Category: Nevin Manimala

Clin Transl Oncol. 2026 Feb 4. doi: 10.1007/s12094-026-04246-3. Online ahead of print.

ABSTRACT

INTRODUCTION: The indicators of surgical outcomes are handy tools in health management. Futility is a very interesting indicator, because it defines those patients who have undergone a surgical procedure with its morbidity and mortality and who have not benefited from the treatment. Knowledge of the factors that influence futility can help us better select patients with carcinomatosis of ovarian origin.

METHODS: Multicenter study was performed.

INCLUSION CRITERIA: > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The definition of Futility in ovarian peritoneal carcinomatosis was: all patients with non-CC-0, death in the first 90 days in the postoperative period or within the first year after surgery were considered futile patients.

RESULTS: We included 365 patients. 84 patients (23.6%) were in the futility group compared with 279 (73.4%) who were not in the futility group. We obtained that non-obtaining CC-0 was the main factor of futility (61.6%). The 2º crucial factor of futility was mortality in the first year after surgery. The incidence of futility in the series is 23.6%. Comparing futility and non-futility groups, we could observe statistically significant differences in hospital stay, higher levels of CA125 (52 vs. 35), and higher postoperative PCI. Patients in the futility group had almost twice PCIs as those who were not. When performing univariate regression, we could observe that PCI and the PCI distributed by categories (< 10; 11-20; > 20) were independent variables associated with futility.

CONCLUSION: PCI is a relevant factor in futility in ovarian cancer.

PMID:41637003 | DOI:10.1007/s12094-026-04246-3

Aging Clin Exp Res. 2026 Feb 4. doi: 10.1007/s40520-026-03331-5. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association of changes in loneliness with subsequent cardiometabolic comorbidity (CMM) among middle-aged and older Chinese and South Korean adults.

METHODS: We used the harmonized individual-level data from the China Health and Retirement Longitudinal Study (CHARLS, n = 9381) from China and the Korean Longitudinal Study of Aging (KLoSA, n = 5052) from South Korea. In both CHARLS and KLoSA, loneliness was measured using a single item from the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) at baseline and in the second survey. CMM was defined as the presence of two or more cardiometabolic conditions, including diabetes, heart disease, and stroke, based on physician-diagnosed self-report. Within each cohort, we used the multivariable Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of incident CMM according to changes in loneliness (never, initiated, relieved, and persistent) over 7 years (CHARLS) or 6 years (KLoSA) of follow-up.

RESULTS: In CHARLS, initiated (aHR 1.42, 95%CI 1.14-1.78), relieved (aHR 1.40, 95%CI 1.16-1.70), and persistent (aHR 2.03, 95%CI 1.64-2.51) loneliness were associated with an increased likelihood of experiencing CMM. In KLoSA, both relieved (aHR 1.72, 95%CI 1.07-2.76) and persistent (aHR 1.86, 95%CI 1.21-2.88) loneliness were significantly associated with CMM, whereas the initiated loneliness showed no significant association (aHR 1.25, 95%CI 0.76-2.07).

CONCLUSIONS: Changes in loneliness were associated with an increased risk of subsequent CMM in both China and South Korea, with the strongest associations observed among individuals experiencing persistent loneliness. These findings indicate that loneliness is a dynamic and potentially modifiable risk factor for cardiometabolic multimorbidity across different sociocultural contexts. Early identification and targeted interventions addressing loneliness may contribute to the prevention of CMM among middle-aged and older adults.

PMID:41636996 | DOI:10.1007/s40520-026-03331-5

Pharmacoeconomics. 2026 Feb 4. doi: 10.1007/s40273-025-01585-x. Online ahead of print.

ABSTRACT

OBJECTIVES: Bevacizumab was approved for first-line treatment of metastatic colorectal cancer (mCRC) in 2004. However, adding bevacizumab to treatment consistently fails to be cost-effective owing to modest response rates. Recently, the European Commission (EC) funded ANGIOPREDICT consortium ( www.angiopredict.com ) identified a link between bevacizumab treatment response and intermediate-to-high chromosomal instability (CIN) in mCRC. Thus, the objective of the current study was to compare the cost-effectiveness of adding bevacizumab with first-line chemotherapy in the bevacizumab responsive CIN subtype across three European countries (Germany, Ireland and Spain) with varying costs of care and reimbursement policies.

METHODS: We developed an open-source health economic model to estimate cost-effectiveness. The ANGIOPREDICT cohort informed progression risks and cause-specific mortality. Health utilities and adverse events probabilities were obtained from the literature. Costs were derived from surveys of collaborating consortium hospitals in Germany, Ireland, and Spain that participated in the recently completed EC funded COLOSSUS translational study (ANGIOPREDICT successor initiative) and the literature. Sensitivity analyses included individual and simultaneous variation of input parameters from a priori defined distributions.

RESULTS: Bevacizumab was not cost effective even at willingness-to-pay (WTP) thresholds that are appreciably higher than those considered realistic. The highest incremental cost-effectiveness ratio (ICER) was in Germany at €241,188 per quality-adjusted life year (QALY), while the lowest was in Ireland at €180,477 per QALY. All deterministic and probabilistic sensitivity analyses demonstrated that these results were robust.

CONCLUSIONS: Even for patients with mCRC manifesting improved outcomes, adding bevacizumab to first-line chemotherapy is invariably not cost-effective in any of the countries examined. Variability in pricing, healthcare costs and WTP thresholds across countries did not commute this result.

PMID:41636995 | DOI:10.1007/s40273-025-01585-x

Odontology. 2026 Feb 4. doi: 10.1007/s10266-026-01323-5. Online ahead of print.

ABSTRACT

The purpose of this randomized clinical trial was to compare the analgesic effectiveness of sublingual administration of wheatgrass (WG) and piroxicam, a non-steroidal anti-inflammatory drug (NSAID), for patients with symptomatic irreversible pulpitis, with or without apical periodontitis. Forty-five patients aged 18-40 years were recruited and randomly allocated into three groups receiving the sublingual drug administration: Group 1-WG (500 mg); Group 2-Piroxicam (20 mg); Group 3-Placebo sugar tablet (20 mg) (control). Pain intensity was assessed using the Numerical Pain Rating Scale (NPRS; 0-10) prior to administration and again 30 min after the respective interventions. The onset of analgesic action was also recorded for each participant. Statistical comparisons among the groups were conducted using one-way ANOVA with the significance threshold set at p < 0.05. Both sublingual WG and piroxicam demonstrated significantly greater reductions in pain scores compared with the placebo group after 30 min. Notably, participants receiving WG exhibited a significantly higher degree of pain reduction than those receiving piroxicam. These findings suggest that WG may offer a rapid and effective analgesic response when administered sublingually. Given its natural origin, WG may serve as a promising adjunct or alternative to conventional NSAIDs for the short-term management of acute dental pain associated with symptomatic irreversible pulpitis.Trial registration: This clinical trial was prospectively registered in Clinical Trial Registry of India under the registration number of CTRI/2024/12/078719 dated on 30/12/2024 ( https://www.ctri.nic.in/ ).

PMID:41636988 | DOI:10.1007/s10266-026-01323-5

Int J Cardiovasc Imaging. 2026 Feb 4. doi: 10.1007/s10554-026-03633-9. Online ahead of print.

ABSTRACT

This study aims to investigate the impact of intravascular ultrasound (IVUS)-detected attenuated plaque (AP) on coronary microvascular dysfunction (CMVD) in patients with unstable angina undergoing percutaneous coronary intervention (PCI). The primary endpoints were the incidence of the no-reflow phenomenon, peri-procedural myocardial injury (PMI), post-procedural Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion frame count (TMPFC), and myocardial perfusion assessed by single-photon emission computed tomography (SPECT). This single-center, observational study, conducted in accordance with the STROBE guidelines, enrolled patients with unstable angina who underwent PCI with IVUS guidance. Based on IVUS findings, patients were retrospectively categorized into an AP group and a non-AP group. We compared the incidence of intraprocedural no-reflow, post-PCI cardiac biomarkers (cTnI and CK-MB), post-PCI TMPFC, and SPECT findings at baseline and 3 days post-PCI. Multivariable logistic regression analysis was performed to identify independent predictors of no-reflow, adjusting for confounders such as plaque burden. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) at 6-month follow-up. A total of 563 patients were included (229 in the AP group, 334 in the non-AP group). Baseline clinical and lesion characteristics were largely comparable, except for higher total cholesterol in the AP group (5.11 ± 0.37 vs. 4.98 ± 0.86 mmol/L, P = 0.031) and a significantly higher plaque burden in the AP group (76.8 ± 9.4% vs. 68.5 ± 10.2%, P < 0.001). The incidence of no-reflow was significantly higher in the AP group compared to the non-AP group (37.1% vs. 12.8%, P < 0.001). Post-PCI levels of cTnI (0.42 ± 0.28 vs. 0.15 ± 0.09 ng/mL) and CK-MB were significantly elevated in the AP group (P < 0.001), indicating greater peri-procedural myocardial injury. Post-PCI TMPFC was prolonged in the AP group (107.55 ± 24.19 vs. 89.86 ± 18.91 frames, P < 0.001), indicating impaired myocardial perfusion. While pre-procedural SPECT results were similar, at 3 days post-PCI, the AP group exhibited significantly greater stress ischemic segment counts, higher resting and stress perfusion total scores, and larger abnormal perfusion areas compared to the non-AP group (all P < 0.05). Multivariable analysis confirmed that the presence of AP was an independent predictor of no-reflow (OR 3.12, 95% CI 1.85-5.26, P < 0.001), independent of plaque burden. At 6-month follow-up, the incidence of MACCE was not statistically different between the two groups (8.2% vs. 6.2%, P = 0.357). In patients with unstable angina undergoing PCI, the presence of IVUS-detected attenuated plaque is strongly associated with an increased incidence of intraprocedural no-reflow, peri-procedural myocardial injury, and objective evidence of post-procedural coronary microvascular dysfunction. Although this did not translate to a significant difference in 6-month clinical outcomes in this cohort, AP serves as a critical independent imaging marker for identifying patients at higher risk for periprocedural microvascular injury.

PMID:41636976 | DOI:10.1007/s10554-026-03633-9

Int J Cardiovasc Imaging. 2026 Feb 4. doi: 10.1007/s10554-026-03626-8. Online ahead of print.

ABSTRACT

Accurate assessment of coronary lesion complexity is essential for guiding revascularization strategies in patients with coronary artery disease. The SYNTAX score, originally derived from invasive coronary angiography (ICA), plays a key role in clinical decision-making. With advancements in cardiac computed tomography angiography (CCTA), its potential as a non-invasive tool for SYNTAX scoring has gained interest, but discrepancies between modalities remain uncertain. To systematically compare SYNTAX scores obtained by CCTA versus ICA and evaluate their concordance, with implications for clinical decision-making. We conducted a systematic review and meta-analysis of studies published between 2013 and 2024 comparing SYNTAX scores derived from CCTA and ICA in the same adult populations. Databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched through January 2025. The primary outcome was the pooled standardized mean difference (Hedges’ g) in SYNTAX scores between modalities. Risk of bias was assessed using QUADAS-2, and meta-regression explored potential sources of heterogeneity. Thirteen studies with a total of over 1,800 patients met inclusion criteria. The pooled analysis demonstrated a statistically significant underestimation of SYNTAX scores by CCTA compared to ICA (Hedges’ g = – 0.121; 95% CI: -0.185 to – 0.056; p < 0.01). Heterogeneity was moderate (I² = 30.7%) after exclusion of one outlier. Meta-regression revealed no significant impact of publication year, scanner generation, or sample size on effect size. Several studies highlighted meaningful discrepancies in SYNTAX classification near critical decision thresholds (22 and 32). Funnel plot symmetry and Q-Q plot normality suggested minimal publication bias. CCTA systematically underestimates SYNTAX scores compared to ICA, which may impact treatment decisions in patients with complex coronary artery disease. While CCTA offers a promising non-invasive alternative, clinicians should interpret CCTA-derived SYNTAX scores with caution-particularly in borderline cases where therapeutic strategies may differ. Further standardization of scoring protocols and incorporation of functional imaging tools such as CT-FFR are warranted.

PMID:41636974 | DOI:10.1007/s10554-026-03626-8

Ann Biomed Eng. 2026 Feb 4. doi: 10.1007/s10439-026-03980-7. Online ahead of print.

ABSTRACT

PURPOSE: This study presents a novel algorithm for the automatic detection of motor unit (MU) fractions within the motor unit potential (MUP) scans derived from multiscanning EMG recordings. MU fractions are spatially distinct regions identified in the MUP scans that reflect the distribution of muscle fibres within each MU. Multiscanning EMG allows recording multiple MUPs simultaneously in a single recording, improving efficiency and reducing patient discomfort.

METHODS: The algorithm combines amplitude thresholding, morphological operations, and connected component analysis to identify MU fractions. Algorithm performance was evaluated using MUP scans from tibialis anterior muscles of five healthy individuals. The analysis was performed in two ways: the first included all the fractions detected automatically, and the second included only those fractions detected in both the automatic and the ground truth. Additionally, the association between muscle depth, number of MU fractions, and signal-to-noise ratio (SNR) of the recorded signals was analysed.

RESULTS: T-tests showed no statistically significant difference between the algorithm and ground truth for both start and end markers. ANOVA indicated that muscle depth did not affect the signal-to-noise ratio (f = 1.06, p = 0.35). Overall, the algorithm reliably identified MU fractions.

CONCLUSION: The proposed automatic method accurately detects MU fractions, providing a valuable tool for analysing motor unit activity in clinical and research settings.

PMID:41636959 | DOI:10.1007/s10439-026-03980-7

J Mol Neurosci. 2026 Feb 4;76(1):24. doi: 10.1007/s12031-026-02474-4.

NO ABSTRACT

PMID:41636955 | DOI:10.1007/s12031-026-02474-4

Breast Cancer Res Treat. 2026 Feb 4;215(3):71. doi: 10.1007/s10549-026-07908-6.

ABSTRACT

BACKGROUND: In patients with ipsilateral breast tumor recurrence (IBTR) previously treated with breast-conserving surgery (BCS) followed by radiotherapy, salvage mastectomy (SM) is still considered standard of care. Currently, there is little evidence available about complication rates of repeat BCS or salvage mastectomy in patients with IBTR and possible differences.

AIM: The primary aim was to report postoperative complication rates after IBTR treatment with salvage mastectomy or repeat BCS after previous BCS (± radiotherapy). Secondary, risk factors associated with complications were examined.

METHODS: Complication rates were reported using descriptive statistics. Complications were classified between short-term (less than 3 months after surgery) and long-term (more than 3 months after surgery). Logistic regression was used to evaluate possible risk factors after salvage mastectomy to report an odds ratio (OR) with a 95% confidence interval (CI).

RESULTS: A total of 549 cases with IBTR after primary BCS were included. Short-term complications occurred in 200 (45.2%) of 442 patients treated with salvage mastectomy and in 9 (16.4%) of 55 patients treated with repeat BCS. Seroma and surgical site infection (SSI) were most common in salvage mastectomy (31.7% and 10.9%, respectively). Long-term complications were reported in 16.7% treated with salvage mastectomy and in 14.5% with repeat BCS. The risk of short-term postoperative complications after salvage mastectomy increased significantly with higher BMI. The regression analysis showed that adjuvant radiotherapy after IBTR surgery was associated with long-term postoperative complications.

CONCLUSIONS: Salvage mastectomy in case of IBTR after primary BCS is associated with high short-term complication rates, especially seroma. The risk of short-term complications after salvage mastectomy increased with increasing BMI, while adjuvant radiotherapy after salvage mastectomy is associated with long-term complications.

PMID:41636939 | DOI:10.1007/s10549-026-07908-6

Hernia. 2026 Feb 4;30(1):84. doi: 10.1007/s10029-026-03593-y.

ABSTRACT

PURPOSE: Ruptured umbilical hernia (UH) is a life-threatening condition in cirrhotic patients with a morbidity and mortality rate of 30%. Despite its high risk, the best surgical treatment strategy for this condition remains controversial. This study aimed to evaluate the feasibility and safety of mesh repair of ruptured UH.

METHODS: 149 patients who underwent surgical management for ruptured UH between January 2018 and December 2022 were included in this retrospective study. The patients were divided into two groups: anatomical repair (group 1, n = 92) and mesh repair (group 2, n = 57). Hernia recurrence, wound infection, and other perioperative morbidity and mortality were evaluated.

RESULTS: The recurrence of hernia was significantly lower after mesh repair (5.3% vs. 17.4%, P = 0.03). Other postoperative complications were not significantly different between the two groups. However, the incidence of wound infection after mesh repair was higher than that after anatomical repair, but this was statistically non-significant (12.3% vs. 8.7%, p = 0.48). Two patients in the mesh repair group required mesh removal due to infection.

CONCLUSIONS: Mesh repair of ruptured UH in cirrhotic patients is a feasible and safe surgical option that results in a significantly lower hernia recurrence rate with acceptable morbidity and mortality, provided that careful patient optimization is carried out.

PMID:41636907 | DOI:10.1007/s10029-026-03593-y