Frontiers in Medicine最新文献

{"title":"Development and internal validation of a CatBoost-SHAP-guided nomogram for significant liver fibrosis in children with chronic hepatitis B.","authors":"Yuanzhen Zhang, Tingting Wu, Yunan Chang, Xiaorong Peng, Kai Zhu, Yijing Liu, Tingting Shang, Tao Qin, Jing Zhu, Jiao Tian, Ruiqiu Zhao, Hongmei Xu","doi":"10.3389/fmed.2026.1927678","DOIUrl":"10.3389/fmed.2026.1927678","url":null,"abstract":"<p><strong>Background: </strong>Significant liver fibrosis can develop in children with chronic hepatitis B (CHB), yet liver biopsy is invasive and unsuitable for repeated assessment. We developed an interpretable, non-invasive prediction model for significant fibrosis in pediatric CHB and evaluated whether baseline risk stratification was associated with subsequent treatment outcomes.</p><p><strong>Methods: </strong>This retrospective study included 232 children with CHB who underwent liver biopsy, with significant fibrosis defined as Scheuer stage S ≥ 2. Patients were randomly assigned to a development cohort (80%) and a held-out test set (20%). A CatBoost model with Bayesian hyperparameter optimization was used to identify the most informative predictors, and these variables were incorporated into a logistic regression nomogram guided by Shapley additive explanations (SHAP). Model performance was evaluated by discrimination, calibration, decision curve analysis, and DeLong testing. Associations between baseline risk groups and longitudinal outcomes were examined using generalized estimating equations adjusted for age and sex and Kaplan-Meier analyses.</p><p><strong>Results: </strong>Significant fibrosis was identified in 96 children (41.4%). Liver stiffness measurement, alanine aminotransferase, and platelet count were retained in the final model. The nomogram achieved an area under the receiver operating characteristic curve (AUC) of 0.828 (95% CI, 0.767-0.889) in the development cohort and 0.782 (95% CI, 0.637-0.927) in the held-out test cohort, with performance comparable to that of the CatBoost model (<i>P</i> = 0.240). Compared with the low-risk group, high-risk patients showed greater longitudinal reductions in alanine and aspartate aminotransferase, whereas longitudinal changes in liver stiffness measurement and hepatitis B virus DNA were similar between groups. Conversely, low-risk patients achieved virological suppression, HBeAg seroconversion, and biochemical response earlier than those classified as high risk.</p><p><strong>Conclusions: </strong>An interpretable three-variable prediction model based on CatBoost-guided feature selection accurately identified significant fibrosis in children with CHB while maintaining performance comparable to the machine-learning model. Baseline risk stratification was also associated with subsequent treatment outcomes, although external validation is needed before clinical implementation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1927678"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223769","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":"Surgical management of intraocular lens dislocation in highly myopic eyes.","authors":"Shiyu Tang, Chenxi Li, Zihan Xie, Fan Yang, Yuye Zhang, Wenting Cai, Tianyu Zheng","doi":"10.3389/fmed.2026.1922084","DOIUrl":"10.3389/fmed.2026.1922084","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the postoperative visual function, intraocular lens (IOL) positional stability and ocular safety of surgical strategies tailored to capsular support status for the treatment of IOL dislocation in patients with high myopia, and to explore the potential impact of such complex surgeries on macular microcirculation.</p><p><strong>Methods: </strong>This single-center retrospective included 28 patients (28 eyes) with high myopia and IOL dislocation who underwent surgical treatment from January 2024 to August 2025. Surgical approaches were selected based on preoperative anatomical conditions and capsular status, including IOL explantation without secondary IOL implantation in 10 eyes, in-the-bag IOL repositioning in 6 eyes, and sutured scleral fixation of a posterior chamber IOL in 12 eyes. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and IOL tilt and decentration before surgery and at 6 months postoperatively. Safety measures included intraocular pressure (IOP), corneal endothelial cell density (ECD), postoperative complications. Postoperative retinal microcirculation parameters assessed by WF-OCTA were included as exploratory outcomes. Whereas the IOL-position comparison included only the 18 operated eyes retaining an IOL and their corresponding 18 matched control eyes. Before quantitative analysis, all OCTA images were reviewed for image quality.</p><p><strong>Results: </strong>Compared with preoperative values, UDVA (0.59 ± 0.46 logMAR, <i>P</i> = 0.005) and CDVA (0.38 ± 0.59 logMAR, <i>P</i> = 0.031) were significantly improved at 6 months postoperatively. Postoperative IOL position was evaluated in the 18 eyes retaining an IOL; 3 (16.7%) exceeded the 6° tilt threshold and 2 (11.1%) exceeded the 0.6 mm decentration threshold. The postoperative 2D tilt of IOL was 4.51 ± 2.17°, 2D decentration was 0.45 ± 0.33 mm, 3D tilt was 4.41 ± 2.09°, and 3D decentration was 0.44 ± 0.34 mm. Corneal ECD decreased from 2672.72 ± 312.26 cells/mm² preoperatively to 2356.61 ± 420.15 cells/mm² postoperatively (<i>P</i> < 0.001), yet no corneal decompensation occurred. IOP remained stable during the follow-up period, and the incidence of complications was low. Regional WF-OCTA parameters varied between the operated and matched control eyes, without a consistent pattern across macular regions.</p><p><strong>Conclusion: </strong>In patients with high myopia and IOL dislocation, different surgical approaches can achieve stable intraocular optical reconstruction and improve mid-to-long-term visual function under the corresponding anatomical conditions. Although the magnitude of visual acuity improvement is limited in this population due to high myopia- related high-risk fundus factors.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1922084"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223924","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":"Hemoglobin-based oxygen carriers: evolution, translational applications and clinical considerations.","authors":"Huan Tang, Xinyi Liu, Hai Zhang, Xiaobo Huang, Chun Pan, Lin Chen","doi":"10.3389/fmed.2026.1939029","DOIUrl":"10.3389/fmed.2026.1939029","url":null,"abstract":"<p><p>Tissue survival depends on adequate oxygen delivery, yet when red blood cell (RBC) transfusions are unavailable or contraindicated, restoring oxygen delivery remains an urgent clinical need. To meet this need, researchers have developed hemoglobin-based oxygen carriers (HBOCs) that transport oxygen via cell-free hemoglobin circulating in plasma. However, the intrinsic toxicity of cell-free hemoglobin (Hb) has slowed its clinical translation. More fundamentally, it has shifted the field's focus from universal blood substitutes toward indication-specific solutions. Despite persistent mitigation efforts, no HBOC has gained full Food and Drug Administration (FDA) approval for human use, suggesting that these toxicities are not tractable engineering problems but intrinsic liabilities of the cell-free Hb molecule. A meta-analysis of early clinical trials reported increased risks of death and myocardial infarction with several HBOCs, prompting a clinical hold on HBOC trials in the United States. In this review, we trace the evolution of engineering strategies and examine the functional mechanisms that underpin these approaches. We then evaluate HBOCs not as universal RBC substitutes but as context-dependent strategies for oxygen delivery across acute resuscitation, organ preservation, and hypoxia-driven pathologies, followed by a safety assessment. In each scenario, clinical value rests on providing temporary oxygen support when standard transfusion is unavailable or inadequate, rather than on replicating the full functionality of RBCs. Although a universal RBC substitute remains a distant goal, HBOCs are progressively evolving into oxygen therapeutics specific to indications. Their clinical adoption will require rigorous evidence of long-term safety, manufacturing reproducibility, and clinically meaningful efficacy in well-defined patient populations.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1939029"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223787","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":"Pathogen-targeted quick multiplex PCR identification of <i>Chlamydia psittaci</i> and <i>Haemophilus influenzae</i> coinfection in pneumonia: a case report.","authors":"Ying Yuan, Jianhong Wang, Ning Feng, Fen Wu, Xiao Dong, Youxin Xu, Shunfeng Zhao, Tingzhao Tan","doi":"10.3389/fmed.2026.1890644","DOIUrl":"10.3389/fmed.2026.1890644","url":null,"abstract":"<p><p>This study describes a rare case of pneumonia induced by coinfection with <i>Chlamydia psittaci</i> (<i>C. psittaci</i>) and <i>Haemophilus influenzae (H. influenzae)</i>. The patient had a history of chronic nephritis and long-term pigeon breeding. The initial manifestation was slurred speech, followed by rapid progression to high fever and respiratory failure. Chest computed tomography revealed bilateral interstitial pneumonia, predominantly in the right lung. Pathogen-targeted quick multiplex polymerase chain reaction (pt-qPCR) confirmed the pathogens as <i>C. psittaci</i> and <i>H. influenzae</i>, and metagenomic next-generation sequencing (mNGS) further verified consistent results. After 7-days of combination therapy with doxycycline and azithromycin, the treatment was switched to doxycycline combined with moxifloxacin for an additional 8-days. The patient achieved complete recovery and was discharged from the hospital. This case suggests that pt-qPCR may facilitate early identification of mixed infections in patients with severe pneumonia and a history of avian exposure, thereby providing valuable information to guide clinical decision-making.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1890644"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223809","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":"Editorial: Paediatric drug development.","authors":"Mette Due Theilade Thomsen, Gesine Bejeuhr, Angeliki Siapkara, Cécile Ollivier, Edit Muhari-Stark, Mark Turner","doi":"10.3389/fmed.2026.1991290","DOIUrl":"https://doi.org/10.3389/fmed.2026.1991290","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1991290"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227617","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":"Physics-consistent equation discovery for drug solubility in supercritical CO₂ through symbolic regression and domain generalization.","authors":"Adel Alhowyan, Ahmad J Obaidullah, Wael A Mahdi","doi":"10.3389/fmed.2026.1972738","DOIUrl":"10.3389/fmed.2026.1972738","url":null,"abstract":"<p><p>Predicting drug solubility in supercritical CO₂ is challenging due to limited data, and strong inter-compound variability conditions that hinder generalization to unseen drugs. Although conventional machine learning models often achieve high accuracy, they rely on spurious correlations and lack interpretability, limiting practical use. This study proposes a unified framework combining symbolic regression with domain generalization techniques, including Invariant Risk Minimization (IRM) and Domain-Adversarial Neural Networks (DANN), to enable equation discovery. The framework enables the discovery of invariant, physically consistent equations that generalize beyond the training distribution. Symbolic regression extracts closed-form relationships, while IRM and DANN enforce invariance across domains within a multi-objective optimization setting. The optimized models achieved validation R² values of 0.907, 0.984, and 0.965 for symbolic regression, DANN, and GPR, respectively. Although the highest predictive accuracy was obtained by DANN and GPR, symbolic regression remained competitive under domain-wise evaluation while uniquely providing explicit closed-form relationships between solubility and the governing physicochemical variables. The results therefore demonstrate that predictive performance, interpretability, equation complexity, and physical consistency should be considered jointly when developing transferable models for supercritical CO₂ solubility.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1972738"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215529","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":"Development and validation of an interpretable prediction model for high-grade vesicoureteral reflux in children with urinary tract infections.","authors":"Le-Zhen Ye, Jian-Xin Sun, Jing Chen, Jin-Liang Chen, Ye Bi, Yan-Ru Zhang","doi":"10.3389/fmed.2026.1864622","DOIUrl":"10.3389/fmed.2026.1864622","url":null,"abstract":"<p><strong>Objective: </strong>High-grade vesicoureteral reflux (VUR) is prone to causing adverse clinical outcomes such as kidney damage, recurrent urinary tract infections, and hypertension. Early identification of the risk of developing high-grade VUR in children with urinary tract infections is of great significance for reducing unnecessary voiding cystourethrography (VCUG), guiding clinical decisions, and optimizing antibiotic management strategies.</p><p><strong>Methods: </strong>A total of 434 children with urinary tract infections who completed VCUG examination were retrospectively enrolled in this study. They were randomly divided into a training set (<i>n</i> = 304) and a test set (<i>n</i> = 130) in a 7:3 ratio. LASSO regression was used for feature selection. Based on the selected features, six machine learning prediction models were constructed: Logistic Regression, Random Forest, XGBoost, Gradient Boosting Machine, Elastic Net, and Support Vector Machine. The performance of the models was comprehensively evaluated using the area under the curve (AUC), integrated calibration index (ICI), precision-recall curve (PR), and decision curve analysis (DCA). Feature importance was ranked and explained using SHAP values.</p><p><strong>Results: </strong>Among the 434 patients, 156 individuals (35.9%) were diagnosed with grade ≥ 3 VUR. Seven predictive features were identified: delayed treatment response, annual UTI episodes, hydronephrosis, abnormal renal signal on MRU, febrile UTI (fUTI)/UTI ratio, age at first UTI, and non-Escherichia coli UTI episodes. Discrimination performance was comparable across the six models (test AUC range: 0.810-0.832; all pairwise DeLong tests <i>p</i> > 0.05); XGBoost was selected as the final model based on its good calibration (ICI=0.074) and consistent clinical net benefit, achieving a test AUC of 0.832 (95% CI: 0.757-0.897). Decision curve analysis showed that the model provided net benefits across threshold probabilities ranging from 0.15 to 0.90.</p><p><strong>Conclusions: </strong>We developed and validated a prediction model based on XGBoost, which can be used to assess the risk of high-grade vesicoureteral reflux in children with urinary tract infections. This model has good discrimination, acceptable calibration, and considerable clinical application potential. Additionally, based on this model, we developed and deployed a free online calculator at https://vur-prediction.yezhiqiu.cn, which can assist in real-time individualized risk assessment.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1864622"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215596","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":"Reclassification of obstetric antiphospholipid syndrome under the 2023 ACR/EULAR criteria: risk of under-recognition in patients with non-criteria antibodies and clinical implications.","authors":"Tingwei Sheng, Yuqi Tang, Zhengwei Tan, Ling Liu, Qiaoding Dai","doi":"10.3389/fmed.2026.1929786","DOIUrl":"https://doi.org/10.3389/fmed.2026.1929786","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize the clinical, serologic, and treatment features of patients with obstetric antiphospholipid syndrome (OAPS), determine the proportion meeting the laboratory domain of the 2023 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria, and examine patients identified through non-criteria antibodies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed consecutive women with a prior clinical diagnosis of OAPS at our center and assigned de-identified codes P1-P45. Of the 45 patients, 41 had sufficiently complete historical serologic documentation for laboratory-domain reclassification; P10, P17, P34 and P42 were retained in the descriptive cohort but treated as not assessable in the evaluable-case analysis. Two investigators independently scored each evaluable patient across the six clinical domains and two laboratory domains; classification required a cumulative score of ≥3 in both the clinical and laboratory domains. For patients with concomitant systemic lupus erythematosus (SLE), obstetric or hematologic manifestations attributable to SLE were excluded from APS scoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 45 patients were included, all female, with a mean age of 33.7 years (43 primary APS, 2 SLE-associated). Thirty-two patients (71.1%) had a history of pregnancy loss, and 20 had recurrent miscarriage. Anticardiolipin (aCL) IgG and IgM were positive in 9 and 14 patients, respectively; anti-&lt;i&gt;β&lt;/i&gt;2-glycoprotein I (anti-&lt;i&gt;β&lt;/i&gt;2GPI) IgG and IgM were positive in 2 and 16 patients, respectively; lupus anticoagulant (LAC) was positive in 2 patients. Fourteen patients (31.1%) carried non-criteria antibodies, including 7 with non-criteria antibodies only. Among the 41 patients with evaluable serologic data, 7/41 (17.1%) definitively met the ≥3-point laboratory threshold and 11/41 (26.8%) met it under the upper-bound assumptions. In the conservative sensitivity analysis, which counted P10, P17, P34 and P42 as below threshold, the corresponding estimates were 7/45 (15.6%) and 11/45 (24.4%). Patients with isolated IgM positivity, IgA-only antibodies, single-positive LAC, or non-criteria antibodies alone did not meet the threshold. An exploratory comparison found no statistically significant difference in documented standardized intervention between live-birth and further-loss cases [28/36 [77.8%] vs 6/9 [66.7%]; two-sided Fisher's exact &lt;i&gt;p&lt;/i&gt; = 0.666].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this single-center retrospective series of 45 patients, many patients were identified through non-criteria antibodies or low-weight serologic profiles and therefore did not meet the 2023 laboratory-domain threshold. Because of the small sample, these findings are descriptive and hypothesis-generating and should not be generalized. Nevertheless, they support using the 2023 criteria primarily to define homogeneous research cohorts rather than as ","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1929786"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149107317","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":"Research trends in post-ERCP pancreatitis: a dual-database bibliometric analysis.","authors":"Wei Tian, Xu Deng, Chunyuan Yang, Jianxing Tian, Zonglong Zhu, Rui Huang, Wei Pan","doi":"10.3389/fmed.2026.1966046","DOIUrl":"10.3389/fmed.2026.1966046","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is associated with several adverse events, of which post-ERCP pancreatitis (PEP) is the most frequent despite established preventive measures. Clinical reviews evaluate risk factors and interventions, but the organization and development of the research field have received less attention. This study examined the development of the literature on PEP incidence, risk stratification, prediction, and prevention.</p><p><strong>Methods: </strong>The Web of Science Core Collection (WoSCC) and Scopus were last searched on July 31, 2026. English-language articles and reviews were merged, deduplicated, screened, and manually standardized. The merged dataset was used to analyze publication output, countries, institutions, authors, source journals, and author keywords; citation-dependent analyses were restricted to WoSCC records. VOSviewer and CiteSpace were used for collaboration, co-occurrence, co-citation, clustering, temporal, and citation-burst analyses.</p><p><strong>Results: </strong>The final dataset comprised 1,686 publications, including 1,414 articles and 272 reviews; 1,449 WoSCC records were available for citation-dependent analyses. Annual publication was sporadic before 1996 and peaked at 133 records in 2025. The United States contributed 485 publications, followed by China (306) and Japan (217), and maintained links with countries across all three collaboration clusters. <i>Gastrointestinal Endoscopy</i> published the most records (<i>n</i> = 170) and was the most frequently co-cited journal (<i>n</i> = 11,065). Temporal analyses showed increasing attention to multimodal prevention and risk assessment. At the retrieval cutoff, adverse events and risk factors had the strongest ongoing keyword bursts, while artificial intelligence and machine learning remained emerging topics.</p><p><strong>Conclusion: </strong>PEP research has moved toward multimodal prevention and individualized risk estimation. The literature remains concentrated in specialist endoscopy journals and established clinical networks, with substantial contributions from East Asia. Broader multicenter collaboration and independent validation are needed before emerging prediction models can inform routine practice.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1966046"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215568","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":"Survival outcomes of spleen-strengthening and dampness-eliminating traditional Chinese medicine granules combined with lenvatinib for unresectable hepatocellular carcinoma: a large-sample retrospective study based on electronic medical records.","authors":"Canchao Sun, Juan Xu, Tiye Sun","doi":"10.3389/fmed.2026.1946173","DOIUrl":"10.3389/fmed.2026.1946173","url":null,"abstract":"<p><strong>Background: </strong>Lenvatinib has been proven as a first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). Traditional Chinese Medicine (TCM), particularly formulations targeting spleen strengthening and dampness elimination, has the potential for synergistic effects with targeted therapies. Researchers conducted a study to investigate the feasibility of combining spleen-strengthening and dampness-eliminating TCM granules with lenvatinib to improve survival rates in patients with unresectable HCC.</p><p><strong>Methods: </strong>This is a single-center retrospective cohort study that examined electronic medical records from one of the Beijing Royal Integrative Medicine Hospital between January 2023 and December 2025. Patients with unresectable HCC who received lenvatinib treatment as first-line therapy were divided into a combination group (TCM granules combined with lenvatinib, <i>n</i> = 186) and a control group (lenvatinib alone, <i>n</i> = 192). Balancing of baseline characteristics was done by use of propensity score matching (PSM). Overall survival (OS) was the primary endpoint; secondary endpoints included the incidence of adverse events, treatment duration, and the improvement of TCM syndromes.</p><p><strong>Results: </strong>Following 1:1 PSM, 156 patients were enrolled in each group. The combination group had a significantly longer median OS compared with the control group (18.7 months vs. 14.2 months; HR = 0.68, 95% CI: 0.52-0.89, <i>P</i> = 0.005). The incidence of Grade 3-4 adverse events was significantly lower in the combination group than in the control group (28.2% vs. 41.0%, <i>P</i> = 0.018). Treatment duration was significantly prolonged in the combination group (9.8 vs. 7.2 months, <i>P</i> = 0.012), and the combination group also showed better improvements in TCM syndrome scores.</p><p><strong>Conclusions: </strong>Adjunctive therapy with spleen-strengthening and dampness-eliminating TCM granules was associated with better survival outcomes and fewer adverse events in patients with unresectable HCC receiving lenvatinib. These findings provide a rationale for prospective trials evaluating the integration of TCM into modern oncological treatment paradigms for HCC.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1946173"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215618","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}