Nevin Manimala

Lung Cancer. 2026 Feb 3;213:108935. doi: 10.1016/j.lungcan.2026.108935. Online ahead of print.

ABSTRACT

BACKGROUND: Multiplex immunofluorescence imaging enables detailed characterization of the tumor immune microenvironment, but whether immune cell densities add prognostic value beyond established clinical factors in non-small cell lung cancer (NSCLC) remains unclear.

METHODS: Tissue samples from an NSCLC cohort (n = 298) were stained with a multiplex immunofluorescence panel targeting immune cell markers (CD4, CD8, FoxP3, CD20), cancer cells (pan-cytokeratin), and cell nuclei (DAPI). We quantified immune cell densities, nuclear pleomorphism features, and clinical variables, and trained four machine learning models (logistic regression, random forest, support vector machine, and k-nearest neighbors) to predict overall survival.

RESULTS: Clinical parameters consistently demonstrated the strongest performance in predicting long and short-term survival (logistic regression mean accuracy 0.60 ± 0.01, AUC 0.66 ± 0.01). The addition of immune cell densities revealed a small, statistically significant improvement in survival prediction (accuracy 0.62 ± 0.01, p < 0.01, AUC 0.67 ± 0.01, p = 0.04), while nuclear pleomorphism features did not improve prediction. When combined with clinical parameters, immune cell densities also improved survival stratification in Cox regression analyses numerically (HR = 0.51 vs. 0.55 for clinical parameters alone). Model interpretation analyses showed that stage and performance status have the largest effect on model performance. Selected immune cell densities (tumor CD4-helper and stroma B-cells) have a limited but consistent effect.

CONCLUSION: Clinical parameters remain the dominant predictors of outcome in NSCLC, with immune cell densities providing only limited prognostic value for clinical stratification. The openly available code and datasets present a unique resource for method development or focused analysis.

PMID:41671623 | DOI:10.1016/j.lungcan.2026.108935

Int J Med Inform. 2026 Feb 5;211:106334. doi: 10.1016/j.ijmedinf.2026.106334. Online ahead of print.

ABSTRACT

BACKGROUND: Urinary incontinence (UI) in women with a history of hysterectomy represents a significant global health concern. It is crucial to clarify the association between hysterectomy for benign indications and UI to avoid unnecessary surgery.

OBJECTIVE: This study aimed to develop a machine learning (ML) model to identify factors associated with UI in women with a history of hysterectomy.

METHODS: We analyzed 2021 patients from the National Health and Nutrition Examination Survey (NHANES) database who underwent hysterectomy for benign indications as our derivation cohort. Thirteen demographic and clinical features were evaluated: age, educational, anthropometric measurements (height, weight, waist), medical history diabetes mellitus (DM), and reproductive history. Six ML algorithms were employed: logistic regression (LR), naïve Bayes (NB), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM). External validation was performed on a cohort consisting of 556 patients from the Second Qilu Hospital of Shandong University. To improve interpretability, the predictive process was graphically illustrated employing a nomogram and SHapley Additive exPlanations (SHAP). Finally, the model was deployed as an online clinical decision support platform for applications.

RESULTS: A comparison of receiver operating characteristic (ROC) curves using LR as the reference model revealed no statistically significant differences across the six ML algorithms. In the internal validation cohorts, the models achieved area-under-the-curve (AUC) values of 0.753-0.763 and accuracies between 0.627 and 0.664. This predictive performance was sustained in the external-validation cohort, with AUC values ranging from 0.702 to 0.718 and accuracies ranging from 0.661 to 0.697.

CONCLUSION: Our findings demonstrated that ML models could effectively identify UI in women with a history of hysterectomy. This approach, facilitated by the nomogram and online tool, enhanced the feasibility and accessibility of identifying women at risk.

PMID:41671616 | DOI:10.1016/j.ijmedinf.2026.106334

Clin Neurol Neurosurg. 2026 Feb 7;263:109339. doi: 10.1016/j.clineuro.2026.109339. Online ahead of print.

ABSTRACT

BACKGROUND: Awake craniotomy (AC) is the gold standard for tumor resections in eloquent brain regions requiring surgical precision. Traditional AC uses pins to immobilize the head, which may contribute to scalp injury, discomfort, and hemodynamic fluctuations. We evaluated perioperative outcomes of AC performed with and without pin fixation at a single tertiary center.

METHODS: We conducted a retrospective cohort study of adults undergoing AC between October 2018 and June 2023. Outcomes included head movement and movement-related workflow disruptions, anesthetic dosing, hemodynamics, operative duration, and postoperative recovery.

RESULTS: Head movement was greater in unpinned cases (p < 0.001), although disruptive movements were uncommon (Grade 4: 6 %; no Grade 5 events). Propofol dosing was higher in pinned patients (3.2 ± 1.9 vs 2.4 ± 2.2 mg/kg/hr; p = 0.029), while dexmedetomidine dosing was similar between groups. RASS scores were comparable overall, with sex-based differences observed. Unpinned AC was associated with smaller increases in systolic blood pressure (17.5 ± 24.1 vs 25.4 ± 24.7 mmHg; p = 0.021), shorter operative duration (151.7 ± 56.3 vs 184.2 ± 74.7 min; p = 0.001), and similar ICU length of stay (p = 0.649).

CONCLUSIONS: Unpinned AC was associated with greater head movement but rare clinically disruptive events, alongside modest differences in anesthetic requirements, hemodynamics, and operative duration. These findings suggest potential workflow and comfort benefits in carefully selected patients rather than major safety differences. Prospective multicenter studies with standardized protocols are warranted to better define patient selection and validate these observations.

PMID:41671615 | DOI:10.1016/j.clineuro.2026.109339

Aten Primaria. 2026 Feb 10;58(5):103421. doi: 10.1016/j.aprim.2025.103421. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness in the promotion of physical and mental health of health professionals working in primary care through the use of a mobile application that includes three modules: physical exercise, nutrition and positive emotional health.

DESIGN: Quasi-experimental, before-after, non-randomized study that evaluates the effectiveness of the Cuídate section of the SalusOne® mobile application, specifically in the modules of emotional well-being, virtual gym and healthy eating.

PLACE: Bilbao-Basurto and Rioja Alavesa Integrated Health Organizations.

PARTICIPANTS: 100 primary care professionals, of whom 58 completed the study. The majority were women (93.1%), with a mean age of 45.2 years. Nursing professionals predominated (56.9%).

INTERVENTIONS: Use of the “Cuídate” section of the SalusOne® app, which includes: virtual gym, healthy eating module and emotional well-being module.

MAIN MEASUREMENTS: Baseline and 6-month assessments on physical health, mental health (DASS-21 scale), eating habits and satisfaction with the intervention.

RESULTS: Significant improvements were observed in LDL-cholesterol (-4.5mg/dL; p=0.033), HDL-cholesterol (+3.8mg/dL; p=0.004), glycosylated hemoglobin (-0.05%; p=0.038) and daily fruit consumption (+0.43 pieces; p<0.001). The DASS-21 scale showed statistically significant reductions in depression, anxiety and stress. 74.6% expressed high satisfaction and a desire to continue using the tool.

CONCLUSIONS: Cuídate program could have a positive effect on the physical and emotional health of healthcare professionals. Despite the methodological limitations and the low adherence rate, the results suggest its usefulness as an accessible strategy for promoting occupational health.

PMID:41671606 | DOI:10.1016/j.aprim.2025.103421

J Surg Res. 2026 Feb 10;319:77-89. doi: 10.1016/j.jss.2026.01.002. Online ahead of print.

ABSTRACT

INTRODUCTION: Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.

METHODS: We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.

RESULTS: Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 versus 57.3 ys, P = 0.0199). Mortality rate was 9.1% (n = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (P = 0.0019) but not with pain (P = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.

CONCLUSIONS: Most of ruptures occurred in small aneurysms (<10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.

PMID:41671601 | DOI:10.1016/j.jss.2026.01.002

J Surg Res. 2026 Feb 10;319:125-133. doi: 10.1016/j.jss.2026.01.006. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgical treatment of noncolorectal, non-neuroendocrine liver metastases (NCNNLM) remains unclear. This nationwide study evaluated the outcome of patients with NCNNLM, evaluated at multidisciplinary team conferences and included in the Danish Liver Cancer Group Database, according to surgery or no surgery.

METHODS: We identified all patients with NCNNLM evaluated at multidisciplinary team conferences at the four specialized centers in Denmark between October 2013 and November 2023. Patient characteristics and survival were analyzed using descriptive statistics and illustrated by Kaplan-Meier curves, respectively. Prognostic factors were assessed with logistic regression, Cox regression, and accelerated failure time models.

RESULTS: 605 patients were included in the analyses. The median follow-up was 20 mo, none were lost to follow-up. The median age of patients was 64 y, with a female predominance (58%). Most patients (93%) had World Health Organization (WHO) performance status 0-1. The overall 5-y survival rate was 29%, with a median survival of 27 mo. Surgery was performed in 307 patients (51%). Surgical intervention was associated with better survival compared with nonsurgical treatment (median survival 39 versus 13 mo, P < 0.05). Poor prognostic factors included age exceeding 64 y (hazard ratio = 1.022, P < 0.0001) and WHO performance status 2-4 (odds ratio 6.89, P = 0.007).

CONCLUSIONS: NCNNLM carries a poor prognosis. Surgery of liver metastasis is associated with improved survival with age, WHO performance status, and primary cancer type serving as important prognostic factors. However, from our study we could not establish a causal effect of surgery and confounding by indication is likely.

PMID:41671599 | DOI:10.1016/j.jss.2026.01.006

J Surg Res. 2026 Feb 10;319:100-107. doi: 10.1016/j.jss.2026.01.017. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the association between unplanned ICU admission and clinical outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, this study assesses predictors of worsened outcomes in this population.

METHODS: This retrospective cohort study analyzed the ACS-TQIP database (2017-2023) to analyze outcomes associated with unplanned ICU admission in adult and geriatric trauma patients (ISS ≥ 15) with severe sepsis. The primary outcome was in-hospital mortality, and secondary outcomes included discharge disposition, ICU-LOS, ventilator-free days, and complications.

RESULTS: In both adult and geriatric patients, unplanned ICU admission was associated with significantly lower in-hospital mortality (aOR: 0.460, 95% CI: 0.346-0.610, P < 0.001, SE: 0.145) (aOR: 0.657, 95% CI: 0.438-0.987, P = 0.043, SE: 0.207) and more ventilator-free days (β = 5.067, 95% CI: 3.981-6.153, P < 0.001, SE: 0.554) (β = 2.402, 95% CI: 0.625-4.180, P = 0.008, SE: 0.905). Advanced age (over 64 years) (aOR: 1.487, 95% CI: 1.140-1.924, P = 0.003, SE: 0.134), ISS over 25 (aOR: 1.487, 95% CI: 1.251-1.768, P < 0.001, SE: 0.088), and having multiple comorbidities (aOR: 1.402, 95% CI: 1.152-1.706, P < 0.001, SE: 0.100) were found to be associated with worse outcomes.

CONCLUSIONS: Findings from this national analysis highlighted predictors associated with worsening outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, while unplanned ICU admission was associated with improved outcomes in both adult and geriatric trauma patients with severe sepsis compared to those admitted to hospital floors, its high resource utilization emphasizes the importance of developing targeted care strategies to prevent resource overutilization and clinical deterioration in this patient population.

PMID:41671596 | DOI:10.1016/j.jss.2026.01.017

J Infect Public Health. 2026 Feb 6;19(4):103169. doi: 10.1016/j.jiph.2026.103169. Online ahead of print.

ABSTRACT

BACKGROUND: Rifampicin-resistant tuberculosis (RR-TB) remains a global health challenge, which is often characterized by limited treatment options and increased morbidity and mortality. Despite advances in diagnostics and the introduction of new drug regimens, treatment success for drug-resistant TB remains low. There is limited data on clinical, sociodemographic, and microbiological factors that influence patient outcomes. The aim of the study is to evaluate TB treatment outcomes among individuals diagnosed with RR-TB and to identify predictors of favourable and unfavourable treatment outcomes.

METHODS: We conducted a retrospective study to analyse treatment outcomes of 162 individuals diagnosed with RR-TB using GeneXpert MTB/RIF and phenotypic drug susceptibility testing (pDST) from 2016 to 2023. Treatment outcome proportions were estimated using the binomial exact method with 95 % confidence intervals (CI). Predictors associated with unfavourable treatment outcomes were assessed using logistic regression models.

RESULTS: Of the 162 individuals, 102(62.7 %) were male with a median age of 39 (interquartile range (IQR): 29-50). Most individuals, 78(48.1 %), were from the Greater Gaborone health district, and 88(54.3 %) were people living with HIV (PLWH). Among included individuals, 137(84.6 %, 95 % CI: 78.2-89.7) were successfully treated. Males had higher odds of unfavourable treatment outcomes compared to females (OR = 1.70; 95 % CI: 0.73-3.98). Among those cured, a slightly higher proportion was observed among PLWH (71.8 %, 95 % CI: 62.1-80.3) compared to people not living with HIV (PNLWH) (69.2 %, 95 % CI: 58.7-78.5). However, the mortality rate was higher among PLWH (10.7 %; 95 % CI: 5.5-18.3) than among PNLWH (6.6 %; 95 % CI: 2.5-13.8). Those with a history of TB treatment had 1.03 odds of unfavourable treatment outcomes (95 % CI: 0.40-2.73); however, this association was not statistically significant.

CONCLUSION: Our study shows a high rate of successful treatment outcomes among individuals with RR-TB, with no significant difference based on sex, TB treatment history, or HIV status. Higher mortality among PLWH highlights the need for targeted interventions among high-risk groups.

PMID:41671595 | DOI:10.1016/j.jiph.2026.103169

JMIR Perioper Med. 2026 Feb 11;9:e82472. doi: 10.2196/82472.

ABSTRACT

BACKGROUND: Enhanced recovery after surgery (ERAS) programs bundle evidence-based interventions to standardize care, expedite recovery, and improve outcomes. As ERAS programs have expanded, it has become clear that a major challenge is monitoring the compliance of bundle elements and outcomes to feedback performance to stakeholders and guide changes. Manual data abstraction is onerous and not feasible. Reliance on receiving new reports from busy health system IT groups is challenging. Therefore, we sought to address this unmet need at our hospital by developing a novel ERAS Datamart system.

OBJECTIVE: Our objectives were to develop a novel Datamart and Tableau dashboard to (1) enable continuous analysis of data, harvested directly from the electronic medical record (EMR), measure compliance and outcomes, and (2) enable end users (e.g., an ERAS coordinator) to create reports customized based on surgical procedure types, requested data variables, and custom date ranges.

METHODS: After “buy-in” from hospital leadership and other stakeholders, data metrics were identified and categorized according to phase of care, that is, preoperative, intraoperative, and postoperative. A multidisciplinary team reviewed International Classification of Diseases, Tenth Revision procedure codes to capture EMR data for patients undergoing ERAS procedures. IT was given a master list with metric names, definitions, and screenshots of the discrete field in the EMR to assist with building the metrics. Validations of the novel Datamart were done against known ERAS patient populations maintained by the surgery clinic.

RESULTS: The Datamart and Tableau dashboard has been built, is functional, and contains over 17,000 patients across 5 ERAS service lines: colorectal (n=1742), joint replacement (n=4235), surgical oncology (n=941), bariatric (n=1130), and cesarean section (n=9390). Currently, 56 metrics spanning the perioperative period have been validated across these populations. Reports can be tailored according to patients, time frames, and metrics. If desired, patient-level raw data can be exported for statistical analyses. Two use cases (total joint replacement and surgical oncology ERAS programs) are presented showing how the Datamart can be used.

CONCLUSIONS: Discrete fields within an EMR can be successfully captured into a novel Datamart and visualized using a custom Tableau dashboard for providing stakeholder feedback, facilitating quality improvement analyses, and auditing pathways.

PMID:41671571 | DOI:10.2196/82472

Neuroradiol J. 2026 Feb 11:19714009261423695. doi: 10.1177/19714009261423695. Online ahead of print.

ABSTRACT

This meta-analysis investigated endovascular thrombectomy (EVT) efficacy and safety versus best medical treatment (BMT), including intravenous thrombolysis or other treatments when applicable, in acute ischemic stroke (AIS) patients with pre-stroke disability (mRS >2), a group frequently excluded from large vessel occlusion trials. Following PRISMA 2020 guidelines, systematic searches of PubMed, Cochrane Central, Web of Science, Scopus, and Embase databases (inception-July 2025) identified English studies (≥4 patients) comparing EVT versus BMT. Data on all-cause mortality, return to baseline mRS, and symptomatic intracranial hemorrhage (sICH) were extracted. OR with 95% CI was estimated via a random-effects model. Five studies (1400 patients; 897 EVT and 503 BMT) with pre-stroke mRS 2-4 were included. EVT significantly reduced all-cause mortality (OR: 0.49, 95% CI: 0.29-0.82, p = .007), demonstrating moderate heterogeneity (I² = 66.9%). It also improved return to baseline mRS (OR: 3.21, 95% CI: 2.02-6.09, p < .001) with negligible heterogeneity (I² = 0%). sICH was more frequent in EVT (OR: 2.24, 95% CI: 0.84-5.94) but not statistically significant (p = .11). EVT offers survival benefits and increased return to baseline functional status for AIS patients with pre-stroke disability, without definitively increasing sICH. Prospective studies are crucial for informing inclusive clinical guidelines.

PMID:41671570 | DOI:10.1177/19714009261423695