Tag: pubmed

Eur Spine J. 2026 Aug 10. doi: 10.1007/s00586-026-10262-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare clinical outcomes after unipolar versus bipolar sternocleidomastoid (SCM) release for congenital muscular torticollis (CMT), and to describe how patient age, chronicity, and postoperative rehabilitation varied across studies and may have contributed to between study differences.

METHODS: Following PRISMA guidelines, 17 observational studies were included, comprising 382 surgical procedures (unipolar 228; bipolar 154). The primary outcome was achievement of a global good-excellent clinical result using validated composite scoring systems (Lee, Cheng-Tang, Tanabe, or Lee-Kang). Secondary outcomes were recurrence and complications. Comparative quantitative synthesis was restricted to studies reporting both techniques within the same cohort and extractable technique-specific data. For recurrence, comparative quantitative synthesis was feasible in two cohorts. For global good-excellent outcome, head-to-head data were too sparse and confounded for a robust pooled comparison, and evidence remained descriptive. Heterogeneity was assessed using I².

RESULTS: Only a small number of studies provided extractable head-to-head comparisons. In these cohorts, no statistically significant difference was observed between unipolar and bipolar release in achieving a good-excellent global clinical outcome, and recurrence rates did not differ significantly between techniques, although confidence intervals were wide and events were sparse. Across single-arm cohorts, both techniques were associated with high rates of good-excellent outcomes and low recurrence, with greater variability observed in bipolar cohorts that more frequently included older or neglected cases. Complications were uncommon overall and were predominantly minor; technique-stratified reporting suggested a higher frequency of minor complications following bipolar release. Where reported, cervical alignment and range of motion improved substantially after both procedures, with no consistent radiographic advantage of one technique over the other. Across studies, postoperative rehabilitation intensity and patient chronicity appeared to influence durability of correction at least as much as release extent.

CONCLUSION: Within the limits of available observational evidence, unipolar and bipolar SCM release yield comparable global clinical outcomes with low recurrence and complication rates. No consistent comparative advantage of greater release extent was demonstrated. Between-study differences may also reflect variation in patient age, deformity chronicity, and postoperative rehabilitation. Comparative certainty remains limited by small head-to-head cohorts, heterogeneous outcome definitions, and incomplete arm-level reporting.

PMID:42572053 | DOI:10.1007/s00586-026-10262-2

Eur J Pediatr. 2026 Aug 10;185(9):650. doi: 10.1007/s00431-026-07310-w.

ABSTRACT

Streptococcal mortality burden threatens children’s health in low- and middle-income countries (LMICs), yet their temporal trends, geographic disparities, and socioeconomic determinants remain unclear. Using the MICROBE database and World Bank data, we conducted a cross-sectional study to assess infant mortality burden of group A Streptococcus (GAS), group B Streptococcus (GBS), Streptococcus pneumoniae, and other streptococci in LMICs. Joinpoint regression estimated the average annual percent change (AAPC). Frontier analysis assessed the potential reduction in antimicrobial resistance (AMR) mortality burden for Streptococcus. Random forest with SHapley Additive exPlanations (SHAP) identified key socioeconomic drivers. During 1990-2021, infant streptococcal mortality burden in LMICs declined from 798.8 to 241.1 per 100,000. However, a post-2016 increase in the mortality burden of early-onset neonatal GAS and GBS bacteremia (0-6 days) was observed (annual percent change, 1.9% and 1.7%). Streptococcal mortality burden declined most slowly, or increased, among neonates in sub-Saharan Africa and South Asia (AAPC, – 5.8 to 1.6%). Multiple LMICs in sub-Saharan Africa, South Asia, and Oceania exhibited a high AMR-related mortality burden from streptococcal infections. SHAP analysis indicated that increased health expenditure was associated with lower mortality burden across most streptococcal pathogens. WASH (Water, Sanitation, and Hygiene) and skilled birth attendance were linked to lower GAS/GBS mortality burden. Complete pneumococcal vaccination was negatively associated with pneumococcal mortality burden, mainly through reduced incidence.

CONCLUSION: Infant streptococcal mortality burden persists in LMICs, especially among neonates. Increasing health investment, strengthening WASH, improving perinatal care, promoting vaccination, and enhancing antibiotic stewardship are critical.

WHAT IS KNOWN: • Infant streptococcal mortality burden in low- and middle-income countries (LMICs) constitutes a major public health concern.

WHAT IS NEW: • Infant streptococcal mortality burden in LMICs declined by 69.8% (1990-2021), but remained concentrated in neonates, with rising early-onset GAS/GBS bacteremia mortality burden. • Infant streptococcal mortality burden is predominant in sub-Saharan Africa and South Asia, where resistance to penicillin and third-generation cephalosporins is relatively high. • Government health expenditure, WASH, tailored perinatal care, full-course pneumococcal vaccination, and antibiotic stewardship are key to reducing infant streptococcal mortality burden in LMICs.

PMID:42572050 | DOI:10.1007/s00431-026-07310-w

Matern Health Neonatol Perinatol. 2026 Aug 10;12(1):36. doi: 10.1186/s40748-026-00284-5.

ABSTRACT

BACKGROUND: Cross-national comparability of fetal mortality indicators is limited by heterogeneous definitions and denominators. Mexico’s official fetal death indicators include all gestational ages and use live births as the denominator, diverging from international standards. We recalculated late fetal death rates using ICD-11 criteria and compared them with published national and international data.

METHODS: We conducted a retrospective analysis of national fetal death data from Mexico (2013-2023). Publicly available statistics on fetal deaths and registered live-birth datasets were used. All procedures followed ICD-11 recommendations for international reporting standards. Recalculated rates were compared with official Mexican publications, PAHO/WHO estimates for Mexico, and United States (US) rates.

RESULTS: From 2013 to 2023, 254,567 fetal deaths were recorded in Mexico. The recalculated ICD-11 late fetal death rate averaged 4.9 per 1,000 total births, increasing from 4.5 (2013-2015) to 5.5 (2020-2023). However, this increase should be interpreted with caution, as it is largely driven by a decline in the number of registered live births over the study period. Official Mexican fetal death rates ranged from 10.1 to 15.5 per 1,000. PAHO/WHO estimates for Mexico (2013-2023) were 7.0-7.9 per 1,000, and US rates (2014-2023) were 2.7-2.9 per 1,000. Most fetal deaths occurred before 28 weeks, with increasing proportions among cases ≤499 g. Most deaths were classified as antepartum (84%).

CONCLUSIONS: The recalculated ICD-11 late fetal death rate increased from 2013 to 2023. While national late fetal death rates were lower than historical official rates, they were nearly twice as high as US rates.

TRIAL REGISTRATION: Not applicable.

PMID:42572034 | DOI:10.1186/s40748-026-00284-5

Isr J Health Policy Res. 2026 Aug 10;15(1):31. doi: 10.1186/s13584-026-00775-y.

ABSTRACT

BACKGROUND: As populations age, changing living conditions and declining self-advocacy often create barriers to essential care. Mobile Geriatric Teams (MGTs) offer a potential solution by providing assessments within a patient’s regular environment, potentially reaching underdiagnosed and undertreated individuals who struggle to access routine healthcare. The aim of this study was to evaluate the clinical impact and reach of MGTs in the Northern District of Israel. Specifically, we aimed to assess the extent of MGT-initiated Comprehensive Geriatric Assessments and compare therapeutic and diagnostic outcomes between patients seen by MGTs and those receiving standard community-based geriatric consultations.

METHODS: This is a retrospective, data-based study serving as a proof-of-concept evaluation for MGT implementation in Israel. The intervention was implemented in MHS between January 1, 2020, and December 31, 2023, and data were collected 3 and 6 months after the MGT appointment. Group comparisons were conducted using chi-square tests, Fisher’s exact tests, and Wilcoxon rank-sum tests. In addition, we performed matched logistic regression models.

RESULTS: A total of 8,152 individuals were included in the study; 4,348 were assessed by MGTs. The MGT group participants were slightly older and had a higher proportion of males and a lower SES category than the comparison group. The MGTs group had fewer diagnoses of mild cognitive impairment, dementia, and depression, compared to the comparison group. They also had more diagnoses of orthostatic hypotension, and they were more likely to be assessed for fall risk. The MGT group was also prescribed fewer medications in the months following the assessment. After the MGT intervention, we report an increase in primary care visits in the relevant population in the district where it was implemented, while the comparison group did not have a corresponding trend.

CONCLUSIONS: In this study, we demonstrated that MGTs can reach a specific subpopulation of the elderly who might not otherwise undergo a geriatric assessment, primarily males, those of low SES, and possibly those with less urgent health concerns. These findings highlight the complementary role of MGTs in increasing accessibility, promoting equity, and addressing unmet needs in populations less likely to seek care on their own.

PMID:42572029 | DOI:10.1186/s13584-026-00775-y

J Crohns Colitis. 2026 Aug 5;20(8):jjag100. doi: 10.1093/ecco-jcc/jjag100.

ABSTRACT

BACKGROUND: 5-Aminosalicylic acid (5-ASA) remains the first-line therapy for mild-to-moderate ulcerative colitis (UC). Modern treatment goals extend beyond symptom control to include steroid-free remission, endoscopic healing, and biomarker normalization. Real-world evidence on 5-ASA’s ability to achieve these targets is limited. This study assessed remission levels and associated factors in Belgian UC patients in clinical remission on 5-ASA.

METHODS: This cross-sectional, multicenter, phase 4 study included UC patients in clinical remission (PRO-2 ≤ 1, no rectal bleeding) treated with 5-ASA for ≥6 months. Patients receiving corticosteroids, immunomodulators, or advanced therapies were excluded. Outcomes were complete clinical remission (PRO-2 = 0, no urgency), endoscopic remission (MES ≤ 1, UCEIS ≤ 1), complete endoscopic remission (MES = 0), histological remission (Geboes 0-1), biological remission (fecal calprotectin <150 µg/g), and deep remission (clinical, endoscopic, and histological). Adherence was assessed using MARS-5.

RESULTS: In total, 198 patients were enrolled (median age 50 years; 41% female). Treatment was oral 5-ASA only (n = 134, 68%), rectal only (n = 19, 9%), or combination (n = 45, 23%). Biological remission was observed in 78%, endoscopic remission in 87%, complete endoscopic remission in 70%, and histological remission in 80%. Deep remission occurred in 24%, limited by persistent urgency (63%). Adherence was high (median MARS-5: 24). Oral 5-ASA only was significantly associated with endoscopic remission (P < .001).

CONCLUSION: In this real-world Belgian cohort, patients in clinical remission on 5-ASA achieved high rates of objective remission, while deep remission was low because of persistent urgency. These findings confirm 5-ASA’s continued relevance in mild-to-moderate UC and highlight the importance of addressing residual symptoms despite mucosal healing.

PMID:42572012 | DOI:10.1093/ecco-jcc/jjag100

Age Ageing. 2026 Aug 3;55(8):afag234. doi: 10.1093/ageing/afag234.

ABSTRACT

BACKGROUND: Social isolation, loneliness and frailty commonly emerge in later life, yet understanding of how their interrelationships relate to all-cause death remains limited. This longitudinal study aimed to examine the associations between social isolation and loneliness and risk of all-cause death and to examine the mediating role of frailty in these associations.

METHODS: This study analysed data from four large international cohorts (Health and Retirement Study, China Health and Retirement Longitudinal Study, Survey of Health, Ageing and Retirement in Europe and Mexican Health and Ageing Study) covering 31 countries. Cox proportional hazards models were used to estimate the associations of social isolation and loneliness with frailty and all-cause death. A random-effects meta-analytic model was used to pool cohort-specific estimates. Finally, mediation analysis was conducted to quantify the mediating effect of frailty in the associations between social isolation, loneliness and all-cause death.

RESULTS: Over a mean follow-up of 7.07 years, there were 20 504 (25.61%) participants who developed frailty and 6212 (7.76%) all-cause death among total of 80 050 participants. Social isolation was associated with increased risks of frailty (pooled HR = 1.26, 95% CI: 1.09-1.44) and all-cause death (pooled HR = 1.33, 95% CI: 1.12-1.56). Loneliness was associated with an increased risk of frailty (pooled HR = 1.19, 95% CI: 1.00-1.41) and all-cause death (pooled HR = 1.25, 95% CI: 1.10-1.41). Frailty mediated 24.43% (17.35%-34.43%) of the association between social isolation and all-cause death and 55.18% (47.12%-64.43%) of the association between loneliness and all-cause death.

CONCLUSION: In later life, social isolation and loneliness increased risks of all-cause death and frailty served as a key mediator. These findings underscore the urgent need for public health policies and clinical practice to prioritise systematic identification and intervention targeting social isolation and loneliness, while integrating frailty screening and management into healthy ageing strategies.

PMID:42572000 | DOI:10.1093/ageing/afag234

Eval Rev. 2026 Aug 9:193841X261476152. doi: 10.1177/0193841X261476152. Online ahead of print.

ABSTRACT

Scholarly publications in social sciences have increased sharply and continue to expand in the era of big data and artificial intelligence. However, comprehensive syntheses of quantitative research methods remain scarce, presenting significant challenges for early-career researchers and graduate students in selecting appropriate research methods for their studies. To address this gap, we propose a conceptual framework that provides a structured guide to quantitative techniques, thereby enhancing methodological literacy and supporting informed decision-making in academic publishing. By integrating applied statistics and operations research-spanning basic to advanced analytics along a static-dynamic continuum, this framework empowers novice scholars to navigate technique selection effectively and mitigates the dominance of a few methodological choices in economics, business, and management research.

PMID:42571994 | DOI:10.1177/0193841X261476152

Diabetes Obes Metab. 2026 Aug 9. doi: 10.1111/dom.71212. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate and recalibrate commonly used 10-year cardiovascular disease (CVD) risk prediction models in two Chinese cohorts: the general population and adults with type 2 diabetes.

METHODS: We analysed data from the Wuzhong subcohort of the China Kadoorie Biobank (CKB) and the Jiangsu Biobank for the Prevention and Control of Diabetes (JBPCD). After excluding participants with baseline CVD, baseline diabetes in CKB or missing predictors, 42 937 CKB participants and 14 125 JBPCD participants were included. We evaluated CKB-CVD, Globorisk, Framingham General CVD and WHO 2019 in both cohorts, and SCORE2-Diabetes in JBPCD. Performance of original and recalibrated models was assessed by 10-year inverse probability of censoring weighting (IPCW) C-statistic, calibration measures including the expected-to-observed (E/O) event ratio and Brier score. In JBPCD, overlap in high-risk classification was examined using a 20% predicted 10-year risk threshold.

RESULTS: During a median follow-up of 11.96 years in the general population cohort and 10.03 years in the type 2 diabetes cohort, 3740 and 2794 ischemic heart disease or stroke events occurred, with 10-year risks of 6.04% and 19.72%, respectively. Discrimination was higher in the general population cohort than in the type 2 diabetes cohort (C-statistic 0.723-0.778 vs. 0.584-0.629). Original models were poorly calibrated, with systematic overprediction in the general population cohort (E/O 1.47-3.78) and heterogeneous miscalibration in the type 2 diabetes cohort (E/O 0.32-2.70). Recalibration markedly improved calibration and reduced Brier scores, with little change in discrimination. In the type 2 diabetes cohort, recalibrated CKB-CVD classified 48.4% as high risk, with an observed 10-year risk of 25.7%.

CONCLUSION: Widely used 10-year CVD risk models showed acceptable or modest discrimination but substantial miscalibration in Chinese populations, especially among adults with type 2 diabetes. Recalibration is essential before threshold-based clinical or public-health use.

PMID:42571983 | DOI:10.1111/dom.71212

Zhonghua Yi Xue Za Zhi. 2026 Aug 11;106(29):3033-3039. doi: 10.3760/cma.j.cn112137-20260519-01340.

ABSTRACT

Objective: To explore the clinical efficacy and application value of O-arm navigation-assisted zoning laminectomy in the treatment of severe thoracic ligamentum flavum ossification (TOLF). Methods: A retrospective cohort study was conducted to analyze 83 patients with severe TOLF admitted to Zhengzhou Orthopedic Hospital from May 2019 to August 2023. There were 48 males and 35 females, the age was (50.1±6.0) years. Preoperative three-dimensional reconstruction of the ossified ligamentum flavum in the thoracic spine was performed using Mimics 21.0 software for preoperative planning. According to different treatment methods, patients were divided into the O-arm navigation-assisted zoning laminectomy group (navigation group, n=41) and the simple zoning laminectomy group (control group, n=42). The baseline data, operation time, intraoperative blood loss and total hospital stay of the two groups were compared. The modified Japanese Orthopaedic Association (mJOA) score and improvement rate were used to evaluate the changes in neurological function before the operation, 1 month, 3 months after the operation and at the last follow-up. The occurrence of complications in the patients was recorded. Results: The 83 patients were followed up for (20.3±6.9) months. There was no statistically significant differences in gender, age, lesion involved segments and disease duration between the two groups (all P>0.05). The operation time of the navigation group was significantly shorter than that of the control group [(134.4±29.9) vs (152.9±30.2) min, P=0.006]. There were no statistically significant differences in intraoperative blood loss [(412.2±98.6) vs (433.3±80.1) ml] and total hospital stay [(7.8±1.5) vs (7.8±1.4) d] between the navigation group and the control group (both P>0.05). The mJOA scores of the navigation group at 1 month, 3 months after the operation and the last follow-up were significantly higher than the preoperative mJOA score (all P<0.001). There was no significant difference in mJOA scores between the two groups at each time point (all P>0.05). There was no statistically significant difference in therapeutic effect between the two groups (P=0.616). There was no significant difference in the improvement rate of mJOA between two groups [(67.8%±19.9%) vs (69.8%±19.3%), P=0.760]. There were 7 cases of cerebrospinal fluid leakage after the operation in the navigation group. In the control group, there were 11 cases of cerebrospinal fluid leakage and 1 case of transient neurological dysfunction. The incidence of postoperative complications in the navigation group was lower than that in the control group [(7/41, 17.1%) vs (12/42, 28.6%), P=0.035]. Conclusion: O-arm navigation-assisted technology helps achieve precise decompression during surgery, shortens the operation time and enhance the surgical safety.

PMID:42571970 | DOI:10.3760/cma.j.cn112137-20260519-01340

Zhonghua Yi Xue Za Zhi. 2026 Aug 11;106(29):3026-3032. doi: 10.3760/cma.j.cn112137-20260306-00626.

ABSTRACT

Objective: To analyze the influencing factors associated with cirrhosis in patients with indeterminate-phase chronic hepatitis B (CHB). Methods: CHB patients in the indeterminate phase who did not receive antiviral treatment at the Senior Department of Hepatology, the Fifth Medical Center of Chinese PLA General Hospital between January 2020 and June 2025 were retrospectively included. According to whether cirrhosis had occurred, the patients were divided into the cirrhosis group (patients diagnosed with cirrhosis) and the non-cirrhosis group (patients not diagnosed with cirrhosis). Differences in demographic characteristics, virological indicators, routine blood parameters, and liver function-related clinical indicators were compared between the two groups. Restricted cubic spline analysis was used to determine the threshold values of platelet and age in relation to cirrhosis risk. A multivariate logistic regression model was used to analyze factors associated with cirrhosis in patients with indeterminate-phase CHB. Results: A total of 422 patients was included. There were 182 patients in the cirrhosis group with 128 males and 54 females, aged (47±9) years; and 240 patients in the non-cirrhosis group with 146 males and 94 females, aged (43±11) years. Patients in the cirrhosis group were older than those in the non-cirrhosis group (P<0.001). The distribution of HBV DNA differed statistically between the two groups (P=0.002). Compared with the non-cirrhosis group, the cirrhosis group had a lower proportion of low HBV DNA load (<2×10³ U/ml) [14.8% (27/182) vs 29.6% (71/240), P<0.001] and a higher proportion of intermediate HBV DNA load (2×10³-<2×10⁷ U/ml) [67.6% (123/182) vs 57.5% (138/240), P=0.032], whereas the proportion of high HBV DNA load (≥2×10⁷ U/ml) did not differ significantly [17.6% (32/182) vs 12.9% (31/240), P=0.160]. Platelet count [M (Q₁, Q₃), 158 (94, 199)×10⁹/L vs 205 (171, 244)×10⁹/L] and HBsAg levels (log HBsAg) [2.9 (2.5, 3.2) vs 3.1 (2.7, 3.6) U/ml] were lower in the cirrhosis group than those in the non-cirrhosis group (both P<0.001). Restricted cubic spline analysis showed non-linear associations of platelet count and age with cirrhosis risk in patients with indeterminate-phase CHB (P<0.05). The corresponding threshold values were 45 years and 180×10⁹/L of age and platelet count, respectively. Multivariate logistic regression analysis showed that decreased HBsAg levels (log HbsAg) (OR=1.99, 95%CI: 1.35-2.93), HBV DNA between 2×10³ and<2×10⁷ U/ml (OR=2.12, 95%CI: 1.18-3.81), HBV DNA≥2×10⁷ U/ml (OR=4.02, 95%CI: 1.80-9.00), age≥45 years (OR=2.06, 95%CI: 1.32-3.24), and platelet count<180×10⁹/L (OR=3.99, 95%CI: 2.55-6.23) were associated with cirrhosis in patients with indeterminate-phase CHB. Conclusion: Age≥45 years, platelet count<180×10⁹/L, HBV DNA≥2×10³ U/ml and decreased HBsAg are influencing factors for the progression to cirrhosis in patients with indeterminate-phase CHB who did not receive antiviral treatment.

PMID:42571969 | DOI:10.3760/cma.j.cn112137-20260306-00626