Category: Nevin Manimala

JAMA Netw Open. 2026 Apr 1;9(4):e265585. doi: 10.1001/jamanetworkopen.2026.5585.

ABSTRACT

IMPORTANCE: Life-prolonging targeted therapies are available based on alterations detected on next-generation sequencing (NGS); however, clinical data on NGS adoption are limited.

OBJECTIVE: To assess trends and disparities in NGS among patients with common advanced or metastatic cancers.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 280 US-based cancer clinics (approximately 800 sites of care) using electronic health record-derived deidentified information from Flatiron Health Research Database. Participants were patients diagnosed with metastatic breast (mBC), metastatic prostate (mPC), advanced non-small cell lung (aNSCLC), metastatic colorectal (mCRC), and metastatic pancreatic (mPanC) cancers between January 1, 2018, and December 30, 2022. Data were analyzed from April 2024 to December 2025.

MAIN OUTCOMES AND MEASURES: Time to NGS from diagnosis, considering death as competing risk. Multivariable cause-specific Weibull accelerated failure time models evaluated association of socioeconomic status (SES), race and ethnicity, insurance type, practice setting, and sex with time to NGS.

RESULTS: Overall, 63 294 patients with advanced or metastatic cancer who underwent NGS were eligible and included: 12 085 with mBC (19.1%), 4341 with mPC (6.9%), 27 050 with aNSCLC (42.7%), 13 648 with mCRC (21.6%), and 6170 with mPanC (9.7%). The median (IQR) age was 68 (60-76) years and 33 975 patients (53.7%) were female; 1703 (2.7%) were Asian, 6551 (10.0%) were Black, 3772 (6.0%) were Hispanic, 38 318 (61.0%) were White, and 12 950 (20.3%) were other races and ethnicities. One-year cumulative incidence of NGS increased in patients diagnosed in 2022 compared with 2018 across all cancer types. Significantly longer time to NGS (time ratio [TR]) was observed in those with mBC with low SES (1, lowest: TR, 1.3; 95% CI, 1.1-1.6; 2: TR, 1.3; 95% CI, 1.1-1.5), those who were Hispanic (TR, 1.4; 95% CI, 1.2-1.7), or those on Medicare (TR, 1.5; 95% CI, 1.3-1.8). Longer TRs were also observed in those with mPC and Hispanic ethnicity (TR, 1.6; 95% CI, 1.3-2.1), those on Medicaid (TR, 2.0; 95% CI, 1.2-3.5), those with aNSCLC with low SES (1, lowest: TR, 1.6; 95% CI, 1.5-1.8; 2: TR, 1.4; 95% CI, 1.3-1.6; 3: TR, 1.2; 95% CI, 1.1-1.3), Black patients (TR, 1.4; 95% CI, 1.2-1.5), and those on Medicare (TR, 1.4; 95% CI, 1.3-1.5). For mCRC, TRs were elevated for those with low SES (1, lowest: TR, 1.3; 95% CI, 1.1-1.5; 2: TR, 1.1; 95% CI, 1.0-1.3), Black patients (TR, 1.4; 95% CI, 1.2-1.6), Hispanic patients (TR, 1.4; 95% CI, 1.2-1.6), and those on Medicare (TR, 1.4; 95% CI, 1.3-1.6). Elevated TRs were also observed for mPanC in Black patients (TR, 1.5; 95% CI, 1.2-1.8) and those on Medicare (TR, 1.3; 95% CI, 1.1-1.5).

CONCLUSIONS AND RELEVANCE: In this cohort study, most patients with advanced or metastatic cancers did not undergo tumor genomic testing. Low SES, Black race or Hispanic ethnicity, and Medicaid or Medicare coverage were associated with significantly longer time to NGS, highlighting the need for awareness and health care policies aimed at bridging these gaps.

PMID:41945343 | DOI:10.1001/jamanetworkopen.2026.5585

Anatol J Cardiol. 2026 Apr 3. doi: 10.14744/AnatolJCardiol.2026.5770. Online ahead of print.

ABSTRACT

BACKGROUND: Premature ventricular complexes (PVCs) arising from the right and left ventricular outflow tracts (RVOT and LVOT) require accurate localization for successful ablation. Existing electrocardiographic (ECG) algorithms are limited by anatomical variability. This study aimed to develop a supervised learning approach model based on logistic regression using validated ECG parameters and to compare its diagnostic performance with 7 established algorithms.

METHODS: A retrospective cohort of 116 patients with idiopathic outflow tract PVCs who underwent successful ablation between 2015 and 2020 was analyzed. Four ECG parameters were selected through backward stepwise logistic regression. The performance of the model and 7 published algorithms was assessed using receiver-operating characteristic (ROC) curve analysis, Youden index, and accuracy metrics. Subgroup analysis was performed in patients with V3 precordial transition.

RESULTS: The supervised learning model achieved the highest diagnostic accuracy with an area under the ROC curve of 0.942 in the overall cohort and 0.878 in the V3 transition subgroup, significantly outperforming all comparator algorithms (P < .001). The model demonstrated a Youden index of 0.66, sensitivity of 82.7%, and specificity of 84.4%.

CONCLUSION: The supervised learning approach model outperformed existing rule-based ECG algorithms in differentiating RVOT from LVOT PVCs. By integrating validated ECG features into a statistically optimized and interpretable framework, it provides a reliable noninvasive tool to support ablation planning. Larger multicenter validation studies are warranted.

PMID:41945340 | DOI:10.14744/AnatolJCardiol.2026.5770

J Craniofac Surg. 2026 Apr 7. doi: 10.1097/SCS.0000000000012600. Online ahead of print.

ABSTRACT

To investigate the difference between the 3-dimensional structure of the cavity in patients with isolated cleft palate and Pierre-Robin syndrome with cleft palate. Retrospective measurements of high need ratio (NR), velopharyngeal gap (VPG), soft palate length (SPL), and long velopharyngeal depth (VPD) were taken from lateral and anteroposterior (AP) cephalometric radiographs of isolated cleft palate and PRS with cleft palate. A total of 29 isolated cleft palate and 18 PRS patients with cleft palate were included. The VPG, SPL, and VPD of cleft palate were higher than those in the PRS group. But there is no statistically significant difference of the NR values between the 2 groups (P=0.509). NR and long VPD were contributing factors to velopharyngeal insufficiency (VPI) occurrence. The higher VPD in isolated cleft palate patients compared with PRS may reflect age-related assessment variability. However, the 2 groups show no significant difference in NR values, suggesting comparable velopharyngeal insufficiency between PRS and isolated cleft palate patients.

PMID:41945325 | DOI:10.1097/SCS.0000000000012600

Sports Med Open. 2026 Apr 7;12(1):40. doi: 10.1186/s40798-026-00993-3.

ABSTRACT

BACKGROUND: Exercise-induced muscle damage (EIMD) is known to impair neuromuscular performance, provoke inflammation, and delay recovery. Tart cherry (TC) juice, a polyphenol-rich nutritional product, has been proposed as a strategy to support recovery in athletes; however, findings across studies remain inconsistent.

OBJECTIVE: The aim was to conduct a systematic review combined with a meta-analysis and corroborate the certainty of evidence underpinning the effects of TC juice supplementation on physical, biochemical, and perceptual recovery markers following EIMD in trained athletes.

METHODS: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, ScienceDirect, Web of Science and SPORTDiscus were searched from inception to 25 December 2025.

RESULTS: Nineteen trials were included. Our results revealed TC juice supplementation significantly improved MVC recovery in the main analysis across all time points (post: ES = 0.63; 24 h: ES = 1.12; 48 h: ES = 1.29; 72 h: ES = 2.14; 96 h: ES = 4.82), with substantial heterogeneity (I² 69-93%). CMJ showed no significant effects post-exercise or at 24h but improved at 48 h (ES = 1.41; I² = 72%). TC juice significantly reduced CRP post-exercise and up to 48 h (post: ES = -0.46; 24 h: ES = -0.73; 48 h: ES = -0.68), whereas no significant pooled effects were found for muscle soreness, CK, IL-6, TNF-α, ROM, or most subgroup time points. Subgroup analyses suggested model-specific responses (e.g., MVC improvements at 24-48 h in whole-body protocols and at 72 h in isolated protocols). Sensitivity analyses indicated that statistical significance at selected time points (MVC post and 72 h; CMJ 48 h; CRP 24-48 h) was influenced by individual studies. Certainty of evidence ranged from very low to moderate.

CONCLUSIONS: TC juice supplementation may support recovery of selected functional and inflammatory markers following exercise-induced muscle damage in trained athletes; however, findings are heterogeneous and supported by low-to-moderate certainty of evidence, warranting cautious interpretation.

PMID:41945263 | DOI:10.1186/s40798-026-00993-3

Adv Clin Exp Med. 2026 Apr 7. doi: 10.17219/acem/208614. Online ahead of print.

ABSTRACT

BACKGROUND: No comprehensive comparative research has been conducted to evaluate open Bankart (OB), arthroscopic Bankart (AB), open Latarjet (OL), and arthroscopic Latarjet (AL) simultaneously across all relevant clinical outcomes and parameters.

OBJECTIVES: To compare the efficacy of OB, AB, OL, and AL procedures in the treatment of shoulder dislocation.

MATERIAL AND METHODS: The databases PubMed, Embase, the Cochrane Library, and Web of Science were utilized for the literature search. The study evaluated recurrent instability, re-dislocation, apprehension, functional outcomes, and postoperative pain. The results were visually represented through network diagrams, forest plots, league tables, and rank probability plots to provide a comprehensive understanding of each outcome.

RESULTS: Overall, 37 studies were included in the analysis. Individuals who underwent OL experienced a notably reduced risk of recurrent instability compared with those who underwent AB (random-effects model pooled relative risk (RR) = 0.34, 95% credible interval (95% CrI): 0.24-0.48) and OB (random-effects model pooled RR = 0.51, 95% CrI: 0.31-0.85). The risk of re-dislocation was also significantly lower for patients treated with OL compared with AB (pooled RR = 0.15, 95% CrI: 0.04-0.45). While not statistically significant, the OL procedure tended to have the lowest risk of apprehension and the highest Subjective Shoulder Value (SSV) score. Regarding postoperative pain, patients who underwent OB had the highest likelihood of attaining the lowest scores on the visual analogue scale (VAS). In addition, OL was associated with the highest probability of complications.

CONCLUSION: The open Latarjet procedure appears to offer superior shoulder stability; however, while functional outcomes for patients undergoing OL are likely to be non-inferior, the procedure is not significantly associated with reduced postoperative pain as measured with the VAS score. Additionally, the OL procedure is associated with an increased likelihood of complications. Consequently, it is essential to implement preventive measures to manage postoperative pain and address potential complications following OL procedure.

PMID:41945260 | DOI:10.17219/acem/208614

Int J Clin Pharm. 2026 Apr 7. doi: 10.1007/s11096-026-02134-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Medication non-adherence is common in patients with acute coronary syndrome (ACS) and may increase the risk of cardiac readmissions and mortality.

AIM: To evaluate the effect of a clinical pharmacist-led, behavioural theory-based discharge service designed to promote medication adherence on 30-day cardiac readmissions (primary outcome) and on clinical, humanistic, and healthcare utilisation outcomes over 360 days in patients with ACS.

METHOD: In this single-centre, parallel-group randomised controlled trial, adult patients hospitalised with ACS were assigned by permuted block randomisation (block size 8) to the intervention or control group. The intervention comprised a clinical pharmacist-led, behavioural theory-based discharge service to promote medication adherence. The intervention consisted of medication reconciliation, medication review and patient counselling based on components of the behaviour change technique taxonomy and Health Belief Model. The primary outcome was 30-day hospital readmission for cardiac reasons. Secondary outcomes included all-cause and cardiac readmissions, emergency department visits, all-cause and cardiac mortality, medication adherence, LDL (low-density lipoprotein) target attainment, and quality of life over 360 days.

RESULTS: A total of 167 patients were analysed (intervention: n = 80; control: n = 87). The primary outcome occurred in 0/80 (0.0%) in the intervention group versus 5/87 (5.7%) in the control group (risk difference – 5.7%, 95% CI – 12.8 to 2.1%; p >0.050). Over 360 days, the control group had higher adjusted odds of cardiac readmission (aOR 4.4; 95% CI 1.2-16.0; p = 0.027), all-cause readmission (aOR 3.7; 95% CI 1.1-11.7; p = 0.029), and non-adherence at 30 days (aOR 2.4; 95% CI 1.1-5.2; p = 0.028). At 180 days, the control group had lower adjusted odds of LDL target attainment (aOR 0.4; 95% CI 0.2-0.9; p = 0.038).

CONCLUSION: This intervention reduced 30-day cardiac readmission, but the effect was not statistically significant. According to findings of secondary outcomes, this behavioural theory-based discharge service at discharge might be effective in reducing healthcare utilisation in the long term and improving the short-term target for medication adherence in patients with acute coronary syndrome.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05153707.

PMID:41945242 | DOI:10.1007/s11096-026-02134-y

Hepatol Int. 2026 Apr 7. doi: 10.1007/s12072-026-11083-7. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic hepatitis B virus (HBV) infection remains a major burden. The “Hot Wave Project,” a hospital-wide initiative launched in 2022, aims to enhance HBV care by integrating patient education with systematic screening, referral, diagnosis, treatment, and follow-up.

METHODS: We conducted a comparative analysis of hospital-wide HBV care metrics between 2021 (preintervention) and 2024 (postintervention). An interrupted time series (ITS) analysis was conducted on monthly data to evaluate the causal impact of the intervention. A decision-analytic Markov model was used to simulate the cost-effectiveness and epidemiological impact of the project on a hypothetical cohort of one million patients.

RESULTS: From 2021 to 2024, the HBsAg screening rate hospital-wide increased from 11.75% to 15.25%. Referrals of HBsAg-positive patients from nonhepatology departments surged from 9.26% to 17.87% (p < 0.0001), and the overall antiviral treatment rate rose from 71.00% to 80.25%. ITS analysis confirmed that the intervention caused significant immediate increases in screening and referral rates and a sustained acceleration in treatment uptake. Regular follow-up rates increased modestly from 59.96% to 61.5%. The model projected that the 2024 intervention levels would avert 17.4 HBV-related deaths per 100,000 person-years, yielding an incremental cost-effectiveness ratio (ICER) of $5688 per quality-adjusted life year (QALY) gained.

CONCLUSION: The “Hot Wave Project” is a cost-effective and scalable hospital-based model that significantly improves the HBV care continuum. By enhancing interdisciplinary coordination, this approach offers an adaptable framework to help China advance toward its viral hepatitis elimination targets.

PMID:41945219 | DOI:10.1007/s12072-026-11083-7

Insights Imaging. 2026 Apr 7;17(1):88. doi: 10.1186/s13244-026-02263-y.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the feasibility and accuracy of automated contrast-to-noise ratio (CNR) analysis in chest CT using the open-source body and organ analysis (BOA) framework and to validate segmentation modifications for reproducible image-quality assessment.

MATERIALS AND METHODS: This retrospective study analyzed 100 contrast-enhanced chest CTs (mean age 60.2 ± 15 years; 40% female; 50 CTA, 50 CTPA) and validated the approach in an external cancer imaging archive (TCIA) cohort (n = 100). Automated BOA segmentations of the aorta, pulmonary trunk, and paraspinal muscles were modified by fat subtraction and binary erosion and compared with manual measurements from three radiologists. Agreement was assessed using statistical testing, Bland-Altman analysis, and intraclass correlation coefficients (ICC).

RESULTS: Unmodified BOA segmentations yielded significantly lower CNRs than manual measurements (all p < 0.01, mean difference up to 6.3). Fat subtraction and binary erosion progressively reduced deviations, with the optimized variant (m_erode6 combined with a_erode6 or p_erode6) showing no significant differences from radiologists (p ≥ 0.35). In the external TCIA validation cohort (n = 100), agreement was excellent (ICC 0.89-0.93), and Bland-Altman analysis demonstrated minimal bias (Aorta: 0.16 [limits of agreement (LoA) -3.47 to 3.80]; PT: 0.42 [LoA -4.03 to 4.87]).

CONCLUSIONS: A minimally modified open-source segmentation framework enables fully automated, reproducible CNR assessment in chest CT, achieving expert-level agreement, including robust performance in external validation. This scalable alternative to manual region-of-interest (ROI) measurement streamlines image-quality assessment, facilitates protocol optimization, and provides standardized metrics ready for integration into AI workflows.

CRITICAL RELEVANCE STATEMENT: This study provides a validated, fully automated method for quantitative CT image quality assessment, reducing observer dependence and enabling consistent evaluation across scanners, protocols, and institutions, thereby supporting reproducible image quality metrics in clinical routine.

KEY POINTS: Automated CNR assessment enables objective and reproducible evaluation of image quality in CTA and CTPA. Adjustments of the segmentation strategy can substantially improve the accuracy of automated measurements. The fully automated approach provides a foundation for standardized and scalable CT image quality analysis in research and clinical practice.

PMID:41945209 | DOI:10.1186/s13244-026-02263-y

Support Care Cancer. 2026 Apr 7;34(5):409. doi: 10.1007/s00520-026-10605-1.

ABSTRACT

PURPOSE: Antineoplastic treatment commonly leads to nausea and vomiting (NV), which considerably affects the quality of life and adherence to therapy of patients. This study aimed to analyze the incidence of NV induced by antineoplastic agents using the Japanese Adverse Drug Event Report (JADER) database and to explore novel antiemetic therapies for oral antineoplastic agents.

METHODS: Data from April 2004 to March 2023 were extracted from the JADER database. The analysis considered guideline-recommended antiemetics and involved the temporal evaluation of cases with NV. The onset patterns of NV were analyzed for each oral antineoplastic agent. The reported odds ratio was used to identify adjunctive medications that showed inverse associations with these symptoms.

RESULTS: A large number of NV cases were reported for platinum compounds and irinotecan. Among the oral agents, a notable incidence of NV was induced by antimetabolites and tyrosine kinase inhibitors. A decreasing trend in the use of single-agent antiemetic therapy was observed from 2010. Distinct NV patterns were identified. Silodosin and meropenem emerged as potential adjunct therapies to suppress NV induced by oral agents.

CONCLUSION: Although there is a trend toward improvement in NV management with increased adherence to antiemetic therapies, a substantial gap remains between guidelines and actual practice. The need for tailored management strategies based on the onset patterns of NV for specific agents has been emphasized. Investigating the mechanisms underlying the antiemetic effects of adjunctive therapies, such as silodosin and meropenem, may pave the way for new antiemetic options for oral antineoplastic agents.

PMID:41945168 | DOI:10.1007/s00520-026-10605-1

World J Urol. 2026 Apr 7;44(1):285. doi: 10.1007/s00345-026-06343-y.

ABSTRACT

PURPOSE: Drug-coated balloon (DCB) urethral dilatation which offers an alternative to standard endoscopic treatments of male anterior urethral stricture disease (AUSD). Its ease of delivery has facilitated its use by urologists with various subspecialty interests. The objective of this study was to characterise real-world practice patterns of a DCB device.

METHODS: An exploratory cross-sectional online survey was distributed to Optilume^® users via national and international urological societies and device distributor mailing lists. Descriptive and inferential statistics were performed using SPSS software.

RESULTS: N = 102 urologists responded to the survey of whom n = 47 (46%) were reconstructive subspecialists. DCB dilatation was predominantly performed under general anaesthesia (n = 59, 58%). Significant variation was seen with catheter duration, perioperative antibiotic use and post-procedure contraception advice. Off-label use was common with respondents offering DCB for penile urethral strictures (65%), primary treatment (64%) and bladder neck stenoses (65%). Higher-volume users (≥ 10/year) were more likely to perform DCB under flexible cystoscopy (OR 5.14, 95% 1.57-16.79, p = 0.007), bladder neck stricture (OR 4.66, 95% CI 1.55-14.03, p = 0.006), and for recurrences (OR 6.92, 95% CI 2.22-21.6, p = 0.001). Limited practitioner experience, an evidence gap, and the importance of shared decision making were highlighted on thematic analysis.

CONCLUSIONS: This study provides an insight into the early experience a novel DCB among practicing urologists. Further research is required to optimize patient selection, procedural protocols and the understanding of long-term outcomes.

PMID:41945167 | DOI:10.1007/s00345-026-06343-y