Tag: pubmed

BMC Musculoskelet Disord. 2026 May 1. doi: 10.1186/s12891-026-09873-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic low back pain (CLBP) is a leading cause of disability worldwide. Physiotherapy is a common treatment, but its effect on physical functioning is generally modest, particularly for patients with severe complaints (i.e., high levels of disability and pain). Virtual Reality (VR) may complement physiotherapy, yet evidence for its effectiveness remains limited. The aim of this study was to assess the effectiveness and feasibility of a VR intervention integrated within physiotherapy for people with severe CLBP.

METHODS: A cluster-RCT across Dutch physiotherapy practices was conducted. Patients in the control group received 12 weeks of usual care following physiotherapy guidelines. Patients in the intervention group received similar usual care, enhanced with integrated, home-based VR consisting of pain education, exercise therapy, and relaxation modules. The primary outcome was physical functioning at three months. Secondary outcomes included feasibility, pain intensity, and catastrophizing. Analyses were conducted using linear mixed-effect models accounting for clustering by physiotherapy practice.

RESULTS: Twenty-five patients participated in the intervention group and seven in the VARIETY control group, instead of the planned sample size of 120 participants. Due to poor recruitment (n = 7), we supplemented the VARIETY control group with 18 historical controls from two comparable trials (total control n = 25), effectiveness analyses are therefore exploratory. Between-group differences were neither statistically significant nor clinically relevant for all outcome measures, compared to the VARIETY control group (e.g., ODI mean difference at three months: -4.80, 95%CI: -17.78;8.18), or the total control group (-8.80, 95%CI: -20.17;2.57). The intervention group showed greater improvements from baseline in physical functioning (42%), compared to the VARIETY control group (26%). The intervention was considered feasible and safe to use in practice.

DISCUSSION: This study found limited support for the use of VR as an adjunct to physiotherapy for people with severe CLBP. Given the use of external control data and the limited sample size, the effectiveness results should be interpreted cautiously. Further well-powered trials should reconsider study procedures to optimize patient recruitment and corroborate VR’s clinical effectiveness in physiotherapy.

TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov on 2022-12-02 (reference number: NCT05701891).

PMID:42067884 | DOI:10.1186/s12891-026-09873-z

BMC Oral Health. 2026 May 1. doi: 10.1186/s12903-026-08497-y. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the effects of post-polymerization protocols with and without glycerin on surface roughness, microhardness, and color change of permanent restorative resins fabricated using stereolithography (SLA) and digital light processing (DLP) technologies under different storage media.

MATERIALS AND METHODS: In this in vitro study, a total of 128 permanent restorative resin specimens fabricated using SLA (Permanent Crown, Formlabs) and DLP (Crowntec, Saremco) technologies were evaluated. The specimens were divided into post-polymerization protocols with and without glycerin. Finishing and polishing procedures were performed using a standardized diamond polishing system. Surface roughness (Ra, Sa) was measured using a confocal microscope, microhardness was assessed by the Vickers hardness test (VHN), and color change was evaluated using the CIEDE2000 (ΔE₀₀) method. The specimens were stored in distilled water, tea, coffee, and cola, and measurements were repeated at baseline and after 7 and 30 days.

RESULTS: No statistically significant difference in surface roughness was observed between post-polymerization protocols with and without glycerin. In contrast, specimens post-polymerized with glycerin exhibited significantly higher microhardness values for both fabrication techniques. With respect to color change, lower ΔE₀₀ values were observed in the glycerin-treated groups, particularly in the coffee storage medium.

CONCLUSIONS: Post-polymerization with glycerin increased microhardness without adversely affecting surface roughness and supported color stability under specific staining storage media.

CLINICAL RELEVANCE: In permanent restorative resins fabricated by 3D printing, post-polymerization with glycerin can be considered a complementary protocol that is easily applicable in clinical practice and may positively support the color stability and microhardness of restorations.

PMID:42067883 | DOI:10.1186/s12903-026-08497-y

Arthritis Res Ther. 2026 May 1. doi: 10.1186/s13075-026-03821-x. Online ahead of print.

ABSTRACT

INTRODUCTION: The 6-minute walk distance (6MWD) is commonly used to assess functional capacity in patients with systemic sclerosis (SSc), but its ability to reflect changes in cardiopulmonary status during follow-up remains uncertain. This study aimed to investigate whether variations in the 6MWD accurately mirror changes in organ involvement over time in SSc patients.

METHODS: We conducted a longitudinal study on a global cohort of 227 consecutive SSc patients, including a subgroup of 88 patients with ILD or PH, over a two-year follow-up period. Statistical analyses were performed to assess associations between variations (Δ) of 6MWD (Δ6MWD) and evolution of organ involvement.

RESULTS: The 6MWD varied only mildly during follow-up (mean Δ6MWD – 11.6 ± 67.5 m), including in patients with ILD or PH (mean Δ6MWD – 16 ± 74 m). Significant associations were noted between Δ6MWD and variations of several SSc parameters, mostly with modifications in functional status (changes in ΔBorg (ΔΔBorg) score, p = 0.002; ΔNYHA, p < 10^{– 3}), PH parameters (Δright atrial area, p = 0.045; persistently elevated Nt-pro-BNP levels, p < 10^{– 3}), chronotropic function (ΔΔheart rate, p = 0.015; Δinitial heart rate, p = 0.024), musculoskeletal involvement (occurrence of joint symptoms, p = 0.006) and perceived quality of life (ΔHAQ-DI score, p = 0.023). In most cases, the strength of these associations was mild to moderate (R² = 0.53, adjusted R² = 0.36 in multivariate analysis), suggesting the influence of additional factors to explain the majority of Δ6MWD.

CONCLUSION: While it remains valuable as a marker of disability and functioning, the variation in the 6MWD does not seem to be a robust surrogate for modifications in organ involvements of SSc patients.

PMID:42067881 | DOI:10.1186/s13075-026-03821-x

BMC Public Health. 2026 May 1. doi: 10.1186/s12889-026-27571-2. Online ahead of print.

ABSTRACT

BACKGROUND: Online antenatal education is increasingly used to improve maternal psychological outcomes and preparedness for childbirth. However, evidence regarding its effectiveness remains inconsistent, particularly due to heterogeneity in intervention types and outcome measures.

METHODS: This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, EMBASE, Scopus, Web of Science, CINAHL, and the Cochrane Library were searched from inception to March 2026. Randomized controlled trials and observational studies evaluating digital antenatal interventions in pregnant women were included. Outcomes included maternal depression, anxiety, fear of childbirth, self-efficacy, and small-for-gestational-age (SGA) incidence. Random-effects models were used, and standardized mean differences (SMDs) and odds ratios (ORs) were calculated. Heterogeneity was assessed using I² statistics.

RESULTS: Twelve studies involving 4,982 participants were included. No significant effects were observed for depression (SMD = – 0.18; 95% CI: -0.45 to 0.09; I² = 86.5%; p = 0.188), anxiety (SMD = – 0.10; 95% CI: -0.66 to 0.46; I² = 92.8%; p = 0.723), or self-efficacy (SMD = 0.56; 95% CI: -0.11 to 1.23; I² = 90.6%; p = 0.102). A reduction in fear of childbirth did not reach statistical significance (SMD = – 0.53; 95% CI: -1.06 to 0.003; p = 0.051. No significant association was found for SGA (OR = 0.73; 95% CI: 0.17-3.14; p = 0.670). Substantial heterogeneity was present across outcomes, limiting the interpretability of pooled estimates.

CONCLUSION: Current evidence, characterized by substantial heterogeneity, does not demonstrate statistically significant effects of online-based antenatal education on maternal depression, anxiety, or fear, nor on improving self-efficacy or preventing SGA infants. However, the high heterogeneity (I² >85% for most outcomes) indicates that these pooled estimates are exploratory, and clinically meaningful effects for specific intervention types cannot be ruled out. Findings should be interpreted cautiously.

PMID:42067880 | DOI:10.1186/s12889-026-27571-2

BMC Med Educ. 2026 May 1. doi: 10.1186/s12909-026-09359-5. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple Choice Questions (MCQs) remain the most widely used written assessment format in health professions education due to their efficiency and reliability; however, their susceptibility to cueing raises concerns regarding their authenticity in assessing true knowledge. Very Short Answer Questions (VSAQs) have emerged as a promising alternative that reduces cueing effects and requires learners to generate responses with greater cognitive engagement, while retaining the logistical advantages of computer-marked assessments. This systematic review and meta-analysis evaluates the comparative performance, discrimination, reliability, and practice effects of VSAQs versus MCQs.

METHODS: Following PRISMA guidelines (31), a systematic search identified studies comparing VSAQs and MCQs in undergraduate and postgraduate health professions education. Data extraction and risk of bias assessment were conducted independently by two reviewers, with disagreements resolved through consensus. Mean scores, standard deviations, discrimination indices, and reliability coefficients were extracted. Standardized Mean Differences (SMD) were pooled using a random-effects model. Psychometric indices were transformed using Fisher’s z-scores. Heterogeneity was quantified using the I² statistic, and sensitivity and subgroup analyses were performed to explore the impact of outliers.

RESULTS: Six cohorts (n = 1,191) derived from three included studies contributed data for score comparisons. The initial pooled analysis showed no significant difference between VSAQs and MCQs (SMD = – 0.52; 95% CI – 1.34 to 0.30), with extreme heterogeneity (I² = 98%). Sensitivity analysis identified Dhok et al. (2023) as an outlier. Excluding this dataset yielded a significant effect favoring MCQs (SMD = – 0.86; 95% CI – 1.01 to – 0.70; p < 0.00001) with markedly reduced heterogeneity (I² = 4%). Meta-analysis of psychometric properties demonstrated strong discrimination (pooled Fisher’s z = 1.45) and acceptable reliability (pooled Fisher’s z = 0.43) for VSAQs. Evidence on practice effects was mixed, with no consistent advantage for either format.

CONCLUSION: VSAQs exhibit strong psychometric integrity and are designed to reduce the cueing effect observed in MCQs. Although associated with lower student scores, VSAQs likely provide a more accurate reflection of independent knowledge and clinical reasoning ability. Their integration into medical assessment systems may enhance the authenticity and validity of written examinations.

PMID:42067879 | DOI:10.1186/s12909-026-09359-5

Epilepsy Behav. 2026 Apr 30;181:111074. doi: 10.1016/j.yebeh.2026.111074. Online ahead of print.

ABSTRACT

We aimed to assess differences in auditory deviance detection and the underlying sources’ effective connectivity between participants with juvenile myoclonic epilepsy (JME) (N = 60) and healthy controls (N = 39). 256-channel EEG data were recorded during an auditory roving oddball paradigm. Dynamic causal modeling (DCM) was used to estimate effective connectivity between brain regions involved in generation of auditory mismatch negativity (MMN) and P3a component of event-related potentials (ERPs). Between-group statistics were used to compare the MMN and P3a amplitudes. DCM and Parametric Empirical Bayes (PEB) were used to model experimental perturbations in cortical connectivity and assess between-group differences. Hypothesis-driven correlation tests between the sensor space MMN and P3a amplitudes, as well as DCM connectivity estimates, with heavy executive function load cognitive tests were also evaluated. MMN and P3a amplitudes were significantly smaller in the JME patients group compared to controls. DCM and PEB analyses revealed group-level differences in cortical connectivity as the result of experimental effects (i.e., differential response to the deviant stimuli in relation to the standard ones): (1) Significantly reduced extrinsic connectivity for JME participants versus controls between right superior temporal gyrus (r-STG) and right inferior frontal gyrus (r-IFG), as well as (2) Increase in intrinsic (within a region) excitability in left STG. Weak-to-moderate associations were found between the electrophysiological variables under study and neuropsychological tests of executive function. Reduced auditory deviance detection, as well as a decreased right-sided feedforward connectivity in our JME cohort, correlated with cognitive test performance. These findings reflect aberrant neurophysiology underlying JME warranting potential interventions.

PMID:42066395 | DOI:10.1016/j.yebeh.2026.111074

Epilepsy Behav. 2026 Apr 30;181:111065. doi: 10.1016/j.yebeh.2026.111065. Online ahead of print.

ABSTRACT

The primary aim of this systematic review and meta-analysis is to evaluate the impact of educational programs for children with epilepsy and/or their parents on disease management. A comprehensive literature search was performed across eight electronic databases from inception to January 20, 2026, to identify studies evaluating educational interventions for children with epilepsy and/or their parents or caregivers. Following screening and eligibility assessment, ten studies were included in the final systematic review and meta-analysis. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers using standardized tools. Meta-analyses were conducted using RevMan software, applying fixed- or random-effects models based on heterogeneity, and the certainty of evidence was assessed using the GRADE approach. This meta-analysis included ten randomized controlled trials evaluating educational programs for children with epilepsy and/or their parents. In the analysis of seizure frequency, educational programs showed an effect in reducing the likelihood of seizures, but the result was not statistically significant (OR = 0.62; 95% CI: 0.37-1.03; p = 0.07; I² = 0%). Educational programs significantly improved parental quality of life (SMD = 0.71; 95% CI: 0.15-1.27; p = 0.01; I² = 69%). Strong trends were found towards decreased parental anxiety (SMD = – 0.82; 95% CI: -1.68-0.04; p = 0.06; I² = 93%) and increased self-efficacy (SMD = 2.63; 95% CI: -0.18-5.44; p = 0.07; I² = 98%), but these findings did not reach statistical significance. Knowledge level regarding epilepsy significantly increased with educational programs (SMD = 1.29; 95% CI: 0.56-2.02; p = 0.0005; I² = 87%). Epilepsy management significantly improved with educational programs (MD = 0.48; 95% CI: 0.21-0.76; p = 0.0005; I² = 0%). This meta-analysis demonstrates consistent and significant benefits of educational programs on epilepsy management, knowledge level, and parental quality of life. While the effects on seizure frequency, parental anxiety, and self-efficacy were not statistically conclusive, the observed effect trends point to clinically positive potential. It supports the inclusion of education-based interventions as a complementary and empowering component in epilepsy care.

PMID:42066394 | DOI:10.1016/j.yebeh.2026.111065

Comput Biol Chem. 2026 Apr 22;124(Pt 1):109086. doi: 10.1016/j.compbiolchem.2026.109086. Online ahead of print.

ABSTRACT

Non-small cell lung cancer (NSCLC) contains rare cancer stem cells (CSCs) that contribute to relapse and drug resistance. Bulk RNA-seq overlooks these cells due to its averaging of expression across all cell types, whereas standard single-cell RNA-seq (scRNA-seq) analyses often struggle to reliably identify these rare CSC states. To address this, we developed an scRNA-seq pipeline that integrates machine learning with explainable AI (XAI) to detect CSC-like epithelial cells in NSCLC (GSE198099, n = 2 patients; analyses supported by effect size-based validation despite limited statistical power). Patient-derived scRNA-seq profiles underwent quality control and batch correction using scVI, and annotated using CellTypist. A 45-gene stemness score was used to identify candidate CSC-like states. Four machine learning models (Logistic Regression, LightGBM, XGBoost, and CatBoost) were trained to refine the CSC-like state identification. SHAP-based feature attribution analyses converged on six key biomarkers: DLL1, ITGA6, ATXN2, NOTCH1, DCLK1, and PUM1. These biomarkers are involved in regulating transcription, adhesion, cytoskeletal dynamics, and post-transcriptional control. Pathway analysis and validation using TCGA validation data provided supportive evidence for the biological relevance of these biomarkers. This framework provides a methodologically reproducible approach to reveal rare CSC-like states with improved mechanistic clarity, providing candidate biomarkers for studying NSCLC tumor plasticity.

PMID:42066389 | DOI:10.1016/j.compbiolchem.2026.109086

Neurosurg Focus. 2026 May 1;60(5):E8. doi: 10.3171/2025.12.FOCUS25941.

ABSTRACT

OBJECTIVE: Surgical intervention is a standard treatment for severe cervical spondylotic myelopathy (CSM), but postoperative outcomes can vary based on socioeconomic characteristics such as insurance status. The aim of this study was to investigate the influence of insurance on patient-reported outcomes (PROs) at 60 months postoperatively.

METHODS: In this prospective cohort study, the Spine CORe™ study group analyzed data from the Quality Outcomes Database (QOD) database. Chi-square and Kruskal-Wallis tests were performed to identify the associations between sociodemographic and clinical variables and insurance type. The chi-square test was also used to examine the influence of insurance type on the achievement of minimal clinically important difference (MCID) for each outcome measure. Statistically significant covariates (p < 0.001) were used in a multivariate linear regression model measuring the influence of insurance type on 60-month changes in scores for neck and arm pain numeric rating scale (NRS), Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scores.

RESULTS: From a dataset of 1085 patients who underwent CSM surgery, 106 patients died during the 5-year follow-up period and 793 had an NDI score at the 5-year follow-up. The follow-up rate was 83% ([793 with NDI + 106 died]/1085 patients). Of the 1085 patients, the authors excluded patients with Veterans Affairs insurance, no insurance, or who were missing baseline PROs, which left 1030 patients with Medicare (n = 408), Medicaid (n = 75), and private (n = 547) insurance with 60-month PROs. Insurance status varied based on demographics and medical comorbidities (each p < 0.05). Medicaid patients had significantly worse scores at baseline and 60 months for arm and neck NRS, NDI, EQ-5D, and mJOA (each p < 0.05). In multivariate analysis after adjustment for relevant covariates, compared with private insurance, only Medicare insurance was associated with lower 60-month EQ-5D scores (β -0.05, 95% CI -0.09 to -0.01; p < 0.05). Otherwise, there was no significant difference in PROs. Medicaid insurance was not significantly associated with differences in any of the outcomes after covariate adjustment compared to private insurance.

CONCLUSIONS: Despite having worse baseline scores, patients with Medicaid insurance coverage had similar rates of achievement of MCID compared with those with private insurance. These results suggest that patients with CSM who underwent surgery had improvement in PROs for all insurance types.

PMID:42066370 | DOI:10.3171/2025.12.FOCUS25941

J Neurosurg. 2026 May 1:1-11. doi: 10.3171/2025.12.JNS251528. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical procedures involving varying tissue depths present challenges to surgeons regarding accessibility and precision, restricting instrument movement and increasing the risk of tissue injury. Understanding how experts navigate varying depths is essential, yet research on this issue is limited. Artificial intelligence (AI)-powered systems enable real-time analysis of 3D psychomotor performance during virtual reality simulation tasks. In this study, the authors evaluated performance in a complex brain tumor resection simulation, testing two hypotheses: 1) neurosurgeons’ performance scores would remain at an expert level across varying depths, and 2) trainees’ scores would decline as they navigated into deeper and more challenging areas.

METHODS: Participants included neurosurgeons (n = 14), senior trainees (n = 14), junior trainees (n = 10), and medical students (n = 12). Five left-handed participants were excluded to avoid confounding due to hand dominance, resulting in a final analyzed sample of 45 participants. The Intelligent Continuous Expertise Monitoring System, an AI-powered real-time performance assessment system, assessed surgical performance and measured metrics such as instrument tip separation distance, bleeding risk, healthy tissue injury risk, aspirator force applied, bipolar cautery force applied, and an overall composite score. An average score for each metric at each depth interval (0-15 mm) was calculated across expertise levels for statistical comparison in a retrospective single-center analysis.

RESULTS: Neurosurgeons maintained their performance score across varying depths, demonstrating their expertise. Senior trainees had lower scores with increased depth. Surprisingly, increased depth resulted in higher composite scores among medical students and junior trainees, as they had to adapt better instrument techniques in deeper surgical sites. However, their scores remained in the novice spectrum. There was an increasing trend in bleeding risk with greater depth regardless of the expertise level, indicating the more challenging nature of deeper sites.

CONCLUSIONS: The unique responses observed at varying depths at each expertise level indicate the necessity for adaptive training modules that accommodate trainee skill set levels and individual learning curves, ensuring development of the competencies required for mastering challenging tasks.

PMID:42066367 | DOI:10.3171/2025.12.JNS251528