Tag: pubmed

JMIR Med Inform. 2026 Jun 22;14:e86700. doi: 10.2196/86700.

ABSTRACT

BACKGROUND: Lymph node metastasis (LNM) is a critical clinical indicator for determining the initial treatment strategy for patients with lung cancer. However, accurately diagnosing LNM preoperatively remains a significant challenge. Data-driven predictive modeling has become a mainstream approach to address this issue, yet it often overlooks existing clinical knowledge. Large language models (LLMs) have demonstrated the potential to predict clinical risks in a zero-shot manner based on the extensive clinical knowledge learned from large-scale corpora.

OBJECTIVE: LLMs have demonstrated the potential to predict clinical risks in a zero-shot manner based on the extensive clinical knowledge learned from large-scale corpora. This study aims to investigate the integration of LLM-derived knowledge with data-driven patterns to enhance the accuracy of LNM prediction.

METHODS: We propose a novel ensemble framework that combines the strengths of LLMs and machine learning (ML) models for LNM prediction in lung cancer. Specifically, 3 ML models were trained using clinical data, and their predicted probabilities, along with the original clinical features, were incorporated into prompts for LLMs. Three LLMs-GPT-5.4, GPT-5.4-nano, and DeepSeek-V3.2-were used to independently predict LNM risk 5 times, and 4 ensemble strategies were applied to aggregate their predictions into a final outcome.

RESULTS: The proposed approach was evaluated on clinical data from 767 patients with lung cancer at Peking University Cancer Hospital. Experimental results show that our proposed framework significantly outperforms base ML models, achieving an area under the curve of 0.781 and an average precision of 0.420. Compared with the no reasoning English setting, both the reasoning English setting and nonreasoning Chinese setting showed a lower area under the curve but higher average precision.

CONCLUSIONS: This study presents a novel knowledge-augmented strategy for integrating the clinical knowledge embedded in LLMs with the statistical patterns captured by ML models to improve the LNM prediction of lung cancer, offering a new paradigm for integrating medical knowledge and patient data in clinical predictions.

PMID:42330511 | DOI:10.2196/86700

Medwave. 2026 Jun 22;26(5):e3191. doi: 10.5867/medwave.2026.05.3191.

ABSTRACT

INTRODUCTION: This article analyzes the prolonged trough phase in the epidemic curve associated with COVID-19 dynamics in Chile during the period July-December 2020, characterized by a relatively stable daily record of 1 000-2500 cases.

METHODS: Unlike traditional (, )-SIR models, with constant parameters and associated respectively with the transmission and removal rates in the infectious process, which predict unimodal behavior, we propose an approach based on Contagion Mechanics that incorporates a dynamic law for the transmission rate .

RESULTS: Using official data from the Department of Health Statistics and Information, we demonstrate how this approach quantitatively captures the observed stabilization, resulting from sustained adherence to non-pharmaceutical measures by the Chilean population. The model reveals that maintaining the infection rate below its intrinsic value required sustained collective effort, enabling controlled management of hospital demand during the pre-vaccination stage.

CONCLUSIONS: Our results validate the usefulness of Contagion Mechanics in explaining complex epidemiological dynamics and offer new perspectives on the population response to prolonged health interventions.

PMID:42330510 | DOI:10.5867/medwave.2026.05.3191

Ann Intern Med. 2026 Jun 23. doi: 10.7326/ANNALS-26-00132. Online ahead of print.

ABSTRACT

BACKGROUND: Comprehensive telehealth is used effectively for treatment-resistant chronic diseases in certain integrated health systems but has seldom been implemented in systems that provide mainly fee-for-service (FFS) care.

OBJECTIVE: To examine the effectiveness and implementation of comprehensive telehealth delivered in an FFS environment for patients with uncontrolled type 2 diabetes (T2D) and comorbid hypertension.

DESIGN: Pragmatic, randomized, effectiveness-implementation trial. (ClinicalTrials.gov: NCT05120544).

SETTING: 6 academic primary care or endocrinology clinics.

PARTICIPANTS: Participants had both T2D with hemoglobin A_1c (HbA_1c) persistently at 8.0% or higher for at least 6 months and hypertension with at least 1 systolic blood pressure (BP) above 140 mm Hg or diastolic BP above 90 mm Hg in the past year.

INTERVENTION: Two 12-month, mobile monitoring-enabled interventions: a self-monitoring control program and a nurse-delivered, comprehensive telehealth program incorporating self-management support and medication management.

MEASUREMENTS: Primary (HbA_1c) and secondary outcomes were evaluated at 12 months. Implementation analyses evaluated fidelity and barriers to intervention delivery.

RESULTS: Participants were 64% female and 68% Black. The mean age was 54.5 years, mean HbA_1c 9.8%, and mean BP 135/81 mm Hg. The estimated mean change in HbA_1c from 0 to 12 months was -0.7 percentage points with self-monitoring and -1.1 percentage points with comprehensive telehealth; the estimated mean between-group difference in HbA_1c change at 12 months was -0.4 percentage points (95% CI, -1.0 to 0.3 percentage points). Between-group differences in change in secondary outcomes did not reach statistical significance, except for diabetes self-care (0.4 [CI, 0.0 to 0.9], favoring comprehensive telehealth). The comprehensive program was delivered with suboptimal fidelity (median encounters per participant, 9; fidelity threshold, ≥12); analyses identified barriers to program delivery.

LIMITATION: Generalizability to dissimilar populations and systems lacking telehealth infrastructure may be limited.

CONCLUSION: Comprehensive telehealth did not substantially lower HbA_1c relative to control in this study. Population factors, intervention and control program design, and barriers to FFS implementation of comprehensive telehealth may have contributed to these findings.

PRIMARY FUNDING SOURCE: National Institute of Nursing Research and Duke Clinical & Translational Science Institute.

PMID:42330500 | DOI:10.7326/ANNALS-26-00132

Neural Comput. 2026 Jun 22:1-61. doi: 10.1162/NECO.a.1547. Online ahead of print.

ABSTRACT

Evaluating the variability of posterior estimates is a key aspect of Bayesian model assessment. In this study, we focus on the posterior covariance matrix W, defined through the log likelihoods of individual observations. Previous studies, notably MacEachern and Peruggia (2002) and Thomas et al. (2018), examined the role of the principal space of W in Bayesian sensitivity analysis. Here, we show that the principal space of W is also central to frequentist evaluation, using the recently proposed Bayesian infinitesimal jackknife (Bayesian IJ) approximation (Giordano & Broderick, 2023) as a key tool. We further clarify the relationship between W and the Fisher kernel, showing that a modified version of the Fisher kernel can be viewed as an approximation to W. Moreover, the matrix W itself can be interpreted as a reproducing kernel, which we refer to as the W-kernel. Based on this connection, we investigate the relation between the W-kernel formulation in the data space and the classical asymptotic formulation in the parameter space. We also introduce the matrix Z, which is effectively dual to W in the sense of PCA; this formulation provides another perspective on the relationship between W and classical asymptotic theory. In the appendixes, we explore approximate bootstrap methods for posterior means and show that projection onto the principal space of W facilitates frequentist evaluation when higher-order terms are included. In addition, we introduce incomplete Cholesky decomposition as an efficient method for computing the principal space of W and discuss the concept of representative subsets of observations.

PMID:42330490 | DOI:10.1162/NECO.a.1547

Phys Rev Lett. 2026 Jun 5;136(22):221801. doi: 10.1103/c1x7-f9wn.

ABSTRACT

The first measurements of the top- and antitop-quark differential production cross sections and the top-quark charge asymmetry in the forward region are presented, using proton-proton collision data collected by the LHCb experiment at a center-of-mass energy of 13 TeV corresponding to an integrated luminosity of 5.4 fb^{-1}. The total production cross sections of top and antitop quarks are also determined. Measurements are performed using the μ+b-jet final state within a fiducial region defined by b-jet p_{T,jet}>50 GeV and pseudorapidity 2.2<η_{jet}<4.0, with the muon from the W-boson decay required to have p_{T,μ}>25 GeV and 2.0<η_{μ}<4.5. The muon and b-jet system must satisfy p_{T}(μ+jet)>20 GeV. The measured integrated production cross sections for the top and antitop quarks are σ_{t}=0.95±0.04±0.08±0.02 pb, σ_{t[over ¯]}=0.81±0.03±0.07±0.02 pb, where the first uncertainty is statistical, the second systematic, and the third accounts for the luminosity uncertainty. The top-quark charge asymmetry is measured to be A_{C}^{t}=0.08±0.03±0.01, where the first uncertainty is statistical and the second is systematic. These results are consistent with next-to-leading order Standard Model predictions.

PMID:42330470 | DOI:10.1103/c1x7-f9wn

Sex Transm Dis. 2026 Jun 23. doi: 10.1097/OLQ.0000000000002381. Online ahead of print.

ABSTRACT

BACKGROUND: Testing for sexually transmitted infections (STIs) is a routine component of prenatal care. Treating partners is challenging and the inconsistency contributes to maternal reinfection and neonatal morbidity. This study evaluated documentation of partner treatment among pregnant women diagnosed with different STIs.

METHODS: This retrospective cohort study included pregnant women who received care at two safety-net hospitals in Harris County, TX, between 2019 and 2022. Electronic health records were reviewed for documented partner treatment among patients with chlamydia, gonorrhea, hepatitis B infection (HBV), or syphilis during pregnancy. Patients with chlamydia and gonorrhea are typically offered expedited partner therapy by physicians, whereas the local health department coordinates partner treatment of HBV and syphilis. Gaps in hospital and health department records were supplemented through brief patient interviews. Multivariable Poisson regression models with robust error variance examined associations between STI and physician counseling on partner treatment, adjusting for age, race and ethnicity, marital status, preferred language, and substance use. Adjusted relative risk (aRR) with 95% confidence intervals (CI) were calculated. P<0.05 was considered statistically significant.

RESULTS: Among 369 eligible patients, physician documentation of partner treatment was highest for patients with chlamydia only (54%), followed by gonorrhea only (46%), syphilis (43%), and lowest for HBV (1%). Documented barriers to partner treatment included lack of partner contact (gonorrhea only 75%, chlamydia only 43%, syphilis 34%) and partner refusal (HBV 43%). Physician counseling on partner treatment was documented for ≥80% of patients with STIs except HBV (56%, aRR=0.68 compared to chlamydia only, 95% CI 0.51-0.91). Sufficient prenatal care was associated with higher partner treatment for chlamydia only (67% vs. 45%, p=0.023).

CONCLUSIONS: Partner treatment and physician counseling vary by STI. Physician reliance on public health-managed partner treatment may hinder completion and sustain high rates of STIs during pregnancy.

PMID:42330427 | DOI:10.1097/OLQ.0000000000002381

PLoS One. 2026 Jun 22;21(6):e0351890. doi: 10.1371/journal.pone.0351890. eCollection 2026.

NO ABSTRACT

PMID:42330424 | DOI:10.1371/journal.pone.0351890

Rheumatology (Oxford). 2026 Jun 22:keag321. doi: 10.1093/rheumatology/keag321. Online ahead of print.

ABSTRACT

OBJECTIVES: Lymphoid interstitial pneumonia (LIP) is a rare form of Interstitial Lung Disease (ILD), often associated with Sjögren Disease (SjD). However, the clinical-serologic characteristics of SjD-LIP remain poorly characterized. Our objective was to describe the clinical course and outcome of SjD-associated LIP and to compare this subgroup with other SjD-ILD patterns.

METHODS: SjD patients with HRCT-confirmed ILD followed in Pisa Rheumatology Unit (January 2019-November 2024) were retrospectively enrolled. ILD patterns were classified through multidisciplinary discussion. Clinical and laboratory data were collected according to ESSDAI definitions, along with pulmonary symptoms and function tests (PFTs).

RESULTS: Fifty-five SjD-ILD patients were included (M: F = 9:46), of whom 11 were diagnosed with LIP (F: M = 11:0). LIP patients showed thin-walled parenchymal cysts as the predominant HRCT finding, and largely preserved pulmonary function (median FVC 101% [IQR 98-105]; DLCO 76% [IQR 75-81]). After a median 5-years follow-up (IQR 2-7) all LIP patients were alive with stable PFTs. Compared with the remaining 44 non-LIP, LIP patients were younger at SjD diagnosis (p<0.001) and more frequently presented purpura (p=0.012), constitutional symptoms (p=0.001), lymphadenopathy (p=0.023), hypergammaglobulinemia (p<0.001), triple anti-Ro60/52/La positivity (p=0.035) and C3 hypocomplementemia (p=0.009).ILD preceded SjD diagnosis in 30/44 non-LIP vs 1/11 LIP patients (p<0.001), with lower FVC% (p=0.049) and DLCO% (p=0.036) in non-LIP.

CONCLUSION: LIP defines a distinct, immunologically active phenotype within the spectrum of SjD-ILD, characterized by greater extrapulmonary systemic involvement and serologic markers of B cell hyperactivity, but limited pulmonary functional impact. These findings support long-term lymphoma surveillance and a potential role for B cell targeted therapies in selected patients.

PMID:42330423 | DOI:10.1093/rheumatology/keag321

Medicina (B Aires). 2026;86(3):575-584.

ABSTRACT

INTRODUCTION: Massive bone defects remain a significant challenge in limb reconstruction and salvage procedures. The aim of this study was to analyze the clinical outcomes and implant survival in a series of patients undergoing extensive femoral resections reconstructed with modular megaprosthesis.

MATERIALS AND METHODS: A retrospective case analysis was conducted including patients who underwent massive femoral bone resections, with a median age of 59 years (IQR 57-70) and a mean follow-up of 6.7 years (SD 4.9). Twenty-nine endoprostheses were used for oncologic resections and eleven for non-oncologic massive bone defects. Reconstructions included 21 proximal femurs, 17 distal femurs, one intercalary prosthesis, and one total femur replacement. Implant survival, complication rates and their management were analyzed. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.

RESULTS: Nineteen patients (47.5%) experienced complications: 9 in proximal femoral reconstructions and 7 in distal femoral cases. The most frequent complication was periprosthetic joint infection 20% (8), followed by prosthetic dislocation 15% (6), and aseptic loosening 10% (4). The MSTS improved from (11.8 ± 6.2) preoperatively to (17.3 ± 7.9) (p< 0.001). The incidence of death was higher in patients with an oncologic diagnosis compared to non-oncologic diagnosis. without reaching statistical significance.

CONCLUSION: Modular resection endoprostheses offer a versatile option for segmental bone reconstruction, providing acceptable mid-term functional outcomes. However, prosthetic instability, particularly in proximal femoral replacements and periprosthetic joint infection remains a frequent relevant complication.

PMID:42330373

Bioinformatics. 2026 Jun 22:btag432. doi: 10.1093/bioinformatics/btag432. Online ahead of print.

ABSTRACT

SUMMARY: We developed DirectASRM, a comprehensive database for the systematic identification, integration, and annotation of allele-specific RNA modifications (ASRMs) from direct RNA sequencing data. DirectASRM enables single-base, transcript-level detection of ASRMs across multiple RNA modification types, diverse organisms and condition-specific contexts. The database further evaluates the confidence of each ASRM-SNP pair association within isoform context by jointly considering statistical evidence of allelic modification imbalance and independent support from external next-generation sequencing (NGS) – based RNA modification resources. DirectASRM also provides extensive functional annotations for ASRMs and their associated variants, including intra-sample transcript-level allele-specific expression (ASE) and allele-specific splicing, as well as additional post-transcriptional regulatory features such as miRNA binding, circRNA, RNA-protein interactions, and disease relevance. Overall, DirectASRM serves as a comprehensive resource that supports systematic investigation of the potential functional impact of genetic variants in epitranscriptomic regulation.

AVAILABILITY AND IMPLEMENTATION: DirectASRM database is freely accessible at http://modinfor.com/DirectASRM/. DirectASRM pipeline is available at GitHub (https://github.com/jiayin1101/DirectASRM_pipeline) and Zenodo (DOI: https://doi.org/10.5281/zenodo.19876077).

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:42330361 | DOI:10.1093/bioinformatics/btag432