Category: Nevin Manimala

J Neurosurg. 2026 Jan 23:1-12. doi: 10.3171/2025.8.JNS25496. Online ahead of print.

ABSTRACT

OBJECTIVE: Epilepsy affects nearly 50 million individuals worldwide, with one-third of cases resistant to antiseizure medications. For these patients, surgical intervention offers a potential path to seizure freedom. While resective surgery has been the gold standard, laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative. The aim of this study was to evaluate the efficacy and safety of LITT versus resective surgery in patients with nontumoral epilepsy.

METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus, including studies comparing seizure freedom rates, complications, and procedural outcomes between LITT and open surgery in nontumoral epilepsy. Eleven studies met the inclusion criteria, comprising 389 LITT and 557 open surgery patients with varying epilepsy etiologies, including temporal lobe epilepsy, focal cortical dysplasia, and tuberous sclerosis. Statistical analysis was performed using a random-effects model to assess seizure freedom, complications, and reoperation rates.

RESULTS: Open surgery demonstrated higher rates of complete seizure freedom, although not reaching significance (68.1% vs 53.7%, RR 0.81, p = 0.07). This outcome was sensitive to influential analysis and reached significance in the epileptogenic zone-directed resection subgroup analysis. Although adequate seizure freedom was comparable between the groups (LITT: 63.0% vs open: 74.0%, RR 0.90, p = 0.11), the open surgery group had higher rates of control in the pediatric and non-temporal lobe epilepsy subgroups. Complication rates were significantly higher in the open surgery group (30.0% vs 18.3%, RR 0.55, p < 0.01). LITT patients had significantly shorter hospital stays (3.4 vs 6.8 days, standardized mean difference -0.93, p < 0.01). Reoperation rates were comparable between groups (13.1% for LITT vs 13.4%, RR 1.59, p = 0.26).

CONCLUSIONS: While LITT offers a less invasive approach with reduced hospitalization and morbidity, open surgery remains slightly superior in achieving long-term seizure freedom. Patient selection remains critical, and further studies are needed to refine decision-making criteria based on epilepsy subtype and lesion characteristics.

PMID:41576371 | DOI:10.3171/2025.8.JNS25496

JMIR Res Protoc. 2026 Jan 23;15:e76815. doi: 10.2196/76815.

ABSTRACT

BACKGROUND: Cytisinicline has proven to be an effective, efficient, and safe molecule in smoking cessation. However, the established 25-day regimen could be insufficient in a high percentage of smokers, so it is necessary to study maintained therapies of this drug.

OBJECTIVE: This study aims to compare the efficacy of the cytisinicline regimen used in routine clinical practice versus 2 maintained regimens of 50 and 75 days, respectively. In addition, the safety and economic impact of each regime will be determined.

METHODS: A prospective, multicenter, open-label, controlled, parallel, phase IV clinical trial of 402 smoker patients prepared to quit smoking. The study was conducted in 10 hospitals in Spain. A control group is compared to 2 intervention groups in which the duration of the drug is increased without increasing its dose, administering half and all, respectively, of an additional marketed container that includes 100 tablets. Thus, participants will be randomized to three groups in a 1:1:1 ratio to receive cytisinicline: (1) a control group treated with cytisinicline according to the usual clinical guidelines and product information (25 days); (2) a group with a 50-day cytisinicline regimen (an additional 25 days at a dose of 1.5 mg every 12 hours), seeking to increase its efficacy while minimally impacting adherence; and (3) a group with a 75-day regimen (an additional 50 days at a dose of 1.5 mg every 12 hours), attempting to increase its efficacy, although the longer duration of the drug may threaten adherence. Efficacy in the 3 arms will be analyzed through sustained abstinence at 6 and 12 months, point abstinence rate assessed every 7 days, and abstinence rate from Day 25 to Day 50 and from Day 25 to Day 75 in the 3 study arms. (1) The variation in withdrawal and craving symptoms in the 3 groups, (2) safety through the percentage of adverse events in the 3 treatment arms, and (3) economic impact by evaluating the cost-effectiveness and cost-utility ratios of the 2 prolonged regimens versus the usual clinical cytisinicline regimen. To calculate the differences between the 3 groups for each outcome variable, a univariate analysis will be performed. Statistically significant variables will be included in a multivariate model.

RESULTS: Recruitment for the trial and patient enrollment were completed in November 2026. Follow-up of all participants will extend to December 2027.

CONCLUSIONS: In conclusion, this study evaluates the optimization of cytisinicline in daily clinical practice, increasing the benefits of its pharmaceutical properties without affecting patient safety. All of this will improve the effectiveness of smoking cessation by reducing the number of smokers, which implies lower morbidity and mortality and lower costs associated with smoking.

TRIAL REGISTRATION: European Clinical Trials Register 2024-518936-36-00; https://euclinicaltrials.eu/ctis-public/view/2024-518936-36-00.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/76815.

PMID:41576369 | DOI:10.2196/76815

JMIR Ment Health. 2026 Jan 23;13:e76051. doi: 10.2196/76051.

ABSTRACT

BACKGROUND: This study aims to detect self-harm or suicide (SH-S) ideation language used by youth (aged 13-21 y) in their private Instagram (Meta) conversations. While automated mental health tools have shown promise, there remains a gap in understanding how nuanced youth language around SH-S can be effectively identified.

OBJECTIVE: Our work aimed to develop interpretable models that go beyond binary classification to recognize the spectrum of SH-S expressions.

METHODS: We analyzed a dataset of Instagram private conversations donated by youth. A range of traditional machine learning models (support vector machine, random forest, Naive Bayes, and extreme gradient boosting) and transformer-based architectures (Bidirectional Encoder Representations from Transformers and Distilled Bidirectional Encoder Representations from Transformers) were trained and evaluated. In addition to raw text, we incorporated contextual, psycholinguistic (linguistic injury word count), sentiment (Valence Aware Dictionary and Sentiment Reasoner), and lexical (term frequency-inverse document frequency) features to improve detection accuracy. We further explored how increasing conversational context-from message-level to subconversation level-affected model performance.

RESULTS: Distilled Bidirectional Encoder Representations from Transformers demonstrated a good performance in identifying the presence of SH-S behaviors within individual messages, achieving an accuracy of 99%. However, when tasked with a more fine-grained classification-differentiating among “self” (personal accounts of SH-S), “other” (references to SH-S experiences involving others), and “hyperbole” (sarcastic, humorous, or exaggerated mentions not indicative of genuine risk)-the model’s accuracy declined to 89%. Notably, by expanding the input window to include a broader conversational context, the model’s performance on these granular categories improved to 91%, highlighting the importance of contextual understanding when distinguishing between subtle variations in SH-S discourse.

CONCLUSIONS: Our findings underscore the importance of designing SH-S automatic detection systems sensitive to the dynamic language of youth and social media. Contextual and sentiment-aware models improve detection and provide a nuanced understanding of SH-S risk expression. This research lays the foundation for developing inclusive and ethically grounded interventions, while also calling for future work to validate these models across platforms and populations.

PMID:41576367 | DOI:10.2196/76051

Can J Microbiol. 2026 Jan 23. doi: 10.1139/cjm-2025-0248. Online ahead of print.

ABSTRACT

Candida albicans is a common commensal yeast and an opportunistic pathogen of global health importance. However, its global geographic and temporal patterns of genetic variation remain poorly understood. Here we analyzed sequence data on seven housekeeping loci from >5000 isolates in the C. albicans PubMLST database representing >60 countries and spanning >70 years. Diploid sequences at each locus were phased into haplotypes to provide higher-resolution insights into diversity, differentiation, and recombination. Our analyses revealed high allelic and genotypic diversities within most geographic and temporal populations. Pairwise FST estimates revealed low but statistically significant differentiation among both geographic and temporal populations, with AMOVA revealing that most genetic variation resides within rather than among subpopulations. STRUCTURE analysis identified two genetic clusters but with extensive admixture within most geographic populations, consistent with frequent gene flow. Phylogenetic and haplotype network analyses revealed evidence of clonal expansion, with globally distributed haplotypes being genetically closer to one another than among more localized haplotypes. Finally, recombination analyses revealed evidence of non-random recombination within populations, including an overall deficiency of heterozygosity, suggesting the importance of parasexuality and/or mitotic recombination in C. albicans populations. Together, these results highlight the global evolutionary dynamics and population structure of C. albicans.

PMID:41576362 | DOI:10.1139/cjm-2025-0248

Dimens Crit Care Nurs. 2026 Mar-Apr 01;45(2):96-102. doi: 10.1097/DCC.0000000000000743. Epub 2026 Jan 23.

ABSTRACT

OBJECTIVE: This study aimed to examine the effectiveness of the care intervention, which consists of the combination of cold water spray, cold water application with swap, and menthol moisturizer application in reducing dry mouth and thirst in intensive care (ICU) patients.

DESIGN: The population of this quasi-experimental study consisted of patients hospitalized in the level 3 ICU of a university hospital between October 2019 and March 2021.

RESEARCH METHODOLOGY: The care intervention consisting of cold water spray, cold water application with swap, and menthol moisturizer application was applied to the experimental group 3 times a day for 2 days. The control group underwent routine oral care in the clinic. The population of this quasi-experimental study: main outcome measures: The study data were collected using the Thirst Severity Assessment Scale (TSAS), Thirst Distress Assessment Scale (TDAS), and Eilers Oral Assessment Guide.

RESULTS: No statistical difference was found between the groups when the mean score differences of dry mouth on day 1 and day 2 after the intervention compared with before the intervention (P>0.05). However, when the mean differences of Thirst Severity and Thirst Distress scores on both day 1 and day 2 were compared, it was observed that the mean scores of the experimental group patients decreased significantly more (P<0.05).

CONCLUSIONS: It was concluded that the care intervention consisting of cold water spray, cold water application with swap, and menthol moisturizer application was not effective in eliminating dry mouth, but it was effective in reducing the feeling of thirst.

IMPLICATIONS FOR CLINICAL PRACTICE: This care practice can be used to reduce the feeling of thirst, which is one of the most common symptoms in the ICU.

PMID:41576357 | DOI:10.1097/DCC.0000000000000743

Blood Adv. 2026 Jan 23:bloodadvances.2025017619. doi: 10.1182/bloodadvances.2025017619. Online ahead of print.

ABSTRACT

This study investigated the pathophysiological effects of cell-free hemoglobin (Hb) generated by mechanical hemolysis during venovenous extracorporeal circulation (VVECC). We hypothesized that Hb scavenger protein constructs that bind Hb, heme and iron, could attenuate end-organ injury caused by intravascular hemolysis during VVECC. Scavenger constructs consisted of an apohemoglobin-haptoglobin (apoHb-Hp) complex designed to bind Hb and heme, as well as a separate preparation of haptoglobin, albumin, hemopexin, transferrin, termed the protein cocktail. To test the hypothesis, Golden Syrian hamsters were instrumented with dorsal window chambers and catheters, and VVECC was maintained for a total of 2 h, with a maximum flow rate equivalent to 50% of the animal’s cardiac output. VVECC circuits were primed with either two binding materials, the apoHb-Hp and the protein cocktail, or a control solution of 5% human serum albumin (HSA). Microvascular Hb oxygen saturation in arterioles (saO2) and venules (svO2) were studied. All groups displayed a significant decrease in saO2 and svO2 at maximum VVECC when compared to baseline, while statistically significant changes between treatment groups showed no consistent trend. The protein cocktail bound 24% of cell-free Hb, while the apoHb-Hp bound 66% of cell-free Hb. Additionally, markers of renal damage and inflammation such as plasma creatinine, urinary NGAL, 4-HNE, and KIM-1 were significantly reduced in both Hb scavenger groups as compared to the HSA control. Results from this study suggest that Hb, heme and iron scavenging solutions used to prime VVECC circuits are indicated to support organ function.

PMID:41576345 | DOI:10.1182/bloodadvances.2025017619

Gastroenterol Nurs. 2026 Jan-Feb 01;49(1):9-16. doi: 10.1097/SGA.0000000000000919. Epub 2026 Jan 23.

ABSTRACT

The aim of this study was to evaluate the effect of virtual reality goggles on pain, anxiety, and comfort in patients undergoing non-sedated upper gastrointestinal tract endoscopy. This randomized controlled study was conducted with 60 patients who underwent upper gastrointestinal tract endoscopy in the endoscopy unit of a training and research hospital in Istanbul. The intervention group (n = 30) was shown videos of relaxing forest and bird sounds of their choice using virtual reality goggles during the procedure. The control group (n = 30) did not receive any intervention. Data were collected using a Patient Information Form, Visual Analog Scale, and State Anxiety Inventory. There was no statistically significant difference in pain, anxiety, and comfort scores before the endoscopy procedure between both groups. While there was no statistically significant difference between the two groups in terms of pain scores after the endoscopy procedure, there was a significant difference in terms of anxiety and comfort scores. Post-procedure anxiety scores were lower and comfort scores were significantly higher in the intervention group. This study concluded that the use of virtual reality goggles during the endoscopy procedure did not affect the pain levels of participants, while it had a positive effect on anxiety and comfort levels.

PMID:41576331 | DOI:10.1097/SGA.0000000000000919

JMIR Res Protoc. 2026 Jan 23;15:e82696. doi: 10.2196/82696.

ABSTRACT

BACKGROUND: Mental disorders are highly prevalent, and they significantly impact individuals and society. Patients experiencing long-term, severe mental disorders with functional impairment and reduced quality of life often have a history of adolescent onset anxiety and depressive disorders. Despite the long-term costs to both patients and society, studies examining treatment effects over time and across diagnoses are scarce.

OBJECTIVE: The Norwegian Adult Mental Health Registry (NAMHR) aims to systematically reuse health data to monitor and improve treatment outcomes, patient safety, health service quality, and research. The registry addresses the need for comprehensive data on the effects and utility of mental health services, interventions, and therapy variants in specialized mental health care.

METHODS: The NAMHR is a nationwide naturalistic registry, including all Norwegian adults eligible for treatment in specialized mental health care services who have not opted out. Patients are automatically enrolled when treated in these services. The population includes patients treated in public specialized services and those treated in private services having a contract with public health services. The registry is based on secondary data from the Norwegian Patient Registry (NPR), patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), the Norwegian Registry for Primary Health Care (KPR), and several other sources, including electronic health records (EHRs). Data linkage uses unique national identity numbers, ensuring high-quality data. The registry collects information on diagnoses, treatments, medication, and patient-reported outcomes, providing a holistic approach to mental health care. Statistical analyses will be defined in each project.

RESULTS: As of December 2025, the NAMHR is approved and is being constructed. The registry anticipates enrolling up to 170,000 participants, with a new incidence rate of around 10,000 patients per year. Key predictors and outcomes include PROMs and PREMs, and automatically reported measures involving a wide range of data, including EHR data from inpatient and outpatient treatments, data from primary health care, data on job and education status, and data on cause of death. Enrollment is planned to start in 2026, initially by adding journal data and patient-reported data. Other sources will be included. The NAMHR has no planned end date. Results will be made available for internal quality improvement purposes, and data for research are expected to be available around mid-2026 for approved projects.

CONCLUSIONS: The NAMHR will promote quality improvement initiatives and research, including registry-based randomized clinical trials. It will also be possible to link the NAMHR to a similar registry for children and adolescents, making it possible to follow patients from birth to death and supporting the monitoring of diagnostic drift. The NAMHR will inform health policy decisions at local, regional, national, and international levels, contributing to the evaluation and development of clinical guidelines and enhancing personalized treatment approaches.

PMID:41576321 | DOI:10.2196/82696

Neurology. 2026 Feb 24;106(4):e214644. doi: 10.1212/WNL.0000000000214644. Epub 2026 Jan 23.

ABSTRACT

BACKGROUND AND OBJECTIVES: Although stroke technology and care infrastructure have advanced significantly, it remains unclear whether recent expansions of certified stroke centers have benefited rural patients equitably across income levels. This study assessed whether rural communities of varying income experienced similar gains in access to certified stroke centers and whether such expansions were associated with improvements in acute stroke treatment and outcomes.

METHODS: We conducted a retrospective cohort study using 100% Medicare Provider and Analysis Review data from January 1, 2009, to December 31, 2019. This study included all Medicare fee-for-service beneficiaries diagnosed with acute ischemic stroke who resided in rural US communities. Communities were classified as exposed if a newly certified stroke center-acute stroke ready hospital (ASRH), primary stroke center, thrombectomy-capable stroke center (TSC), or comprehensive stroke center (CSC)-opened within a 30-minute drive. A community fixed-effects linear probability model was used to evaluate changes in outcomes after stroke center certification. Primary outcomes included the following: (1) admission to a stroke-certified hospital, (2) receipt of thrombolytic therapy, (3) receipt of thrombectomy, and (4) one-year mortality.

RESULTS: Among 590,191 rural stroke patients, 4% of low-income and 22% of high-income patients had access to a nearby certified stroke center in 2009. By 2019, 30% of low-income and 50% of high-income communities had gained access to at least 1 newly certified stroke center; high-income communities were 3 times more likely than low-income communities to be exposed to a newly certified TSC or CSC (5.4% vs 1.8%). Exposure to ASRHs increased the probability of thrombolysis by 0.63 percentage points (95% 0.05-1.22), whereas exposure to TSC/CSCs increased the probability by 1.39 points (95% CI 0.28-2.49) and thrombectomy by 1.12 points (95% CI 0.41-1.83). No differences in 1-year mortality were observed.

DISCUSSION: During the study period, high-income rural communities experienced more frequent and higher tier stroke center expansion than low-income rural communities. These access disparities were associated with differential gains in advanced stroke treatments, suggesting that expansions may have inadvertently widened income-based disparities in rural stroke care. These findings underscore the need for equity-focused implementation strategies, ensuring that infrastructure improvements translate into equitable clinical benefits.

PMID:41576313 | DOI:10.1212/WNL.0000000000214644

J Clin Oncol. 2026 Jan 23:JCO2501625. doi: 10.1200/JCO-25-01625. Online ahead of print.

ABSTRACT

PURPOSE: There is growing scientific interest in incorporating patient-reported outcomes (PROs) in early phase dose-finding oncology trials (DFOTs) to assess tolerability, inform dose selection, and guide later stage trial design. However, research indicates that PRO objectives in DFOTs are often unclear. The Incorporating Patient-Reported Outcomes in Dose-Finding Trials-Research Objectives Recommendations (OPTIMISE-ROR) project was established to support trialists to effectively incorporate PROs into DFOTs.

METHODS: Using the Enhancing Quality and Transparency of Health Research (EQUATOR) Network’s methodological framework, guideline development included the following: (1) a methodological review of published DFOTs incorporating PROs; (2) candidate item generation, refined through expert consultation; (3) a two-round international multistakeholder Delphi survey (N = 109 in Round 1 [October 2024]; N = 96 in Round 2 [December 2024]); and (4) an independently chaired virtual consensus meeting (N = 31; January 2025) where multidisciplinary, international experts reviewed and voted to finalize items for inclusion.

RESULTS: Consensus was reached on six recommendations emphasizing three core PRO tolerability concepts: overall side effect impact, symptomatic adverse events, and overall health-related quality of life. The integration of PROs to inform final dose recommendations in dose escalation and optimization trials should be considered, regardless of trial design. The recommendations highlight the importance of PRO data analysis over time and across dose levels, defining PRO research objectives as descriptive or statistically powered, and assessing PRO-related end points to guide end point selection for subsequent studies.

CONCLUSION: This foundational guidance outlines key PRO research objectives in DFOTs. By facilitating the systematic integration of PROs, this guidance supports the utilization of patient-centered evidence for the tolerability and efficacy assessment of therapies to inform dose escalation, optimization, and regulatory evaluation-ultimately contributing to the development of safer, more effective therapies.

PMID:41576310 | DOI:10.1200/JCO-25-01625