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Digital intervention mylovia improves sexual functioning in women with sexual dysfunction in randomized controlled trial 数字干预mylovia改善性功能障碍女性的随机对照试验
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-02-03 DOI: 10.1038/s41746-026-02385-z
Wiebke Blaszcyk, Melanie Büttner, Linda T. Betz, Antje Riepenhausen, Gitta A. Jacob, Jan Philipp Klein, Johanna Schröder
Given the widespread issue of female sexual dysfunction and the scarcity of treatment options, novel therapeutic approaches are needed. This randomized controlled trial evaluated the use of mylovia©, a self-guided digital intervention for female sexual dysfunction and sexual pain disorder based on CBT and mindfulness, in addition to treatment as usual (TAU) compared to TAU plus information material. 252 women participated. At three months, the intervention group showed significantly greater improvements (Cohen’s d = 0.51, p < 0.001) in sexual functioning, measured by the Female Sexual Function Index (FSFI), with effects maintained at six months. Clinical relevance was confirmed by Reliable Change Index (RCI) responder analysis. The intervention group also reported greater improvements in sexual desire, satisfaction, and pain-related cognitions and behaviors. There were no significant between-group differences in depressive symptoms or adverse events. The intervention demonstrated comparable efficacy to existing psychosocial treatments, offering a digital therapeutic that could narrow the current gender healthcare gap. This trial was registered on ClinicalTrials.gov on 24 January 2024, with the identifying number NCT06237166.
鉴于女性性功能障碍的普遍问题和治疗选择的稀缺性,需要新的治疗方法。这项随机对照试验评估了mylovia©的使用,mylovia©是一种基于CBT和正念的女性性功能障碍和性疼痛障碍的自我引导数字干预,除了常规治疗(TAU)与TAU加信息材料相比。252名女性参与了调查。在三个月时,通过女性性功能指数(FSFI)测量,干预组在性功能方面表现出明显更大的改善(Cohen’s d = 0.51, p < 0.001),并在六个月时保持效果。临床相关性通过可靠变化指数(RCI)应答者分析得到证实。干预组在性欲、满意度和与疼痛相关的认知和行为方面也有更大的改善。在抑郁症状或不良事件方面,组间无显著差异。干预显示出与现有的社会心理治疗相当的疗效,提供了一种可以缩小当前性别保健差距的数字治疗。该试验于2024年1月24日在ClinicalTrials.gov上注册,识别号为NCT06237166。
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引用次数: 0
Author Correction: Leveraging AI and transfer learning to enhance out-of-hospital cardiac arrest outcome prediction in diverse setting. 作者更正:利用人工智能和迁移学习来增强不同环境下院外心脏骤停结果的预测。
IF 15.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-02-02 DOI: 10.1038/s41746-025-02225-6
Siqi Li, Yohei Okada, Wenjun Gu, Michael Hao Chen, Son Ngoc Do, Quyet Dinh Pham, Quoc Ta Hoang, Marcus Eng Hock Ong, Nan Liu
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引用次数: 0
Digital medicine's international race for regulatory sandboxes and voluntary alternative pathways picks up tempo. 数字医疗在监管沙盒和自愿替代途径方面的国际竞赛加快了节奏。
IF 15.1 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-02-02 DOI: 10.1038/s41746-026-02414-x
Stephen Gilbert
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引用次数: 0
DARE-FUSE: domain aligned evidence guided learning for joint brain tumor MRI segmentation and classification DARE-FUSE:领域对齐证据引导学习用于关节脑肿瘤MRI分割和分类
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-02-02 DOI: 10.1038/s41746-026-02365-3
Yuqi Liu, Chen Sun, Yuning Niu, Xu Wang, Zehua Yue, Tieqiang Zhang, Jiang Li, Xiudong Guan, Dainan Zhang, Wang Jia
Brain tumor MRI segmentation and classification are essential for preoperative boundary assessment, lesion burden quantification, postoperative response monitoring, and radiotherapy planning, yet edema overlap, sequence heterogeneity, and artifacts often blur lesion margins. Together with the high cost of pixel-level annotation, these factors limit robust, cross-institution deployment. We propose DARE-FUSE (Domain Aligned Representation with Evidence-guided FUSE), a unified framework for pixel-level segmentation and image-level classification under limited samples and labels. Dual encoders with a feature-interaction bridge learn a shared embedding, and a Domain Alignment Refiner maps it to task-aligned representations for the segmentation and classification branches. For segmentation, U-SEG decodes features and SEGU outputs pixel-wise uncertainty to regularize boundary over/under-segmentation. For classification, CPG produces predictions and multi-scale Grad-CAM++ evidence. A Generative Lesion Removal Prior reconstructs a tumor-free counterpart to yield a difference prior, and FUSE combines this prior with Grad-CAM++ under uncertainty attenuation to guide segmentation and suppress hallucinations. DARE-FUSE achieves stable, leading performance on BraTS segmentation benchmarks and several classification datasets; ablations and label-reduction experiments confirm complementary gains and smooth degradation as pixel annotations decrease. The resulting uncertainty maps and continuous priors support interpretable decision assistance in surgery, radiotherapy contouring, triage, and longitudinal follow-up.
脑肿瘤MRI分割和分类对于术前边界评估、病灶负担量化、术后反应监测和放疗计划至关重要,但水肿重叠、序列异质性和伪影常常模糊病灶边缘。再加上像素级注释的高成本,这些因素限制了健壮的跨机构部署。我们提出了DARE-FUSE (Domain Aligned Representation with Evidence-guided FUSE),这是一个在有限样本和标签下进行像素级分割和图像级分类的统一框架。具有特征交互桥的双编码器学习共享嵌入,领域对齐细化器将其映射到用于分割和分类分支的任务对齐表示。对于分割,U-SEG对特征进行解码,SEGU输出逐像素的不确定性来正则化边界分割过/欠。对于分类,CPG产生预测和多尺度的Grad-CAM++证据。生成病变去除先验(Generative病变Removal Prior)重建无肿瘤对应物,产生差异先验,FUSE将该先验与不确定性衰减下的Grad-CAM++结合,指导分割,抑制幻觉。DARE-FUSE在brat分割基准和几个分类数据集上实现了稳定、领先的性能;消融和标签约简实验证实了互补增益和平滑退化,因为像素注释减少。由此产生的不确定性图和连续的先验支持手术、放疗轮廓、分诊和纵向随访中可解释的决策辅助。
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引用次数: 0
Towards a speech-based digital biomarker for cognitive impairment: speech as a proxy for cognitive assessment 迈向基于语音的认知障碍数字生物标志物:语音作为认知评估的代理
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-026-02360-8
Jonathan Heitz, Ines M. Engler, Nicolas Langer
With the growing prevalence of cognitive decline in ageing populations, accessible and scalable screening tools are essential for early intervention. This study investigated the potential of automated speech analysis as a proxy for cognitive assessment in 1003 older adults. Employing machine learning regression models, we demonstrated that linguistic and acoustic features extracted from spontaneous speech quadrupled performance compared to models using demographic information alone, when predicting cognitive domain scores. We then trained a binary classifier to identify individuals performing below normative thresholds (ROC-AUC up to 0.81), illustrating possible applications such as large-scale screening for cognitive impairment and improved participant selection for clinical trials. Finally, we evaluated our approach on an independent clinical dataset of Alzheimer’s disease (AD) patients and controls, demonstrating its generalizability. These findings highlight the clinical feasibility of speech analysis as a low-cost, non-intrusive digital biomarker for cognitive monitoring and screening.
随着老年人认知能力下降的日益普遍,可获得和可扩展的筛查工具对于早期干预至关重要。这项研究调查了1003名老年人自动语音分析作为认知评估代理的潜力。使用机器学习回归模型,我们证明了从自发语音中提取的语言和声学特征在预测认知领域分数时,与仅使用人口统计信息的模型相比,性能提高了四倍。然后,我们训练了一个二元分类器来识别表现低于标准阈值的个体(ROC-AUC高达0.81),说明了可能的应用,如大规模筛查认知障碍和改进临床试验的参与者选择。最后,我们在阿尔茨海默病(AD)患者和对照组的独立临床数据集上评估了我们的方法,证明了它的普遍性。这些发现强调了语音分析作为一种低成本、非侵入性的数字生物标志物用于认知监测和筛查的临床可行性。
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引用次数: 0
Challenges in applying the EU AI act research exemptions to contemporary AI research 将欧盟人工智能法案研究豁免应用于当代人工智能研究的挑战
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-025-02263-0
Janos Meszaros, Isabelle Huys, John P. A. Ioannidis
The EU Artificial Intelligence Act (AI Act) is the world’s first comprehensive, cross-sectoral legal framework dedicated specifically to AI. It introduces a structured regulatory approach to ensure that AI systems are safe, transparent, and trustworthy. To foster innovation, it includes research exemptions that place certain AI systems - those under development or used solely for scientific research - outside of its scope and obligations. However, this paper argues that these exemptions rely on distinctions that may not fully capture the realities of contemporary AI research. These include the unclear divide between research and commercial activities, and between lab-based development and real-world testing. Through legal analysis and practical scenarios, we demonstrate how the blurred boundaries between academic and commercial interests, as well as between controlled research and real-world use, create regulatory uncertainty and open the door to potential misuse. The paper highlights the risks stemming from vague definitions and the lack of harmonized guidance. It ultimately calls for clearer guidance, stronger safeguards, and more realistic frameworks that reflect the complexities of modern AI research.
《欧盟人工智能法案》是世界上第一个专门针对人工智能的综合性跨部门法律框架。它引入了一种结构化的监管方法,以确保人工智能系统安全、透明和值得信赖。为了促进创新,它包括了研究豁免,将某些人工智能系统——那些正在开发或仅用于科学研究的系统——置于其范围和义务之外。然而,本文认为,这些豁免依赖于可能无法完全捕捉当代人工智能研究现实的区别。这些问题包括研究和商业活动之间,以及基于实验室的开发和现实世界测试之间的不明确的界限。通过法律分析和实际场景,我们展示了学术和商业利益之间以及受控研究和现实世界使用之间的模糊界限如何造成监管不确定性并为潜在的滥用打开了大门。本文强调了定义模糊和缺乏统一指导所带来的风险。它最终要求更明确的指导、更强有力的保障措施和更现实的框架,以反映现代人工智能研究的复杂性。
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引用次数: 0
Diverging trajectories of trust in healthcare and on-line information seeking: what's next with LLMs. 医疗保健和在线信息搜索的信任偏离轨迹:法学硕士的下一步是什么?
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-026-02408-9
Ryan A Heumann,Steven R Steinhubl
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引用次数: 0
Flight rules for clinical AI: lessons from aviation for human-AI collaboration in medicine. 临床人工智能的飞行规则:航空对人类-人工智能医学合作的启示。
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-026-02410-1
Ariel Yuhan Ong,David A Merle,Andreas Pollreisz,Siegfried K Wagner,Mertcan Sevgi,Pearse A Keane,Roman Huemer,Julian Oehling,Markus Jäger,Josef Huemer
The parallels between medicine and aviation are well-recognised. The aviation industry's early experience with automation improved safety and efficiency, but simultaneously introduced new vulnerabilities and occasionally created misplaced trust in complex systems. Aviation has developed a robust safety framework in response to these costly lessons. In this Perspective, which draws from the experiences of clinicians and aviation experts, we argue that it is now time for the medical community to consider how we can learn from these lessons as artificial intelligence (AI) becomes increasingly integrated into clinical care. We propose that this requires a shift in perspective from AI as "autopilot" to collaboration with a "digital copilot", as well as considerations of practicalities such as scenario-based training, clinician benchmarking, and minimum unaided practice, with the ultimate aim of optimising human-AI collaboration to improve patient care.
医学和航空之间的相似之处是公认的。航空业在自动化方面的早期经验提高了安全性和效率,但同时也引入了新的漏洞,偶尔会对复杂系统产生错误的信任。航空业已经制定了一个强有力的安全框架,以应对这些代价高昂的教训。根据临床医生和航空专家的经验,我们认为,随着人工智能(AI)越来越多地融入临床护理,现在是医学界考虑如何从这些教训中吸取教训的时候了。我们建议,这需要将人工智能的视角从“自动驾驶”转变为与“数字副驾驶”合作,并考虑基于场景的培训、临床医生基准测试和最低限度的独立实践等实用性,最终目标是优化人类与人工智能的合作,以改善患者护理。
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引用次数: 0
CFG-MambaNet: Contextual and Frequency-Guided Mamba Network for medical image segmentation CFG-MambaNet:用于医学图像分割的上下文和频率引导曼巴网络
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-026-02393-z
Guoqiang Ren, Zhen Chen, Pengxiang Su, Da Li, Xiaoping Yang, Di Gai, Xin Wei, Weifeng Xu, Hongping Chen, Xiaoguang Zhao, Xiaofei Wang, Pengfei Liu, Honghua Ye, Yanfeng Ma
Accurate medical image segmentation continues to pose significant challenges, as existing methods often struggle to concurrently achieve efficient global context modeling, precise boundary delineation, and robust generalization. To address these issues, a novel framework named Contextual and Frequency-Guided Mamba Network (CFG-MambaNet) is presented. Specifically, a variable-scale state space block based on Mamba is employed so that long-range dependencies can be captured with linear complexity, efficiently addressing the inefficiency of Transformer-based models in high-resolution medical imaging. Moreover, a frequency-guided representation module is incorporated to explicitly separate global low-frequency structures from high-frequency boundary details, which significantly alleviates the difficulty of segmenting lesions with blurred contours or weak textures. Furthermore, an adaptive context aggregation mechanism is introduced to integrate heterogeneous semantic cues and to consistently highlight clinically critical regions, substantially improving robustness across diverse anatomical scales and morphologies. To further stabilize training and improve boundary adherence, a composite loss combined with deep supervision is employed. Extensive experiments were conducted on four publicly available datasets, including ACDC, Kvasir-SEG, ISIC, and SEED, covering cardiac MRI, endoscopy, dermoscopy, and pathology images.
由于现有方法往往难以同时实现高效的全局上下文建模、精确的边界划分和鲁棒泛化,因此准确的医学图像分割仍然面临着重大挑战。为了解决这些问题,提出了一个名为上下文和频率引导曼巴网络(CFG-MambaNet)的新框架。具体而言,采用了基于Mamba的变尺度状态空间块,从而可以捕获具有线性复杂性的远程依赖关系,有效地解决了基于transformer的模型在高分辨率医学成像中的低效率问题。此外,引入频率引导表示模块,将全局低频结构与高频边界细节明确分离,显著缓解了轮廓模糊或纹理弱的病变分割的困难。此外,引入了自适应上下文聚合机制来整合异构语义线索,并一致地突出临床关键区域,从而大大提高了不同解剖尺度和形态的鲁棒性。为了进一步稳定训练和提高边界依从性,采用了复合损失和深度监督相结合的方法。在ACDC、Kvasir-SEG、ISIC和SEED四个公开可用的数据集上进行了广泛的实验,涵盖心脏MRI、内窥镜、皮肤镜和病理图像。
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引用次数: 0
Ten-year population-based assessment of multimorbidity burden progression in a regional cohort of 5.5 million adults 550万成人区域队列中基于人群的十年多病负担进展评估
IF 15.2 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Pub Date : 2026-01-31 DOI: 10.1038/s41746-026-02395-x
Damià Valero-Bover, David Monterde, Gerard Carot-Sans, Emili Vela, Rubèn González-Colom, Josep Roca, Caridad Pontes, Xabier Michelena, Maria Mercedes Nogueras, Pilar Aparicio, Inmaculada Corrales, Teresa Biec, Isaac Cano, Jordi Piera-Jiménez
Multimorbidity, a major driver of healthcare demand and clinical complexity, is often addressed in a disease-centric manner and remains insufficiently understood in its population-level dynamics. Using data from a 10-year population-based cohort of 5.5 million adults in Catalonia, Spain, we quantified multimorbidity-associated clinical complexity using the Adjusted Morbidity Groups (AMG) index to predict progression from low/moderate ( < P80) to high/very high ( ≥ P80) complexity. Machine learning models identified predictive factors, while network analyses explored co-occurrence patterns among chronic conditions. During follow-up, 39.2% of the individuals who remained alive throughout the analysis period transitioned to high/very high complexity. Baseline AMG score was the strongest predictor of progression, surpassing models relying solely on individual diagnoses. The most prevalent conditions were nutritional and endocrine disorders, anxiety, and hypertension, with notable sequential links between mental and physical disorders. Findings emphasize the need for integrated, patient-centred care strategies and population-based prevention approaches to mitigate multimorbidity progression.
多病是医疗保健需求和临床复杂性的主要驱动因素,通常以疾病为中心的方式加以解决,但在人口水平的动态中仍未得到充分了解。使用来自西班牙加泰罗尼亚地区550万成年人的10年人群队列数据,我们使用调整发病率组(AMG)指数量化多发病相关的临床复杂性,以预测从低/中度(< P80)到高/非常高(≥P80)复杂性的进展。机器学习模型确定了预测因素,而网络分析探索了慢性病的共现模式。在随访期间,39.2%的存活个体在整个分析期间过渡到高/非常高的复杂性。基线AMG评分是病情进展的最强预测指标,超过了单纯依赖个体诊断的模型。最常见的疾病是营养和内分泌失调、焦虑和高血压,精神和身体疾病之间存在显著的顺序联系。研究结果强调需要综合的、以患者为中心的护理策略和以人群为基础的预防方法来减轻多病进展。
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引用次数: 0
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NPJ Digital Medicine
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