Tag: pubmed

Front Immunol. 2026 Mar 10;17:1771609. doi: 10.3389/fimmu.2026.1771609. eCollection 2026.

ABSTRACT

INTRODUCTION: The role of antineuronal antibody titres in the acute and long-term diagnostic and therapeutic management of autoimmune encephalitis (AE) remains unclear. In this retrospective monocentric cohort study, we aimed to (I) identify specific characteristics in antibody testing distinguishing AE from non-AE patients, (II) evaluate the prognostic significance of antineuronal antibody findings and (III) assess outcomes and long-term immunotherapy in patients with AE.

METHODS: Patients with suspected autoimmune-associated neuropsychiatric conditions underwent antineuronal antibody testing between 01/2017 and 03/2023. Patients with positive antibody tests were stratified into AE and non-AE groups based on the clinical criteria proposed by Graus and colleagues. Long-term outcomes, antibody titres, and therapeutic strategies were analysed in AE patients over a three-year follow-up period. Among 2,466 patients tested, 53 met the diagnostic criteria for AE.

RESULTS: In AE patients with paired serum and CSF samples (n = 44), antibodies were detectable in both serum and CSF in 55% of cases (n = 24), in serum only in 36% (n = 16), and in CSF only in 9% (n = 4). AE patients with poor outcomes (n=5) showed a trend toward higher median CSF titres in the acute phase and at four months post-onset compared to patients with good outcomes (n=14); however, differences were not statistically significant. Regarding long-term immunotherapy, rituximab-treated patients experienced fewer relapses than those receiving intravenous-immunoglobulins (IVIG; p-value = 0.02).

DISCUSSION: These exploratory results from a small, heterogeneous cohort require confirmation in larger, prospective studies. Based on our data regarding serum and CSF antibodies, in a resource- limited setting we propose a stepwise diagnostic approach starting with serum screening; in suspected anti-NMDAR-AE, initial paired serum/CSF testing remains essential. If antibodies are detected in serum, additional CSF antibody testing may provide diagnostic confirmation and help guide treatment decisions, as high acute-phase CSF titres may suggest poorer long-term outcomes; however, this potential prognostic value requires confirmation in larger, antibody-specific studies.

PMID:41884821 | PMC:PMC13008692 | DOI:10.3389/fimmu.2026.1771609

Front Immunol. 2026 Mar 10;17:1757477. doi: 10.3389/fimmu.2026.1757477. eCollection 2026.

ABSTRACT

INTRODUCTION: Autoimmune hepatitis is a chronic inflammatory liver disease in which the immune system attacks liver tissue. While genetic predisposition plays a role, environmental factors are increasingly recognized as contributors to disease onset and progression. This study aimed to examine the association between environmental exposures and autoimmune hepatitis in a Yemeni population.

METHODOLOGY: A case-control study was conducted, including 93 patients with clinically diagnosed autoimmune hepatitis and 280 age- and sex-matched healthy controls. Data was collected through structured interviews and laboratory analyses. Environmental exposures assessed included residence in different temperature zones, history of viral infections, medication use, pesticide exposure, and the habit of chewing Khat. Liver biopsy findings and vitamin D levels were evaluated to assess disease severity. Statistical comparisons were performed using odds ratios and confidence intervals to determine associations.

RESULTS: Khat chewing was significantly more common in autoimmune hepatitis patients than in controls (65.6% versus 42.1%, OR: 2.6; 95% CI: 1.6-4.3, p < 0.001). Exposure to medications known to induce autoimmune reactions, such as nitrofurantoin and minocycline, was also higher among patients (27.9% versus 1.8%, OR: 21.3; 95% CI: 7.9-57.7, p < 0.001). Living in warm temperature zones and exposure to pesticides (OR: 13.1; 95% CI: 2.7-62.8, p < 0.001) were both significantly associated with increased disease risk. Patients with these exposures also demonstrated higher liver enzyme levels and more advanced fibrosis on biopsy. Vitamin D deficiency was associated with greater disease severity.

CONCLUSIONS: These findings highlight the important role of environmental factors, particularly Khat chewing and pesticide exposure, in the development and progression of autoimmune hepatitis in Yemen. Public health interventions addressing these exposures may help reduce disease burden.

PMID:41884811 | PMC:PMC13008630 | DOI:10.3389/fimmu.2026.1757477

SAGE Open Nurs. 2026 Mar 14;12:23779608261435041. doi: 10.1177/23779608261435041. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND: Healthcare-acquired infections (HAIs) remain a significant cause of preventable morbidity and mortality in pediatric care, particularly in low-resource and conflict-affected settings such as Palestine. Pediatric nurses play a critical role in infection prevention and control (IPC); however, deficiencies in knowledge, attitudes, practices (KAP), and perceived institutional support may undermine effective HAI prevention.

OBJECTIVE: This study aimed to evaluate the effectiveness of a structured educational workshop in improving pediatric nurses’ KAP, and perceptions of institutional support related to HAI prevention.

METHODS: A one-group pre-post quasi-experimental design was conducted in 2024 at a specialized pediatric hospital in Palestine. A total of 54 pediatric nurses participated in a two-week educational workshop comprising four interactive sessions focused on core IPC principles. Data were collected using a validated self-administered questionnaire assessing KAP and perceived institutional support. Paired-sample t tests were performed to compare pre- and postintervention scores.

RESULTS: Statistically significant improvements were observed across all outcome domains following the intervention (p ≤ .001). Mean knowledge scores increased from 52.9 ± 3.3 to 61.9 ± 4.1, attitude scores from 44.1 ± 4.1 to 52.6 ± 3.4, and practice scores from 42.1 ± 5.7 to 53.3 ± 3.1. The proportion of nurses reporting good perceived institutional support increased from 40.7% pre-intervention to 98.1% postintervention.

CONCLUSION: The structured, context-specific educational workshop significantly improved pediatric nurses’ IPC-related competencies and perceptions of institutional support. Integrating continuous professional education with organizational engagement is essential for strengthening HAI prevention in pediatric settings within resource-constrained healthcare systems.

PMID:41884808 | PMC:PMC13009566 | DOI:10.1177/23779608261435041

Front Hum Neurosci. 2026 Mar 10;20:1714086. doi: 10.3389/fnhum.2026.1714086. eCollection 2026.

ABSTRACT

Event-related potentials (ERPs) are time-locked voltage changes in averaged EEG signals reflecting neural responses to specific events. ERPs are extracted from EEG by repeating the same stimulus across multiple trials and averaging the recordings. In ERP studies, artifact-contaminated trials (commonly termed “bad trials”) refer to data segments deemed unsuitable for analysis due to excessive noise or artifacts. The criteria for determining such trials depend on overall data quality: researchers increase artifact tolerance when a subject’s data quality is poor to retain statistical power, while applying stricter standards when quality is high to ensure analytical purity and accuracy. Current automated bad trial detection methods rely on static thresholds and fail to replicate the adaptive strategies employed by experts. To address this limitation, we propose YOLOBT, a YOLO-based deep learning framework that mimics expert judgment by integrating global signal quality assessment with dynamic threshold adjustment. By treating EEG signals as visualized waveform images, our approach naturally aligns with expert visual inspection methods while enabling context-aware artifact detection. Our technical contributions include: (1) a Cross-Layer Attention Bottleneck (CLAB) enhancing artifact feature extraction through cross-layer attention mechanisms; (2) a Hierarchical Feature Guidance Module (HFGM) leveraging high-level semantic features to guide low-level feature refinement; and (3) a Global Information Classification Module (GICM) enabling dynamic threshold adjustment based on comprehensive signal quality assessment. Experiments on our manually annotated dataset showed YOLOBT achieved 88.76% precision, 86.89% recall, 92.76% mAP, and 87.82% F1 score, outperforming classical models. Heatmap visualization confirmed the model adaptively adjusts artifact detection strategies based on signal quality, similar to expert judgment processes.

PMID:41884779 | PMC:PMC13008845 | DOI:10.3389/fnhum.2026.1714086

Plast Reconstr Surg Glob Open. 2026 Mar 24;14(3):e7539. doi: 10.1097/GOX.0000000000007539. eCollection 2026 Mar.

ABSTRACT

BACKGROUND: Nearly 90% of Americans face health literacy challenges, limiting their ability to understand complex medical information. In plastic and reconstructive surgery, much of the literature exceeds recommended readability levels, creating barriers to patient education, including disparities-focused research. This study evaluated whether large language models (LLMs) can generate accurate and patient-accessible summaries of such research.

METHODS: Eight disparities-related plastic surgery articles from PubMed were input into 4 LLMs: ChatGPT-4o, Gemini 1.5 Pro, Grok 3, and DeepSeek-V3, using a standardized prompt to simplify the text to a sixth- to eighth-grade reading level. Generated summaries were assessed using 4 readability metrics (Flesch Reading Ease [FRE], Flesch-Kincaid Grade Level [FKGL], Simple Measure of Gobbledygook Index, and Gunning Fog Index) and were reviewed by a physician for accuracy.

RESULTS: Grok generated the most readable summaries, achieving average scores between the seventh- and ninth-grade reading levels (FRE M = 63.06, SD =1.80; FKGL M = 7.69). It significantly outperformed the other models across all metrics (FRE P = 0.001; FKGL P = 0.003; Simple Measure of Gobbledygook P = 0.034; Gunning Fog Index P = 0.007). ChatGPT, Gemini, and DeepSeek showed moderate improvements but did not achieve statistically significant differences from the original articles (P > 0.05), with average grade levels between the 10th and 12th grades.

CONCLUSIONS: Grok demonstrated superior readability while preserving accuracy, making it the only LLM to meet health literacy benchmarks. Other models fell short, underscoring a gap in artificial intelligence tools. Enhancing LLM performance could promote access to surgical literature and empower diverse patient populations through enhanced health communication.

PMID:41884761 | PMC:PMC13012324 | DOI:10.1097/GOX.0000000000007539

Front Glob Womens Health. 2026 Mar 10;7:1644372. doi: 10.3389/fgwh.2026.1644372. eCollection 2026.

ABSTRACT

BACKGROUND: Access to healthcare, particularly for women of reproductive age, is critical for achieving Universal Health Coverage (UHC) and reducing maternal mortality. Somaliland faces significant challenges in healthcare access, but specific barriers for women of reproductive age remain understudied. This study aimed to evaluate healthcare access problems faced by this population in Somaliland.

METHODS: The study utilized secondary data sourced from the Somaliland Demographic and Health Survey. The outcome of the study was barriers to healthcare access. A two-level mixed-effects logistic regression approach, along with 95% confidence intervals (CIs), was employed to determine factors related to healthcare issues among women of reproductive age. Statistical significance was declared for p-values below 0.05.

RESULTS: Nearly 75% of women reported at least one barrier to healthcare access. The multilevel analysis revealed that being in the age group 25-29 (AOR = 1.58; 95% CI; 1.00-2.48), 35-39 (AOR = 1.86; 95% CI; 1.12-3.07), 40-44 (AOR = 1.84; 95% CI; 1.03-3.29), a secondary education level (AOR: 1.70; 95% CI; 1.13-2.560), higher education (AOR = 3.72; 95% CI; 1.96-7.05), women with employed husbands (AOR = 0.69; 95% CI: 0.57-0.84) non-users or those who intend to use later (AOR = 0.51: 95% CI; 0.30-0.85), and having five and more children (AOR = 0.78 95% CI; 0.63-0.96) were significantly associated with healthcare problems at an individual level. On the contrary, regions Woqooyi-galbeed (AOR = 0.50 95% CI; 0.35-0.72), Togdheer (AOR = 0.41; 95% CI; 0.28-0.60), Sool (AOR = 0.37; 95% CI; 0.25-0.54), and Sanaag (AOR = 0.54; 95% CI; 0.38-0.76), women in the middle wealth status (AOR = 2.26; 95% CI; 1.55-3.32), fourth wealth index (AOR = 3.14; 95% CI; 2.17-4.56), and the highest wealth status (AOR = 4.23; 95% CI; 2.88-6.22) were the community-level determinants in access to healthcare.

CONCLUSION: A substantial proportion of women of reproductive age in Somaliland experience significant barriers to healthcare access. Addressing these challenges requires targeted interventions focusing on improving the socioeconomic status, infrastructure, accessible and affordable healthcare services, and region-specific strategies.

PMID:41884748 | PMC:PMC13008970 | DOI:10.3389/fgwh.2026.1644372

Rural Remote Health. 2026 Mar;26(1):10621. doi: 10.22605/RRH10621. Epub 2026 Mar 24.

ABSTRACT

INTRODUCTION: Rural health systems depend on family and other unpaid care partners to bridge gaps created by distance, workforce shortages, and limited infrastructure, yet evidence about their delivery-facing roles is dispersed. Therefore, the objective of this study was to map how unpaid caregivers contribute to rural health delivery, identify common enablers and barriers, and summarize reported outcomes for patients, caregivers, and health systems.

METHODS: We conducted a scoping review in accordance with PRISMA-ScR guidelines. We searched MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, and ProQuest from January 2000 to September 2025. Eligible English-language studies examined unpaid caregivers supporting individuals of any age in rural/remote/frontier settings where caregiver activities intersected with health service delivery.

RESULTS: Forty-five studies were included. Eight recurring domains described caregiver work: coordination and navigation; medication and treatment management; telehealth mediation; monitoring and early triage; transport and home or environmental adaptation; cultural and linguistic brokerage and trust-building; palliative, disability, and long-term support; and caregiver competence and burden. Barriers included device gaps, fragmented hand-offs, limited respite, and travel costs. Programs integrating caregivers reported improved adherence, continuity, and earlier escalation.

CONCLUSION: Unpaid caregivers are important members of rural care teams. Formal recognition, resourcing, and measurement, alongside investments in coordination infrastructure, broadband, respite, and financial supports, are essential for sustainable and equitable rural care.

PMID:41881822 | DOI:10.22605/RRH10621

Ann Otol Rhinol Laryngol. 2026 Mar 25:34894261428393. doi: 10.1177/00034894261428393. Online ahead of print.

ABSTRACT

BACKGROUND: Sinonasal malignancies (SNM) are rare cancers associated with poor prognosis and impaired quality of life (QOL). The 22-question Sino-Nasal Outcome Test (SNOT-22) has been used to assess QOL in patients with SNM.

OBJECTIVE: To determine the minimal clinically important difference (MCID) for the SNOT-22 in patients with SNM.

METHODS: About 264 patients with SNM were drawn from a prospective, longitudinal, multi-institutional study. SNOT-22 scores were collected at pre-treatment baseline and follow-up through 5 years post-treatment. Cronbach’s alpha was used to assess the internal consistency of the SNOT-22. Distribution-based approaches were used to estimate the MCID. Multivariable regression identified factors associated with SNOT-22 improvement exceeding the determined MCID.

RESULTS: Cronbach’s alpha was >.85. The estimated MCIDs were: 1.44 (Cohen’s effect size), 1.32 (standard error of the mean), 10.45 (1/2 of baseline standard deviation), and 3.67 (minimum detectable change). The mean MCID across methods was 4.22. Multivariable regression demonstrated higher odds of clinically meaningful improvement from baseline in patients with early-stage disease (odds ratio (OR) 3.510, P = .035), no neck irradiation (OR 11.050, P = .014), and neoadjuvant therapy (OR 16.667, P = .047).

CONCLUSIONS: The SNOT-22 MCID was estimated as 4.22 in a large multi-center cohort of patients with SNM, suggesting that relatively small QOL changes are clinically relevant. When applying the MCID to the current cohort, advanced stage, treatment of neck disease, and not requiring neoadjuvant therapy were predictive of worse QOL.

PMID:41881811 | DOI:10.1177/00034894261428393

Water Environ Res. 2026 Apr;98(4):e70355. doi: 10.1002/wer.70355.

ABSTRACT

Accurate identification of nitrate sources in aquatic environments is vital for implementing effective measures to prevent and control nitrate pollution. The combination of isotopes of nitrate with Bayesian models has proven effective in tracing nitrate pollution sources in aquatic environments. Nevertheless, broad systematic errors in both qualitative and quantitative assessments lead to significant uncertainties in quantifying the contributions of nitrate sources. This review initiates by outlining the fundamental principles and procedures of employing nitrate isotopes in conjunction with Bayesian models. It further consolidates the empirically determined values for two pivotal parameters, isotope abundances and effects, within these models and provides a detailed analysis of their spatial and temporal variability sources. Then it meticulously dissects the origins of systematic errors encountered in applying this technique, including overlooking isotope effects, disregarding the spatiotemporal variability of isotopes, and failing to validate whether data conform to the normal distribution assumption inherent in Bayesian models. Subsequently, the review compiles and discusses emerging strategies from both qualitative, including emerging isotopes that increase the precision of source identification, fecal-specific indicators, statistical tools, and fluorescence spectrum methods, and quantitative, including mathematical methods and/or their combination with mass balance models perspectives to mitigate these systematic errors. It also forecasts the trajectory of development within this technical domain. By examining the application of isotope technology for nitrate source identification from multiple angles, this review offers theoretical references for the prevention, control, and mitigation of nitrate in water, as well as for the formulation and implementation of pertinent policies by regulatory authorities.

PMID:41881806 | DOI:10.1002/wer.70355

Zhonghua Wai Ke Za Zhi. 2026 Mar 25;64:538-544. doi: 10.3760/cma.j.cn112139-20250820-00409. Online ahead of print.

ABSTRACT

Objective: To evaluate the efficacy and safety of rapamycin-eluting stents in treating stenosis of the vertebral artery V1 segment. Methods: This retrospective cohort study analyzed 191 patients with vertebral artery V1 segment stenosis who underwent stent implantation at our institution between January 2023 and August 2024. There were 161 male cases and 30 female cases. The age of the cohort was (68±8) years (range: 47 to 86 years). Patients were divided into two groups based on the stent type: the rapamycin-eluting stent (DES) group (n=93) and the bare-metal stent (BMS) group (n=98). Baseline characteristics showed no significant differences between the groups. Outcome measures included technical success rate, periprocedural (30-day) complications (stroke, mortality), and follow-up outcomes at 12 months (stent patency, stroke recurrence). Statistical analyses were performed using the independent sample t test, χ² test, or Fisher’s exact test, as appropriate. Survival analysis was conducted using the Kaplan-Meier method. Results: The operation time of patients in the DES group was (63±31) min (range: 24 to 120 min), with a technical success rate of 98.9% (92/93), and the periprocedural stroke rate within 30 d was 1.1% (1/93). The operation time of the BMS group was (58±24) min (range: 26 to 110 min), with a technical success rate of 100%, and the incidence of stroke within 30 d of the operation was 2.0% (2/98). There were no statistically significant differences in operation time, technical success rate, and the periprocedural stroke rates between the two groups (all P>0.05), and no deaths occurred in either group. A total of 91 cases in DEs group and 95 cases in BMS group were followed up for more than 12 months. The Kaplan-Meier survival analysis results showed that the patency rate at 12 months after operation, the DES group demonstrated significantly higher stent patency rates (94.5%(86/91) vs. 83.2%(79/95), χ²=5.838,P=0.016) and a higher stroke-free survival rate (97.8%(89/91) vs. 89.5%(85/95), χ²=5.410,P=0.020) compared to the BMS group. Conclusions: In the treatment of V1 segment vertebral artery stenosis, DES demonstrates a favorable perioperative safety profile, significantly higher stent patency and a lower stroke recurrence rate compared to BMS at 12 months follow-up. Further extended follow-up is required to evaluate their long-term efficacy.

PMID:41881799 | DOI:10.3760/cma.j.cn112139-20250820-00409