Tag: pubmed

BMC Oral Health. 2026 Jul 20. doi: 10.1186/s12903-026-09183-9. Online ahead of print.

ABSTRACT

BACKGROUND: Additive manufacturing has expanded the clinical application of resin-based materials for definitive fixed dental prostheses (FDPs). This study aimed to evaluate the effect of different printing orientations on marginal and internal misfit, overall discrepancy, and fracture load of three-unit FDPs fabricated from a reinforced resin-based material (VarseoSmile TriniQ).

METHODS: Forty-eight three-unit FDPs were fabricated and divided into four groups (n = 12): a lithium disilicate control group (IPS, IPS e.max CAD) and three experimental groups of a permanent composite resin (VST, VarseoSmile TriniQ) printed at 0°, 45°, and 90° build orientations (VST-0, VST-45, and VST-90). Marginal and internal misfit values were evaluated using micro-computed tomography (micro-CT) before and after chewing simulation. Dynamic aging was followed by fracture load testing using a single-load-to-failure protocol. Failure modes were classified under stereomicroscopic examination. Data were analyzed using nonparametric statistical methods. Intergroup comparisons were performed using the Kruskal-Wallis test with Dunn’s post hoc analysis, while pre- and post-aging comparisons were assessed using the Wilcoxon signed-rank test. Correlations between misfit parameters and fracture load were evaluated using Spearman’s rank correlation analysis (α = 0.05).

RESULTS: Printing orientation significantly affected the marginal and internal misfit of TriniQ restorations. The 45° build orientation demonstrated the most consistent fit values both before and after the chewing simulation. Chewing simulation resulted in statistically significant increases in marginal, internal misfit as well as overall discrepancy values across all groups (p < 0.05). No statistically significant differences in fracture load were observed among the groups (p = 0.094). However, the IPS control group exhibited the highest Weibull modulus (m = 8.41). Spearman’s rank correlation analysis revealed no statistically significant correlations between fracture load and overall discrepancy in any group (p > 0.05). IPS restorations predominantly exhibited catastrophic brittle fractures, whereas TriniQ restorations mainly exhibited connector-related and deformation type failure patterns.

CONCLUSIONS: Build orientation influenced the adaptation accuracy of additively manufactured three unit FDPs, whereas no statistically significant differences in fracture load were observed among the groups. Minor variations in overall discrepancy did not appear to influence fracture load under static loading conditions. All tested groups exhibited fracture resistance values exceeding reported physiological masticatory forces. IPS e.max CAD restorations demonstrated higher structural reliability and more consistent, yet comparatively brittle, fracture behavior.

PMID:42477658 | DOI:10.1186/s12903-026-09183-9

BMC Nephrol. 2026 Jul 20. doi: 10.1186/s12882-026-05211-6. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney biopsy is the gold standard for diagnosing kidney disease, yet its use during pregnancy remains controversial due to concerns about procedure related complications and limited contemporary evidence. This study evaluates long term kidney outcomes with biopsy timing in pregnant and postpartum females.

METHODS: We conducted a retrospective cohort study spanning over 22-years including females aged ≥ 18 years who underwent native kidney biopsy during pregnancy or within three months postpartum. Demographic, clinical, histopathological, maternal, fetal, and long-term kidney outcomes were abstracted from electronic health records. Kaplan-Meier analysis evaluated kidney survival, defined as time to dialysis initiation and statistical significance was set at p-value < 0.05.

RESULTS: In our cohort, 29 females met inclusion criteria: 13 biopsied during pregnancy and 16 postpartum. Long term kidney survival did not differ significantly between groups (log rank p = 0.3). Complication rates were comparable between groups; low, limited to small, and self-limiting hematomas. Lupus nephritis was the most frequent diagnosis in both groups.

DISCUSSION: Although long term dialysis rates were comparable between the two groups, the postpartum cohort had a shorter duration of follow up. Biopsies performed during pregnancy and postpartum were safe in this cohort and yielded clinically meaningful information that frequently altered acute management. Nephrotic range proteinuria and an eGFR below 60 mL/min/1.73 m² were key predictors of progression to ESKD.

CONCLUSION: In our study, no statistically significant difference in long-term kidney survival was observed by biopsy timing during pregnancy vs. postpartum, even though pregnancy group had much longer follow-up than the postpartum group.

PMID:42477653 | DOI:10.1186/s12882-026-05211-6

BMC Pediatr. 2026 Jul 20. doi: 10.1186/s12887-026-07230-6. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the effectiveness and safety of different phototherapy strategies in preterm infants using a network meta-analysis of randomized controlled trials, and to explore whether treatment and population-level characteristics modify the rate of bilirubin decline.

METHODS: We performed a systematic review and frequentist random-effects network meta-analysis of randomized controlled trials enrolling preterm infants (< 37 weeks’ gestation). Phototherapy interventions were grouped based on light source and delivery configuration. Prespecified network meta-regression analyses were conducted to explore potential effect modification by irradiance intensity, delivery configuration, gestational age, birth weight, and baseline bilirubin. The primary outcome was rate of total serum bilirubin decline within 24 h of treatment initiation. This network meta-analysis was prospectively registered in PROSPERO (CRD420261307223).

RESULTS: Twenty randomized trials were included. Double surface phototherapy led to increased TSB reduction (mean difference 0.17 mg/dl/h, 95% CI 0.11-0.22). Higher irradiance strategies demonstrated greater point estimates, although most pairwise comparisons did not reach statistical significance. Meta-regression did not identify statistically significant effect modification, but effect directions were consistent.

CONCLUSIONS: In preterm infants, phototherapy efficacy appears to be more closely related to irradiance intensity and exposed body surface area than to device category alone.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42477649 | DOI:10.1186/s12887-026-07230-6

BMC Cancer. 2026 Jul 20. doi: 10.1186/s12885-026-16554-6. Online ahead of print.

ABSTRACT

BACKGROUND: Gastrointestinal tract (GIT) cancers are a leading cause of cancer-related death worldwide. Chemotherapy, a cornerstone of treatment, often causes toxicities that can compromise clinical outcomes. However, evidence on the prevalence and risk factors of chemotherapy-induced toxicity among GIT cancer patients in Ethiopia remains limited. Therefore, this study aimed to assess the prevalence and associated factors of chemotherapy-induced toxicity among GIT cancer patients at two Tertiary Care Hospitals in Addis Ababa, Ethiopia.

METHODS: A hospital-based prospective observational study was conducted among patients enrolled prior to chemotherapy initiation and followed biweekly until treatment completion. Adverse drug reactions (ADRs) were collected from patient interviews and medical records, and assessed using the Naranjo algorithm, Hartwig-Siegel scale, and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5. Data were analyzed using descriptive statistics and logistic regression in SPSS version 26, with P < 0.05 considered statistically significant.

RESULTS: The mean (± SD) age of patients was 51.59 (± 11.18) years. A total of 1499 ADRs were reported, of which 47.4% (n = 710) were hematological toxicities. Based on the Naranjo scale, 54.8% of the ADRs were classified as probable, while the Hartwig-Siegel scale severity score classified 53.7% as mild ADRs. According to NCI-CTCAE v5.0 grading score, 37.1% of the ADRs were graded ≥ 3. Poor pathological grade (AOR: 4.410, 95% CI: 1.823-10.666, p = 0.001), low baseline hemoglobin (AOR: 4.456, 95% CI: 2.021-9.824, p = 0.001) and low absolute neutrophil counts (AOR: 2.237, 95% CI: 1.061-4.717, p = 0.034) were significantly associated with severe ADRs. Granulocyte colony-stimulating factor (G-CSF) use was independently associated with lower odds of high-grade ADRs (AOR = 0.508, 95% CI: 0.260-0.995, p = 0.048).

CONCLUSION: Chemotherapy-induced toxicities were highly prevalent among GIT cancer patients, with a substantial proportion experiencing severe toxicities. Poor pathological grade, low baseline hemoglobin, and low absolute neutrophil count were significantly associated with high-grade toxicities, while G-CSF use was protective. These findings highlight the need for improved toxicity management and personalized treatment strategies in Ethiopian oncology practice.

PMID:42477648 | DOI:10.1186/s12885-026-16554-6

BMC Public Health. 2026 Jul 21. doi: 10.1186/s12889-026-28553-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Academic achievement anxiety is a common psychosocial stressor among university students and may be associated with menstrual health outcomes. However, limited research has examined the relationships between academic achievement anxiety, perceived stress, menstrual pain, and menstrual hygiene behaviors simultaneously in female university populations.

MATERIALS AND METHODS: This cross-sectional study included 307 female university students in Turkiye (mean age = 20.59 ± 2.02 years). Participants completed online self-report measures assessing academic achievement anxiety, perceived stress, menstrual pain severity and menstrual hygiene behaviors. Descriptive statistics, Pearson correlations and regression analyses were conducted to examine associations among the variables.

RESULTS: Academic achievement anxiety was positively associated with perceived stress and menstrual pain and negatively associated with genital hygiene behaviors. Multiple linear regression analyses showed that these associations remained significant after controlling for relevant covariates, including age, income level, menstrual regularity, and faculty. Academic achievement anxiety emerged as a significant predictor of perceived stress(β = 0.315, p < 0.001), menstrual pain (β = 0.211, p < 0.001), and genital hygiene behaviors (β = -0.126, p = 0.026).

CONCLUSION: Academic achievement anxiety was associated with higher perceived stress, increased menstrual pain and slightly less optimal menstrual hygiene practices among female university students. However, these associations were modest, suggesting that academic-related stress may represent one of several factors related to menstrual health outcomes. Addressing academic-related stress within a broader context that includes psychological and structural factors may support student wellbeing. Future research should further explore these relationships using more comprehensive designs.

PMID:42477642 | DOI:10.1186/s12889-026-28553-0

BMC Ophthalmol. 2026 Jul 20. doi: 10.1186/s12886-026-05147-3. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic optic neuropathy (TON) is a potentially blinding complication of craniofacial trauma with an uncertain prognosis and no established standard of care. Evidence on outcomes and prognostic factors remains limited, particularly in Southeast Asian populations.

METHODS: A retrospective observational study was conducted at a tertiary referral centre in Malaysia between September 2020 and August 2025. Patients diagnosed with TON were identified through medical record review. Visual acuity (VA) was categorised according to the World Health Organization (WHO) visual impairment classification. Visual outcomes at one-year follow-up were analysed using the Wilcoxon signed-rank test, and factors associated with visual improvement were evaluated using Fisher’s exact test.

RESULTS: Fifty-eight patients were identified, of whom 54 had complete data for visual outcome analysis. The median age was 23.5 years, and most patients were male (82.8%). Road traffic accidents were the predominant aetiology, accounting for 86.2% of TON cases. TON occurred across all traumatic brain injury severities, with comparable distribution in mild and severe cases. At presentation, 53.8% had severe visual impairment, including 13.8% with no perception of light. There was a statistically significant overall improvement in visual acuity at one-year follow-up compared with baseline (p = 0.003). However, subgroup analysis showed no significant association between treatment modality and visual improvement. Visual improvement was also not significantly associated with age, baseline severity, timing of corticosteroid initiation, or the presence of orbital or skull fractures and intracranial haemorrhage (all p > 0.05).

CONCLUSION: Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis. Due to the relatively small sample size of this cohort, these findings may not be generalisable to broader populations.

PMID:42477640 | DOI:10.1186/s12886-026-05147-3

Int Dent J. 2026 Jul 20;76(5):109760. doi: 10.1016/j.identj.2026.109760. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to estimate the relative contributions of genetic and environmental factors on acquired tooth loss among middle-aged and older twins in Qingdao, China.

METHODS: A total of 377 complete twin pairs (240 monozygotic, 137 dizygotic) were recruited from the Qingdao Twin Registry in China, and acquired tooth loss was recorded through structured interviews. Heritability of acquired tooth loss was estimated using correlation analysis and structural equation model, adjusting for age and sex.

RESULTS: The median age of the twins was 50 years (IQR: 46-57). The polychoric correlations for monozygotic twins (0.67; 95% CI: 0.55-0.78) were more than twice as high as that for dizygotic twins (0.25; 95% CI: 0.03-0.48). Therefore, we fitted an additive, dominant, and unique environmental factors model and its nested submodels. Based on the Akaike information criterion, the additive and unique environmental factors model was selected as the preferred model. After adjusting for age and sex, the model indicated that 56.51% (95% CI: 43.21%-69.81%) of the variance in acquired tooth loss was attributable to additive genetic factors, and 43.49% (95% CI: 30.20%-56.79%) to unique environmental influences.

CONCLUSION: This study demonstrated that variation in acquired tooth loss is influenced by both additive genetic and unique environmental factors. These findings may assist in developing strategies for tooth loss prevention and oral health maintenance.

PMID:42475771 | DOI:10.1016/j.identj.2026.109760

Placenta. 2026 Jul 14;182:348-353. doi: 10.1016/j.placenta.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Maternal obesity is a well-established risk factor for preeclampsia; however, whether increased maternal BMI is associated with biologically distinct subtypes of this disorder remains unknown.

OBJECTIVE: To investigate whether maternal BMI is associated with differences in placental gene expression patterns observed in preeclampsia and to identify transcriptomic signatures with potential relevance for future biomarker research.

STUDY DESIGN: This exploratory analysis used placental transcriptomic data obtained from the Gene Expression Omnibus. Differential expression within prespecified contrasts encoding preeclampsia status and maternal BMI was analyzed using a multivariable linear modeling framework with adjustment for relevant confounders. In a secondary analysis, maternal BMI was modeled continuously with an interaction term between BMI and preeclampsia status.

RESULTS: Placental transcriptomic data from 132 placentas representing a range of maternal hypertensive and normotensive states were analyzed. Genes commonly associated with preeclampsia, including FLT1, LEP, HTRA4, and FSTL3, were differentially expressed across all BMI categories. SERPINA3 demonstrated the strongest differential expression in the obese contrast, with an estimated eight-fold increase (95% CI: 3.9-16.6) in preeclamptic pregnancies complicated by obesity, whereas expression differences were smaller and not statistically significant in healthy-weight and overweight contrasts. Gene set enrichment analysis suggested heterogeneity in the underlying biology of preeclampsia across BMI strata.

CONCLUSION: Placental transcriptional patterns associated with preeclampsia differed across maternal BMI strata. These findings are consistent with previously proposed molecular subtypes of preeclampsia and highlight SERPINA3 as a candidate transcriptomic marker warranting further investigation, specifically in pregnancies complicated by obesity.

PMID:42475769 | DOI:10.1016/j.placenta.2026.07.005

J Healthc Qual Res. 2026 Jul 20;41(4):101223. doi: 10.1016/j.jhqr.2026.101223. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Inappropriate use of antimicrobial agents accelerates the emergence and spread of resistance. Antimicrobial treatment guidelines (ATG) stand between evidence and clinical practice as they are designed to guide policy decision framework for all stakeholders promoting the prudent use of antimicrobials in bedside care. The trustworthiness of these decision-making instruments relies on their methodological quality and reporting. The aim of this systematic review is to critically appraise the methodological quality and reporting of antimicrobial treatment guidelines using the AGREE II, AGREE-REX tools and the RIGHT checklist respectively.

MATERIALS AND METHODS: A systematic review was conducted. ATGs from public institutions and hospitals with over 500 beds were identified through a systematic search using the Google search engine and by consulting members of the AFinf workgroup (https://gruposdetrabajo.sefh.es/afinf/en/). Screening and data extraction were performed in duplicate. Quality and reporting were assessed using the validated checklists AGREE II, AGREE REX and RIGHT. Central tendency, dispersion, and correlations were calculated and compared using Student’s t-test. Results are de-identified. Prospective protocol: https://osf.io/cey2v RESULTS: N=22. The mean scores for AGREE II, AGREE-REX, and RIGHT were generally low: 31.0% (95% CI: 23.7%-38.3%), 20.4% (95% CI: 15.6%-25.1%), and 28.7% (95% CI: 23.4%-34.0%) respectively. Low rates were observed for development rigour (10.2%); reference existing reviews (4.6%); quality assurance (4.6%); conflict of interests disclosure (4.6%); values and preferences (1.9%) while clarity (94.8%) and implementability (37.7%) rated the highest. Strong correlations among AGREE II and AGREE-REX (corr=0.9092) and RIGHT (corr=0.9203).

CONCLUSION: There is room for improvement in the quality and reporting of current ATGs in Spain, especially at hospital level, where they have greater potential to optimize antibiotic prescribing practices.

PMID:42475767 | DOI:10.1016/j.jhqr.2026.101223

Med Image Anal. 2026 Jun 16;113:104159. doi: 10.1016/j.media.2026.104159. Online ahead of print.

ABSTRACT

Despite high performance of deep learning in medical imaging applications, the critical lack of validated computational metrics for explainable AI (XAI) impedes clinical integration. To address this gap, our study introduces a multi-level validation framework to rigorously assess seven computational evaluation metrics applied to eight widely-used post-hoc attribution methods – spanning gradient-based, input attribution, and decomposition-based families – on large-scale structural MRI datasets (UK Biobank and ADNI) with two different benchmark tasks across several deep learning architectures. At the first level, we benchmark metrics against three scales of clinical relevance: voxel-based morphometry, regional volumetric associations, and expert radiologist assessments, revealing that many widely used conventional metrics exhibit negligible correlation with clinical evidence. At the second level, we show that metrics in addition are often significantly confounded by model architecture rather than reflecting explanation quality. At the third level, we conduct a computational efficiency and stability analysis focused on practical dimensions of the metrics. Across all levels, our statistical analyses show that only one of the metrics has consistent high performance: the Robustness score – defined as the stability of explanations across random training initializations – demonstrates strong alignment with morphometry, volumetric associations, and human expert judgments, effectively isolates the quality of the XAI method from architectural bias, and possesses good computational efficiency. Our novel, multi-level framework therefore establishes Robustness as a superior, scalable proxy for clinical validity and trustworthy AI in medical imaging.

PMID:42475759 | DOI:10.1016/j.media.2026.104159