Tag: pubmed

J Orthop Surg Res. 2025 Dec 31. doi: 10.1186/s13018-025-06550-0. Online ahead of print.

ABSTRACT

BACKGROUND: Degenerative spondylolisthesis (DS) is a common cause of low back pain and lumbar spinal stenosis, necessitating various surgical interventions. Traditional management includes fusion surgery, but recently decompression with or without dynamic stabilization has been explored. However, the relative efficacy and safety of these interventions, including their time-effect relationships, have not been comprehensively evaluated.

OBJECTIVE: To systematically assess and compare the effectiveness and safety of decompression alone, decompression plus dynamic stabilization, and decompression plus fusion in patients with low back pain due to DS, and to analyze the time-effect relationship among these interventions over a follow-up period of up to 12 years.

METHODS: A network meta-analysis was conducted involving 10 studies, including 9 randomized controlled trials, with a total of 1052 participants diagnosed with DS. The interventions compared were decompression alone, decompression plus dynamic stabilization, and decompression plus fusion. Primary outcomes included visual analog scale for low back pain (VAS-LBP), visual analog scale for leg pain (VAS-LP), and Oswestry disability Index (ODI). Secondary outcomes were complications, reoperation rate, operation time, and blood loss. We assessed global inconsistency, risk of bias, and conducted a time-effect analysis using the TE-max model.

RESULTS: The analysis did not reveal significant global inconsistency or a high risk of bias among the included studies. There were no significant differences between the three interventions regarding changes in VAS-LBP, VAS-LP, and ODI. Decompression alone was associated with significantly shorter operation time (MD = 89.5, 95% CI – 123.91 to – 55.12) and less blood loss (MD = 151.5, 95% CI 37.31 to 265.70) compared to both decompression with fusion and decompression with dynamic stabilization. The time-effect analysis predicted non-inferiority of decompression alone compared to other methods over a follow-up period of up to 12 years.

CONCLUSIONS: Decompression alone demonstrates non-inferiority in terms of efficacy for treating low back pain due to DS compared to fusion, with additional benefits in operation time and blood loss. The addition of dynamic stabilization to decompression does not yield significant benefits. Further research with larger cohorts and extended follow-up is necessary for definitive conclusions.

PMID:41476308 | DOI:10.1186/s13018-025-06550-0

J Health Popul Nutr. 2025 Dec 31. doi: 10.1186/s41043-025-01199-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the effects of multivitamin combined with magnesium sulfate on placental hemodynamics, coagulation function, and maternal and infant outcomes in preeclampsia patients.

METHODS: A randomized controlled study was conducted among 194 pregnant women diagnosed with preeclampsia between April 2022 and April 2023. Participants were randomly assigned to either the control group (n = 97), receiving intravenous magnesium sulfate alone, or the observation group (n = 97), receiving magnesium sulfate combined with multivitamin supplementation. Magnesium sulfate was administered with a loading dose of 2.5-5 g via rapid IV infusion and a maintenance dose of 5-20 g by continuous drip. The observation group additionally received one oral multivitamin tablet (Bayer S.A., 30 tablets/box) once daily in the morning. The treatment duration for both groups was two weeks. Blood pressure, 24-hour urinary protein, placental Doppler indices (RI, PI, S/D), coagulation markers (PT, APTT, FIB, TT), and maternal-infant outcomes were measured and compared.

RESULTS: After treatment, both groups showed significant reductions in systolic and diastolic blood pressure, but there was no significant difference between them. However, the observation group had significantly lower 24-hour urinary protein levels (0.71 ± 0.31 g vs. 0.92 ± 0.28 g, P < 0.001). Coagulation function improved in both groups, with the observation group showing greater improvements: longer PT, APTT, and TT times, and lower FIB levels (P < 0.01). Placental hemodynamics also improved more in the observation group, with lower resistance indices and S/D ratios in both the umbilical and spiral arteries (P < 0.001). The observation group had better maternal and neonatal outcomes, including fewer cases of postpartum hemorrhage (10 vs. 22, P = 0.020), low birth weight (10 vs. 23, P = 0.013), and NICU admissions (9 vs. 21, P = 0.018). Eclampsia occurred only in the control group (3 cases), though this was not statistically significant (P = 0.081). Other outcomes, such as uterine inertia and neonatal asphyxia, were similar between groups. Subgroup analysis showed that patients with severe preeclampsia in the observation group experienced greater improvements in proteinuria and placental blood flow than those in the control group. Cesarean section rates were comparable (58 vs. 62), with main indications including fetal distress, failed labor, and poorly controlled PE. Logistic regression confirmed that multivitamin use was an independent factor for better outcomes (OR = 3.297; 95% CI: 1.731-6.282; P < 0.001), regardless of age, BMI, or gestational age.

CONCLUSION: Multivitamin supplementation combined with magnesium sulfate improves outcomes in preeclampsia more effectively than magnesium sulfate alone. It reduces proteinuria, enhances placental blood flow and coagulation function, and lowers the risk of complications such as postpartum hemorrhage, low birth weight, and NICU admission. These benefits are particularly notable in severe cases and are independent of baseline maternal factors, supporting the use of combined therapy in clinical practice.

PMID:41476304 | DOI:10.1186/s41043-025-01199-1

J Orthop Surg Res. 2026 Jan 1. doi: 10.1186/s13018-025-06586-2. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the risk factors for symptomatic hematoma (SH) after cervical spine surgery, thereby providing evidence-based guidance for the early prevention, timely intervention, and appropriate management.

METHODS: Relevant observational studies were retrieved from PubMed, Embase, the Cochrane Library, and Web of Science from inception to September 2025. Meta-analyses were performed to assess potential risk factors across several domains, including patient demographics, comorbidities, antithrombotic therapy, preoperative evaluation, and surgical factors. The odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (CI) were adopted to evaluate associated factors. Subgroup analyses, meta-regression, and sensitivity analyses were conducted.

RESULTS: Seventeen studies involving 564,700 patients were included. The overall incidence of SH was 0.11% (608/564,700), with individual study estimates ranging from 0.03 to 1.51%. The meta-analysis identified the male sex (OR = 1.68, 95% CI 1.39 to 2.03), advanced age (WMD = 2.53 years, 95% CI 1.57 to 3.48), presence of ossification of the posterior longitudinal ligament (OPLL) (OR = 3.38, 95% CI 1.54,7.41), and undergoing anterior cervical corpectomy and fusion (ACCF) (OR = 1.71, 95% CI 1.26 to 2.31) as being significantly associated with an increased risk of SH after cervical spine surgery Meta-regression revealed that male proportion significantly modified the OPLL-SH association. The subgroup analysis results showed that in study populations with a lower proportion of male participants, OPLL was significantly associated with an increased risk of postoperative SH (when the male proportion < 60%, OR = 7.89, 95% CI 4.02 to 15.49); whereas no significant association was observed in study populations with a higher male proportion (when the male proportion ≥ 60%, OR = 1.42, 95% CI 0.87 to 2.33). Prolonged operative duration was associated with SH (WMD = 13.66 min, 95% CI 3.97 to 23.35), but this relationship was substantially influenced by factors related to surgical complexity, as differences in the number of surgical segments explained a substantial portion (76.96%) of the heterogeneity observed across studies. No significant associations were observed for body mass index (BMI), smoking history, common comorbidities, antithrombotic therapies, and most laboratory parameters. A statistically significant but clinically small difference was noted for preoperative PT (WMD = 0.20 s, 95% CI 0.07 to 0.33).

CONCLUSIONS: Male sex, advanced age, OPLL, and ACCF were identified as being significantly associated with an increased risk of SH after cervical spine surgery. Importantly, male sex also acts as an effect modifier, substantially influencing the association between OPLL and hematoma risk. Prolonged operative duration was linked with an increased risk of SH, though this relationship was substantially influenced by factors related to surgical complexity. These findings underscore the importance of comprehensive preoperative risk assessment that considers both individual factors and their potential interactions, alongside meticulous surgical technique, for effective hematoma prevention.

PMID:41476302 | DOI:10.1186/s13018-025-06586-2

Virol J. 2025 Dec 31. doi: 10.1186/s12985-025-03061-6. Online ahead of print.

ABSTRACT

Merkel cell polyomavirus (MCPyV) has been identified as the causative agent of Merkel cell carcinoma, and its non-coding control region (NCCR) has been demonstrated to play a critical role in regulating viral transcription. While NCCR variants exist, their comparative impact on bidirectional promoter activity remains poorly characterized. The present study conducted an in vitro evaluation of bidirectional transcription levels of five major MCPyV NCCR types (I, IIa-1, IIa-2, IIb, IIc). The NCCRs were subsequently cloned into a bidirectional reporter vector, which expresses green (EGFP, early) and red (RFP, late) fluorescent proteins. Subsequent to transfection into HEK293 cells, promoter activity was quantitatively analyzed via fluorescence imaging and flow cytometry. Bioinformatic analysis revealed high sequence similarity (> 94%) among the five NCCRs and predicted conserved transcription factor binding sites. The results indicated that all the variants exhibited stronger late promoter activity compared with the early promoter activity (p < 0.01). These observations are in alignment with the established biology of MCPyV. However, no statistically significant differences in the early/late transcription ratio or overall fluorescence intensity were observed between the different NCCR types under these conditions. These findings suggest that the core promoter function is conserved among these major NCCR variants in this model system. This study provides a foundational comparison of MCPyV NCCR activity, highlighting the need for further investigation in more physiologically relevant models to understand how NCCR diversity may influence viral pathogenesis in vivo. Moreover, incorporating models of viral genome integration is essential to understand mechanism of MCPyV carcinogenesis and viral-host interaction.

PMID:41476298 | DOI:10.1186/s12985-025-03061-6

Eur J Med Res. 2025 Dec 31. doi: 10.1186/s40001-025-03767-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare modified transforaminal lumbar interbody fusion (M-TLIF) and posterior lumbar interbody fusion (PLIF) in patients with lumbar degenerative disease complicated by osteoporosis who underwent bone cement-augmented pedicle screw placement, with a focus on lumbar radiographic parameters and clinical outcomes.

METHODS: A retrospective comparative study was conducted on patients with lumbar degenerative disease and osteoporosis who underwent lumbar fusion surgery with bone cement-augmented pedicle screws between January 2021 and June 2023. Based on the surgical procedure received, patients were divided into an M-TLIF group (n = 49) and a PLIF group (n = 44). The comparison encompassed perioperative indicators, radiographic parameters-including the coronal Cobb angle, average surgical segment disc height (ASDH), lumbar lordosis (LL), segmental lordosis (SL), Bridwell fusion grade, and Marchi subsidence grade-and clinical efficacy scores, including the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score, which were assessed preoperatively, immediately postoperatively, and at 2-year postoperatively.

RESULTS: The study included 93 patients (M-TLIF: n = 49; PLIF: n = 44). The two groups were comparable in all baseline characteristics (P > 0.05). Regarding perioperative indicators, the M-TLIF group had a significantly longer operative time per segment (185.79 ± 78.46 min vs. 152.92 ± 71.64 min, P = 0.038) but a lower volume of bone cement used per screw (1.86 ± 0.58 ml vs. 2.15 ± 0.62 ml, P = 0.023). Both groups demonstrated significant improvements in all clinical scores (VAS, ODI, JOA) and radiographic parameters (Cobb, ASDH, LL, SL) at all postoperative time points compared to preoperative values (all P < 0.05). At the 2-year postoperatively, VAS and ODI scores were comparable between groups (P > 0.05). Although the JOA score was statistically higher in the PLIF group (25.73 ± 1.26 vs. 25.12 ± 1.51, P = 0.040), the absolute difference of 0.61 points is clinically negligible. Radiographically, the PLIF group achieved a significantly greater SL angle at follow-up (16.59 ± 8.59° vs. 12.17 ± 8.16°, P = 0.013), while the M-TLIF group showed a significantly superior Bridwell fusion grade (P = 0.020). There was no significant intergroup difference in cage subsidence (P > 0.05).

CONCLUSION: Both M-TLIF and PLIF effectively improved the clinical symptoms and radiographic parameters of these patients, with equivalent clinical efficacy in relieving pain and restoring function. The choice of procedure can be individualized: M-TLIF is preferred when superior interbody fusion is the priority, while PLIF is more suitable for achieving greater segmental lordosis.

PMID:41476296 | DOI:10.1186/s40001-025-03767-x

Nature. 2026 Jan;649(8095):73-82. doi: 10.1038/s41586-025-09819-w. Epub 2025 Dec 31.

ABSTRACT

Wearable healthcare electronics are rapidly emerging as a distinct electronics sector in the digital era^1-6, offering substantial economic opportunities and crucial medical benefits. However, their interactions with environmental and social systems remain poorly understood^7-9, leaving critical sustainability challenges unaddressed. Although current efforts have focused on material-level improvements, broader system-level dynamics remain unexplored. Here we present an integrated systems engineering framework based on de novo life-cycle inventories and diffusion-linked scaling to quantify global eco-footprint hotspots and identify effective mitigation strategies. Cradle-to-grave analysis of representative wearable healthcare electronics (glucose, cardiac and blood pressure monitors and diagnostic imagers) generates full-spectrum environmental impact metrics, identifying warming impacts of 1.1-6.1 kgCO₂-equivalent per device. The global device consumption is projected to increase 42-fold by 2050, approaching 2 billion units annually and generating 3.4 MtCO₂-equivalent emissions alongside ecotoxicity and e-waste issues. Contrary to the conventional sustainability emphasis on plastics, this work demonstrates that recyclable or biodegradable plastics offer only marginal benefits, whereas substituting critical-metal conductors and optimizing circuit architectures can significantly reduce impacts without compromising performance. This systems engineering-based life-cycle assessment framework holds promise for establishing ecologically responsible innovation in next-generation wearable electronics.

PMID:41476272 | DOI:10.1038/s41586-025-09819-w

Nature. 2026 Jan;649(8095):83-90. doi: 10.1038/s41586-025-09860-9. Epub 2025 Dec 31.

ABSTRACT

Despite successes in replicating the primary-secondary-tertiary structure hierarchy of protein, it remains elusive to synthetically materialize protein functions that are deeply rooted in their chemical, structural and dynamic heterogeneities^1-12. We propose that for polymers with backbone chemistries different from that of proteins, programming spatial and temporal projections of sidechains at the segmental level can be effective in replicating protein behaviours^13,14; and leveraging the rotational freedom of polymer can mitigate deficiencies in monomeric sequence specificity and achieve behaviour uniformity at the ensemble level^2,3,15-20. Here, guided by the active site analysis of about 1,300 metalloproteins, we design random heteropolymers (RHPs) as enzyme mimics based on one-pot synthesis. We introduce key monomers as the equivalents of the functional residues of protein and statistically modulate the chemical characteristics of key monomer-containing segments, such as segmental hydrophobicity²¹. The resultant RHPs form pseudo-active sites that provide key monomers with protein-like microenvironments, co-localize substrates with catalytic or cofactor-binding sidechains and catalyse reactions such as oxidation and cyclization of citronellal with isopulegol/menthoglycol selectivity. This RHP design led to enzyme-like materials that can retain catalytic activity under non-biological conditions, are compatible with scalable processing and have expanded substrate scope, including environmentally long-lasting antibiotic tetracycline²².

PMID:41476271 | DOI:10.1038/s41586-025-09860-9

Sci Rep. 2025 Dec 31. doi: 10.1038/s41598-025-33124-1. Online ahead of print.

ABSTRACT

The impact of Dexmedetomidine (Dex) use on the prognosis of patients with ventilator-associated pneumonia (VAP) remains a subject worthy of further investigation. This study seeks to evaluate the association between Dex administration and prognosis in critically ill patients with VAP. We conducted a retrospective cohort study using the MIMIC-IV database, including adults (≥ 18 years) with VAP and ICU stays ≥ 24 h. Patients were divided into the DEX group and the non-DEX group based on Dex administration. The primary endpoint was in-hospital mortality, and the secondary endpoint was 90-day survival rate. We used multivariable logistic regression and propensity score matching (PSM) to adjust for baseline imbalances. Kaplan-Meier analysis assessed survival differences. Stratified analyses evaluated temporal trends (2008-2022), dosage (mcg/kg/h), and infusion duration (hours) to further validate the robustness of the results. This research included a total of 1766 VAP patients (DEX: n = 905; non-DEX: n = 861), Dex was associated with reduced in-hospital mortality (unadjusted OR 0.55, 95% CI 0.44-0.69; adjusted OR 0.62, 95% CI 0.47-0.83).The survival curve was calculated based on Kaplan-Meier analysis, which indicated that the DEX group exhibited a relatively longer survival time, and this difference was highly statistically significant (p < 0.001).It is worth mentioning that the mortality reduction remained robust across all sensitivity analyses, including PSM, temporal stratification, and dose-duration subgroups. Dex is associated with significantly lower in-hospital mortality in VAP patients.

PMID:41476257 | DOI:10.1038/s41598-025-33124-1

Eur J Med Res. 2025 Dec 31. doi: 10.1186/s40001-025-03783-x. Online ahead of print.

ABSTRACT

OBJECTIVE: Insulin resistance (IR) plays a critical role in shaping long-term outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Recent findings suggest that biological sex may influence the onset and progression of MASLD, yet it remains unclear whether sex modifies the link between IR and mortality in those with MASLD and advanced liver fibrosis.

METHODS: We analyzed data from 14,081 MASLD patients (7327 men and 6754 women) drawn from the 2001-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Participants were categorized based on sex-specific deciles of the Metabolic Score for Insulin Resistance (METS-IR). Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess the association between METS-IR and all-cause mortality. Restricted cubic spline (RCS) modeling explored potential non-linear relationships.

RESULTS: Marked sex-related disparities were identified in clinical and metabolic characteristics. Elevated METS-IR significantly predicted increased all-cause mortality in females with MASLD (log-rank p < 0.001), whereas this trend was not evident in males (p = 0.54). Multivariable Cox models showed that higher METS-IR independently correlated with mortality in women with MASLD and advanced fibrosis, but not in their male counterparts.

CONCLUSION: The prognostic significance of METS-IR differs by sex in MASLD. Elevated METS-IR independently increases long-term mortality risk in females, supporting the need for sex-specific risk evaluation in managing metabolic liver disease.

PMID:41476240 | DOI:10.1186/s40001-025-03783-x

Antimicrob Resist Infect Control. 2026 Jan 1. doi: 10.1186/s13756-025-01688-2. Online ahead of print.

ABSTRACT

BACKGROUND: Antimicrobial resistance refers to the ability of microorganisms to become resistant to antibiotics, fungicides, and other antimicrobial agents, which are essential for treating illnesses in humans, land and water-based animals, and plants. This issue is quickly emerging as a major danger to health, economic stability, and livelihoods. One notable driver of these resistant microorganisms is the misuse of antimicrobial medications.

OBJECTIVE: To assess the practices and perspectives on antimicrobial drug misuse in Wolaita Zone, 2024.

METHODS: This study employed a community-based cross-sectional mixed-methods design. The study data were collected from 423 community residents for the quantitative phase and 15 participants for the qualitative phase, data collection for the quantitative component was collected using structured interview-administered questionnaires, and the qualitative component involved in-depth interviews with purposively selected participants, guided by a structured interview. Quantitative data management involved the use of EpiData V4.6 and the Statistical Package for the Social Sciences for data entry and analysis, respectively. The qualitative data underwent thematic analysis utilizing OpenCode software, a qualitative data analysis tool.

RESULTS: In this study, the quantitative data found that 67.1% of participants misused antimicrobial drugs. The factors significantly associated with the misuse of antimicrobial drugs included educational status [AOR: 1.91 (95% CI: 0.93-2.11)], drug cost [AOR: 3.22 (95% CI: 1.18-5.3)], knowledge regarding the use of antimicrobial drugs [AOR: 2.23 (95% CI: 1.66-4.01)], and adherence to stewardship guidelines [AOR: 3.37 (95% CI: 2.44-9.24)]. Additionally, the qualitative study identified four key themes from the data analysis namely, factors related to drug providers, patient-driven factors, sociocultural influences, and limitations in regulatory and policy frameworks.

CONCLUSION: The study reveals a troubling rate of antimicrobial drug misuse among the population. The finding underscores the urgent need to address the gaps and barriers that impede proper use of antimicrobial drugs. It is recommended that government and non-government health sectors, along with relevant stakeholders, implement educational initiatives and health campaigns to combat this problem.

PMID:41476239 | DOI:10.1186/s13756-025-01688-2