Tag: pubmed

Indian J Gastroenterol. 2026 Apr 20. doi: 10.1007/s12664-025-01963-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Transient elastography of liver and spleen, along with platelet count, identify cirrhosis patients with esophageal varices needing treatment (VNT). Inflammation can drive rapid rise in portal pressure and development and progression of varices in acute-on-chronic liver failure (ACLF) patients. We aimed at developing a non-invasive model to predict VNT in ACLF patients.

METHODS: Baseline liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) were done using Fibroscan 630 Expert and esophagogastroduodenoscopy was performed to detect VNT. Varices with red color signs or large size were considered VNT. A model was developed and validated. Decision curve analysis (DCA) was used to assess net benefit (NB) of model at different threshold probabilities.

RESULTS: Of the 216 patients analyzed (males 95.4%, mean age 42.2 yr, model for end-stage liver disease [MELD] score 25.5, alcohol etiology 83.4%), 104 (48.14%) had VNT. Patients with VNT had higher SSM (kPa) (76.71 ± 17.54 vs. 60.56 ± 20.21, p = 0.006), LSM (kPa) (71.96 ± 6.87 vs. 61.93 ± 17.76, p = 0.001) and lower platelet count (10³ /µl) (91.73 ± 17.71 vs. 126.94 ± 42.97, p < 0.001). A model incorporating these parameters had an area under the receiver operating characteristic (AUROC) of 0.842 and could spare esophagogastroduodenoscopy in 34.3% of patients with missing VNT rate of 4.8%. The results were internally validated by bootstrap analysis. On DCA, NB of model was higher for threshold probabilities range 0.07 to 0.8. The model had good calibration with Brier score of 0.15. It performed well in alcohol and non-alcohol related causes with AUROCs of 0.830 and 0.884, respectively.

CONCLUSION: A model comprising SSM, LSM and platelet count identifies VNT non-invasively in ACLF patients.

PMID:42010208 | DOI:10.1007/s12664-025-01963-5

J Robot Surg. 2026 Apr 21;20(1):456. doi: 10.1007/s11701-026-03319-3.

ABSTRACT

The aim of the study is to evaluate the effectiveness of Individualised Counselling Session (ICS) on Robotic Assisted Surgery to reduce stress and anxiety among parents of children undergoing Robotic Assisted Surgery. The objective was to assess the level of pre-operative stress and anxiety among the parents of children undergoing Robotic Assisted Surgery in selected surgical wards in experimental and control groups. A Quasi experimental study design and 50 samples were taken. The samples were selected by purposive sampling techniques, who fulfilled the sample criteria. The demographic variable and structured questionnaire were used for data collection. The descriptive and inferential statistics were used for data analysis with the help of SPSS software version 27. Out of 50 samples (25 each in experimental and control group) the experimental group RAS type pyeloplasty counts for 10(41.7%), Ureteric Reimplantation 4(16.7%), Bladder reconstruction surgery 5(20.8%), Mitrofanoff surgery 6(20.8%). Length of the stay for patient before surgery were 4-8 days in 12 patients (50%), 8-10 days in 11 patient (45.8%), 10-12 days in 2 patient (4.2%). Level of education of father who were included in the study were secondary education counts for 2(4.2%), Senior secondary education 7(29.2%), Graduation 16(66.7%) whereas level of education of mother who were included in the study were primary education counts for 3(12.5%), secondary education 4(12.5%), senior secondary 11(45.8%), graduation 7(29.2%) under the control group male were included in the study were 22(88%) and female were 3(12%).The RAS type pyeloplasty counts for 12(48%), Ureteric Reimplantation 4(16%), Bladder reconstruction surgery 3(12%), Mitrofanoff surgery 6(24%). Length of the stay for patient before surgery were 4-8 days in 10 patients (40%), 8-10 days in 13 patient (52%), 10-12 days in 2 patient (8%). Level of education of father who were included in the study were primary education counts for 2(8%), Senior secondary education 9(36%), Graduation 14(56%) whereas level of education of mother who were included in the study were primary education counts for 2(8%), secondary education 6(24%), senior secondary 10(40%), graduation 7(28%). Effectiveness of Individualised counselling Session (ICS) among parents were assessed with the help of structured tool APAIS and B-MEPS for anxiety and stress respectively in experimental and control group. In the experimental group in pre-test their Median was 1 and 26 in stress and anxiety respectively and after giving the Individualised Counselling Session (ICS) their post Test Score was Median 0.78 and 26 in stress and anxiety respectively. After apply the Wilcoxon Signed rank Test the p-value was significant i.e. < 0.001 for both stress and anxiety. The Z-value was -4.374 and -4.391in stress and anxiety respectively. In the control group in pre-test median was 1 and 25 in stress and anxiety respectively, and the post- test score was 0.78 and 26 in stress and anxiety respectively. After applying the Wilcoxon signed rank test the p-value was < 0.001 for stress and 0.412 for anxiety. It shows significantly increase in anxiety but not stress. The Z-value was -4.05 and -0.821 in stress and anxiety respectively. Therefore, it is concluded that there is effectiveness in experimental group after giving the counselling their stress and anxiety got reduced whereas in control group their stress got reduced but anxiety was persistent pre-operatively.

PMID:42010175 | DOI:10.1007/s11701-026-03319-3

Pediatr Res. 2026 Apr 20. doi: 10.1038/s41390-026-05001-8. Online ahead of print.

ABSTRACT

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of infant mortality and morbidity, yet national trends in RSV outcomes, particularly during the COVID-19 era, are not well defined. This study evaluated temporal patterns in RSV-related infant mortality and hospitalizations across the United States.

METHODS: We analyzed RSV-associated infant mortality data from 2007-2022 using the CDC WONDER database and hospitalization rates from 2018-2025 using the hospitalization surveillance network (RSV-NET). Infant mortality and hospitalization patterns were assessed by season, race/ethnicity, and birth weight.

RESULTS: Over 16 years, RSV-related infant mortality remained relatively stable, with no statistically significant year-to-year variation. Mortality rates were disproportionately higher among Black or African American infants and those with low birth weight. Seasonal hospitalization patterns varied substantially: the 2020-2021 RSV season recorded the lowest hospitalization rate, likely reflecting widespread COVID-19 mitigation measures, whereas the 2022-2023 season recorded the highest rate since 2018.

CONCLUSION: Although infant RSV mortality has remained stable, persistent disparities exist, and hospitalization rates show substantial seasonal fluctuations. These findings provide critical baseline data for assessing the impact of emerging RSV immunization strategies and highlight the need for targeted strategies to reduce persistent inequities in infant outcomes in the post-COVID-19 era.

IMPACT: RSV-related infant mortality in the United States has shown both stability and a sharp post-pandemic surge, with persisting disparities by sex, birthweight and race. This study integrates temporal, demographic, and geographic patterns to provide the national-level evidence of RSV mortality and hospitalization patterns among infants during COVID-19 era. These findings establish essential baseline estimates to evaluate effectiveness of preventive measures, while underscoring the urgency of targeted strategies to reduce disproportionate risks among vulnerable infants.

PMID:42010159 | DOI:10.1038/s41390-026-05001-8

Clin Neuroradiol. 2026 Apr 20. doi: 10.1007/s00062-026-01654-4. Online ahead of print.

ABSTRACT

PURPOSE: Despite advances in mechanical thrombectomy for acute ischemic stroke (AIS), the relationship between successful angiographic reperfusion and functional outcome remains imperfect. We investigated the value of an optimal immediate postthrombectomy National Institutes of Health Stroke Scale (NIHSS) cutoff, termed the “NIHSS drop,” as a predictor of favorable 90-day outcome and compared its prognostic performance with first-pass effect (FPE).

METHODS: We conducted a single-center retrospective analysis of prospectively collected data from 554 patients with AIS who underwent mechanical thrombectomy between 2018 and 2024. Eligible patients presented with an NIHSS score > 8, an Alberta Stroke Program Early CT Score (ASPECTS) of 6-10, and M1 occlusion. Immediate postprocedural NIHSS assessment allowed calculation of the NIHSS drop. Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff, and logistic regression was used to assess its predictive value after adjustment for complete reperfusion (Thrombolysis in Cerebral Infarction [TICI] grade 3 vs 2b), FPE, and other major confounders.

RESULTS: An NIHSS drop ≥ 6 was strongly associated with favorable outcome (area under the curve [AUC] = 0.762, sensitivity 63%, specificity 82%). Patients with an NIHSS drop ≥ 6 (n = 235) had better outcomes (modified Rankin Scale [mRS] 0-2: 83% vs 40%, p < 0.001), fewer complications, and lower median NIHSS scores at 24 h (3 vs 12) and at discharge (1 vs 5), as well as lower in-hospital mortality (1.7% vs 15%, p < 0.001) and 90-day mortality (3.0% vs 19%, p < 0.001). In multivariable analysis, an NIHSS drop ≥ 6 remained the strongest predictor of favorable outcome (odds ratio [OR] 7.21, 95% confidence interval [CI] 4.62-11.5; p < 0.001), showing a stronger association than complete reperfusion or FPE individually.

CONCLUSION: Immediate neurological improvement after thrombectomy was strongly associated with favorable functional outcome. An NIHSS drop ≥ 6 may serve as a useful early prognostic marker and may complement traditional procedural metrics such as TICI grade and FPE, although prospective validation is needed.

PMID:42010130 | DOI:10.1007/s00062-026-01654-4

Commun Med (Lond). 2026 Apr 20;6(1):233. doi: 10.1038/s43856-026-01578-7.

ABSTRACT

BACKGROUND: Developmental plasticity refers to biological adaptations, most often prenatally, to environmental cues. These can help organisms adapt to similar postnatal environments, with health benefits if prenatal and postnatal conditions match. While associations between various prenatal exposures and adverse offspring health have been documented, the interaction between prenatal and postnatal conditions remains less understood. We address this gap by examining whether pre- and postnatal drought exposures interact in their impact on cognitive performance, as early-life nutrition is a critical factor for cognitive development.

METHODS: Standardized math and reading scores from 11-16 year-olds in rural India (N = 2,032,917) from the 2007-2018 Annual Status of Education Report (a cross-sectional cognitive assessment household survey) were combined with University of Delaware Terrestrial Precipitation data. Given the high reliance on rainfed agriculture in the setting, rainfall levels below the 20th percentile of the district-specific long-term mean served as a proxy for nutritional adversities in a quasi-experimental study setup.

RESULTS: We show that early-life droughts adversely impact cognitive function. We find positive interaction terms between prenatal and postnatal drought exposures, suggesting that children already exposed to droughts prenatally are better equipped for postnatal droughts.

CONCLUSIONS: The findings of this study align with the predictions around phenotypic plasticity, i.e., that prenatal conditions prepare organisms for similar postnatal challenges. However, given the increasing unpredictability of the climate, such alignments cannot be planned or anticipated, implying frequent mismatches between prenatal and postnatal conditions.

PMID:42010115 | DOI:10.1038/s43856-026-01578-7

J Clin Psychol Med Settings. 2026 Apr 20. doi: 10.1007/s10880-026-10151-2. Online ahead of print.

ABSTRACT

It is unknown whether youth with abdominal pain-related disorders of gut-brain interaction (AP-DGBI) and clinically elevated pain intensity, functional disability, and anxiety (“high-risk”) respond differentially to the Aim to Decrease Anxiety and Pain Treatment (ADAPT), an evidence-based cognitive behavioral therapy program, compared to youth with fewer risk factors (“low-risk”). This secondary analysis included youth aged 9-14 with AP-DGBI recruited from outpatient gastroenterology clinics and randomized to receive ADAPT plus treatment as usual (TAU) or TAU-alone. Baseline risk status was determined using an established grading system derived from validated measures. Differences in post-treatment (~ 8 weeks) pain intensity, functional disability, and anxiety were examined using a multivariate analysis of covariance model with an interaction of risk-status-by-treatment-allocation. Data from 79 youth were analyzed; 29 (36.7%) were high-risk. Risk status (F(3, 72) = 3.30, Wilks’ Λ = 0.879, p = 0.025) predicted higher post-treatment pain intensity (estimated marginal mean difference high versus low risk 1.47 [95% Confidence Interval (CI) 0.44, 2.50]) and functional disability (5.71 [95% CI 1.38, 10.05]), but not anxiety. Accounting for risk status, ADAPT did not affect post-treatment outcomes and no risk-by-treatment-interaction emerged. Risk status predicted post-treatment outcomes for youth with AP-DGBI. Clinical implications include screening of psychosocial risk factors.

PMID:42010055 | DOI:10.1007/s10880-026-10151-2

Clin Transl Oncol. 2026 Apr 20. doi: 10.1007/s12094-026-04349-x. Online ahead of print.

ABSTRACT

BACKGROUND: Medicines awaiting price and reimbursement (P&R) decisions represent a delicate situation in the Spanish NHS. The interval between marketing authorisation (MA) and PR averages 616 days, leaving patients without standard access to EU-approved treatments for almost 2 years, despite their eventual availability. While early access before MA is regulated, no framework exists for the period between MA and PR. Responsibility for funding falls to hospitals or autonomous regions, with no harmonised criteria, leading to inequities in access.

OBJECTIVES: To describe our access model to medicines in special situations (MSS), and to evaluate the clinical and regulatory implications of this procedure.

METHODS: We conducted a 2-year retrospective review of MSS access requests. Our tertiary hospital uses a transparent pathway: clinicians submit a consultation to Clinical Pharmacology and Hospital Pharmacy; departments issue independent reports to Hospital Administration, which decides, considering individual justification, clinical need, early access, and treatment benefit.

RESULTS: A total of 295 request were received, and 78 involved products pending PR decision. Of them, 73 (93.6%) were granted local access. Subsequently, PR status changed to regular access in 64.1% of these requests (50/78), ensuring early access for 62.8% of patients (49/78). Onco-haematological patients granted early access showed an overall disease control rate of 63%, with a median survival of 16 months.

CONCLUSIONS: Until legislation regulates access to medicines awaiting reimbursement, or decision times are reduced, implementing robust local procedures is essential to guarantee fair and equitable MSS access, particularly for patients requiring treatment before national PR resolution.

PMID:42010054 | DOI:10.1007/s12094-026-04349-x

J Robot Surg. 2026 Apr 21;20(1):438. doi: 10.1007/s11701-026-03391-9.

NO ABSTRACT

PMID:42010040 | DOI:10.1007/s11701-026-03391-9

Intern Emerg Med. 2026 Apr 20. doi: 10.1007/s11739-026-04348-4. Online ahead of print.

ABSTRACT

Chronic type B aortic syndrome (cTBAS) is a rare condition characterized by persistent dissection, intramural hematoma or penetrating ulcer within the thoracic descending or thoraco-abdominal aorta. In cTBAS, pathological aortic remodeling leads to a high burden of morbidity and mortality. Guidelines recommend medical treatment with anti-impulse (AI) and lipid-lowering (LL) drugs to improve outcomes, but underlying evidence is sparse, trials are lacking, and feasibility is unknown. We performed a retrospective observational study on consecutive patients with cTBAS followed in a medical clinic from 2021 to 2025, while receiving dual AI/LL therapy with guideline-compliant targets. Response to medical therapy and occurrence of major aortic events (MAEs) were recorded. Thirty-five patients with cTBAS (23 with aortic dissection, 10 with intramural hematoma, and 2 with penetrating aortic ulcer) were followed for a median of 28 months. A MAE occurred in 11 (31%) patients. Demographic and clinical characteristics including systolic/diastolic blood pressure (SBP/DBP), heart rate and lipid levels at baseline were similar in patients who did or did not develop MAEs. During follow-up, patients without MAEs had significant reductions in SBP (P = 0.005), total and LDL cholesterol (P = 0.002, P < 0.001), and increased achievement of SBP < 130 mmHg (P = 0.046), and LDL cholesterol < 70 or < 55 mg/dL (P < 0.001, P = 0.003). All variables were statistically unchanged in patients who developed MAEs. On-target SBP at 6 months and LDL cholesterol at 12 months were associated with protection from MAEs (hazard ratio 0.19, P = 0.014, and 0.15, P = 0.004, respectively). In conclusion, results provide proof-of-concept that in cTBAS, strict dual AI/LL medical therapy is feasible and associated with favorable outcomes.

PMID:42010024 | DOI:10.1007/s11739-026-04348-4

Stress Biol. 2026 Apr 21;6(1):31. doi: 10.1007/s44154-026-00303-7.

ABSTRACT

Heat stress (HS) negatively affects cattle welfare, productivity, and sustainability, with marked differences between heat-tolerant breeds such as Nellore and heat-susceptible breeds such as Angus. In this study, an untargeted UHPLC-Orbitrap-MS metabolomic approach was used to investigate breed-specific differences in the blood metabolome associated with HS. Blood samples were collected from the same Nellore and Angus steers during peak HS exposure and after recovery, allowing both inter-breed and within-animal longitudinal comparisons. Multivariate analyses revealed a clear metabolic divergence between breeds during the challenge period, involving metabolites related to amino acid metabolism, lipid remodeling, energy pathways, and steroid metabolism. Longitudinal analyses accounting for repeated measures showed pronounced breed-specific metabolic responses. Nellore cattle displayed extensive and statistically robust metabolic changes across phases, with 114 metabolites remaining significant after false discovery rate (FDR) correction, including amino acids and peptides, nucleotide derivatives, carbohydrates, acyl-carnitines, steroids, and tetrapyrrole-related compounds. In contrast, Angus cattle showed only a limited number of FDR-significant metabolites, indicating a less consistent systemic response to HS. Pathway analysis identified porphyrin, purine, and pyrimidine metabolism as key pathways modulated by HS, particularly in Nellore cattle. Overall, these results suggest that heat tolerance is associated with coordinated metabolic adaptations rather than isolated metabolite changes. Further studies on larger cohorts are needed to validate the functional relevance of these findings.

PMID:42010023 | DOI:10.1007/s44154-026-00303-7