Tag: pubmed

J Cardiothorac Vasc Anesth. 2026 Aug 3:S1053-0770(26)00646-4. doi: 10.1053/j.jvca.2026.07.056. Online ahead of print.

ABSTRACT

OBJECTIVE: Thoracic paravertebral block (PVB) is an effective analgesic technique for video-assisted thoracoscopic surgery (VATS). The intertransverse process block (ITPB) may offer comparable analgesia with a better safety profile. The aim of this study is to compare the postoperative analgesic effects of ITPB and PVB in terms of morphine consumption and pain score.

DESIGN: A randomized, double-blind, non-inferiority trial.

SETTING: A university hospital.

PARTICIPANTS: This study enrolled 55 adult patients who underwent elective VATS, with 5 subsequently excluded.

INTERVENTIONS: Fifty patients were randomly allocated (1:1) to receive either an ultrasound-guided ITPB (n = 25) or a PVB (n = 25) at the T5-6 level. Both groups received a bolus of 20 mL 0.25% bupivacaine, followed by a continuous infusion of 10 mL/h for 48 hours.

MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was total morphine consumption in the first 48 postoperative hours. Secondary outcomes comprised postoperative visual analog scale (VAS) at rest and with deep breathing and block performance time. The 48-hour morphine consumption was similar between the ITPB and PVB groups (9.9 ± 2.8 mg v 8.9 ± 2.1 mg, respectively; mean difference 1.0 mg, 95% CI -0.39 to 2.45; p = 0.151). As the upper limit of this 95% confidence interval (2.45 mg) exceeded the prespecified non-inferiority margin of 1.0 mg, non-inferiority of ITPB to PVB was not statistically confirmed. VAS scores at rest and with deep breathing were comparable at all time points (p > 0.05 for all). The block performance time was shorter in the ITP group versus the PVB group (4.3 ± 0.8 v 6.9 ± 1.4 minutes; p < 0.001).

CONCLUSION: Continuous ITPB resulted in similar 48-hour morphine consumption, pain scores, and complication rates to continuous PVB for VATS, together with a shorter time to perform the block. However, the non-inferiority of ITPB to PVB was not statistically confirmed.

PMID:42637591 | DOI:10.1053/j.jvca.2026.07.056

ISA Trans. 2026 Aug 22:S0019-0578(26)00430-1. doi: 10.1016/j.isatra.2026.08.016. Online ahead of print.

ABSTRACT

To mitigate the degradation in transfer diagnostic performance caused by unseen target domains in complex industrial scenarios, a novel saliency-aware heterogeneous independence decoupling network (SA-HIDN) is proposed for mechanical transfer fault diagnosis. Initially, a heterogeneous decoupled feature extractor is constructed to align the network capacity with the distinct physical attributes of signal components. It employs a deep branch with deep resonance shrinkage to perform soft-thresholding denoising for domain-invariant fault impulses, and a shallow branch with a statistical feature layer to explicitly capture global statistical moments as domain-specific condition features. Subsequently, a statistical independence constraint based on the Hilbert-Schmidt Independence Criterion (HSIC) is introduced to mathematically force the fault and condition subspaces to be independent in the reproducing kernel Hilbert space, effectively suppressing high-order information leakage between decoupled branches. Finally, a saliency-aware adaptive fusion (SAAF) module is developed to proactively protect subtle fault signatures and achieve high-fidelity feature reconstruction through a saliency-masking compensation mechanism. Extensive experiments on planetary transmission and train transmission system datasets demonstrate that the proposed SA-HIDN achieves transfer diagnostic accuracies of 98.13% and 94.48% on two datasets, respectively. These quantitative results and mechanistic analyses confirm that the proposed method significantly outperforms state-of-the-art methods while maintaining a favorable balance between diagnostic precision and computational cost.

PMID:42637588 | DOI:10.1016/j.isatra.2026.08.016

Ren Fail. 2026 Dec;48(1):2700810. doi: 10.1080/0886022X.2026.2700810. Epub 2026 Aug 24.

ABSTRACT

BACKGROUND: Serum uric acid is associated with chronic kidney disease (CKD) progression; however, causality remains uncertain. Although renal urate handling, rather than merely hyperuricemia, may dominate kidney outcomes, the prognostic value of urinary urate indices and the potential modifying effect of urate-lowering therapy (ULT) remain unclear.

METHODS: This retrospective study included patients with an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73m². Exposures were fractional excretion of uric acid (FEUA) and the urinary uric acid-to-creatinine ratio (UUCR). Major adverse kidney event (MAKE) was defined as ≥40% decline in eGFR, initiation of kidney replacement therapy, or death. Associations between FEUA and MAKE, and the modifying effect of ULT were evaluated using Kaplan-Meier analyses and multivariable Cox proportional hazards models, including stratification by baseline ULT.

RESULTS: Among 551 patients (244 receiving ULT), 117 experienced MAKE over a median follow-up of 2.3 years. In the adjusted analysis, FEUA <5.5% was associated with a higher overall risk (hazard ratio [HR], 3.56; 95% CI, 1.96-6.48), with a stronger association in the no-ULT group (HR, 11.59; 95% CI, 3.80-35.31). Conversely, FEUA was not associated with the outcome within the ULT group. FEUA × ULT interaction was significant, indicating that the prognostic meaning of FEUA depends on concomitant ULT.Conclusion: Reduced urinary urate excretion was associated with a higher risk for MAKE. ULT modifies the prognostic impact of FEUA, underscoring the clinical relevance of renal urate handling when assessing kidney risk in CKD and suggesting that pharmacological urate-lowering may modify this risk.

PMID:42637577 | DOI:10.1080/0886022X.2026.2700810

Am J Epidemiol. 2026 Aug 25:kwag197. doi: 10.1093/aje/kwag197. Online ahead of print.

ABSTRACT

Exclusive breastfeeding is a key pillar of healthy nutrition in infancy. While the importance of breastfeeding is undisputed, measuring early breastfeeding behavior remains challenging. This study evaluated the impact of addressing missingness in feeding variables, incorporating prelacteal feeding, reducing sampling bias through age weighting, and adjusting measurement periods on estimated exclusive breastfeeding prevalence. We show that imputing missing values reduces estimated prevalence from 42.9% (95% CI, 40.3-45.6) to 41.2% (95% CI, 38.5-44.0). Including prelacteal feeding in the definition further decreases estimates to 32.2% (95% CI, 29.5-34.8), while applying age weights slightly increased the prevalence to 33.6% (95% CI, 31.0-36.3). Measuring exclusive breastfeeding compliance at 6 months, rather than looking at average feeding behavior in the first six months of an infant’s life, yields an estimated exclusive breastfeeding prevalence of 5.9% (95% CI, 4.6-7.6). Given the major differences in exclusive breastfeeding prevalence estimates from different methodological adjustments, a standardized exclusive breastfeeding measurement is urgently needed to accurately assess early-life nutrition and guide policy based on reliable and comparable estimates.

PMID:42637574 | DOI:10.1093/aje/kwag197

Biostatistics. 2026 Jan 20;27(1):kxag030. doi: 10.1093/biostatistics/kxag030.

ABSTRACT

This paper introduces a novel decomposition framework to explain heterogeneity in causal effects observed across different studies, considering both observational and randomized settings. We present a formal decomposition of between-study heterogeneity, identifying sources of variability in treatment effects across studies. The proposed methodology allows for robust estimation of causal parameters under various assumptions, addressing differences in pre-treatment covariate distributions, mediating variables, and the outcome mechanism. Our approach is validated through a simulation study and applied to data from the Moving to Opportunity (MTO) study, demonstrating its practical relevance. This work contributes to the broader understanding of causal inference in multi-study environments, with potential applications in evidence synthesis and policy-making.

PMID:42637568 | DOI:10.1093/biostatistics/kxag030

Sex Health. 2026 Oct 20;23(5):SH26088. doi: 10.1071/SH26088.

ABSTRACT

BACKGROUND: Overseas-born gay, bisexual, and other men who have sex with men (GBMSM) experience higher HIV notification rates compared with Australian-born GBMSM. This disparity is perpetuated by delayed access to HIV testing and biomedical prevention driven by a range of factors including Medicare eligibility, language and cultural barriers, and unfamiliarity with the health system. Community-based services offer an alternative pathway to HIV testing that may better serve migrant GBMSM facing challenges accessing mainstream healthcare settings.

METHODS: We conducted a cross-sectional study comparing settings of first HIV test within our service, either peer-led community-based testing or traditional clinic-based testing for overseas-born GBMSM who arrived in Australia between January 2022 and January 2024. Participants were grouped by time of arrival to first HIV test (either less than 6 months or more than 6 months). Comparative analysis and multivariable logistic regression were used to identify characteristics associated with attendance at the community-based setting.

RESULTS: A total of 1204 GBMSM were included with 424 (35.2%) attending community-based setting for their first HIV test after arrival. Those who attended community-based testing were more likely to have arrived in Australia more than 6 months ago (66.8% vs 26.9%) and never previously tested for HIV (37.5% vs 17.2%). These factors were also associated with higher likelihood of community-based testing in the multivariable model (aOR 5.27, 95% CI 3.98-6.97 and aOR 2.13, 95% CI 1.57-2.91 respectively).

CONCLUSION: Community-based, peer-led HIV testing services play an important role in engaging overseas-born GBMSM who may be under-served by traditional clinic-based models, particularly those with longer residence in Australia and no prior HIV testing.

PMID:42637540 | DOI:10.1071/SH26088

J Neurol Neurosurg Psychiatry. 2026 Aug 24:jnnp-2026-339037. doi: 10.1136/jnnp-2026-339037. Online ahead of print.

ABSTRACT

BACKGROUND: Autosomal dominant Alzheimer’s disease (ADAD) serves as a model for presymptomatic biomarker discovery. Characterising the temporal profile of plasma biomarker levels in presymptomatic individuals may enhance understanding of disease pathogenesis, inform future clinical trials and guide clinical interpretation.

METHODS: We evaluated 124 proteins using a NUcleic acid-Linked Immuno-Sandwich Assay panel in 270 plasma samples from a longitudinal cohort study of ADAD, comprising 113 individuals (73 mutation carriers and 40 non-carriers). We determined the plasma proteomic changes that distinguished mutation carriers from non-carriers. We then used predicted age at symptom onset to determine the approximate timing of presymptomatic divergence in biomarker levels in carriers relative to non-carriers.

RESULTS: Nine proteins (amyloid-beta 42 (Aβ42), beta-secretase 1 (BACE1), glial fibrillary acidic protein (GFAP), pTau181, pTau231, pTau217, t0tal tau (MAPT), neurofilament light (NfL) and acetylcholinesterase (AChE)) robustly differed between carriers and non-carriers cross-sectionally. Longitudinal analyses showed elevated Aβ42 levels were statistically discernible in carriers approximately 26 years before expected symptom onset. Carriers diverged from non-carriers in phosphorylated tau markers at approximately 21-24 years before expected symptom onset, total tau at 19 years, GFAP and BACE1 at 14 years and NfL at 6 years. Differences in AChE were seen in symptomatic individuals likely reflecting cholinesterase inhibitor use.

CONCLUSION: Multiple plasma proteins are elevated in presymptomatic and symptomatic ADAD mutation carriers relative to non-carriers. Changes in eight biomarkers occur sequentially from 26 to 6 years prior to symptom onset. Combining biomarkers may help in staging presymptomatic AD and optimise clinical trial inclusion. Further work is needed to assess how these findings generalise to non-monogenic AD.

PMID:42637536 | DOI:10.1136/jnnp-2026-339037

BMJ Paediatr Open. 2026 Aug 24;10(1):e004598. doi: 10.1136/bmjpo-2026-004598.

ABSTRACT

BACKGROUND: Under-five undernutrition remains a critical public health challenge, but national averages frequently mask how acute vulnerabilities are socioeconomically and structurally distributed. A distributional epidemiology framework helps isolate actionable entry points for equity-oriented policy.

OBJECTIVES: To evaluate the socioeconomic and structural distribution of acute child undernutrition in Uganda and assess aetiological specificity across alternative nutritional outcomes.

DESIGN: Secondary analysis of a nationally representative cross-sectional household survey.

SETTING: Central, Eastern, Northern and Western regions of Uganda (2019/2020 round).

PARTICIPANTS: 815 children aged 24-59 months with complete anthropometric records sampled via a two-stage stratified systematic cluster design.

MAIN OUTCOME MEASURES: Childhood wasting (weight-for-height z-score<-2SD) was the primary outcome; chronic stunting and underweight served as specificity checks. Socioeconomic inequalities were quantified using concentration indices. Predictors were modelled using Firth’s penalised logistic regression to minimise small-sample bias.

RESULTS: Prevalences for stunting, underweight and wasting were 16.9% (n=138), 11.8% (n=96) and 6.1% (n=50), respectively. Macrolevel socioeconomic inequality in wasting was modest and statistically non-significant (Relative Concentration Index=-0.0085, p=0.941). However, sharp structural barriers emerged: children residing ≥4 km from a health facility faced a more than threefold increase in the odds of wasting (adjusted OR (AOR)=3.42, 95% CI 1.01 to 11.54, p=0.048), reflecting an 8.2% absolute risk expansion. This geographic barrier was uniquely specific to wasting. Female children exhibited significantly higher wasting vulnerability (AOR=4.13, 95% CI 1.62 to 10.53, p=0.003; absolute risk increase: 5.0%). Household poverty showed an unexpected inverse trend bordering significance (AOR=0.48, 95% CI 0.21 to 1.09, p=0.080).

CONCLUSIONS: Childhood wasting in Uganda is more closely linked to physical access barriers and demographic factors than household asset wealth. Mitigating acute undernutrition requires shifting from wealth-based targeting towards universal structural expansions, specifically prioritising decentralised primary healthcare and gender-sensitive community interventions.

PMID:42637528 | DOI:10.1136/bmjpo-2026-004598

J Vasc Nurs. 2026 Sep;44(3):240-249. doi: 10.1016/j.jvn.2026.07.004. Epub 2026 Jul 30.

ABSTRACT

PROBLEM CONSIDERED: Diabetic foot ulcers (DFUs) are a major global complication of diabetes, leading to high rates of disability, amputation, and mortality. Evidence suggests that inadequate knowledge, negative attitudes, and poor practices (KAP) contribute significantly to preventable DFUs, yet regional data from South Asia remain scarce. Therefore, this study aimed to assess the KAP of patients with diabetes regarding DFU prevention in Dhaka, a South Asian region, and to identify socio-demographic predictors to inform targeted interventions and health policy.

METHODS: A hospital-based cross-sectional study was conducted among 424 adult patients with diabetes at East West Medical College and Hospital, Dhaka. Data were collected using a structured, researcher-developed 30-item KAP questionnaire developed based on existing literature, with expert review, pilot testing, and acceptable internal consistency, and analyzed with descriptive statistics, Chi-square tests, and multivariable logistic regression to identify independent predictors of good KAP. Model adequacy was confirmed using the Hosmer-Lemeshow test (p > 0.05).

RESULTS: Engagement in DFU prevention was alarmingly low. Only 15.8% of participants demonstrated good knowledge, 1.7% had a positive attitude, and 4.7% reported good preventive practices. Bivariate analysis indicated a weak association between age and attitude (p = 0.046), while multivariate models revealed no significant independent predictors, indicating poor KAP was widespread across all demographic groups.

CONCLUSION: The findings demonstrate inadequate knowledge, attitudes, and preventive practices related to diabetic foot ulcer prevention among patients with diabetes in Dhaka, with the predominance of neutral responses suggesting substantial uncertainty and limited practical awareness. These results underscore the need for systematic foot-risk screening, structured patient education initiatives, and the integration of diabetic foot ulcer prevention strategies into routine diabetes management and broader non-communicable disease care services in Bangladesh.

PMID:42637496 | DOI:10.1016/j.jvn.2026.07.004

J Vasc Nurs. 2026 Sep;44(3):207-215. doi: 10.1016/j.jvn.2026.06.006. Epub 2026 Jul 14.

ABSTRACT

OBJECTIVE: To describe the demographic and clinical profile of people diagnosed with chronic venous disease (CVD) referred from primary care to a vascular specialist at hospitals in Catalonia.

DESIGN: This study used a retrospective cohort design.

METHODS: Retrospective cohort study with a sample of 265,883 people for whom sociodemographic data were available, of a total of 333,455 individuals referred from primary care to a hospital vascular specialist between 2015 and 2021. We examined sex, age, health region of origin, number of referrals per year according to stage of the disease, and comorbidities associated with the diagnosis.

RESULTS: 69.4% of the cohort were women and 30.6% men, and the mean age of the referred individuals was 61 years. For diagnoses under the heading “phlebitis and thrombophlebitis”, the number of referrals increased from 3639 in 2015 to 5200 in 2021. The proportion of venous ulcers remained fairly constant, ranging from 3.7% in 2019 to 5% in 2020. Asymptomatic varicose veins (without visible or palpable signs of venous disease) constituted 34.6% of referrals Primary hypertension and obesity were the most frequent comorbidities in all stages of chronic venous disease.

CONCLUSION: Most people with chronic venous disease referred to hospitals were female, and the proportion of phlebitis and thrombophlebitis referrals increased over the study period. A significant percentage of individuals diagnosed with asymptomatic varices were unnecessarily referred to hospitals. This phenomenon may suggest that primary care professionals need more information and training about the recommended referral criteria.

PMID:42637492 | DOI:10.1016/j.jvn.2026.06.006