Frontiers in Medicine最新文献

{"title":"Disseminated BCG disease and recurrent pulmonary infections in a child with trisomy 21 carrying a novel <i>BACH2</i> variant of uncertain significance: a 5-year case report.","authors":"Diana Marangu-Boore, Brian Maugo, Rita Afriye Boateng","doi":"10.3389/fmed.2026.1934925","DOIUrl":"10.3389/fmed.2026.1934925","url":null,"abstract":"<p><strong>Background: </strong>Trisomy 21 is associated with combined immune dysregulation, including lymphopenia, impaired responses to vaccines, and heightened susceptibility to respiratory infections, driven in part by triplication of chromosome 21-encoded interferon receptor genes. <i>BACH2</i> haploinsufficiency is a rare monogenic immunodeficiency characterized by lymphopenia, hypogammaglobulinemia, and susceptibility to infections and autoimmune diseases. Co-occurrence of these two conditions has not been previously described.</p><p><strong>Case presentation: </strong>We report a 5-year longitudinal course in a Kenyan girl with trisomy 21, congenital heart disease, aspiration, and severe gastroesophageal reflux disease (GERD) found via whole exome sequencing to carry a heterozygous <i>BACH2</i> missense variant (c.1420C > G;p.Leu474Val) of uncertain significance; parental segregation remains incomplete. In silico protein structural modeling (FoldX and Missense3D) yielded discordant predictions of the variant's effect on the protein's stability and structure. Additional <i>in silico</i> pathogenicity predictions were also inconsistent: Sorting Intolerant from Tolerant (SIFT), Evolutionary Model of Variant Effect (EVE), PolyPhen-2, and CADD Phred scores predicted pathogenicity, while REVEL and AlphaMissense suggested a lack of deleteriousness. Persistent panlymphopenia and profoundly low IgM levels were documented throughout the follow-up period. Over these 5 years, the girl sustained six hospitalized lower respiratory tract infections (LRTIs), with four requiring intensive care, which were disseminated Bacille Calmette-Guérin (BCG) disease, respiratory syncytial virus and SARS-CoV-2 infections, and influenza A(H1N1)pdm09 pneumonia. Chest computed tomography at 4 years showed bilateral consolidations without bronchiectasis. Annual autoimmune screening remained negative.</p><p><strong>Conclusion: </strong>This case illustrates the burden caused by severe and diverse respiratory pathogenic infections in a child with trisomy 21 and a candidate <i>BACH2</i> variant. Trisomy 21 alone plausibly explains much of the phenotype; an independent contribution from the <i>BACH2</i> variant remains unproven pending functional and segregation studies. Clinical considerations supported by this case include the potential value of prevaccination immunological screening to prevent BCG disease, equitable access to viral prophylaxis, and early specialist engagement in refractory cases.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1934925"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of cardiopulmonary ultrasound in diagnosing cardiogenic pulmonary edema in patients with heart failure.","authors":"Yanfen Zhong, Jie Shen, Jingtao Li, Hongyu Zheng","doi":"10.3389/fmed.2026.1938070","DOIUrl":"10.3389/fmed.2026.1938070","url":null,"abstract":"<p><strong>Objective: </strong>Heart failure (HF) is generally complicated with cardiogenic pulmonary edema (CPE), the early diagnosis and treatment is essential. We aimed to evaluate the effects of cardiopulmonary ultrasound (CPUS) in the diagnosis of CPE in HF patients, to provide reference for the management of HF.</p><p><strong>Methods: </strong>HF patients entering The People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Academy of Medical Sciences intensive care unit (ICU) between March 2025 and July 2026 were included. All patients underwent CPUS and chest computed tomography (CT), and comparison of the detection rates of cardiogenic pulmonary edema between CPUS and CT.</p><p><strong>Results: </strong>A total of 117 patients with HF were enrolled in this study. Of the 117 HF patients, 46 were diagnosed with CPE, and 43 were correctly diagnosed by CT, with a diagnostic accuracy of 94.9%, the positive predictive value (PPV) was 93.5%, the negative predictive value (NPV) was 95.8%, the sensitivity was 93.5%, the specificity was 95.8%, the positive likelihood ratio (PLR) was 22, and the negative likelihood ratio (NLR) was 0.07. While 41 were correctly diagnosed by CPUS, with a diagnostic accuracy of 92.3%, the PPV was 91.1%, NPV was 93.1%, the sensitivity was 89.1%, the specificity was 94.3%, the PLR was 16, and the NLR was 0.12. Comparison of CT and CPUS in the diagnosis of CPE, there was no statistically significant difference between the two methods (<i>X</i> ² = 0.111, <i>P</i> > 0.05). And The Cohen's kappa for the diagnosis of CPE by CT and CPUS is 0.873 (95% CI was 0.782-0.963, <i>P <</i> 0.001).</p><p><strong>Conclusions: </strong>In conclusion, the present study suggests that CPUS is feasible for identifying cardiogenic pulmonary edema in ICU patients with heart failure. Based on diagnostic agreement analysis, CPUS demonstrates promising performance for CPE detection in this critically-ill cohort.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1938070"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy and prognostic factors of regenerative endodontic procedure for immature permanent teeth with periapical periodontitis.","authors":"Huan Jiang, Siyu Bai, Ping Chen","doi":"10.3389/fmed.2026.1945140","DOIUrl":"10.3389/fmed.2026.1945140","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical effects of regenerative endodontic procedures in the treatment of immature permanent teeth with periapical periodontitis and to analyze the factors influencing prognosis.</p><p><strong>Methods: </strong>Clinical data of 148 immature permanent teeth with periapical periodontitis treated at our hospital from January 2022 to December 2025 were retrospectively analyzed. The patients were equally divided into Group A (regenerative endodontic procedure, <i>n</i> = 74) and Group B (apexification, <i>n</i> = 74). Clinical efficacy, root development, periodontal parameters, gingival crevicular fluid VEGF levels, and complication rates were compared. All subjects underwent 6-month follow-up and were stratified into good and poor prognosis subgroups. Multivariate logistic regression was used to screen for prognostic factors.</p><p><strong>Results: </strong>After 6 months of therapy, Group A achieved a superior overall response rate, thicker root canal walls, longer root lengths, lower SBI, PLI, and PD, elevated gingival crevicular fluid bFGF and VEGF levels, and fewer complications (<i>P</i> < 0.05). All participants completed the 6-month follow-up and were categorized into poor-prognosis (<i>n</i> = 26) and good-prognosis (<i>n</i> = 122) cohorts. The poor-prognosis group had fewer regenerative endodontic procedure cases and larger apical lesion areas (<i>P</i> < 0.05). Multivariate logistic regression identified treatment modality and apical lesion size as independent risk factors for an unfavorable prognosis (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Regenerative endodontic procedures are associated with favorable short-term (6-month) outcomes in immature permanent teeth with apical periodontitis, including improved root development and repair, a more favorable periodontal microenvironment, increased levels of repair-related cytokines, and fewer complications. The treatment modality and extent of the apical lesion were associated with prognosis. Individualized treatment decisions should consider the apical lesion characteristics and clinical status of the affected tooth to optimize outcomes in pediatric patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1945140"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: CXCL2/CXCR2 pathway regulates CD169^high large macrophages to promote progression of malignant pleural effusion from lung adenocarcinoma.","authors":"Sitong Chen, Chunyan Li, Yuezhang Sun, Yanyan Huang, Guifu Gong, Yuxuan Bao, Liyun Xu","doi":"10.3389/fmed.2026.2003813","DOIUrl":"https://doi.org/10.3389/fmed.2026.2003813","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fmed.2026.1943314.].</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"2003813"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and mortality risk of sarcopenia in interstitial lung disease: a systematic review and meta-analysis.","authors":"Lijuan Zhou, Xuan Wang, Weiwei Yuan, Yahui Yang, Ting Lu, Lu Guo, Xing He","doi":"10.3389/fmed.2026.1955396","DOIUrl":"10.3389/fmed.2026.1955396","url":null,"abstract":"<p><strong>Objective: </strong>Sarcopenia, prevalent in interstitial lung disease (ILD), increases the risk of poor outcomes. This study aimed to define the clinical characteristics of ILD patients with sarcopenia (ILD-S) and quantify sarcopenia's impact on mortality.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus for English studies up to 1 September 2026 reporting clinical variables (mean ± SD) in ILD vs. ILD-S groups and adjusted hazard ratios with 95% confidence intervals (CI) for mortality risk. Subgroup analyses were stratified by sarcopenia diagnostic criteria, ILD subtype, and survival time. Heterogeneity was assessed using Cochran's Q and I² statistics. Sensitivity analyses (leave-one-out) and publication bias assessments (Egger's test, trim-and-fill method) were performed.</p><p><strong>Results: </strong>Fourteen studies comprising 1,546 participants (628 with ILD-S) were included. Compared with ILD patients without sarcopenia, those with ILD-S were significantly older (WMD = 3.03, 95% CI: 2.12-3.93), had higher Gender-Age-Physiology (GAP) scores (WMD = 0.43, 95% CI: 0.15 to 0.71), and a higher FEV₁/FVC ratio (WMD = 1.97, 95% CI: 0.21 to 3.73, <i>P</i> = 0.03). Conversely, the ILD-S group showed lower values for FEV₁% predicted (WMD = -6.95, 95% CI: -9.80 to -4.09), FVC% predicted (WMD = -9.46, 95% CI: -12.04 to -6.88), DLCO% predicted (WMD = -5.87, 95% CI: -11.68 to -0.06), body mass index (WMD = -1.35, 95% CI: -1.89 to -0.82), handgrip strength (WMD = -12.80, 95% CI: -17.02 to -8.58), 6-minute walk distance (WMD = -31.01, 95% CI: -60.05 to -1.97), and appendicular skeletal muscle index (WMD = -1.45, 95% CI: -2.15 to -0.76). No significant difference was observed in smoking history. Sarcopenia was strongly associated with increased mortality risk (HR = 2.02, 95% CI: 1.67 to 2.45), and this association remained stable across different follow-up periods. Sensitivity and publication bias analyses confirmed the robustness of the findings.</p><p><strong>Conclusion: </strong>Patients with ILD-S exhibit a distinctive profile characterized by older age, higher GAP scores, poorer pulmonary function, lower BMI, reduced muscle strength and mass, and significantly elevated mortality. Systematic recognition of these clinical features may facilitate early identification of ILD-S and inform the development of targeted interventions to improve patient outcomes.</p><p><strong>Systematic review registration: </strong>https://inplasy.com/, INPLASY202570030.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1955396"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent classes and symptom network analysis of kinesiophobia in older adult patients with chronic obstructive pulmonary disease.","authors":"Mengyao Liang, Congying Kang, Li Feng, Jiajia Hua","doi":"10.3389/fmed.2026.1919256","DOIUrl":"10.3389/fmed.2026.1919256","url":null,"abstract":"<p><strong>Objective: </strong>To identify the latent classes of kinesiophobia in older adult patients with chronic obstructive pulmonary disease (COPD), analyze the symptom network structure of different classes, determine the core symptoms, and provide evidence for precision pulmonary rehabilitation interventions.</p><p><strong>Methods: </strong>A convenience sample of 546 older adult COPD patients was recruited from the Department of Respiratory and Critical Care Medicine, Nantong Sixth People's Hospital, between March 2025 and April 2026. Participants completed a general information questionnaire, the Breathlessness Beliefs Questionnaire (BBQ), and a COPD symptom survey. Latent profile analysis was used to identify potential classes of kinesiophobia. Symptom networks for each subgroup were constructed using R software, and three centrality indices (strength, closeness, and betweenness) were calculated to determine core symptoms.</p><p><strong>Results: </strong>The prevalence of kinesiophobia in older adult patients with COPD was 88.46%. Latent profile analysis identified two classes: a high-fear-somatic focus group (67.4%) and a lower-fear-activity avoidance group (32.6%). Symptom network analysis revealed that the core symptom was dyspnea (strength = 1.78) in the high-fear group, whereas fatigue (strength = 1.64) was the core symptom in the lower-fear group. The difference in network structure between the two groups was not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Kinesiophobia in older adult patients with COPD exhibits population heterogeneity, with different core symptoms across subgroups. The findings of this study suggest that dyspnea deserves particular attention in the high-fear group, while fatigue deserves particular attention in the lower-fear group. Future longitudinal or interventional studies are needed to further verify the causal relationships between core symptoms and pulmonary rehabilitation participation, thereby informing the development of individualized pulmonary rehabilitation strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1919256"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-led rehabilitation after total hip or knee arthroplasty: a systematic review and meta-analysis of functional recovery, self-efficacy, and quality of life.","authors":"Ying Xu, Yan Chen, Yuan Yin, Mengxia Tang, Qin Luo","doi":"10.3389/fmed.2026.1911533","DOIUrl":"10.3389/fmed.2026.1911533","url":null,"abstract":"<p><strong>Background: </strong>Nurse-led rehabilitation is increasingly embedded in postdischarge care after total hip or knee arthroplasty, but its effect on patient-reported recovery has not been quantified through meta-analysis.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the effects of nurse-led rehabilitation versus usual care on functional recovery, self-efficacy, and quality of life after total hip or knee arthroplasty.</p><p><strong>Methods: </strong>PubMed, Scopus, Web of Science, and ClinicalTrials.gov were searched (2010-2026; English only) for randomized controlled trials comparing nurse-led rehabilitation with usual care. Standardized mean differences (Hedges <i>g</i>) were pooled using random-effects models with Hartung-Knapp confidence intervals. Heterogeneity was assessed with <i>I</i> ² and prediction intervals, robustness with leave-one-out and subgroup analyses, and certainty with Grading of Recommendations Assessment, Development and Evaluation (GRADE).</p><p><strong>Results: </strong>Eleven trials (1,107 participants) were included. Nurse-led rehabilitation improved functional recovery (10 trials; <i>g</i> = 1.11, 95% confidence interval 0.42-1.81; <i>I</i> ² = 94.5%), self-efficacy (five trials; <i>g</i> = 1.10, 0.00-2.20; <i>I</i> ² = 93.8%), and quality of life (four trials; <i>g</i> = 0.77, 0.08-1.46; <i>I</i> ² = 81.7%). The certainty of evidence (GRADE) was rated low for all three primary outcomes. Secondary outcomes were directionally favorable but imprecise. The functional recovery effect was robust to leave-one-out analysis, whereas self-efficacy was statistically fragile. Quality of life showed a homogeneous benefit after knee replacement (<i>g</i> = 1.12, <i>I</i> ² = 0%) but not hip (between-subgroup <i>p</i> = 0.032), and functional recovery differed by delivery model (<i>p</i> = 0.012, largest for digital). Heterogeneity was substantial throughout, all prediction intervals crossed the null, and funnel plot asymmetry suggested possible small-study effects.</p><p><strong>Conclusions: </strong>Nurse-led rehabilitation after hip or knee arthroplasty was associated with improved function, self-efficacy, and quality of life, consistently favoring nurse-led care in direction but with evidence of low certainty, substantial between-study heterogeneity, prediction intervals that crossed the null, and possible small-study effects. Therefore, the magnitude of benefit remains uncertain. Adequately powered, outcome-blinded trials are needed.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425216, PROSPERO CRD420261425216.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1911533"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is painless colonoscopy associated with trainee learning? A single-center study of insertion speed and adenoma detection curves in 1,769 procedures.","authors":"Yiming Ding, Hongjuan Wang, Xiangchun Lin","doi":"10.3389/fmed.2026.1965959","DOIUrl":"10.3389/fmed.2026.1965959","url":null,"abstract":"<p><strong>Objective: </strong>To compare the learning curves of cecal intubation time and adenoma detection rate (ADR) between painless (sedated) and conventional (non-sedated) colonoscopy performed by trainees.</p><p><strong>Methods: </strong>This single-center retrospective cohort comprised the first 1,769 colonoscopies performed by eight trainees without prior colonoscopy experience, grouped by sedation status into a conventional group (<i>n</i> = 852) and a painless group (<i>n</i> = 917). Mixed-effects models characterized the learning trajectories of cecal intubation time and ADR, and an extended model allowing a random case-order slope tested individual heterogeneity. The caseload to independent cecal intubation competency was estimated with a rolling 20-procedure success-rate threshold and Bernoulli cumulative sum (CUSUM) analysis.</p><p><strong>Results: </strong>Cecal intubation time was shorter in the painless group (median 6 vs. 10 min, <i>P</i> < 0.001). The case-order × procedure-type interaction fell from -0.113/SD (<i>P</i> < 0.001) in the random-intercept model to -0.027/SD (<i>P</i> = 0.589) in the random-slope model and was not significant under an exact trainee-level permutation test (exact <i>P</i> = 0.23); the overall shortening of intubation time with painless colonoscopy was robust to all specifications. Sedation status, calendar era, and scope model were highly correlated at the trainee level (<i>r</i> = 0.92), precluding separation of their independent effects. The overall ADR was 13.0% and declined early with experience (odds ratio 0.80/SD, <i>P</i> = 0.002). Fewer procedures were required to reach independent cecal intubation competency in the painless group (rolling threshold 37 vs. 114; CUSUM 107 vs. 134); however, this difference could not be separated from calendar era and equipment upgrades.</p><p><strong>Conclusion: </strong>Intubation time was shorter overall under sedation, but the faster learning of the painless group vanished once individual heterogeneity was modeled, and ADR showed no robust improvement. Sedation, era, and equipment were confounded; no causal inference regarding the effect of sedation on learning can be drawn from these data, and prospective confirmation is required. Intubation speed alone should not serve as a benchmark of overall colonoscopy competence.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1965959"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BCG-YOLO: an efficient YOLO-based framework for multi-class blood cell detection in microscopic images.","authors":"Zhu Chen, Yiliang Bao, Yi Liu, Zhongyu Li, Dini Zhang, Meijing Xiao, Yuan Guo, Jinque Luo","doi":"10.3389/fmed.2026.1934762","DOIUrl":"10.3389/fmed.2026.1934762","url":null,"abstract":"<p><strong>Objectives: </strong>Automated blood cell detection from microscopic images is essential for routine hematological examination and computer-assisted laboratory diagnosis. However, accurate detection remains challenging because of the small size, dense distribution, overlap, and indistinct boundaries of blood cells. This study aimed to develop an efficient deep learning framework for accurate multi-class detection of blood cells in microscopic images.</p><p><strong>Methods: </strong>We developed BCG-YOLO, an enhanced detector based on YOLO11n that integrates a lightweight backbone network, an improved multi-scale feature fusion module, and a dynamic detection head to improve feature representation and adaptive detection of small and densely distributed blood cells. The proposed model was evaluated on the public BCCD dataset and compared with representative one-stage detectors, transformer-based methods, and real-time object detection models. Ablation studies were conducted to assess the effectiveness of each proposed component. Additional five-fold cross-validation and paired image-level bootstrap analyses were performed for YOLO11n and BCG-YOLO.</p><p><strong>Results: </strong>On the original fixed test split, BCG-YOLO achieved an mAP@0.5 of 95.3%, an mAP@0.5:0.95 of 67.6%, and a recall of 89.8% while requiring only 3.80 GFLOPs. Under the common training and evaluation protocol used in this study, BCG-YOLO achieved the best overall detection performance among all evaluated models. Ablation experiments further demonstrated the effectiveness of the proposed modules, confirming consistent improvements in overall detection performance and computational efficiency.</p><p><strong>Conclusions: </strong>BCG-YOLO provided a favorable balance between detection accuracy and computational cost in the internal evaluation on BCCD. These findings support its feasibility for microscopic blood-cell detection, while independent external validation is required to establish generalizability across laboratories, staining protocols, and imaging systems.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1934762"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety awareness, attitudes, and behaviors among university students in Saudi Arabia: implications for pre-employment safety readiness.","authors":"Mohammed Alsubaie, Sadeq Abu-Dawas, Aiman Alwadi, Sereen Kazim, Narmeen Shaikh, Fouad Jabri, Mohammad Hasan Rajab, Noara Alhusseini, Majed Ramadan","doi":"10.3389/fmed.2026.1940131","DOIUrl":"10.3389/fmed.2026.1940131","url":null,"abstract":"<p><strong>Background: </strong>Safety culture supports safe learning environments and is widely regarded as a determinant of safety practice, yet evidence among university students in Saudi Arabia remains limited. Because students represent the future workforce in safety-sensitive fields such as healthcare, engineering, and science, characterizing their safety awareness, attitudes, and behaviors is relevant to occupational health practice. This study assessed these three domains among students at a single private university in Riyadh and identified demographic factors associated with them.</p><p><strong>Methods: </strong>A single-center cross-sectional survey was conducted among a convenience sample of 370 undergraduate and graduate students at Alfaisal University, Riyadh, Saudi Arabia, using a previously validated 19-item questionnaire assessing safety awareness and attitudes (12 items) and safety behaviors (7 items). Descriptive statistics and multivariable generalized linear model (GLM) analyses identified demographic factors independently associated with each domain. Findings are discussed in relation to pre-employment safety readiness; workplace safety behavior and performance were not measured.</p><p><strong>Results: </strong>Most participants were aged 18-22 years (76.2%), female (62.2%), and undergraduate (86.2%). Mean scores were 3.44 ± 0.71 for safety awareness and attitudes and 3.63 ± 0.69 for safety behavior. Female students scored significantly higher than male students on both safety awareness and attitudes (<i>β</i> = 0.27, 95% CI: 0.12 to 0.42; <i>p</i> = 0.0006) and safety behavior (<i>β</i> = 0.23, 95% CI: 0.08 to 0.38; <i>p</i> = 0.002). Non-Saudi students scored significantly higher than Saudi students on both safety awareness and attitudes (<i>β</i> = 0.27, 95% CI: 0.10 to 0.44; <i>p</i> = 0.001) and safety behavior (<i>β</i> = 0.19, 95% CI: 0.03 to 0.36; <i>p</i> = 0.010). Adjusted models accounted for a small proportion of variance (R² = 0.082 and 0.070, respectively). Age, academic level, marital status, and college affiliation were not significantly associated with either outcome.</p><p><strong>Conclusions: </strong>University students showed generally positive yet moderate safety awareness, attitudes, and behaviors. Gender and nationality were the only variables that reached statistical significance in the adjusted models, and the associated effects were small. Because subsequent workplace safety readiness and performance were not measured, these findings describe students at one point in time and do not demonstrate future occupational behavior. They identify pre-workforce groups with lower current scores and provide baseline, hypothesis-generating evidence for multicenter and longitudinal studies in Saudi Arabia.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1940131"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}