Nevin Manimala

Surg Oncol. 2026 Jun 30;67:102490. doi: 10.1016/j.suronc.2026.102490. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Peritoneal metastasis (PM) of gastric cancer (GC) is frequently resistant to systemic chemotherapy, which leads to a poor prognosis. This study was designed to compare the safety and tolerability of hyperthermic intraperitoneal chemotherapy (HIPEC) with recombinant mutant human tumor necrosis factor-α (rmhTNF) versus paclitaxel after radical surgery for GC.

METHODS: Patients with locally advanced or metastatic GC who underwent surgical exploration at the Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University were prospectively enrolled and randomly assigned to three groups. All patients received HIPEC on the 1st and 3rd postoperative day. The HIPEC regimens were as follows: rmhTNF (Group A), paclitaxel (Group B), and rmhTNF + paclitaxel (Group C).

RESULTS: A total of 30 patients were enrolled in this study, with 10 patients each in groups A, B and C. There were no statistically significant differences in postoperative first activity, gastrointestinal function recovery, catheter removal, and length of hospital stay (P > 0.05). Postoperative complications, including abdominal distension, discomfort, anastomotic leakage, myelosuppression, infection, and fever, did not demonstrate statistically significant differences among the three groups (P > 0.05). Similarly, no statistically significant differences were observed in hematology, liver and kidney function, and postoperative coagulation function among the three groups of patients before surgery, after the first HIPEC treatment, before the second HIPEC treatment, and after the second HIPEC treatment (P > 0.05). After a median follow-up of 14 months, a total of 10 patients (34.5%) experienced recurrence.

CONCLUSION: The safety and tolerability of rmhTNF for HIPEC in GC were confirmed. Additionally, rmhTNF did not impede gastrointestinal recovery or increase postoperative complication rates.

PMID:42391679 | DOI:10.1016/j.suronc.2026.102490

Injury. 2026 Jun 30;57(8):113477. doi: 10.1016/j.injury.2026.113477. Online ahead of print.

ABSTRACT

BACKGROUND: Nurses are central to trauma care in both peacetime and conflict, where training and expertise directly affect patient outcomes. Cooperative training between healthcare professionals from opposing communities is rare in regions of ongoing violence, yet may be a powerful mechanism for strengthening regional trauma systems and advancing health diplomacy. Operating Together is a binational initiative that brings Palestinian and Israeli trauma providers together for joint training. This study describes the establishment of a regional Advanced Trauma Care for Nurses (ATCN) program serving both Israeli and Palestinian communities, evaluates course effectiveness, and health‑diplomacy attitudes.

METHODS: Between January 1 and December 31, 2025, six ATCN providers and two ATCN instructor courses were conducted. Participants completed anonymous questionnaires assessing satisfaction, perceived clinical relevance, and attitudes toward Palestinian-Israeli health cooperation. Descriptive statistics summarized responses, and comparisons used independent‑samples t tests and Fisher’s exact tests (significance p < 0.05).

RESULTS: Of 52 participants, 36 completed the study (50% Israeli, 50% Palestinian). Participants reported high course satisfaction (M = 8.44/10) and perceived educational impact (M = 4.39/5). Most (94.4%) expressed interest in maintaining professional contact. The belief that cooperation improves patient care is strongly correlated with positive health‑diplomacy attitudes (rs =.74, p < .001). Palestinian nurses reported significantly higher scores regarding the role of health cooperation in conflict resolution and mutual understanding (both p = .006). Male participants had higher health‑diplomacy index scores than female participants (p = .004).

CONCLUSION: In the context of ongoing conflict, joint ATCN courses for Palestinian and Israeli nurses were associated with high educational satisfaction and strong support for continued professional cooperation. Participants perceived binational training as beneficial for trauma care and contributing to a more positive climate. Joint trauma nursing education may provide a promising platform for strengthening trauma systems and advancing health diplomacy in conflict‑affected settings.

LEVEL OF EVIDENCE: Prognostic and epidemiological; Level II-III (educational intervention).

PMID:42391665 | DOI:10.1016/j.injury.2026.113477

J Med Internet Res. 2026 Jul 2;28:e84262. doi: 10.2196/84262.

ABSTRACT

BACKGROUND: Knee osteoarthritis is a heterogeneous condition characterized by chronic pain, stiffness, and fatigue that fluctuate rapidly over time. Traditional clinical assessments provide only static diagnoses of disease severity, failing to capture the dynamic, day-to-day symptom variability that impacts patient quality of life. While wearable technologies offer the potential for continuous, high-frequency monitoring, previous reviews have examined general technological interventions for knee osteoarthritis management, yet they lack a specific synthesis of technologies for symptom monitoring.

OBJECTIVE: This study aims to synthesize current research on sensor technologies used for the continuous monitoring of knee osteoarthritis symptoms in free-living or simulated daily environments. Specifically, the review seeks to (1) map sensor modalities to specific symptom domains (biomechanical, physiological, and behavioral); (2) evaluate the alignment between objective sensor metrics and patient-reported outcome measures; and (3) identify gaps in current monitoring paradigms.

METHODS: A systematic literature search was conducted across PubMed, Embase, Web of Science, and IEEE Xplore. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility criteria included studies involving participants with knee osteoarthritis using wearable or portable sensors capable of continuous monitoring (eg, inertial measurement units and electrocardiography) and assessing clinical symptoms (eg, pain, fatigue, and stiffness). Studies relying solely on stationary laboratory equipment (eg, force plates) without a portable component were excluded to ensure relevance to real-world applicability. Data regarding sensor types, sampling frequencies, monitored symptoms, and the statistical association between objective features and subjective symptom severity (key findings) were extracted.

RESULTS: A total of 16 studies met the inclusion criteria. The summary constructed from the results revealed a distinct technological saturation: the majority of studies (n=6) used inertial measurement units to quantify biomechanical deficits (eg, gait asymmetry and range of motion), which showed robust correlations with functional limitations. In contrast, there was a notable scarcity of research using physiological sensors (eg, electrocardiography and bioimpedance) to monitor systemic symptoms. Crucially, findings highlighted a significant discrepancy between subjective and objective data, particularly in sleep monitoring, where poor self-reported sleep quality predicted pain exacerbations despite stable objective actigraphy metrics. Furthermore, most systems operated as passive data loggers, with a lack of integration into active feedback loops.

CONCLUSIONS: Unlike previous reviews focused solely on biomechanics, this study innovatively maps the use of sensors across a multidimensional symptom spectrum, revealing a critical gap in the monitoring of fatigue and physiological stress. The findings suggest that current sensor applications are limited by a lack of integration with subjective patient experiences. Real-world implementation requires a hybrid monitoring paradigm that combines the ecological validity of wearable sensors with the clinical relevance of patient-reported outcomes. This approach paves the way for digital phenotyping and active feedback systems, offering a personalized strategy for managing the complex symptom burden of knee osteoarthritis.

PMID:42391637 | DOI:10.2196/84262

J Med Internet Res. 2026 Jul 2;28:e86808. doi: 10.2196/86808.

ABSTRACT

BACKGROUND: Patients with gastrointestinal cancers experience a broad range of symptoms, including anxiety, pain, and reduced quality of life. Although immersive virtual reality (IVR) has emerged as a potential intervention, its efficacy specifically in patients with gastrointestinal cancer remains unclear.

OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the effects of IVR on symptom management in patients with gastrointestinal cancer.

METHODS: Twelve databases and 1 gray literature source were searched from inception to April 30, 2026. RCTs comparing IVR interventions to routine care or nonimmersive alternatives for symptom management in adults (≥18 years) with gastrointestinal cancer were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. The evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Random-effects meta-analyses were performed for primary outcomes (anxiety, pain, quality of life) and secondary outcomes (knowledge, length of stay, vital signs, safety). Heterogeneity was explored using subgroup analyses and meta-regression.

RESULTS: Fourteen RCTs were included, comprising individuals (N=837) with colorectal, liver, esophageal, gastric, pancreatic, and biliary tract cancers. IVR interventions-including immersive scenes, interactive games, anatomical models, and cognitive behavioral modules-were primarily delivered during perioperative and chemotherapy periods. Meta-analysis showed that IVR significantly reduced anxiety (standardized mean difference [SMD] -0.58, 95% CI -0.95 to -0.20; P=.01; 95% prediction interval [PI] -1.36 to 0.21) and pain (SMD -0.75, 95% CI -1.48 to -0.03; P=.04; 95% PI -2.21 to 0.71). Subgroup analysis revealed that the anxiolytic effect was more pronounced when IVR was administered during active treatment and when single sessions lasted ≥20 minutes. Hospital stay was significantly shorter in the IVR group (mean difference -4.11 days, 95% CI -7.39 to -0.82; P=.03; 95% PI -13.82 to 5.60 days). No significant effects were detected for quality of life, knowledge acquisition, or vital signs. The evidence certainty was moderate to very low, with common limitations including risk of bias and imprecision.

CONCLUSIONS: This meta-analysis provides evidence that IVR is an effective nonpharmacological adjunct for symptom management in patients with gastrointestinal cancer, significantly reducing anxiety and pain when implemented during active treatment for at least 20 minutes. However, these findings should be interpreted with caution due to moderate to high heterogeneity, substantial risk of bias in the included studies, and low to very low GRADE evidence certainty. While the 95% CIs indicate a statistically significant average effect, the wide 95% PIs suggest that the true effect in future clinical settings may vary considerably, ranging from marked benefit to negligible impact. These results support the integration of IVR into perioperative and chemotherapy care pathways while underscoring the need for larger, more rigorously designed trials to establish definitive conclusions.

PMID:42391636 | DOI:10.2196/86808

JMIR Hum Factors. 2026 Jul 2;13:e84802. doi: 10.2196/84802.

ABSTRACT

BACKGROUND: Effective health monitoring is essential for personalized care and comprehensive health assessment. Personal health indices and profiles offer a concise summary of an individual’s overall health, supporting both clinical decision-making and self-management. However, global standardization remains challenging due to diverse practices and data formats across countries.

OBJECTIVE: This study aimed to present a novel model for computing a personal health index and health profile using the International Classification of Functioning, Disability and Health (ICF) framework. The model was designed to handle incomplete and heterogeneous datasets and aimed to provide standardized, interpretable health metrics.

METHODS: We developed a recursive algorithm that calculates the health index based on the hierarchical structure of the ICF, using all available measurements. The model incorporates time decay and linkage reliability to weight input data. Preliminary validation was conducted on data from 505 individuals, using statistical correlation analyses with self-assessed health measures (EuroQol Visual Analogue Scale and pain ratings), and a sensitivity analysis was performed to assess model robustness.

RESULTS: The computed health index showed moderate positive correlations with EuroQol Visual Analogue Scale scores (all P<.001) and negative correlations with maximum pain trajectories, supporting its validity. Sensitivity analysis confirmed predictable behavior in response to input changes, and the model demonstrated resilience to missing data.

CONCLUSIONS: The proposed model offers a flexible and scientifically grounded approach to computing personal health indices and profiles within the ICF framework. It enables the integration of diverse health data sources and supports the visual representation for clinical and personal use. This model has potential applications in health monitoring, rehabilitation planning, and machine learning-based health informatics.

PMID:42391635 | DOI:10.2196/84802

JMIR Form Res. 2026 Jul 2;10:e93934. doi: 10.2196/93934.

ABSTRACT

BACKGROUND: Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology.

OBJECTIVE: The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology.

METHODS: This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6-17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability).

RESULTS: The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children’s motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate.

CONCLUSIONS: Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.

PMID:42391633 | DOI:10.2196/93934

Obstet Gynecol. 2026 Jul 2. doi: 10.1097/AOG.0000000000006363. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess associations between pregestational and early-gestational exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and maternal pregnancy complications.

DATA SOURCES: A comprehensive search across the PubMed and EMBASE databases was conducted from inception to November 2025.

METHODS OF STUDY SELECTION: Eligibility criteria for inclusion were 1) exposure to GLP-1 RAs before or during gestation; 2) cohort, case-control, or randomized controlled trial (RCT) study reporting quantitative data on maternal obstetric outcomes; and 3) study population greater than 10. Two reviewers independently abstracted study data and assessed quality and risk of bias using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Risk of Bias for Randomized Crossover Trials tool for RCTs. Odds ratios (ORs) were pooled using random effects with the Knapp-Hartung adjustment to reduce chance of false-positives and the restricted maximum likelihood estimator for heterogeneity testing.

TABULATION, INTEGRATION, AND RESULTS: Eight studies totaling 186,598 pregnancies (47,159 exposed) were included. No statistically significant differences were seen for gestational diabetes (OR 0.99, 95% CI, 0.61-1.61), preterm birth (OR 1.01, 95% CI, 0.76-1.33), preeclampsia (OR 1.05, 95% CI, 0.60-1.84), or hypertensive disorder of pregnancy (OR 0.79, 95% CI, 0.34-1.83), although results from leave-one-out sensitivity testing suggest that GLP-1 RA exposure may have a protective effect against developing gestational diabetes (OR 0.81, 95% CI, 0.67-0.98). Newcastle-Ottawa Quality Assessment Scale results demonstrated variability in study quality and high heterogeneity attributable to differences in exposure and outcome definitions, cohort selection, and control for confounders.

CONCLUSION: Use of a GLP-1 RA in the peri-fertilization period was not associated with change in odds of maternal pregnancy complications. Exploratory sensitivity results suggest that peri-fertilization exposure may lower odds of gestational diabetes. Further research is necessary to explore these hypotheses-generating results.

PMID:42391628 | DOI:10.1097/AOG.0000000000006363

JMIR AI. 2026 Jul 2;5:e92193. doi: 10.2196/92193.

ABSTRACT

BACKGROUND: Clinician burnout has reached crisis levels in emergency medicine, with clinical documentation burden identified as a central contributing factor. Ambient artificial intelligence (AI) scribes offer a promising approach to reduce this burden, but objective evidence in the emergency department (ED) setting remains limited, and prior reports have been constrained by short observation windows and low adoption.

OBJECTIVE: This study aimed to evaluate the association between ambient AI scribe use and on-shift documentation time during a 13-month staged rollout in a busy ED, accounting for physician- and patient-level factors.

METHODS: We conducted a retrospective cohort study at a tertiary academic ED from February 2025 to March 2026. The analytic cohort comprised 10,344 encounters managed by 100 attending physicians across 4 ED care settings. We restricted analysis to encounters managed by a single attending physician and excluded those with human scribes. The comparison group comprised encounters in which the ambient AI scribe was not used; use was determined entirely at attending physician discretion on an encounter-by-encounter basis. The primary outcome was on-shift documentation time derived from electronic health record audit logs. We used mixed-effects linear models with physician random intercepts to adjust for patient and encounter characteristics.

RESULTS: Ambient AI scribe use was associated with a 72.6-second reduction in on-shift documentation time per encounter (95% CI 63.8-81.4; P<.001). The effect was similar in magnitude for high-use physicians (use rates of ≥18.2%, which was the cohort mean; -71.6 seconds) and low or moderate users (-64.2 seconds), with no statistically significant difference (P=.51). Note character count decreased by 690 characters (95% CI 273-1107; P=.001); after-shift documentation time increased modestly by 9.1 seconds (95% CI 2.9-15.3; P=.004). Negative control outcomes were largely null, and a within-clinician placebo permutation test yielded a distribution centered at 0 (mean -0.8 seconds), inconsistent with the observed effect arising from confounding alone.

CONCLUSIONS: In this single-center analysis, ambient AI scribe use was associated with a statistically significant reduction in on-shift documentation time (P<.001), equivalent to approximately 24 minutes per 8-hour shift if used across 20 encounters. These findings extend prior descriptive work with adjusted inferential evidence and support the clinical relevance of ambient AI scribes for ED documentation burden, although the magnitude of benefit varies by physician, patient, and workflow factors.

PMID:42391625 | DOI:10.2196/92193

Toxicol Sci. 2026 Jul 2:kfag063. doi: 10.1093/toxsci/kfag063. Online ahead of print.

ABSTRACT

Ethylene oxide (EtO) is a highly reactive industrial chemical and known human carcinogen with a mutagenic mode of action (MOA). Its genotoxicity is primarily mediated through alkylation of DNA, forming the mutagenic adduct O6-(2-hydroxyethyl)-2′-deoxyguanosine (O6-HE-dG), albeit in small quantities, and the more abundant but less- or non-mutagenic N7-(2-hydroxyethyl)guanine (N7-HE-G) adduct. However, dose-response relationships of these DNA adducts, particularly at low inhalation exposure levels (< 3 ppm), remain unknown. These data are necessary to inform the biological plausibility of different statistical dose-response models that have been applied to human or animal data used for cancer risk assessment. In this study, B6C3F1 mice were exposed to EtO (0-200 ppm) for 6 hours/day over 28 consecutive days. DNA adducts in lung, liver, bone marrow, and mammary gland were quantified using highly sensitive mass spectrometry platforms. N7-HE-G was detected in all tissues and exposure groups, showing linear dose-response relationships in the low-dose range (≤ 1 ppm) and increased sharply and exposure-disproportionately in the high-dose range (≥ 50 ppm). Despite high sensitivity, O6-HE-dG was undetectable in any tissue at exposure < 50 ppm, reflecting adduct levels that are below the current quantifiable limit. At higher exposures (≥ 50 ppm), O6-HE-dG exhibited a dose-response pattern of N7-HE-G. Notably the mammary gland, despite being anatomically distant from the site of inhalation, exhibited the second-highest levels of both adducts at higher doses. This study provides the first reliable quantitative dose-response evidence of DNA adducts in tumor target and non-target (liver) tissues across a wide range of EtO exposures. The two DNA adducts differ markedly in their abundance, repairability and mutagenic potential and together provide a molecular MOA dose-response framework to provide the biological foundation for informing quantitative cancer risk assessment and genotoxic hazard characterization.

PMID:42391620 | DOI:10.1093/toxsci/kfag063

JCO Clin Cancer Inform. 2026 Jul;10(3):e2600041. doi: 10.1200/CCI-26-00041. Epub 2026 Jul 2.

ABSTRACT

PURPOSE: Survivorship care models that extend beyond recurrence surveillance to ones that also address treatment-related symptoms are needed. Using data obtained in routine clinical care, we aimed to examine patient-reported symptom burden among adult thyroid cancer survivors.

METHODS: Between September 2019 and September 2022, adults were electronically administered the MDASI-Thy, a patient-reported outcome measure that measures symptom severity and interference, within 7 days before their visit at a dedicated thyroid cancer survivorship clinic. The MDASI-Thy generates (1) core symptom severity, (2) thyroid-specific symptom severity, and (3) symptom interference scores, where lower is better. High alert values (HAVs) were defined for four symptoms: Distress (Upset), Pain, Sad, and Shortness of Breath. Multivariable generalized linear models examined associations of patient, cancer, and treatment factors with scores and any HAV.

RESULTS: Among 1,557 thyroid cancer survivors, 864 (55.5%) responded. Respondents were a median of 5 years from diagnosis (IQR, 4-8) and predominantly female (79.1%), and most had papillary thyroid carcinoma (92.5%). Mean (standard deviation) scores were 1.20 (1.34) for core severity, 0.99 (1.26) for thyroid-specific severity, and 1.07 (1.80) for interference. Fatigue (11.5%) and Disturbed Sleep (11.3%) were the most common severe symptoms. HAVs occurred in 72 survivors (8.3%), of whom 54 (75%) had a documented plan addressing the HAV. Higher symptom burden was associated with female sex, Black race, greater comorbidity, active smoking, and total thyroidectomy.

CONCLUSION: Routine patient-reported symptom screening in thyroid cancer survivorship identified generally low symptom burden but meaningful variations, with a subset reporting severe symptoms, functional interference, and HAVs requiring action.

PMID:42391597 | DOI:10.1200/CCI-26-00041