Tag: pubmed

Obes Surg. 2026 Jun 8. doi: 10.1007/s11695-026-08790-3. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) provides durable, stable weight loss and ameliorates renal dysfunction, hyperuricemia (HUA), and other obesity-related metabolic disorders. Renal function is tightly linked to serum uric acid (SUA) metabolism, but conventional estimated glomerular filtration rate (eGFR) equations have well-documented substantial bias in individuals with obesity.

METHODS: We retrospectively collected clinical data from 202 patients who underwent LSG, with assessments performed at baseline and 1, 3, and 6 months postoperatively. Patients were stratified into the renal hyperfiltration (HF, 1n = 147) and normal filtration (NF, n = 55) groups using a baseline eGFR cutoff of 125 mL/min/1.73 m². 1:1 propensity score matching (PSM) was conducted using 7 covariates to balance baseline between-group heterogeneity.

RESULTS: The main effect of time on SUA levels was marginally significant pre-PSM (P = 0.054), but reached statistical significance post-PSM (P = 0.034). A significant main effect of group was observed at both stages (pre-PSM P = 0.008; post-PSM P = 0.037), with consistently higher SUA levels in the NF group. No significant time-by-group interaction effect was detected in either pre- or post-PSM analyses (both P > 0.05). Bonferroni-adjusted post hoc pairwise comparisons revealed significant SUA reductions at 3 and 6 months postoperatively relative to baseline in the pre-PSM HF group, with no significant temporal changes in the pre-PSM NF group; no significant pairwise differences across time points were seen in the matched cohort.

CONCLUSION: Temporal changes in SUA levels after LSG are not significantly associated with baseline renal filtration status.

KEY POINTS: • The time-by-group interaction effect was not significant in either pre- or post-PSM analyses, meaning the temporal trends of SUA levels after LSG did not differ significantly by baseline renal filtration status (HF vs. NF). • Both before and after PSM, SUA levels were consistently lower in the HF group than in the NF group; therefore, a longer duration of SUA monitoring may be necessary for the NF group.

PMID:42260255 | DOI:10.1007/s11695-026-08790-3

Spine Deform. 2026 Jun 8. doi: 10.1007/s43390-026-01464-1. Online ahead of print.

ABSTRACT

PURPOSE: To determine how often physician-ordered limited CTs in pediatric spine patients are not followed, and if this leads to excess radiation.

METHODS: Single-center retrospective review of a tertiary pediatric spine practice.

INCLUSION: CT scans ordered for specific vertebrae (e.g., L4-5) Exclusion: generalized regions (cervical, thoracic, lumbar). Demographics, CT orders and scans, and radiation data were obtained from electronic records. A vertebra was considered imaged only if the entire vertebral body was imaged. Analyses used descriptive statistics, chi-square tests, and one-way ANOVA with Tukey-adjusted post-hoc pairwise comparison.

RESULTS: 93 patients (mean age 16.1 ± 3.4) with 121 CT scans met criteria. In 53 (44%) CTs, more vertebrae were imaged than ordered, yielding a mean of 2.1 times more radiation. Scans occurred at 30 sites. A tertiary medical center with a new limited CT protocol performed 61 (50.4%) scans, with 49.2% scanning additional vertebrae. A private network of 3 outpatient imaging centers with established imaging protocols performed 26 scans, with 3.8% scanning additional vertebrae. The remaining 34 scans were performed at 23 external sites, with 64.7% scanning additional. The imaging center was significantly associated with additional vertebrae imaging frequency (X² = 23.6, P = 0.0002).

CONCLUSION: 44% of patients with limited CT scans of the spine had additional vertebrae scanned compared to what was ordered. This corresponded to an estimated mean of twice the intended radiation dose. Limited CTs at centers with established imaging protocols do not image additional vertebrae in > 96% of patients. Pediatric spine centers should look to develop specific limited CT protocols to help decrease radiation exposure.

PMID:42260251 | DOI:10.1007/s43390-026-01464-1

CVIR Endovasc. 2026 Jun 9;9(1):66. doi: 10.1186/s42155-026-00715-6.

ABSTRACT

BACKGROUND: Type II endoleak after endovascular aneurysm repair is the most common endoleak type. Identifying pre-operative anatomical features that could signal higher risk will improve surveillance post-procedure. This systematic review and meta-analysis evaluated the association between inferior mesenteric artery (IMA) diameter and type II endoleak.

METHODS: MEDLINE and EMBASE were searched via OVID (1946/1974 respectively to January 2025), in line with the PRISMA statement, for adult patients undergoing endovascular aneurysm repair for infrarenal abdominal aortic aneurysm with reported pre-operative inferior mesenteric artery diameter and post-operative type II endoleak outcomes. Both retrospective and prospective observational studies were eligible. Meta-analysis via a random-effects model evaluated the pooled mean IMA diameter among patients with type II endoleak and the mean difference in IMA diameter between patients with and without endoleak. The risk of bias was assessed using the Newcastle-Ottawa scale.

RESULTS: Twenty studies met inclusion criteria; ten provided extractable quantitative data for pooling (2176 patients; 532 type II endoleaks). Assessment with the Newcastle-Ottawa scale demonstrated that the studies had scores between 6 and 8 out of 9. The pooled mean inferior mesenteric artery diameter among cases with endoleak was 2.95 mm (95% CI 2.64-3.26 mm; p < 0.01; I² = 95%). The pooled mean difference in diameter between patients with and without endoleak was 0.50 mm (95% CI 0.36-0.64 mm; p < 0.01; I² = 62%), indicating larger arteries in those who developed type II endoleak. Substantial heterogeneity reflected differences in endoleak definitions, imaging protocols, and measurement methods. Subsequent sac expansion and the need for reintervention were not reported uniformly across all studies, and when reported, insufficient data were available regarding these outcomes and their relation to IMA diameter.

CONCLUSION: Larger pre-operative inferior mesenteric artery diameter was associated with an increased likelihood of type II endoleak after endovascular aneurysm repair. However, the clinical relevance of a 0.5 mm difference remains uncertain, particularly in view of potential inter-observer measurement variability. Multicentre randomised controlled trials are needed to define actionable thresholds for treatment, considering confounding factors and clinical significance of the endoleak.

PMID:42260250 | DOI:10.1186/s42155-026-00715-6

EJNMMI Rep. 2026 Jun 9;10(1):22. doi: 10.1186/s41824-026-00305-8.

ABSTRACT

PURPOSE: Despite the approval of 177Lu-PSMA-617 as standard treatment for patients with mCRPC, at least 50% of patients do not respond to the therapy, especially those with visceral disease. This study analyzes real-world outcomes of 177Lu-PSMA-I&T used in heavily pretreated patients in Brazil.

METHODS: Retrospective analysis of patients with mCRPC previously treated with at least one androgen receptor pathway inhibitor (ARPI) who underwent 177Lu-PSMA-I&T between 2020 and 2025 in two large oncology centers. Our primary endpoint was prostate-specific antigen (PSA) response rate of 50% or more (PSA50). Secondary endpoints included overall survival (OS) and time to next sequential therapies (TNST). Statistical analyses were performed in JAMOVI and RStudio.

RESULTS: Forty-three patients were included, with median age 74 years and median baseline PSA 41 ng/mL. Prior to 177Lu-PSMA-I&T, 86% received more than one ARPI line and 23.3% underwent more than one taxane-based chemotherapy. Visceral disease was present in 41.9%. The overall PSA50 response for all patients was 44.2% and for patients with visceral disease was 33.3%. Median OS was 13.9 months [95% confidence interval (CI) 10.9-19.2] and 12-month survival was 55.5% [95% CI 42.1%-73.3%]. Out of the 24 patients who received subsequent therapies, median TNST was 2.9 months [95% CI 1.6-5.4].

CONCLUSIONS: Our results showed that 177Lu-PSMA-I&T achieved a PSA response comparable to those treated with 177Lu-PSMA-617 in randomized trials, despite our heavily treated patients’ characteristics. A significant number of patients had visceral disease with expected lower PSA response, highlighting the need for more active combinations in this subgroup.

PMID:42260246 | DOI:10.1186/s41824-026-00305-8

J Robot Surg. 2026 Jun 9;20(1):582. doi: 10.1007/s11701-026-03486-3.

ABSTRACT

Robotic colorectal surgery has emerged as an alternative to laparoscopy, offering technical advantages particularly in complex procedures such as rectal surgery. However, its adoption is influenced by the learning curve, which remains incompletely characterized according to tumor location. Cumulative sum (CUSUM) analysis provides an objective method to assess surgical learning curves. A retrospective analysis of 60 consecutive patients undergoing robotic colorectal surgery was performed. The learning curve was evaluated using CUSUM analysis of total operative time. Patients were stratified according to tumor location into right colon (n = 23), sigmoid colon (n = 16), and rectum (n = 21). Perioperative outcomes, including operative time, console time, and postoperative complications, were compared among groups. Non-parametric tests and proportion analyses were used, with statistical significance set at p < 0.05. Operative time was significantly longer in rectal surgery compared to right colon and sigmoid procedures (median: 205.0 vs 145.0 vs 175.0 min; p = 0.000306). Similarly, console time was higher in the rectal group (180.0 vs 127.5 vs 154.0 min; p = 0.000215). No significant differences were observed in postoperative complication rates among groups (p = 0.191). CUSUM analysis identified inflection points at case 6 for right colon, case 5 for sigmoid colon, and case 8 for rectal surgery, indicating a more prolonged learning curve for rectal procedures. The learning curve in robotic colorectal surgery depends on tumor location. Right colectomies show a faster acquisition of technical skills, whereas rectal surgery requires a greater number of cases to achieve stabilization of operative performance. Likewise, procedural safety is maintained during the learning phase, reaching a stable point on the curve after approximately 20 cases, in agreement with the global literature.

PMID:42260235 | DOI:10.1007/s11701-026-03486-3

Theory Biosci. 2026 Jun 9;145(3):28. doi: 10.1007/s12064-026-00480-z.

ABSTRACT

The classification of plant varieties is a key task in plant breeding and variety registration. Red fescue (Festuca rubra L.), a widely cultivated grass species, includes numerous closely related varieties, making automated classification a challenging multi-class problem. This study aimed to develop and evaluate a multilayer perceptron (MLP) neural network combined with a subset-based decision framework for accurate classification of red fescue varieties and recognition of previously unseen varieties. The study analyzed 76 varieties described by seven morphological features. To address the complexity of the multi-class problem, the dataset was divided into multiple subsets and the effectiveness of different partitioning strategies was evaluated. A confidence-based and majority-based decision rule (majority ratio ≥ 0.9 and mean Softmax confidence ≥ 0.8) was introduced to improve the reliability of final predictions and enable open set recognition. The model was evaluated using accuracy, precision, F1 score, and recall. The most optimal solution was to divide the dataset into 15 subsets, with the first subset containing six varieties and the remaining subsets containing five varieties each. This approach provided the best balance between predictive performance and decision consistency, enabling correct classification of known varieties and stable detection of unknown samples. Combining MLP neural networks with strategic subset division and confidence-driven decision rules offers a robust solution to high-dimensional, multi-class classification challenges in plant variety recognition. The model’s ability to recognize new varieties is crucial for its practical application, ensuring the algorithm’s flexibility. This is particularly useful in agriculture and horticulture, where new varieties are bred over the years.

PMID:42260232 | DOI:10.1007/s12064-026-00480-z

Hormones (Athens). 2026 Jun 8. doi: 10.1007/s42000-026-00794-z. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to comprehensively investigate the independent associations between a wide array of novel metabolic indices and the prevalence of circadian syndrome (CircS), as well as to explore, within a cross‑sectional framework, whether the C‑reactive protein triglyceride glucose index (CTI) shows statistical associations consistent with mediation.

METHODS: A cross‑sectional analysis was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave, involving 6,507 participants aged ≥ 45 years. Multivariable logistic regression, restricted cubic splines, and mediation analyses were employed to assess associations, non‑linearity, and indirect effects (cross‑sectionally consistent with mediation).

RESULTS: In fully adjusted models, multiple metabolic indices – including dynapenic abdominal obesity, frailty, TyG‑related indices, and the cardiometabolic index (CMI) – showed significant positive associations with CircS prevalence (all P < 0.001), while CCR was inversely associated. Restricted cubic spline analyses revealed significant non‑linear relationships for all indices (log‑likelihood ratio test P < 0.001). Mediation analysis indicated that CTI had a statistically significant indirect effect (cross‑sectionally consistent with mediation), with the proportion of the total effect statistically attributable to CTI ranging from 20.8% to 86.5%.

CONCLUSION: This large‑scale cross‑sectional study identified significant, often non‑linear, associations between multiple novel metabolic indices and CircS. CTI, a composite marker of inflammation and metabolism, showed a substantial indirect effect cross‑sectionally consistent with mediation in these associations. These hypothesis‑generating findings highlight the potential importance of the “metabolic‑inflammatory” axis in relation to CircS and offer epidemiological clues for early identification and risk stratification. Prospective studies are needed to assess temporality and causality.

PMID:42260226 | DOI:10.1007/s42000-026-00794-z

Hormones (Athens). 2026 Jun 8. doi: 10.1007/s42000-026-00798-9. Online ahead of print.

ABSTRACT

PURPOSE: Pheochromocytomas and paragangliomas (PPGLs) can trigger major cardiovascular events (MACEs) due to unpredictable release of catecholamines. The aim of this systematic review and meta-analysis was to determine prognostic factors associated with MACEs in PPGLs patients.

METHODS: A literature search was conducted in PubMed and the Cochrane Library from January 1980 to March 2026. Assessment of clinical, laboratory, imaging, histological, and genetic parameters was performed on the pooled data.

RESULTS: Nine retrospective cohort studies involving 1566 patients with PPGL were included. MACEs were observed in 302 patients [pooled estimate of 21% (95% CI 14-29%)], 95 of those having Takotsubo syndrome [pooled estimate 39% (95% CI 23-54%)]. Tumor necrosis/hemorrhage and diabetes were associated with increased risk of MACEs [71% (95% CI 25-115%, p < 0.001) and 56% (95% CI 2-109%, p = 0.02), respectively]; additional predictors of MACES were dyspnea and chest pain [5-fold (95% CI 3.3-7.4, p < 0.001) and 2.7-fold (95% CI 1.5-4, p < 0.001) increased risk of MACEs]. Patients with MACEs had an average maximum diastolic blood pressure increase of 19.3 mmHg (95% CI 2.5-36mmHg, p = 0.02) and 9.4 mm larger tumor size (95% CI 1.2-17.56, p = 0.02) than those without. No significant associations between age, adrenergic-noradrenergic phenotype, metastatic disease, familial PPGLs, and MACEs were found.

CONCLUSION: This is, to the best of our knowledge, the first meta-analysis of cohort studies of catecholamine-induced MACEs in patients with PPGL. 21% of PPGL cases developed MACEs. Necrosis/hemorrhage, dyspnea, chest pain, and diabetes were associated with an increased likelihood of development of MACEs. However, these results should be interpreted with caution due to statistical and methodological heterogeneity.

PMID:42260224 | DOI:10.1007/s42000-026-00798-9

Int J Colorectal Dis. 2026 Jun 8. doi: 10.1007/s00384-026-05168-w. Online ahead of print.

ABSTRACT

PURPOSE: The global rise in early-onset colorectal cancer (EOCRC) is a growing concern, particularly in low-resource settings. However, comprehensive data from Ethiopia are limited.

AIM: This study aimed to describe the clinicopathological profile and proportional hospital-based representation of EOCRC at Ethiopia’s largest tertiary referral center.

METHODS: We conducted a retrospective cross-sectional analysis of 630 histologically confirmed colorectal cancer (CRC) cases diagnosed at Tikur Anbessa Specialized Hospital between January 2019 and September 2024. EOCRC was defined as a diagnosis before the age of 50 years and late-onset CRC (LOCRC) as a diagnosis at the age of 50 years or older. Data on demographics, tumor location, histology, differentiation grade, and TNM stage were also extracted. Descriptive statistics, chi-square tests, and binary logistic regression were used for the analysis.

RESULTS: Of the 630 CRC cases, 292 (46.3%) were EOCRC (mean age 36.1 years, SD 7.9). Rectal tumors were significantly more common in EOCRC (31.2% vs. 22.5%, p = 0.012), as were poorly differentiated/undifferentiated tumors (21.9% vs. 13.0%, p = 0.003). Metastasis at diagnosis was less frequent in the EOCRC group (27.4% vs. 66.3%, p < 0.001). Multivariable analysis identified rectal location (adjusted odds ratio (AOR) = 1.60, 95% confidence interval (CI) 1.11-2.30) and poor differentiation (AOR = 1.94, 95% CI 1.25-3.00) as independent predictors of EOCRC, while metastasis was inversely associated (AOR = 0.20, 95% CI 0.14-0.29).

CONCLUSION: In this hospital-based sample, EOCRC constitutes a substantial proportion of CRC cases, with distinct clinicopathological features, including rectal predilection and aggressive histology. These findings highlight the need for heightened clinical suspicion in younger adults while acknowledging the influence of Ethiopia’s young population structure on the observed proportions.

PMID:42260223 | DOI:10.1007/s00384-026-05168-w

Int Urol Nephrol. 2026 Jun 9. doi: 10.1007/s11255-026-05232-y. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera, and Mei, to assess their discrimination, calibration, and clinical utility in a contemporary cohort.

PATIENTS AND METHODS: We retrospectively reviewed patients undergoing surgery for cT1 renal masses at our institution. The primary endpoint was pathological upstaging to pT3a. Model performance was evaluated using the Area Under the Curve (AUC) for discrimination and the Brier Score for overall accuracy. Calibration was assessed using parametric and nonparametric Loess-smoothed curves. Clinical utility was quantified using Standardized Decision Curve Analysis.

RESULTS: The institutional upstaging rate was 17.1% (19/111), and clear cell histology predominated (77.5%). Nocera (AUC = 0.736) and Barra (AUC = 0.733) had higher point estimates of discriminative ability than Mei (AUC = 0.677), but the differences were not significant. All models descriptively overestimated absolute risk. However, Mei demonstrated the highest absolute calibration stability, whereas the Nocera model showed significant global unreliability (U = 0.052, p = 0.021). The Barra model achieved the lowest overall error (Brier Score = 0.122) and the highest clinical net benefit within the decisive 8%-18% decision window, although the overall accuracy differences were not statistically significant.

CONCLUSION: All nomograms are useful risk-stratification adjuncts, but wide confidence intervals and low event counts mean these findings are exploratory. No single model is definitively superior. Nocera and Barra are effective for relative risk-ranking, while Mei provides superior absolute precision for patient counseling.

PMID:42260216 | DOI:10.1007/s11255-026-05232-y