Frontiers in Medicine最新文献

{"title":"Risk factor analysis and development of a risk prediction model for facial pressure injury associated with noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease based on symptom science theory.","authors":"Chen Cheng, Lulu Cui, Changhai Wang, Yujie Zhang, Jun Ge, Jinmei Peng, Bin Zhang, Rong Zhao, Duoduo Qiao, Xiaoyun Chen, Yaojun Zhang, Pei Zhang, Manhong Zhang, Yan Wang, Xuling Gao, Changchun Song, Qiankun Liu","doi":"10.3389/fmed.2026.1897955","DOIUrl":"10.3389/fmed.2026.1897955","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive positive pressure ventilation is a key treatment for acute exacerbations of chronic obstructive pulmonary disease and is associated with a facial pressure injury incidence of 20% to 30%. However, current risk assessment still relies on generic tools such as the Braden scale, and there is a lack of risk prediction instruments that incorporate ventilation related respiratory mechanical parameters.</p><p><strong>Objective: </strong>Based on the Symptom Science Model 2.0, this study systematically examined factors associated with noninvasive positive pressure ventilation related facial pressure injury in patients with chronic obstructive pulmonary disease and developed and temporally validated a risk prediction model to provide a quantitative tool for early clinical warning and risk stratified prevention.</p><p><strong>Methods: </strong>From January 2020 to February 2025, we collected clinical data from 390 patients with chronic obstructive pulmonary disease receiving noninvasive positive pressure ventilation. Participants were divided by enrollment time into a training cohort of 273 patients enrolled between January 2020 and September 2023 for model development and a temporal validation cohort of 117 patients enrolled between October 2023 and February 2025 for model validation. Facial pressure injury was the outcome. Candidate predictors were screened using univariate analysis and least absolute shrinkage and selection operator regression, followed by multivariable logistic regression for model development, and 17 machine learning models were compared using five fold cross validation. Model performance was assessed using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis, and DeLong's test was used to compare area under the curve values. The selected model was further interpreted and visualized using SHAP.</p><p><strong>Results: </strong>The overall incidence of noninvasive positive pressure ventilation-related facial pressure injury was 23.33%. Multivariable logistic regression identified leak volume >40 L/min, higher inspiratory pressure, total ventilation time >100 h, single session duration ≥4 h, serum albumin <35 g/L, and a history of noninvasive ventilation use as independent risk factors, whereas BMI ≥18.5 kg/m<sup>2</sup> was a protective factor. Among the 17 models, the traditional and parsimonious logistic regression model was recommended, achieving an AUC of 0.785 (95% CI: 0.702-0.868) in the temporal validation cohort; calibration and decision curve analyses also indicated good agreement and favorable clinical net benefit. SHAP analysis showed that serum albumin, total ventilation time, and inspiratory pressure contributed most to the model.</p><p><strong>Conclusion: </strong>Based on the Symptom Science Model 2.0, we developed and temporally validated a risk prediction model that integrates noninvasive positive pressure ventilation-speci","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1897955"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215600","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":"Changes in spinopelvic sagittal parameters and functional outcomes after unilateral microscopic decompression for lumbar spinal stenosis.","authors":"Keyu Zhao, Jiale Wang, Hao Liu, Xiaoyang Tao, Tiantian Wang, Junjie Kang, Wupeng Yang, Yonghua Wang","doi":"10.3389/fmed.2026.1955497","DOIUrl":"10.3389/fmed.2026.1955497","url":null,"abstract":"<p><strong>Background: </strong>We evaluated short-term clinical and standing sagittal changes after unilateral microscopic channel-assisted decompression for lumbar spinal stenosis and examined their associations with disability and leg-pain improvement.</p><p><strong>Methods: </strong>This retrospective cohort included 68 patients treated between June 2024 and June 2025 and followed for 6-12 months. Oswestry Disability Index (ODI), leg-pain visual analog scale (VAS), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) were assessed before surgery and at final follow-up. Changes were calculated as final follow-up minus preoperative values. Correlations with ODI and VAS improvement rates were tested with Holm correction. Interobserver and intraobserver reliability were assessed using intraclass correlation coefficients. An adjusted association analysis included age, body mass index, baseline ODI, and decompression extent.</p><p><strong>Results: </strong>ODI and VAS decreased significantly after surgery. PT and SVA decreased, whereas SS, LL, and TK increased; PI did not change significantly. The increase in LL was modestly associated with ODI improvement (Pearson r = 0.360, 95% CI 0.133-0.551; Holm-adjusted <i>p</i> = 0.026). No sagittal parameter was significantly correlated with VAS improvement after correction. In the adjusted analysis, <i>Δ</i>LL was not independently associated with ODI improvement (B = -0.108, 95% CI -0.276-0.060; <i>p</i> = 0.207). Follow-up duration was not associated with <i>Δ</i>LL or <i>Δ</i>SVA. Reliability was good to excellent.</p><p><strong>Conclusion: </strong>Clinical outcomes and standing sagittal parameters changed over follow-up. In this cohort, a greater increase in LL was modestly associated with greater ODI improvement only in the unadjusted analysis. The sagittal changes may represent functional postural adaptation rather than structural correction, but the observational design does not establish causality.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1955497"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215597","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":"Associations of multiregional OCTA metrics and systemic hematologic biomarkers With 12-month diabetic retinopathy progression.","authors":"Lina Ge, Shenghai Huang, Weihe Zhou, Lijin Huang, Chaoying Ye, Ying Huang, Xueyi Chen","doi":"10.3389/fmed.2026.1951011","DOIUrl":"10.3389/fmed.2026.1951011","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the associations of multiregional macular and peripapillary OCTA metrics and systemic hematologic biomarkers with 12-month diabetic retinopathy progression and evaluated whether their combination improved prognostic discrimination.</p><p><strong>Methods: </strong>This single-center longitudinal cohort study included 55 adults with type 2 diabetes and established DR, contributing 108 eyes. Baseline macular and peripapillary vessel density parameters were obtained by OCTA, and peripheral blood laboratory markers were measured. DR progression was defined as worsening by at least two steps on the Diabetic Retinopathy Severity Scale (DRSS) at 12 months. Generalized estimating equation (GEE) models were used to account for within-participant inter-eye correlation. Univariable and multivariable GEE analyses were conducted to identify baseline factors independently associated with DR progression. Receiver operating characteristic analysis was performed for the individual markers and combined models.</p><p><strong>Results: </strong>During follow-up, 52 eyes (48.15%) showed DR progression and 56 eyes (51.85%) did not. In the final multivariable GEE model, higher temporal peripapillary VD (adjusted OR, 0.88; 95%CI, 0.81-0.95), higher deep VD within the 1-3-mm parafoveal annulus (adjusted OR, 0.86; 95% CI, 0.78-0.96; <i>P</i> = 0.01), and higher lymphocyte count (adjusted OR, 0.31; 95% CI, 0.11-0.87; <i>P</i> = 0.03) were associated with lower odds of progression. The AUCs were 0.72 for temporal peripapillary VD, 0.70 for deep parafoveal VD, and 0.70 for lymphocyte count. The OCTA model combining the two VD parameters achieved an AUC of 0.80 (95% CI, 0.72-0.88), whereas the OCTA-plus-lymphocyte model achieved an AUC of 0.84 (95% CI, 0.77-0.92). After internal validation by participant-level cluster bootstrap (500 resamples), the optimism-corrected AUC of the OCTA-plus-lymphocyte model was 0.83 (apparent AUC 0.84; optimism ≤0.012), and the 10-fold participant-level cross-validated AUC was 0.81 for the combined model vs. 0.78 for the OCTA-only model.</p><p><strong>Conclusion: </strong>Lower temporal peripapillary VD, lower deep parafoveal VD, and lower peripheral blood lymphocyte count were associated with 12-month DR progression. Their combination demonstrated the highest apparent discrimination in this cohort. As this is a single-center exploratory cohort without external validation, these discriminative estimates should be regarded as apparent, and the model requires confirmation in larger, multicenter longitudinal studies before clinical application.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1951011"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215769","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":"Case Report: Primary epithelioid angiosarcoma of the femur: two rare cases with atypical skeletal involvement.","authors":"Fangfang Xu, Min Xu, Qian Li, Fei Dong, Chao Wang","doi":"10.3389/fmed.2026.1955241","DOIUrl":"10.3389/fmed.2026.1955241","url":null,"abstract":"<p><strong>Background: </strong>Primary epithelioid angiosarcoma (EA) is an exceptionally rare malignant vascular tumor with aggressive behavior and nonspecific imaging features. Femoral involvement is particularly uncommon and may mimic other destructive bone neoplasms.</p><p><strong>Case report: </strong>We describe two men with primary EA of the femur. One patient presented with progressive right hip pain and a pathological fracture of the proximal femur, whereas the other presented with progressively worsening pain in the distal left thigh. Imaging demonstrated destructive osteolytic lesions with intramedullary involvement and variable extension into the adjacent soft tissues. Both patients underwent wide tumor resection followed by prosthetic reconstruction. Histopathological examination revealed malignant epithelioid vascular neoplasms, and immunohistochemical (IHC) positivity for endothelial markers supported the diagnosis.</p><p><strong>Conclusion: </strong>Primary femoral EA should be considered in the differential diagnosis of aggressive osteolytic lesions, particularly when relatively limited enhancement, hemorrhagic components, and adjacent soft tissue extension are present. Definitive diagnosis requires integrated assessment of radiological, histopathological, and IHC findings.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1955241"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215545","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":"Global trends and knowledge structure of cardiovascular magnetocardiography research: a bibliometric analysis.","authors":"Yaxing He, Xu Zhang, Xiaole Han, Zifeng Zhang, Shiqiang Zheng, Kangqi Tian, Min Xiang","doi":"10.3389/fmed.2026.1960096","DOIUrl":"10.3389/fmed.2026.1960096","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases remain a leading global health threat. Recent advances in room-temperature sensing and artificial intelligence (AI) have renewed research interest in the clinical translation of magnetocardiography (MCG) for cardiovascular diagnosis, yet the global research evolution of MCG has yet to be quantitatively characterized.</p><p><strong>Methods: </strong>Literature from the Web of Science Core Collection and Scopus (2000-2026) was analyzed using CiteSpace, VOSviewer, and R to evaluate publication trends, knowledge networks, and evolving frontiers.</p><p><strong>Results: </strong>A total of 631 WoSCC and 755 Scopus articles were included. The publication trajectory exhibits a prolonged plateau followed by substantial recent growth. Germany, the United States, and China are the most prolific contributors. Keyword analysis revealed a diversification of technological and analytical themes. While early literature was strongly associated with superconducting quantum interference devices-based MCG, recent research has increasingly highlighted optically pumped magnetometers, magnetic-field control, sensor arrays, magnetic noise suppression, and AI-based signal analysis. The application landscape has broadened from physiological validation to coronary artery disease diagnosis, arrhythmia assessment, and fetal electrophysiology.</p><p><strong>Conclusion: </strong>Collectively, these findings suggest that the evolution of cardiovascular MCG reflects the parallel development and interaction of sensor technologies, AI-based analysis, and emerging clinical applications. Future research should prioritize standardized protocols, scalable and robust acquisition systems, and explainable AI models to accelerate clinical implementation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1960096"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215680","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":"Mapping the complement-targeted landscape in igA nephropathy: a systematic review with structured descriptive synthesis.","authors":"Xin-Yu Li, Chang-Ying Zhong, Li-Nan Zhang, Yang Liu","doi":"10.3389/fmed.2026.1933632","DOIUrl":"10.3389/fmed.2026.1933632","url":null,"abstract":"<p><strong>Background: </strong>Complement activation is a key driver of disease progression in IgA nephropathy (IgAN). While previous syntheses were limited to phase II evidence, pivotal phase III data-including the 24-month results of the APPLAUSE-IgAN trial-have recently emerged, necessitating an updated appraisal of complement-targeted therapies.</p><p><strong>Methods: </strong>We conducted a systematic literature search in PubMed, Web of Science, Embase, and Cochrane up to April 24, 2026, for randomized controlled trials of complement inhibitors in adults with biopsy-proven IgA nephropathy. Due to marked mechanistic heterogeneity across agents targeting distinct complement nodes, a quantitative meta-analysis was not performed. Instead, we performed a structured descriptive synthesis, a predefined, domain-based comparative method, focusing on efficacy signals, safety profiles, and methodological disparities across trials.</p><p><strong>Results: </strong>Four RCTs comprising 584 patients were included, representing factor B and C5 inhibition. The phase III iptacopan trial demonstrated robust proteinuria reduction, eGFR slope attenuation, and a decreased risk of kidney failure, but a higher serious-infection rate and confirmed pneumococcal infections highlighted that alternative-pathway inhibition attenuates rather than abolishes encapsulated-bacteria risk. Phase II trials of ravulizumab, iptacopan, and cemdisiran provided early efficacy signals with no encapsulated-bacterial events reported, though small size and short follow-up limit safety inference. All trials required prophylactic vaccination, and infection-risk obligations differed by target-terminal-pathway inhibitors carrying the strictest REMS requirements. Methodological heterogeneity-particularly regarding biopsy timing and fibrosis exclusion-emerged as a major barrier to cross-trial comparisons. Beyond these RCTs, a dynamic pipeline of ASO, siRNA, and small-molecule inhibitors continues to evolve.</p><p><strong>Conclusion: </strong>Complement inhibitors show promising but heterogeneous signals across individual trials; however, marked differences in molecular targets, trial design, and eligibility preclude any inference of a uniform class effect. Infection risk mitigation differs by complement target-terminal-pathway inhibitors carry the highest encapsulated-bacterial burden and strictest regulatory constraints, whereas alternative-pathway inhibitors preserve partial vaccine-mediated defence but still require comprehensive vaccination and surveillance. These observations are hypothesis-generating and underscore the need for mechanism-specific phase III programmes with hard renal endpoints and individual patient-level meta-analyses to advance precision complement therapeutics in IgAN.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261385690.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1933632"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215316","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":"A latent metabolic dysfunction phenotype integrating insulin resistance and leptin is associated with disease severity in COPD.","authors":"Oana Maria Catana, Denisa Maria Mitroi, Ramona Cioboata, Ovidiu Mircea Zlatian, Mircea Popescu-Driga, Cristina Calarasu, Costin Teodor Streba","doi":"10.3389/fmed.2026.1915198","DOIUrl":"10.3389/fmed.2026.1915198","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is increasingly recognised as a systemic condition in which metabolic dysfunction may influence disease severity and exacerbation risk. The combined effects of insulin resistance and leptin dysregulation on COPD outcomes remain incompletely defined. This study evaluated their associations with exacerbation burden, airflow limitation and patient-reported outcomes, and assessed the discriminative performance of HOMA-IR and serum leptin for identifying advanced disease.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted at a tertiary care centre in southern Romania, including 96 patients with COPD and 24 healthy controls. Fasting insulin and serum leptin were measured, and insulin resistance was assessed using HOMA-IR. Spirometry and patient-reported outcomes (CAT, mMRC and SGRQ-C) were assessed in COPD patients. Metabolic markers were analysed individually and as a latent metabolic dysfunction phenotype using generalized structural equation modelling (GSEM).</p><p><strong>Results: </strong>Compared with controls, COPD patients had higher HOMA-IR (+206.9%), insulin (+112.2%) and leptin (+52.8%) levels. Both HOMA-IR and leptin were inversely correlated with spirometric indices, with stronger associations observed for HOMA-IR. Within the COPD cohort, neither individual metabolic markers nor a latent metabolic dysfunction phenotype integrating HOMA-IR, body mass index and leptin was associated with annual exacerbation rate (latent factor IRR = 1.089, 95% CI: 0.841-1.410, <i>p</i> = 0.517). HOMA-IR demonstrated better discrimination of advanced disease than leptin (AUC = 0.769 vs. 0.590, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Metabolic dysfunction is substantially more pronounced in COPD than in individuals without airflow obstruction and correlates with the degree of airflow limitation, but does not independently predict exacerbation frequency within the COPD population. HOMA-IR outperformed leptin as a marker of disease severity, a finding that requires further validation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1915198"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215587","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":"Previous caesarean delivery is associated with adverse obstetric and perinatal outcomes: a real-world cohort study of 26,843 singleton pregnancies.","authors":"Yi Yuan, Fan Wu, Jinfang Wang, Chuanmei Qin, Haoyi Jia, Yan Hou, Huiling Zhang, Shuqin Ma, Weihong Zeng, Yi Lin","doi":"10.3389/fmed.2026.1915443","DOIUrl":"10.3389/fmed.2026.1915443","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between a history of caesarean delivery and subsequent obstetric and perinatal outcomes.</p><p><strong>Design: </strong>A real-world retrospective cohort study was conducted at a large tertiary maternity hospital in Shanghai, China.</p><p><strong>Patients: </strong>Among 118,375 deliveries from January 2014 to August 2021, a total of 26,843 singleton pregnancies ≥28 weeks' gestation were included for analysis, comprising 11,359 women with a previous caesarean section (CS) and 15,484 with a prior vaginal delivery.</p><p><strong>Main outcomes: </strong>Obstetric and perinatal outcomes including placenta previa, placenta abruption, abnormal placental morphology, emergency CS, elective CS, gestational diabetes mellitus (GDM), preeclampsia (PE), postpartum hemorrhage, preterm birth, low birth weight, congenital malformation, neonatal asphyxia, and congenital infection.</p><p><strong>Results: </strong>After adjusting for relevant confounders, multivariable modified Poisson regression analyses showed that women with a previous CS history were associated with placenta previa [adjusted risk ratio (aRR): 1.71, 95% confidence interval (CI): 1.39-2.10], GDM (aRR: 1.28, 95% CI: 1.20-1.37), PE (aRR: 1.88, 95% CI: 1.56-2.27), elective CS (aRR: 1.35, 95% CI: 1.30-1.40), emergency CS (aRR: 1.24, 95% CI: 1.14-1.35), postpartum hemorrhage (aRR: 1.94, 95% CI: 1.45-2.58), preterm birth (aRR: 1.50, 95% CI: 1.36-1.65) and low birth weight (aRR: 1.37, 95% CI: 1.22-1.55). In sensitivity analyses using propensity score matching and multiple imputation, the associations remained consistent.</p><p><strong>Conclusion: </strong>A previous CS history is associated with adverse obstetric and perinatal outcomes, particularly placenta previa, GDM, PE, postpartum hemorrhage, preterm birth, and low birth weight. The association may vary by maternal age and history of miscarriage.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1915443"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215456","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":"Quantitative CT features for COPD classification and GOLD spirometric severity assessment: a single-center model-development study.","authors":"Kaifeng Du, Jiameng Gao, Ji Li, Xiaojing Liu, Fang Wang, Yuhao Qian, Xiwen Gao, Zhihong Chen","doi":"10.3389/fmed.2026.1900490","DOIUrl":"10.3389/fmed.2026.1900490","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is diagnosed primarily by post-bronchodilator spirometry, but quantitative CT can characterize emphysema and visible-airway structural abnormalities that are not fully captured by airflow measurements alone. Because CT-derived emphysema and airway features have been extensively studied, this single-center study aimed to develop and describe quantitative CT-based classification models and to explore bronchial-tree morphology as a hypothesis-generating imaging phenotype, rather than to establish a clinically validated diagnostic replacement for pulmonary function testing.</p><p><strong>Methods: </strong>We enrolled 229 participants (138 with COPD and 91 control participants) at Fudan University Zhongshan Hospital. HRCT was used to quantify visible-airway dimensions at a prespecified eighth-generation airway, emphysema extent quantified as low attenuation area percentage (LAA%), and bronchial-tree morphology. Clinical variables including smoking history, modified Medical Research Council (mMRC) dyspnea score, and pulmonary function tests were recorded. Multivariable logistic regression was used to develop single-center models for COPD classification and for classification of severe airflow obstruction (FEV1%pred < 50%, corresponding to GOLD spirometric grades 3-4). Model performance is reported as apparent performance because internal and external validation were not performed.</p><p><strong>Results: </strong>Compared with control participants, COPD participants had smaller airway lumen area, higher wall-to-diameter ratio (T/D), higher wall area percentage (WA%), and higher LAA%. Mean wall thickness did not differ significantly, indicating that the group difference mainly reflected lumen narrowing rather than wall thickening. Emphysema extent was associated with lower FEV1/FVC and FEV1%pred. Sparse-type bronchial morphology was associated with COPD in multivariable analysis (OR 28.6, 95% CI 6.7-149.8), but the wide confidence interval and the need for reproducible operational validation require cautious interpretation. The combined clinical-CT development models achieved apparent AUCs of 0.906 for COPD classification and 0.859 for classification of severe airflow obstruction.</p><p><strong>Conclusion: </strong>Quantitative HRCT emphysema and visible-airway measurements were associated with COPD status and spirometric airflow obstruction. The models should be regarded as single-center development models, and the bronchial-tree morphology finding should be interpreted as hypothesis-generating until reproducibility, calibration, incremental value, and external validation are demonstrated.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1900490"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215551","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: The gut-liver axis in MASLD: microbiome, metabolism, disease progression and therapeutic pathways.","authors":"Zhengyang Bao","doi":"10.3389/fmed.2026.1947178","DOIUrl":"10.3389/fmed.2026.1947178","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1947178"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215735","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}