Tag: pubmed

JAMA Intern Med. 2026 Jun 1. doi: 10.1001/jamainternmed.2026.1893. Online ahead of print.

ABSTRACT

IMPORTANCE: Acute and subacute low back pain (LBP) often progresses to a chronic impactful back problem in patients with elevated risk. The most effective way to prevent this progression is unknown.

OBJECTIVE: To determine the effectiveness of spinal manipulation and clinician-supported biopsychosocial self-management vs medical care for preventing chronic impactful LBP.

DESIGN, SETTING, AND PARTICIPANTS: This 2 × 2 factorial randomized clinical trial was conducted in research clinics at the University of Minnesota and the University of Pittsburgh, Pennsylvania, from November 2018 to May 2023, with follow-up concluding in June 2024. Adults with acute or subacute LBP with a moderate to high risk of chronicity were included.

INTERVENTIONS: Four interventions were applied for 8 weeks: spinal manipulation therapy; supported self-management; combined spinal manipulation therapy and supported self-management; and guideline-based medical care. Spinal manipulation and supported self-management were provided by physical therapists and chiropractors.

MAIN OUTCOMES AND MEASURES: Mean LBP impact score per the US National Institutes of Health Task Force on Chronic LBP scale (8 [best] to 50 [worst]) during 10 to 12 months, responder analyses of group differences in the proportion of participants with at least 50% reductions. A reduction of 30% was considered the minimal clinically important within-patient difference. Secondary outcomes included measures of chronicity and LBP burden (ie, health care and medication use, productivity), important patient-reported outcomes (eg, improvement, satisfaction), biopsychosocial measures (eg, Patient-Reported Outcomes Measurement Information System), and potential mediating psychosocial measures (eg, self-efficacy, kinesiophobia, pain catastrophizing).

RESULTS: Of the 1000 participants (mean [SD] age, 47 [16] years; 577 females [58%]) randomized, 928 (93%) completed the trial. An omnibus test of the primary outcome was statistically significant (P = .006). Group differences in mean LBP impact scores were small but statistically significant: supported self-management vs medical care, -1.7 (95% CI, -2.7 to -0.6); combined self-management and spinal manipulation vs medical care, -1.3 (95% CI, -2.5 to 0). Spinal manipulation therapy and medical care did not differ: -0.3 (95% CI, -1.5 to 1.0). Adding spinal manipulation to supported self-management did not provide additional benefit. The supported self-management group had a significantly higher proportion with at least 50% reduction in LBP impact vs medical care (64% vs 55%). Supported self-management also performed better on most secondary outcomes compared to medical care, including 12% fewer reporting chronic pain that frequently interfered with regular activities. Mediation analyses showed changes in psychosocial factors at 6 months and explained 76% of supported self-management effects at 1 year.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that for patients with acute or subacute LBP at increased risk of chronic impactful LBP, clinician-supported biopsychosocial self-management resulted in a lower mean LBP impact score at 10 to 12 months vs medical care; spinal manipulation and medical care did not differ. While the LBP impact difference was small, the consistent results of the responder analyses and most secondary outcomes suggest differences between clinician-supported self-management and medical care are clinically relevant.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03581123.

PMID:42223934 | DOI:10.1001/jamainternmed.2026.1893

JACC Cardiovasc Interv. 2026 May 21:S1936-8798(26)01448-2. doi: 10.1016/j.jcin.2026.05.007. Online ahead of print.

ABSTRACT

(350/350) BACKGROUND: Standardized implant protocols have shown promise in improving outcomes in transcatheter aortic valve replacement (TAVR). However, the impact of implant depth on clinical outcomes remains unclear.

OBJECTIVES: To evaluate clinical and hemodynamic outcomes across varying TAVR implantation depths using data from the Optimize PRO study.

METHODS: This prospective, multicenter Optimize PRO study included patients with symptomatic severe aortic stenosis undergoing TAVR with Evolut PRO/PRO+ systems. Patients were stratified by core laboratory-adjudicated non-coronary cusp implant depth. The echocardiographic outcome composite included none/trace paravalvular regurgitation, aortic mean gradient ≤10mmHg and no prosthesis-patient-mismatch at discharge.

RESULTS: Patients (N=603) were stratified by implant depth: <1mm (N=88), 1 to ≤3mm (N=196), >3 to ≤5mm (N=170), and >5mm (N=149). Baseline characteristics were similar across implant depth groups, except for a higher proportion of females in higher implant depths. Higher implant depths were associated with less resheathing and recapture (27.3% [24/88], 33.7% [66/196], 48.8% [83/170], 51.7% [77/149]; P<.001), and shorter median [Q1, Q3] hospital stay (days: 1[1,1], 1[1,2], 2 [1,3], 2 [1,4]; P<.001). Rates of valve migration (0% [95% CI:NA], 0.5% [95% CI:0.1-3.6], 0.6% [95% CI:0.1-4.1], 1.3% [95% CI:0.3-5.3]; P=.63) were low across implant depth groups. The 1-year all-cause mortality or all-stroke rate was comparable across implant depth groups (8.1% [95% CI:3.9-16.2], 7.2% [95% CI:4.3-11.8], 10.7% [95% CI:6.9-16.5], 12.5% [95% CI:8.1-19.2]; P=.40). After 1 year, higher implant depths were associated with lower rates of permanent pacemaker implantation (PPI, 2.3% [95% CI:0.6-8.8], 9.2% [95% CI:5.9-14.3], 15.9% [95% CI:11.2-22.4], 20.3% [95% CI:14.6-27.7]; P<.001). Rates of New York Heart Association functional class I were numerically different across implant depth groups but did not reach statistical significance (NYHA, 77.8% [56/72], 71.8% [130/181], 65.2% [101/155], 67.7% [84/124], P=.09 across all classes). In males, echo outcome composite rates were not statistically different across depth groups (58.6%[17/29], 50.6% [39/77], 43.8% [35/80], 36.1% [26/72]; P=.14), although the exploratory trend test reached statistical significance (P=.02).

CONCLUSIONS: Higher TAVR device implantation was associated with improved clinical outcomes with similar safety events, including valve migration, across depths. The long-term effect of this approach including the ability to perform redo-TAVR safely, will be further studied in the future.

PMID:42223923 | DOI:10.1016/j.jcin.2026.05.007

Acta Crystallogr D Struct Biol. 2026 Jul 1. doi: 10.1107/S2059798326003943. Online ahead of print.

ABSTRACT

Radiation damage to macromolecular structures remains a significant challenge for accurate structure solution by X-ray crystallography, leading to incorrect structural and chemical interpretation of the data. Site-specific radiation damage is insidious, typically unidentifiable solely from summary statistics, and is primarily discussed with reference to the predominant forms: disulfide-bond cleavage, metal-centre reduction and decarboxylation of acidic residues. A method is presented for identifying potentially oxidatively damaged cysteines by interrogating the accuracy of the built model within the electron density and the geometry of the difference density peaks surrounding a cysteine. We also highlight that cysteines located within protein active sites or that are in hydrolases are predisposed to this damage.

PMID:42223917 | DOI:10.1107/S2059798326003943

J Racial Ethn Health Disparities. 2026 Jun 1. doi: 10.1007/s40615-026-02952-w. Online ahead of print.

ABSTRACT

The term “Hispanic Paradox” refers to research findings that Hispanic immigrants often exhibit better health than more socioeconomically advantaged U.S.-born populations. However, much of this research attributes this epidemiological phenomenon to immigration selectivity and rarely examines (1) whether a Hispanic-specific health advantage persists within immigrant-only populations and (2) how any such advantage is structured by race and sex inequalities across highly heterogeneous immigrant groups. Using data from the IPUMS National Health Interview Survey (NHIS), 2006-2018 (N = 166,700), this study applies an intersectional approach to evaluate a Hispanic health effect in health-related functional limitations – a measure strongly linked to mortality and health care needs – across race-sex immigrant groups. Logistic regression and post-estimation results show that a health advantage associated with Hispanic identity appears only among female and male immigrants who identify as White, with no comparable benefit for other race-sex intersections. These findings indicate that a Hispanic health advantage among immigrants is not universal but shaped by structural inequality, underscoring the need for intersectionality-informed research that uncovers masked vulnerabilities across ethnoracially diverse immigrant populations.

PMID:42223888 | DOI:10.1007/s40615-026-02952-w

Ann Nucl Med. 2026 Jun 1. doi: 10.1007/s12149-026-02221-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the value of ¹⁸F-FDG PET/CT in assessing the local aggressiveness of desmoid-type fibromatosis (DF) and in predicting prognosis of DF.

METHODS: We retrospectively analyzed ¹⁸F-FDG PET/CT of DF lesions in participants. Clinical data and ¹⁸F-FDG PET/CT imaging features were collected and analyzed. The diagnostic performance of ¹⁸F-FDG PET/CT versus contrast-enhanced MRI (CE-MRI) for assessing peritumoral invasion was compared using reference of pathology. Lesions were followed up to record progressive disease (PD) and postoperative recurrence (POR), and event-free survival (EFS) was determined. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of PD or POR.

RESULTS: Fifty-five lesions from 44 participants were included. ¹⁸F-FDG PET/CT showed higher accuracy and sensitivity than CE-MRI for assessing peritumoral invasion, with no statistically significant differences in paired comparisons. Notably, pathology in one case demonstrated tumor invasion of the lymph node capsules. Furthermore, DF lesions with PD or POR had significantly higher maximum standardized uptake value (SUV_max) and target-to-background ratio (TBR). SUV_max, TBR and irregular lesion morphology were identified as independent predictors of PD or POR. The AUC for SUV_max was 0.79 (95% CI: 0.64-0.95), with sensitivity, specificity, and overall accuracy of 78.6% (11/14), 82.9% (34/41), and 81.8% (45/55), respectively. Kaplan-Meier survival analysis revealed that SUV_max> 5.0 was associated with significantly shorter EFS (692.4 [427.5-957.3] days vs. 2419.9 [1989.5-2850.3] days).

CONCLUSION: ¹⁸F-FDG PET/CT showed numerically higher sensitivity and accuracy than CE-MRI for assessing peritumoral invasion of DF lesions, though with lower specificity. SUV_max, TBR, and lesion morphology were independent predictors of PD or POR.

PMID:42223872 | DOI:10.1007/s12149-026-02221-0

Ann Nucl Med. 2026 Jun 1. doi: 10.1007/s12149-026-02242-9. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the clinical utility of preoperative [¹⁸F]FDG PET/CT for CT-guided biopsy planning of large tumors, including predictors of PET/CT-informed target adjustment and malignant yield with FDG hotspot targeting in very large tumors.

METHODS: In this retrospective single-center study (January 2015-December 2025), we analyzed 82 patients who underwent pre-biopsy [¹⁸F]FDG PET/CT at our institution within 90 days. Target adjustment was retrospectively adjudicated as the presence of a spatial difference between the contrast-enhanced CT-based target and the PET/CT-informed target selected after considering intratumoral FDG uptake. ROC analysis was used to evaluate whether tumor size predicted target adjustment and to determine the optimal cutoff. Multivariable logistic regression included age, sex, tumor size, PET system (analog vs. digital), ΔSUV, lesion location (chest vs. other), and lymphoma (vs. other). In tumors ≥ 52 mm, malignant yield was compared between hotspot (highest uptake) and non-hotspot targeting.

RESULTS: Target adjustment was performed in 28/82 cases (34.1%). Interobserver agreement was 89% with Cohen’s κ = 0.74 (95% CI, 0.58-0.89). Tumor size predicted target adjustment (AUC 0.847; 95% CI 0.761-0.934), and the Youden-optimal cutoff was 52 mm (sensitivity 0.82, specificity 0.81). Target adjustment rates were 5/49 (10.2%) for < 52 mm and 23/33 (69.7%) for ≥ 52 mm (p < 0.001). In multivariable analysis, tumor size (per 10 mm) was independently associated with target adjustment (OR 2.33; 95% CI 1.56-3.50; p < 0.001), while female sex was inversely associated (OR 0.20; 95% CI 0.04-0.96; p = 0.045). Lymphoma showed a trend toward an inverse association that did not reach statistical significance (OR 0.11; 95% CI 0.01-1.11; p = 0.062). The multivariable model showed good discrimination (AUC 0.90; 95% CI 0.82-0.98; DeLong). Among tumors ≥ 52 mm, malignant pathology was obtained in 14/14 cases (100%) with hotspot targeting versus 5/9 (55.6%) with non-hotspot targeting (p = 0.014).

CONCLUSIONS: Preoperative [¹⁸F]FDG PET/CT supports CT-guided biopsy planning of large tumors by identifying cases likely to require target adjustment and was associated with higher malignant yield when the FDG hotspot was targeted in tumors ≥ 52 mm.

PMID:42223871 | DOI:10.1007/s12149-026-02242-9

MedScience. 2026 May 30. doi: 10.1007/s11684-026-1253-8. Online ahead of print.

NO ABSTRACT

PMID:42223858 | DOI:10.1007/s11684-026-1253-8

J Robot Surg. 2026 Jun 1;20(1):558. doi: 10.1007/s11701-026-03542-y.

ABSTRACT

INTRODUCTION: Imageless navigation is widely used in total hip arthroplasty (THA), yet evidence for procedures in the lateral decubitus position remains limited because pelvic orientation and registration differ from the supine position. This study evaluated the accuracy of imageless navigation for acetabular component positioning in lateral-position primary THA, using postoperative EOS-based 3D assessment as a postoperative reference method for agreement analysis.

METHODS: The study comprised in-vitro pretests and an in-vivo cohort. In vitro, a pelvic model was systematically rotated along all axes to assess effects on navigated cup inclination and anteversion. In vivo, 70 patients undergoing primary THA in lateral decubitus were included. Intraoperative imageless navigation values were compared with postoperative EOS-3D-measurements.

RESULTS: In vitro, z-axis (tilt) variations substantially altered both parameters. In vivo, inclination showed a small but statistically significant inter-method difference (mean 1.4°, p = 0.036, Cohen’s d = 0.26), whereas anteversion demonstrated a larger systematic underestimation by imageless navigation (mean -7.5°, p < 0.001, Cohen’s d = -0.78) with poor inter-method agreement (ICC = 0.168).

CONCLUSION: Imageless navigation demonstrated acceptable inclination agreement with postoperative EOS assessment, whereas anteversion showed a larger systematic deviation and poor inter-method agreement; sagittal pelvic tilt and positional frame-of-reference differences appear to be major contributing factors.

CLINICAL TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register with the registration number DRKS00026749.

PMID:42223835 | DOI:10.1007/s11701-026-03542-y

J Robot Surg. 2026 Jun 1;20(1):559. doi: 10.1007/s11701-026-03530-2.

ABSTRACT

This study aimed to evaluate and compare perioperative outcomes of robotic versus laparoscopic cholecystectomy in patients with acute cholecystitis within an Acute Care Surgery setting. A retrospective cohort study was conducted including patients who underwent cholecystectomy for acute cholecystitis between January 1, 2023, and March 1, 2026. Patients were stratified by operative approach (robotic vs. laparoscopic). Baseline demographics, comorbidities, and postoperative outcomes were analyzed. Continuous variables were compared using Mann-Whitney U test, and categorical variables were assessed with Pearson χ². Statistical significance was defined as p < 0.05. A total of 322 patients were included, with 107 undergoing robotic and 215 laparoscopic cholecystectomies. Baseline characteristics were similar between groups. Median operative time did not differ significantly (78.0 [63.0-107.0] minutes robotic vs. 77.0 [60.0-95.0] minutes laparoscopic, p = 0.31). Conversion to open surgery occurred in one laparoscopic case (0.5%) and none in the robotic group. Length of hospital stay was comparable. Early postoperative complications were similar (10.3% robotic vs. 12.6% laparoscopic, p = 0.97), including comparable rates of severe (Clavien-Dindo III-IV) complications. Readmission and reintervention rates did not differ significantly. Two postoperative bile leaks occurred, one in each group. Subgroup analysis of gangrenous cholecystitis showed no significant differences in operative time, length of stay, or postoperative outcomes. Robotic cholecystectomy demonstrates comparable safety and efficacy to laparoscopic cholecystectomy for acute cholecystitis, including in severe cases, supporting its feasibility in acute care settings.

PMID:42223833 | DOI:10.1007/s11701-026-03530-2

Sports Med. 2026 Jun 1. doi: 10.1007/s40279-026-02461-0. Online ahead of print.

NO ABSTRACT

PMID:42223829 | DOI:10.1007/s40279-026-02461-0