Tag: pubmed

Crit Care. 2025 Jun 12;29(1):239. doi: 10.1186/s13054-025-05469-6.

ABSTRACT

BACKGROUND: Invasive group A streptococcus (iGAS) infection incidence is rising. These infections have been studied as a whole but can be associated with critical illness in a population with a wide array of underlying conditions, sites of infection and clinical presentations. Using an unsupervised clustering approach, we aimed to identify specific clinical phenotypes regarding presentation, management and outcome.

METHODS: This was a retrospective multicentric study including all patients admitted to one of 9 ICUs of Paris University Hospitals for an iGAS infection between 01/03/2018 and 01/08/2023. iGAS infection was defined as GAS growth in any microbiological sample from a sterile site. Patients were grouped according to a clustering algorithm (k-prototypes) using a comprehensive set of clinical and biological variables available upon ICU admission. Clusters were described and clinical presentation, management and outcome were compared.

RESULTS: 148 patients were included. According to the Silhouette criterion, patients were grouped in 3 clusters, and 7 patients remained unclassified. Cluster 1 (n = 73) comprised a greater proportion of less severely-ill female patients with painful skin and soft tissue infections, a quarter of whom had taken non-steroidal anti-inflammatory drugs. Cluster 2 (n = 42) was characterized by a high rate of respiratory infections with frequent viral co-infections. Cluster 3 (n = 26) included mostly socially deprived patients with high rates of chronic alcohol consumption and psychiatric illness, with severe organ dysfunction related to otherwise pauci-symptomatic skin and soft tissue infections. There was no significant difference in time to source control across clusters (0 [0-0] vs 0 [0-0] vs 0 [0-1] days, p = 0.12). Patients included in cluster 2 less frequently received antitoxin antibiotics than patients from clusters 1 and 3 (79% vs 45% vs 69%, p < 0.001) and tended to more frequently require ECMO support (3% vs 12% vs 0%, p = 0.07), while those from cluster 1 were less likely to receive invasive mechanical ventilation (48% vs 74% vs 77%, p = 0.005). There was no difference in ICU-mortality between clusters (19% vs 29% vs 31%, p = 0.32).

CONCLUSIONS: Based on simple and readily available clinical admission characteristics of critically ill patients with iGAS, unsupervised clustering analysis identified three specific patient populations that differed regarding ICU management. Whether tailoring management would affect outcome warrants further research.

PMID:40506732 | DOI:10.1186/s13054-025-05469-6

Harm Reduct J. 2025 Jun 12;22(1):106. doi: 10.1186/s12954-025-01246-4.

ABSTRACT

BACKGROUND: Drug consumption rooms (DCRs) are harm reduction facilities providing safer and hygienic setting for supervised administration of drugs aimed at decreasing negative health and social consequences of drug use. The first DCR in Czechia was opened in September 2023 in city of Brno in a mobile form operating in a socially excluded area (SEA). A research project informed the implementation of the DCR.

METHODS: A mixed methods design was applied in the following phases: desk review, research before and after the launch of the mobile DCR, and routine monitoring of programme performance. Two cross-sectional questionnaire surveys among PWUDs (n = 131 and 135), ethnographic observation, focus group (n = 19), interviews with PWUDs (n = 26 and 19), with personnel of addiction services and local officials (n = 16 and 12), and residents (n = 7 and 6) were performed prior to and after the launch of the DCR. Thematic analysis of qualitative data, descriptive and regression analyses of quantitative data were performed.

RESULTS: There was a need and high willingness to use the DCR among potential clients. The significant predictors were opioid use (adjusted odds ratio, AOR = 3.4 in survey 1 and 3.9 in survey 2), drug injection in the last 30 days (AOR 4.3 in survey 1), being in the probationary period during the previous 30 days (AOR 10.0 in survey 1), witnessing an overdose in the past 30 days (AOR 8.5 in survey 2), HCV positivity ever in life (AOR 2.9 in survey 2), living in SEA (AOR 2.7 in survey 2) and Roma ethnicity (AOR 2.8 in survey 2). The beginnings of the DCR were relatively slow with low initial number of clients and drug administrations. However, with time, and programme adjustments following research results, the attendance at the facility has grown.

CONCLUSIONS: Research was instrumental in shaping the DCR in Brno before and during its implementation. The DCR showed a potential to attract the most vulnerable PWUDs from SEA. Despite a slow start, the DCR has become an integral part of low-threshold services for PWUDs in Brno and has proven its feasibility in the Czech settings.

PMID:40506711 | DOI:10.1186/s12954-025-01246-4

Malar J. 2025 Jun 12;24(1):189. doi: 10.1186/s12936-025-05444-0.

ABSTRACT

BACKGROUND: Global malaria control programmes such as approaches to community engagements to deliver malaria control interventions have been successful in controlling malaria. Strategies aimed at accelerating patients’ adherence to prescribed artemisinin-based combination therapy (ACT) are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education in improving patients’ adherence to ACT. The objective of this study was to establish the impact of a community health education intervention on the patients’ adherence to malaria ACT in Kamuli District, Uganda.

METHODS: A pre-post-test intervention study without a control group was used to understand the impact of community health education training in improving patients’ adherence to ACT. Quantitatively, equal number of 1266 patients were enrolled and assigned into any of the three arms equally (422)-no follow up, follow-up on day 2 and day 4 arm at pre-test and post-test phases. Qualitatively, 24 key informants were enrolled purposively. Mann-Whitney U test was used to establish the impact of the community health education on patients’ adherence to ACT. Statistical significance was established at p < 0.05. Qualitative data was analysed using the thematic analysis technique.

RESULTS: A total of 1688 patients were analysed. At pre-test, the median age was 20 years with majority (64.3%) being females while patients’ adherence was reported to be 588/844 (69.7%). At post-test, the median age was 21 years, majority (62.6%) females, and patients’ adherence 700/844 (82.9%). A Mann-Whitney U test showed a statistically significant difference in the patients’ adherence to ACT of pre-test and post-test after the intervention (U = 308,904, Z = – 6.409, p < 0.0001), with higher adherence at post-test (median = 900.5) than pre-test (median = 788.5) and small effect (0.156). Qualitatively, not all health workers explain clearly how to use the ACT medicines prescribed.

CONCLUSION: Community health education as an intervention was effective in improving patient’s adherence to ACT. Therefore, there is need to avail medical supplies and patient education with adherence support to ensure adequate patients’ adherence to ACT.

PMID:40506709 | DOI:10.1186/s12936-025-05444-0

Ann Surg Oncol. 2025 Jun 12. doi: 10.1245/s10434-025-17640-y. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy (NAC) has emerged as a potential alternative to upfront surgery (US) followed by adjuvant chemotherapy in locally advanced colon cancer (LACC), offering benefits such as early micrometastases eradication and improved surgical outcomes. However, its efficacy and safety remain uncertain owing to conflicting evidence.

PATIENTS AND METHODS: A systematic review and meta-analysis was conducted evaluating randomized controlled trials (RCTs) comparing NAC with US with adjuvant chemotherapy for LACC. Primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Secondary outcomes included positive surgical margin rates and anastomotic leak/abscess. Statistical analyses employed random-effects models, with trial sequential analysis (TSA) assessing the robustness of results.

RESULTS: Eight RCTs with low risk of bias involving 3038 patients were included. NAC improved 5-year OS (81.4% versus 77.8%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.64-0.91, p = 0.0028) and DFS (79.2% versus 73.7%, HR 0.80, 95% CI 0.68-0.93, p = 0.0033), with low heterogeneity (I² ≤ 4.4%). NAC significantly reduced positive margin rates (4.1% versus 6.3%, HR 0.49, p = 0.0011) without increasing anastomotic leak/abscess (p = 0.09). The leave-one-out and the TSA analyses confirmed the robustness of OS and DFS findings, with the cumulative Z-curve crossing both the conventional and trial sequential monitoring boundaries for benefit. The GRADE assessments indicated high quality of evidence for the primary outcomes.

CONCLUSIONS: NAC offers superior OS, DFS, and surgical margin outcomes in LACC without heightened surgical risks, supporting its inclusion as a viable and safe treatment option.

PMID:40506679 | DOI:10.1245/s10434-025-17640-y

J Oral Rehabil. 2025 Jun 12. doi: 10.1111/joor.14009. Online ahead of print.

ABSTRACT

INTRODUCTION: Dental implant surgery has become a prevalent treatment option for patients with single tooth defects. However, the success of this surgery relies heavily on precise planning and execution. This study investigates the application of artificial intelligence (AI) in assisting the planning process of dental implant surgery for single tooth defects. Single tooth defects in the oral cavity pose a significant challenge in restorative dentistry. Dental implant restoration has emerged as an effective solution for rehabilitating such defects. However, the complexity of the procedure and the need for accurate treatment planning necessitate the integration of advanced technologies. In this study, we propose the utilisation of AI to enhance the precision and efficiency of implant surgery planning for single tooth defects.

MATERIALS AND METHODS: A total of twenty patients with single tooth loss were enrolled. Cone-beam computed tomography (CBCT) and intra-oral scans were obtained and imported into the AI-dentist software for 3D reconstruction. AI assisted in implant selection, tooth position identification, and crown fabrication. Evaluation included subjective verification and objective assessments. A paired samples t-test was used to compare planning times (dentist vs. AI), with a significance level of p < 0.05.

RESULTS: Twenty patients (9 male, 11 female; mean age 59.5 ± 11.86 years) with single missing teeth participated in this study. Implant margins were carefully positioned: 3.05 ± 1.44 mm from adjacent roots, 2.52 ± 0.65 mm from bone plate edges, 3.05 ± 1.44 mm from sinus/canal, and 3.85 ± 1.23 mm from gingival height. Manual planning (21.50 ± 4.87 min) was statistically significantly slower than AI (11.84 ± 3.22 min, p < 0.01). Implant planning met 100% buccolingual/proximal/distal bone volume criteria and 90% sinus/canal distance criteria. Two patients required sinus lifting and bone grafting due to insufficient bone volume.

CONCLUSION: This study highlights the promising role of AI in enhancing the precision and efficiency of dental implant surgery planning for single tooth defects. Further studies are necessary to validate the effectiveness and safety of AI-assisted planning in a larger patient population.

PMID:40506671 | DOI:10.1111/joor.14009

J Relig Health. 2025 Jun 12. doi: 10.1007/s10943-025-02356-w. Online ahead of print.

ABSTRACT

In illnesses such as cancer, which require prolonged and intensive treatment, patients’ spiritual well-being plays a critical role in enhancing their sense of life meaning and may positively influence treatment outcomes. This descriptive study evaluated the spiritual well-being of patients with cancer. The sample consisted of 300 cancer patients receiving care in the medical oncology service and outpatient chemotherapy unit of a training and research hospital in Ankara between February and May 2024. Data were collected using an introductory information form and the Spiritual Well-Being Scale. A statistically significant relationship was found between the subscale scores and patients’ gender, education level, income level, diagnostic status, and time since diagnosis (p < 0.05). In conclusion, the study showed that cancer patients demonstrated moderate levels of meaning and peace and high levels of belief. These findings indicate a potential need for interventions that address the spiritual and religious care needs of cancer patients following diagnosis.

PMID:40506662 | DOI:10.1007/s10943-025-02356-w

Ultrasonics. 2025 Jun 9;155:107725. doi: 10.1016/j.ultras.2025.107725. Online ahead of print.

ABSTRACT

The purpose of this study was to assess eye lesions by analyzing wave speed (WS) of lesions using ultrasound vibro-elastography (UVE) together with a parametric ultrasound imaging approach. Ten subjects with eye lesions (5 nevus (N) vs. 5 melanoma (M)) were recruited and tested using UVE. In addition, the sliding window method was used to reconstruct and analyze horizontal Normalized Shannon Entropy (hNSE) images and Nakagami-m/omega images. Two-way ANOVA statistical analysis was performed to compare mean values of the contrast to noise ratio (CNR), hNSE, and m/omega of these images between the two types of lesions. The results show that there were significant differences in CNR of the m map images (p = 0.0174) and omega map images (p = 0.0128) reconstructed from shear wave velocity (SWV) between the two types of lesions and significant differences in CNR of the m map images (p = 0.0209) and omega map images (p < 0.0001) reconstructed from two dimensional (2D) speed maps between the two lesions Furthermore, the m values of 2D speed maps shows significant differences between N vs. M of all three frequencies (i.e., 100 Hz (p = 0.0052), 150 Hz (p = 0.0100), 200 Hz (p = 0.0174)). The results suggest that CNR, m and omega of Nakagami method are useful biomarkers for assessing eye lesion with UVE technique. Nakagami imaging of SWV and 2D speed maps have better performance than hNSE imaging for analyzing characteristics of eye lesions. UVE based Nakagami imaging is a promising method for evaluating eye lesions.

PMID:40505172 | DOI:10.1016/j.ultras.2025.107725

JACC Heart Fail. 2025 Jun 11;13(8):102497. doi: 10.1016/j.jchf.2025.03.041. Online ahead of print.

ABSTRACT

BACKGROUND: Pooling data from participants with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) from all completed outcomes trials evaluating finerenone to date may enhance understanding of its safety and efficacy in this high-risk and heterogeneous population.

OBJECTIVES: In this prespecified participant-level pooled analysis of the FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF trials (FINE-HEART), we evaluated the safety and efficacy of finerenone in individuals with HFmrEF/HFpEF.

METHODS: The treatment effects of finerenone vs placebo on cardiovascular death or heart failure hospitalization were evaluated using Cox proportional hazards regression models stratified by trial. Additional endpoints included cardiovascular death, HF hospitalization, new-onset atrial fibrillation, and all-cause death.

RESULTS: Among 18,991 pooled trial participants, 7,008 (36.9%) had HFmrEF/HFpEF (mean age, 71 ± 10 years; 44% female). Over a median follow-up of 2.5 years, finerenone reduced cardiovascular death or heart failure hospitalization compared with placebo (HR: 0.87 [95% CI: 0.78-0.96]; P = 0.008). Consistent effects were observed across trials (P_interaction = 0.24), key subgroups, and baseline estimated glomerular filtration rate (P_interaction = 0.47), urine albumin-to-creatinine ratio (P_interaction = 0.62), and glycated hemoglobin (P_interaction = 0.93). Finerenone additionally appeared to reduce heart failure hospitalization (HR: 0.84 [95% CI: 0.74-0.94]; P = 0.003) and new-onset atrial fibrillation (HR: 0.75 [95% CI: 0.58-0.97]; P = 0.030), but did not statistically significantly decrease cardiovascular death or all-cause death. Hyperkalemia was more common, and hypokalemia was less common, with finerenone vs placebo. Serious adverse events were similar between the treatment arms.

CONCLUSIONS: This participant-level pooled analysis of 3 large-scale outcomes trials supports the use of finerenone in individuals with HFmrEF/HFpEF across a broad range of cardiovascular-kidney-metabolic risk. (PROSPERO registration: CRD42024570467).

PMID:40505158 | DOI:10.1016/j.jchf.2025.03.041

J Med Internet Res. 2025 Jun 12;27:e66055. doi: 10.2196/66055.

ABSTRACT

BACKGROUND: Although much progress has been made in artificial intelligence (AI), several challenges remain substantial obstacles to the development and translation of AI systems into clinical practice. Even large language models, which show excellent performance on various tasks, have progressed slowly in clinical practice tasks. Providing precise and explainable treatment plans with personalized details remains a big challenge for AI systems due to both the highly specialized medical knowledge required and patients’ complicated conditions.

OBJECTIVE: This study aimed to develop an explainable and efficient decision support system named H-SYSTEM to assist neurosurgeons in diagnosing and treating patients with hypertensive intracerebral hemorrhage. The system was designed to address the limitations of existing AI systems by integrating a medical domain knowledge graph to enhance decision-making accuracy and explainability.

METHODS: The H-SYSTEM consists of 3 main modules: the key named entity recognition (NER) module, the semantic analysis and representation module, and the reasoning module. Furthermore, we constructed a medical domain knowledge graph for hypertensive intracerebral hemorrhage, named HKG, which served as an external knowledge brain of the H-SYSTEM to enhance its text recognition and automated decision-making capability. The HKG was exploited to guide the training of the semantic analysis and representation module and reasoning module, which makes the output of the H-SYSTEM more explainable., To assess the performance of the H-SYSTEM, we compared it with doctors and different large language models.

RESULTS: The outputs based on HKG showed reliable performance as compared with neurosurgical doctors, with an overall accuracy of 94.87%. The bidirectional encoder representations from transformers, inflated dilated convolutional neural network, bidirectional long short-term memory, and conditional random fields (BERT-IDCNN-BiLSTM-CRF) model was used as the key NER module of the H-SYSTEM due to its fast convergence and efficient extraction of key named entities, achieved the highest performance among 7 key NER models (precision=92.03, recall=90.22, and F1-score=91.11), significantly outperforming the others. The H-SYSTEM achieved an overall accuracy of 91.74% in treatment plans, showing significant consistency with the gold standard (P<.05), with diagnostic measures achieving 88.18% accuracy, 97.03% area under the curve (AUC), and a κ of 0.874; surgical therapy achieving 98.53% accuracy, 98.53% AUC, and a κ of 0.971; and rescue therapies achieving 89.50% accuracy, 94.67% AUC, and a κ of 0.923 (all P<.05). Furthermore, the H-SYSTEM showed high reliability and efficiency when compared to doctors and ChatGPT, achieving statistically higher accuracy (95.26% vs 91.48%, P<.05). Additionally, the H-SYSTEM achieved a total accuracy of 92.22% (ranging from 91.14% to 95.35%) in treatment plans for 605 additional patients from 6 different medical centers.

CONCLUSIONS: The H-SYSTEM showed significantly high efficiency and generalization capacity in processing electronic medical records, and it provided explainable and elaborate treatment plans. Therefore, it has the potential to provide neurosurgeons with rapid and reliable decision support, especially in emergency conditions. The knowledge graph-enhanced deep-learning model exhibited excellent performance in the clinical practice tasks.

PMID:40505141 | DOI:10.2196/66055

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6). doi: 10.5435/JAAOSGlobal-D-24-00287. eCollection 2025 Jun 1.

ABSTRACT

INTRODUCTION: Although increased treatment of pediatric anterior cruciate ligament (ACL) injury is well-documented, surrounding trends remain unknown. We evaluated national trends over 21 years using data from pediatric ACL reconstructions (ACLR) submitted to the American Board of Orthopaedic Surgeons (ABOS) Part II Oral Examination and compared fellowship training, geographic variation, and case volume trends.

METHODS: The ABOS SCRIBE database was queried for ACLR in pediatric (<19) patients between 2000 and 2021. Data included geographic region, fellowship training, and patient demographics. ACLRs per capita was estimated using census data. Data were stratified by age and sex. Multiple linear regression assessed whether year, sex, and age/sex category predicted surgery number.

RESULTS: From 2000 to 2021, ABOS Part II candidates reported 12,124 pediatric ACLR. Nearly 2/3 were in patients 16 years or older. Most were in the Midwest (22.8%) and South (22.2%). Each region decreased in ACLR. Overall, pediatric ACLR decreased 31.3% and contributing surgeons decreased 40.4%. Female ACLR increased 39.5% from 2009 to 2014, with 11.9% more than male patients in 2014. After 2014, sex differences and total ACLR decreased. 81.3% were reported by surgeons with sports medicine training and 6.0% with dual sports medicine and pediatric orthopaedics fellowships. Dual training increased in 2009 and declined after 2013. Surgeries in male patients compared with female patients (B = -6.777, 95% confidence interval, -9.534 to -4.279) and male patients 16 to 18 years compared with male patients younger than 16 years (B = -4.935, 95% confidence interval, -6.596 to -3.273) decreased.

CONCLUSION: Pediatric ACLR performed by ABOS Part II candidates decreased overall, but a concern for increased ACLR in female patients persists. More surgeries were done in the Midwest and South.

STUDY DESIGN: Cross-sectional Study Level of Evidence: III.

PMID:40505137 | DOI:10.5435/JAAOSGlobal-D-24-00287