Tag: pubmed

Cutan Ocul Toxicol. 2026 Jun 3:1-6. doi: 10.1080/15569527.2026.2680300. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly used for the dissemination of health-related information. However, data regarding the accuracy and adequacy with which they present information on the safety, contraindications, and adverse effects of botulinum toxin (BoNT) applications remain limited.

METHODS: In this study, the performance of the ChatGPT-5 mini (OpenAI), DeepSeek-V3.2, and Gemini 3 Flash LLMs in presenting safety and risk-related information on BoNT applications was comparatively evaluated using 10 categorized and structured questions. Responses were independently scored by three dermatologists using a predefined four-point evaluation scale.

RESULTS: ChatGPT-5 mini (OpenAI) and DeepSeek-V3.2 achieved higher and more consistent scores in the domains of general safety, contraindications, and adverse effects. In contrast, the Gemini 3 Flash model demonstrated lower performance, particularly in patient safety-critical areas such as systemic spread and toxicity, as well as drug interactions. A statistically significant difference was observed in the distribution of response quality among the models (p < 0.05).

CONCLUSION: The findings suggest that the level at which LLMs present information related to BoNT applications may vary. Therefore, these tools should be considered supportive aids under physician supervision rather than independent sources of clinical decision-making.

PMID:42235011 | DOI:10.1080/15569527.2026.2680300

Neuroradiol J. 2026 Jun 3:19714009261456600. doi: 10.1177/19714009261456600. Online ahead of print.

ABSTRACT

BackgroundArterial calcification is commonly found in patients with cerebrovascular disease and may negatively affect outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). This systematic review and meta-analysis aimed to evaluate the impact of intracranial or aortic arch calcification on procedural success and functional outcomes in AIS patients undergoing anterior circulation EVT.MethodsWe systematically searched the PubMed, EMBASE, and Cochrane databases to identify studies comparing EVT outcomes between AIS patients with and without arterial calcification. Outcomes assessed included first-pass effect (FPE), successful reperfusion at the end of the procedure, modified Rankin scale (mRS), mortality, and symptomatic intracerebral hemorrhage (sICH). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random effects models, with heterogeneity evaluated with I² statistics.ResultsA total of six observational studies were included, with a total of 3834 patients (2303 with calcification and 1531 controls). Arterial calcification was associated with a lower chance of achieving FPE (RR: 0.50, 95% CI: 0.36-0.69, p < 0.001) and successful reperfusion (RR: 0.90, 95% CI: 0.86-0.94, p < 0.001). Patients with calcification had a greater risk of poor outcome (mRS 3-6) (RR: 1.29, 95% CI: 1.16-1.43, p < 0.001), mortality (RR: 1.51, 95% CI: 1.14-2.00, p < 0.001), and sICH (RR: 1.29, 95% CI: 1.16-1.43, p < 0.001). Heterogeneity was low, with I² ≤ 34%.ConclusionArterial calcification may be indicative of advanced vascular disease, potentially leading to diminished technical success and worse functional outcomes following EVT for AIS. These findings underscore that vascular calcification acts as an associative marker of procedural complexity and advanced vascular disease in EVT candidates.

PMID:42234997 | DOI:10.1177/19714009261456600

Aging Dis. 2026 Jun 2. doi: 10.14336/AD.2025.1653. Online ahead of print.

ABSTRACT

While chronological age is an important risk factor for osteoporosis, biological aging measures may better capture nuances in systemic and bone-tissue aging among same-age individuals. This review aims to summarize the associations between DNA methylation/telomere dysfunction (mainly telomere shortening) and bone health. We searched for human epidemiological studies that examined the associations between blood-based epigenetic aging clocks or leukocyte telomere length (LTL) and osteoporosis-related outcomes on PubMed and Embase. Five epigenetic aging-related studies and 14 LTL-related studies were eventually included, from which data on study design, population, bone health-related outcomes, and statistically significant effect estimates were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. Findings were summarized narratively due to heterogeneity in study design, biomarkers, and outcome definitions. This review concludes that while laboratory-based studies often provide evidence of aging biomarkers’ association with bone outcomes, population-level epidemiological studies provide inconclusive evidence, highlighting limited studies on epigenetic aging clocks and bone health, and inconsistent findings regarding the association between LTL and bone health. Challenges many of the human studies faced include small sample sizes, inadequate study designs, non-diverse cohorts, and heterogeneity in epigenetic clock selection and/or bone health outcomes. Future research should focus on conducting prospective studies with larger, independent cohort sizes and comprehensive adjustment for intervening factors to paint a clearer picture of the biological aging markers’ associations with osteoporosis and provide guidance on their potential clinical relevance in bone health.

PMID:42234964 | DOI:10.14336/AD.2025.1653

Neurology. 2026 Jul 14;107(1):e218053. doi: 10.1212/WNL.0000000000218053. Epub 2026 Jun 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Rural residence is linked to poor access to neurologists and specialized epilepsy centers, yet its impact on clinical epilepsy outcomes remains unclear. To address this knowledge gap, we assessed the association between rurality and epilepsy outcomes in a nationally representative cohort in the United States.

METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (2016-2021), including patients with a primary diagnosis of epilepsy and recurrent seizures. The primary exposure was patient rurality, defined using the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Logistic regression models were used to study the effect of rurality on in-hospital mortality, presenting in status epilepticus, prolonged length of stay, nonroutine discharge, and receipt of EEG. Models were adjusted for demographic, socioeconomic, and hospital-related characteristics and Elixhauser comorbidities. Subanalyses examined patients presenting in status epilepticus, those with private insurance, and those admitted to urban teaching hospitals.

RESULTS: A total of 841,445 epilepsy admissions were included (median age 56 years, 47.2% female). After adjusting for covariates, patients from the most rural counties experienced significantly higher odds of in-hospital mortality (odds ratio [OR] 1.93 [95% CI 1.56-2.39], p < 0.001), presenting in status epilepticus (OR 1.32 [95% CI 1.24-1.41], p < 0.001), and prolonged length of stay (OR 1.29 [95% CI 1.19-1.41], p < 0.001), relative to patients from the most urban counties. The most rural patients also experienced lower odds of receiving EEG (OR 0.88 [95% CI 0.77-1.00], p = 0.047) and nonroutine discharge (OR 0.90 [95% CI 0.85-0.96], p = 0.001). When subanalyzing only patients with private insurance, the associations between rurality and mortality, presenting in status epilepticus, and prolonged length of stay were no longer observed.

DISCUSSION: Increasing rurality was associated with markedly worse epilepsy outcomes, including nearly double the odds of in-hospital mortality. The attenuation of these disparities among privately insured patients suggests that modifiable structural barriers drive rural-urban disparities, rather than geography alone. Inherent to observational studies, residual confounding and limited clinical granularity remain important considerations. These findings underscore the urgent need for targeted public health interventions to improve outcomes for rural epilepsy populations.

PMID:42234954 | DOI:10.1212/WNL.0000000000218053

Blood Adv. 2026 Jun 3:bloodadvances.2026019765. doi: 10.1182/bloodadvances.2026019765. Online ahead of print.

ABSTRACT

Children and adolescents with early-stage nodular lymphocyte-predominant Hodgkin lymphoma (nLPHL) have a 5-year event-free survival (EFS) of about 77% after complete lymph node resection and around 89% with anthracycline-containing chemotherapy. We investigated whether patients with early-stage nLPHL can be successfully treated with surgical resection alone or with low-intensity, anthracycline-free CVP chemotherapy for those with unresectable nodal disease. EuroNet-PHL-LP1 was a prospective phase III trial enrolling patients under 18 years with stage IA/IIA nLPHL. Completely resected lymph nodes led to active surveillance. Patients with unresectable disease received three cycles of CVP (cyclophosphamide, vinblastine, prednisone). In CVP-cohort-1, treatment cessation required a negative 18F -FDG-PET. An amendment in 2014 omitted PET for end-of-treatment response; CT and/or MRI alone defined response in CVP-cohort-2. The primary endpoint was 5-year EFS, with death, relapse, second malignancy and PET-positivity counting as events; for CVP-cohort-2, progression-free survival (PFS) was primary. Among 267 registered patients (2009-2018), 247 were evaluable. Seventy-eight underwent resection only; their 5-year EFS/PFS was 79.5%. Six of 18 patients who relapsed after surgical resection re-entered the CVP arm. In CVP-cohort-1, 51/82 (62%) achieved a complete metabolic response (CMR). 5-year EFS was 56.4%, while 5-year PFS in the CMR group was 91.3%. In contrast, PFS in 84 CVP-cohort-2 patients was 64.7%. During CVP, 68.3% of patients experienced grade 3-4 neutropenia. No treatment-related deaths were reported. Excellent outcomes were achieved after complete resection and with low-intensive, anthracycline-free chemotherapy if 18F-FDG-PET showed CMR after chemotherapy. This strategy now constitutes the EuroNet-PHL standard of care for early-stage nLPHL. The trial was registered under EudraCT-No.: 2007-004092-19.

PMID:42234940 | DOI:10.1182/bloodadvances.2026019765

J Clin Oncol. 2026 Jun 3:JCO2501896. doi: 10.1200/JCO-25-01896. Online ahead of print.

NO ABSTRACT

PMID:42234933 | DOI:10.1200/JCO-25-01896

Blood Adv. 2026 Jun 3:bloodadvances.2025019356. doi: 10.1182/bloodadvances.2025019356. Online ahead of print.

ABSTRACT

We report outcomes of the phase 2 study combining carfilzomib (CFZ) plus vincristine, dexamethasone, asparaginase, and daunorubicin (CFZ-VXLD) in heavily pre-treated, pediatric patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL). We investigated whether post-induction complete remission (CR) rates after CFZ-VXLD induction are superior to an external real-world control (EC). Patients aged ≥1 month to <21 years with R/R ALL received CFZ-VXLD induction, followed by optional consolidation (experimental arm). EC arm included similar patients receiving real-world, curative-intent regimens at Therapeutic Advances in Childhood Leukemia sites between 2000-2023. Primary endpoint was CR after induction; overall response rate (ORR; CR/CR with partial/incomplete hematologic recovery/CR without platelet recovery) was a secondary endpoint. Comparative analyses used inverse probability of treatment weighting. Experimental and EC arms included 105 and 140 patients, respectively. CR rates after induction were 14.8% vs 7.8% (odds ratio [OR] 2.04; 95% CI, 0.54-7.66) in patients with B-ALL and 13.6% vs 9.1% (OR 1.58; 95% CI, 0.47-5.31) in patients with T-ALL. There was no statistically significant increase in post-induction CR for the CFZ-VXLD arm vs the EC arm and the study did not meet its primary endpoint. In patients with B-ALL, ORR was 42.6% vs 26.3% favoring the CFZ-VXLD arm vs the EC arm. Adverse event rates with CFZ were consistent with previous reports. Taken together, the CFZ-VXLD regimen may be an option for some selected pediatric patients with R/R ALL and this study highlights that novel treatments for R/R ALL remain an area of unmet medical need. NCT02303821.

PMID:42234929 | DOI:10.1182/bloodadvances.2025019356

JMIR Serious Games. 2026 Jun 3;14:e79784. doi: 10.2196/79784.

ABSTRACT

BACKGROUND: Cognitive impulsivity is a multifaceted construct associated with symptom severity, functional impairment, and poor quality of life in eating disorders (EDs) and mental ill-health. However, objective assessment of cognitive impulsivity is piecemeal and complex, with many assessment tools lacking psychometric evaluation and ecological validity. Furthermore, validated assessment tools are rarely perceived to be engaging or meaningful by individuals who complete them, limiting their utility in research and forming a barrier to clinical translation. Thus, although cognitive impulsivity predicts treatment engagement and outcomes, it is rarely assessed or addressed in a clinical context.

OBJECTIVE: We aimed to redesign and evaluate the Cognitive Impulsivity Suite (CIS), a validated gamified assessment battery of cognitive impulsivity, through user-centered co-design, agile game development, and user-centered evaluation. This collaborative study partnered researchers with individuals with lived experiences (LEs) of EDs and commonly co-occurring mental ill-health, and game development experts.

METHODS: In a sequential mixed methods design, we first defined user requirements through inductive thematic analysis of data from 2 focus groups incorporating 7 individuals with LE of EDs and commonly co-occurring mental health conditions (mean age 27.6, SD 7.03 y; 4 women, 2 men, 1 nonbinary), researchers, clinicians, and technology professionals. Agile game development was achieved through 6-week-long sprints, involving game developers and a play-testing team of researchers. During LE evaluation, we collected and analyzed data from an expanded sample (n=18; mean age 30.5, SD 6.56 y; 12 women, 3 men, 2 nonbinary), using a pragmatic blending of qualitative and quantitative research methods. This included inductive and deductive thematic analysis of “thinking aloud” data, descriptive statistics, and ANOVA tests of the Game User Experience Satisfaction Scale, short version (GUESS-18) surveys.

RESULTS: We co-designed guiding principles and ideas for aesthetics, story concepts, and gameplay features, which closely aligned with leading theories of psychological well-being, clinical evidence concerning ED recovery, and gamification frameworks. Qualitative evaluations of the new tool, CIS Papillon Park, showed user engagement and motivation were driven by opportunities for autonomy, personal accomplishment, and simulated interpersonal relationships, aligning with approaches to gamification based on self-determination theory. In quantitative evaluation, a mean GUESS-18 composite score of 45.9 (SD 9.85) showed CIS Papillon Park achieved sound overall user satisfaction, with subscale scores revealing strengths in usability, narrative, visual and audio aesthetics, and personal gratification.

CONCLUSIONS: The contributions of this study are grounded in its integration of user-centered co-design and evaluation, agile game development, and theory-driven approaches to cognitive assessment and gamification, to redesign and evaluate a validated online task battery. The resulting CIS Papillon Park combines appealing aesthetics, gamification elements that address cognitive, emotional, and social needs, and accessible playing experiences, which maximized user satisfaction and engagement while prioritizing psychological safety. Next steps involve psychometric evaluation and dissemination.

PMID:42234926 | DOI:10.2196/79784

Iran J Kidney Dis. 2026 May 31;20(3):138-148. doi: 10.61882/ijkd.3.03.9536.

ABSTRACT

INTRODUCTION: In studies involving hemodialysis patients, repeated laboratory measurements (longitudinal data) and survival outcomes are often analyzed separately, which can lead to biased results due to ignoring measurement errors and the intrinsic dependency between the two analyses. Joint modeling has emerged as a powerful approach to handle such data. This study aims to investigate the impact of six time-varying biochemical markers, along with baseline covariates, on the survival of hemodialysis patients using a multivariate joint model.

METHODS: A longitudinal cohort of 894 maintenance hemodialysis (MHD) patients, who had started dialysis between 2004 and 2023, were included. Baseline and follow-up clinical information and monthly laboratory measurements were analyzed. A multivariate linear mixed-effects model was jointly fitted with a Cox proportional hazards model to simultaneously assess the longitudinal biomarkers and time-to-event data. Analyses were performed using R software.

RESULTS: The model indicated that older age (Hazard Ratio, HR = 1.02, P < .001), male gender (HR = 1.72, P < .001), diabetes mellitus (HR = 1.61, P < .001), walking disability at admission (HR = 1.78, P < .001), and catheter-based vascular access (HR = 1.71, P < .001) were significantly associated with an increased risk of mortality. Higher square root of phosphate levels (HR = 13.97, P < .001) were linked to increased, and higher square root of creatinine (HR = 0.32, P < .001), hemoglobin (HR = 0.75, P = .009) and albumin (HR = 0.31, P < .001) levels were associated with decreased mortality.

CONCLUSION: Findings of the joint model confirm the importance of baseline clinical risk factors and modifiable biochemical markers on the survival outcomes of hemodialysis patients.

PMID:42234920 | DOI:10.61882/ijkd.3.03.9536

Iran J Kidney Dis. 2026 May 31;20(3):131-137. doi: 10.61882/ijkd.3.03.9421.

ABSTRACT

INTRODUCTION: Kidney transplantation significantly improves survival and quality of life in End-Stage Kidney Disease (ESKD). However, kidney transplant recipients (KTRs) are prone to complications leading to hospitalization. Data on hospitalization etiologies among Iranian KTRs remain limited.

METHODS: This cross-sectional study included all KTRs hospitalized in the two centers with kidney transplant department in Isfahan between March 2023 and March 2024. Demographic, clinical, and laboratory data were collected from medical records. Etiologies of admission were classified, and descriptive and analytical statistics were calculated using SPSS, version 22.

RESULTS: A total of 408 patients (60.7% male, mean age 45.6 ± 15.2 years) were included. The most frequent comorbidities were diabetes mellitus (DM) (27.2%) and hypertension (HTN) (22.2%). Most patients (42.5%) had undergone transplantation for more than 10 years. The leading causes of admission were constitutional symptoms including fever, myalgia, and fatigue in 165 (40.4%), azotemia in 55 (13.5%), dysuria in 23 (5.6%) and limb edema in 21 (5.1%) patients. The main final diagnosis in hospitalized KTRs were infections (42.5%) and acute kidney injury (AKI)/AKI superimposed on chronic kidney disease (CKD) (15.6%). Laboratory findings revealed a mean serum creatinine of 2.58 ± 2.16 mg/dL, with 50% above 1.7 mg/dL. Anemia (Hb < 10 g/dL) was present in 43.7% of cases. Urinalysis showed hematuria in 50.3% and pyuria in 64.2% of patients. Graft failure requiring dialysis occurred in 9 (2.2%) patients. Eighteen (4.4%) patients died during hospitalization period.

CONCLUSION: Infections and acute kidney injury (AKI) were the predominant causes of hospitalization among Isfahan KTR population.

PMID:42234919 | DOI:10.61882/ijkd.3.03.9421