Nevin Manimala

Cancer. 2026 Aug 15;132(16):e70571. doi: 10.1002/cncr.70571.

ABSTRACT

BACKGROUND: Nonmetastatic esophagogastric adenocarcinoma require multimodal treatment for management. However, real-world treatment patterns and outcomes in these patients are limited. We evaluated the survival outcomes associated with the common treatment combinations in the National Cancer Database.

METHODS: A total of 4715 patients met the predefined inclusion and exclusion criteria. Four groups were created: group 1, preoperative chemotherapy; group 2, perioperative chemotherapy; group 3, preoperative chemotherapy followed by chemoradiation; and group 4, preoperative chemoradiotherapy. Kaplan-Meier curves were used to assess overall survival. Cox proportional hazard regression estimated hazard ratios (HR) and 95% CIs for associations between covariates and overall survival. Inverse probability of treatment weighting based on propensity scores were used to account for differences in baseline characteristics between treatment groups.

RESULTS: The median age was 63 years; 75.9% were male and 82.9% were non-Hispanic White; overall, 47.5% had clinical stage III disease and 57.8% had regional lymph node involvement. Median follow-up was 79.5 months. Patients who received perioperative chemotherapy had improved median overall survival compared with patients who received preoperative chemoradiotherapy (79.1 vs 74.6 months; p < .001). After adjustment for age, race, Charlson-Deyo Score, facility type, year of diagnosis, presence of regional lymph nodes, clinical stage, the association remained statistically significant (HR = 0.78; 95% CI, 0.66-0.92; p = .003).

CONCLUSION: Although several multimodality treatment strategies are used for esophagogastric adenocarcinoma, perioperative chemotherapy is associated with better overall survival compared to preoperative chemoradiotherapy.

PMID:42603143 | DOI:10.1002/cncr.70571

Risk Anal. 2026 Sep;46(9):e70323. doi: 10.1111/risa.70323.

ABSTRACT

Essential services are necessary for individuals to recover from and adapt to disruptive events, yet the relationship between access to such services and recovery trajectory is poorly understood. Data on household recovery times are typically only available through surveys, which are limited in scale and scope. Further, the availability of all open and accessible essential services facilities in a region may not be recorded anywhere. Location-based services (LBS) data from cell phones offers new opportunities for estimating this relationship. Using LBS data, we approximate facility availability and household recovery times following Hurricane Irma in Southwest Florida in 2017 and then statistically model the importance of access for recovery incorporating social vulnerability, local storm parameters, and infrastructure outage variables. We show that power, cell service, and school outages rank highest in importance, followed by measures of access to essential services. These results underscore the importance of including access metrics for predicting community recovery and evaluating resilience as well as the need for planning and policies that improve access to essential services both in times of stability and disruption.

PMID:42603109 | DOI:10.1111/risa.70323

J Magn Reson Imaging. 2026 Aug 15. doi: 10.1002/jmri.70497. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative identification of short-term survival in glioblastoma may guide management but remains challenging because of clinical and imaging heterogeneity.

PURPOSE: To develop and externally validate a multiscale magnetic resonance imaging (MRI)-based deep learning model for short-term survival assessment and explore transcriptomic correlates.

STUDY TYPE: Retrospective, multicenter.

POPULATION: Adults with pathologically confirmed, newly diagnosed glioblastoma (n = 728): training cohort (n = 290; median age, 55 years; 169 men) and external cohorts 1-3 (n = 225/182/31; median ages, 64/61/56 years; 136/108/20 men, respectively).

FIELD STRENGTH/SEQUENCE: 1.5 T or 3.0 T; axial precontrast T1-weighted, T2-weighted, T2-weighted fluid-attenuated inversion recovery, and postcontrast T1-weighted MRI.

ASSESSMENT: Short-term survival was overall survival of 9 months or less. Whole-brain, three-dimensional tumor, and 2.5-dimensional tumor inputs were integrated and compared with clinical, conventional MRI morphometric, and combined clinical-MRI baselines.

STATISTICAL TESTS: Kruskal-Wallis, Mann-Whitney U/Wilcoxon rank-sum, chi-square, Fisher exact, DeLong, and log-rank tests; Benjamini-Hochberg false discovery rate (FDR) correction; calibration, decision curves, edgeR, and correlation-adjusted mean-rank gene-set testing were used. Areas under the receiver operating characteristic curve (AUCs) with 95% confidence intervals (CIs) summarized discrimination; threshold metrics used the Youden index. Two-sided p < 0.05 or FDR-adjusted p < 0.05 indicated significance.

RESULTS: Apparent training AUC was 0.870 (95% CI: 0.830, 0.910); external AUCs were 0.871 (95% CI: 0.821, 0.920), 0.828 (95% CI: 0.761, 0.895), and 0.798 (95% CI: 0.640, 0.956). AUC gains over the combined clinical-MRI morphometric baseline were 0.161 and 0.131 in external cohorts 1 and 2; only cohort 1 remained significant after FDR correction (cohort 2, FDR-adjusted p = 0.0897). Immune/inflammatory and cell-division/genome-maintenance pathway associations were directionally concordant, significant after FDR correction in both cohorts, and leave-one-out consistent.

DATA CONCLUSION: Multiscale MRI deep learning demonstrated favorable discrimination for short-term survival; model output was associated with immune- and cell-cycle-related transcriptomic programs.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42603108 | DOI:10.1002/jmri.70497

J Med Virol. 2026 Aug;98(8):e71103. doi: 10.1002/jmv.71103.

ABSTRACT

After the COVID-19 emergency, respiratory viruses have re-emerged with changing and region-specific patterns. We aimed to characterize how these shifts affected viral circulation, clinical severity, and management of pediatric viral-associated lower respiratory tract disease (LRTD)across two post-pandemic seasons in Rome, Italy. We conducted a retrospective observational study of children (< 6 years) hospitalized with PCR-confirmed viral LRTDs during the 2022-2023 and 2023-2024 seasons. Of the 1,249 children hospitalized for LRTD, 49.08% were admitted during the 2022-2023 season and 50.92% during the 2023-2024 season. Clinical severity at presentation (PRESS ≥ 4) did not differ between the two seasons; however, a severe in-hospital course (CSS > 3) was more frequent in 2023-2024 (8.96% vs. 4.24%; p = 0.001). In 2023-2024, the corticosteroid use increased (77.20% vs. 72.43%; p = 0.05), whereas antibiotic use decreased (47.80% vs. 39.78%; p = 0.004). Respiratory syncytial virus remained the most common pathogen in both seasons, with no significant variation between them. Similarly, influenza showed no significant difference in prevalence. Compared with 2022-2023, 2023-2024 showed a higher prevalence of rhinovirus (50.31% vs. 37.36%), enterovirus (24.53% vs. 15.82%), bocavirus (13.99% vs. 8.16%) and viral codetection (51.89% vs. 45.02%) while adenovirus was more frequent in 2022-2023 (7.39% vs. 13.21%). Multivariable analysis identified the 2023-2024 season (OR 2.37; 95% CI 1.45-3.87), younger age (OR 0.96 per month; 95% CI 0.94-0.98), and comorbidities (OR 2.91; 95% CI 1.66-5.11) as independent predictors of severe in-hospital course. Male sex, viral codetection, and viral clinical categories were not associated with severity. In conclusion, in Rome’s regional context, the evolving viral ecology highlights the need for continued local surveillance to guide clinical preparedness and optimize management in forthcoming seasons.

PMID:42603107 | DOI:10.1002/jmv.71103

Int J Urol. 2026 Aug;33(8):e70598. doi: 10.1111/iju.70598.

ABSTRACT

BACKGROUND: Clinical trials in locally advanced or metastatic urothelial carcinoma (mUC) often enroll younger and fitter patients than those treated in routine practice, limiting applicability to real-world populations. We developed a simple descriptive metric, the eligibility gap (EG) score, to place trial and real-world cohorts on a common scale and summarize differences in baseline eligibility profiles.

METHODS: Pivotal clinical trials were identified through a PubMed search, and three real-world datasets from Japan, the United States, and Spain were included. The EG score used three consistently reported domains: age, ECOG performance status, and cisplatin eligibility. Each domain was scaled from 0 to 33.3 points and summed to yield a score from 0 to 99.9, with higher scores indicating younger, fitter populations. Robustness was assessed across alternative model specifications, including prespecified weighting schemes, random-weight simulations, alternative age and ECOG scoring functions, and one-domain-out analyses.

RESULTS: EG scores were generally higher in cisplatin-based trials (74.8-90.1) than in immune checkpoint inhibitors (ICI)-based trials (52.3-81.2) and real-world cohorts (35.1-45.5), while the cisplatin-ineligible trial had the lowest score (24.5). Alternative age transformations and a linear ECOG model did not change ranking. In one-domain-out analyses, omission of ECOG preserved ranking, whereas omission of age or cisplatin-fitness produced minor shifts. Across prespecified weighting schemes, rank-order concordance remained high (Spearman’s rho = 0.982-1.000), and 10 000 random-weight simulations showed a median rho of 0.982.

CONCLUSIONS: The EG score may provide a simple descriptive summary of eligibility domains across mUC studies, with stable cohort ordering across alternative model specifications.

PMID:42603090 | DOI:10.1111/iju.70598

Int J Urol. 2026 Aug;33(8):e70602. doi: 10.1111/iju.70602.

ABSTRACT

BACKGROUND: Salvage radical prostatectomy (sRP) is a potentially curative treatment for localized recurrence after radiation therapy for prostate cancer; however, nationwide real-world perioperative outcomes remain unclear.

METHODS: We conducted a retrospective descriptive study using the Japanese National Clinical Database (NCD). Patients who underwent sRP after radiation therapy were identified, and perioperative, functional, and pathological outcomes were summarized descriptively according to surgical approach and prior radiation modality without comparative statistical analysis.

RESULTS: A total of 162 patients were included. The median age was 71 years, and high-risk features were common (Gleason score ≥ 8, 49.4%; pathological stage ≥ pT3, 45.7%). Robot-assisted surgery was performed in 88.3% of cases. The median operative time was 254.5 min, and estimated blood loss was 101 mL. Blood transfusion was required in 4.3% of patients. Major complications (Clavien-Dindo grade ≥ III) occurred in 4.9%, with one postoperative death (0.6%). Operative time and blood loss tended to be higher in patients with prior BT than EBRT, whereas major complication rates were comparable. Positive surgical margins were observed in 24.1%, and extraprostatic extension in 36.4%. Early continence recovery was limited, with 27.2% of patients using 0-1 pad/day at 1 month.

CONCLUSIONS: This nationwide NCD study provides contemporary real-world data regarding perioperative outcomes after salvage radical prostatectomy in Japan. Although perioperative morbidity appeared acceptable in appropriately selected patients, these findings should be interpreted descriptively because formal comparative analyses were not performed.

PMID:42603088 | DOI:10.1111/iju.70602

Int Arch Otorhinolaryngol. 2026 Aug 14;30(3):1-11. doi: 10.1055/a-2852-9524. eCollection 2026 Jul.

ABSTRACT

INTRODUCTION: In some patients with conductive or mixed hearing loss, or single-sided deafness, bone conduction implants (BCIs) offer an effective treatment; and scar appearance is a relevant factor in the overall outcome.

OBJECTIVE: To compare scar appearance and alopecia between linear and curved scalp incisions in patients undergoing transcutaneous BCIs surgery.

METHODS: An observational, cross-sectional study was conducted at a tertiary referral center in patients who underwent transcutaneous BCI. Postoperative follow-up period was between 6m to 3y. Scar evaluation was performed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). Alopecia was defined as absence of hair follicles within 2 mm of the incision line. Statistical comparisons between linear and curved incisions groups were conducted, as well as multivariate analysis with logistic regression models.

RESULTS: Eighty-four cases were analyzed: 28 underwent linear incisions and 56 underwent curved incisions. Patients reported significantly better scar appearance with linear incisions in POSAS, p = 0.035. Alopecia occurred less frequently among patients who received the Bonebridge implant (OR = 0.113; 95% CI: 0.027-0.478; p = 0.003). No statistically significant differences were found in observer assessment of POSAS or VSS scores.

CONCLUSION: Linear incisions may offer advantages in scar appearance with transcutaneous BCIs. Certain scar characteristics may also be influenced by the type of device and the surgical approach required for its placement, making it challenging to isolate this effect from that attributed solely to type of incision. These results highlight the need to consider both cosmetic factors and auditory outcomes in surgical planning.

PMID:42603080 | PMC:PMC13476099 | DOI:10.1055/a-2852-9524

O G Open. 2026 Aug 13;3(4):e196. doi: 10.1097/og9.0000000000000196. eCollection 2026 Aug.

ABSTRACT

OBJECTIVE: To describe the cervical cancer screening preferences of transgender and gender-diverse individuals presenting for care at the study institution.

METHODS: We administered a cross-sectional survey to a convenience sample of 50 patients 18-65 years of age assigned female at birth and self-identifying as transgender or gender-diverse (TGD) from a single academic endocrinology clinic. The 30-item survey, adapted from previous research in this population, included gender-neutral language and various multimedia. We used descriptive statistics to characterize preferences for cervical cancer screening in the form of a ranked list, as well as responses regarding comfort with self-swabs and past experiences with screening. We also performed a post hoc content analysis of free-text responses related to respondent cervical cancer screening preferences.

RESULTS: We enrolled 51 patients, and 50 completed the survey (98% response rate). Overall, 56.0% of respondents chose human papillomavirus (HPV) self-swab as their first-choice cervical cancer screening preference, followed by provider-collected HPV swab (18.0%), decline screening (14.0%), and Pap test (12.0%). Themes identified from free-text responses around cervical cancer screening included fear of provoking gender dysphoria, value of preventive health care, appreciation of privacy with self-swabs, and desire for gender-diverse-competent health care teams.

CONCLUSION: In this sample of TGD patients, the majority of respondents preferred self-collected HPV tests for cervical cancer screening, and some respondents preferred to forego screening altogether. Participants emphasized the importance of preventive health care and clinician competency in transgender health and trauma-informed care.

PMID:42603067 | PMC:PMC13475924 | DOI:10.1097/og9.0000000000000196

Ann Pediatr Cardiol. 2026 Jul-Aug;19(4):389-395. doi: 10.4103/apc.apc_153_25. Epub 2026 Jul 31.

ABSTRACT

INTRODUCTION: Total anomalous pulmonary venous drainage (TAPVD) constitutes approximately 1.5% of all congenital heart defects. Surgical correction has traditionally been performed using the conventional technique; however, the sutureless approach has emerged as a recent alternative. This study aims to compare the surgical outcomes of the two techniques and to identify the variables influencing them.

SUBJECTS AND METHODS: This was a retrospective study over a 17-year period from 2007 to 2024. There were 55 patients of TAPVD: supracardiac ( n = 32), intracardiac ( n = 18), infracardiac ( n = 3), and mixed ( n = 2).

RESULTS: The median age of surgical intervention was 43 days (interquartile range [IQR]: 30-120), and the median weight was 3.40 kg (IQR: 3.00-4.30). Prematurity was present in 3 (5.5%) patients, 11 (19.6%) had preoperative pulmonary vein obstruction, 2 (3.6%) had atrial septal defect obstruction, and 23 (41.1%) had preoperative pulmonary hypertension. Twelve (21.4%) patients required preoperative intubation, 4 (7.1%) required inhaled nitric oxide, and 7 (12.5%) had hemodynamic instability/cardiopulmonary resuscitation (CPR). Surgical correction (supracardiac and infracardiac) was by conventional repair in 20 patients and sutureless in 15 patients. When comparing sutureless and conventional TAPVD repair techniques, no statistically significant differences were observed in rates of pulmonary hypertension crisis, hospital stay duration, noninvasive ventilation duration, postoperative infections, or chest re-exploration rates. Similarly, the incidence of pulmonary venous obstruction (PVO) and early mortality was comparable between the two groups. The predictors of early mortality were seen in patients with preoperative pulmonary hypertension (odds ratio [OR]: 5.63, P = 0.048), preoperative intubation (OR: 9.29, P = 0.008), and preoperative CPR (OR: 36.67, P ≤ 0.001). Incidence of postoperative low cardiac output syndrome was strongly associated with preoperative pulmonary hypertension (OR: 3.90, P = 0.02), while predictors of postoperative extracorporeal membrane oxygenation predominant in patients with preoperative PVO (OR: 24.57, P = 0.007), associated pulmonary abnormality (OR: 4.57, P = 0.031), and preoperative intubation (OR: 3.88, P = 0.05).

CONCLUSIONS: Early postoperative outcomes were found to be closely associated with the patients’ preoperative clinical status. Overall, in our cohort, no difference was seen between the conventional and sutureless technique of TAPVD repair. These findings may be influenced by the study’s limited sample size, potentially reducing its statistical power.

PMID:42603057 | PMC:PMC13475845 | DOI:10.4103/apc.apc_153_25

Ann Pediatr Cardiol. 2026 Jul-Aug;19(4):379-388. doi: 10.4103/apc.apc_235_25. Epub 2026 Jul 31.

ABSTRACT

BACKGROUND: Congenital heart disease (CHD) is a leading noninfectious cause of mortality during childhood and adolescence, particularly in developing countries where timely diagnosis and treatment are limited. Despite its public health significance, data on mortality trends and their predictors in resource-limited settings remain scarce. This study aimed to assess mortality trends and identify predictors among children with CHD in a resource-limited setting.

MATERIALS AND METHODS: We conducted a retrospective follow-up study on 6228 children and adolescents with CHD who received care at the Cardiac Center of Ethiopia, either as outpatients or inpatients, with follow-up between 2015 and 2024. Data were collected through medical record reviews and phone interviews with caregivers from January 1 to August 1, 2025. Joinpoint was used to assess trends in CHD-related mortality by calculating the annual percent change (APC), and the average APC (AAPC) was used to evaluate overall mortality trends. Predictors of CHD-related mortality were identified using a Cox proportional hazards model.

RESULTS: The median age of patients was 0.7 years (interquartile range, 0.3-3.8 years), with a female-to-male ratio of 1.42:1. During follow-up, 827 patients (13.3%) died. The overall AAPC in mortality per 1000 CHD cases was -8.19% (95% confidence interval [CI]: -11.2–5.47, P < 0.001), indicating a statistically significant annual decline. A marked decrease occurred between 2019 and 2022 (APC: -40.94%; 95% CI: -47.41–27.50; P = 0.04). Malnutrition increased mortality risk by 2.9-fold (adjusted hazard ratio [AHR]: 2.9; 95% CI: 1.9-3.9; P < 0.001), pulmonary hypertension (PH) by 3.5-fold (AHR: 3.5; 95% CI: 2.2-6.6; P < 0.001), and the presence of syndromic associations (with or without extracardiac anomalies) by 30% (AHR: 1.3; 95% CI: 1.1-2.2; P = 0.04). Conversely, undergoing surgery or an interventional procedure reduced mortality risk by 80% (AHR: 0.2; 95% CI: 0.1-0.8; P < 0.001).

CONCLUSION: Mortality among children and adolescents with CHD in Ethiopia has shown a significant decline in recent years. However, malnutrition, PH, syndromic associations, and lack of surgical or interventional care remain key predictors of poor outcomes. Strengthening timely access to interventions, enhancing nutritional and multidisciplinary support, and prioritizing early identification of high-risk patients are essential to further reduce CHD-related mortality in resource-limited settings.

PMID:42603051 | PMC:PMC13475836 | DOI:10.4103/apc.apc_235_25