Tag: pubmed

Travel Med Infect Dis. 2026 Apr 3:102977. doi: 10.1016/j.tmaid.2026.102977. Online ahead of print.

ABSTRACT

BACKGROUND: Acute mountain sickness (AMS) prevention requires prioritizing multiple interrelated determinants in pre-travel counseling. Conventional syntheses often focus on statistical significance of single factors and rarely integrate evidence strength (E*), effect magnitude (M*), and controllability (C*) into actionable priorities.

METHODS: We mapped factors into an E-M-C space and computed a Priority Index (PI = E* × M* × C* × kweight), with down-weighting for sparsely studied factors (kweight = 0.5 for k<5; 0.33 for k<3). Pooled effects were synthesized using conservative random-effects inference with prespecified robustness checks (heterogeneity assessment and influence/leave-one-out analyses).

RESULTS: Across 81 variable-level syntheses, heterogeneity was common but the principal signals remained stable under conservative inference and influence checks. High-priority risk signals were dominated by the ascent process (ascent speed, ascent mode-especially direct air travel-and attained/sleeping altitude), while acetazolamide prophylaxis remained the leading protective option. We identified an action-ready set (i.e., directly modifiable levers suitable for routine counseling) for immediate implementation. A small set of factors with greater uncertainty were classified as confirm-before-adopt (i.e., plausible but currently insufficient to drive routine advice), warranting standardized exposure contexts and multi-centre prospective validation.

CONCLUSIONS: The E-M-C framework and PI provide a quantitative, reproducible basis for prioritizing AMS prevention actions in pre-travel counseling. Despite common heterogeneity, the principal signals support high-yield, actionable counseling priorities.. Managing the ascent process and considering acetazolamide when indicated remain the most immediate, controllable risk-reduction options; importantly, the framework adds a structured way to rank competing determinants and communicate uncertainty to guide future evidence-building and iterative updates.

PMID:41937024 | DOI:10.1016/j.tmaid.2026.102977

J Gastrointest Surg. 2026 Apr 3:102412. doi: 10.1016/j.gassur.2026.102412. Online ahead of print.

ABSTRACT

INTRODUCTION: Multivisceral resection (MVR) in pancreatic ductal adenocarcinoma (PDAC) involves en bloc resection of adjacent organs due to direct invasion. Despite its clinical significance, adjacent organ invasion is not included as a determinant in AJCC staging or NCCN resectability criteria. This study aimed to evaluate the safety and efficacy of MVR compared to standard resection.

METHODS: We analyzed 1,222 patients who underwent surgery for PDAC between 2009 and 2019 at a tertiary institution. Patients with stage IV disease, recurrent operations, incomplete data, or MVR performed for double primary malignancy were excluded. Propensity Score Matching (PSM) was conducted at a 1:2 ratio, matching for operation type and AJCC T/N stages. Short- and long-term outcomes were compared between two groups.

RESULTS: Before PSM, 42 MVR cases and 1,099 standard resections demonstrated similar postoperative hospital stay lengths (11.4 vs. 12.6 days, p=0.094), major complications (23.8% vs. 19.0%, p=0.566), and clinically relevant postoperative pancreatic fistula (11.9% vs. 6.6%, p=0.310). However, MVR showed poorer long-term outcomes including 2-year overall survival rate (2YSR) (33.3% vs. 49.9%, p=0.006), 2-year disease-free survival rate (2YDFSR) (11.3% vs. 25.9%, p=0.018), and 2-year local recurrence rate (2YLRR) (41.3% vs. 30.9%, p=0.319). After PSM, both groups maintained similar short-term outcomes and showed no statistical difference in 2YSR (p=0.143), 2YDFSR (p=0.279), and 2YLRR (p=0.362).

CONCLUSION: MVR demonstrates comparable short- and long-term outcomes to standard resection and should be considered for selected patients with suspected organ invasion. These findings reinforce current staging and resectability criteria and support surgical decision-making for PDAC.

PMID:41936997 | DOI:10.1016/j.gassur.2026.102412

J Affect Disord. 2026 Apr 3:121742. doi: 10.1016/j.jad.2026.121742. Online ahead of print.

ABSTRACT

Affective disorders affect approximately 12% of the global population and include major depressive disorder (MDD) and bipolar disorder (BD), which often present with clinically indistinguishable depressive episodes. This highlights the need to identify reliable biomarkers for diagnostic differentiation. In this study, serum platelet-derived growth factor BB (PDGF-BB) and plasma thrombospondin-1 (TSP-1) were quantified by ELISA in 63 patients with MDD, 43 patients with BD, and 61 healthy controls. Patients were assessed during an acute depressive episode (T1) and in a (partially) remitted state (T2). Depressive symptom severity was evaluated using the Montgomery-Åsberg Depression Rating Scale (MADRS) (at T1: MDD = 33.16 ± 8.1; BD = 28.16 ± 9.74). Group differences and longitudinal changes were analyzed using non-parametric statistics, with adjustment for age, body mass index, and medication. PDGF-BB levels differed significantly between diagnostic groups during acute depression. Longitudinal analyses revealed significant lower levels of PDGF-BB from T1 to T2 in BD patients, but not in MDD patients, indicating a state-dependent change associated with remission in BD. These effects remained significant after adjustment for potential confounders, including lithium treatment. In contrast, TSP-1 levels showed no group- or state-dependent differences. When replicated, PDGF-BB may serve as a diagnostic biomarker distinguishing MDD from BD during acute episodes and as a potential state marker reflecting remission in bipolar disorder, even after accounting for relevant clinical confounders.

PMID:41936983 | DOI:10.1016/j.jad.2026.121742

J Affect Disord. 2026 Apr 3:121739. doi: 10.1016/j.jad.2026.121739. Online ahead of print.

ABSTRACT

BACKGROUND: Researchers have studied transcranial direct current stimulation (tDCS) as a possible treatment for major depressive disorder (MDD), especially for people with treatment-resistant depression (TRD). This systematic review and meta-analysis evaluate the effectiveness and safety of tDCS for TRD by analyzing data from randomized clinical trials.

METHODS: To evaluate the impact of tDCS on TRD, we adhered to the 2020 PRISMA guidelines and registered our protocol with PROSPERO (CRD42024606468). A comprehensive search was performed using keywords related to tDCS and TRD across six databases, focusing on English-language studies published until June 10, 2024. RCTs were included based on specific PICO criteria, with a thorough risk of bias assessment using the Cochrane ROB-2 tool. Statistical analyses were conducted using Stata-17 software.

RESULTS: A total of 448 studies were initially identified, with six studies (200 participants) meeting inclusion criteria for assessing immediate post-treatment effects of tDCS on TRD. Meta-analysis showed active tDCS significantly reduced depressive symptoms compared to sham (SMD: -1.17 [-1.85, -0.49]; P < 0.001). Significant outcome predictors included session number, age, male percentage, and duration. A follow-up analysis of delayed effects (30-day post-treatment), using four studies (154 participants), found no significant difference between active and sham tDCS (SMD: -0.12 [-1.98, 1.74]; P = 0.90).

CONCLUSIONS: This review suggests tDCS may provide modest, short-term benefits in TRD, but findings were inconsistent, highly heterogeneous, and based on limited small trials. Standardized, large-scale studies with optimized protocols and longer follow-up are needed to confirm efficacy and safety.

PMID:41936982 | DOI:10.1016/j.jad.2026.121739

Am J Clin Nutr. 2026 Apr 3:101305. doi: 10.1016/j.ajcnut.2026.101305. Online ahead of print.

ABSTRACT

BACKGROUND: Prebiotic fiber supplementation increases calcium absorption but its long-term effects on bone mass are mixed in children and adolescents.

OBJECTIVES: To determine the effect of one-year soluble corn fiber (SCF) supplementation compared to Placebo (maltodextrin; Main comparison), with or without calcium (calcium gluconate; Secondary comparison) on bone mineral content (BMC) and density (BMD) in children and adolescents with low habitual calcium intake through a randomized clinical trial. We hypothesized that SCF supplementation will result in higher bone mass.

METHODS: Healthy children and adolescents (9-14 years old) with usual low calcium intake were recruited and randomized for 1 year to SCF (12 g/d) or Placebo (12 mg/d), with or without calcium (600 mg/d). Bone mass was measured using dual energy x-ray absorptiometry (DXA) at baseline, 6 months and 12 months. Results are shown as mean±SD. Statistical analyses included linear mixed-effects and analysis of variance.

RESULTS: 213 participants were recruited and 177 were randomized. Most were White (41.3%), Hispanic (69.5%) and with healthy weight (74.0%). Girls had significantly higher Tanner score (3.10±1.20) compared to boys (2.30±1.20; p<0.001) and a significantly higher body fat % (p<0.05), therefore, results were stratified by sex. Among completers (n=151), whole-body BMC and BMD significantly increased from baseline to 6-months and to 12-months. In girls, 1-year gain in whole-body BMC was higher with SCF (216.3±138.3 g or 18.8%) compared to Placebo (139.9±84.0 g, 12.9%) after adjusting for age, Tanner stage, height velocity, weight velocity, lean mass velocity, fat mass velocity, and compliance (p<0.05). Similar results were found for BMD in girls. This was not observed in boys or when calcium supplementation was added.

CONCLUSIONS: 1-year supplementation with SCF resulted in a higher whole-body BMC and BMD compared to Placebo in girls only. This effect could have potential long-term benefits on bone mass acquisition in girls.

CLINICALTRIALS: GOV: NCT02916862; https://clinicaltrials.gov/study/NCT02916862 CLINICALTRIALS.

GOV REGISTRATION: NCT02916862.

PMID:41936980 | DOI:10.1016/j.ajcnut.2026.101305

J Equine Vet Sci. 2026 Apr 3:105880. doi: 10.1016/j.jevs.2026.105880. Online ahead of print.

ABSTRACT

BACKGROUND: Immune-mediated keratitis (IMMK) is a chronic inflammatory corneal disease in horses. Long-term topical therapy with cyclosporine is often impractical, highlighting the need for sustained-release alternatives.

AIMS/OBJECTIVES: To assess clinical response, tolerability, and duration of effect of episcleral silicone matrix cyclosporine implants (ESMC) in horses with presumed IMMK.

METHODS: Medical records of 12 horses (14 eyes) treated between 2019 and 2023 were retrospectively reviewed. IMMK subtypes were classified as epithelial (n = 3 eyes), anterior stromal (n = 9), or mid-stromal (n = 2). Collected data included treatment success or failure, complications, and duration of therapeutic effect. Statistics were applied with non-parametric testing.

RESULTS: No local or systemic adverse effects were observed. All epithelial IMMK eyes (3/3) achieved treatment success, with a median duration of therapeutic effect of 698 days (interquartile range – IQR 375). Seven of nine anterior stromal eyes presented successful outcome, with median duration of therapeutical effect of 104 days (IQR 88). Two eyes failed, requiring enucleation or surgical management. Both eyes with mid-stromal IMMK were classified as failure, with a median duration of therapeutic effect of 39 days (IQR 3). Significant differences in the duration of therapeutic effect were detected between epithelial and anterior stromal (p = 0.04) and between epithelial and mid-stromal subtypes (p = 0.03). No correlation was found between the number of implants and the duration of therapeutic effect (p = 0.7).

CONCLUSION: Episcleral silicone matrix cyclosporine implants were well tolerated in horses with presumed IMMK. The treatment showed high success rates in epithelial and anterior stromal subtypes, but poor outcomes in mid-stromal subtype. The therapeutic effect was longest in epithelial IMMK, suggesting implant efficacy may vary with disease subtype.

PMID:41936975 | DOI:10.1016/j.jevs.2026.105880

J Equine Vet Sci. 2026 Apr 3:105877. doi: 10.1016/j.jevs.2026.105877. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The DMRT3 gene, often referred to as the “gait keeper,” plays a key role in controlling alternative gaits in horses, such as tölt and pace. This study aimed to determine the frequency of known and to screen for potential novel polymorphisms within the second exon of the DMRT3 gene.

DATA COLLECTION: A total of 244 blood or hair samples were collected from representative individuals of the six horse breeds: gaited (Icelandic Horse, French Trotter), non-gaited (Arabian Horse, Malopolski Horse), and pony breeds (Welsh Pony, Shetland Pony).

RESEARCH METHODS: The second exon of the DMRT3 gene analyzed using Sanger sequencing. Detected polymorphisms were annotated and classified using Ensembl and NCBI databases. Allele frequencies and genotype distributions were statistically compared between breeds and breeding populations. Putative novel variants were further analysed using in silico approaches to predict their potential structural and functional consequences at the protein level.

RESULTS: Six polymorphisms were identified, including three novel variants. The known stop-gain variant c.902C>A (DMRT3_Ser301STOP) was confirmed in Icelandic Horses and French Trotters, with significant genotype differences between two French Trotter studs (p < 0.05). A novel 18-nucleotide in-frame duplication (c923_943dup; Ala297_Ala302dup) was found exclusively in Shetland Ponies. Additionally, a missense variant (c.967T>A; p.Tyr323Asn) and a synonymous change (c.855T>C) were detected in non-gaited breeds. In silico analyses suggested no major structural impact of the identified variants on the predicted DMRT3 protein.

CONTRIBUTIONS: This study confirms the distribution of the DMRT3_Ser301STOP allele in gaited breeds and identifies novel polymorphisms in DMRT3. It expands current knowledge by identifying population- and breed-specific variants, suggesting a broader genetic influence on locomotor traits beyond gaited horses. The findings support the continued identification of DMRT3 as a molecular marker in equine locomotion research and selective breeding.

PMID:41936970 | DOI:10.1016/j.jevs.2026.105877

Ann Allergy Asthma Immunol. 2026 Apr 3:S1081-1206(26)00148-1. doi: 10.1016/j.anai.2026.03.026. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-Interleukin 5/Rα (IL5/Rα) for severe asthma has demonstrated marked reductions in systemic corticosteroid use. However, little is known about the long-term total (inhaled and systemic) corticosteroid exposure.

OBJECTIVE: Estimate total corticosteroid exposure reduction and prevalence of corticosteroid remission over five years of anti-IL5/Rα therapy for severe asthma.

METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during 2016-2019 were followed for five years. Corticosteroid exposure was assessed annually using national registries, and changes were estimated using mixed models. Corticosteroid remission was defined as no systemic corticosteroid exposure and low-to-moderate daily inhaled corticosteroid doses.

RESULTS: In total, 253 patients were included (median age 57, 51% female). At baseline, 33% were using daily maintenance oral corticosteroids. The year prior to biologic therapy, median total corticosteroid exposure was 3,604mg (3,404, 3,803) prednisolone equivalents. Year one, total corticosteroid exposure was reduced by 25.2% (13.4, 36.9) increasing to a reduction of ∼45% years three through five. Systemic corticosteroids accounted for the majority of reductions, with decreases of 32.8% (21.1-44.6) during the first year and ∼60% during later years. For inhaled corticosteroids, statistically significant reductions were observed during year four at -149.7mcg (-13.7, -285.7) budesonide-equivalents and -189.1mcg (-23.2, -355.1) during year five. During later treatment years, inhaled corticosteroids represented the main source of corticosteroid exposure. An annual average of 23% achieved corticosteroid remission, while only 2.4% achieved five-year sustained corticosteroid remission.

CONCLUSION: Over five years, anti-IL5/Rα treatment significantly reduced total corticosteroid exposure. Reductions were driven by marked reductions in systemic corticosteroid exposure, whereas modest reductions in inhaled corticosteroid exposure were observed.

PMID:41936962 | DOI:10.1016/j.anai.2026.03.026

Ann Allergy Asthma Immunol. 2026 Apr 3:S1081-1206(26)00146-8. doi: 10.1016/j.anai.2026.03.024. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment which reduces systemic corticosteroid (SCS)-related adverse effects but maintains disease control is of broad public health importance.

OBJECTIVE: To evaluate the effect of mepolizumab versus chronic-SCS use on SCS-related adverse effects in patients with severe asthma.

METHODS: This retrospective, longitudinal cohort study (GSK ID: US 218950) used claims data from the Optum Clinformatics Data Mart database from November 2014 – December 2022. Eligible patients (aged ≥12 years with ≥2 asthma diagnostic claims), had ≥2 mepolizumab claims (mepolizumab-treated cohort) or ≥6 months continuous SCS use (chronic-SCS-treated cohort). Inverse probability of treatment weighting was used to balance cohort characteristics.

PRIMARY OUTCOME: SCS-related adverse effects.

SECONDARY OUTCOMES: exacerbation frequency, SCS/oral corticosteroid (OCS) use, healthcare resource utilization (HCRU), and costs (excluding cost of therapy).

RESULTS: Overall, 1,219 (mepolizumab-treated) and 835 (chronic-SCS-treated) patients with severe asthma were included (median follow-up 12 months). Cohorts were well-balanced after weighting (mean age 63-65 years, 66% female). The mepolizumab-treated cohort had significant reductions in overall, acute, and chronic-SCS-related adverse effects (rate ratio [RR] [95% confidence interval] 0.80 [0.70-0.92], 0.63 [0.47-0.84], 0.80 [0.70-0.92], respectively) versus the chronic-SCS-treated cohort; SCS dose reduction of 4.7 mg/day corresponds to a 20% reduction in SCS-related adverse effects (p=0.002). Similar trends were observed in exacerbation rates, HCRU, and medical costs, although not all reached statistical significance.

CONCLUSION: Mepolizumab treatment reduced acute and chronic corticosteroid effects in patients with severe asthma versus chronic-SCS use, suggesting avoidance of corticosteroid use can lead to measurable regression of SCS-associated adverse effects and more favorable disease trajectory.

PMID:41936961 | DOI:10.1016/j.anai.2026.03.024

J Hepatol. 2026 Apr 3:S0168-8278(26)00199-6. doi: 10.1016/j.jhep.2026.03.044. Online ahead of print.

NO ABSTRACT

PMID:41936952 | DOI:10.1016/j.jhep.2026.03.044