Tag: pubmed

Front Cardiovasc Med. 2026 Jul 20;13:1841870. doi: 10.3389/fcvm.2026.1841870. eCollection 2026.

ABSTRACT

BACKGROUND: The first 2-3 months after discharge for acute or decompensated chronic heart failure (HF) constitute a “vulnerable phase” marked by high risks of rehospitalization and death. Symptom fluctuations during this period may be associated with adverse outcomes, yet evidence on post-discharge symptom trajectories is limited. This study applied a latent class trajectory model to characterize KCCQ symptom evolution and its association with early cardiovascular events.

METHODS: In this prospective cohort study, 1,109 patients with chronic HF admitted to a tertiary hospital in Nanchang, China (August 2020-July 2025), completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) at six time points: day 3 after admission, at discharge, and 1, 2, 3, and 6 months post-discharge. Symptom trajectories were identified using latent class trajectory modeling. Associations between trajectory groups and major adverse cardiovascular events (MACEs) were analyzed using multivariable logistic regression, and an exploratory mediation analysis was conducted to examine whether trajectory patterns partly accounted for the association between KCCQ scores and MACEs.

RESULTS: During follow-up, 207 patients (18.7%) experienced MACEs. Latent class trajectory analysis identified four distinct groups: persistently declining, slowly improving, stable-moderate, and stable-high. Relative to the stable-moderate group, patients in the persistently declining group had higher odds of MACEs (OR = 2.242, 95% CI: 1.073-4.718, P = 0.032). The exploratory mediation analysis suggested a statistically significant indirect association through trajectory patterns (β=-0.007, P < 0.001).

CONCLUSIONS: Symptom recovery after HF hospitalization is heterogeneous and was associated with cardiovascular outcomes. Persistently worsening symptoms predict the highest risk, while stable or improving trajectories indicate favorable recovery. Tracking KCCQ trajectories may support early risk stratification and personalized management during the vulnerable phase.

PMID:42548830 | PMC:PMC13429835 | DOI:10.3389/fcvm.2026.1841870

Front Med (Lausanne). 2026 Jul 20;13:1879189. doi: 10.3389/fmed.2026.1879189. eCollection 2026.

ABSTRACT

PURPOSE: To assess intensive care unit (ICU) nurses’ and respiratory therapists’ knowledge and practice regarding airway pressure release ventilation (APRV) use in acute respiratory distress syndrome (ARDS) patients and identify barriers to its implementation in China.

METHODS: A multicenter cross-sectional survey. Between June 22, 2024, and August 10, 2024, an online cross-sectional survey of ICU nurses and respiratory therapists from five cities in Sichuan Province, China, was conducted. Descriptive statistics were used to analyze the data.

RESULTS: Among 239 valid responses from ICU nurses and respiratory therapists in Sichuan Province, 55.2% (132/239) respondents reported no prior didactic APRV training, and 54.4% (130/239) had never used APRV for ARDS. While 97.9% (234/239) correctly identified ARDS as an indication, substantial variability was observed in the alignment of parameter settings with evidence-based recommendations. Key barriers to APRV use included lack of guidelines/standardized protocols (56.5%, 135/239), insufficient training (57.3%, 137/239), and lack of awareness (45.2%, 108/239).

CONCLUSION: Considerable variability in APRV knowledge and practice was observed among ICU nurses and respiratory therapists, coupled with a lack of standardized training and institutional protocols, highlighting a critical need for targeted educational interventions. The lack of guidelines or standardized protocols is the most common impediment to APRV use.

PMID:42548807 | PMC:PMC13429676 | DOI:10.3389/fmed.2026.1879189

Front Artif Intell. 2026 Jul 20;9:1844254. doi: 10.3389/frai.2026.1844254. eCollection 2026.

ABSTRACT

Patient subtyping is significantly challenged by intra-sample heterogeneity, which limits the effectiveness of traditional multi-class classification approaches enforcing mutually exclusive labels. Despite recent promising results in the transition from multi-class to multi-label classification, this process is not straightforward and proves hard to systemize, especially when working with datasets of small dimensions. Here, we design a novel approach, implemented in a computational framework, leveraging machine learning models and an original nested conformal prediction strategy for small datasets to enable a rigorous transition to multi-label classification. Conformal prediction can indeed offer a statistically sound approach for robust subtype predictions; yet, so far, it has been limited to be exploited only in large datasets, not often available in real biomedical scenarios. We evaluate our approach using breast cancer patient RNA-seq data from The Cancer Genome Atlas, with subtypes originally defined via the PAM50 classifier. From a methodological standpoint, our innovative nested strategy enables the successful application of conformal prediction, which commonly requires large datasets, to a relatively small sample size. Specifically, conformal prediction is adapted and applied both to the reference PAM50 classification and to multiple machine learning models to test coherence and compare the obtained multi-label predictions. Our results reveal subtype- and sample-specific complexity and highlight consistent patterns of ambiguity across models. Importantly, we distinguish between robust, inherently heterogeneous, and weak assignments, providing deeper insight into clear subtype confirmations and complexity, but also critical incoherent predictions. Thus, overall, this work demonstrates the utility of our framework for uncertainty-aware sample subtyping, particularly in small and highly unbalanced sample settings.

PMID:42548800 | PMC:PMC13429844 | DOI:10.3389/frai.2026.1844254

Mayo Clin Proc Innov Qual Outcomes. 2026 Jul 27;10(5):100739. doi: 10.1016/j.mayocpiqo.2026.100739. eCollection 2026 Oct.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of Tofersen in patients with superoxide dismutase 1 gene (SOD1-ALS) patients in France in a real-world setting, using disease progression within patient comparisons and with a historical cohort.

PATIENTS AND METHODS: Patients with SOD1-ALS were included from across 19 French FILSLAN network centers. Baseline was defined as the treatment initiation date. Main endpoints were the ALSFRS-R progression rate and plasmatic neurofilament light chain (NfL) levels at baseline and 12 months after baseline.

RESULTS: In the Tofersen Cohort (N=46), within-group comparisons showed that the mean ALS functional rating scale revised (ALSFRS-R) progression rate slowed from 0.53 ± 0.5 at baseline to 0.22 ± 0.3 point/month at 12 months (P=.006). NfL levels significantly decreased from 89.0 ± 9.0 pg/ml at baseline to 29.2 ± 19.5.5 at 12 months (P=.004). Exploratory comparisons with a propensity score (PS) matched historical cohort (39 matched pairs) using a mixed-effects model, ALSFRS-R progression rate at baseline, 6 months, and 12 months after baseline, showed no statistically significant differences between groups P=.30, whereas longitudinal ALSFRS-R scores differed significantly between groups (time-treatment interaction P=.006). The mean survival of the PS matched population was longer in the Tofersen Cohort (42.6 months) than the Historical Cohort (31.8 months) P=.004. Time-dependent adjusted cox analysis showed that Tofersen was associated with a reduction in mortality risk (adjusted HR=0.34; 95% CI, 0.12-0.91; P=.03).

CONCLUSION: Tofersen seems to be associated with slower functional decline and reduced NfL levels. While limitations of retrospective design and ALSFRS-R sensitivity must be acknowledged, these findings provide real-world evidence suggesting a clinical benefit of Tofersen.

PMID:42548788 | PMC:PMC13429897 | DOI:10.1016/j.mayocpiqo.2026.100739

Behav Res Methods. 2026 Aug 3;58(9):256. doi: 10.3758/s13428-026-03131-9.

ABSTRACT

In spite of the inherently dynamic nature of actions, most psycholinguistic studies investigating action naming have relied on static images. To address this gap for French, we present a new database comprising 134 action videos. For each video, we developed five key psycholinguistic variables: Name agreement (NA), H-statistic, naming latency, uniqueness naming point (i.e., the moment in the video when the action becomes unmistakably identifiable), and adjusted naming latency. All variables are provided both for the overall sample and separately for adults under 50 years and those aged 50 and above. We then examined the influence of these variables on response latencies collected from 394 French-speaking participants. NA, the H-statistic, and instrumentality significantly predicted response latencies. The video-based action naming database is freely available to clinicians and researchers. This study provides a new resource to explore action naming in both clinical and research contexts.

PMID:42547762 | DOI:10.3758/s13428-026-03131-9

Geroscience. 2026 Aug 4. doi: 10.1007/s11357-026-02427-0. Online ahead of print.

ABSTRACT

Vascular dysfunction in aging is driven by multiple interconnected hallmarks of aging, including DNA damage, oxidative stress, chronic inflammation, mitochondrial dysfunction, and cellular senescence and features by endothelial impairment, inflammation, and reduced nitric oxide-cyclic guanosine monophosphate (NO-cGMP) signaling. Targeting this pathway may offer therapeutic benefit beyond traditional atherosclerosis-focused treatments. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD42025597982, CRD42025597983, CRD42025598016). PubMed and Embase were systematically searched (August 2024, updated September 2025) for preclinical studies investigating the effect of anti-inflammatory agents (DMARDs), phosphodiesterase (PDE) inhibitors, and soluble guanylate cyclase (sGC) modulators targeting the NO-cGMP pathway in aged animal models of vascular dysfunction. Studies were screened in duplicate using predefined criteria, and data extraction was performed using standardized forms. Risk of bias was assessed using the SYRCLE tool with additional reporting quality items. Meta analyses was conducted using multi-level models accounted for data clustering, and heterogeneity was assessed using I² statistics. Thirteen studies in total were included. DMARDs (n = 6 studies) significantly improved ACh-induced vasorelaxation (2.55 [1.68; 3.42]). PDE inhibitors enhanced SNP-induced vasorelaxation (0.5 [0.04; 0.96], n = 5) and microvascular perfusion (0.76 [0.28; 1.25], n = 4) but showed no significant effect on ACh-induced vasorelaxation. Similarly, sGC modulators improved microvascular perfusion (1.12 [0.46; 1.78], n = 2) without significantly affecting ACh-induced vasorelaxation (0.45 [-0.23; 1.13], n = 3). Pooled analysis (of DMARDS, PDE, and sGC) demonstrated overall improvement in both ACh-induced vasorelaxation (1.73 [0.63; 2.82], n = 13) and microvascular function via any modulation within the NO-cGMP pathway (0.89 [0.49; 1.28], n = 6). The risk of bias assessment showed mixed quality across studies, with generally low risk in randomization (except PDE inhibitors), but high risk in power reporting and some concerns in baseline comparability, allocation, and incomplete outcome data. Modulation of the NO-cGMP pathway improves vascular function through complementary mechanisms. While PDE inhibitors and sGC modulators primarily act on downstream smooth muscle signaling, anti-inflammatory strategies may target upstream endothelial dysfunction. These findings support multi-level therapeutic targeting of vascular aging, although they should be interpreted cautiously given potential bias, heterogeneity, and reliance on the quality of included studies.

PMID:42547759 | DOI:10.1007/s11357-026-02427-0

Can J Anaesth. 2026 Aug 3. doi: 10.1007/s12630-026-03165-9. Online ahead of print.

NO ABSTRACT

PMID:42547755 | DOI:10.1007/s12630-026-03165-9

Ann Surg Oncol. 2026 Aug 3. doi: 10.1245/s10434-026-20210-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Peritoneal carcinomatosis from lower gastrointestinal malignancies causes debilitating intra-abdominal complications, including bowel obstruction, ascites, and biliary/ureteral obstruction. Guidelines addressing palliative cytoreductive surgery (CRS) in patient’s ineligible for curative resection remain limited.

METHODS: Patients who underwent CRS for appendiceal cancer (AC)- or colorectal cancer (CRC)-related carcinomatosis not amenable to complete cytoreduction at one referral center (2004-2025) were retrospectively reviewed. Tumor grade was dichotomized into low- (well- and well-to-moderately differentiated ACs) versus high-grade (moderately or poorly differentiated/signet ring ACs, all CRCs). Descriptive statistics summarize patient demographics. Carcinomatosis-related complication-free (CRCFS), obstruction-free (OFS), ascites-free (AFS), and overall survival (OS) were estimated by using the Kaplan-Meier method.

RESULTS: A total of 131 patients underwent palliative CRS. The most common reasons for incomplete cytoreduction were high tumor burden/multiple unresectable areas 62 (47%), portal 20 (15%), small bowel 19 (14%), or pelvic 17 (13%) disease. Common palliative procedures included omentectomy 86 (66%), hyperthermic intraperitoneal chemotherapy 63 (48%), bowel resection 63 (48%), gastrostomy tube/gastropexy 60 (46%), and intestinal bypass 27 (20%). Twenty-two (17%) patients had major complications, and median length of stay was 11 days (IQR 9-14). Median CRCFS, OFS, AFS, and OS were 11, 16, 62, and 13 months for high-grade versus 36, NR, NR, and 37 months for low-grade tumors. The strongest predictor of shortened CRCFS, OFS, AFS, and OS was high-grade histology.

CONCLUSIONS: Palliative CRS for incompletely resectable carcinomatosis is associated with prolonged OFS and AFS for patients with low-grade histology. Palliative surgical intervention should be considered in carefully selected patients.

PMID:42547753 | DOI:10.1245/s10434-026-20210-5

Cardiovasc Eng Technol. 2026 Aug 3. doi: 10.1007/s13239-026-00850-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Chronic cardiovascular diseases have motivated the development of wearable systems capable of continuously monitoring physiological variables such as oxygen saturation (SpO 2 ) and non-invasive blood pressure (NIBP). However, motion artifacts remain one of the main limitations affecting the reliability of these measurements in ambulatory environments. This article presents a novel framework for motion artifact reduction in photoplethysmography (PPG) and NIBP signals based on redundant sensing, inertial measurements, ECG-guided temporal synchrony, and multichannel signal processing.

METHODS: The proposed framework combines independent component analysis and recursive least-squares adaptive filtering to separate physiological information from motion-induced interference. Performance was compared with conventional finite impulse response (FIR) filtering and wavelet shrinkage (WS) methods using signal-to-noise ratio (SNR), weighted distortion assessment (WDA), oxygen saturation estimation, and blood pressure estimation metrics.

RESULTS: The proposed method achieved statistically significant improvements in signal quality and physiological parameter estimation. Average SNR improved from – 5.93 ± 5.05 dB to – 3.43 ± 2.02 dB in the red PPG channel ( p = 0.02 ), while the WDA index increased from 0.48 to 0.73. Oxygen saturation estimation improved from 80.87 ± 9.09 % in motion-contaminated signals to 94.16 ± 2.72 % after denoising ( p = 0.04 ), approaching resting measurements ( 95.23 ± 2.31 % ). For NIBP signals, statistically significant improvements were also observed ( p = 0.045 ), particularly for systolic pressure estimation, although diastolic pressure remained affected by residual motion-related distortions.

CONCLUSIONS: The proposed framework improves the robustness of wearable PPG and NIBP monitoring under motion conditions through the combined use of sensor redundancy, ECG-guided temporal coupling, inertial measurements, and adaptive multichannel signal processing. The results demonstrate significant improvements in signal quality and physiological parameter estimation compared with conventional denoising approaches, supporting the potential use of the method in ambulatory cardiovascular monitoring applications.

PMID:42547737 | DOI:10.1007/s13239-026-00850-0

Odontology. 2026 Aug 3. doi: 10.1007/s10266-026-01511-3. Online ahead of print.

ABSTRACT

This study evaluated the impact of guideline-based prompting on the performance of large language models (LLMs) in answering dental trauma-related questions. Sixteen multiple-choice questions (MCQs) and sixteen open-ended questions (OEQs) derived from the International Association of Dental Traumatology (IADT) guidelines were used. ChatGPT-4o, Gemini-2.5 Flash, and DeepSeek v3.2 were tested under two conditions: with and without guideline support. Questions were asked three times daily over three consecutive days using independent chat sessions. In the guideline-based condition, the dental trauma guideline was uploaded and models were instructed to answer according to the document. Responses were evaluated using predefined answer keys and a structured rubric. Statistical analyses were performed using the Shapiro-Wilk test, aligned rank transform (ART) analysis, and Bonferroni-adjusted multiple comparisons. Multiple-choice performance was consistently high across all models, with no significant effects of day, time, or AI model. Guideline-based prompting substantially improved performance and guideline concordance on open-ended questions. In the guideline-supported condition, DeepSeek achieved a median score of 32, while ChatGPT and Gemini achieved median scores of 30. Without guideline support, median scores decreased to 26, 20, and 23, respectively. All models achieved 100% accuracy on MCQs with guideline support, whereas accuracy ranged from 81.2% to 100% without guideline support. Significant differences between AI models were observed for OEQ scores (p < 0.001). Guideline-based prompting improved guideline concordance and overall performance, particularly for open-ended dental trauma questions. These findings support the use of guideline grounding to enhance the guideline concordance and reliability of LLM-generated responses while emphasizing the continued need for clinician oversight.

PMID:42547726 | DOI:10.1007/s10266-026-01511-3