groups showing a downward trend, but no significant differences were observed between techniques at 3, 6, or 9 months (P > 0.05). Tip rotation showed a similar pattern; no significant differences between techniques at any time point. Repeated measures ANOVA confirmed a significant effect of time on rotation (P = 0.001) without a significant time-by-group interaction (P = 0.285).

CONCLUSION: Both structural rhinoplasty with SG and preservation rhinoplasty with underlay PLG yield similar outcomes in maintaining tip projection and rotation over 9 months. Time-dependent reductions were observed, but no statistically significant differences existed between techniques.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42045684 | DOI:10.1007/s00266-026-05847-7

AIDS Behav. 2026 Apr 28. doi: 10.1007/s10461-026-05145-y. Online ahead of print.

ABSTRACT

Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being relates to ART adherence among youth with HIV (YWH), including those using oral or LAI-based regimens. We analyzed baseline data from YWH aged 18-29 years in the United States enrolled between 2023 and 2025 in a randomized controlled trial addressing HIV care barriers, mental health, and substance use. Oral ART adherence was measured using a validated scale, with high adherence defined as a score ≥ 80%. For participants on LAI-ART, high adherence was defined as having no missed or delayed injection visits. We assessed the associations between financial well-being (i.e., unmet subsistence needs, overall financial situation, and mobile technology vulnerability) and adherence using descriptive statistics and adjusted prevalence ratios (PRs) estimated with log-Poisson models with robust standard errors. Among 201 participants, the median age was 27 years. Most (89.1%, n = 179) used oral ART, while 10.0% (n = 20) received LAI-ART. High adherence was achieved by 69.8% of oral ART users and 90% of LAI-ART users. Participants who reported they could “barely get by” financially had significantly lower adherence compared to those living comfortably (RR 0.70, 95% CI 0.52-0.95). Greater unmet subsistence needs were also associated with reduced adherence (RR 0.85, 95% CI 0.73-0.99). Financial well-being was linked to adherence among YWH using both oral and LAI-ART. Efforts to reduce financial hardship may support improved HIV treatment outcomes.

PMID:42045638 | DOI:10.1007/s10461-026-05145-y

Arch Gynecol Obstet. 2026 Apr 27;313(1):176. doi: 10.1007/s00404-026-08431-1.

ABSTRACT

INTRODUCTION: Cervical cerclage is an acceptable procedure in women with cervical insufficiency and is known to be effective in the prevention of preterm delivery. However, limited data exist regarding long-term health outcomes among offspring exposed to cerclage during pregnancy. Since the presence of a foreign body during pregnancy may change the vaginal microbiome, we aimed to study whether a cervical cerclage is associated with long-term infectious morbidity of the offspring.

STUDY DESIGN: A retrospective population-based cohort study was performed at a tertiary medical center, including all singleton deliveries between the years 1991-2021. Long-term infectious morbidity was compared among offspring after pregnancies with and without cervical cerclage. The diagnoses of infectious morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan-Meier survival curve was utilized to evaluate the cumulative incidence. A Cox proportional hazards model was used to control for confounders.

RESULTS: Out of 356,356 offspring included in the analysis, 0.4% (n = 1416) were following pregnancies with cervical cerclage. Unadjusted analyses demonstrated no significant difference in total infectious morbidity between the groups (OR 1.0, 95% CI 0.9-1.1; p = 0.369, Table 1). Kaplan-Meier analysis showed no difference in cumulative incidence (log-rank test P-value = 0.19, Fig. 1). In the primary analysis, cerclage was not associated with long-term infectious morbidity. However, in a secondary model, after adjustment for confounders including gestational age, obesity and diabetes, cerclage exposure was associated with a modest reduction in the risk of long-term infectious morbidity (adjusted HR 0.9, 95% CI 0.87-0.99, p = 0.036).

CONCLUSION: In this large population-based cohort, cervical cerclage was not associated with increased long-term infectious morbidity in offspring. A modest association with reduced infectious morbidity was observed after adjustment for confounding factors. These findings should be interpreted cautiously given the observational design and potential residual confounding.

PMID:42045628 | DOI:10.1007/s00404-026-08431-1

Lung. 2026 Apr 27;204(1):23. doi: 10.1007/s00408-026-00889-9.

ABSTRACT

PURPOSE: Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare lung disorder characterized by autoantibodies against Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF). Whole-lung lavage is the conventional treatment, but it does not address the underlying pathophysiology. This systematic review and meta-analysis aims to further evaluate the effects of inhaled GM-CSF on gas exchange, oxygenation, and lung volume.

METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. A literature search was performed across PubMed, Embase, and the Cochrane Library from inception to October 2025. Randomized Controlled Trials (RCTs) comparing inhaled GM-CSF to a control in adult patients with aPAP were included. The primary outcomes assessed pulmonary gas exchange, oxygenation, and lung volume, while exercise capacity and dyspnea levels were secondary outcomes. Statistical analyses were performed using Review Manager (RevMan) version 5.4.1 and R version 4.5.2, with heterogeneity assessed using I² statistics.

RESULTS: Four phase III RCTs comprising 402 patients (224 inhaled GM-CSF, 178 control) with ≥ 25 weeks of follow-up were included. Inhaled GM-CSF significantly enhanced DLCO% predicted (MD 5.09; 95% CI 2.05 to 8.13; p = 0.001; I² = 0%) and reduced PA-aO₂ (MD – 4.25; 95% CI – 6.62 to – 1.88; p = 0.0004; I² = 0%), with corresponding increases in PaO₂. Dyspnea scores significantly improved (SMD – 0.49; 95% CI – 0.70 to – 0.29; I² = 9%). No significant improvements were observed in lung volume or exercise capacity. Continuous and intermittent regimens demonstrated comparable efficacy and side effects across subgroups.

CONCLUSION: Inhaled GM-CSF improves gas exchange, oxygenation, and dyspnea in aPAP while maintaining a favorable safety profile, indicating its potential as a noninvasive, targeted therapy.

PMID:42045620 | DOI:10.1007/s00408-026-00889-9

Sci Rep. 2026 Apr 27. doi: 10.1038/s41598-026-50567-2. Online ahead of print.

ABSTRACT

This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in moderate acne vulgaris and to assess the corresponding changes in patient-reported quality-of-life. In this open label, randomised controlled trial conducted at a university student clinic, Muscat, Oman, 163 patients with moderate and severe acne vulgaris were assigned equally to receive either oral azithromycin or oral doxycycline. Treatments were administered over a three-month period with monthly clinical assessments. Acne severity was quantified using a validated acne severity scale, and quality of life was measured at baseline and at study end via a standardised questionnaire. Analyses were performed using univariate statistics. The cohort comprised 163 participants (mean age 20.2 ± 1.7 years; 67.3% female). Both groups experienced significant and comparable reductions in acne severity after three months. Parallel, statistically significant improvements were observed in quality-of-life scores across domains related to symptoms, emotional well-being, and social functioning. Oral azithromycin and doxycycline demonstrate equivalent efficacy in reducing moderate acne vulgaris and both confer substantial enhancements in patients’ quality of life. These findings support either antibiotic as an appropriate option for addressing both the dermatological and psychosocial burdens of moderate acne. The trial was registered with the Australia New Zealand Clinical Trial Registry (ACTRN12619000073101; Date: 18^th of January 2019).

PMID:42045615 | DOI:10.1038/s41598-026-50567-2

Sci Rep. 2026 Apr 27. doi: 10.1038/s41598-026-50540-z. Online ahead of print.

ABSTRACT

Neuroimaging hyperscanning-the monitoring of brain activity of two or more persons simultaneously-has emerged as a popular tool to uncover the neural mechanisms of social interactions. The use of functional near-infrared spectroscopy (fNIRS)-a non-invasive, child-friendly technique tolerant of motion artifacts-has significantly advanced the research of social interactions. Despite its popularity, the field has yet to agree on best practices for quantifying inter-brain connections (IBC) during social interactions, including the frequency band of interest (FOI) for signal analysis. Various choices of FOIs, along with subject-level physiological differences or experimental design, may have contributed to inconsistent findings across prior studies. In this study, we reviewed various methods used and their corresponding FOI results in previous fNIRS hyperscanning research focused on the topics of cooperation. Additionally, we propose a new methodology to quantify FOI that aims to point to the origin of synchronization between brains. We tested the proposed method on three independent fNIRS hyperscanning datasets. The three datasets involved three different populations and three types of social interactions commonly studied in the literature. We examined the effect of sample sizes and data exclusion rates on the calculation of FOIs and statistical results. We offer a method for testing and adoption within the fNIRS community, aimed at eliminating arbitrary FOI selections and potentially enhancing the reproducibility of results in future fNIRS hyperscanning research.

PMID:42045603 | DOI:10.1038/s41598-026-50540-z

Sci Rep. 2026 Apr 27. doi: 10.1038/s41598-026-50824-4. Online ahead of print.

ABSTRACT

Hastelloy C276 is extensively used in aerospace, chemical, and high-temperature engineering systems, yet its poor machinability leads to rapid tool degradation and reduced productivity. This study develops a comprehensive machine-learning (ML) framework to model and predict flank-wear progression during the turning of Hastelloy C276 under Dry, Minimum Quantity Lubrication (MQL), and nanoparticle-assisted MQL environments. A series of controlled machining experiments were performed by varying cutting speed, feed, depth of cut, and machining length, generating more than 700 labeled wear samples measured using optical microscopy. Four ML models-Ridge Regression, Decision Tree, Random Forest, and Support Vector Regression- were trained using five-fold cross-validation for hyperparameter optimization, and their final performance was evaluated on an independent test dataset. Among them, Random Forest exhibited the highest predictive accuracy (R² = 0.982, MAE = 0.004 mm, RMSE = 0.006 mm), effectively capturing nonlinear wear behavior associated with thermal-mechanical interactions. Experimental results confirmed the strong influence of lubrication environment on tool life, with nano-MQL reducing average flank wear by 28-35% compared to Dry machining due to enhanced cooling and tribo-film formation by hBN nanoparticles. Feature-importance analysis further identified lubrication condition, machining length, and feed rate as the dominant predictors governing wear evolution. The study demonstrates that reliable tool-wear prediction can be achieved using machining parameters alone-without additional sensors-highlighting the potential of ML-driven frameworks for future intelligent tool-condition monitoring and sustainable machining of difficult-to-cut superalloys.

PMID:42045593 | DOI:10.1038/s41598-026-50824-4

Sci Rep. 2026 Apr 27. doi: 10.1038/s41598-026-50838-y. Online ahead of print.

ABSTRACT

We explore the critical dynamics of driven interfaces propagating through a two-dimensional disordered medium with long-range spatial correlations, modeled using fractional Brownian motion (FBM). Departing from conventional models with uncorrelated disorder, we introduce quenched noise fields characterized by a tunable Hurst exponent [Formula: see text], allowing systematic control over the spatial structure of the background medium. The interface evolution is governed by a quenched Kardar-Parisi-Zhang (QKPZ) equation modified to account for correlated disorder, namely QKPZ[Formula: see text]. Through analytical scaling analysis, we uncover how the presence of long-range correlations reshapes the depinning transition, alters the critical force [Formula: see text], and gives rise to a family of critical exponents that depend continuously on [Formula: see text]. Our findings reveal a rich interplay between disorder correlations and the non-linearity term in QKPZ[Formula: see text], leading to a breakdown of conventional universality and the emergence of nontrivial scaling behaviors. The exponents are found to change by H in the anticorrelation regime ([Formula: see text]), while they are nearly constant in the correlation regime ([Formula: see text]), suggesting a robust-universal behavior for the latter. By a comparison with the quenched Edwards-Wilkinson model, we study the effect of the non-linearity term in the QKPZ[Formula: see text] model.

PMID:42045590 | DOI:10.1038/s41598-026-50838-y