Nevin Manimala

J Glaucoma. 2026 Jan 26. doi: 10.1097/IJG.0000000000002693. Online ahead of print.

ABSTRACT

PRECIS: Phacoemulsification combined with endoscopic cyclophotocoagulation had a statistically significant reduction in both intraocular pressure and number of medications as compared to Phacoemulsification alone.

PURPOSE: Comparative evaluation of Phacoemulsification combined with Endoscopic Cyclophotocoagulation (Phaco-ECP) Vs Phacoemulsification (Phaco) alone in primary angle closure glaucoma (PACG) with cataract.

DESIGN: Prospective, randomized, parallel group, active controlled trial.

PARTICIPANTS: Patients of PACG with cataract.

METHODS: A total of 100 consecutive patients with PACG and cataract were screened, of whom 66 patients meeting the inclusion criteria were recruited. Patients were randomized into 2 groups and underwent Phaco-ECP or Phaco alone. The patients were examined at baseline and at 1 week, 1 month, 3, 6, 12, 18 and 24 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at baseline, and at 3, 6 and 12-months follow-up. Main Outcome Measures: The primary outcome measure was reduction in intraocular pressure (IOP) and the number of anti-glaucoma medications.

RESULTS: The mean baseline IOP was 19.9±5.8 mmHg and 19.5±7.2 mmHg in Phaco-ECP and Phaco groups, respectively (P=0.59). The mean IOP decreased to 14.0±2.6 mmHg and 15.7±2.2 mmHg at 24 months in Phaco-ECP and Phaco group, respectively (P=0.02). The reduction in number of medications was also significantly higher in Phaco-ECP group (1.8±1.10 mmHg vs. 1.0±0.8 mmHg; P=0.02) as compared to Phaco alone group. Qualified success with IOP ≤12 mmHg was obtained in 46.6% of patients in Phaco-ECP group and 13.7% of patients in Phaco group (P=0.01). No absolute failures (requirement of trabeculectomy) were noted in Phaco-ECP whereas 6.9% of patients had failure in Phaco group (P=0.23). A significant widening of the angle parameters was noted postoperatively at 3, 6, 12 and 18 months as compared to baseline in both the groups. The other secondary outcome parameters like BCVA, visual field changes, endothelial cell count, pupil diameter and complication rate were comparable between the groups.

CONCLUSIONS: Phaco-ECP group demonstrated a significant reduction in IOP and number of medications, along with a notable widening of nasal anterior chamber angle parameters as compared to Phaco alone group.

PMID:41591796 | DOI:10.1097/IJG.0000000000002693

JAMA Netw Open. 2026 Jan 2;9(1):e2554512. doi: 10.1001/jamanetworkopen.2025.54512.

ABSTRACT

IMPORTANCE: Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was designed to improve access to care and reduce health disparities. Its association with breast cancer mortality and related disparities remains unclear.

OBJECTIVES: To evaluate the association between Medicaid expansion and overall mortality among women with breast cancer and to assess whether survival differs by race and ethnicity, disease stage, income, and treatment modality.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, hospital-based cohort study used a National Cancer Database cohort of 1 595 845 women aged 40 to 64 years with breast cancer who received a diagnosis from January 1, 2006, to December 31, 2021. States were classified as either Medicaid expansion or nonexpansion states. Statistical analyses were performed between January and July 2025.

EXPOSURE: Residence in a state that implemented Medicaid expansion by January 2014.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality. Policy effects were derived from difference-in-differences Cox proportional hazards regression models, reported as hazard ratios (HRs) and percentage change in hazard. Effect modification by race and ethnicity, disease stage, zip code-level income, and treatment was tested with 3-way interactions and joint Wald χ2 tests.

RESULTS: Of 1 595 845 women with breast cancer (mean [SD] age, 53.7 [6.8] years), 922 862 (57.8%) lived in early-expansion states, and 672 983 (42.2%) in nonexpansion states. Medicaid expansion was associated with lower overall mortality (HR, 0.95; 95% CI, 0.95-0.96; P < .001), a 4.8% relative hazard reduction vs nonexpansion. Hazard reductions were -3.4% (95% CI, -4.2% to -2.6%) for non-Hispanic White women, -4.3% (95% CI, -6.3% to -2.2%) for non-Hispanic Black women, and -19.0% (95% CI, -20.8% to -17.2%) for Hispanic women; associations for non-Hispanic women of other race or ethnicity were not significant. Lower mortality was most pronounced among patients with metastatic disease (-13.9%; 95% CI, -20.0% to -7.2%), those in the highest-income neighborhoods (-9.7%; 95% CI, -10.7% to -8.7%), and those receiving immunotherapy (-24.1%; 95% CI, -28.6% to -19.3%).

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that Medicaid expansion under the ACA was associated with lower overall mortality among women aged 40 to 64 years with breast cancer. Benefits were uneven, underscoring persistent racial and ethnic and socioeconomic disparities and the need for targeted interventions.

PMID:41591779 | DOI:10.1001/jamanetworkopen.2025.54512

JAMA Netw Open. 2026 Jan 2;9(1):e2554524. doi: 10.1001/jamanetworkopen.2025.54524.

ABSTRACT

IMPORTANCE: Sex differences in Alzheimer disease (AD) neuropathology have not been examined extensively across multiple pathological constructs within broadly representative samples.

OBJECTIVE: To examine sex differences in neuroimaging biomarkers of AD-related pathologies in a racially and ethnically diverse cohort.

DESIGN, SETTING, AND PARTICIPANTS: Data for this cross-sectional study were collected from a community-based sample of adults without cognitive impairment aged 60 to 69 years in New York City from March 1, 2016, to September 31, 2022, and analyzed in March 2025.

EXPOSURE: The primary exposure was self-reported sex (women or men).

MAIN OUTCOMES AND MEASURES: The outcomes were global amyloid burden measured with florbetaben labeled with fludeoxyglucose 18 (18F) positron emission tomography (PET), tau burden in Braak stages I to VI measured with 18F-MK-6240 PET, and magnetic resonance imaging (MRI)-derived AD signature cortical thickness and white matter hyperintensity volumes. Linear regression analyses were performed to examine sex differences in the outcomes. Covariates included demographics, APOE ε4 status, and vascular health-related factors. Sex × age, sex × APOE ε4, and sex × race and ethnicity interactions were additionally examined on the outcomes. False discovery rate (FDR) correction for multiple comparisons were also performed.

RESULTS: A total of 503 participants (mean [SD] age, 64.6 [2.8] years; 321 [63.8%] women; 305 [60.6%] Hispanic, 120 [23.9%] non-Hispanic Black, and 78 [15.5%] non-Hispanic White) with Aβ PET, MRI (n = 501), and tau PET (n = 355) data were studied. Compared with men, women had greater amyloid burden (B = 0.05; 95% CI, 0.02-0.07; P < .001), Braak stages III and IV (B = 0.05; 95% CI, 0.02-0.08; P = .003) and Braak stages V and VI (B = 0.09; 95% CI, 0.06-0.12; P < .001) tau burden, and AD signature thickness (B = 0.04; 95% CI, 0.02-0.05; P < .001). A significant sex × APOE ε4 interaction was observed, with women showing greater Braak stages I and II (B = 0.15; 95% CI, 0.04-0.25; P = .006) and Braak stages III and IV (B = 0.08; 95% CI, 0.02-0.14; P = .01) tau burden than men among APOE ε4 carriers. All findings remained statistically significant after FDR correction. No significant sex × age or sex × race and ethnicity interactions were observed on any outcome.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of community-based adults found greater AD pathology yet better preserved structural brain integrity in women compared with men. Sex differences in tau burden across early to middle Braak stages were more pronounced among APOE ε4 carriers compared with noncarriers. These findings were not modified by age or race and ethnicity. Overall, the results underscore sex-specific distinctions in AD pathology burden and brain structure at the cross-sectional level.

PMID:41591778 | DOI:10.1001/jamanetworkopen.2025.54524

JAMA Netw Open. 2026 Jan 2;9(1):e2555428. doi: 10.1001/jamanetworkopen.2025.55428.

ABSTRACT

IMPORTANCE: Many acceptable-quality deceased donor kidneys go unused every year. Older transplant candidates are more vulnerable to rapid health decline.

OBJECTIVE: To assess the cost-effectiveness of increasing the kidney transplantation rate among older patients with end-stage kidney disease by using acceptable-quality deceased donor kidneys.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation with cost-effectiveness analysis uses a microsimulation model of the kidney transplantation process for a synthetic cohort of adult candidates aged 65 years or older on the transplant waiting list between 2010 and 2019 over their remaining lifetimes. Statistical analysis was performed from January 2023 to December 2025.

INTERVENTION: Increasing the transplantation rate in 5% increments higher than the status quo rate from 5% to 25% using acceptable-quality deceased donor kidneys, with a corresponding shift in the distribution of kidney quality to reflect the use of donor kidneys of lower quality than the status quo.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the number of key waiting list and posttransplant outcomes, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Health state transition probabilities were derived from Scientific Registry of Transplant Recipients data. Costs and quality-of-life weights were derived from published literature and US Renal Data System annual reports, all of which were varied in a probabilistic sensitivity analysis.

RESULTS: In this synthetic cohort of 100 000 individuals, the mean age was 68.8 years (95% CI, 65.0-78.0 years), they had received dialysis for a mean of 1.2 years (95% CI, 0-6.6 years), 61.7% were male, and 56.8% had diabetes. It was estimated there would be 141 (range, 118-161) fewer waiting list deaths per 10 000 candidates if the deceased donor transplantation rate were increased by 25%. Increasing the deceased donor transplantation rate by 25% would cost $8100 (95% credible interval, $700-$14 100) per QALY gained or was cost saving from the health care sector and modified health care sector perspectives. From the health care sector perspective, a 25% increase in the deceased donor transplantation rate was the preferred strategy in all probabilistic sensitivity analysis samples for willingness-to-pay thresholds of $40 000 or more per QALY gained.

CONCLUSIONS AND RELEVANCE: This economic analysis of increasing the kidney transplantation rate in older adults suggests that using acceptable-quality deceased donor kidneys would be cost-effective or cost saving. Decision-makers should consider policies that make better use of recovered kidneys to increase transplantation rates among older patients and any other patients with similar preferences.

PMID:41591776 | DOI:10.1001/jamanetworkopen.2025.55428

Minerva Urol Nephrol. 2026 Jan 27. doi: 10.23736/S2724-6051.25.06301-3. Online ahead of print.

ABSTRACT

BACKGROUND: The role of surgical exploration and frozen sections (FSs) in monorchid patients with testicular nodules is still not well defined. We tested the role of surgical exploration and FSs in monorchid patients and the impact on the chance of testis sparing surgery (TSS).

METHODS: We identified 81 consecutive monorchid patients with testicular nodules between 2008 and 2024 candidates to surgical exploration and FSs. The statistical significance of differences in medians and proportions was tested with the Wilcoxon rank sum and chi-square tests. Multivariable logistic regression models (MLRMs) were used.

RESULTS: Testicular lesions number was available in 61 patients and was one in 35 (57.4%) of those, two in 15 (24.6%), three in 7 (11.5%) and more than three in 4 (6.5%). Median larger lesion size was 12 mm (IQR 9-20 mm). FSs were performed in 59 (73%) patients and showed germ-cell tumor (GCT) in 53 (65.4%). Orchidectomy was performed in 68 patients (84%). In 55 of 56 patients (98.3%) definitive histology confirmed FSs. Thirteen (16%) had TSS including 7 patients with seminomatous GCT, of those none had disease relapse at follow-up. At MLRMs older age was associated with lower probability of GCT (Odds Ratio 0.91, Confidence Interval 0.84-0.99, P value 0.03).

CONCLUSIONS: FSs are feasible and reliable in monorchid patients following a history of GCT. Nonetheless, TSS is rarely performed, as most of these patients actually have GCT. The few ones who had TSS had excellent oncological results.

PMID:41591767 | DOI:10.23736/S2724-6051.25.06301-3

J Gen Intern Med. 2026 Jan 27. doi: 10.1007/s11606-025-10114-7. Online ahead of print.

ABSTRACT

IMPORTANCE: Alcohol use disorder (AUD) has been associated with reduced adherence to and discontinuation of HIV preexposure prophylaxis (PrEP), potentially compromising its effectiveness.

OBJECTIVE: This study examines the relationship between AUD and PrEP adherence and continuation.

DESIGN: Retrospective cohort study using MarketScan Commercial Claims data.

PARTICIPANTS: We included individuals aged 16-64 who initiated PrEP between January 1, 2014, and December 31, 2021, and had continuous insurance coverage.

MAIN MEASURES: AUD diagnosis was identified within six months before PrEP initiation. Adherence was measured using the proportion of days covered (PDC) over 180 days and categorized by clinically relevant thresholds (≥ 85%, ≥ 80%, ≥ 57%). Continuation was assessed based on uninterrupted PrEP supply without a ≥ 30-day gap. Statistical analyses included propensity-score matching and regression modeling.

KEY RESULTS: Among 43,913 eligible individuals, 1,245 (2.84%) had an AUD diagnosis prior to PrEP initiation. In a matched sample of 1,153 individuals, those with AUD had lower mean PDC (59.54% [34.14] vs. 65.85% [33.18]; p < 0.001) and fewer mean days of continuous PrEP use (107 [67.20] days vs. 119.90 [65.21] days; p < 0.001) compared to the Without AUD group. Regression analyses showed individuals with AUD had 6.31% lower mean PDC (95% CI: -9.05% to -3.57%; p < 0.001) and 12.93 fewer days of PrEP continuity (95% CI: -18.34 to -7.52 days; p < 0.001) compared to the Without AUD group. Findings may not be generalizable beyond commercially insured individuals, and we may have not captured all factors that influence PrEP adherence.

CONCLUSION: Individuals with AUD before PrEP initiation exhibited lower adherence and continuation compared to those without AUD. Targeted interventions may be required to enhance PrEP adherence and continuity in this population.

PMID:41591743 | DOI:10.1007/s11606-025-10114-7

Saudi Dent J. 2026 Jan 27;38(2):12. doi: 10.1007/s44445-025-00116-w.

ABSTRACT

Canine teeth are essential to dentofacial aesthetics and functional harmony. When impacted they impair both form and function leading to psychological distress and poor health-related quality of life. This study investigates the approaches to managing impacted canines in the southern region of Najran, Kingdom of Saudi Arabia. This was a retrospective study with data collection from Najran Specialty Regional Dental Center in Najran, Kingdom of Saudi Arabia from 2020 to 2024. Clinical record data extracted include age, sex, radiographs, position of impacted canine, location of impacted canine and management protocol. The data were analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp). P-value ≤ 0.05 was considered statistically significant. A total of 98 patients comprising 44 males (44.9%) and 54 females (55.1%) with impacted canines were managed during the study period. Age ranged from 13 to 30 years with mean ± SD age of 19.3 ± 3.3 years. Age group 16-20 years were in the majority (56 (57.1%)) while age group 26-30 were the least (3 (3.1%)). The majority of the impacted canines were located in the maxilla (85 (86.7%). Considering, management protocol, the majority (57 (58.2%)) of the patients with impacted canine were treated by non-surgical canine exposure. Most of our patients are young adults with the majority having maxillary canine impaction in the palatal location. Our favorite option is non-surgical canine exposure. Treatment durations ranges from two to four years with the majority in the 2.5 to 3 years.

PMID:41591704 | DOI:10.1007/s44445-025-00116-w

Int J Clin Oncol. 2026 Jan 27. doi: 10.1007/s10147-026-02974-8. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia is a critical comorbidity in esophageal cancer patients undergoing neoadjuvant therapy (NAT), linked to poor surgical outcomes and survival. However, its reported prevalence varies widely, and a comprehensive synthesis of evidence is lacking.

OBJECTIVE: To systematically evaluate and quantify the prevalence of the sarcopenia disease in in patients known to be diagnosed with esophageal cancer and receiving preoperative neoadjuvant therapy and examine its association with clinical outcomes.

METHODS: Following PRISMA guidelines 2020, This systematic review and meta-analysis that was registered on PROSPERO (CRD420251109294), provides a comprehensive search through PubMed, SCOPUS, Web of Science, and the Cochrane Library to identify research papers reporting sarcopenia prevalence in esophageal cancer patients undergoing neoadjuvant chemotherapy or chemoradiotherapy. Pooled prevalence estimates and outcome associations were calculated using random-effects models. Subgroup and sensitivity analyses were performed to explore heterogeneity, and study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS: Twenty-six research studies comprising 3298 patients were included. The pooled prevalence of sarcopenia following neoadjuvant therapy was 48% (95% CI 38-58%), with considerable heterogeneity (I² = 95.7%). Sarcopenia was significantly associated with worse overall survival (HR: 2.10; 95% CI 1.72-2.57) but showed no statistically significant association with recurrence-free survival or postoperative complications. Most studies were of moderate to high quality, though differences in diagnostic criteria and assessment timing contributed to heterogeneity.

CONCLUSIONS: Sarcopenia is highly prevalent among patients with esophageal cancer undergoing neoadjuvant therapy. Although sarcopenia was consistently associated with poorer overall survival, these findings are derived from heterogeneous definitions, variable assessment timing, and unadjusted outcome analyses, and should therefore be interpreted as associative rather than causal. Standardized diagnostic criteria, incorporation of muscle strength assessment, and prospective studies are required in future research.

PMID:41591683 | DOI:10.1007/s10147-026-02974-8

Discov Oncol. 2026 Jan 27. doi: 10.1007/s12672-025-03876-3. Online ahead of print.

ABSTRACT

Aging-related diseases, particularly cancer, remain major health challenges that demand new therapeutic strategies. Chimeric antigen receptor (CAR) T cell therapy has emerged as a powerful modality in immuno-oncology, enabling patient-derived T cells to be engineered ex vivo to recognize and eliminate tumor antigens. Here, we identify FAM168B (family with sequence similarity 168 member B, also known as myelin-associated neurite-outgrowth inhibitor, MANI) and its homolog FAM168A (tongue cancer resistance-associated protein 1, TCRP1) as candidate membrane-associated proteins expressed on cancer cell surfaces. The unique characteristics of FAM168B suggest its potential as a tumor-specific target for CAR T cell development. This approach could expand the therapeutic repertoire of CAR T cell therapy and support the design of more precise and versatile treatment strategies for diverse cancer types.

PMID:41591662 | DOI:10.1007/s12672-025-03876-3

Adv Ther. 2026 Jan 27. doi: 10.1007/s12325-025-03473-4. Online ahead of print.

ABSTRACT

INTRODUCTION: Sickle cell pain crises (SCPCs) are debilitating pain events that significantly impact quality of life in patients with sickle cell disease (SCD), but no fit-for-purpose tool exists to capture patients’ experiences of them. We developed a patient-reported outcome (PRO) tool to capture patients’ SCPC experiences and ensured its content validity through cognitive debriefing (CD) interviews with adolescents and adults with SCD.

METHODS: In this non-interventional, qualitative research study, a targeted literature review (TLR) was conducted to create preliminary items and a preliminary conceptual model (CM) of SCPCs in patients with SCD. Next, an item-generation session was held with clinical experts, followed by hybrid concept elicitation (CE) and CD interviews with patients over three waves; the preliminary items and CM were refined iteratively after each wave. SCPC and impact disturbance ratings were summarised using descriptive statistics. CD responses were analysed on the basis of a semi-structured discussion guide.

RESULTS: The TLR identified 12 articles describing 47 concepts related to pain, anatomical sites, duration, frequency, and impacts of SCPCs. In CE interviews, patients described various aspects of their SCPC experience, including anatomical sites affected, pain characteristics, and duration. CD interviews confirmed the content validity of the eDiary, with patients finding most questions and response options clear and useful. The diary was modified on the basis of patient feedback per wave.

CONCLUSION: The SCPC eDiary is a novel PRO instrument that captures the frequency, severity, and impact of home-managed pain crises. Future studies should assess its real-world use and performance in clinical settings.

PMID:41591645 | DOI:10.1007/s12325-025-03473-4