BMC Rheumatol. 2026 May 5;10(1):36. doi: 10.1186/s41927-026-00643-x.
NO ABSTRACT
PMID:42083017 | DOI:10.1186/s41927-026-00643-x
Tag: pubmed
BMC Musculoskelet Disord. 2026 May 4. doi: 10.1186/s12891-026-09843-5. Online ahead of print.
ABSTRACT
BACKGROUND: Subtrochanteric femur fractures are challenging to treat due to complex anatomy and high mechanical stresses. Cephalomedullary nailing is the standard treatment, often performed with the patient supine on a traction table, but this can prolong setup and cause complications (pressure or nerve injuries). Lateral decubitus positioning without a traction table may facilitate reduction and reduce traction-related risks, yet comparative data in subtrochanteric fractures are limited. This study compared outcomes of lateral decubitus versus traction table positioning for subtrochanteric fracture nailing.
METHODS: A retrospective cohort study included 68 patients with subtrochanteric femur fractures treated with cephalomedullary nails. Patients underwent surgery supine on a traction table (n = 37) or in lateral decubitus without a traction table (n = 31). Operative metrics (entry point determination time, operative time, fluoroscopy duration, and blood loss) and postoperative outcomes (transfusion requirements, time to mobilization, complications, and final Harris Hip Score) were compared between groups.
RESULTS: Lateral decubitus positioning was associated with shorter entry-point determination time (median 2 vs. 7 min; p = 0.05), shorter operating-room time (80.3 ± 23.6 vs. 108.2 ± 23.2 min; p = 0.03), reduced fluoroscopy time (151.2 ± 19.2 vs. 178.2 ± 16.1 s; p = 0.03), and lower estimated blood loss (752 ± 346 vs. 1459 ± 611 mL; p = 0.01) compared with traction-table positioning. No statistically significant differences were observed in transfusion requirements, time to mobilization, final Harris Hip Score, or complication rates (all p > 0.05).
CONCLUSION: Compared with traction-table positioning, lateral decubitus cephalomedullary nailing was associated with better functional outcome, shorter operative and fluoroscopy times, and lower estimated blood loss, while union and complication rates were similar between groups. These findings suggest that lateral decubitus positioning is a viable alternative for subtrochanteric fracture fixation, particularly when traction-table setup may compromise operating-room efficiency. Given the observational design and potential confounding related to reduction techniques and surgeon factors, these findings should be interpreted as associations; prospective studies are warranted.
PMID:42083005 | DOI:10.1186/s12891-026-09843-5
BMC Med. 2026 May 4. doi: 10.1186/s12916-026-04900-1. Online ahead of print.
ABSTRACT
BACKGROUND: No epidemiological studies have systematically evaluated the associations between prenatal exposure to organophosphate esters and polychlorinated biphenyls and the risk of congenital heart disease (CHD) in offspring. Moreover, the potential modifying role of maternal B-vitamin status in persistent organic pollutants (POPs)-CHD associations has not been examined. We therefore investigated the cardiotoxic effects of prenatal POPs exposure and evaluated effect modification by maternal B-vitamin levels.
METHODS: A multicenter case-control study was conducted in China from 2016 to 2021, including 425 participants. Thirty POPs and seven plasma B vitamins were quantified using high-resolution mass spectrometry. Single-exposure associations were examined by logistic regression, while multipollutant effects were assessed through Bayesian kernel machine regression (BKMR) and Weighted Quantile Sum (WQS) models. Potential effect modification by B vitamins was systematically evaluated.
RESULTS: Prenatal exposure to p-cresyl diphenyl phosphate was associated with an increased risk of CHD (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.08, 1.71). Mixture analyses consistently showed an increasing trend in CHD risk with higher exposure to the POPs mixture, with the WQS model yielding a statistically significant association (OR = 1.20, 95% CI: 1.03, 1.40). Higher concentrations of pyridoxamine, pyridoxal, and vitamin B12 were inversely associated with CHD risk, and mixture analyses using both BKMR and WQS regression further demonstrated a significant negative association between the overall B-vitamin mixture and CHD risk. In the interaction analysis, B vitamins significantly modified the association between prenatal POPs exposure and CHD risk (OR = 0.14, 95% CI: 0.04, 0.52).
CONCLUSIONS: This study provides the first population evidence that prenatal POPs exposure is associated with increased CHD risk and adequate maternal B-vitamin levels may attenuate the developmental cardiotoxicity of emerging flame retardants, highlighting the importance of maternal nutritional status in modifying environmental risk factors for CHD.
PMID:42083004 | DOI:10.1186/s12916-026-04900-1
BMC Med Educ. 2026 May 4. doi: 10.1186/s12909-026-09376-4. Online ahead of print.
ABSTRACT
OBJECTIVE: The present study aimed to evaluate the feasibility, acceptability, and diagnostic utility of a structured Medical Licensing Examination (MLE) preparatory course designed for Saudi medical interns. The evaluation focused on assessing the program participants’ readiness by evaluating their knowledge, test-taking skills, and participant satisfaction.
METHODS: This convergent mixed-methods evaluation design study was carried out at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. The entire cohort of 103 interns was included. The preparatory program was organized into a three-phase process. The initial planning phase involved identifying student needs and designing the course. This was followed by the implementation phase, which focused on delivering the course through interactive learning sessions and practice examinations. The final evaluation phase was dedicated to assessing participant satisfaction, gathering feedback, and analyzing benefits. For data collection, the researchers developed a questionnaire to assess satisfaction and administered a post-course mock examination as formative tool to measure the interns’ knowledge and readiness for the licensing exam. Data analysis integrated descriptive statistics for numerical data with thematic analysis for open-ended responses.
RESULTS: Out of 76 interns, 67 (88.15%) reported high levels of satisfaction with all the sessions. Most participants agreed that the course objectives were clearly defined (n = 59, 77.6%) and that participation and interaction were encouraged (n = 75, 98.7%). The mean test score was 21.71 (43.42%), which suggests a relatively low level of preparation for this type of examination. Qualitative feedback further supported these findings, highlighting strengths in content delivery and instructional strategies.
CONCLUSION: The integration of the MLE preparation program and mock assessment within the medical curriculum offers a structured approach to familiarizing interns with the format and content of the licensure examination. Participant feedback suggests positive perceptions of the learning experience, while the mock assessment provided a useful diagnostic snapshot of performance at the time of administration. These findings describe the potential role of such interventions in supporting exam preparation.
PMID:42082995 | DOI:10.1186/s12909-026-09376-4
BMC Sports Sci Med Rehabil. 2026 May 4. doi: 10.1186/s13102-026-01690-0. Online ahead of print.
ABSTRACT
BACKGROUND: This study aimed to examine the differential effects of two Tabata-based high-intensity interval training (HIIT) modalities-calisthenic/plyometric-focused versus kettlebell-focused exercise-on neuromuscular performance and physiological adaptations in competitive table tennis athletes.
METHODS: Twenty-four male athletes (aged 18-24 years) were randomly assigned to a calisthenic/plyometric HIIT group (n = 12) or a kettlebell HIIT group (n = 12). Both groups performed their respective Tabata protocols in addition to regular table tennis training, three days per week for eight weeks. Flexibility, agility, sprint performance, vertical jump height, peak and average power output, and maximal oxygen uptake (VO₂max) were assessed before and after the intervention. Analysis of normally distributed data was performed using a 2 (group) × 2 (time) mixed-design analysis of variance (ANOVA). When significant interaction effects were detected, post-hoc comparisons were conducted using paired t-tests with Bonferroni correction. Statistical significance was set at p < 0.05.
RESULTS: Both HIIT methods resulted in significant improvements in most measured parameters (p < 0.05). The calisthenic/plyometric protocol led to greater gains in agility, flexibility, and vertical jump performance, indicating enhanced neuromuscular function. Conversely, the kettlebell protocol elicited superior improvements in sprint performance. Both groups demonstrated increases in VO₂max; however, these changes were not significantly different between groups.
CONCLUSION: Tabata-based HIIT effectively enhances neuromuscular and physiological performance in table tennis athletes; however, adaptations differ based on exercise modality. Calisthenic/plyometric-focused HIIT preferentially improves agility, mobility, and explosive leg power, while kettlebell-focused HIIT yields greater benefits for speed and aerobic capacity. These findings demonstrate that modality-specific HIIT programming is a practical and time-efficient approach to target sport-specific performance demands in racket sport athletes.
TRIAL REGISTRATION: ClinicalTrials.gov (NCT07403461), registered on 16/01/2026.
PMID:42082994 | DOI:10.1186/s13102-026-01690-0
BMC Public Health. 2026 May 4. doi: 10.1186/s12889-026-27626-4. Online ahead of print.
ABSTRACT
OBJECTIVE: To our knowledge, a systematic comparison of nutrients contribution to mortality in large scale cohort of middle-aged to elderly individuals has not yet been done. We aim to investigate the associations between most of the available nutrients and all-cause and disease-specific mortality, and explored their joint effect on mortality risk.
METHODS: A total of 208,312 participants from the UK Biobank (UKB) with baseline 24-hour dietary recall data were enrolled. Cox proportional hazards models were used for a nutrients-wide association analysis of all-cause mortality and disease-specific mortality. Mixed-effects analyses were further conducted to evaluate the combined effects of nutrients significantly associated with mortality risk by Bayesian kernel machine regression (BKMR) and Quantile G-Computation (Qgcomp) regression models.
RESULTS: No significant associations were found between total energy, total protein, total lipid, or total carbohydrate intake and all-cause mortality risk. However, energy density was moderately and positively associated with all-cause mortality (HR=1.017, 95%CI: 1.004-1.030). Nutrient type and quality exhibited significant impacts: plant-derived protein (HR=0.995, 95%CI: 0.992-0.998), plant-derived lipids (HR=0.997, 95%CI: 0.995-0.999), were negatively associated with all-cause mortality. Among carbohydrates, starch, lactose, and intrinsic/milk sugars showed protective effects, while free sugars, non-milk extrinsic sugars, sucrose, and maltose were positively associated with increased mortality risk. For minerals and vitamins, copper, manganese, total iron, non-haem iron, vitamin E, riboflavin, biotin, and pantothenic acid exhibited inverse associations with all-cause mortality. Mixed-effects analyses revealed cumulative inverse trends of beneficial nutrients and positive trends of harmful nutrients on mortality risk, with manganese, maltose, biotin, and niacin being key contributors. Disease-specific analysis showed that energy density and certain sugars were positively associated with neoplasms mortality; multiple sugars were linked to nervous system disease mortality; and alcohol, maltose were positively associated with digestive system disease mortality, while most macronutrients, minerals, vitamins, and fibre had protective effects. Sodium and chloride were positively associated with circulatory system disease mortality.
CONCLUSION: Total intake of major macronutrients was not significantly associated with mortality risk, but nutrient type and quality played critical roles. Plant-derived nutrients, specific minerals, vitamins, dietary fibre, and natural carbohydrates were protective against mortality, whereas refined sugars and high energy density were detrimental. These findings highlight the importance of dietary quality in reducing mortality risk and provide evidence for developing targeted dietary recommendations.
PMID:42082993 | DOI:10.1186/s12889-026-27626-4
BMC Med Ethics. 2026 May 5. doi: 10.1186/s12910-026-01465-9. Online ahead of print.
ABSTRACT
BACKGROUND: Rapid Autopsy Programs (RAP) are essential research infrastructures for precision medicine, providing high-quality biospecimens. While international standards emphasize the importance of antemortem informed consent, Japan’s ethical and legal frameworks for RAP remain underdeveloped. Currently, Japan lacks a consistent approach to postmortem tissue utilization, with requirements for individual consent varying significantly between pathological autopsies, systematic dissection, and organ transplantation. This study aims to clarify Japanese public perceptions regarding the necessity of antemortem consent for RAP in comparison with these established methods to inform the development of future ethical guidelines.
METHODS: A nationwide internet survey was conducted in January 2025, involving 3,102 participants representative of the Japanese population’s sex, age, and regional distribution. Participants viewed an educational video explaining four methods of postmortem tissue utilization: pathological autopsy, RAP, systematic dissection, and organ transplantation. To prevent bias, actual names and current legal statuses were not disclosed. Respondents rated the necessity of antemortem individual consent for each method using a six-point Likert scale. Statistical analyses were performed to identify differences between methods and demographic influences.
RESULTS: The survey revealed a strong public preference for antemortem consent across all methods. Specifically, over 70% of respondents agreed that antemortem consent is necessary for pathological autopsies, and over 85% expressed the same view for RAP, systematic dissection, and organ transplantation. The results showed a marked discrepancy between Japan’s current legal system-which often relies on family consent-and public ethical awareness emphasizing individual will. While 90% valued antemortem consent for respecting individual wishes, over 50% acknowledged the difficulty of refusing a physician’s request and emphasized the importance of family intentions. Women and older adults placed significantly greater importance on antemortem consent for RAP.
CONCLUSIONS: The Japanese public maintains high expectations for individual antemortem consent that exceed current legal requirements for some procedures. However, the findings also highlight the role of “relational autonomy,” where family involvement and the clinical-research power dynamic influence decision-making. Developing an ethical framework for RAP in Japan requires not only prioritizing individual autonomy but also implementing “supported decision-making” and a clear separation between clinical and research teams to ensure social trust and cultural compatibility.
PMID:42082991 | DOI:10.1186/s12910-026-01465-9
BMC Pulm Med. 2026 May 4. doi: 10.1186/s12890-026-04332-w. Online ahead of print.
ABSTRACT
BACKGROUND: Accurate discrimination between tuberculous (TPE) and malignant pleural effusion (MPE) is a major clinical challenge. Most existing models rely on non-routine laboratory tests and lack rigorous multicenter external validation.
OBJECTIVE: To develop and validate a clinical prediction model integrating the pleural fluid adenosine deaminase to lactate dehydrogenase ratio (ADA/LDH) and routine indicators for TPE vs. MPE differentiation.
METHODS: In this multicenter retrospective study conducted between January 2023 and December 2025, patients from five hospitals in Anhui Province, China, were divided into a training cohort (n = 290), an internal validation cohort (n = 72), and an external validation cohort (n = 93). Predictors were screened via univariable analysis and backward stepwise regression based on the Akaike Information Criterion (AIC). The optimal ADA/LDH cutoff was identified as 5.83% using restricted cubic splines (RCS) and simplified to 6.0% for clinical practicability without compromising model performance. A Firth penalized logistic regression model was constructed to mitigate data separation caused by the strong predictive effect of the ADA/LDH ratio.
RESULTS: The final model included three statistically significant variables: pleural fluid ADA/LDH ratio (≥ 6.0% vs. < 6.0%), age, and sex. An ADA/LDH ratio ≥ 6.0% was the strongest independent predictor (OR = 13.32, 95% CI 6.51-27.28, P < 0.001). The model demonstrated excellent and stable discriminative ability with AUCs of 0.901 (training cohort), 0.893 (internal validation cohort), and 0.916 (external validation cohort). Calibration was good across all cohorts (Brier scores: 0.1235, 0.1249, 0.1159, respectively). Decision curve analysis demonstrated that the model provided numerically higher net benefit than the “treat all” and “treat none” strategies across the clinically relevant threshold range of 0%-90%.
CONCLUSION: This multicenter study developed and validated a robust Firth penalized prediction model centered on the pleural fluid ADA/LDH ratio. The model demonstrates excellent discriminative ability, good calibration, and potential clinical utility for differentiating TPE from MPE in TB-endemic regions of China.
PMID:42082984 | DOI:10.1186/s12890-026-04332-w
BMC Musculoskelet Disord. 2026 May 4. doi: 10.1186/s12891-026-09900-z. Online ahead of print.
ABSTRACT
BACKGROUND: The surgical rate for distal radius fractures is steadily rising despite limited evidence of its benefits over non-surgical treatment. Using a natural experimental approach, we aimed to compare patient-reported outcomes following surgical versus non-surgical treatment of distal radius fractures.
METHODS: Registered in the Swedish Fracture Register by 36 Swedish hospitals from 2013 to 2018, we included a cohort of 13,356 fractures on 13,031 patients aged 18 years or older with distal radius fractures Arbeitsgemeinschaft fur Osteosynthesefragen (AO) 23-A2.1-2, A3, and C1-C3. The observational study utilized differences in the frequency of surgical treatment across hospitals as a source of random treatment assignment and a natural experiment. We assumed that all hospitals encountered a similar range of fractures each year. Therefore, the annual frequency of surgery per hospital was used as a proxy for randomization between surgical and nonsurgical treatment, regardless of each patient’s actual treatment. The outcome was the individual Patient Reported Outcome Measures (PROM) at 1 year, with the Arm and Hand Function Index from the Short Musculoskeletal Function Assessment (SMFA) as the primary measure.
RESULTS: The surgical rate per hospital year ranged from 7 to 66%. Surgical treatment was associated with lower Arm and Hand Function Index scores in comminuted intraarticular fractures of type C2 (11.9 units, p = 0.004) and type C3 (19.4 units, p = 0.029). There was a tendency for a positive association with surgical treatment in dorsally angulated extraarticular fractures (23A2.2), but the difference of 5.1 units (p = 0.079) was below the Minimal Clinically Important Difference (MCID). In other extra-articular fractures (23-A2.1 and 23-A3) and simple intra-articular fractures (23-C1), the benefits of surgical treatment were small and also not statistically significant. Several sensitivity analyses were conducted to test the study design, and all supported the primary results.
CONCLUSIONS: In this comparison of surgical and non-surgical treatment for distal radius fractures across hospitals with varying surgical rates, comminuted intra-articular distal radius fractures (AO 23-C2/C3) treated surgically were associated with better one-year patient-reported outcomes than those treated non-surgically.
PMID:42082980 | DOI:10.1186/s12891-026-09900-z
J Cardiothorac Surg. 2026 May 4. doi: 10.1186/s13019-026-04061-5. Online ahead of print.
ABSTRACT
BACKGROUND: Intravenous drug abuse (IVDA) has increased the incidence of infective endocarditis. Standard management includes traditional open surgery and more recently described percutaneous tricuspid valve debulking. Study goals were to compare clinical outcomes and identify financial differences between percutaneous tricuspid debulking and tricuspid surgery for isolated tricuspid valve endocarditis.
METHODS: A single-center, retrospective cohort patient study of isolated tricuspid valve endocarditis was performed. Patients underwent either percutaneous debulking with the AngioVac system (n=14, 83% IVDA) or tricuspid valve surgery (n=23, 76% IVDA). Length of stay, readmission rates, mortality, echocardiographic parameters, hematologic markers, transfusion rates, and total charges for index hospitalization were evaluated between groups.
RESULTS: In patients who underwent either percutaneous debulking or open surgery, length of stay (17±17 vs 20±13 days, p=0.48), 30-day readmission (29% vs 26%, p=0.87), in-hospital mortality (7% vs 0%, p=0.20), and 30-day mortality (7% vs 0%, p=0.20) were not statistically different. One-year mortality (21% vs 4%, p=0.11) trended toward but did not reach significance. Postoperative tricuspid valve regurgitation (2.5±1.1 vs 1.0±0.3, p<0.0001) and transfusion rates (2±3 vs 6±6 units, p=0.02) were significantly different between therapies. Total charges for hospitalization were not statistically different ($557,066±457,520 vs $571,615±324,254, p=0.91).
CONCLUSIONS: Tricuspid debulking is a potential alternative to surgery for patients with infective tricuspid endocarditis. Similar outcomes, costs, and avoidance of prosthetic material in patients with active IVDA are potential benefits.
PMID:42082977 | DOI:10.1186/s13019-026-04061-5