Category: Nevin Manimala

J Dual Diagn. 2026 Mar 8:1-10. doi: 10.1080/15504263.2026.2638190. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic prompted a rapid expansion of telehealth services in patients with substance use disorders (SUD) and comorbid mental health conditions (dual diagnosis). However, evidence on the effectiveness and utilization of hybrid care (combining in-person and telehealth modalities) in this population remains limited.

OBJECTIVE: This study aims to analyze the use of a hybrid treatment (telehealth and in-person treatment) among patients with dual pathology across three distinct periods-before, during, and after COVID-19-related public health measures-and to assess the impact of hybrid care on treatment dropout rates.

METHODS: A retrospective observational study was conducted using electronic health records (EHR) from 6,365 outpatients diagnosed with SUD and comorbid mental disorders, between March 2018 and September 2023. Patients were classified by treatment modality (in-person vs. hybrid) and period of care. Bivariate statistics and Cox regression analyses were performed to identify predictors of treatment dropout, accounting for demographic and clinical variables.

RESULTS: Hybrid care utilization increased significantly during the pandemic and remained elevated post-pandemic. Women and patients with opioid use disorder were more likely to receive hybrid care. Patients receiving hybrid therapy had significantly lower dropout rates and longer treatment durations. Also, patients in coordinated care (addiction and mental health centers) show lower rates of dropout. Cox regression confirmed that hybrid care was the strongest predictor of reduced treatment dropout across all periods.

CONCLUSIONS: Hybrid care models enhance treatment retention among dual diagnosis patients, underscoring the need to maintain and optimize telehealth options for this high-risk group even beyond pandemic-related restrictions.

PMID:41795803 | DOI:10.1080/15504263.2026.2638190

Int J Clin Oncol. 2026 Mar 8. doi: 10.1007/s10147-026-03005-2. Online ahead of print.

ABSTRACT

BACKGROUND: Metastatic bladder urothelial carcinoma has poor survival, and large comparative genomic studies using uniform targeted sequencing of paired primary and metastatic lesions remain limited. We compared gene- and pathway-level alterations between primary and metastatic tumors METHODS: We analyzed 2,880 bladder urothelial carcinoma samples (2,305 primary; 575 metastatic) from 2,343 patients profiled with MSK-IMPACT. Somatic mutations and copy number alterations were integrated per gene and compared between primary and metastatic samples in the full cohort and in a paired subset using standard statistical tests.

RESULTS: Primary and metastatic samples showed broadly similar driver landscapes. In the full cohort, KDM6A, FGFR3, STAG2, and ERCC2 were more frequently altered in primary tumors, whereas no individual genes were enriched in metastases; these differences were not significant in paired analyses. At the pathway level, TP53 pathway alterations were relatively more frequent in metastases, while DNA damage response alterations were enriched in primary tumors; other pathways showed comparable alteration rates. Apoptosis-focused analyses identified no significant gene-level differences, but suggested a trend toward higher alteration rates in the TP53 pathway and apoptosis regulators in metastases.

CONCLUSION: Primary and metastatic lesions of bladder urothelial carcinoma show broadly similar gene- and pathway-level alteration profiles on targeted DNA sequencing. TP53 pathway and apoptosis-related alterations are modestly more frequent in metastases, consistent with impaired stress responses and apoptosis evasion.

PMID:41795757 | DOI:10.1007/s10147-026-03005-2

Int J Clin Oncol. 2026 Mar 8. doi: 10.1007/s10147-026-02980-w. Online ahead of print.

ABSTRACT

BACKGROUND: The 9th edition of the UICC TNM classification redefined N categories and clinical stages for salivary gland cancer (SGC). We validated the prognostic utility of this redefinition and evaluated the impact of anatomical nodal spread.

METHODS: We retrospectively analyzed 166 patients with SGC and 93 parotid gland cancer (PGC) patients treated with curative surgery. Cases were restaged according to the TNM classification of the UICC 9th edition. Kaplan-Meier survival curves, Cox models, and statistical indices (AIC, likelihood ratio χ², C-index) were used to compare the findings based on the 8th and 9th editions. Nodal metastases were classified as “Intraparotid lymph nodes (LNs) only”, “Limited to levels I-III LNs”, and “Beyond levels I-III LNs”.

RESULTS: Kaplan-Meier curves showed clearer separation by N category and clinical stage for the 9th edition, although its prognostic performance by statistical indices was similar to that of the 8th edition. In the PGC surgery subset, LN metastasis, particularly N2 in the 9th edition, was the strongest adverse prognostic factor, and the new 9th edition pathological N categories were also useful. Additionally, prognosis worsened with increasing nodal extent. Twelve patients with metastases beyond levels I-III developed distant metastases despite standard treatment, and 10 with salivary duct carcinoma, indicating potential benefit from adjuvant systemic therapy.

CONCLUSIONS: Kaplan-Meier analyses suggested that the 9th edition provided better intercategory discrimination than the 8th edition, despite no statistical superiority being demonstrated. Nodal metastasis extending beyond levels I-III may be a useful biomarker for selecting patients for adjuvant systemic therapy.

PMID:41795756 | DOI:10.1007/s10147-026-02980-w

Aging Clin Exp Res. 2026 Mar 8. doi: 10.1007/s40520-026-03349-9. Online ahead of print.

NO ABSTRACT

PMID:41795734 | DOI:10.1007/s40520-026-03349-9

Oecologia. 2026 Mar 8;208(3):40. doi: 10.1007/s00442-026-05876-8.

ABSTRACT

Climate change is rapidly altering high-latitude coastal wetlands through increasing temperatures, more frequent flooding, and changing herbivore abundance and distribution. Examining plant functional trait responses to these drivers provides insight into how plant communities are shaped by climate change. We used a one-year full-factorial mesocosm experiment in coastal Alaska to assess immediate responses of two size-related traits (vegetative height and leaf area) and two leaf economics traits (specific leaf area [SLA] and leaf dry matter content [LDMC]) to warming, flooding, and goose herbivory in three dominant species across two wetland communities (Lowland and Upland) differing in landscape position. We sampled different sedges (Carex rariflora and Carex lyngbyei) and the same deciduous dwarf-shrub (Salix fuscescens) in the two wetlands. Warming increased plant size for the sedge (leaf area: + 15%) and the shrub (height: + 15%; leaf area: + 19%) in the Lowland wetland only. Flooding promoted acquisitive trait values for the Lowland sedge (SLA: + 8%; LDMC: – 6%) and conservative values for the Upland shrub (SLA: – 9%; LDMC: + 11%). The shrub thus showed clear wetland-specific responses to warming and flooding. Herbivory triggered coordinated responses across all three species, consistently decreasing size-related trait values (height: – 17-35%; leaf area: – 33-50%) and promoting acquisitive trait values (SLA: + 14-40%; LDMC: – 12-23%). Despite the absence of interactions, each driver contributed significantly to trait variation, underscoring the value of multifactorial approaches. The combination of consistent (herbivory) and context-dependent (flooding and warming) responses highlights the complexity of trait responses and improves predictions of rapid phenotypic adjustments in coastal high-latitude wetlands.

PMID:41795722 | DOI:10.1007/s00442-026-05876-8

Inquiry. 2026 Jan-Dec;63:469580261427434. doi: 10.1177/00469580261427434. Epub 2026 Mar 8.

ABSTRACT

Value-Based Healthcare (VBHC) is gaining traction in civilian systems, but its relevance and feasibility for Military Health Systems (MHSs) in Central and Eastern Europe (CEE) remain unclear. This pilot study explored familiarity, perceived applicability and desirability of VBHC among military healthcare stakeholders. A pilot cross-sectional perception study was conducted during the 2024 VIMIMED Military Medicine Conference, combining a brief expert introduction with a structured survey. The survey assessed baseline familiarity, perceived applicability in home-base and operational care, and desirability of VBHC implementation. Descriptive statistics were used. The association between familiarity and desirability was explored using Fisher’s exact test. Among 65 workshop participants, 37 completed the survey. Over half of respondents reported low baseline familiarity with VBHC (51.4%). Despite this, VBHC was widely perceived as desirable (89.1%). No statistically significant association was found between familiarity and desirability (Fisher’s exact test, P = .672). Thirty-five respondents considered VBHC applicable in at least one domain and were included in component-level analyses. The components “multidisciplinary team,” “educate, innovate & improve,” and “IT & data” were most frequently endorsed as applicable. Respondents who perceived VBHC as applicable in both home-base and operational care tended to endorse more components than those who perceived applicability in home-base care only. Despite limited baseline familiarity, VBHC was widely perceived as desirable and contextually applicable within CEE MHSs. These exploratory findings suggest potential for targeted, phased integration of selected VBHC components. Larger and, more representative studies are needed to assess implementation feasibility, pathways, and sustainability of VBHC in MHSs.

PMID:41795694 | DOI:10.1177/00469580261427434

Med Phys. 2026 Mar;53(3):e70373. doi: 10.1002/mp.70373.

ABSTRACT

BACKGROUND: Noninvasive assessment of diastolic dysfunction relies on multiple echocardiographic indicators, including measurements from both standard B-mode images and Doppler, obtained at various cardiac locations such as the mitral annulus, tricuspid annulus, left ventricle, and left atrium. The diagnostic process is complex and subject to interobserver variability, making accurate and rapid evaluation challenging. Automated semantic segmentation of key cardiac structures, such as the left atrium, left ventricle, and mitral valve annulus, offers a potential solution by capturing temporal changes throughout the cardiac cycle.

PURPOSE: This study aims to improve the accuracy of segmenting the left atrium, left ventricle, and mitral valve annulus in echocardiographic images and to leverage the resulting temporal segmentation features for more reliable identification of diastolic dysfunction.

METHODS: This study presents Diff-TransUNet, a novel segmentation model incorporating a noise-robust Differential Transformer module. Evaluations on private (1137 training images, 135 validation images, and 88 test images), CAMUS (1400 training images, 200 validation images, and 200 test images), and EchoNet-Dynamic (5000 training images, 2546 validation images, and 2528 test images) datasets demonstrate improved performance over state-of-the-art methods, assessed by Dice coefficient (Dice), Intersection-over-Union (IoU), and 95th percentile Hausdorff Distance (HD₉₅) metrics. Statistical analysis was performed to compare Diff-TransUNet with baseline methods across evaluation metrics. To control for errors arising from multiple comparisons, p-values were adjusted using the Benjamini-Hochberg false discovery rate (FDR) correction. Statistical significance was assessed at a 95% confidence level. In addition to p-values, Cohen’s d effect size was computed to quantify the practical significance of performance differences.

RESULTS: The proposed Diff-TransUNet achieved a Dice of 87.49%, IoU of 79.07%, and HD₉₅ of 1.48 on the private dataset. Compared with state-of-the-art models, Dice improved by 1.35%-4.30% (p < 0.05, Cohen’s d = 0.32-0.90), IoU by 1.97%-5.67% (p < 0.05, Cohen’s d = 0.37-1.03), and HD₉₅ by 0.16-0.83 (p < 0.05, Cohen’s d = 0.21-0.90). On the CAMUS dataset, the model achieved a Dice of 88.74%, IoU of 80.58%, and HD₉₅ of 2.83, showing improvements of 1.07%-4.96% (p < 0.05, Cohen’s d = 0.18-0.63) in Dice, 1.55%-6.89% (p < 0.05, Cohen’s d = 0.19-0.71) in IoU, and 0.41-2.85 (p < 0.05, Cohen’s d = 0.12-0.46) in HD₉₅ compared to advanced models. On the EchoNet-Dynamic dataset, the model obtained a Dice of 92.25%, IoU of 85.87%, and HD₉₅ of 1.65, outperforming other methods by 0.42%-2.00% (p < 0.05, Cohen’s d = 0.10-0.40) in Dice, 0.69%-3.21% (p < 0.05, Cohen’s d = 0.10-0.43) in IoU, and 0.21-1.12 (p < 0.05, Cohen’s d = 0.09-0.34) in HD₉₅. Furthermore, by extracting volumetric segmentation features, the proposed method achieved an accuracy of 88.95% (95 % CI 87.15% to 90.08%) in identifying diastolic dysfunction.

CONCLUSIONS: The proposed Diff-TransUNet model achieves significant improvements in ultrasound segmentation. Features extracted from the left ventricle, left atrium, and mitral annulus segmented by Diff-TransUNet can be effectively used for the identification of diastolic dysfunction.

PMID:41795688 | DOI:10.1002/mp.70373

ACS Biomater Sci Eng. 2026 Mar 8. doi: 10.1021/acsbiomaterials.6c00194. Online ahead of print.

ABSTRACT

Metastasis, leading to 90% of cancer-related deaths, is driven by invasive forces exerted by cancer cells on their microenvironment. While actin is central to force generation and motility, the effects of intracellular force-localization during invasion remain largely unexplored. We previously demonstrated, in a clinically relevant assay, invasive cancer cells indenting soft, elastic gels to cell-scale depths, and developed corresponding experimentally validated finite element models. Here, we applied those models to investigate how the force-application location, above (top) or below (bottom) the nucleus, affects invasion efficiency. Under low force-levels (≤100 nN), top-applied forces produce 35-42% deeper indentations than bottom-applied forces, with modest increases in intracellular stress, indicating potentially increased invasiveness. However, with top-applied forces, ∼10% less stress is transmitted to the gel, suggesting less effective microenvironmental mechanical interaction. In contrast, under higher forces (≥150 nN), bottom-applied forces become more effective, transmitting >15% more stress to the gel, with indentation depths becoming comparable between top- and bottom-applied configurations, and significantly (>250%) less nuclear stress generated, thereby supporting invasion. These trends are particularly evident when the cytoplasm is softer than the nucleus, as is typical of (invasive cancer) cells. Thus, top-applied forces may support shallow invasion into soft environments, whereas bottom-applied forces mimicking actin-rich, stiff, leading-edge protrusions, optimize deep, forceful invasion with reduced cell-integrity risk. We demonstrate that intracellular force-localization critically influences the mechanical trade-offs between invasion efficiency and cellular stability, potentially offering targets for antimetastatic strategies.

PMID:41795681 | DOI:10.1021/acsbiomaterials.6c00194

Alzheimers Dement. 2026 Mar;22(3):e71259. doi: 10.1002/alz.71259.

ABSTRACT

INTRODUCTION: Associations between television/computer use and dementia in socially inactive older adults remain unclear, and optimal limits are unknown.

METHODS: We followed 89,671 dementia-free, socially inactive adults aged ≥55 from UK Biobank for a mean of 12.2 years. Adjusted Cox models assessed associations with incident all-cause dementia and subtypes.

RESULTS: Computer use ≤2.4 h/day was associated with lower all-cause dementia risk (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.82-0.94), whereas higher use increased risk (HR 1.19, 95% CI 1.05-1.34); patterns were similar for Alzheimer’s and vascular dementia. Television viewing showed no association below 2.06 h/day but higher risk thereafter (HR 1.17; 95% CI 1.03-1.32), with a roughly linear increase for vascular dementia. Heavy computer use in apolipoprotein E (APOE) -ε4 homozygotes and higher television viewing in adults < 65 were more harmful.

DISCUSSION: In socially inactive older adults, moderate computer use may be protective, whereas higher computer use and television viewing are linked to increased dementia risk.

PMID:41795676 | DOI:10.1002/alz.71259

Alzheimers Dement. 2026 Mar;22(3):e71277. doi: 10.1002/alz.71277.

ABSTRACT

INTRODUCTION: We investigated whether Alzheimer’s disease and related dementias (ADRD) are more common among transfeminine (TF) adults than among demographically similar cisgender people enrolled in the same health system.

METHODS: We analyzed electronic health records of 856 TF adults aged 65+ and matched cisgender men (CM) and cisgender women (CW) and compared ADRD prevalence across groups by calculating enrollment-adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS: The aOR of ADRD among TF adults were 1.39 (95% CI: 0.99-1.97) relative to CM and 1.29 (95% CI: 0.92-1.82) relative to CW referents. For TF adults with evidence of receiving gender-affirming hormone therapy (GAHT) receipt, the associations were slightly stronger: 1.75 (1.13-2.69) and 1.70 (1.11-2.60). Results restricted to minoritized ethnoracial groups appeared smaller, but imprecise.

DISCUSSION: These findings suggest that ADRD diagnosis and management may represent a priority in the healthcare of older TF people, particularly those with a history of GAHT.

PMID:41795672 | DOI:10.1002/alz.71277