Tag: pubmed

J Thorac Dis. 2026 May 31;18(5):521. doi: 10.21037/jtd-2026-1-0386. Epub 2026 May 27.

ABSTRACT

BACKGROUND: Pulmonary resection is an important adjunct to antifungal therapy in selected patients with Aspergillus-related lung disease. However, the impact of surgical margin status on treatment outcomes remains poorly defined. The objective is to compare the impact of surgical margins on treatment response in patients with pulmonary fungal infections, analyzing persistence of symptoms, perpetuation of fungal colonization, and disease recurrence.

METHODS: This retrospective study analyzed patients treated between 2020 and 2024 with inflammatory/infectious pulmonary diseases caused by Aspergillus, undergoing pulmonary resection due to complications or as an adjunct to clinical treatment with curative intent. Patients were divided into two groups: tangential margin (distance to pulmonary margin <0.1 cm) and non-tangential margin (distance >0.1 cm). Patients were followed for one year. Exclusion criteria included incomplete records, loss to follow-up, or pneumonectomy cases.

RESULTS: Nineteen patients were included, of whom four experienced disease recurrence. All recurrence cases occurred in the “tangential margin” group. Tangential margins were strongly associated with symptom persistence, with an odds ratio (OR) of 11.0 [95% confidence interval (CI): 1.30-140.9, P=0.04]. Patients in this group also showed a smaller reduction in Aspergillus serology titers (50%) compared to the “non-tangential margin” group (75%), with statistical significance (P=0.04). The study also examined the correlation between the extent of lung disease and treatment outcomes but found no statistically significant association with recurrence, symptom persistence, or serology titer reductions.

CONCLUSIONS: As lung-sparing surgeries become more prevalent, an adequate surgical margin remains critical to achieving disease-free survival. This study suggests the importance of ensuring sufficient margins in pulmonary resections for fungal infections to optimize therapeutic outcomes. Additional research is needed to confirm our findings.

PMID:42306664 | PMC:PMC13266717 | DOI:10.21037/jtd-2026-1-0386

JTCVS Struct Endovasc. 2024 Dec 10;5:100037. doi: 10.1016/j.xjse.2024.100037. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: The treatment of complex aortic arch pathologies demands the reconstruction (endovascular or surgical) of 1 or multiple supra-aortic vessels to restore the blood flow of these vessels during thoracic endovascular aortic repair. However, the patency and fate of the endovascular bypass remain unclear. This report compares the midterm outcome of endovascular versus surgical bypass in thoracic endovascular aortic repair.

METHODS: Between 2007 and 2015, 395 patients underwent thoracic endovascular aortic repair at our institution. Only thoracic endovascular aortic repairs landing proximally at landing zones zero, 1, and 2 were included (244/395). We recorded the type of bypass method used (endovascular or surgical) and the number of supra-aortic vessels bypassed.

RESULTS: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for thoracic endovascular aortic repair. Endovascular bypass was more commonly used in thoracic endovascular aortic repair landing proximally at zone 1. The 30-day postoperative mortality rate was 11% (25 patients), but it was not different among both methods. Six patients (10.5%) in the endovascular group and 27 patients (16.5%) in the surgical bypass group needed reintervention. The late survival and adverse events were similar. Postoperative stroke occurred in 15 patients (6.8%). Type Ia endoleak was more common after endovascular bypass (17 patients, 36.2%), but this was not statistically significant.

CONCLUSIONS: In our report, with a tailored approach, the endovascular reconstruction of the supra-aortic vessels was not inferior to the surgical approach and had an acceptable patency rate at mid follow-up with a low rate of complications after surgery.

PMID:42306644 | PMC:PMC13244688 | DOI:10.1016/j.xjse.2024.100037

JTCVS Struct Endovasc. 2024 Dec 24;5:100041. doi: 10.1016/j.xjse.2024.100041. eCollection 2025 Mar.

ABSTRACT

OBJECTIVE: Hypoattenuated leaflet thickening (HALT) is a computed tomography (CT) finding after transcatheter aortic valve replacement (TAVR) that is indicative of bioprosthetic valvular thrombosis. There are currently no standardized or validated methods for predicting HALT, which can cause bioprosthetic valve dysfunction and has been associated with adverse patient outcomes. The objective was to develop a novel fast-response, artificial intelligence, and machine learning (ML)-driven computational pipeline to predict HALT using preprocedural CT scans.

METHODS: The pipeline consisted of (1) pre-TAVR CT reconstruction and reduced order modeling simulations to automatically predict postprocedural geometric parameters, (2) a landmark-guided automated left ventricle segmentation method to predict hemodynamic parameters, and (3) statistical and ML analyses to develop HALT predictive metrics.

RESULTS: Pre- and postprocedural scans from 45 patients (21 with HALT, 24 without) were used as inputs for the pipeline. We identified statistically significant relationships between HALT and peak systolic blood velocity (P < .01) and peak systolic blood flow through the bioprosthetic valve (P < .01), left ventricular ejection time (P < .01), ejection volume (P < .05), and right coronary height (P < .05). ML-yielded metrics related to circulation in the neosinuses correlated strongly with HALT occurrence (P < .001) along with the greatest accuracy of 84.40% and area under receiver operating characteristic curve of 0.87.

CONCLUSIONS: A computational pipeline using pre-procedural CT scans as inputs that outputs post-TAVR geometric and hemodynamic measurements was developed to assess metrics with the potential to predict the risk of HALT. Such a tool may help guide decision-making and understanding of prevention of postprocedural thrombosis.

PMID:42306643 | PMC:PMC13244794 | DOI:10.1016/j.xjse.2024.100041

Front Neurol. 2026 Jun 1;17:1840684. doi: 10.3389/fneur.2026.1840684. eCollection 2026.

ABSTRACT

BACKGROUND: Gait disorder and cognitive dysfunction are the most common symptoms in patients with cerebral small vessel disease (CSVD), significantly impacting patients’ quality of life. Currently, there remains a lack of effective treatment for gait disorder and cognitive dysfunction of CSVD. In this randomized, single-blind, sham-controlled study, we conducted high-dose accelerated intermittent theta burst stimulation (aiTBS) in 36 patients with CSVD to investigate the efficacy and safety of high-dose aiTBS targeting the primary motor cortex (M1 area) for treating various symptoms of CSVD, particularly gait and cognitive function.

METHODS: The patients were randomly assigned to two groups of real (n = 19) or sham (n = 17) aiTBS targeting the primary motor cortex. Both groups received 14 consecutive sessions of real-aiTBS or sham-aiTBS. Primary outcome was the change of 3-meter Timed Up and Go (3mTUG) duration, assessed at baseline (T0) and immediately post-intervention (T1), with follow-up evaluations at 4 weeks after intervention (T2). Secondary outcomes included changes in the Tinetti Performance-Oriented Mobility Assessment (Tinetti) score, the Chinese version of the Mini-Mental State Examination (CMMS) score, the Montreal Cognitive Assessment (MoCA) score, three-dimensional gait analysis, and multidimensional function scale scores after intervention.

RESULTS: Compared to the sham-aiTBS group, the real-aiTBS group exhibited significantly greater improvements in multidimensional gait, cognitive, affective and autonomic nervous function assessments. At the 4-week follow-up, time effects were statistically significant for the 3mTUG duration, Tinetti, CMMS, and MoCA scores. The real-aiTBS group exhibited more pronounced group-by-time interaction effects for the 3mTUG duration, Tinetti, and CMMS scores, while no statistically significant differences from the sham-aiTBS group were observed for the MoCA score. The aiTBS intervention response is correlated to the CSVD neuroimaging features, including periventricular white matter hyperintensity, enlarged perivascular space, cortical atrophy, lacune and total CSVD burden score.

CONCLUSION: The aiTBS holds promise as a valuable therapeutic approach for CSVD. High-dose aiTBS targeting the M1 area improved clinical symptoms such as gait and cognitive disorder in patients with CSVD. The therapeutic response to aiTBS in CSVD patients is related to the CSVD neuroimaging phenotypes.

PMID:42306624 | PMC:PMC13265494 | DOI:10.3389/fneur.2026.1840684

J Ethnobiol Ethnomed. 2026 Jun 16. doi: 10.1186/s13002-026-00917-1. Online ahead of print.

ABSTRACT

BACKGROUND: Bryophytes are ecologically and socioeconomically important but remain largely understudied from an ethnobotanical perspective, particularly in Africa. This study provides the first assessment of traditional knowledge, uses, perceived threats, and conservation strategies for bryophytes in Benin Republic.

METHODS: Ethnobotanical data were collected through semi-structured interviews (n = 637), free-listing, and participatory ranking among fifteen sociolinguistic groups across the three climatic zones of Benin (humid, sub-humid, and semi-arid). Descriptive and inferential statistics were used to assess (i) bryophyte knowledge, (ii) use patterns, (iii) socio-demographic factors associated with knowledge of bryophytes, (iv) perceived threats, and (v) proposed conservation measures.

RESULTS: Sixteen species were cited, of which twelve had documented traditional uses. Vernacular classifications relied mainly on habitat-based descriptors, while medicinal uses were predominant. Philonotis africana (Müll. Hal.) Rehmann ex Paris, Index Bryol. emerged as the most widely known and culturally important species, whereas other taxa showed marked geographic and cultural specificity. Knowledge of bryophytes varied significantly with ethnicity, age, occupation, and education, with elders, traditional healers, and few ethnic groups holding the richest knowledge. Species diversity and uses declined from the humid to the semi-arid zone, consistent with the ecological apparency hypothesis. Deforestation and agricultural expansion were identified as the main threats. Proposed conservation measures emphasized protected areas, reduced forest clearing, and preservation of humid microhabitats.

CONCLUSIONS: Overall, this study provides important baseline on bryophytes in Benin and essential insights towards their sustainable management. Further studies should be conducted on Philonotis Africana, especially regarding its medicinal and environmental benefits.

PMID:42304201 | DOI:10.1186/s13002-026-00917-1

BMC Public Health. 2026 Jun 16. doi: 10.1186/s12889-026-27764-9. Online ahead of print.

ABSTRACT

BACKGROUND: Retirement is a major life transition that affects psychological well-being and coping. This study evaluated the effect of a health promotion program grounded in an ecological framework on retirement adjustment, psychological well-being, and coping strategies among Iranian retirees.

METHODS: A randomized controlled trial was conducted with 178 retirees from retirement centers affiliated with the Departments of Education and the Oil Industry in Fars province, southern Iran. Participants were systematically selected and randomly assigned to intervention (n = 90) and control (n = 88) groups using stratified block randomization. The intervention comprised a multicomponent program including blended learning (face-to-face sessions and mobile-based delivery via WhatsApp) and support from family and organizations. Educational strategies were guided by the PRECEDE-PROCEED model and Lazarus’ transactional model of stress and coping. Data were collected at baseline, three months, and six months post-intervention using the Retirement Adjustment Scale, Ryff Psychological Well-Being Scale, and Ways of Coping Questionnaire. Statistical analyses included repeated measures ANOVA, MANCOVA (adjusting for baseline scores), and independent samples t-tests.

RESULTS: Groups did not differ significantly at baseline. Over time, the intervention group showed improvements in retirement adjustment, total psychological well-being, subjective well-being, psychological well-being dimension, ways of coping, and problem-focused coping (P < 0.001). Emotion-focused coping showed no significant change. Significant time-by-group interaction effects were observed for all these variables (P < 0.001).

CONCLUSION: An ecological, theory-driven health promotion program improved well-being, coping skills, and adjustment in retirees. Multilevel interventions addressing individual, family, and organizational levels may support healthy aging and successful retirement.

TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT) with a code of IRCT20180516039690N2, registered 16th September 2022.

PMID:42304185 | DOI:10.1186/s12889-026-27764-9

Diabetol Metab Syndr. 2026 Jun 16. doi: 10.1186/s13098-026-02210-3. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, the prevalence of early-onset hypertension is high, with a high risk of premature mortality. Consequently, this research intended to ascertain the association of early-onset diabetes mellitus (DM) with early-onset hypertension and premature all-cause mortality.

METHODS: This research utilized NHANES data from six cycles between 2007 and 2018. Weighted logistic regression was employed to explore the association between early-onset DM and early-onset hypertension, while weighted Cox regression was adopted to analyze the association between early-onset DM and premature all-cause mortality. Kaplan-Meier survival curves were leveraged to elucidate the trends in survival probability over time between individuals with and without DM. Subgroup analysis was implemented to ascertain potentially vulnerable populations who were at high risk of early-onset hypertension and premature all-cause mortality.

RESULTS: In the analysis of the association between early-onset hypertension and early-onset DM, 22,053 participants were included, with a positive rate of 1.17% for early-onset hypertension. In the analysis of the association between early-onset DM and premature all-cause mortality, 23,434 participants were included, with a premature all-cause mortality rate of 5.79%. Weighted logistic regression showed that early-onset DM was significantly associated with early-onset hypertension (OR = 4.252, 95% CI: 3.326, 5.437). Weighted Cox regression indicated that early-onset DM was significantly associated with premature all-cause mortality (HR = 3.017, 95% CI: 2.296, 3.963). Subgroup analysis suggested significant interaction effects of poverty income ratio (PIR) and drinking status on the association between early-onset DM and early-onset hypertension. A significant interaction between PIR and the association between early-onset DM and premature all-cause mortality was noted.

CONCLUSION: Early-onset DM is associated with a higher prevalence of early-onset hypertension and premature all-cause mortality in the study population.This finding provides crucial theoretical support for understanding the accelerated progression of the disease in younger populations, and further guides the development of early, proactive, and multidimensional intervention strategies.

PMID:42304179 | DOI:10.1186/s13098-026-02210-3

Ann Ital Chir. 2026 May 18;97(6):1060-1068. doi: 10.62713/aic.4480.

ABSTRACT

AIM: Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. However, open tension-free repairs remain essential in specific clinical contexts. This study aimed to compare perioperative outcomes, postoperative recovery, complication rates, and medical costs between small-incision tension-free mesh repair combined with scrotal drainage and laparoscopic TAPP repair, providing evidence-based guidance for surgical selection in diverse practice environments.

METHODS: A retrospective cohort study was conducted at Yanbian University Hospital between June 2018 and February 2023. A total of 323 consecutive patients were enrolled. Group A included 107 patients who underwent small-incision tension-free mesh repair combined with scrotal drainage, and Group B included 216 patients who underwent TAPP. Baseline demographics were compared to ensure group equivalence. Intraoperative parameters (blood loss, operative time), postoperative recovery indicators (time to first flatus, ambulation initiation, pain resolution), length of hospital stay, medical costs, complication rates, and recurrence within six months were assessed using appropriate statistical tests (p < 0.05 indicated significance).

RESULTS: No significant differences in baseline characteristics were detected between the two groups (p > 0.05). Compared with TAPP (Group B), small-incision tension-free mesh repair with scrotal drainage (Group A) was associated with greater intraoperative blood loss (p < 0.001) but a shorter operative time (p < 0.001). Postoperatively, Group A had longer hospital stays and delayed recovery of gastrointestinal function (time to first flatus), ambulation, and pain resolution (all p < 0.001). Total hospitalization costs were significantly lower in Group A than in Group B (p < 0.001). The mean duration of drain placement in Group A was 2.03 ± 0.65 days. Chronic groin pain occurred in 8.4% vs. 4.6% (p > 0.05) of patients, and hernia recurrence rates were 1.9% vs. 1.4% (p > 0.05) for Groups A and B, respectively. Incisional infection was more frequent in Group A (3.7%) than in Group B (0%, p < 0.05).

CONCLUSIONS: Both small-incision tension-free mesh repair with scrotal drainage and TAPP are safe and effective when performed by experienced surgeons within standardized perioperative protocols. The small-incision approach is particularly suitable for elderly patients and those with comorbidities limiting tolerance to general anaesthesia, as well as for resource-constrained settings. Targeted drain placement effectively prevents postoperative seroma formation but may also increase local tissue trauma, prolong postoperative discomfort, delay mobilization, and increase the risk of superficial wound infection.

PMID:42304161 | DOI:10.62713/aic.4480

Ann Ital Chir. 2026 May 27;97(6):1112-1119. doi: 10.62713/aic.4527.

ABSTRACT

AIM: To compare the correlation between three-dimensional stereophotography (3D-SPG) and visual analogue scale (VAS) in the evaluation of periorbital swelling after upper blepharoplasty, and to provide a basis for postoperative swelling monitoring and recovery evaluation.

METHODS: This retrospective study included 39 patients who underwent upper blepharoplasty between December 2024 and April 2025. On postoperative days 1, 7, 14, and 28, 3D-SPG was used to measure objective morphological volume and double-eyelid fold width, while periorbital swelling experienced by the patients was assessed using a visual analogue scale. Changes in objective morphological volume and VAS scores from their baseline levels were calculated. Repeated measures analysis of variance was used to assess changes over time, and Pearson correlation analysis was used to evaluate the correlation between objective morphological volume and VAS scores. Standardized response mean (SRM) was calculated to compare the responsiveness of the two parameters.

RESULTS: During the postoperative 28-day period, the double-eyelid fold width, VAS score, and objective morphological volume decreased significantly over time (all p < 0.001). There was a significant positive correlation between the objective morphological volume and VAS score in the early postoperative period (d1-d7) (left eye: d1 r = 0.467, p = 0.003; d7 r = 0.546, p < 0.001; right eye: d1 r = 0.449, p = 0.004; d7 r = 0.497, p = 0.001). At late postoperative days (d14-d28), the correlation weakened and became not statistically significant (left eye: d14 r = 0.098, p = 0.555; d28 r = 0.175, p = 0.286; right eye: d14 r = 0.254, p = 0.119; d28 r = 0.113, p = 0.494). Sensitivity analysis showed that both parameters demonstrated high responsiveness in the early intervals (d1-d7 and d7-d14). However, 3D-SPG maintained consistently higher responsiveness throughout the observation period (SRM = 3.406-5.007), whereas VAS showed a decline in responsiveness in the late interval (d14-d28), potentially due to a floor effect (SRM = 0.902-1.355).

CONCLUSIONS: Both 3D-SPG and VAS demonstrate distinct performance characteristics across postoperative stages. 3D-SPG provides objective, quantitative volumetric data, while VAS captures patient-perceived symptoms. These findings suggest that both methods assess different dimensions of postoperative swelling. However, further studies are needed to determine whether their combined use offers additional clinical benefit.

PMID:42304158 | DOI:10.62713/aic.4527

Ann Ital Chir. 2026 May 27;97(6):1120-1126. doi: 10.62713/aic.4318.

ABSTRACT

AIM: Splenic flexure resection (SFR) is a technically demanding procedure due to the region’s complex vascular anatomy and limited colonic mobility. The orientation of the colonic anastomosis-either isoperistaltic or anisoperistaltic-represents a critical yet understudied technical factor that may influence operative complexity and postoperative recovery. This study aimed to compare short-term outcomes between these two anastomotic configurations.

METHODS: We conducted a retrospective cohort study at a tertiary colorectal center, including consecutive patients who underwent elective SFR for colon cancer between January 2023 and December 2024 (n = 53). Patients were stratified according to the orientation of the side-to-side anastomosis: isoperistaltic (ISO, n = 32) or anisoperistaltic (ANISO, n = 21). Demographic, oncologic, surgical, and postoperative variables were analyzed. Primary endpoints were operative time, gastrointestinal recovery (time to first flatus and first stool), and length of hospital stay. Secondary endpoints included estimated blood loss, conversion rate, 30-day complications, inflammatory markers, analgesic use, costs, and quality of life assessed using the Gastrointestinal Quality of Life Index (GIQLI).

RESULTS: Baseline demographics were largely comparable between groups, although patients in the ANISO group were significantly older (71.4 ± 6.0 vs. 67.8 ± 4.4 years; p = 0.023) and had a slightly lower body mass index (BMI) (25.4 ± 1.4 vs. 26.5 ± 2.3 kg/m²; p = 0.049). Operative time was significantly shorter in the ANISO group (126.5 ± 13.8 vs. 154.8 ± 23.4 minutes; p < 0.001). Gastrointestinal recovery was faster following anisoperistaltic anastomosis, with earlier first flatus (31.7 ± 8.7 vs. 39.3 ± 10.2 hours; p = 0.005), while time to first stool did not differ significantly (51.2 ± 12.5 vs. 55.8 ± 9.0 hours; p = 0.159). Length of hospital stay was comparable (5.2 ± 0.8 vs. 5.6 ± 1.3 days; p = 0.172). Estimated blood loss was significantly lower in the ANISO group (34.6 ± 17.0 vs. 47.6 ± 13.6 mL; p = 0.006). Conversion rate and postoperative complications were comparable between groups (p = 1.000 and p = 0.743 respectively). No differences were observed in inflammatory markers, analgesic use, or costs. GIQLI scores at 30 days were similar between groups (126.9 ± 11.0 vs. 123.0 ± 8.1; p = 0.166).

CONCLUSIONS: Anisoperistaltic anastomosis following splenic flexure resection is safe and effective and is associated with shorter operative time and faster postoperative gastrointestinal recovery without compromising short-term outcomes. The choice of anastomotic orientation may be influenced by intraoperative anatomical conditions and technical factors.

PMID:42304157 | DOI:10.62713/aic.4318