Category: Nevin Manimala

Lifetime Data Anal. 2026 Feb 9;32(1):13. doi: 10.1007/s10985-026-09693-2.

ABSTRACT

The time-to-first-event analysis is often used for studies involving multiple event times, where each component is treated equally, regardless of their clinical importance. Alternative summaries such as Win Ratio, Net Benefit, and Win Odds (WO) have drawn attention lately because they can handle different types of outcomes and allow for a hierarchical ordering in component outcomes. In this paper, we focus on WO and propose proportional WO regression models to evaluate the treatment effect on multiple outcomes while controlling for other risk factors. The models are easily interpretable as a standard logistic regression model. However, the proposed WO regression is more advanced; multiple outcomes of different types can be modeled together, and the estimating equation is constructed based on all possible and potentially dependent pairings of a treated individual with a control one under the functional response modeling framework. In addition, informative ties are carefully distinguished from those inconclusive comparisons due to censoring, and the latter is handled via the inverse probability of censoring weighting method. We establish the asymptotic properties of the estimated regression coefficients using the U-statistic theory and demonstrate the finite sample performance through numerical studies.

PMID:41661385 | DOI:10.1007/s10985-026-09693-2

Int Ophthalmol. 2026 Feb 9;46(1):107. doi: 10.1007/s10792-026-03977-0.

ABSTRACT

BACKGROUND / PURPOSE: Keratoconus is a progressive corneal ectasia characterized by stromal thinning and protrusion, leading to irregular astigmatism and visual impairment. To mitigate these issues, iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) was developed to enhance riboflavin penetration while preserving the epithelium, aiming for comparable biomechanical effects with fewer adverse events. This systematic review and meta-analysis aim to compare the efficacy and safety of iontophoresis-assisted transepithelial corneal collagen cross-linking (I-CXL) and standard epithelium-off corneal collagen cross-linking (S-CXL) in the management of keratoconus.

METHODS: This systematic review and meta-analysis was registered with PROSPERO (ID: CRD420251091187). PubMed, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), ClinicalTrials.gov, Google Scholar, and DOJA were searched from inception until August 2025. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and Newcastle-Ottawa Scale (NOS) for observational cohort studies. Meta-analysis was conducted using Review Manager (RevMan) version 5.4 (Cochrane Collaboration). A random-effects model was used to assess heterogeneity across studies.

RESULTS: 14 studies with a total of 629 patients were included, with10 incorporated into the quantitative analysis. Pooled analysis showed no significant difference between S-CXL and I-CXL in K-max reduction (mean difference MD = 0.52 D; 95% CI = [- 0.20, 1.23]; P = 0.16). I-CXL had more improvement in UCVA and BCVA, but without statistical significance (UCVA MD = – 0.03 logMAR; P = 0.30; BCVA MD = – 0.01 logMAR; P = 0.57). there was no significant difference between the two in terms of ECC, CCT, and TPT. I-CXL was associated with less adverse events and better patient comfort.

CONCLUSION: Both S-CXL and I-CXL are effective in halting keratoconus progression. S-CXL offered better corneal flatting, whereas I-CXL achieved better visual acuity parameters with less side effects and better patient comfort. Due to the high heterogeneity, lack of long-term trials, especially on pediatric population, further research is required.

PMID:41661382 | DOI:10.1007/s10792-026-03977-0

Lifetime Data Anal. 2026 Feb 9;32(1):14. doi: 10.1007/s10985-026-09689-y.

ABSTRACT

This study develops estimation methods for a deep partially linear Cox proportional hazards model with a change point under current status data, aiming to accommodate complex change-point effects. Prior work has largely relied on linear models, which may inadequately capture relationships among multivariate covariates and thus hinder accurate change-point detection. To address this, we use a deep neural network to model covariate effects within the Cox framework and propose a maximum likelihood estimation procedure for the model. We establish asymptotic properties of the resulting estimators, including consistency, asymptotic independence, and semiparametric efficiency. Simulation studies indicate that the proposed inference procedure performs well in finite samples. An analysis of a breast cancer dataset is provided to illustrate the methodology.

PMID:41661381 | DOI:10.1007/s10985-026-09689-y

Int Ophthalmol. 2026 Feb 9;46(1):106. doi: 10.1007/s10792-026-03939-6.

ABSTRACT

BACKGROUND: We aim to evaluate the effect of pharmacological pupil dilation on spherical and toric intraocular lens (IOL) power calculations using biometric measurements from the Anterion optical biometer.

METHODS: This was a prospective observational study of adults undergoing cataract surgery. Pre- and post-dilation biometric measurements were obtained using the Anterion biometer. IOL power calculations, including both spherical and toric values, were performed using the following formulas: Barrett Universal II, Cooke K6, EVO, Hill-RBF, Hoffer® QST, Kane, and Pearl-DGS. Vector analysis was used to compare pre- and post-dilation corneal astigmatism and toric IOL magnitude and axis.

RESULTS: A total of 74 eyes from 37 patients (17 male, 20 female; mean age 52.4 ± 7.8 years) were analysed. Pupil dilation resulted in a statistically significant increase in reported central corneal thickness (CCT, p < 0.05), while other biometric parameters remained unaffected. Both spherical and toric IOL power calculations showed no significant changes across formulas following dilation. Vector analysis revealed that the centroid difference in corneal astigmatism and toric IOL magnitude ranged from 0.09 D to 0.05, and axis orientation differences ranged from 3° to 6°, indicating no systematic bias due to dilation. Approximately 75% of eyes showed changes of < 0.50 D in spherical IOL power, while ~ 25% exceeded 0.50 D. For toric IOL power, ~ 90% of eyes showed changes < 0.50 D, with ~ 25% reaching or exceeding 0.50 D.

CONCLUSION: Most eyes show minimal IOL power variation with pupil dilation; however, a subset may experience clinically relevant differences, particularly in toric IOL calculations.

PMID:41661359 | DOI:10.1007/s10792-026-03939-6

Surg Today. 2026 Feb 9. doi: 10.1007/s00595-026-03248-6. Online ahead of print.

ABSTRACT

PURPOSE: Perihilar cholangiocarcinoma (PHCC) often presents challenges with intraoperatively detected distal bile duct margin (DM) positivity. We evaluated the safety and oncological impact of performing an additional pancreatoduodenectomy (ad-PD) for converting R1 to R0 resection.

METHODS: We retrospectively reviewed 272 patients (1990-2024) who underwent major hepatectomies for PHCC. Patients with positive DM were divided into an ad-PD group (n = 8) and a hepatectomy alone group (DMpos-HA, n = 10).

RESULTS: A manalysis identified lymph node metastasis, non-R0 resection, vascular resection, and CA19-9 > 90 U/mL as independent predictors of a poor overall survival (OS) in the entire cohort (n = 272). Regarding the DM-positive subgroup, the ad-PD group achieved a 100% R0 rate, whereas the DMpos-HA group had a 0% rate (p < 0.001). The 5-year OS rate tended to be higher in the ad-PD group (50.0% vs. 20.0%, p = 0.396), although the difference was not statistically significant. Major complications (Clavien-Dindo ≥IIIa) occurred in 38% of the ad-PD group and 20% of the DMpos-HA group (p = 0.613). Importantly, the in-hospital mortality rate was 0% in both groups.

CONCLUSION: In carefully selected patients, concomitant ad-PD is a feasible option that achieves a high R0 rate and suggests a trend toward an improved long-term survival without increasing mortality.

PMID:41661327 | DOI:10.1007/s00595-026-03248-6

Neurourol Urodyn. 2026 Feb 9. doi: 10.1002/nau.70231. Online ahead of print.

ABSTRACT

OBJECTIVES: Stress urinary incontinence (SUI) has been linked to excessive urethral mobility, yet clinical evaluation has been largely limited to assessing maximal excursion rather than capturing the full dynamics of visible urethral movement. In this study, we hypothesize that an automated, ultrasound-based method can objectively differentiate urethral mobility patterns between women with SUI and continent controls.

METHODS: We used a previously validated optical flow-based algorithm to automatically track urethral motion from transperineal ultrasound images during cough, Valsalva maneuver, and pelvic muscle contraction (PMC) in 11 women with SUI and 10 continent controls. Urethral motion was assessed by defining three regions of interest along the urethra (proximal, mid, and distal). Segmental urethral kinematics were computed and statistically compared between groups.

RESULTS: Substantial variability and overlap between groups were observed, with coefficient of variation ranging 25%-90%. On average, women with SUI demonstrated significantly larger urethral displacement compared to controls, particularly at the proximal segment during Valsalva (10.6 ± 1.2 mm vs. 6.0 ± 0.6 mm, p < 0.01), with pronounced inferior-posterior motion. Additionally, displacement between the upper and lower urethra was significantly larger in the SUI group (0.47 ± 0.10 mm/mm vs. 0.13 ± 0.03 mm/mm, p < 0.05), indicating localized hypermobility particularly near the proximal urethra. Maneuver-specific differences were also noted within the SUI group, with Valsalva producing significantly larger and less uniform urethral movements compared to cough (10.6 ± 1.2 mm vs. 6.6 ± 0.5 mm, p < 0.05).

CONCLUSION: Our results demonstrate that the automated method is capable of capturing urethral mobility characteristics associated with SUI. Significant inter-individual variability in both continent and SUI groups indicates that urethral kinematics are heterogeneous. The detailed kinematic data have the potential to identify distinct sub-types of urethral mobility, facilitating systematic comparisons with underlying structural and neuromuscular defects. This approach can move clinical evaluation from simple group comparisons toward personalized SUI diagnosis and targeted treatment selection. Future studies with larger sample sizes and inclusion of additional pelvic floor conditions will be needed to validate these findings and advance their translation into clinical practice.

PMID:41657287 | DOI:10.1002/nau.70231

Microsurgery. 2026 Feb;46(2):e70190. doi: 10.1002/micr.70190.

ABSTRACT

BACKGROUND: Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasing limb dependency, to enhance venous adaptation. However, wide variability exists in their design, and the impact of dangling duration and frequency on complication rates remains unclear.

METHODS: A systematic meta-analysis was performed to evaluate pooled complication rates associated with dangling protocols and to assess whether protocol duration (minutes per session) or frequency (number of sessions) was associated with adverse outcomes. Following PRISMA 2020 guidelines, we searched Medline, Embase, Web of Science, and Cochrane for relevant studies published through 2024. Then, a random-effects model was used to estimate pooled rates of partial flap loss, total flap loss, venous congestion, arterial compromise, hematoma, infection, wound dehiscence, return to the operating room, and donor site complications. Meta-regression was performed to examine associations with dangling protocol characteristics.

RESULTS: Across pooled studies, overall complication rates were low, including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). No statistically significant associations were found between dangling duration and any complication type. While increased frequency of dangling was significantly associated with higher return-to-OR rates in the full model (slope = 0.0224; p = 0.0002), this relationship was entirely driven by a single study reporting 24 sessions/day. When this outlier was excluded, the association became non-significant.

CONCLUSION: Dangling protocols appear safe and well tolerated, with low rates of major complications. While the duration of dangling sessions does not affect complication risk, higher frequency may increase the likelihood of surgical re-intervention. These findings support the need for standardized, evidence-based protocols and further research into the physiologic and clinical thresholds guiding postoperative flap care. A meta-analysis of lower extremity free flap studies demonstrated low complication rates across common endpoints including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%).

PMID:41657266 | DOI:10.1002/micr.70190

J Holist Nurs. 2026 Mar;44(1):37-48. doi: 10.1177/08980101241302509. Epub 2024 Dec 29.

ABSTRACT

The aim is to determine nurses’ professional values and individualized care experiences and the affecting factors. This cross-sectional study was conducted with 470 nurses in a city hospital between September and November 2021. Information Form, Nurses Professional Values Scale (NPVS), and The Individualized Care Scale-Nurse Version (ICS-Nurse) were used for data collection. The average score on the NPVS was 118.16 ± 21.9. The total ICS-Nurse score of the participants was 3.96 ± 0.7. A positive, weak and statistically significant relationship was found between the NPVS and ICS-Nurse in terms of clinical status, personal life, and decision-making subdimension scores (p < .05). The professional values of nurses were found to be at a moderate level which directly affect their approaches to individualized care. Having high levels of professional values can help nurses provide better individualized care to their patients.

PMID:41657265 | DOI:10.1177/08980101241302509

Am J Trop Med Hyg. 2025 Nov 20;114(1):47-54. doi: 10.4269/ajtmh.25-0534. Print 2026 Jan 7.

ABSTRACT

The selection of authors for editorials reflects perceptions of expertise and influence. Our objectives were to determine author geographic and gender distribution, determine temporal trends in editorial authorship, and identify factors associated with the inclusion of authors affiliated with low- and middle-income countries (LMICs) in editorials on research conducted in LMICs. We conducted a cross-sectional study of editorials on research in LMICs published in 15 global health, pediatrics, and general medicine journals from 2014 to 2024. To assess temporal changes in authorship, we plotted the proportion of editorial authors affiliated with LMICs and those with female names by year. We used multivariable logistic regression to identify factors associated with the inclusion of one or more LMIC-affiliated authors. There were 107,629 publications and 1,350 editorials on research in LMICs with 2,401 authors. Authors of editorials were most often affiliated with institutions in North America (38.1%) and high-income countries (71.6%). The proportion of authors of editorials affiliated with institutions in high-income countries decreased from 84.9% in 2014 to 65.3% in 2024. Authors of editorials more commonly had male names than female (60.1% versus 38.7%, P <0.001). The proportion of editorial authors with female names increased from 32.1% in 2014 to 48.2% in 2024. Editorials accompanying publications reporting studies with larger sample sizes (aOR = 1.52, 95% CI: 1.03-2.26) and research conducted in sub-Saharan Africa (aOR = 2.84, 95% CI: 1.74-4.68) were more likely to include LMIC-affiliated authors. Additional efforts are needed to include authors affiliated with LMICs in editorials on research conducted in LMICs.

PMID:41657262 | DOI:10.4269/ajtmh.25-0534

Nurs Crit Care. 2026 Mar;31(2):e70361. doi: 10.1111/nicc.70361.

ABSTRACT

BACKGROUND: Leadership styles play a crucial role in shaping nurses’ psychological well-being and communication behaviours, especially in high-stress settings like critical care. Paternalistic leadership-characterised by benevolence, moral integrity and authority-has gained recognition for its impact on healthcare outcomes. However, its influence on organisational dissent, particularly through the lens of psychological well-being, remains underexplored.

AIM: To Investigate the Mediating Role of Psychological Well-Being in the Relationship Between Paternalistic Leadership and Organisational Dissent Among Nurses in Critical Care Settings.

STUDY DESIGN: A cross-sectional descriptive study was conducted. A convenience sample from 23 critical care units in a large educational government hospital participated. Data were collected using the Paternalistic Leadership Scale, Psychological Well-Being Scale and Organisational Dissent Scale. Statistical analyses included Pearson correlation, regression and path analysis.

RESULTS: Among 460 nurses, paternalistic leadership was positively correlated with psychological well-being (r = 0.263, p < 0.001) and negatively correlated with organisational dissent (r = -0.278, p < 0.001). Psychological well-being also negatively correlated with dissent (r = -0.258, p = 0.001). Regression and path analysis confirmed that psychological well-being partially mediated the relationship between paternalistic leadership and organisational dissent. The mediation model showed statistically significant direct and indirect effects.

CONCLUSIONS: Paternalistic Leadership Enhances Nurses’ Psychological Well-Being and Reduces Organisational Dissent. Psychological Well-Being Acts as a Partial Mediator, Emphasising Its Importance in Translating Leadership Support Into Reduced Dissent Behaviours.

RELEVANCE TO CLINICAL PRACTICE: Fostering paternalistic leadership and supporting nurses’ psychological well-being are critical to maintaining constructive communication and reducing harmful dissent. Healthcare institutions should implement leadership development and mental health support initiatives to improve workforce morale and patient care.

PMID:41657259 | DOI:10.1111/nicc.70361