Tag: pubmed

J Pediatr Orthop B. 2026 Apr 28. doi: 10.1097/BPB.0000000000001351. Online ahead of print.

ABSTRACT

While opioid medications are commonly used to manage postoperative pain in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis, their use is associated with negative short and long-term effects. There is a paucity of data evaluating the feasibility and efficacy of opioid-free pain regimens in this population. The purpose of this study was to compare a multimodal opioid-free with a traditional opioid-containing protocol in pediatric patients undergoing instrumented PSF for idiopathic scoliosis. We hypothesized that the opioid-free pain management pathway would result in equivalent length of stay (LOS) and fewer opioids prescribed at discharge compared with an opioid-containing pathway. This was a prospective case-control study comparing opioid-free versus opioid-containing pathways. Eligible participants included patients aged 10-20 years at time of surgery with idiopathic scoliosis who underwent primary instrumented PSF by a single, fellowship-trained pediatric orthopedic surgeon during a 2-year period. Total opioid use was recorded. Statistical analysis included Wilcoxon, Chi-square, and Fisher’s exact tests for group comparisons. Patients in the opioid-free group had a greater number of levels fused (P = 0.036), had a similar inpatient LOS postoperatively (P = 0.917), and required fewer opioid prescriptions at discharge [10/36 patients (27.8%) vs. 55/56 patients (98.2%), respectively; P < 0.0001]. A comprehensive, multimodal, opioid-free pain management pathway following instrumented PSF for idiopathic scoliosis results in equivalent LOS and fewer opioids prescribed at discharge compared with an opioid-containing pathway. Establishing patient/family expectations beforehand is crucial to the successful engagement and implementation of this opioid-free protocol.

PMID:42037458 | DOI:10.1097/BPB.0000000000001351

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2026 May;40(5):477-481. doi: 10.13201/j.issn.2096-7993.2026.05.012.

ABSTRACT

Objective:To compare the effects of remote interactive voice therapy versus traditional in-person therapy on treatment adherence and clinical outcomes in patients with voice disorders. Methods:A retrospective historical control study was conducted, categorizing patients into three groups based on distinct periods of COVID-19 prevention policies: the 2019 traditional therapy group（n=82）, the 2021 traditional therapy group（n=43）, and the 2022 remote therapy group（n=54）. Adherence differences were analyzed by geographic subgroup（Guangzhou vs. non-Guangzhou）, and improvements in Voice Handicap Index（VHI）, jitter, and shimmer were compared pre-and post-treatment. Results:Adherence: The overall〓adherence rate in the 2022 remote therapy group（38.89%） was higher than in the 2019（31.71%） and 2021（23.26%） traditional groups, although the difference was not statistically significant（P>0.05）. Notably, non-Guangzhou patients exhibited significantly higher adherence with remote therapy（2022: 45.45%） compared to traditional therapy（2019: 5.00%; 2021: 0）（P<0.01 for both comparisons）. Efficacy: Among patients with good adherence, all three groups showed significant improvements in VHI, jitter, and shimmer（all P<0.01）. Further analysis revealed no statistically significant differences in the magnitude of improvement between the 2022 remote group and the 2019/2021 traditional groups（all P>0.05）, indicating comparable therapeutic efficacy. Conclusion:Remote interactive voice therapy significantly enhances adherence among non-local patients, with equivalent efficacy to traditional in-person therapy. This approach provides an effective solution to overcome spatial and temporal barriers in voice rehabilitation, and holds important practical significance for optimizing voice disorder management strategies and improvinghealthcare service accessibility.

PMID:42037438 | DOI:10.13201/j.issn.2096-7993.2026.05.012

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2026 May;40(5):473-476. doi: 10.13201/j.issn.2096-7993.2026.05.011.

ABSTRACT

Objective:To investigate the expression of HPV 6/11 in NIP tissues and evaluate the adjuvant therapeutic effect of interferon-α gel on HPV-positive NIP patients. Methods:Forty-two newly diagnosed Nasal Inverted Papilloma（NIP） patients were included, and the expression of HPV6/11 in tissues was detected using fluorescence in situ hybridization with specific probes. Twenty-two HPV-positive patients were randomly divided into an interferon treatment group（n=11） and a control group（n=11）. Both groups underwent endoscopic tumor resection, with the treatment group receiving local application of interferon-α gel during and after surgery. Postoperative recovery was assessed using the DIP endoscopic scoring system at 3, 6, and 12 months. Results:The positive expression rate of HPV6/11 in NIP tissues was 52.38%（22/42）, which was significantly higher than that in the nasal polyp control group（8.33%, 1/12）（P<0.05）. Among HPV-positive NIP patients, there were no statistically significant differences were observed in DIP scores between the interferon treatment group and the control group at 3, 6, and 12 months postoperatively（P>0.05）. Conclusion:HPV6/11 shows high expression in NIP tissues, but the use of interferon-α gel did not improve postoperative recovery in HPV-positive patients.

PMID:42037437 | DOI:10.13201/j.issn.2096-7993.2026.05.011

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2026 May;40(5):457-461. doi: 10.13201/j.issn.2096-7993.2026.05.008.

ABSTRACT

Objective:To investigate the preoperative coagulation characteristics and postoperative changes in patients with primary hyperparathyroidism（PHPT）. Methods:A retrospective analysis was conducted on the clinical data of 55 PHPT patients treated at Beijing Chaoyang Hospital, including preoperative and postoperatively（1 week） serum calcium, serum phosphorus, parathyroid hormone（PTH）, 25-hydroxyvitamin D, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（FIB）, thrombin time（TT）, D-dimer（D-Dimer）, and thromboelastography（TEG） parameters such as coagulation index（CI）, reaction time（R）, kinetic time（K）, maximum amplitude（MA）, and lysis at 30 minutes（LY30）. The preoperative coagulation status and the impact of postoperative biochemical changes on coagulation function were analyzed. Results:All 55 patients successfully underwent parathyroid tumor resection, pathological findings were 41 cases of adenoma（74.5%）, 12 cases of atypical tumor（21.8%）, and 2 cases of carcinoma（3.6%）. The median preoperative serum calcium and PTH levels were 2.67 mmol/L and 171.60 pg/mL, respectively. All patients had PT, APTT, FIB, TT, CI, MA, K, and LY30 values within normal ranges, but 11 patients（20.0%） exhibited reduced preoperative R values. Compared to the normal R-value group, the reduced R-value group had shorter APTT, higher D-Dimer, and higher CI values, with statistically significant differences（P<0.05）, suggesting a hypercoagulable state preoperatively. One week postoperatively, the median serum calcium and PTH levels significantly decreased to 2.14 mmol/L and 35.10 pg/mL, respectively（P<0.05）. Except for a slight increase in D-Dimer, PT, APTT, FIB, TT, CI, MA, K, and LY30 values remained stable within normal ranges. The differences in APTT, D-Dimer, and CI values between the reduced R-value group and the normal R-value group were no longer statistically significant（P>0.05）. Conclusion:Some PHPT patients exhibit a hypercoagulable state with reduced R values preoperatively, and surgical resection of parathyroid tumor helps improve coagulation function in these patients.

PMID:42037434 | DOI:10.13201/j.issn.2096-7993.2026.05.008

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2026 May;40(5):427-431. doi: 10.13201/j.issn.2096-7993.2026.05.003.

ABSTRACT

Objective:To investigate the clinical value of thoracoscopic partial parathyroidectomy via the subclavian approach for the treatment of parathyroid adenoma with primary hyperparathyroidism. Methods:A retrospective analysis was conducted on 26 patients with parathyroid adenoma and primary hyperparathyroidism treated between September 2023 and April 2024. Patients were divided into two groups based on surgical approach: the thoracoscopic subclavian approach group and the median anterior cervical open approach group. Multiple indicators, including perioperative parameters, postoperative complications, postoperative pain, and incision cosmetic satisfaction, were compared and analyzed. The clinical efficacy of thoracoscopic partial parathyroidectomy via the subclavian approach was evaluated. Results:All surgeries were completed successfully. There were significant differences between the two groups in terms of operative time and intraoperative blood loss（P=0.001,<0.001）, while there were no statistically significant differences in age, lesion size, preoperative/postoperative serum parathyroid hormone（PTH）, preoperative/postoperative serum calcium, postoperative drainage volume, drainage tube placement time, length of hospital stay, and cost（all P>0.05）. At 24 hours postoperative serum PTH and calcium concentrations were significantly decreased compared to preoperative levels（P=0.012,<0.001; P=0.018,<0.001）. There was no statistically significant difference in the incidence of postoperative complications between the endoscopic and open surgery groups（P>0.05）. At 24 hours postoperatively, the visual analogue scale（VAS） pain scores were comparable between the two groups（P>0.05）. In contrast, cosmetic satisfaction scores were significantly higher in the endoscopic cohort compared to the open surgery group（P=0.003）. Conclusion:Subclavicular approach endoscopic parathyroidectomy is an ideal treatment option compared to the median approach, effectively reducing serum PTH and calcium levels without increasing the risk of postoperative complications, while also satisfying patients’ aesthetic needs. The surgery is safe and feasible, and has high clinical application value.

PMID:42037429 | DOI:10.13201/j.issn.2096-7993.2026.05.003

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2026 May;40(5):422-426;431. doi: 10.13201/j.issn.2096-7993.2026.05.002.

ABSTRACT

Objective:To identify reliable anatomical landmarks through endoscopic dissection of the palatovaginal canal（PVC） and to introduce a novel posterior nasal neurectomy（PNN） approach via this canal, while evaluating its clinical efficacy in allergic rhinitis（AR）. Methods:Surgical-route dissection was performed on 10 dry skulls and 2 fresh cadaveric heads to obtain high-definition images of the PVC region. A retrospective analysis was conducted on 30 AR patients who underwent PNN in which the PVC served as the key landmark. Symptom severity was assessed with a visual analogue scale（VAS） pre-operatively and 12 months post-operatively. Results:Critical landmarks for the new approach were identified, including the sphenoidal process of the palatine bone, posterior aperture of the PVC, posterior sulcus, PVC itself, vomerovaginal canal, vaginal process, and sphenopalatine foramen. One year after surgery, mean VAS scores for nasal obstruction, itching, sneezing, rhinorrhea, and overall discomfort were all lower than baseline with statistically significant differences. Aside from transient palatal numbness in five patients, no other complications occurred. Conclusion:Endoscopic PNN via the palatovaginal canal is a safe and effective surgical method for the treatment of allergic rhinitis.

PMID:42037428 | DOI:10.13201/j.issn.2096-7993.2026.05.002

Am J Epidemiol. 2026 Apr 27:kwag073. doi: 10.1093/aje/kwag073. Online ahead of print.

ABSTRACT

Unmeasured confounding bias threatens the validity of observational studies. Although sensitivity analyses and study designs have been proposed to address this problem, they often overlook the growing availability of auxiliary data. Using negative controls from these data is a promising new approach to reduce unmeasured confounding bias. In this article, we develop a Bayesian nonparametric method to estimate a causal exposureresponse function (CERF) using information from negative controls to adjust for unmeasured confounding for continuous exposures. We model the CERF as a mixture of linear models. This strategy captures the potential nonlinear shape of CERFs while maintaining computational efficiency, and it leverages closed-form results that hold under the linear model assumption. We assess the performance of our method through simulation studies. We find that the proposed method can recover the true shape of the CERF in the presence of unmeasured confounding under assumptions. To show the practical utility of our approach, we apply it to adjust for a possible unmeasured confounder when evaluating the relationship between long-term exposure to ambient PM2.5 and cardiovascular hospitalization rates among the elderly in the continental US. We implement our estimation procedure in open source software and have made the code publicly available to ensure reproducibility.

PMID:42037424 | DOI:10.1093/aje/kwag073

J Clin Microbiol. 2026 Apr 27:e0122325. doi: 10.1128/jcm.01223-25. Online ahead of print.

ABSTRACT

Antibiograms are challenging to construct in long-term care (LTC) homes in part due to low isolate counts and limited precision. Regional-local antibiograms offer a potential solution by using partial pooling, combining data from both the home and the broader LTC population. We developed regional-local urinary antibiograms and compared this approach to standard antibiograms. This cross-sectional study included urine cultures from LTC residents across Ontario. (i) Standard syndromic combined antibiograms were created for each LTC home with ≥30 total isolates. Homes with <30 isolates used the mean of susceptibility for each drug for the entire province. (ii) Partially pooled regional-local antibiograms were constructed using logistic mixed models with a random intercept for each home to ensure each LTC home could be provided a facility-specific antibiogram. We compared susceptibility and rank order of recommended antibiotics using each method. Among 627 LTC homes, 340 (54.2%) met the ≥30 isolate threshold. Regional-local methods allowed for the development of 627 LTC home-specific antibiograms. These methods narrowed susceptibility estimate ranges compared to standard methods (e.g., trimethoprim-sulfamethoxazole [TMP-SMX]: 57%-77% vs 37%-90%, respectively). A total of 119 (19.0%) homes had at least one antibiotic with over 80% susceptibility using the standard approach; only 11 (1.8%) homes met this threshold with the regional-local antibiogram. The antibiotic with the highest susceptibility varied based on methodology (amoxicillin-clavulanate for standard vs TMP-SMX for regional-local antibiogram). Regional-local antibiograms allow for the creation of facility-specific antibiograms, even among facilities with small isolate counts. This approach may provide more precise antibiotic susceptibility estimates by reducing misleading inter-facility variation.IMPORTANCELocal antibiograms can help inform empiric antibiotic treatment for long-term care residents with urinary tract infections. However, many facilities have too few isolates to create precise susceptibility estimates. A regional-local antibiogram is a novel strategy that uses a weighted approach: it prioritizes local data where available, but increasingly uses regional population-level data for homes with smaller sample sizes to improve statistical precision and reduce misleading inter-facility variation. This regional-local approach allows for the development of facility-specific antibiograms for a greater number of homes compared to traditional methods of developing antibiograms.

PMID:42037421 | DOI:10.1128/jcm.01223-25

J Virol. 2026 Apr 27:e0022526. doi: 10.1128/jvi.00225-26. Online ahead of print.

ABSTRACT

The ongoing adaptive evolution of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is characterized by the continued emergence of variants with increased transmissibility and the ability to escape infection- and/or vaccine-induced immunity. This sustained antigenic evolution has necessitated updates to COVID-19 vaccine compositions to better match circulating viral variants. To optimize protection against emerging variants, a reliable means of predicting the immune escape of novel variants is needed to enable at-risk preparation of new vaccine strain compositions. Herein, we describe the development and applications of a quantitative risk calculator that predicts relative immune escape of SARS-CoV-2 variants using a statistical modeling framework. The approach integrates large-scale, experimentally derived spike-antibody epitope and escape maps with serum neutralization data generated using pseudotyped viruses and clinical sera. By aggregating site-level escape information into a strain-level metric, the calculator enables the grouping of antigenically related SARS-CoV-2 variants to guide strain selection for at-risk vaccine design and preparation, in anticipation of seasonal strain change recommendations by global public health agencies and the WHO. Here, we demonstrate the utility of this framework through retrospective and prospective strain selection exercises for the XBB.1.5-, JN.1/KP.2-, and LP.8.1-adapted mRNA-1273 COVID-19 vaccines during the 2023-2026 seasons, respectively. In all cases, model predictions were largely supported by clinical immunogenicity data and aligned with subsequent recommendations by global public health agencies.IMPORTANCEWe present a framework to estimate the relative immune escape potential of emerging variants by integrating previously published experimental epitope-level escape data with serum neutralization measurements. By consolidating mutation-level effects into a strain-level metric, this approach enables classification of antigenically similar variants. Retrospective and prospective applications demonstrate that model-based assessments are consistent with observed immunogenicity data. This framework provides a practical tool to support preparedness efforts by informing at-risk vaccine development activities in advance of seasonal strain selection guidance.

PMID:42037411 | DOI:10.1128/jvi.00225-26

Biol Open. 2026 Apr 15;15(4):bio062411. doi: 10.1242/bio.062411. Epub 2026 Apr 27.

ABSTRACT

Over the last 15 years, an optical density (OD-based) technique to quantify bacterial killing assays (BKAs) has been steadily gaining in popularity. This technique uses spectrophotometry to quantify bacterial growth, rather than the colony counts (CFUs) used previously, and reduces the time, resources, and variability inherent to the assay. However, we argue that the OD-based method relies on assumptions that are not true of all immune components, such as leukocytes, and that methods may not be interchangeable. We performed a targeted literature review focused on the methodology of BKAs across vertebrate taxa in ecoimmunology. We then compared the CFU and OD-based methods using leukocytes isolated from Mojave desert tortoises (Gopherus agassizii) and analyzed the quantification method and bactericidal ability using correlation and agreement statistics. Our results suggest poor agreement between techniques, and that immunological processes in cell-based BKAs are likely changing the optical properties of the cultures.

PMID:42037363 | DOI:10.1242/bio.062411