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176 papers

Accuracy and Documentation of Richmond Agitation-Sedation Scale Assessments in a Cardiothoracic Critical Care Unit: A Prospective, Cross-Sectional Audit.

Szentgyorgyi L et al. · Jul 1, 2026

Background Sedation is a fundamental component of critical care and requires regular, accurate assessment to support its safe titration and minimise harm. International guidelines and local policy at the Wythenshawe Hospital's Cardiothoracic Critical Care Unit mandate hourly documentation of the Richmond Agitation-Sedation Scale (RASS). Aims This audit evaluated adherence to these standards and explored factors associated with documentation completeness and assessment accuracy. Study design A prospective, cross-sectional audit of bedside RASS assessment was conducted without prior notification. Nursing RASS scores were compared with expert auditor ratings. Data were collected using an anonymous, secure, auditor-completed online survey. Statistical analysis examined the relationship between documentation completion and RASS accuracy. Results Seventy-six nursing assessments were included. Most nurses were Band 5, with a median of 3.5 years of experience. Patients were predominantly male, mechanically ventilated and receiving sedation. Overall, 75% of nurse RASS assessments (n = 57) were accurate; however, only 33% (n = 25) were documented hourly as required by policy. Greater nursing experience was associated with improved accuracy in RASS. Deeper sedation was associated with lower agreement between nurse and expert assessments. Higher self-reported confidence was associated with poorer completion of documentation. Most discrepancies were small, with nurse and expert ratings differing by one RASS point. Conclusions This audit identified important gaps in the accuracy and documentation of nurse-led RASS assessment in a cardiothoracic critical care setting. The findings suggest that perceived familiarity and confidence may not be sufficient to ensure accurate and consistently documented sedation assessment. Relevance to clinical practice Suboptimal RASS documentation and scoring accuracy may limit reliable titration of sedation in critically ill patients and reduce the effectiveness of protocolised sedation strategies. These findings support targeted staff education, reinforcement of standardised assessment processes and improvements in documentation systems to strengthen sedation monitoring and patient safety.

Medicine

Personalized eye protection for head CT organ-based tube current modulation: A deep learning approach to derive 3D eyeball models from a single-view topogram.

Meng X et al. · Jul 1, 2026

Background The lens of the eye is highly radiosensitive, yet personalized shielding during head CT remains challenging due to the lack of a rapid, pre-scan localization method. Purpose To develop and validate a deep learning solution that enables automated, patient-specific eye protection by generating a precise 3D eyeball model directly from a single-view topogram. Methods Our two-stage approach combines an advanced data simulation pipeline-which generates realistic training topograms from digitally reconstructed radiographs (DRRs) using a table-movement-aware model and CycleGAN-based stylization-with a dedicated generative network (EyeGen-Net). The model was trained on 400 synthetic and validated on 100 real clinical samples. Results EyeGen-Net achieved a Dice Similarity Coefficient of 0.79 ± 0.08, a Hausdorff Distance of 5.40 ± 1.57 mm, and an Average Surface Distance of 1.84 ± 0.65 mm against expert segmentations. Crucially, phantom validation demonstrated that the derived 3D model facilitates organ-based tube current modulation (OBTCM), yielding an approximate 30% reduction in lens dose across different scanning modes without compromising diagnostic image quality. Conclusions This work provides a practical, automated pathway for implementing personalized radioprotection in routine head CT, aligning with the ALARA (As Low As Reasonably Achievable) principle.

Medicine

Helping families thrive while developing a strong working alliance: The benefits of Recipe 4 Success.

Braaten SM et al. · Jul 1, 2026

This study explored whether the strength of parent-home visitor working alliances might alter the benefits of Recipe 4 Success, a highly structured food-based curriculum designed to promote parents' sensitive scaffolding, responsive food parenting practices, toddlers' self-regulation, and healthy eating habits. This study included 242 parents and their toddlers residing in the United States, most of whom were living in poverty (37% white, 25% Black, 19% Latiné, 17% Multiracial, and 2% Asian; median income = $1555 per month). Families were randomly assigned to Recipe 4 Success or usual practice home visits within home visitor caseload. Home visitors tended to rate their working alliance as very strong versus less strong. Within-group regression equations revealed that, among families with a less strong working alliance, Recipe 4 Success was more effective than usual practice home visits in improving parents' sensitive scaffolding, responsive food parenting practices, and toddlers' self-regulation. In contrast, among families who had a strong working alliance, Recipe 4 Success was more effective than usual practice home visits in changing toddlers' healthy eating habits, including reducing body mass index for toddlers with overweight/obesity. These findings highlight how families with varying strengths of working alliances may benefit differently from highly structured evidence-based curricula.

Medicine

Stress native mapping does not distinguish patients with previous myocardial infarction with non-obstructive coronary arteries from healthy volunteers.

Andersson DF et al. · Jul 1, 2026

Aims Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) may be affected by coronary microvascular dysfunction with reduced stress perfusion. Changes in native T1 and T2 reflect changes in myocardial perfusion; therefore, the aim of our study was to investigate whether non-contrast, adenosine stress native T1 and T2 are affected in patients with previous suspected MINOCA. Methods and results Patients with MINOCA and a normal CMR (n = 15, 59 ± 7 years, 60% female) underwent 1.5T CMR together with age- and sex-matched volunteers. The protocol included native T1, native T2 and quantitative perfusion mapping, at rest and during adenosine stress. Myocardial stress perfusion was globally reduced, both transmurally (2.9 ± 0.9 vs. 3.6 ± 0.7 mL/min/g, p = 0.02) and in the subendocardium (2.64 ± 0.81 vs. 3.47 ± 0.78 ml/min/g, p = 0.008) in patients with MINOCA, with a reduced global ratio of subendocardial-to-transmural stress perfusion (0.921 ± 0.042 vs 0.957 ± 0.039, p = 0.021). However, there were no differences in global transmural rest native T1 or T2, stress native T1 or T2, or ΔT1- or ΔT2 values between patients and volunteers. Overall, transmural myocardial perfusion correlated with native T1 (R 2 = 0.27, p 2 = 0.48, p 2 = 0.15, p Conclusions Native T1- and T2-mapping during adenosine stress, although correlated with quantitative myocardial perfusion, are not alone sufficiently sensitive methods for distinguishing patients with MINOCA and reduced stress perfusion from healthy volunteers.

Medicine

Gluten Analysis and Regulation: Scientific, Analytical, and Economic Dimensions of Gluten-Free Assurance.

Popping B et al. · Jul 1, 2026

Gluten-free regulations require analytical systems that can reliably measure gluten in wheat, rye, and barley, and, in some jurisdictions, in oats across diverse food ingredients and processed foods. Examples include baked goods, fermented products such as beer, and extruded snack foods, where processing can alter gluten extractability and antibody recognition. This review examines the scientific, analytical, and regulatory factors that determine whether gluten quantification can support robust enforcement of the 20 mg gluten/kg threshold used in most jurisdictions, with a focus on method performance criteria (MPCs). The molecular complexity of gluten and the structural changes induced by baking, fermentation, and other processing steps influence extractability and epitope availability. These effects contribute to variable results across enzyme-linked immunosorbent assays that use different antibodies, extraction chemistries, and calibration standards. The widespread use of PWG gliadin (gliadin reference material) as a calibrant supports harmonized calibration for wheat-based analyses. Still, it can introduce bias because it does not reflect the gluten composition in processed or mixed-cereal foods. Improved incurred reference materials offer advantages but are not yet widely accessible. Proficiency testing data from DLA and FAPAS show that interlaboratory agreement is strongest for unprocessed matrices and decreases in baked, fat-rich, or fermented foods. These findings highlight the need for harmonized validation and for statistical criteria that define acceptable assay performance around the regulatory threshold. Advanced techniques such as liquid chromatography-tandem mass spectrometry provide detailed peptide-level information and can support confirmation in matrices where immunoassays lose sensitivity. A coordinated, performance-based framework aligned with Codex guidance would enable analytical methods to be evaluated against common criteria for recovery, precision, and detection capability. Codex alignment also introduces method dependency, as the current Type I Codex approach for gluten relies on the R5 Méndez ELISA as the defining method. Because Type I methods are empirical defining methods, results are comparable to the definition established by that method rather than necessarily being traceable to an independent reference value for gluten. The use of a single Type I method can therefore limit comparability when laboratories use assays based on other antibodies or extraction and calibration systems, particularly in processed matrices. Integrating such MPCs into regulatory practice, proficiency testing, and private certification systems would improve the comparability of gluten testing results and improve the reliability of gluten-free labeling in international markets.

Medicine

Nebivolol Protects the Thoracic and Abdominal Aorta and Their Perivascular Adipose Tissue From the Differential Detrimental Effects of Obesity.

Dourado TMH et al. · Jul 1, 2026

The effects of obesity on the vasculature and perivascular adipose tissue (PVAT) function vary according to the vascular territory. Nebivolol is a third-generation β-blocker that exerts vasculoprotective effects in obesity. The thoracic and abdominal aorta show different responses under physiological conditions, and their PVATs have a distinctive composition and secretory profile. We hypothesized that obesity would affect thoracic and abdominal aortic responsiveness, as well as their PVAT function, differently and that nebivolol would restore obesity-induced vascular and PVAT changes. To test this hypothesis, male Wistar Hannover rats were fed a hypercaloric diet for 14 weeks. Nebivolol (10 mg/kg/day) was administered via gavage during the last 4 weeks. Obesity increased superoxide (O 2 • - ) generation within the thoracic PVAT, but this response did not result in a loss of its anticontractile effect. Vascular hypercontractility was detected in thoracic aortas, which was mediated by the overproduction of NADPH oxidase-derived O 2 • - and reduced nitric oxide (NO) bioavailability. Conversely, obesity induced a pro-contractile phenotype in the PVAT of the abdominal aorta. This response occurred in an endothelium-dependent manner, was ameliorated by tiron, and was accompanied by increased O 2 • - levels. In all cases, nebivolol reversed the effects of obesity. In summary, obesity differentially affects the thoracic and abdominal aorta and their respective PVATs. Nebivolol exerts vasculoprotective effects through antioxidant mechanisms, leading to a reversal of obesity-induced vascular hypercontractility in both aortic segments. The beneficial effects of nebivolol described here could help mitigate cardiovascular complications associated with obesity. Obesity induces PVAT dysfunction. Extending this knowledge, we demonstrated that obesity differentially affects the thoracic and abdominal aorta along with their associated PVATs. This widespread impairment of PVAT function can drive various adverse vascular consequences, including arterial hypertension and aneurysm formation. Critically, peri-aortic PVAT is of particular clinical relevance due to its association with metabolic risk factors and vascular calcification. Nebivolol exerts vasculoprotective effects via antioxidant mechanisms within PVAT, ultimately reversing obesity-induced vascular hypercontractility in both aortic segments. Thus, investigating pharmacological agents that restore PVAT function, as demonstrated here with nebivolol, represents a promising therapeutic strategy to mitigate obesity-related cardiovascular complications.

Medicine

Podocyte mPGES-2 Determines Renal Aging and Contributes to Senile Osteoporosis.

Zhong D et al. · Jul 1, 2026

Renal aging shortens healthspan and propagates organ dysfunction beyond the kidney, yet its molecular drivers remain incompletely defined. Here we identify microsomal prostaglandin E synthase-2 (mPGES-2) as a critical regulator of renal aging and its skeletal consequence. Genetic ablation of Ptges2 improved health indices in aged mice, prolonged median survival, and markedly alleviated glomerulosclerosis, podocyte injury, and renal senescence. Single-cell transcriptomic analysis, together with podocyte- and tubule-specific knockout models, showed that podocyte mPGES-2, rather than tubular mPGES-2, is the dominant intrarenal driver of aging-related kidney injury. Mechanistically, mPGES-2 promoted podocyte senescence through a PGE 2 /EP1 signaling axis. Podocyte-specific Ptges2 deletion also mitigated age-related osteoporosis and restored renal calcitriol and α-klotho, supporting a kidney-bone mechanism secondary to impaired renal endocrine function. Consistent with the genetic models, pharmacological inhibition of mPGES-2 with SZ0232 attenuated renal aging and improved bone microarchitecture in aged mice. Both genetic deficiency and pharmacological inhibition of mPGES-2 were well tolerated, with no overt adverse effects on major organs. These findings identify podocyte mPGES-2 as a druggable determinant of renal aging and a potential therapeutic target for aging-associated osteoporosis.

Medicine

'Heroes Were (And Could Be) Created': An Exploration of Adolescents' Perspectives of Portrayals of Pain and Empathy in Media.

Cormier A et al. · Jul 1, 2026

Background Research suggests that media consumption plays a role in socialization, including the socialization of painful experiences. Findings from previous research examining pain depictions in popular adolescent media suggest that violence and injuries are frequently represented, marginalized populations are underrepresented, and observers lack prosocial responses to sufferers' pain. This study was the first to examine how adolescents perceive, internalize, and discuss pain depictions in popular adolescent media. Methods Fourteen adolescents (between 13 and 18 years of age), both with and without chronic pain, participated in focus groups. Participants watched clips depicting pain in popular adolescent media before providing their feedback. Results Using reflexive thematic analysis, three themes were generated: (1) a failure to communicate, but not to empathize-observers may be fearful or lack the tools and confidence to address sufferer pain, (2) media as the metric-media serves as the metric by which we can compare pain experiences, which may contribute to stigma and disbelief, and (3) media as the conduit for transformation-media may be harnessed to properly represent and build empathy for pain. Significance These novel findings suggest that media portrayals of pain may shape youths' beliefs about pain expression, validation, and empathy. Media could therefore serve as a modifiable target for reducing pain-related stigma and improving empathic responses to pain.

Medicine

Effect of Home-Based Multiple Micronutrient Powder Fortification on Haemoglobin Levels in Infants in Nampula, Mozambique: A Pragmatic Clinical Trial.

Gotine AREM et al. · Jul 1, 2026

To conduct a pragmatic clinical trial with multiple micronutrient powders (MNPs) for anaemia prevention during the first year of life in primary care in Nampula, Mozambique. A total of 275 infants, aged 6-8 months, were randomly assigned to intervention (IG, n = 145) and control (CG, n = 130) groups. The IG received 90 sachets of MNP for daily use up to 180 days; the CG received standard care. Haemoglobin (Hb) was measured at baseline and after 6 months. Analysis used linear regression adjusted for child and maternal variables (p < 0.05). At baseline, mean Hb (95% CI) was 102.2 g/L (100.4-104.0) in the IG and 103.8 g/L (102.0-105.7) in the CG, with corresponding anaemia rates (Hb < 105 g/L) of 55.2% (47.1; 63.0%) and 47.7% (39.3; 56.2%). After intervention, IG had 106.2 g/L (104.2-108.1) vs CG 99.5 g/L (97.3-101.8), with anaemia rates of 36% (27.8; 45.1) and 67.3% (57.9; 75.4), respectively. Adjusted mean intra-group difference of haemoglobin (g/L) from baseline to follow-up was +2.8 in IG and -4.3 in CG. MNPs improved haemoglobin levels, supporting their potential for anaemia control in vulnerable populations. TRIAL REGISTRATION: https://ensaiosclinicos.gov.br/rg/RBR-4r37q7z. Registered 11/11/2024.

Medicine

A subset of high-grade sarcomas with myogenic differentiation are associated with recurrent FGFR fusions.

Yeung MC et al. · Jul 1, 2026

Recurrent fusions involving FGFR1-4 genes have been previously described in rare subsets of mostly benign chondroid and mesenchymal neoplasms involving bone and soft tissue. However, a more comprehensive analysis of sarcomas associated with FGFR fusions, including their incidence and histotypes, has not been performed. Triggered by an FGFR1-rearranged unclassified high-grade sarcoma with myogenic differentiation, we investigated our molecular database for sarcomas with FGFR gene fusions to assess their recurrent potential and morphologic spectrum. A total of six unclassified sarcomas were identified, occurring in five females and one male, with a median age of 66.5 years. Tumors were located in the uterus and retroperitoneal/trunk soft tissue. Histologically, all tumors were high grade, composed predominantly of spindle cell morphology with variable cytologic atypia, high mitotic activity, and areas of necrosis. By immunohistochemistry, all tumors demonstrated evidence of myogenic differentiation, with focal or diffuse positivity for one or more markers (desmin, h-caldesmon, smooth muscle actin). However, none of the cases displayed diagnostic features of leiomyosarcoma or other known pathologic entities. Molecular studies revealed recurrent fusions involving FGFR1 (n = 3), FGFR2 (n = 1), and FGFR4 (n = 2), retaining the kinase domain. Additional recurrent genomic alterations included TP53 mutations, CDKN2A homozygous deletions, and RB1 alterations. Most patients followed an aggressive clinical course, including metastases and disease-related mortality. These findings expand the spectrum of sarcomas driven by FGFR gene fusions, underscoring the importance of molecular testing for accurate diagnosis and potential targeted therapy in high-grade sarcomas with myogenic features.

Medicine