Category: Nevin Manimala

Allergy. 2026 May 1. doi: 10.1111/all.70372. Online ahead of print.

ABSTRACT

BACKGROUND: To achieve adequate symptom control, patients with allergic rhinitis (AR) often need to increase their medication dose or add other treatments (co-medication). We aimed to perform a systematic review to compare the efficacy and safety of AR medications for increased dose versus co-medication.

METHODS: We searched four bibliographic databases and three trial databases for randomised controlled trials assessing the effect of intranasal and/or oral medications in patients of all ages with seasonal or perennial AR. We performed pairwise meta-analysis based on direct evidence to compare (i) non-standard versus standard treatment doses, and (ii) co-medication strategies versus monotherapy using standard doses. Furthermore, we fitted dose-response network meta-analysis (NMA) to obtain projected estimates for comparisons involving two times the standard dose of AR medications in monotherapy versus co-medication with the standard dose of the same medications. We assessed the certainty of evidence using GRADE for NMA.

RESULTS: We included 262 studies. Co-medication schemes involving oral antihistamines (OAH) + intranasal corticosteroids (INCS) resulted in higher improvements of nasal symptoms and quality of life than doubling the dose of OAH. However, doubling the dose of intranasal medications led to better results than having intranasal medications + OAH. Doubling the dose of INCS was associated with higher efficacy than adding intranasal antihistamines (INAH). No relevant safety differences were found between treatment strategies.

CONCLUSIONS: Results favoured (i) doubling the dose of intranasal medications versus adding OAH, and (ii) adding INCS to OAH over doubling the dose of OAH. This study will inform the ARIA-EAACI 2024-2025 guidelines.

PMID:42068093 | DOI:10.1111/all.70372

Int J Urol. 2026 May;33(5):e70483. doi: 10.1111/iju.70483.

ABSTRACT

INTRODUCTION: We assessed the extent of pelvic lymph node dissection (PLND) at partial cystectomy (PC) according to PC eligibility (≤cT2 stage, tumor ≤ 3 cm and segmental resection possible) and tested its effect on cancer-specific mortality (CSM).

METHODS: Within the SEER database (2004-2021), we identified PC patients undergoing PLND and tabulated the number of lymph nodes (LNs) removed according to PC eligibility. Multivariable Cox-regression models tested the effect of PLND extent on CSM after adjusting for age, sex, T stage, N stage, and chemotherapy.

RESULTS: Of 1017 PC patients undergoing PLND, 197 (19.4%) were eligible vs. 820 (80.6%) ineligible according to PC eligibility criteria. Median number of LNs removed at PLND was 6 (IQR: 3-11) in eligible versus 7 (IQR: 3-14) in ineligible patients (p = 0.09). Mean numbers of LNs removed at PLND increased over the study period, from 7 to 16 (p = 0.007) in PC-eligible and from 8 to 13 (p = 0.001) in PC-ineligible patients. In 1017 patients regardless of PC eligibility, 5-year CSM-free survival rate was 65.6%, and PLND extent predicted lower CSM (multivariable hazard ratio [mHR]: 0.99, p = 0.036). In 197 PC-eligible patients, 5-year CSM-free survival rate was 84.2%, and the PLND extent was not associated with CSM (mHR: 0.96, p = 0.2). Conversely, in 820 PC-ineligible patients, 5-year CSM-free survival rate was 61.1%, and PLND extent predicted lower CSM (mHR: 0.99, p = 0.043).

CONCLUSION: In all PC patients regardless of eligibility status, more extensive PLND was associated with improved cancer-specific survival.

PMID:42068079 | DOI:10.1111/iju.70483

Glob Chang Biol. 2026 May;32(5):e70894. doi: 10.1111/gcb.70894.

ABSTRACT

Decades of evidence suggests that the relationship between landscape diversity and ecosystem productivity is positive, nonlinear, and saturating-with remarkable consistency across organisms and conditions. Despite this consensus, evidence of the impact of landscape diversity on agricultural productivity remains mixed. We use mixture modeling to systematically examine consistency in the relationship between landscape diversity and crop yields in the United States across heterogeneous model specifications for different major crops and approaches to operationalizing landscape diversity. While the diversity-productivity relationship varies across crops and landscape diversity metrics, we find a consistent (87%) positive association between landscape diversity and yields. Although not significant at a 95% credibility level, across all conditions examined highly diverse landscapes are associated with yields that are, on average, 2.7% higher than yields in highly simplified landscapes. Moreover, this relationship is not saturating, suggesting that the upper limits of positive landscape diversity effects have not been reached within contemporary U.S. cropping systems.

PMID:42068077 | DOI:10.1111/gcb.70894

FEBS Open Bio. 2026 May 1. doi: 10.1002/2211-5463.70247. Online ahead of print.

ABSTRACT

FcγRI is a high-affinity receptor for IgG, associated with autoimmune disease pathology and determines clinical responses to antibody-based immunotherapies. FcγRI has a complex evolutionary history that is not fully understood, and to address this we explored signatures of positive selection in the receptor’s functional gene, FCGR1A, using codon-based selection tests on aligned 1-1 orthologous sequences from placental mammals (n = 32). Signatures of positive selection have occurred at several locations within the gene, with two sites (H¹⁴⁸ (M2a ω 0.997 & M8 ω = 0.993)) and (W¹⁴⁹ (M2a ω = 0.999 & M8 ω = 1.000)) exhibiting highest posterior probabilities, suggesting strong evidence of positive selection; these positions are known to form one of the FcγRI-IgG binding interfaces. We employed ancestral reconstruction to statistically infer prior codon sequences at these sites and identified ancestral H¹⁴⁸P and W¹⁴⁹R codons at different nodes in the phylogeny. Employing molecular dynamics simulations, we determined how evolutionary changes at these sites may have influenced the binding of FcγRI-IgG of modern-day Homo sapiens. Measuring RMSD, free energy, radius of gyration, hydrogen bond formation, and analyzing free energy landscapes, we demonstrate that structural instability between mutant structures vs the WT counterpart; however, overall binding potential increases at position 148, yet decreases at 149 in potential. H¹⁴⁸P protonation at physiological pH remains similar, yet during acidotic calculations, protonation is likely reduced, with predicted reduction in affinity for IgG. While ancestral W¹⁴⁹R substitutions demonstrate an implication for electron conjugation. Examining key sites at this binding FcγRI-IgG interface, our data demonstrate that these two codons have evolved in humans to be relatively insensitive to shifts in pH promoting a more stable interaction with the Fc portion of IgG during diseases that promote acidosis.

PMID:42068062 | DOI:10.1002/2211-5463.70247

Scand J Pain. 2026 May 1;26(1). doi: 10.1515/sjpain-2026-0004. eCollection 2026 Jan 1.

ABSTRACT

OBJECTIVES: To investigate if sociodemographic factors are associated with selection to an interdisciplinary pain rehabilitation program (IPRP) in Swedish tertiary care, in an intersectional perspective.

METHODS: This study involved 39,346 patients referred to tertiary care, who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2009-2016. Self-reported sociodemographic data, and data related to pain and its consequences, were registered prior to IPRP (at baseline). Self-reported data on pain and its consequences were also registered directly after the IPRP and at a 12 months’ follow-up. Patients not selected for IPRP reported only baseline data. The statistical analyses used logistic regressions including interaction terms, and the results were analyzed in an intersectional framework to emphasize unequal health care.

RESULTS: Sex, age, education, and region of birth were found to influence the likelihood of being selected to IPRP. Non-Nordic-born patients with elementary education had the lowest proportion of selection to IPRP, with a similar proportion for men and women. Other subgroups showed a smaller difference between Nordic and non-Nordic countries in the proportion selected to IPRP. For several groups, longer education had a positive impact on the proportion of selection. Selection increased with age to a peak in middle age and then decreased. Unexpectedly, the youngest patients were less likely than middle-aged patients to be selected.

CONCLUSIONS: In Swedish tertiary care, sex, age, education, and region of birth influence selection to IPRP as combinations but not necessarily as single factors. More knowledge is needed to ensure equal, knowledge-based rehabilitation for patients with chronic pain. The regional ethics review board in Uppsala (IRB/REC 2018/036) and the Swedish ethical review authority (IRB/REC 2020-00828) issued ethical approvals.

PMID:42068060 | DOI:10.1515/sjpain-2026-0004

Ecol Lett. 2026 May;29(5):e70393. doi: 10.1111/ele.70393.

ABSTRACT

Understanding how plants influence each other’s spatial distribution is pivotal not only for interpreting current communities, but also for anticipating their responses to global changes. The combination of high-resolution, multi-scale sampling and novel statistical frameworks now enables us to identify species aggregations and segregations within their local co-occurrences. By applying this approach to approximately 800 plant species and their communities across the French Alps, we discovered that local species associations are dependent on soil acidity and nitrogen rather than climate. By building a regional network from these associations, we identified a centralised core comprising a few dominant, stress-tolerant graminoids and shrubs with high leaf dry matter content and no unique functional roles. Our findings demonstrate that plant community assembly is less dependent on random co-occurrence and more dependent on segregation around a few dominant, stress-tolerant species, with soil conditions modulating the outcome of local associations.

PMID:42068051 | DOI:10.1111/ele.70393

Med Sci Monit. 2026 May 2;32:e951712. doi: 10.12659/MSM.951712.

ABSTRACT

BACKGROUND Ankle arthritis is a chronic degenerative disease; its typical symptom is pain in the ankle joint. This retrospective study of 65 patients with mid-stage ankle osteoarthritis aimed to compare clinical outcomes from supramalleolar osteotomy (SMOT) and supramalleolar osteotomy combined with fibular osteotomy (SMOT+FO). MATERIAL AND METHODS Based on whether fibular osteotomy was performed during the procedure, the patients were categorized into the SMOT group (n=34) or the SMOT+FO group (n=31). Surgical outcomes were systematically assessed using the Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion (ROM), and complication rates. Radiographic parameters were compared between the 2 groups, including the distal tibial articular surface angle, talar tilt angle, tibiocrural angle, and tibial lateral surface angle. RESULTS The AOFAS scores, VAS scores, and imaging indicators in both patient groups showed significant improvement compared with preoperative levels (P<0.001). However, no statistically significant improvement was observed in the ROM. Compared to SMOT, the addition of fibular osteotomy demonstrated superior outcomes in terms of AOFAS scores and greater improvement in both the talar tilt and tibiocrural angles (P<0.001). The overall incidence of postoperative complications in the SMOT group was lower than that in the SMOT+FO group (2.9% vs 6.4%; OR, 0.44; 95% CI, 0.04 to 5.10). However, the difference did not reach statistical significance (P=0.500). CONCLUSIONS Combining fibular osteotomy with SMOT not only significantly enhances ankle joint function but also exhibits notable advantages in improving radiological parameters, so as to provide long-term clinical benefits for patients.

PMID:42068025 | DOI:10.12659/MSM.951712

J Hepatobiliary Pancreat Sci. 2026 May 1. doi: 10.1002/jhbp.70124. Online ahead of print.

ABSTRACT

BACKGROUND: The use of minimally invasive (MI) techniques for Hilar cholangiocarcinoma (HCCA) has increased in the last years, but high-quality evidence remains limited. This study aims to assess the safety of laparoscopic (LPS) and robotic (ROB) approaches compared to open surgery in the treatment of HCCA.

METHODS: After a systematic search, a frequentist network meta-analysis and a Trial sequential analysis were performed. Primary outcomes set for the study were major complications and R0 rate.

RESULTS: Fourteen studies including 1169 patients were found eligible, of which 403 were LPS (34.5%) and 137 operated with a ROB approach (11.7%). ROB and LPS techniques showed statistically similar rates of major complications (p = 0.251 and p = 0.143), while ROB was associated with a higher rate of negative resection margins (OR: 2.856, 95% CI: 1.585-5.144; p < 0.001). No differences were observed in the secondary outcomes assessed, except for the operative time, higher in both MI approaches, and length of stay, shorter in the ROB group.

CONCLUSIONS: Global experience in MI surgery for HCCA remains limited and subject to potential bias. Nevertheless, both LPS and ROB approaches seem to represent safe and viable options for carefully selected patients when performed by experienced surgeons in high-volume centers.

PMID:42068018 | DOI:10.1002/jhbp.70124

J Res Adolesc. 2026 Jun;36(2):e70193. doi: 10.1111/jora.70193.

ABSTRACT

Child maltreatment is a significant risk factor for mental and metabolic health, with negative effects that can persist into adulthood. Using data from a U.S.-nationwide study, the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examined the associations between child maltreatment, specifically childhood threat (i.e., harm or threat of harm) and deprivation (i.e., absence of expected environmental inputs), and young adult mental (i.e., depressive symptoms) and metabolic health (i.e., metabolic risk). The moderating effect of social support was also examined, focusing on both quality of different types of support (i.e., from teachers, friends, and other adults) and variety of support sources. Results showed that young adults who experienced more threat during childhood exhibited higher levels of depressive symptoms in young adulthood, and those exposed to more deprivation reported elevated levels of metabolic risk. This study also highlighted the protective-stabilizing role of quality of teacher support in buffering the impact of deprivation on depressive symptoms, and the protective-stabilizing role of high-quality other adult support in the link between childhood deprivation and metabolic risk, such that the benefits of social support remained stable across increasing levels of deprivation. Additionally, the variety of social support showed a protective-reactive pattern in moderating the link between deprivation and metabolic risk, wherein the benefits of variety of social support were released under low deprivation but not high deprivation conditions for metabolic risk. These findings underscore the importance of eliminating child maltreatment experiences and highlight potential interventions, such as enhancing teacher-student relationships and broadening adolescents’ access to diverse support networks, to buffer the long-term mental and metabolic health consequences associated with early experiences of threat and deprivation.

PMID:42068015 | DOI:10.1111/jora.70193

Drug Deliv. 2026 Dec 31;33(1):2665892. doi: 10.1080/10717544.2026.2665892. Epub 2026 May 1.

ABSTRACT

Cisplatin-induced hearing loss (CIHL) in pediatric cancer patients is an irreversible and highly prevalent adverse effect with a devastating impact on quality of life. Sodium thiosulfate (STS) has recently been approved for systemic administration as an otoprotective agent in children. However, implementation of systemic STS has its challenges, and there is currently limited evidence to support local STS for children. This review investigates the potential value of locally administered otoprotective agents other than STS with a focus on future pediatric implementation. We conducted a systematic review on the efficacy and safety of locally applied non-STS otoprotective agents in in vivo settings. This included a summary of investigated drug delivery methods and administration routes. We identified 70 preclinical and eight clinical studies. Agents were categorized based on their biological mechanisms: anti-inflammatory, chemical deactivators, calcium blockers, biologicals, and miscellaneous mechanisms. Preclinical studies investigated 45 different agents. Dexamethasone and N-acetylcysteine were identified as efficacious agents recurrently and progressed to clinical trials. Dexamethasone was investigated in three randomized clinical trials (RCTs) and three non-randomized clinical studies and showed statistically significant but not clinically relevant benefit in two trials. N-acetylcysteine was investigated in two clinical trials and one RCT and was minimally effective in the RCT and in one clinical study. Our review did not identify available studies of local alternative otoprotective agents that could reliably replace systemic STS in terms of safety and efficacy for pediatric patients. Further research on the optimal dosage, delivery method, and timing of otoprotective agents is needed.

PMID:42068011 | DOI:10.1080/10717544.2026.2665892