Nevin Manimala

Orv Hetil. 2026 Jul 19;167(29):1131-1141. doi: 10.1556/650.2026.33600. Print 2026 Jul 19.

ABSTRACT

Acute ischemic and hemorrhagic stroke are among the leading causes of mortality and long-term disability worldwide. In addition to the results of randomized clinical trials, registry data reflecting real-world clinical practice play a key role in evaluating the quality of care. The STROKE platform of the Translational Neuroscience National Laboratory provides a comprehensive overview of the patient population treated at a Hungarian comprehensive stroke center. Our objective was to characterize the STROKE platform and summarize the findings of studies based on its data, to synthesize the main clinical and methodological conclusions, and to present its implications for quality improvement in Hungarian stroke care. The platform is based on standardized data collection of patients admitted to the Department of Neurology or Neurosurgery, University of Pécs within 24 hours due to acute ischemic stroke, transient ischemic attack, or hemorrhagic stroke. Demographic, clinical, imaging, laboratory, therapeutic, and 90-day outcome data were recorded. Outcomes were analyzed using multivariable linear and logistic regression models, propensity score matching, and comprehensive machine learning methods. Based on the platform, 77.0% of admitted patients had ischemic stroke, 16.9% transient ischemic attack, and 6.1% hemorrhagic stroke; the mean age was 72.0 ± 12.5 years. Among patients with ischemic stroke, 62.4% received recanalization therapy. The strongest independent predictors of 90-day functional outcome were neurological status at admission, premorbid functional status, extent of early ischemia, and age. The Stroke-SCORE, based on three parameters (age, premorbid status and neurological deficit), demonstrated strong predictive performance for 90-day outcome (area under the curve = 0.86). In patients undergoing reperfusion therapy, door-to-needle time <60 minutes and door-to-groin time <120 minutes were significantly associated with more favorable outcomes. After multivariable adjustment, neither anticoagulant nor antiplatelet therapy proved to be an independent adverse prognostic factor. The STROKE platform confirms that functional outcome is primarily determined by stroke severity, premorbid status, age, extent of ischemia, and timely, well-organized reperfusion care. Real-world data analyzed with advanced statistical methods substantially contribute to clinical decision-making, the reassessment of contraindications, and quality improvement in Hungarian stroke care. Orv Hetil. 2026; 167(29): 1131-1141.

PMID:42472441 | DOI:10.1556/650.2026.33600

Prostate. 2026 Jul 19. doi: 10.1002/pros.70227. Online ahead of print.

ABSTRACT

BACKGROUND: The modified Glasgow Prognostic Score (mGPS) and systemic immune-inflammation index (SII) are useful prognostic markers for various malignancies. This study aimed to evaluate their prognostic significance in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with cabazitaxel (CBZ).

METHODS: We retrospectively reviewed the data of 344 patients with mCRPC who initiated CBZ treatment at Kobe University Hospital and affiliated institutions. The optimal SII cutoff value for predicting overall survival (OS) was determined using the maximally selected rank statistics (Maxstat) method. The prognostic significance of the mGPS and SII was assessed using Cox proportional hazards models.

RESULTS: The median OS of the entire cohort was 15.9 months. The optimal SII cutoff value determined using the Maxstat method was 850.6. A multivariate analysis demonstrated that an mGPS ≥ 1 and an SII ≥ 850.6 were independent predictors of poorer OS, with hazard ratios of 2.10 (95% confidence interval [CI], 1.55-2.85; p < 0.001) and 1.58 (95% CI, 1.13-2.21; p = 0.008), respectively. Notably, among patients with an mGPS of 0, further stratification using the SII cutoff (mGPS 0/SII-low vs. mGPS 0/SII-high) significantly discriminated OS rates.

CONCLUSION: mGPS and SII are significant prognostic biomarkers in patients with mCRPC treated with CBZ. Their combined assessment may provide improved risk stratification and support clinical decision-making in this population group.

PMID:42472432 | DOI:10.1002/pros.70227

Musculoskelet Surg. 2026 Jul 19. doi: 10.1007/s12306-026-00960-x. Online ahead of print.

ABSTRACT

To evaluate the impact of surgical timing on mortality and functional outcomes in elderly patients with proximal femoral fractures (PFFs), specifically investigating whether a 72-h threshold provides a more sensitive clinical discriminator than the traditional 48-h guideline. A retrospective cohort study was conducted on 314 patients aged ≥ 65 years surgically treated for low-energy PFF (AO/OTA 31-A and B) between January 2018 and December 2019. Patients were initially dichotomized by a 48-h threshold (Group A ≤ 48 h, n = 139; Group B > 48 h, n = 175) and subsequently analyzed using a 72-h cutoff. Primary endpoints were 3-month and 1-year mortality. Multivariate logistic regression was performed to adjust for age, sex, and Charlson Comorbidity Index (CCI). Secondary outcomes included postoperative length of stay (LOS), transfusion requirements, and functional recovery assessed via the Barthel Index. No statistically significant difference in 3-month mortality was observed using the 48-h cutoff (Group A: 11.6% vs. Group B: 12.3%; p > 0.05). Conversely, the 72-h threshold emerged as a significant independent predictor of mortality (p < 0.05). Mortality rates for patients operated beyond 72 h were significantly higher at both 3 months (21.2% vs. 9.2%; p < 0.05) and 1 year (25.6% vs. 19.4%). Multivariate analysis confirmed surgical delay > 72 h as an independent risk factor (OR 2.1; 95% CI 1.3-3.4). The highest risk was observed in males aged > 85 years with extracapsular fractures operated beyond 72 h (1-year mortality: 37.5%). Mean LOS was significantly shorter in the early surgery group (7.6 ± 2.1 vs. 8.4 ± 2.8 days; p = 0.044). No significant differences were found in 3-month functional recovery between groups. In a real-world clinical setting, the 72-h threshold represents a critical “red line” for survival in elderly hip fracture patients. While striving for stabilization within 48 h remains ideal, maximum priority should be shifted toward preventing organizational delays that push vulnerable patients, particularly elderly males with extracapsular patterns, beyond the third day.Level of evidence: Level III (Retrospective cohort study).

PMID:42472414 | DOI:10.1007/s12306-026-00960-x

Discov Oncol. 2026 Jul 19. doi: 10.1007/s12672-026-05594-w. Online ahead of print.

ABSTRACT

BACKGROUND: Hematuria is a common clinical presentation of bladder cancer (BC). Accurate non-invasive diagnostic tools are needed to complement or reduce the reliance on cystoscopy. In this study, we investigated the diagnostic performance of urinary exfoliated-cell chromosomal copy-number aberration detection (UroCAD), a novel assay utilizing low-coverage whole-genome sequencing (LC-WGS) to detect chromosomal instability (CIN) in exfoliated urothelial cells. The evaluation included the use of UroCAD alone and in combination with ultrasonography.

METHODS: A consecutive series of 153 patients with hematuria was prospectively enrolled. Urine samples were subjected to genome-wide copy-number variation (CNV) profiling using UroCAD. The diagnostic performance of UroCAD and ultrasonography, individually and in combination, was assessed using histopathology as the reference standard. Statistical analyses included receiver operating characteristic (ROC) curves, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.

RESULTS: Of the 153 enrolled patients, 151 (113 with pathologically confirmed BC and 38 with benign lesions) were included in the final analysis. UroCAD alone showed a specificity of 78.9% and a PPV of 90.1%, with an area under the ROC curve (AUC) of 0.84 (95% confidence interval [CI]: 0.77-0.91). Ultrasonography alone exhibited higher sensitivity than UroCAD (67.0% vs. 64.6%), but lower specificity (59.5%). The “CIN OR ultrasound” rule achieved the highest sensitivity (85.7%) and overall accuracy (75.8%), with an NPV of 51.5%. The “CIN AND ultrasound” rule yielded the highest specificity (91.9%) and PPV (94.4%). The CNV burden was strongly associated with tumor stage, with higher-stage tumors showing more frequent and pronounced genomic instability.

CONCLUSIONS: UroCAD has potential as a non-invasive assay for BC detection. Combined with ultrasonography, it offers a dual-strategy approach: a high-sensitivity strategy (“CIN OR ultrasound”) that may help identify patients warranting further evaluation, although its low NPV precludes safe exclusion of malignancy; and a high-specificity strategy (“CIN AND ultrasound”) for confirmatory purposes. This synergistic strategy may aid in the risk stratification of patients with hematuria, although further prospective studies are required to validate its clinical utility. Trial registration ISRCTN Registry ISRCTN50547972 (http//www.isrctn.com/ISRCTN50547972). Registration date 27 April 2026.

PMID:42472409 | DOI:10.1007/s12672-026-05594-w

Int Ophthalmol. 2026 Jul 19;46(1):300. doi: 10.1007/s10792-026-04170-z.

ABSTRACT

PURPOSE: This systematic review and meta-analysis aimed to characterize etiological patterns of uveitis in individuals aged 60 years or older.

METHODS: Following the PRISMA 2020 and MOOSE reporting guidelines, we searched PubMed/MEDLINE, Scopus, PubMed Central (PMC), and Web of Science (January 1, 2005-January 1, 2025). Data extraction focused on study characteristics, sample size, uveitis location, and reported causes. Random-effects models were used to pool proportions across studies, heterogeneity assessed by the I² statistic. Methodological quality was evaluated via the Newcastle-Ottawa Scale for cohort studies and the JBI Critical Appraisal Checklist for cross-sectional studies.

RESULTS: Out of 10,829 retrieved citations, 16 studies met the inclusion criteria. Idiopathic uveitis constituted the largest proportion, with a pooled proportion of 41.45% (95% CI 30.63-53.16%). Infectious etiologies included herpetic uveitis (pooled proportion 11.40%, 95% CI 7.45-17.04%), cytomegalovirus (3.09%, 95% CI 1.01-9.06%) and tuberculosis (5.10%, 95% CI 2.58-9.83%). Non-infectious causes, such as sarcoidosis (5.21%, 95% CI 2.78-9.55%) and HLA-B27-associated uveitis (6.05%, 95% CI 3.35-10.71%), also contributed substantially. High heterogeneity (I² > 75%) was noted across most etiologies, likely reflecting variable study populations, diagnostic criteria, and geographic factors.

CONCLUSION: Our meta-analysis underscores the diverse etiological landscape of uveitis in the elderly, with over 40% of cases remaining idiopathic. High heterogeneity highlights regional variations and diagnostic challenges. Standardized evaluation protocols and improved access to advanced investigations may help reduce the burden of undiagnosed cases. Within Asia, the only continent contributing multiple studies, subgroup analysis reduced heterogeneity for some etiologies, suggesting that regional factors contribute to the observed variability.

PMID:42472399 | DOI:10.1007/s10792-026-04170-z

J Interpers Violence. 2026 Jul 19:8862605261463253. doi: 10.1177/08862605261463253. Online ahead of print.

ABSTRACT

Violence towards companion animals (CAs) is prevalent in cases of intimate partner violence (IPV), and several studies have emphasized its impact on survivors’ well-being and decision-making process. However, little is known about its effect on perceived social support among female IPV survivors. This study aims to address this gap. In this study, a sample of 70 female IPV survivors who owned a CA at the time of the abuse completed a protocol including the Portuguese version of the Personality Assessment Inventory (PAI). Independent samples t-tests compared Nonsupport (NON) scale scores between survivors with and without reports of violence towards CAs, and linear regression examined the predictive effect of reported CA-directed violence, controlling for other relevant variables (e.g., unemployment, other PAI scales). Over half of the participants reported abuse directed at their CAs by their partners. Those who reported CAs abuse scored significantly higher on the NON scale, indicating a greater perceived lack of social support. The linear regression model was statistically significant, suggesting that reporting violence against CAs, higher Depression scale scores, lower Traumatic stress scale scores, and unemployment had a significant impact on NON scale scores. Potential explanations are discussed, including the dual role of CA as both social and emotional support providers, and as tools of coercion and control used by the perpetrator. These findings underscore the importance of integrated human and animal welfare services and support the development of professional training programs and legislative reforms to protect IPV survivors and their CAs.

PMID:42472398 | DOI:10.1177/08862605261463253

Eur Spine J. 2026 Jul 19. doi: 10.1007/s00586-026-10209-7. Online ahead of print.

ABSTRACT

PURPOSE: Lumbar pseudarthrosis revision is challenging for both patients and surgeons, with no standard approach. This study aimed to evaluate radiographic fusion and index-level re-revision rates after revision using lateral lumbar interbody fusion (LLIF), comparing standalone LLIF (SA-LLIF) and circumferential LLIF with posterior revision (360°-LLIF). Secondary outcomes included perioperative parameters and sagittal alignment.

METHODS: This retrospective, single-center cohort study included patients undergoing LLIF for lumbar pseudarthrosis between 2007 and 2023 with ≥ 1-year follow-up. Patients were stratified into SA-LLIF and 360°-LLIF groups. Fusion was assessed at one year using the Bridwell grading system (grades I-II considered fused). Perioperative parameters, re-revision, and sagittal alignment were evaluated.

RESULTS: Thirty-eight patients were included (SA-group: n = 26; 360°-group: n = 12). Groups were comparable except for a higher BMI in the 360°-group (p = 0.035). Overall fusion was 84.2%, with rates of 80.8% in SA-LLIF and 91.7% in 360°-LLIF (p = 0.392). No patient required re-revision for non-union; one 360° patient underwent wound revision. Operative time (233 vs. 84 min, p = 0.005), and estimated blood loss (625 vs. 100 mL, p = 0.001) were higher in the 360°-group. Length of stay and sagittal alignment parameters were similar between groups.

CONCLUSION: Both 360°-LLIF and SA-LLIF may represent viable revision strategies for pseudarthrosis after posterior instrumentation, each with distinct advantages. Fusion rates were numerically higher with 360°-LLIF but not statistically different, and no patient in either group required secondary revision surgery for non-union. SA-LLIF was associated with shorter operative times and reduced EBL. Findings should be interpreted cautiously given the small sample size.

PMID:42472391 | DOI:10.1007/s00586-026-10209-7

J Clin Exp Neuropsychol. 2026 Jul 19:1-17. doi: 10.1080/13803395.2026.2703680. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to characterize contemporary technology use in U.S. clinical neuropsychology and identify perceived barriers, facilitators, benefits, competencies, and training needs associated with technology adoption.

METHOD: The AACN Disruptive Technology Initiative developed the Facilitators and Barriers to Adopting Technology in Neuropsychology survey, which was administered from October 2024 through February 2025 to licensed practitioners and trainees through professional organizations and social media. The Qualtrics survey included multiple-choice and open-ended items assessing practice characteristics, technology use, perceived productivity effects, and training experiences. After data cleaning, 302 valid responses were retained for analysis. Descriptive statistics were used to summarize quantitative data, and natural language processing-based topic modeling was applied to open-ended responses to identify thematic categories.

RESULTS: Respondents most commonly reported routine use of computerized assessment platforms and automated scoring systems, whereas home-based, mobile, and ecologically embedded approaches were used less frequently. Commonly endorsed barriers included limited patient access to devices or reliable internet, insufficient validation of available tools, privacy and security concerns, institutional resistance, and financial disincentives related to billing and RVU structures. Reported benefits included greater scoring efficiency, streamlined workflow, faster report turnaround, and expanded access for geographically remote or mobility-limited patients. Although respondents generally endorsed moderate-to-high technological literacy, most reported minimal formal training and substantial reliance on self-directed learning. Younger clinicians also reported greater technological literacy and higher rates of technology uptake.

CONCLUSION: U.S. clinical neuropsychology is in a transitional phase in which technology is increasingly integrated into practice but remains unevenly adopted across settings and modalities. These findings underscore the need for competency-based training across career stages, stronger validation and implementation infrastructure, and reimbursement models that support secure, ethical, and sustainable technology integration in neuropsychological practice.

PMID:42472380 | DOI:10.1080/13803395.2026.2703680

J Eval Clin Pract. 2026 Aug;32(5):e70530. doi: 10.1111/jep.70530.

ABSTRACT

RATIONALE: Medication wastage is a persistent challenge in healthcare systems, yet the economic impact of syringe dead space (DS) and residual volume during routine medication administration remains underexplored outside the vaccine context.

AIMS AND OBJECTIVES: To investigate the economic impact of syringe dead space and residual volume on medication administration in a Brazilian teaching hospital.

METHOD: A retrospective observational study was conducted using medication prescription data from 2022 at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Brazil. All injectable medications were included. Medication cost per millilitre was calculated using hospital procurement records. Syringe sizes were defined according to prescribed volumes. Syringe dead space was measured using an analytical balance (ATY224, Shimadzu, Japan), and wasted volumes and financial losses were estimated. The medication wastage rate was calculated as the ratio between wasted value and total medication expenditure.

RESULTS: A total of 120 medications met the inclusion criteria, accounting for 693,933 prescriptions. The estimated wasted volume due to residual volume was 41,394.47 mL. The top ten medications accounted for 51.72% of prescriptions and 48.18% of the wasted financial value. The overall hospital wastage rate was approximately 1.16%. Syringe dead space, frequency of medication administration, and cost per millilitre were identified as the main contributors to medication wastage.

CONCLUSION: Syringe dead space and residual volume constitute a measurable and avoidable source of medication loss, with relevant economic implications. These findings can inform procurement strategies, waste reduction interventions, and public health policies aimed at optimising healthcare resource use.

PMID:42472378 | DOI:10.1111/jep.70530

J Eval Clin Pract. 2026 Aug;32(5):e70527. doi: 10.1111/jep.70527.

ABSTRACT

BACKGROUND: Financial ties between healthcare professionals and the medical-device industry raise conflict-of-interest and transparency concerns; despite Japan’s 2012 self-regulatory guidelines, device-related payments receive less scrutiny than pharmaceutical payments globally, including in Japan.

OBJECTIVE: To provide the first detailed analysis of honoraria from medical device companies to Japanese physicians in 2019, offering a baseline before the COVID-19 pandemic.

METHODS: We retrospectively examined 2019 payment data from the Yen for Docs database, compiled from disclosures by 118 companies affiliated with the Japan Medical Devices Network and other major firms. The analysis focused on honoraria-lecture, consulting, and writing fees-because these are the only categories disclosed with individual healthcare professionals names. Payments were standardized, cleaned, and aggregated at company and recipient levels. Descriptive analyses identified overall volume, company distribution, and top-earning specialties.

RESULTS: In 2019, 66 companies disclosed 60,161 honorarium payments totaling USD 46.0 million. Most funds (66.7%) were lecture fees, followed by consulting (28.8%) and writing (4.5%). Payments were highly concentrated: the top 10 companies accounted for 63.3% of the total, led by Medtronic, Terumo, and Johnson & Johnson. Among 24,434 recipients, 66.1% received less than USD 1,000, while only seven physicians received more than USD 100,000. Cardiologists (48.0%) and cardiovascular surgeons (24.0%) dominated the top 50 earners.

CONCLUSION: Honoraria from Japan’s device industry were modest in scale compared with pharmaceutical companies but highly concentrated among a few firms and cardiovascular specialists. These findings highlight the need for more comprehensive and legally enforceable transparency frameworks to safeguard clinical integrity and public trust.

PMID:42472377 | DOI:10.1111/jep.70527