Category: Nevin Manimala

Transl Oncol. 2026 Feb 2;65:102670. doi: 10.1016/j.tranon.2026.102670. Online ahead of print.

ABSTRACT

Nasopharyngeal carcinoma (NPC) is prevalent in Southeast Asia, including Taiwan. It exhibits higher morbidity as well as mortality in males than in females. However, the role of the androgen receptor (AR) in NPC remains unclear. In this study, AR expression was detected in most NPC cell lines and patient-derived xenografts. Treatment with enzalutamide, an antiandrogen, substantially inhibited patient-derived xenografts growth and demonstrated additive antitumor effects when combined with chemotherapy in AR-positive models. Additionally, transcriptome analysis following enzalutamide treatment revealed activation of hypoxia-inducible factor-1, steroid hormone, and AR pathways, alongside suppression of interferon and tumor necrosis factor pathways. Protein analysis further supported these transcriptomic changes. In AR-overexpressing NPC-B13 cells, AR appeared to regulate thyroid transcription factor-1 (TTF-1, encoded by NKX2-1 gene) and its downstream target epidermal growth factor receptor (EGFR), thereby promoting cancer cell proliferation. Furthermore, chromatin immunoprecipitation suggested that AR may directly bind to the NKX2-1 promoter to upregulate its mRNA expression. Under AR overexpression, Epstein-Barr virus (EBV) remained in a latent state, accompanied by suppression of lytic gene expression. Additionally, Epstein-Barr nuclear antigen-1 enhanced AR transactivation in a dose-dependent manner in NPC cell line reporter assays. Among 96 metastatic NPC tumor samples, AR expression was observed in 35 cases (36.5%), predominantly in males (33/83, 39.8%). AR expression correlated with poorer overall survival, with statistical significance noted in the full cohort and particularly in male patients. This study suggests that AR may promote metastatic NPC progression via the TTF-1/EGFR signaling pathway and interact with EBV to influence disease behavior, especially in males.

PMID:41633021 | DOI:10.1016/j.tranon.2026.102670

ESMO Open. 2026 Feb 2;11(2):106065. doi: 10.1016/j.esmoop.2026.106065. Online ahead of print.

ABSTRACT

BACKGROUND: Although patients with Eastern Cooperative Oncology Group performance status (PS) of 2 constitute a significant proportion of the cancer population, they are often excluded from pivotal clinical trials owing to presumed higher risks of treatment effect dilution, toxicity, and lower compliance. Here, we conducted a systematic review and meta-analysis to evaluate the impact of including PS 2 participants on efficacy and safety outcomes in pivotal cancer clinical trials.

MATERIALS AND METHODS: We searched the ‘Oncology/Hematologic Malignancies Approval Notifications’ and ‘Drugs@FDA’ databases for clinical trials supporting ‘Food and Drug Administration’ anticancer drug approvals from 1 January 2009 to 31 December 2024. Eligible studies were randomized phase III clinical trials of systemic therapies for metastatic solid tumors permitting the inclusion of PS 2 participants. We assessed efficacy outcomes [progression-free survival (PFS) and overall survival (OS)] and safety outcomes [occurrence of any-grade adverse events (AEs), high-grade AEs, serious AE (SAEs), AE-related deaths, and treatment modifications] in the included studies.

RESULTS: Thirty-six trials were included. In subgroup analyses, no statistically significant differences were found between PS 2 and PS ≤1 participants for PFS [hazard ratio (HR) 0.45, 95% confidence interval (CI) 0.30-0.69 versus HR 0.52, 95% CI 0.41-0.66, P = 0.59] and OS (HR 0.81, 95% CI 0.68-0.97 versus HR 0.71, 95% CI 0.66-0.77, P = 0.18). In meta-regression analyses, no significant associations were found for efficacy outcomes. However, a higher proportion of PS 2 participants was significantly associated with an increased risk of SAEs, AE-related deaths, and treatment discontinuations.

CONCLUSIONS: Although PS 2 participants showed a greater propensity to serious toxicity, no significant differences in efficacy outcomes were observed compared with those with PS ≤1. Our results support the inclusion of PS 2 participants in clinical trials, as their exclusion limits the generalizability of results.

PMID:41633012 | DOI:10.1016/j.esmoop.2026.106065

Ultrasonics. 2026 Jan 23;163:107973. doi: 10.1016/j.ultras.2026.107973. Online ahead of print.

ABSTRACT

Reliable Lamb-wave-based Structural Health Monitoring (SHM) depends on accurate baseline selection under varying temperatures. This study presents LambNet-T, a lightweight path-conditional Transformer-based autoencoder for temperature-aware baseline learning across multiple transducer paths. LambNet-T employs Attention Pooling (AP) to generate contextual embeddings and enables robust baseline selection using Cosine Similarity (CS) with a Median-based evaluation strategy, improving diagnostic accuracy and temperature robustness in multi-path Lamb-wave SHM. Experiments on a composite panel over -10 to +50 °C used only four baseline temperatures to reflect practical constraints, with quadratic interpolation for data augmentation. LambNet-T demonstrated significantly higher training efficiency than a convolutional autoencoder (CAE-GAP). During inference, the Median of the highest path-specific CS values identified the optimal temperature-compensated baseline. The method achieved high precision (R² = 0.994 ± 0.001), outperforming both CAE-GAP and conventional Optimal Baseline Selection (OBS). Integration with an existing damage localization framework reduced impact location errors to as low as 4.12 mm. A conservative statistical filter, based on baseline selection variability, was applied to manage uncertainty. All experimental datasets are openly available for reproducibility.

PMID:41633009 | DOI:10.1016/j.ultras.2026.107973

Burns. 2026 Jan 29;52(3):107877. doi: 10.1016/j.burns.2026.107877. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric burn injuries pose significant health concerns and rank fifth globally in non-fatal injuries. Current evidence associates lower socioeconomic status (SES) with higher incidence of burn injury, greater TBSA, higher need for admission, and greater involvement of child protective services. There is a paucity of Canadian data on the topic, and effects of indices of deprivation on outcomes have not been investigated extensively.

METHODS: A retrospective single-centre study was carried out to examine effects of SES and Ontario Marginalization Index (OMI) on pediatric burn patient outcomes. One-way ANOVA with post hock Bonferroni correction was used for continuous dependent variables (i.e. TBSA, length of stay), and Pearson chi-square analysis was done for categorical variables (i.e. CAS involvement, need for OR, need for admission). P-value of 0.05 was set a priori to determine statistical significance.

RESULTS: No differences in outcomes were found between the four quartiles of SES categories. Analysis of the OMI for Material Resources, Racialized and Newcomer Populations, Age and Labour Force, and Household and Dwellings produced statistically significant findings. Patients with a higher degree of marginalization for most indices tended to have greater TBSA, time to surgery, and length of stay. An unexpected finding was that patients with the lowest Age and Labour Force deprivation indices were likely to have greater TBSA.

CONCLUSION: Identifying the effects of various social determinants of health on pediatric burn patients remains a challenging problem. While this study found no differences in patient outcomes based on income alone, examination of the granularity in deprivation provided notable differences. These effects could be further clarified with a cross-provincial or national study.

PMID:41633001 | DOI:10.1016/j.burns.2026.107877

Knee. 2026 Feb 2;60:104350. doi: 10.1016/j.knee.2026.104350. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) and distal femoral replacement (DFR) can be used in limb-salvage after resection of bony tumors, but few reports have examined patient-reported outcome measurements (PROMs) with survival data in young patients. This study analyzed individuals who underwent TKA/DFR for neoplasm at a young (≤40) age, to report outcomes and survival experience.

METHODS: A retrospective study on 12 TKAs/23 DFRs was conducted between January 1990-2020 in 35 patients ≤40 years old. Electronic medical records were reviewed to identify patients with neoplasm, and collect data. Patients were contacted to obtain PROMs.

RESULTS: The median age (interquartile range) at surgery for TKAs and DFRs was 26.7 (22.7-34.0) and 24.6 years (20.9-28.4), respectively. Median follow-up was 3.95 (0.33-8.14) and 3.01 years (1.72-6.07). TKAs were more commonly due to complications after allograft reconstruction (75.0% vs. 0.00%, p < 0.0001), had lower blood loss (250 vs. 800 ml, p = 0.01) and a higher rate of tourniquet use (75.0% vs. 34.8%, p = 0.04). Revision-free survival (8-year) was 54.7% (95% confidence interval (CI): 13.7%-83.3%) for TKAs and 37.9% (95% CI: 10.4%-66.0%, p = 0.12) for DFRs. For TKAs, median KOOS Jr. was 76.3 (76.3-79.9), VR-12-Physical was 50.0 (40.5-51.7), VR-12-Mental was 40.8 (32.6-45.8), LEAS was 12.0 (12.0-13.0), and FJS was 23.0 (19.0-25.0), without statistical difference from the DFR group.

CONCLUSION: Patients ≤40 years old who underwent TKAs/DFRs for neoplastic disease demonstrated a similarly high postoperative complication rate and poor long-term survival. Almost all PROMs were favorable, reflecting a more promising postoperative experience than survival curves might demonstrate.

PMID:41632986 | DOI:10.1016/j.knee.2026.104350

Biomed Phys Eng Express. 2026 Feb 3. doi: 10.1088/2057-1976/ae4107. Online ahead of print.

ABSTRACT

&#xD;Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a range of motor and non-motor symptoms. Despite extensive research, the neural structure of time distortion, remains unclear. This study aimed to determine the neurobiological origins of time distortion by analyzing dynamic features in PD patients compared to control participants.&#xD;Approach.&#xD;We used PD and control electroencephalography (EEG) signals to investigate brain function during time distortion. The EEG signal was recorded during an interval-timing task. Following artifact reduction and EEG signal segmentation, dynamic features were extracted from each frequency band across all the channels. Channels showing significant discrepancies between the two groups were selected by statistical analysis. The features are sent to an Artificial Neural Network (ANN) classifier to evaluate their discriminative potential.&#xD;Main results.&#xD;The results indicated lower values of Lyapunov Exponent and Approximate Entropy along with higher value of Fractal dimension in PD which presented higher level of irregularity and randomness, particularly in the CPz, P5, P6, and C5 channels. The ANN classifier achieved 90% accuracy, 89% sensitivity, 87% F1 score, and 95% specificity in a 10-fold cross-validation. &#xD;Significance.&#xD;Significantly different channels were concentrated in the central and parietal areas of the brain and were linked to decision-making, maintenance, and retrieval of stored information, and working memory. Moreover, based on dynamic EEG analysis, it seems that disrupted connections between the basal ganglia and posterior parietal cortex in PD appear to compromise frontoparietal network dysfunction, which is associated with impaired temporal processing in patients with PD.&#xD.

PMID:41632980 | DOI:10.1088/2057-1976/ae4107

JMIR Form Res. 2026 Feb 3;10:e84023. doi: 10.2196/84023.

ABSTRACT

BACKGROUND: Poor sleep is a concerning public health problem in the United States. Previous sleep interventions often face barriers such as high costs, limited accessibility, and low user engagement. Recent advancements in artificial intelligence (AI) technologies offer a novel approach to overcoming these limitations. In response, our team developed a prototype AI sleep chatbot powered by a large language model to deliver personalized, accessible sleep support.

OBJECTIVE: This study aimed to examine the feasibility, usability, acceptability, and preliminary efficacy of the AI chatbot for sleep promotion.

METHODS: We conducted a quasi-experimental, single-group study with adults in the United States aged 18 to 75 years who self-reported poor sleep. The chatbot was integrated into a commercially available messaging app. Participants were asked to engage with a virtual sleep therapist via texting over 2 weeks. The chatbot provided ongoing, individualized sleep guidance and adapted recommendations based on participants’ prior conversations. Feasibility, usability, and acceptability were descriptively summarized. Sleep was assessed using questionnaires before and after the intervention.

RESULTS: Of the 107 adults who enrolled in the study, 88 (82.2%) completed chatbot registration. Among these 88 participants, 65 (73.9%) initiated interactions, and 44 (50%) completed the 2-week intervention. The final analysis included 42 adults (mean age 36, SD 11 years; n=12, 28.6% male). On average, participants engaged with the chatbot for 58 (SD 42) minutes, with each chat session lasting approximately 9 (SD 6) minutes. Most reported favorable experiences with the chatbot. The average usability score was 85.2 (SD 10.7) out of 100, which was well above the benchmark of 68. The chatbot was rated as highly acceptable, with a satisfaction score of 27.3 (SD 4.1) out of 32. All participants perceived the chatbot as effective, with ratings ranging from “slightly effective” to “extremely effective.” The preliminary evidence showed improved sleep outcomes after chatbot use: total sleep time increased by 1.4 hours (P<.001); sleep onset latency decreased by 30.9 minutes (P<.001); sleep efficiency increased by 7.8% (P=.007); and scores improved for perceived sleep quality (mean difference [MD] -5.4; P<.001), insomnia severity (MD -7.9; P<.001), daytime sleepiness (MD -4.7; P<.001), and sleep hygiene skills (MD -13.2; P<.001). No significant change was observed in sleep environment (MD -1.1; P=.16).

CONCLUSIONS: Our AI chatbot demonstrated satisfactory feasibility, usability, and acceptability. Improvements were observed following chatbot use, although causality cannot be established. These findings highlight the potential of integrating state-of-the-art large language models into behavioral interventions for sleep promotion. Future research should include objective sleep measurements and conduct randomized controlled trials to validate the study findings. If confirmed, this AI chatbot could be scaled to support sleep health on a broader level.

PMID:41632970 | DOI:10.2196/84023

J Med Internet Res. 2026 Feb 3;28:e82170. doi: 10.2196/82170.

ABSTRACT

BACKGROUND: While artificial intelligence (AI) holds significant promise for health care, excessive trust in these tools may unintentionally delay patients from seeking professional care, particularly among patients with chronic illnesses. However, the behavioral dynamics underlying this phenomenon remain poorly understood.

OBJECTIVE: This study aims to quantify the influence of AI trust on health care delays through integrated survey-based mediation analysis and real-world research, and to simulate intervention efficacy using agent-based modeling (ABM).

METHODS: A cross-sectional online survey was conducted in China from December 2024 to May 2025. Participants were recruited via convenience sampling on social media (WeChat and QQ) and hospital portals. The survey included a 21-item questionnaire measuring AI trust (5-point Likert scale), AI usage frequency (6-point scale), chronic disease status (physician-diagnosed, binary), and self-reported health care delay (binary). Responses with completion time <90 seconds, logical inconsistencies, missing values, or duplicates were excluded. Analyses included descriptive statistics, multivariable logistic regression (α=.05), mediation analysis with nonparametric bootstrapping (500 iterations), and moderation testing. Subsequently, an ABM simulated 2460 agents within a small-world network over 14 days to model behavioral feedback and test 3 interventions: broadcast messaging, behavioral reward, and network rewiring.

RESULTS: The final sample included 2460 adults (mean age 34.46, SD 11.62 years; n=1345, 54.7% female). Higher AI trust was associated with increased odds of delays (odds ratio [OR] 1.09, 95% CI 1.00-1.18; P=.04), with usage frequency partially mediating this relationship (indirect OR 1.24, 95% CI 1.20-1.29; P<.001). Chronic disease status amplified the delay odds (OR 1.42, 95% CI 1.09-1.86; P=.01). The ABM demonstrated a bidirectional trust erosion loop, with population delay rates declining from 10.6% to 9.5% as mean AI trust decreased from 1.91 to 1.52. Interventions simulation found broadcast messaging most effective in reducing delay odds (OR 0.94, 95% CI 0.94-0.95; P<.001), whereas network rewiring increased odds (OR 1.04, 95% CI 1.04-1.05; P<.001), suggesting a “trust polarization” effect.

CONCLUSIONS: This study reveals a nuanced relationship between AI trust and delayed health care-seeking. While trust in AI enhances engagement, it can also lead to delayed care, particularly among patients with chronic conditions or frequent AI users. Integrating survey data with ABM highlights how AI trust and delay behaviors can strengthen one another over time. Our findings indicate that AI health tools should prioritize calibrated decision support rather than full automation to balance autonomy, odds, and decision quality in digital health. Unlike previous studies that focus solely on static associations, this research emphasizes the dynamic interactions between AI trust and delay behaviors.

PMID:41632964 | DOI:10.2196/82170

JMIR Cancer. 2026 Feb 3;12:e70354. doi: 10.2196/70354.

ABSTRACT

BACKGROUND: Ostomy creation for cancer treatment negatively impacts the quality of life of both patients and caregivers. Hispanic patients with cancer and caregivers often face additional challenges, including limited access to supportive care programs.

OBJECTIVE: This study aimed to examine the experiences and preferences of Hispanic patients with cancer living with ostomies and their caregivers to inform the cultural adaptation of an existing intervention program and the design of Ostomy Self-Care Program (Programa de AutoCuidado de Estoma [PACE]).

METHODS: In this 2-stage study, conducted between March and August 2023 in San Antonio, Texas, we used a qualitatively driven mixed methods design, starting with an initial survey followed by qualitative interviews to explore the experiences, needs, and intervention preferences of Hispanic patients and caregivers managing ostomy care. We used Braun and Clarke’s 6-phase thematic analysis approach to analyze the qualitative data and performed descriptive analysis for the quantitative data. Subsequently, we applied affinity diagramming and persuasive systems design principles to guide the design of PACE.

RESULTS: In total, 14 Hispanic participants managing an ostomy (9 patients with cancer and 5 caregivers) completed a survey and participated in interviews, continuing until data saturation was reached. Participants had a mean age of 58.9 (SD 13.01, range 37-79) years, and most (n=12) reported a high school diploma or General Educational Development as their highest education level. Around 5 (36%) participants scored below 26 on the eHealth Literacy Scale (eHEALS), indicating low digital health literacy, and the average Charlson Comorbidity Index (CCI) was 3.21 (SD 1.86, range 0-6). Overall, 3 major themes emerged from the qualitative data analysis, namely perceptions of living with an ostomy, seeking support, and postsurgery challenges. Additionally, two primary themes emerged from participant interviews: (1) importance of preferred language and multimedia delivery and (2) patients and caregivers desire early introduction, multimodal delivery of materials, and inclusion of peer and family support. These themes informed the design and development of a culturally appropriate, web-based, bilingual PACE intervention that integrates content visualization, cultural adaptations, and persuasive technologies-strategies designed to encourage user engagement.

CONCLUSIONS: Our findings emphasize the importance of understanding the ostomy care experiences, supportive care needs, and intervention preferences of Hispanic patients and caregivers. Informed by stakeholders’ insights, we culturally adapted the original intervention program using persuasive systems design principles to design and develop the PACE intervention, aiming to enhance engagement among Hispanic patients with cancer and caregivers, support effective self-management of ostomy care, and improve health outcomes.

PMID:41632962 | DOI:10.2196/70354

JMIR Mhealth Uhealth. 2026 Feb 3;14:e75005. doi: 10.2196/75005.

ABSTRACT

BACKGROUND: Young African American men who have sex with men (AAMSM) experience disproportionately high HIV incidence and are less likely to achieve viral suppression compared to White men who have sex with men, an outcome that relies on antiretroviral therapy (ART) adherence. We created My Personal Health Guide, a talking relational agent-based mobile health app to improve ART adherence among young AAMSM.

OBJECTIVE: The objective was to determine the efficacy of My Personal Health Guide on improving ART adherence among young AAMSM living with HIV.

METHODS: We implemented a randomized controlled trial among young (aged 18-34 years) AAMSM with nonoptimal ART adherence throughout the United States between February 2020 and September 2023, predominantly through social media and by word of mouth, provider referral, and fliers in selected health care settings. Participants were randomized in a 1:1 ratio using permuted blocks of 8 to the intervention, My Personal Health Guide, or the attention control arm. ART adherence was assessed with Wilson’s 3-item self-reported adherence measurement and dichotomized at ≥80%. Logistic regression models using backward selection were used to evaluate the efficacy of My Personal Health Guide on ≥80% ART adherence at 1-month follow-up.

RESULTS: Among the 253 AAMSM at baseline, most (n=180, 71.1%) self-reported being ≥80% adherent to ART, over half (n=145, 57.3%) resided in the Southern United States, but all US regions were represented, nearly half (n=175, 42.3%) had some college education, over one-third (n=96, 37.9%) had less than optimal literacy, and approximately one-quarter (n=61, 24.1%) experienced housing insecurity in the past 6 months. The sample for analysis of the My Personal Health Guide app efficacy was 131 (intervention=76 and control=55). The odds of being ≥80% adherent to ART at 1-month follow-up were 3.97 (95% CI 1.26-12.55) times greater among participants randomized to the My Personal Health Guide app compared to the controls, after adjusting for ART adherence at baseline, treatment adherence self-efficacy, and ever being incarcerated. Additionally, for every 1-point increase in the HIV Treatment Adherence Self-Efficacy Scale, the odds of ≥80% ART adherence increased by 3% (odds ratio 1.03, 95% CI 1.00-1.06).

CONCLUSIONS: Participants randomized to receive My Personal Health Guide reported nearly 4 times greater odds of being ≥80% adherent to ART compared to the attention control group at 1-month follow-up. To our knowledge, this is the first randomized controlled trial demonstrating improved medication adherence using a relational agent-based behavioral intervention. These findings provide evidence of short-term efficacy of My Personal Health Guide to improve ART adherence among young AAMSM. We recommend further research on the inclusion of relational agents in behavioral research, especially in populations affected by stigma and nonoptimal health literacy, where this nonhuman supportive and educational approach may be complementary to health care systems.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04217174; https://clinicaltrials.gov/study/NCT04217174.

PMID:41632958 | DOI:10.2196/75005