Frontiers in Medicine最新文献

{"title":"Case Report: Catamenial pneumothorax: clinical characteristics, diagnosis, and management - a report of two cases with a review of the literature.","authors":"Wen-Song Shi, Yueyao Liu, He Liu, Yu-Zhui Hu, Huijuan Fang, Meng-Hao Zhou, Liang-Yi Dong, Hui-Yu Zheng, Hongjuan Li","doi":"10.3389/fmed.2026.1984821","DOIUrl":"10.3389/fmed.2026.1984821","url":null,"abstract":"<p><p>Pneumothorax is a pathological condition in which gas enters the pleural cavity due to trauma, surgery, positive-pressure ventilation, thoracentesis, or other causes, leading to compression and collapse of the lung tissue. It exhibits a male predominance and can occur in all age groups. Catamenial pneumothorax, also referred to as thoracic endometriosis syndrome-associated pneumothorax, is a rare subtype. It is characterized by spontaneous and recurrent pneumothorax occurring in women of reproductive age during the perimenstrual period. Clinicians often fail to associate pneumothorax with the menstrual cycle, resulting in a high rate of misdiagnosis in clinical practice, which in turn leads to recurrent episodes and protracted clinical courses. This article presents two case reports, summarizes and analyzes their clinical features, and explores diagnostic and therapeutic strategies, with the aim of enhancing awareness of the association between recurrent pneumothorax and menstruation in women of reproductive age, thereby reducing underdiagnosis and misdiagnosis.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1984821"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215249","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":"Disproportionality analysis of adverse event reporting with aspirin, statins, and their co-exposure in FAERS, 2004-2025.","authors":"Zuofeng Cao, Baojun Xie, Ping Lai, Qijian Wang, Hongzhou Zhang, Bei Wang, Yaxuan Qiu, Qinfu Yan, Jiayuan Ling, Yongling Liao","doi":"10.3389/fmed.2026.1923188","DOIUrl":"10.3389/fmed.2026.1923188","url":null,"abstract":"<p><strong>Objective: </strong>To characterize and compare adverse-event reporting patterns for aspirin without statins, statins without aspirin, and aspirin-statin co-exposure in the FDA Adverse Event Reporting System (FAERS), and to explore statistical reporting-interaction signals.</p><p><strong>Methods: </strong>We analyzed FAERS reports from 2004 Q1 through 2025 Q1. Active-comparator disproportionality analyses compared aspirin-statin co-exposure with aspirin-without-statin and statin-without-aspirin reports using the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and empirical Bayesian geometric mean (EBGM), followed by Benjamini-Hochberg false discovery rate (BH-FDR) correction. Candidate preferred terms (PTs) common to both active-comparator analyses underwent adjusted statistical interaction analyses using four exposure groups, including a neither-drug reference. Primary models retained missing age, sex, and reporter type as explicit Unknown categories, and a complete-case sensitivity analysis excluded reports with missing adjustment covariates.</p><p><strong>Results: </strong>After deduplication, 18,932,599 unique FAERS reports were retained. The active-comparator analysis included 134,479 aspirin-without-statin reports, 202,565 statin-without-aspirin reports, and 70,806 aspirin-statin co-exposure reports. Among 9,332 and 9,736 PTs tested in the two active-comparator analyses, 119 and 254 PTs remained after prespecified signal-detection criteria and BH-FDR correction, respectively; 42 PTs were common to both comparisons. Adjusted interaction models were reliably estimable for 40 candidates, and 31 PTs met both additive and multiplicative reporting-interaction criteria. Missingness was substantial for age (42.33%), sex (12.12%), and reporter type (4.35%). The complete-case dataset retained 53.83% of reports, and 21 of the 31 primary both-scale-positive PTs remained jointly positive.</p><p><strong>Conclusions: </strong>Aspirin-statin co-exposure showed distinct adverse-event reporting patterns in FAERS. The identified signals are exploratory statistical reporting interactions and do not establish increased incidence, clinical risk, causality, or pharmacological drug-drug interactions. Only 21 of the 31 primary both-scale-positive PTs remained jointly positive in the complete-case sensitivity analysis, reinforcing the need for cautious interpretation and validation in denominator-based pharmacoepidemiologic datasets.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1923188"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215565","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: Synchronous double primary male breast cancer and non-small cell lung cancer: diagnostic confirmation and multidisciplinary management.","authors":"Ye Zhang, Lei Cao, Yu Zheng, Yang Yang, Xiaoqin Guan, Xiangxin Zheng, Peng Yang, Weiyou Zhu","doi":"10.3389/fmed.2026.1950636","DOIUrl":"10.3389/fmed.2026.1950636","url":null,"abstract":"<p><strong>Background: </strong>Male breast cancer (MBC) is rare, accounting for approximately 1% of all breast cancers. When MBC is diagnosed simultaneously with a second primary lung cancer, treatment planning becomes particularly complex because diagnostic certainty, technical resectability, competing treatment windows, and radiotherapy safety must all be considered.</p><p><strong>Case presentation: </strong>We report a 72-year-old man who was synchronously diagnosed with left invasive ductal breast carcinoma and right lower lobe poorly differentiated non-small cell lung cancer (NSCLC). The breast cancer was staged as pT₃N_2aM₀, AJCC 8th edition stage IIIA, with strong ER/PR expression and HER2 nonamplification. The lung lesion was pathologically diagnosed as poorly differentiated NSCLC without definitive glandular, squamous, or neuroendocrine differentiation and was staged as cT₃N₀M₀, AJCC 8th edition stage IIB. Although stage IIB NSCLC is usually evaluated for surgery, this tumor closely involved the right lower lobe pulmonary vessels and bronchial structures, and thoracic surgeons considered upfront radical resection technically unsafe because of the risks of hemorrhage, extended resection, impaired blood supply to the remaining lobes, and loss of pulmonary function. After multidisciplinary team (MDT) discussion, the patient underwent left modified radical mastectomy, adjuvant AC-T chemotherapy, and simultaneous postmastectomy radiotherapy to the left chest wall/regional nodes with definitive radiotherapy to the right lung lesion plus concurrent cisplatin. Imaging shortly after radiotherapy showed marked shrinkage of the right lung lesion, but subsequent CT and liver MRI suggested systemic progression with multiple hepatic lesions. The patient declined liver biopsy, received one cycle of vinorelbine plus cisplatin with Endostar, discontinued further treatment, and died of liver failure in March 2026.</p><p><strong>Conclusion: </strong>This case illustrates that therapeutic prioritization in synchronous double primary cancers should not be determined solely by TNM stage or chronological order of diagnosis. Instead, treatment decisions should integrate pathological distinction, tumor biology, anatomical treatability, technical resectability, curative potential, competing treatment windows, and short-term clinical threat. In selected patients, simultaneous postmastectomy radiotherapy and definitive lung radiotherapy may be feasible when supported by MDT consensus, dosimetric review, and close toxicity monitoring.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1950636"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215572","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":"Deep learning and metaheuristic optimization for predicting drug release from nanocarrier systems: a data-driven framework for formulation development.","authors":"Hadil Faris Alotaibi, Saad S Alqahtani","doi":"10.3389/fmed.2026.1962360","DOIUrl":"10.3389/fmed.2026.1962360","url":null,"abstract":"<p><p>Drug-release profiles from nanocarrier systems are governed by nonlinear and multiphasic physicochemical interactions that are difficult to predict using conventional kinetic models. This study presents a data-driven predictive framework that integrates deep neural networks (DNNs) with three bio-inspired metaheuristic optimization algorithms: the Transit Search Optimization Algorithm (TSA), Crocodile Hunting Strategy (CHS), and Osprey Optimization Algorithm (OOA). The models were developed and evaluated using a dataset of 403 nanocarrier formulations compiled from 237 peer-reviewed studies. Predictive performance was assessed using RMSE, MSE, R², Nash-Sutcliffe Efficiency (NSE), and GR125, followed by multi-criteria ranking with TOPSIS and statistical validation using the Kruskal-Wallis and Friedman tests. Among the evaluated models, the OOA-optimized DNN achieved the best overall performance, reaching a minimum RMSE of approximately 1.01 and an R² of approximately 0.99 while exhibiting stable convergence and statistically significant improvements over the competing optimization strategies. The proposed framework provides a robust in-silico tool for modeling complex drug-release behavior, reducing experimental screening requirements, and supporting data-driven formulation optimization, Quality by Design (QbD), and Model-Informed Drug Development (MIDD) for nanocarrier systems.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1962360"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215617","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":"Factors associated with high-grade cervical dysplasia in colposcopy patients: the primary role of isolated HPV 16 positivity.","authors":"Alihan Tigli, Yakup Baykus, Rulin Deniz, Oguzhan Karakoc, Guzide Ece Akinci, Nazli Sener, Yasemin Ercan Degirmenci, Erdem Gurkan, Engin Korkmazer, Seyda Yavuzkir, Ahmet Yilmaz, Berrak Yildirim Aksakal, Sermin Kilic, Suleyman Aydin","doi":"10.3389/fmed.2026.1937610","DOIUrl":"10.3389/fmed.2026.1937610","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is the fourth most common cancer and a leading cause of cancer-related fatalities among women globally. Implementing personalized follow-up strategies is crucial for effective prevention of cervical cancer. The present investigation sought to delineate risk factors associated with the development of cervical intraepithelial neoplasia (CIN) in patients undergoing colposcopy through an analysis of colposcopy indications and histopathological outcomes.</p><p><strong>Methods: </strong>This retrospective study included 394 patients aged 30-65 years who underwent colposcopy at Bandırma Onyedi Eylül University Faculty of Medicine Hospital between June 2022 and January 2025 due to high-risk Human Papillomavirus (HR-HPV) positivity, abnormal cervical cytology, or persistent clinical suspicion. The indications for colposcopy, histopathology results, and demographic characteristics such as age and smoking status were analyzed.</p><p><strong>Results: </strong>The mean age of the patients was 44.5 ± 10.9 years. The primary indication for colposcopy was observed to be isolated HPV 16 positivity, which accounted for 28% (<i>n</i> = 112) of cases. Histopathological evaluation showed no cervical dysplasia in 47.3% (<i>n</i> = 186), CIN I in 34.5% (<i>n</i> = 136), CIN II-III in 17.7% (<i>n</i> = 70), and cervical carcinoma in 0.5% (<i>n</i> = 2). Isolated HPV 16 positivity remained a significant independent predictor of CIN II-III after adjustment for age and smoking status (Adjusted Odds Ratio (AOR) = 2.388, 95% Confidence Interval (CI): 1.387-4.112, <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Isolated HPV 16 positivity was independently associated with an approximately 2.4-fold increase in the odds of CIN II-III after adjustment for age and smoking status. This finding reinforces the central role of HPV 16 in identifying women at higher risk for high-grade cervical dysplasia and supports its prioritization in risk-based colposcopy and follow-up strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1937610"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215665","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":"Feasibility and safety of an F16 small-caliber catheter-based, irrigation-free protocol in BPH patients undergoing green laser enucleation of the prostate: a single-center retrospective cohort study.","authors":"Xin Gao, Kaibo Guo, Yijun Fu, Beixun Xu, Puzhao Liang, Jinfeng Xu, Jie Pan, Yongtong Ruan","doi":"10.3389/fmed.2026.1961968","DOIUrl":"10.3389/fmed.2026.1961968","url":null,"abstract":"<p><strong>Objective: </strong>GreenLight laser enucleation of the prostate (GreenLEP) offers superior hemostasis, raising the possibility of omitting postoperative continuous bladder irrigation. This study aimed to evaluate the feasibility and safety of an F16 small-diameter catheter non-irrigation protocol in BPH patients.</p><p><strong>Methods: </strong>A retrospective single-center study included 300 consecutive BPH patients undergoing GreenLEP at Yangjiang Hospital of Traditional Chinese Medicine between January 2024 and June 2025. The exposure was implementation of the F16 non-irrigation protocol. The primary outcome was successful completion without continuous bladder irrigation or secondary hemostatic intervention. Covariates included age, prostate volume (PV), operative time, ASA score, anticoagulant/antiplatelet use, urinary retention, preoperative catheterization, and concomitant bladder stones. Stratified analysis and ROC curve analysis were performed to explore predictors of failure.</p><p><strong>Results: </strong>Overall, 265 patients (88.3%) successfully completed the non-irrigation protocol. Median hemoglobin decrease was 2.0 g/L (IQR 1-3), with no blood transfusions. In the parsimonious multivariable logistic regression model adjusted for age, prostate volume, ASA classification, and anticoagulant/antiplatelet use, prostate volume was not independently associated with MajorFailure (adjusted OR 1.14 per 10-mL increase, 95% CI 0.76-1.71, <i>P</i> = 0.527). ROC analysis suggested a PV cutoff of 76.35 mL for predicting failure (AUC 0.65, 95% CI 0.55-0.75).</p><p><strong>Conclusion: </strong>The F16 non-irrigation protocol after GreenLEP is safe and feasible, with high success rates and minimal perioperative bleeding. Increased PV and anticoagulant therapy modestly reduce success but do not preclude application. These findings support broader implementation of non-irrigation strategies to enhance postoperative comfort and recovery.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1961968"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215700","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":"Air pollution exposure and cataract outcomes: a systematic review and pollutant-specific meta-analysis.","authors":"Bin Zhang, Bing Xu, Kasra Pakdaman","doi":"10.3389/fmed.2026.1969759","DOIUrl":"10.3389/fmed.2026.1969759","url":null,"abstract":"<p><strong>Background: </strong>Air pollution is increasingly recognized as a potentially modifiable environmental determinant of age-related ocular disease, but its association with cataract remains incompletely characterized. Epidemiological evidence remains heterogeneous across pollutants and study methods, although emerging experimental findings support biological plausibility for pollution-related lens injury.</p><p><strong>Objectives: </strong>To systematically evaluate the epidemiologic evidence linking air-pollution exposure with cataract-related outcomes and to quantitatively synthesize pollutant-specific associations where sufficiently comparable data were available.</p><p><strong>Methods: </strong>PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched through August 10, 2026 for observational studies reporting cataract-specific associations with specific air pollutants. Risk of bias was assessed using ROBINS-E for longitudinal follow-up studies and the WHO air-quality epidemiology instrument for cross-sectional and aggregate studies. Comparable hazard ratios (HRs) were synthesized using restricted maximum-likelihood random-effects models in Stata 18, with Knapp-Hartung sensitivity analyses.</p><p><strong>Results: </strong>Fifteen studies were included in the systematic review, of which seven contributed to at least one meta-analysis. The pooled HR was 1.036 (95% CI, 0.988-1.086) per 1 µg/m³ increase in PM₂.₅, 1.041 (95% CI, 1.013-1.070) per 10 µg/m³ increase in NO₂, and 1.010 (95% CI, 0.983-1.038) per study-specific interquartile-range increase in black carbon. Heterogeneity was substantial for PM₂.₅ (I² = 99.68%) and NO₂ (I² = 86.04%) but lower for black carbon (I² = 33.41%). The highest-versus-lowest quartile analysis also showed a positive association for NO₂ (HR, 1.094; 95% CI, 1.057-1.133; I² = 0.11%), whereas corresponding PM₂.₅ and PM₁₀ estimates were not statistically significant. Knapp-Hartung adjustment widened the NO₂ confidence intervals, indicating sensitivity to the small number of contributing studies.</p><p><strong>Conclusion: </strong>NO₂ showed the most consistent association with cataract outcomes, whereas evidence for PM₂.₅ remained heterogeneous and that for black carbon was limited. Although these findings support further investigation of traffic-related and other ambient pollution mixtures in cataract epidemiology, the sensitivity of NO₂ estimates to small-study inference precludes firm causal conclusions. Independent prospective studies with improved exposure assessment and standardized cataract phenotyping are needed.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/recorddashboard#, identifier CRD420261509514.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1969759"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215741","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":"Hyperbaric oxygen therapy as a potential treatment for MDD: a narrative review.","authors":"Yun Chen Pang, Peter Giacobbe, Fahad Alam","doi":"10.3389/fmed.2026.1931426","DOIUrl":"10.3389/fmed.2026.1931426","url":null,"abstract":"<p><p>This narrative review explores the therapeutic potential of hyperbaric oxygen therapy (HBO₂) in treating major depressive disorder (MDD). We highlight the common pathophysiological hypotheses for MDD, the strengths and limitations of current MDD treatments, and the potential for HBO₂ to be a novel MDD therapeutic through anti-inflammatory and neuroprotective mechanisms. The current review discusses the monoamine, neuronal atrophy, and inflammation hypotheses of MDD pathophysiology origin, as well as how present MDD therapeutics target these MDD pathophysiological traits. While there are a multitude of existing treatments for MDD, including those pharmacological, psychotherapeutic, and neuromoduatory in nature, many treatments possess limitations. The management of difficult-to-treat depression is particularly challenging, highlighting the need for innovative, effective treatments to be developed. HBO₂ is a potential novel therapy for MDD, exerting antidepressant effects through its ability to promote neurogenesis and anti-inflammatory processes in the central nervous system. Moreover, HBO₂ has been indirectly correlated with an improvement in depressive symptoms in studies done in the context of treatment for post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), post-stroke recovery, and post-coronavirus disease condition (post-COVID-19). However, there is currently a dearth of direct evidence supporting the indication of HBO₂ for MDD, and clinical trials that investigate HBO₂ as a primary treatment for MDD are needed. The current review provides a rationale for further exploration of the potential of HBO₂ as a novel therapy for MDD.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1931426"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215800","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":"Multi-site metabolomics reveals one-carbon and placental steroid disruption in maternal pre-pregnancy obesity linked to adverse pregnancy outcomes.","authors":"Ke Ye, Yan Liu, Jinghui Zou, Hangyu Wu, Yisheng Zhang","doi":"10.3389/fmed.2026.1904730","DOIUrl":"10.3389/fmed.2026.1904730","url":null,"abstract":"<p><strong>Purpose: </strong>This study characterized metabolomic profiles of maternal adipose tissue, placenta, and cord blood in pre-pregnancy obesity and explored links to adverse pregnancy outcomes (APOs).</p><p><strong>Methods: </strong>From a prospective cohort (Oct 2024-Oct 2025, <i>n</i> = 1,335), 25 obese (pre-pregnancy BMI ≥ 28 kg/m²) and 25 control women undergoing cesarean section were included. Visceral adipose, placenta, and umbilical vein plasma were analyzed using UHPLC-MS/MS. Metabolite differences were analyzed using Random Forest modeling, OPLS-DA, KEGG pathway enrichment analysis, and correlation analysis with clinical indicators, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, macrosomia, postpartum hemorrhage (PPH), and various laboratory parameters. In an independent external cohort, mRNA expression levels of key steroidogenic enzymes in placental tissues were verified by qRT-PCR.</p><p><strong>Results: </strong>The obesity group showed significantly higher incidences of GDM, HDP, PPH and higher neonatal weight. Vitamin B12 and folic acid were key discriminators across all compartments. Adipose tissue metabolites were enriched in arginine/proline, pentose phosphate, and cysteine/methionine metabolism. Placenta was enriched in steroid hormone biosynthesis pathways. Cord blood additionally showed enrichment in TCA cycle, glutamatergic and serotonergic synapses. Key compartment-specific metabolites included etiocholanolone (adipose), 16-glucuronide-estriol (placenta), and 5<i>α</i>-androstan-3-one (cord blood), all of which correlated with clinical indicators. The mRNA expression changes of key steroidogenic enzymes in placental tissues paralleled the alterations in their corresponding metabolite abundances.</p><p><strong>Conclusion: </strong>Pre-pregnancy obesity-related adverse pregnancy outcomes are driven by a disrupted maternal-fetal metabolic axis characterized by three core features: global dysfunction of one-carbon metabolism exemplified by vitamin B12 and folic acid abnormalities, placental steroid hormone biosynthesis abnormalities as the central hub, and disturbances in fetal energy and neurotransmitter metabolism as the downstream consequence. Monitoring these metabolites may enable early risk identification and guide targeted interventions for placental steroid metabolism.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1904730"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215329","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":"General self-efficacy, self-confidence, and satisfaction in simulation-based nursing education: a structural equation modeling and mediation analysis.","authors":"Majed M Aljabri, Bandar S Alharbi","doi":"10.3389/fmed.2026.1945224","DOIUrl":"10.3389/fmed.2026.1945224","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Simulation-based learning has become a fundamental component of nursing education, providing students with opportunities to develop clinical competence, critical thinking, and professional confidence in a safe learning environment. While learning satisfaction and self-confidence are recognized as key outcomes of simulation-based education, the extent to which general self-efficacy is associated with these outcomes remains insufficiently understood. This study examined the associations among general self-efficacy, self-confidence, and satisfaction with simulation-based learning among undergraduate nursing students.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional study was conducted among undergraduate nursing students at King Saud University, Saudi Arabia. All enrolled nursing students were eligible to participate. A total of 209 complete responses were included in the final analysis. Satisfaction and self-confidence were measured using the Student Satisfaction and Self-Confidence in Learning Scale. General self-efficacy was assessed using the General Self-Efficacy Scale. Multiple linear regression identified factors associated with self-confidence and satisfaction, while structural equation modeling examined the hypothesized associations among latent constructs. Bootstrap mediation analysis was conducted to evaluate the indirect association between general self-efficacy and satisfaction through self-confidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our findings showed that general self-efficacy was positively associated with self-confidence (&lt;i&gt;β&lt;/i&gt; = 0.715, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and both general self-efficacy (&lt;i&gt;β&lt;/i&gt; = 0.249, &lt;i&gt;p&lt;/i&gt; = 0.002) and self-confidence (&lt;i&gt;β&lt;/i&gt; = 0.650, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) were positively associated with satisfaction. Students reporting a greater number of simulation sessions also demonstrated higher self-confidence (&lt;i&gt;β&lt;/i&gt; = 0.352, &lt;i&gt;p&lt;/i&gt; = 0.002), whereas academic year was inversely associated with self-confidence (&lt;i&gt;β&lt;/i&gt; = -0.233, &lt;i&gt;p&lt;/i&gt; = 0.037). Multiple linear regression produced findings consistent with the structural equation model. Mediation analysis showed a significant indirect association between general self-efficacy and satisfaction through simulation-related self-confidence (standardized indirect association = 0.465, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), alongside a significant direct association (&lt;i&gt;β&lt;/i&gt; = 0.249, &lt;i&gt;p&lt;/i&gt; = 0.002).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;General self-efficacy and self-confidence were positively associated with nursing students' satisfaction with simulation-based learning, with self-confidence demonstrating the strongest association and partially mediating the relationship between self-efficacy and satisfaction. Our findings highlight the importance of fostering students' confidence and self-efficacy within simulation-based education. Because of the cross-sectional design, the observed relationships should be interpreted as associations rather than causal e","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1945224"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215704","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}