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Biological Conservation

Elsevier BV

Preprints posted in the last 7 days, ranked by how well they match Biological Conservation's content profile, based on 43 papers previously published here. The average preprint has a 0.03% match score for this journal, so anything above that is already an above-average fit.

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Mapping research on Indigenous peoples, traditional knowledge, and biodiversity conservation in the Amazon: gaps and Indigenous knowledge co-production

Santos, J. V. A. S.; Bomfim, F. F.; Monteles, J. S.; Guerrero-Moreno, M. A.; Dantas, Y. C.; da Silva, E. C.; Brito, J. d. S.; Oliveira-Junior, J. M. B.; Panara, K. K.; Panara, S.; Panara, K.; Panara, S.; Panara, K.; Panara, K.; Panara, S.; Panara, N.; Panara, P.; Panara, P. P.; Panara, T.; Ferreira-Satere, T.; Kumaruara, A.; Kuikuro, Y.; Costa, A. R. O.; Sarlo, L.; Coutinho, B.; Araujo, R. d.; Pinheiro, R.; Junqueira, P.; Evangelista, I. M. A.; Dantas Santos, M. P.; Mendes-Oliveira, A. C.; Maschio, G.; Prata, E.; Martinelli, b. M.; Rodrigues, D.; Montag, L.; Michelan, T.; Juen, L.

2026-04-14 ecology 10.64898/2026.04.13.718171 medRxiv
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O_LIIndigenous peoples play a central role in biodiversity knowledge and conservation, yet their participation in scientific research remains underrepresented. Understanding how Indigenous peoples, traditional knowledge, and Indigenous territories are portrayed in the scientific literature is essential for developing more equitable and culturally grounded conservation strategies. C_LIO_LIWe conducted a bibliometric analysis of 94 articles on biodiversity conservation in the Amazon, published between 1997 and 2025, indexed in Scopus and Web of Science. We examined temporal trends, geographic distribution, institutional leadership, Indigenous co-authorship, focal ecosystems and taxa, and the main contributions attributed to Indigenous peoples. Indigenous perspectives were integrated into this analysis through a participatory approach. C_LIO_LIScientific production increased after 2010. Research leadership remains concentrated in institutions from the Global North, even though Brazil, Ecuador, and Peru were the most frequently studied countries. Indigenous co-authorship was identified in only 6.4 % of the studies. Most studies focused on plants, mammals, and birds, whereas aquatic environments and groups such as insects, amphibians, and reptiles received comparatively less attention. The main contributions attributed to Indigenous peoples were related to community-based monitoring and management (41.48%) and cultural practices and traditional ecological knowledge (38.19%). C_LIO_LIThese findings show that Indigenous peoples are widely recognized as knowledge holders and conservation actors, but are still rarely included as authors or research partners. Our study highlights persistent geographic, epistemic, and collaborative asymmetries in Amazonian biodiversity research. Conservation science and policy will be stronger, fairer, and more effective when they move beyond documenting Indigenous knowledge towards supporting Indigenous leadership, equitable partnerships, and inclusive co-production of knowledge. C_LI

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The Balancing Act: Olive baboon (Papio anubis) occupancy is associated with resource-related environmental variables rather than relative abundance of predators.

van Rooyen, N. T.; Prugnolle, F.; Rougeron, V.; Hofmeester, T. R.

2026-04-14 ecology 10.64898/2026.04.13.717486 medRxiv
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Understanding how the fear of predation acts as a driver of spatial distribution is fundamental to animal behaviour research, yet this relationship is not wholly understood in primates such as baboons. Olive baboons (Papio anubis) have evolved a diverse range of antipredator strategies that reduce, but do not eliminate, predation risk from the large carnivores they encounter across their broad geographic range. This raises a critical question: does the need to access essential resources outweigh the risk of predation when determining habitat selection? We addressed this question by examining the relative influence of three environmental factors and relative predator abundance on olive baboon occupancy patterns and detection probability in Serengeti National Park, Tanzania. Using data from 225 camera traps deployed by the Snapshot Safari program, we fitted three separate Bayesian occupancy models, each incorporating the same three environmental covariates (terrain ruggedness index, distance to nearest river, and Normalized Difference Vegetation Index, NDVI), together with the relative abundance of one of three principal predators (lion, leopard, or spotted hyena). This approach allowed us to assess whether environmental covariates associated with baboon occupancy remained consistent across different predator contexts. Baboon occupancy strongly increased with terrain ruggedness in all three models and consistently decreased with a greater distance to rivers. Vegetation greenness (NDVI) showed a positive association with baboon occupancy, though credible intervals narrowly overlapped zero. NDVI also showed a strong positive relationship with baboon detection probability. Associations between predator relative abundance and baboon occupancy varied between models: the relative abundance of lions and spotted hyenas showed no strong association with baboon occupancy, whereas the relative abundance of leopards was strongly correlated with baboon occupancy, consistent with shared habitat preferences. Our findings demonstrate that, independent of predator presence, olive baboon spatial distribution in the Serengeti is primarily and consistently associated with resource-related environmental features. This study expands our knowledge on the ecological factors that influence primate occupancy by showing that, for a behaviourally flexible species with diverse antipredator strategies, access to essential resources can outweigh spatial avoidance of predators in a multi-predator landscape.

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LRRK2 mutations block NCOA4 trafficking upon iron overload leading to ferroptotic death

Goldman, A.; Nguyen, M.; Lanoix, J.; Li, C.; Fahmy, A.; Zhong Xu, Y.; Schurr, E.; Thibault, P.; Desjardins, M.; McBride, H.

2026-04-17 cell biology 10.1101/2025.08.25.672135 medRxiv
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Altered iron homeostasis has long been implicated in Parkinson's Disease (PD), although the mechanisms have not been clear. Given the critical role of PD-related activating mutations in LRRK2 (leucine-rich repeat protein kinase 2) within membrane trafficking pathways we examined the impact of a homozygous mutant LRRK2G2019S on iron homeostasis within the RAW macrophage cell line with high iron capacity. Proteomics analysis revealed a dysregulation of iron-related proteins in steady state with highly elevated levels of ferritin light chain and a reduction of ferritin heavy chain. LRRK2G2019S mutant cells showed efficient ferritinophagy upon iron chelation, but upon iron overload there was a near complete block in the degradation of the ferritinophagy adaptor NCOA4. These conditions lead to an accumulation of phosphorylated Rab8 at the plasma membrane, which is selectively inhibited by LRRK type II kinase inhibitors. Iron overload then leads to increased oxidative stress and ferroptotic cell death. These data implicate LRRK2 as a key regulator of iron homeostasis and point to the need for an increased focus on the mechanisms of iron dysregulation in PD.

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Lamin B1 physically regulates neuronal migration by modulating nuclear deformability in the developing cortex

Shin, M.; Ishida, S.; Yu, J.; Iwashita, M.; Jang, G.-u.; Cortelli, P.; Giorgio, E.; Cani, I.; Ramazzotti, G.; Ratti, S.; Yoshino, D.; Rah, J.-C.; Imai, Y.; Kosodo, Y.

2026-04-17 neuroscience 10.1101/2025.10.22.683830 medRxiv
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Neuronal migration is a vital process that positions billions of neurons to create a functional brain. To navigate the constrained microenvironments within the cortex, precise control over the nuclear mechanics in migrating neurons is indispensable. Here, we show that Lamin B1 (LB1) regulates neuronal migration by modulating nuclear deformability. Excess LB1 in neurons halted migration without altering laminar identity or overall gene expressions in vivo, while in vitro, it elevated nuclear stiffness and impaired neuronal motility in confined spaces. Moreover, mispositioned neurons resulted in electrophysiological defects in the brain. Computational modeling predicted a temporal relationship between nuclear deformation and enhanced migration velocity, which was validated experimentally through live imaging. Notably, cerebral organoid assays using iPS cells established from patients with LMNB1 duplication exhibited impaired neuronal migration in a human model. Collectively, these findings demonstrate that LB1 is a critical regulator of nuclear mechanics, ensuring the accurate spatiotemporal positioning of neurons.

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A geometric-surface PDE model for cell-nucleus translocation through confinement

Ballatore, F.; Madzvamuse, A.; Jebane, C.; Helfer, E.; Allena, R.

2026-04-17 biophysics 10.64898/2025.12.18.695144 medRxiv
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Understanding how cells migrate through confined environments is crucial for elucidating fundamental biological processes, including cancer invasion, immune surveillance, and tissue morphogenesis. The nucleus, as the largest and stiffest cellular organelle, often limits cellular deformability, making it a key factor in migration through narrow pores or highly constrained spaces. In this work, we introduce a geometric surface partial differential equation (GS-PDE) model in which the cell plasma membrane and nuclear envelope are described as evolving energetic closed surfaces governed by force-balance equations. We replicate the results of a biophysical experiment, where a microfluidic device is used to impose compressive stresses on cells by driving them through narrow microchannels under a controlled pressure gradient. The model is validated by reproducing cell entry into the microchannels. A parametric sensitivity analysis highlights the dominant influence of specific parameters, whose accurate estimation is essential for faithfully capturing the experimental setup. We found that surface tension and confinement geometry emerge as key determinants of translocation efficiency. Although tailored to this specific setup for validation purposes, the framework is sufficiently general to be applied to a broad range of cell mechanics scenarios, providing a robust and flexible tool for investigating the interplay between cell mechanics and confinement. It also offers a solid foundation for future extensions integrating more complex biochemical processes such as active confined migration.

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Uncovering the mechanisms of clinically-relevant altered antibiotic responses of Staphylococcus aureus under wound infection-mimetic conditions

Rieger, C. D.; Molaeitabari, A.; Dahms, T. E. S.; El-Halfawy, O. M.

2026-04-17 microbiology 10.64898/2025.12.22.696073 medRxiv
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Standard in vitro antimicrobial susceptibility testing (AST) using Mueller-Hinton broth (MHB) does not reflect infection-site conditions, and its results often do not correlate with therapeutic outcomes. Here, we compared the antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA), a common chronic wound pathogen, in simulated wound fluid (SWF) resembling wound exudate versus MHB, revealing discordant AST results across six of nine tested antibiotic classes. The most significant were 128-fold increased resistance to tetracyclines and 256-fold sensitization to {beta}-lactams in SWF. Tetracycline resistance was mediated by MntC, an extracellular manganese-binding protein, whereas {beta}-lactam sensitization was driven by cell envelope remodelling in SWF. Galleria mellonella wound infection results matched the SWF susceptibility phenotypes, suggesting SWF better predicts in vivo wound infection therapeutic outcomes. These comprehensive phenotypic and mechanistic insights into MRSA antibiotic responses under wound-infection-mimetic conditions with direct in vivo validation identify a potential new antibiotic adjuvant target and may guide improved antibiotic therapy for MRSA wound infections.

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Preoperative CT-Based Habitat Radiomics Classifiers Predict Recurrence in Non-Small Cell Lung Cancer

Altinok, O.; Ho, W. L. J.; Robinson, L.; Goldgof, D.; Hall, L. O.; Guvenis, A.; Schabath, M. B.

2026-04-16 radiology and imaging 10.64898/2026.04.14.26350899 medRxiv
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Objectives: Among surgically resected non-small cell lung cancer (NSCLC) patients with similar stage and histopathological characteristics, there is variability in patient outcomes which highlights urgency of identifying biomarkers to predict recurrence. The goal of this study was to systematically develop a pre-surgical CT-based habitat-based radiomics classifier to predict recurrence-of-risk in NSCLC. Methods: This study included 293 NSCLC patients with surgically resected stage IA-IIIA disease that were randomly divided into a training (n = 195) and test cohorts (n = 98). From pre-surgical CT images, tumor habitats were generated using two-level unsupervised clustering and then radiomic features were calculated from the intratumoral region and habitat-defined subregions. Using ridge-regularized logistic regression, separate classifiers were developed to predict 3-year recurrence using intratumoral radiomics, habitat-based radiomics, and a combined model (intratumoral and habitat) which was generated using a stacked learning framework. For each classifier, probability of recurrence was calculated for each patient then numerous statistical and machine learning approaches were utilized to stratify patients for recurrence-free survival. Results: The combined radiomics classifier yielded a superior AUC (0.82) compared to the intratumoral (AUC = 0.75) and habitat radiomics (AUC = 0.81) models. When the classifiers were used to stratify high- versus low-risk patients utilizing a cut-point identified by decision tree analysis, high-risk patients were yielded the largest risk estimate (HR = 8.43; 95% CI 2.47 - 28.81) compared to the habitat (HR = 5.41; 95% CI 2.08 - 14.09) and intratumoral radiomics (HR = 3.54; 95% CI 1.45 - 8.66) models. SHAP analyses indicated that habitat-derived information contributed most strongly to recurrence prediction. Conclusions: This study revealed that habitat-based radiomics provided superior statistical performance than intratumoral radiomics for predicting recurrence in NSCLC.

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The Cartilage Thickness score (CTh-Score) Captures High-resolution Cartilage Thickness Patterns Associated with Osteoarthritis Onset, Progression, and Knee Replacement: Data from the Osteoarthritis Initiative

Margain, P.; Favre, J.; Omoumi, P.

2026-04-15 radiology and imaging 10.64898/2026.04.14.26350838 medRxiv
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Objective To evaluate the Cartilage Thickness Score (CTh-Score) as a quantitative measure of cartilage damage severity by assessing its association with three osteoarthritis (OA) milestones and comparing its performance with conventional morphometric measures (radiographic minimum joint space width (JSW) and regional average cartilage thickness). Methods Data were obtained from the Osteoarthritis Initiative (OAI) and the publicly available OAI CTh-Maps and CTh-Score dataset. Three matched case-control designs were used to represent major OA milestones: (i) incident radiographic OA onset, (ii) combined pain and structural progression, and (iii) knee replacement (KR) in the coming 2 years. Progression subjects were extracted from the FNIH Biomarkers Consortium cohort. Cases and controls were compared at 4 years (T-4Y), 2 years (T-2Y), and 0 years (T0) before the milestone. MRI-based CTh-Score and regional average cartilage thickness, as well as JSW, were analyzed cross-sectionally and longitudinally. Associations with case status were assessed using adjusted logistic regression models, and responsiveness was evaluated using longitudinal change and standardized response means. Results The onset cohort included 307 matched case-control pairs, the progression cohort 164 cases and 369 controls, and the KR cohort 81 cases and 324 controls. Across all three study designs, the CTh-Score significantly differentiated cases from controls at all timepoints. In the onset cohort, the CTh-Score was higher in future cases than controls at T-4Y (16.2 vs 12.6, p=0.007), T-2Y (23.5 vs 16.7, p<0.001), and T0 (39.8 vs 18.6, p<0.001), whereas JSW and regional thickness measures showed limited or later discrimination. Similar findings were observed for progression (43.2 vs 33.0 at T-4Y; p<0.001) and KR (55.4 vs 46.1 at T-4Y; p=0.02) cohorts. Longitudinally, CTh-Score changes differentiated cases from controls earlier and more consistently than JSW or regional average thickness, and its responsiveness was consistently the highest across OA milestones and time intervals. In adjusted models, the CTh-Score was independently associated with all outcomes at T-4Y and T-2Y, with odds ratios per standard deviation increase ranging from 1.3 to 2.2. Conclusion The CTh-Score captures high-resolution cartilage thickness patterns associated with OA onset, progression, and future knee replacement, outperforming conventional morphometric measures in early discrimination, responsiveness, and predictive association. These findings support CTh-Score as a sensitive quantitative marker of cartilage damage severity across the OA continuum.

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Center-of-Mass Work Patterns Reveal a Dissociation Between Gait Organization and Limb-level Mechanical Function in Post-stroke Walking

Hosseini-Yazdi, S.-S.; Fitzsimons, K.; Bertram, J. E.

2026-04-16 rehabilitation medicine and physical therapy 10.64898/2026.04.14.26350877 medRxiv
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Walking speed is widely used to assess gait recovery following stroke, yet it provides limited insight into how walking performance is mechanically organized. This study examined how center of mass (COM) work organization and propulsion-support coupling vary across walking speeds in individuals with post stroke hemiparesis to distinguish recovery of gait organization from recovery of limb level mechanical function. Eleven individuals with post stroke hemiparesis performed treadmill walking across speeds ranging from 0.2 to 0.7 m/s while ground reaction forces were recorded. Limb specific COM power and work were computed using an individual limbs framework, and interlimb asymmetry in net and positive work, along with the propulsion-support ratio (PSR), were quantified. A qualitative transition in gait organization was observed: at lower walking speeds, COM power exhibited a simplified two phase pattern, whereas at higher walking speeds (approximately >=0.5 m/s), a structured four phase COM power pattern emerged, including identifiable push off and preload phases. Despite this recovery of gait organization, interlimb work asymmetry remained elevated and paretic PSR remained reduced across all speeds, indicating persistent limb level mechanical deficits. These findings demonstrate that increases in walking speed and the emergence of typical COM power structure reflect recovery of gait organization rather than restoration of underlying limb level mechanical capacity. Consequently, walking speed alone is insufficient to characterize gait recovery after stroke, and biomechanically informed measures of COM work organization and propulsion-support coupling provide complementary insight by distinguishing organizational recovery from limb-level mechanical recovery.

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Explainable machine learning for revisiting reported Irritable Bowel Syndrome correlates in a student cohort

Ramirez-Lopez, L.; Kang, P.

2026-04-15 gastroenterology 10.64898/2026.04.13.26350820 medRxiv
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Irritable Bowel Syndrome (IBS) affects a substantial proportion of university students, yet its factors remain incompletely characterised in South Asian populations. We reanalysed a publicly available dataset of 550 Bangladeshi students from Hasan et al. (2025), conducting a data audit that identified implausible records, including males reporting menstrual symptoms, and reduced the analytic sample to 506 observations. Using Explainable Boosting Machines (EBMs), which capture non-linear effects and pairwise interactions without sacrificing interpretability, we found that psychological distress, elevated BMI and academic dissatisfaction were the strongest predictors of IBS (mean AUC = 0.852 across 100 stratified train-test splits). Critically, several findings diverged from the original logistic regression analysis. Physical activity showed a non-linear risk pattern only at high intensity, the association with gender was substantially weaker when we accounted for metabolic and psychological factors as well and malnourishment does not have a strong an impact as in the original study. These divergences likely arise because the machine-learning model captures non-linear effects and interactions that were not represented in the original regression specification. Our findings underscore the value of reanalysing existing datasets with methods suited to capturing complexity and highlight data quality verification as a necessary step in the secondary analysis.

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PPI-Refractory GERD in Systemic Sclerosis Is Driven by Distinct Esophageal and Gastric Motility Abnormalities

Alcala-Gonzalez, L. G.; Guillen-del-Castillo, A.; Felix Tellez, F. A.; Aguilar, A.; Barber-Caselles, C.; Malagelada, C.; Polo Figueras, L.; Triginer, L.; Codina-Clavaguera, C.; Hughes, M.; Simeon-Aznar, C. P.; Serra, J.; McMahan, Z. H.

2026-04-17 rheumatology 10.64898/2026.04.13.26350585 medRxiv
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BackgroundGastroesophageal reflux disease (GERD) is highly prevalent in systemic sclerosis (SSc) and frequently persists despite proton pump inhibitor (PPI) therapy. However, the mechanisms underlying PPI-refractory GERD in SSc remain incompletely understood. MethodsWe conducted a singlel7lcentre, retrospective study of adults with SSc who underwent ambulatory pH-multichannel intraluminal impedance (pH/MII) monitoring while receiving twicel7ldaily PPI therapy (2021-2025). Esophageal motility (highl7lresolution manometry, HREM) and gastric emptying scintigraphy were integrated to examine associations between gastro-esophageal dysmotility and reflux phenotypes. ResultsThirty patients were included, of whom 67% had PPI-refractory reflux symptoms and 33% were undergoing pre-lung transplantation evaluation. Refractory GERD was present in 29/30 patients (97%) based on Lyon 2.0 classification, with conclusive evidence in 53% and borderline evidence in 43%. Esophageal dysmotility was identified in 80%, most commonly absent contractility (67%), and was associated with impaired reflux clearance, reflected by longer acid clearance times (2.20 [1.15-3.75] vs 1.15 [0.43-1.90] min) and prolonged reflux episode duration (16.60 [4.38-40.63] vs 1.95 [0.53-20.43] min). Gastric dysmotility was identified in 60.7% and was associated with an increased reflux episode burden (51.00 [30.00-81.50] vs 25.00 [21.00-54.00] episodes/24h). ConclusionsPPIl7lrefractory GERD is nearly universal in this SSc cohort and reflects heterogeneous, quantifiable abnormalities across the foregut, including impaired esophageal clearance and increased reflux burden related to gastric retention. These findings support integrated physiologic evaluation to define reflux mechanisms, inform risk stratification (including lung transplantation), and guide targeted, mechanism-based therapies beyond acid suppression.

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Frequent vs single active bouts differentially affect movement behavior and energy balance in adults with overweight/obesity

Santo Andre, H. C.; Roux, E. L.; De Jong, N. P.; Smith, P. R.; Lange, A. H.; Mendez, C.; Zahariev, A.; Mamele, M. L.; Johnson, G.; Pan, Z.; Simon, C.; Bessesen, D. H.; Pinto, A. J.; Bergouignan, A.

2026-04-16 sports medicine 10.64898/2026.04.14.26350871 medRxiv
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Objective: To investigate the effects of breaking up prolonged sedentary behavior (SB) on daily movement behavior and energy balance in adults with overweight/obesity. Methods: Thirty participants (16F/14M; 34.2+-7.3y; 29.5+-3.2kg/m2) were randomized to either BREAK (nine hourly 5-min brisk walking bouts) or a duration-matched intervention, ONE (45-min brisk walking), both performed 5 days/week for 6 weeks. Pre- and post-intervention, daily SB and physical activity (PA; accelerometry), body composition (doubly labeled water [DLW]), total daily energy expenditure (TDEE; DLW), appetite, and fasting leptin were measured. Linear-mixed effects models tested time effects and time-by-group interactions. Results: Only BREAK reduced prolonged SB (-8%; interaction: p=0.043). Both groups shifted SB-PA composition toward greater moderate-to-vigorous PA with proportional reductions in SB and light PA (time: all p<0.012), which were associated with increases in TDEE (+0.67 MJ/d; time: p=0.040). Body and fat mass increased in ONE only (interaction: p=0.061 and p=0.055). No differences were noted in energy intake, appetite, or leptin levels. Conclusions: Spreading short PA bouts throughout the day increases MVPA and TDEE to the same extent as a traditional continuous PA bout. Future studies should investigate whether minor differences in body composition are driven by distinct behavioral/physiological compensations influenced by the daily pattern of PA/SB.

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Combined Flywheel Resistance and Aerobic Exercise on Power output and Function in Chronic Kidney Disease: An Exploratory Study on the Influence of Physical Activity

Gollie, J.; Ryan, A. S.; Harris-Love, M. O.; Kokkinos, P.; Scholten, J.; Pugh, R. J.; Hazel, C. G.; Blackman, M. R.

2026-04-16 sports medicine 10.64898/2026.04.14.26350873 medRxiv
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Physical inactivity is common in chronic kidney disease (CKD) and is associated with poor neuromuscular and functional outcomes. Whether habitual physical activity (PA) influences adaptations to structured exercise in CKD remains unclear. This study examined if adaptations to combined flywheel resistance and aerobic exercise (FRE+AE) differed based on self-reported PA in Veterans with CKD stages 3 and 4. Twenty older male Veterans with CKD stages 3-4 (mean eGFR 37.9 +/- 10.2 mL/min/1.73 m2) were randomized to six weeks of FRE+AE (n=11) or health education (EDU; n=9). Participants were classified as meeting (Meets PA) or below (Low PA) weekly moderate intensity PA recommendations using the 7-day Physical Activity Recall. Outcomes included vastus lateralis muscle thickness (VL MT), knee extensor power output (60/s and 180/s), gait speed (GS), and five-repetition sit-to-stand (STS). FRE+AE increased VL MT (p=0.030), power output at 180/s (p=0.021), GS (p=0.001), and reduced STS time (p=0.012), with significant between-group differences versus EDU for VL MT (p=0.009) and GS (p=0.028). Low PA experienced greater increases in power output at 60/s (Hedges g; Low PA=0.44, Meets PA=0.25) and 180/s (Hedges g; Low PA=1.38, Meets PA=0.38) compared to Meets PA after FRE+AE. Conversely, Meets PA had greater improvements in GS (Hedges g; Low PA=0.93, Meets PA=1.29) and STS (Hedges g; Low PA=-0.72, Meets PA=-2.20) compared to Low PA. Six weeks of FRE+AE produced clinically meaningful neuromuscular and functional improvements in Veterans with CKD stages 3 and 4 irrespective of PA level, supporting FRE+AE as a feasible intervention in this population.

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Variation in Haemostasis and VTE Prophylaxis in Elective Adult Cranial Neurosurgery: A Global Survey of Perioperative Practice

Pandit, A. S.; Chaudri, T.; Chaudri, Z.; Vasilica, A. M.; Dhaliwal, J.; Sayar, Z.; Cohen, H.; Westwood, J. P.; Toma, A. K.

2026-04-16 surgery 10.64898/2026.04.14.26350905 medRxiv
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Background Venous thromboembolism (VTE) remains a major cause of perioperative morbidity in cranial neurosurgery, yet clinical practice varies widely, and formal guidelines are inconsistent. Understanding internationally sampled neurosurgical practice is essential for informing consensus and future trials. Methods An international, 2-stage cross-sectional, internet-based survey was conducted. Practising neurosurgeons performing elective adult cranial surgery were eligible. Descriptive statistics were used to summarise practice. Responses covered patterns of pre-operative haemostasis decision making, use and timing of mechanical and/or chemical prophylaxis, use of perioperative imaging prior to anticoagulation, and frequency of clinical assessment for VTE. Associations with geographical income status, subspecialty, and years post-certification were statistically tested. Practice heterogeneity was quantified and contextual influence was summarised using mean effect sizes across stratifying variables in order to determine domains of true equipoise. Results Of 585 responses, 456 (78%) met criteria for inclusion: representing 322 units across 78 countries (71% high-income). Thirteen per cent reported no departmental VTE plan; 23% followed no guidelines and 12% used multiple. Routine pre-operative testing almost universally included haemoglobin/platelets/haematocrit, with fibrinogen more common in high-income settings. Compared with high-income country respondents, low- and middle-income respondents reported higher haemoglobin transfusion thresholds (>90 g/dL; p<0.001) and shorter antiplatelet interruption (p[&le;]0.03), and less frequent outpatient VTE assessment (p<0.001). Mechanical prophylaxis was common (TEDs 81%, IPC 62%), typically started pre- or intra-operatively. Among those completing the chemoprophylaxis section (n=310), 57% required a CT or MRI scan before LMWH which was then initiated on average 31.4 hours after surgery. 1% of respondents did not routinely use LMWH. Many clinical decisions demonstrated statistical equipoise ie. high heterogeneity with low contextual influence. Conclusion Peri-operative haemostasis and VTE prophylaxis practices in adult elective cranial neurosurgery vary substantially worldwide, with some decisions reflecting geographical or socioeconomic differences and many others reflecting true clinical equipoise rather than contextual determinants. By mapping contemporary real-world practice across diverse health-system contexts, this study provides a necessary empirical foundation for rational trial design and future guideline development.

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Clinical Application of CT-Guided Lung Nodule Localization Needles in Preoperative Localization of Small Pulmonary Nodules

Xu, R.; Dou, H.; Zhang, M.; Liu, Z.

2026-04-16 surgery 10.64898/2026.04.13.26350830 medRxiv
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Background: To investigate the safety and efficacy of CTguided lung nodule localization needles for the preoperative localization of small pulmonary nodules. Methods: A retrospective study was conducted on 102 patients with a total of 113 small pulmonary nodules who underwent preoperative localization at Jinan Fourth People's Hospital from January 2024 to December 2025. Nodule diameter and depth, localization time, the number of pleural punctures, the localization success rate, and postoperative complications (hook dislodgement, hemorrhage, and pneumothorax) were recorded. All patients underwent video assisted thoracoscopic surgery (VATS) after localization. Results: The mean nodule diameter was 0.97{+/-}0.36 cm, the mean depth was 1.26{+/-}0.48 cm, and the mean localization time was 9.8{+/-}3.65 minutes. The hook dislodgement rate was 0.98% (1/102), the intrapulmonary hemorrhage rate was 14.71% (15/102), and the pneumothorax rate was 16.67% (17/102). All pulmonary nodules were successfully resected by VATS at 73.82{+/-}13.83 minutes after localization, and no severe complications occurred. Conclusions: The use of a CTguided lung nodule localization needle for the preoperative localization of small pulmonary nodules decreases the time needed for intraoperative nodule detection and operation time. This strategy is a simple, safe, and accurate preoperative localization method that is worthy of increased clinical use.

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Deep-learning-Assisted Photoacoustic and Ultrasound Evaluation for Pre-transplant Human Liver Graft Quality and Transplant Suitability

Zhang, Q.; Tang, Q.; Vu, T.; Pandit, K.; Cui, Y.; Yan, F.; Wang, N.; Li, J.; Yao, A.; Menozzi, L.; Fung, K.-M.; Yu, Z.; Parrack, P.; Ali, W.; Liu, R.; Wang, C.; Liu, J.; Hostetler, C. A.; Milam, A. N.; Nave, B.; Squires, R. A.; Battula, N. R.; Pan, C.; Martins, P. N.; Yao, J.

2026-04-15 transplantation 10.64898/2026.04.13.26350786 medRxiv
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End-stage liver disease (ESLD) is one of the leading causes of death worldwide. Currently, the only curative option for patients with ESLD is liver transplantation. However, the demand for donor livers far exceeds the available supply, partly because many potentially viable livers are discarded following biopsy evaluation. While biopsy is the gold standard for assessing liver histological features related to graft quality and transplant suitability, it often leads to high discard rates due to its susceptibility to sampling errors and limited spatial coverage. Besides, biopsy is invasive, time-consuming, and unavailable in clinical facilities with limited resources. Here, we present an AI-assisted photoacoustic/ultrasound (PA/US) imaging framework for quantitative assessment of human donor liver graft quality and transplant suitablity at the whole-organ scale. With multimodal volumetric PA/US images as the input, our deep-learning (DL) model accurately predicted the risk level of fibrosis and steatosis, which indicate the graft quality and transplant suitability, when comparing with true pathological scores. DL also identified the imaging modes (PAI wavelength and B-mode USI) that correlated the most with prediction accuracy, without relying on ill-posed spectral unmixing. Our method was evaluated in six discarded human donor livers comprising sixty spatially matched regions of interest. Our study will pave the way for a new standard of care in organ graft quality and transplant suitability that is fast, noninvasive, and spatially thorough to prevent unnecessary organ discards in liver transplantation.

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Beyond skills: The impact of personality traits, empathy and stress mindset on OSCE outcomes

Henderson, D.; Lignier, B.; Moxham, B.; Plaisant, O.; OSCEs study group, U. P. C.; Buffel du Vaure, C.; Faye, A.; Bouzid, D.; Lemogne, C.; Guedon, A.

2026-04-16 medical education 10.64898/2026.04.14.26350876 medRxiv
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ABSTRACT Objective Structured Clinical Examinations (OSCEs) are widely used to assess medical students clinical skills, including non-technical abilities such as communication and empathy. However, the potential influence of individual psychological traits, such as personality dimensions, empathy, and stress-related mindset on OSCE performance remains understudied. This study investigated associations between personality traits, empathy levels, stress mindsets, and performance in OSCEs among medical students. An online questionnaire (including the Big Five Personality Traits Inventory 2, the Jefferson Scale of Physician Empathy (Medical Student version), the Growth Mindset Scale, the Stress Mindset Measure) was provided to all fifth-year medical students enrolled at the Universite Paris Cite for six weeks before undertaking graduation summative OSCEs. Their scores were correlated with OSCE performance using Spearmans correlation and linear regression analyses. A total of 99 questionnaires were included and analysed. None of the psychometric tests we assessed showed a significant correlation with OSCE scores. The strongest predictors of success in OSCEs were higher scores in written examinations, previous OSCE performance, and being female. In non-interactive OSCE stations, conscientiousness was the only significant predictor, with a positive association (p=0.001). Neuroticism was positively associated with performance improvement between OSCE sessions (p=0.042). Personality traits, self-reported empathy, and stress-related mindsets do not predict success in OSCEs as isolated traits. Further research is needed to determine whether it holds true for all kinds of OSCEs. Multidimensional psychometric assessment may be relevant when investigating performance outcomes in OSCEs.

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Engaging patient communities in intracranial neuroscience research

Walton, A. E.; Versalovic, E.; Merner, A. R.; Lazaro-Munoz, G.; Bush, A.; Richardson, M.

2026-04-16 medical ethics 10.64898/2026.04.14.26350320 medRxiv
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Patients who participate in intracranial neuroscience research make invaluable contributions to our understanding of the brain, accelerating the development of neurotechnological interventions. Engagement of patients as part of this research presents unique challenges, where study goals can be distant from immediate clinical applications and require specialized domain knowledge. Yet methods for meaningfully integrating patient communities as part of these research efforts is essential, as intracranial neuroscience guides the application of artificial intelligence for understanding and enhancing human cognition. In order to identify what patients consider meaningful research engagement we interviewed individuals who participated in a study during their Deep Brain Stimulation (DBS) surgery and attended a group event where they interacted with our research team. Analysis of semi-structured interviews identified four main themes: interest in science and the future of clinical care, contributing to science to improve lives, connecting with others, and accessibility considerations. Based on these insights, we propose strategies for transformational participation of patient communities in intracranial neuroscience research with respect to engagement objectives, communication and scope. This approach offers a foundation for sustaining relationships between scientists and communities rooted in trust and transparency, to ensure that impacts of neurotechnology on human health and cognition are aligned with patient needs as well as desired public values.

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Are Nutritional Aspects And Body Composition Associated With The Can Do, Do Do Concept In People With COPD In Latin America? An Observational Study

Borges, P.; Freire, A. P. F.; Pedroso, M. A.; Spolador de Alencar Silva, B.; Lima, F. F.; Uzeloto, J. S.; Gobbo, L. A.; Grigoletto, I.; Cipulo Ramos, E. M.

2026-04-15 rehabilitation medicine and physical therapy 10.64898/2026.04.13.26350788 medRxiv
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IntroductionIndividuals with COPD can be classified according to their levels of physical activity (PA) and physical capacity (PC). The relationship between nutrition and body composition within these classifications remains unclear. ObjectivesTo compare the body composition and food intake of people with COPD and verify the associations. MethodsCross-sectional exploratory analysis study in which body composition and food intake were assessed in individuals with COPD. Classification was based on six-minute walk test (PC) and accelerometry(PA): Quadrant "can do, dont do" (I-preserved PC, low PA); quadrant "can do, do do" (II-preserved PC, preserved PA). Results72 individuals with COPD, 39 in quadrant I and 33 in quadrant II, with mean ages of (69 {+/-} 6) (67 {+/-} 7), respectively. Group I had a higher proportion of males, whereas group II had a higher proportion of females. A positive trend in skeletal muscle mass (p=0.011) (B= 2.883) and a negative trend in basal metabolic rate (p=0.010) (B=-0.092) for group I. ConclusionBrazilians with COPD classified in quadrants I and II showed similar results in terms of body composition and food intake. A positive trend in skeletal muscle mass was observed for the group I. These findings align with the pathophysiological model of COPD, in which the preservation of muscle mass and adequate protein intake support functional capacity and the maintenance of higher physical activity levels.

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Risk factors, outcomes, and predictors of therapeutic response in preterm infants with patent ductus arteriosus: A retrospective cohort study

Hamida, H. B.; El Ouaer, M.; Abdelmoula, S.; El Ghali, M.; Bizid, M.; Chamtouri, I.; Monastiri, K.

2026-04-17 pediatrics 10.64898/2026.04.10.26350668 medRxiv
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BackgroundPatent ductus arteriosus (PDA) is a common and potentially serious cardiovascular condition in preterm infants, particularly those with low gestational age and birth weight. Its management remains controversial due to variability in screening, diagnostic criteria, and treatment strategies. This study aimed to evaluate risk factors, outcomes, and management strategies for PDA in preterm infants, and to identify predictors of clinical and echocardiographic response to therapy. MethodsWe conducted a retrospective cohort study over a 4-year period (2016-2019) in the neonatal intensive care unit (NICU) of a tertiary care center. All consecutive preterm infants admitted during the study period were eligible. Infants with echocardiographically confirmed PDA who received pharmacological treatment with intravenous paracetamol or ibuprofen were included in the analysis. Missing data were minimal and handled using available-case analysis. Statistical analyses included descriptive statistics, Pearsons chi-square test, and multivariable logistic regression. ResultsAmong 2154 preterm infants admitted to the NICU, 60 were diagnosed with PDA (incidence : 2.8%). The mean gestational age was 29 {+/-} 2.6 weeks, and the median birth weight was 1200 g. Respiratory distress occurred in 95% of cases, mainly due to hyaline membrane disease (86.7%). PDA was symptomatic in 80% of infants. First-line treatment resulted in clinical improvement in 77% and ductal closure in 83.3% of cases, most within 3 days. Predictors of successful closure included gestational age [&ge;] 28 weeks (OR = 5.9; 95% CI : 1.7-20.2) and antenatal corticosteroid exposure (OR = 1.2; 95% CI : 1.0-1.6). Overall mortality was 35% and was significantly higher in infants < 28 weeks (OR = 5.0; 95% CI : 2.4-10.3). Clinical improvement (OR = 3.7) and echocardiographic closure (OR = 4.5) after first-line treatment were associated with reduced mortality. ConclusionsPDA in preterm infants is associated with substantial morbidity and mortality, particularly in those born before 28 weeks of gestation. Early diagnosis, antenatal corticosteroid exposure, and timely pharmacological treatment may improve outcomes. Systematic echocardiographic screening in high-risk neonates should be considered.