Tag: pubmed

Eur J Orthop Surg Traumatol. 2026 Aug 1;36(1):315. doi: 10.1007/s00590-026-04901-z.

ABSTRACT

INTRODUCTION: Early identification of patients at high risk of deep surgical site infection after open extremity fractures is crucial for timely intervention and improved outcomes. This study aimed to develop and internally validate a clinical prediction model, the BIGB²OSS score, for predicting deep surgical site infection within three months of injury using variables easily obtained in early post-injury phase.

METHODS: A prospective cohort study was conducted at two university hospitals in Japan, including 570 consecutive patients with open extremity fractures. Data on 18 candidate predictors were collected in the early post-injury phase. The primary outcome was the occurrence of deep surgical site infection within three months of injury. A backward stepwise logistic regression model was used to build the prediction model. Model performance was assessed using the area under the curve (AUC) and internal validation with bootstrap methods.

RESULTS: The BIGB²OSS score was a 5-point model based on four predictors: BMI ≥ 25 (1 point), Gustilo-Anderson classification IIIA (1 point), Gustilo-Anderson IIIB or IIIC (2 points), OTA-OFC skin = 3 (1 point), and smoking history (1 point). The model showed fair discriminative ability with an AUC of 0.76 (95% CI 0.70-0.83). Internal validation using bootstrap resampling with 1000 repetitions yielded an optimism-adjusted C-statistic of 0.76 (95% CI 0.70-0.83). The estimated probabilities of deep surgical site infection were 2.7% for scores 0-1, 11% for scores 2-3, and 30% for scores 4-5, closely matching the actual prevalence.

CONCLUSION: The BIGB²OSS score is a simple clinical prediction model with fair discrimination for deep surgical site infection in patients with open extremity fractures. It uses early post-injury variables and may support timely risk communication and follow-up planning. Further external validation is needed to confirm its utility in diverse clinical settings.

PMID:42542500 | DOI:10.1007/s00590-026-04901-z

Environ Monit Assess. 2026 Aug 1;198(8):900. doi: 10.1007/s10661-026-15759-3.

ABSTRACT

The Danjiangkou Reservoir is the drinking-water source of the South-to-North Water Diversion Middle Route and a national Class I drinking-water protection area. Ensuring low turbidity is essential for safeguarding downstream public health and national water security. However, turbidity retrieval in large inland reservoirs using remote sensing is often constrained by limited in situ samples and weak model generalization across seasons and years. We integrated 49 GaoFen-1 (GF-1) satellite images with in situ measurements from the national water quality network to construct a matchup dataset for model development and validation from 2020 to 2024. Using this matchup dataset, five modeling approaches were compared under a time-ordered validation framework to identify a suitable model for predicting in situ turbidity from GF-1 spectral features. Among them, the sparrow search algorithm (SSA)-optimized extreme gradient boosting (XGBoost) approach achieved the best performance and was selected for retrospective quarterly mapping from 2013 to 2024. Across 45 quarterly clear-sky scenes, 95.5% of all retrieved turbidity values were below 15 nephelometric turbidity units (NTU), while persistent spatial heterogeneity and recurrent inflow-zone hotspots remained evident. Scene-wise diagnostics indicated stable performance across acquisition dates, with per-scene mean absolute error (MAE) < 4 NTU for all 49 scenes and 61.2% of scenes falling within 0-2 NTU. Precipitation showed the clearest association with turbidity and exhibited a region-dependent lagged response within the 52-h pre-acquisition window, with the strongest response observed in the precipitation-sensitive zone about 28-51 h before image acquisition (r = 0.36). Water temperature showed a moderate negative relationship with turbidity (r = – 0.47). These results provide spatial evidence for long-term turbidity surveillance, recurrent hotspot identification, and post-storm monitoring in large source-water reservoirs.

PMID:42542499 | DOI:10.1007/s10661-026-15759-3

J Math Biol. 2026 Aug 1;93(2):29. doi: 10.1007/s00285-026-02428-9.

ABSTRACT

We study mechanisms and effects of ideal free distributions (IFDs) on an ecological community consisting of n prey and m predator species, for any positive integers n and m, by considering the corresponding diffusive Lotka-Volterra system with time-periodic coefficients. We define a notion of joint IFD in a time-periodic environment, and give necessary and sufficient conditions for it to be achieved by a subcollection of prey and predator species with suitable dispersal strategies. Next, we show, via construction of a Lyapunov functional, that such dispersal strategies are evolutionarily stable, in the sense that if a subcollection of prey and predator species adopts an ideal free dispersal strategy, then the total community must converge to an IFD for large time; if a unique combination of prey-predator species adopts an ideal free strategy, then it can drive all other species to extinction. Conversely, if a combination of prey-predator species adopts a non-ideal free dispersal strategy, then it can be invaded by some suitable mutant strategies. Our results provide insight into the evolution of spatial distribution of ecological communities with predator-prey interactions.

PMID:42542498 | DOI:10.1007/s00285-026-02428-9

Pain Ther. 2026 Aug 1. doi: 10.1007/s40122-026-00872-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Persistent postoperative low back pain remains a concern after unilateral biportal endoscopic (UBE) surgery, but the impact of surgery-related interspinous ligament edema is unclear. This study investigated whether magnetic resonance imaging (MRI)-detected interspinous ligament region edema (ISLRE) was associated with delayed pain recovery and persistent postoperative low back pain after UBE surgery.

METHODS: This retrospective cohort study included patients who underwent single-level UBE surgery between October 2021 and October 2024. On the basis of MRI within 3 days postoperatively, ISLRE was graded as grade 0 (no/minimal edema), grade 1 (localized edema), or grade 2 (diffuse or confluent edema involving most of the operated interspinous region). Clinical outcomes included visual analogue scale scores for low back pain (VAS-LBP), Oswestry disability index (ODI), and persistent postoperative low back pain, defined as 12-month VAS-LBP > 3. Multivariable linear and logistic regression analyses were performed to assess independent associations, and linear mixed-effects modeling was used to evaluate longitudinal pain recovery trajectories.

RESULTS: A total of 245 patients were included (grade 0: n = 117; grade 1: n = 74; grade 2: n = 54). Interobserver agreement for MRI grading was substantial (κ = 0.802). At 12 months, VAS-LBP scores increased progressively across edema grades (1.66 ± 1.20, 2.34 ± 1.45, and 3.54 ± 1.65 for grades 0-2, respectively; P < 0.001), while persistent postoperative low back pain occurred in 21.4%, 41.9%, and 68.5% of patients, respectively (P < 0.001). Compared with grade 0 edema, grade 2 edema was independently associated with higher 12-month pain scores (β = 1.78, 95% confidence interval [CI] 1.34-2.22; P < 0.001) and more than eightfold increased odds of persistent postoperative low back pain (odds ratio [OR] 8.90, 95% CI 4.01-19.76; P < 0.001). Linear mixed-effects modeling demonstrated significantly delayed pain recovery trajectories in higher-grade edema groups. Although statistically significant, the magnitude of ODI differences at 12 months was below the minimal clinically important difference (MCID) threshold, suggesting limited clinical relevance.

CONCLUSIONS: The extent of postoperative ISLRE, particularly grade 2 edema, may be useful for postoperative risk stratification and targeted patient management after UBE surgery.

PMID:42542473 | DOI:10.1007/s40122-026-00872-5

Evid Based Dent. 2026 Aug 1. doi: 10.1038/s41432-026-01239-7. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Awawdeh L, Almesleh B, Hammouri H, Al-Qudah A. The outcome of pulp revascularization of necrotic mature permanent teeth with periapical lesions using platelet-rich fibrin versus induced bleeding: a prospective preliminary randomized clinical trial. Clinical Oral Investigations. 2026; https://doi.org/10.1007/s00784-026-06877-w .

DESIGN: A single-centre, prospective, two-arm parallel randomised clinical trial presented as a preliminary (early-phase) investigation.

CASE SELECTION: Fifty adults presenting with mature permanent teeth where the pulpal status was diagnosed as necrotic with associated periapical lesions were included. The pool of patients was allocated to one of two regenerative endodontic treatment protocols, each containing 25 patients. In one group, 25 patients underwent a procedure where a canal scaffold was generated by deliberately provoking bleeding from the periapical tissues (induced bleeding, IB). In the second group of patients, an autologous platelet-rich fibrin (PRF) membrane was placed to serve as a biological barrier. A clinical and radiographic review was done at baseline, 6 months, and 12 months after treatment completion.

DATA ANALYSIS: Pre-specified endpoints were set to determine, firstly, tooth survival and overall treatment success and secondly, periradicular healing through radiographic evaluation. Within- and between-group comparisons were made using the appropriate statistical tests and statistical significance was set at p < 0.05.

RESULTS: At the one-year mark, 98% of teeth had survived (47/48). Interestingly, survival did not differ meaningfully between the two treatment groups (p = 0.166). Both treatment options produced healing with a statistically significant reduction in periradicular pathology compared with baseline at the six- and twelve-month reviews (p < 0.001). Also, a statistically significant impact was found on the overall success rate at the endpoint (p = 0.022). In the IB group, a 100% success rate was achieved (23/23) compared to 75% in the PRF group (18/24), with a combined overall success of 85.4%.

CONCLUSIONS: Whichever treatment pathway was followed, all teeth survived the chosen regenerative endodontic procedure after 12 months. The preliminary results indicated that results and clinical outcomes were comparable. Although the IB option showed a higher overall success rate, this finding should be interpreted with caution as the results fall within the early phase clinical evidence framework. Further investigations are required to determine the superiority of one method over the other.

PMID:42542468 | DOI:10.1038/s41432-026-01239-7

Evid Based Dent. 2026 Aug 1. doi: 10.1038/s41432-026-01245-9. Online ahead of print.

ABSTRACT

BACKGROUND: Ozonated water is increasingly being explored as a gentler alternative to chlorhexidine for chemical plaque control because of its antimicrobial and anti-inflammatory properties and the absence of common side effects such as staining or altered taste. However, the evidence on its effectiveness-especially in healthy individuals-remains unclear. This systematic review and meta-analysis aimed to determine whether ozonated water is more effective than placebo or chlorhexidine mouthwash in reducing dental plaque.

METHODS: An extensive literature search was carried out across PubMed, Cochrane Library, Scopus, Web of Science, LILACS, ScienceDirect, EBSCOhost, and Google Scholar up to August 5, 2025. Randomized controlled trials involving healthy participants and comparing ozonated water with placebo or chlorhexidine were included. In total, five studies were selected for qualitative synthesis, of which four were included in the meta-analysis. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was applied to calculate standardized mean differences (SMDs) with 95% confidence intervals.

RESULTS: The meta-analysis suggested that ozonated water may provide slightly better short-term plaque reduction than placebo or chlorhexidine (SMD = -1.35; 95% CI: -2.77 to 0.06). However, as the confidence interval crossed the line of no effect, this difference was not statistically significant. Risk of bias was high in one study, unclear in three studies, and low in one study. The overall certainty for plaque reduction was rated as “low”.

CONCLUSION: While ozonated water appears to be a promising short-term option for plaque control-especially for individuals unable to tolerate chlorhexidine-the current evidence is not strong enough to confirm that it works better than standard rinses or even plain water. Well-designed, longer-term clinical trials are needed before ozonated water can be recommended for routine daily use.

PMID:42542467 | DOI:10.1038/s41432-026-01245-9

Eur J Orthop Surg Traumatol. 2026 Aug 1;36(1):314. doi: 10.1007/s00590-026-04883-y.

ABSTRACT

PURPOSE: Renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), are commonly prescribed antihypertensive medications with proposed antifibrotic and bone-protective effects. Their impact on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study evaluates the association between perioperative RAAS inhibitor exposure and postoperative outcomes after TSA.

METHODS: A retrospective cohort study using the TriNetX network identified patients undergoing primary shoulder arthroplasty (2005-2025), stratified by ACEi or ARB use. One-to-one propensity score matching was performed. Outcomes included 90-day medical complications and 1-year mechanical complications and revision.

RESULTS: Post-matching, 27,938 patients per cohort (ARB vs. control) and 30,602 per cohort (ACEi vs. control) were included. Neither ARB nor ACEi use reduced rates of manipulation under anesthesia or capsular release at one year. Both cohorts had higher 90-day rates of emergency department visits, readmission, myocardial infarction, and acute renal failure. ACEi use was additionally associated with pulmonary embolism, deep-vein thrombosis, transfusion, and sepsis. At one year, both cohorts showed higher rates of periprosthetic joint infection, aseptic loosening, and revision. Dislocation risk was increased with ACEi use only.

CONCLUSION: Perioperative RAAS inhibitor use was not associated lower rates of antifibrotic procedures following TSA. Instead, RAAS inhibitor use was associated with higher rates of several perioperative medical complications and longer-term surgical events, including infection and revision. ACE inhibitor exposure demonstrated a broader complication profile compared with ARB exposure. However, because patients receiving RAAS inhibitors often have greater comorbidity burden, these findings should be interpreted as associative rather than causal.

LEVEL OF EVIDENCE III: Retrospective Cohort Study.

PMID:42542466 | DOI:10.1007/s00590-026-04883-y

Support Care Cancer. 2026 Aug 1;34(8):820. doi: 10.1007/s00520-026-11054-6.

ABSTRACT

BACKGROUND AND AIM: The increasing incidence of cancer and the fact that the family is an important factor in cancer care; attention to the positive mental health of cancer patients should be sought to provide solutions to improve the mental health of these caregivers. The present study aimed to investigate the effect of web-based education on positive mental health of family caregivers of breast cancer patients undergoing chemotherapy in educational and treatment centers of Zahedan University of Medical Sciences.

MATERIALS AND METHODS: This study is a semi-experimental study. The statistical population of the study included all family members of breast cancer patients undergoing chemotherapy who referred to Imam Ali Hospital in Zahedan in 1402. The samples included 70 people who were randomly assigned to two groups: the intervention group and the control group. Caregivers in the intervention group received the necessary training and education for 20 days through a website prepared by the researcher. Data collection was carried out using the demographic information formula and the 9-question positive mental health questionnaire of Lockett before the intervention and 30 days after the intervention. The data were analyzed using descriptive and analytical tests using SPSS 27 statistical software and independent t-tests, paired t-tests, and chi-square tests.

RESULTS: Before the intervention, there was no significant difference between the two groups in terms of positive mental health (p = 0.43). However, after web-based training, the results of the analysis of covariance (ANCOVA) with adjustment for pre-test scores showed that the positive mental health score in the intervention group was 19.02 ± 3.05, compared to 15.94 ± 2.61 in the control group (p = 0.0001).

CONCLUSION: The findings of this study suggest that web-based educational programs can enhance the positive mental health of family caregivers of breast cancer patients undergoing chemotherapy. Accordingly, such interventions may be considered an effective supportive approach for family caregivers in oncology care settings.

PMID:42542461 | DOI:10.1007/s00520-026-11054-6

Diabetologia. 2026 Aug 1. doi: 10.1007/s00125-026-06807-1. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to evaluate hepatic, pancreatic and abdominal fat depots across glycaemic categories in Asian Indians with matched BMI, and to identify predictors of dysglycaemia.

METHODS: In this cross-sectional study, 45 adults (15 each with normoglycaemia or living with prediabetes and newly diagnosed type 2 diabetes) were matched for BMI. Fat fractions in the liver and pancreas were quantified on the basis of the proton density fat fraction (PDFF) measured using multi-echo chemical-shift-encoded MRI (CSE-MRI). We quantified the cross-sectional area of following abdominal fat compartments by MRI: subcutaneous adipose tissue (SCAT) (anterior, posterior, superficial, deep), intra-abdominal adipose tissue (IAAT), intra-peritoneal adipose tissue, retroperitoneal adipose tissue etc. Total body fat (%) and total fat mass (g) were measured using dual-energy x-ray absorptiometry (DEXA). Insulin sensitivity and beta cell function were derived from HOMA indices.

RESULTS: The hepatic fat fraction (HFF) was nearly twofold higher in the prediabetes group (10.78 ± 6.50%) and the type 2 diabetes group (10.35 ± 9.95%) compared with the normoglycaemia group (5.34 ± 4.69%), with significant differences for both comparisons (p=0.009 and p=0.026, respectively). The fat fractions in the pancreas were similarly elevated in individuals living with prediabetes (5.83 ± 4.73%) and type 2 diabetes (5.35 ± 4.75%) compared with the normoglycaemic group (2.97 ± 3.56%, p<0.05). IAAT, superficial SCAT, posterior SCAT and retroperitoneal adipose tissue were significantly higher in individuals living with prediabetes and those with type 2 diabetes than in the normoglycaemic group (p<0.05). Superficial SCAT and posterior SCAT were also significantly higher in individuals living with prediabetes compared to those with type 2 diabetes (p<0.05). After adjustment for age and BMI, only fat fractions in the liver remained an independent predictor of dysglycaemia (OR 1.11 per 1% increase; p=0.023). Each 1% increase in the fat fraction in the liver increased odds of prediabetes by 16% and those of overall dysglycaemia by 11%. HOMA-β was preserved or elevated in individuals living with prediabetes but decreased in those with type 2 diabetes.

CONCLUSIONS/INTERPRETATION: Asian Indians living with prediabetes or type 2 diabetes at a modestly increased BMI of approximately 25 kg/m² exhibit marked ectopic fat. The fat fraction in the liver independently predicted dysglycaemia. These findings highlight the need for early and aggressive interventions at the stage of normoglycaemia and prediabetes to avert beta cell decline and diabetes progression in Asian Indians.

TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/06/054228).

PMID:42542458 | DOI:10.1007/s00125-026-06807-1

Eur J Pediatr. 2026 Aug 1;185(8):632. doi: 10.1007/s00431-026-07286-7.

ABSTRACT

Sudden Unexplained Death in Youth (SUDY) requires thorough investigation to identify underlying causes and guide prevention strategies. In the Netherlands, cases are investigated using the standardized Postmortem Evaluation of Sudden Unexplained Death in Infants and Children (PESUDIC), in which autopsy is offered as a standard component. However, its invasive nature and associated time burden may limit parental acceptance. This study evaluated to what extent the cause of death can be established using a limited set of diagnostic tests compared to the standard procedure including autopsy. In this observational study, children > 2 years of age who died suddenly and unexpectedly and underwent PESUDIC, including imaging and autopsy, were included. Two expert panels, consisting of a forensic and a pediatric specialist, independently assessed early diagnostic tests available before autopsy. Cases were classified by level of diagnostic certainty and need for autopsy. Panel conclusions were compared with the reference standard: a multidisciplinary audit incorporating all available information, including autopsy findings. Sixty-six cases were included (median age 12 years (IQR 4-14.7), 63% male). Panels identified indicative information for a cause of death in 60 patients (91%). Nevertheless, autopsy was required in most cases (n = 59) to confirm the diagnosis. In 7 cases (10.6%), panels were sufficiently confident to establish the cause of death without autopsy with complete agreement with the reference standard. Causes included obstructive gastrointestinal pathology (n = 5) and diabetic ketoacidosis with dehydration (n = 2).

CONCLUSIONS: Only a small proportion of children > 2 years of age with sudden unexpected death have a cause of death that can be established with sufficient certainty at an early stage. In the vast majority of cases, the cause of death remains uncertain, supporting the recommendation to perform an autopsy.

WHAT IS KNOWN: • Autopsy in sudden unexplained death in youth is worldwide recognized as the gold standard for postmortem examination. However, its invasive nature and associated time burden may limit parental acceptance.

WHAT IS NEW: • In 7 of 60 sudden and unexplained deceased minors (10%), sufficient certainty regarding the cause of death can be obtained by other minimal invasive diagnostic test, so without the need of an autopsy. Causes without the need of an autopsy included obstructive gastrointestinal pathology and diabetic ketoacidosis with dehydration.

PMID:42542442 | DOI:10.1007/s00431-026-07286-7