Nevin Manimala

Adv Ther. 2026 Feb 28. doi: 10.1007/s12325-026-03520-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Psoriasis is a chronic inflammatory disease often accompanied by musculoskeletal symptoms and psoriatic arthritis (PsA). Early identification of PsA remains challenging, underscoring the need for interdisciplinary care between dermatology and rheumatology. To evaluate the diagnostic and therapeutic impact of an interdisciplinary dermatology-rheumatology board (IDRB) for patients with psoriasis, we initiated a non-randomized, prospective bicentric study.

METHODS: A total of 182 patients with psoriasis were enrolled at baseline (V0), of whom 111 completed the 12-month follow-up (V2). Forty-seven (25.8%) patients participated in the IDRB, and 135 (74.2%) patients received standard dermatological care. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-A/D), pain, systemic inflammation, psoriatic arthritis (PsA) diagnosis, and systemic therapy courses were analyzed. Group differences and changes over time were assessed using non-parametric and parametric tests, and predictors of therapy modification were explored using univariate logistic regression.

RESULTS: Over 12 months, patients in the IDRB group showed statistically significant improvements in PASI, DLQI, and HADS-A (all p ≤ 0.05). Among participants without PsA at baseline and with complete PsA documentation at follow-up, new PsA diagnoses occurred more often in the IDRB cohort (31%) than in standard care (9.8%) (Fisher’s exact p = 0.0295; χ² p = 0.0360; OR = 4.14). In univariate analyses, higher baseline PASI, DLQI, and HADS-A values were each associated with subsequent therapy modification. Within the IDRB group, biologic treatments shifted over time toward IL-17- and IL-23-targeted agents, indicating a move toward more streamlined and targeted systemic therapy patterns compared with standard care.

CONCLUSION: An IDRB may contribute to more structured PsA assessment and to more informed therapeutic decisions in patients with psoriasis. Integrating objective clinical measures together with patient-reported burden appears crucial for guiding treatment modification and optimizing outcomes. Given the non-randomized, self-selected design, these findings should be interpreted as associations.

TRIAL REGISTRATION: DRKS-Deutsches Register Klinischer Studien listing: DRKS00037907.

PMID:41762372 | DOI:10.1007/s12325-026-03520-8

Lifetime Data Anal. 2026 Feb 28;32(2):17. doi: 10.1007/s10985-026-09695-0.

ABSTRACT

Current methodological research on randomized controlled trial design has predominantly focused on studies with a single primary endpoint. However, many trials in practice involve multiple competing target events. The optimal designs for survival trials with competing target events have not been systematically addressed in the statistical literature. This paper fills this significant gap by developing design methodologies for randomized discrete-time-to-event trials with competing endpoints. We derive the Fisher information matrix for the general discrete-time survival model (DTSM) by transforming the original discrete-time survival data into proper multinomial responses. By introducing a cost-based generalized [Formula: see text]-optimal design criterion, we identify various types of optimal designs for estimating the treatment effects. Under the assumption of a parametric competing risks model for the underlying survival process, we demonstrate that the optimal treatment allocation scheme is critically influenced by the parameter values within this model. Our methodology is applied to the redesign of the SANAD trial, which examines withdrawal times from anti-epileptic drugs, thereby highlighting the advantages of our optimal design strategies. A key finding is that assigning subjects equally to the different groups in a two-arm DTSM trial with competing risks is generally a favorable choice, unless the hazard rates over the duration of the trial in both groups are low.

PMID:41762364 | DOI:10.1007/s10985-026-09695-0

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12442-6. Online ahead of print.

NO ABSTRACT

PMID:41762263 | DOI:10.1007/s00330-026-12442-6

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12382-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prevalence of adrenal vein involvement in primary and metastatic adrenal lesions and to determine if morphological changes in tumor shape precede venous extension.

MATERIALS AND METHODS: This retrospective, single-center observational study evaluated 102 patients: 28 adrenal cortical carcinoma (ACC) patients, and 74 non-ACC cancer patients that presented adrenal metastasis (82 metastatic adrenal lesions). Two readers reviewed cross-sectional imaging to assess tumor size, laterality, venous invasion, and the presence of the “edge sign.” Surgical and histopathological confirmation was the reference standard for ACCs, while for metastases, sequential imaging or PET-CT results showing hypermetabolism were used in 70.7% of cases and histopathology in 29.3% of cases.

RESULTS: Of the 28 ACC patients, 82.1% were female, with balanced laterality. Metastases primarily originated from the lung (24.4%), colorectal (13.4%), and breast (12.2%) cancers and had a left-sided dominance (61.7%). Venous extension was present in 14.6% of metastases and 21.4% of ACCs, a non-significant difference (p = 0.40). The “edge sign” was more frequently observed in metastatic lesions than in ACCs, 26.8 × 17.8%, although this difference has not reached statistical significance (p = 0.34). In multivariate analysis, both mean size and the “edge sign” were independent predictors of adrenal and renal vein extension. Interobserver agreement was almost perfect for venous extension (κ = 0.9256) and substantial for the edge sign (κ = 0.7844).

CONCLUSION: Venous extension was less prevalent in metastatic adrenal lesions compared to ACCs. The edge sign may precede venous extension, especially in metastatic cases, indicating the nature of the lesion. These findings potentially may alter disease management, expediting the decision for surgery; however, prospective multicenter studies are needed to confirm their clinical impact.

KEY POINTS: Question What is the prevalence of venous extension in malignant adrenal lesions-whether primary or secondary-and how can early involvement be recognized on imaging? Finding Adrenal vein involvement occurred similarly in ACCs (21.4%) and metastases (14.6%). Early extension may be preceded by the adrenal edge sign in 25% of cases. Clinical relevance Adrenal vein involvement occurs in both primary and metastatic adrenal lesions, with a tendency to be more prevalent in adrenocortical carcinomas. The ‘edge sign’ may precede venous extension in malignant lesions, aiding both diagnosis and therapeutic planning.

PMID:41762262 | DOI:10.1007/s00330-026-12382-1

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12389-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The selection of ultrasound (US) plane for evaluating the taller-than-wide (TTW) shape remains controversial. This study aimed to determine whether the diagnostic value of TTW criteria differs when used alone or in combination with other US features, and to identify the optimal TTW criterion across four major Thyroid Imaging Reporting and Data Systems (TIRADS: Chinese (C)-TIRADS, American College of Radiology (ACR)-TIRADS, European (EU)-TIRADS and Korean (K)-TIRADS).

MATERIALS AND METHODS: Preoperative US images of thyroid nodules were reviewed retrospectively. Four TTW criteria were defined as follows: transverse plane only (T-only), longitudinal plane only (L-only), both planes (Dual-plane), and either one or both planes (Single- or dual-plane). Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI) for malignancy prediction and fine-needle aspiration (FNA) guidance.

RESULTS: Among 1125 nodules, 558 (49.6%) were benign and 567 (50.4%) were malignant. Using the TTW shape alone, Single- or dual-plane achieved the highest AUC for malignancy (0.813). Within TIRADS, Dual-plane demonstrated the highest AUCs in C-TIRADS (0.884) and EU-TIRADS (0.874) and improved reclassification, whereas in ACR-TIRADS and K-TIRADS, Dual-plane and Single- or dual-plane performed similarly and outperformed the T-only and L-only. For FNA guidance, the Dual-plane also showed improvements in C-TIRADS and ACR-TIRADS.

CONCLUSION: The optimal TTW US plane differs when applied alone versus when combined with other suspicious US features. Within the TIRADS, assessment of the TTW shape in both transverse and longitudinal planes achieves superior accuracy and contributes to improving malignancy diagnosis and FNA decision-making.

KEY POINTS: Question Which TTW criterion provides the best diagnostic performance for malignancy risk stratification and FNA guidance across the four major TIRADS? Findings Dual-plane TTW yielded the best performance in C-TIRADS and EU-TIRADS, and improved FNA guidance in C-TIRADS and ACR-TIRADS versus other TTW criteria. Clinical relevance The stricter criterion not only improves the malignancy diagnosis but also provides better guidance for biopsy, offering valuable evidence for refining future guideline recommendations and standardizing the evaluation of thyroid nodules.

PMID:41762261 | DOI:10.1007/s00330-026-12389-8

World J Urol. 2026 Feb 28;44(1):212. doi: 10.1007/s00345-026-06312-5.

ABSTRACT

PURPOSE: Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists.

METHODS: An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10-17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics.

RESULTS: Of 2,078 members, 222 (11%) responded, mostly aged 30-45 years. Retrograde urethrography (26%), uroflowmetry (90%), and cystourethroscopy (61%) were used for diagnosis, with academic urologists employing these more often (p < 0.05). Blind dilatation with metal bougies (47%) exceeded plastic dilators over guidewire (23%) or disposable catheters (26%). Material preference was unrelated to experience (p = 0.39), but non-metal methods were more common in academic centers (p = 0.04). For 1-2 cm primary bulbar strictures, 7% chose urethroplasty, while 72% preferred Direct Vision Internal Urethrotomy (DVIU) with dilatation. Academic urologists performed more urethroplasties (p = 0.01). In recurrent cases, 76.5% performed DVIU ≥ 4 times, and 79.3% recommended periodic post-DVIU dilatation.

CONCLUSIONS: Urologists’ approaches to urethral strictures often deviate from guidelines. Retrograde urethrography use is low, metal bougies dominate dilatation, and urethroplasty is underused, favoring repeated DVIU and dilatation. Academic urologists adhere more to guideline recommendations than non-academic peers.

PMID:41762243 | DOI:10.1007/s00345-026-06312-5

Diagnosis (Berl). 2026 Mar 2. doi: 10.1515/dx-2025-0152. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical prediction requires formalizing uncertainty into a statistical model. However, persistent confusion between prediction and inference, and between traditional (stepwise) and modern (penalized) development strategies, leads to unstable, poorly calibrated, and overfit models. A structured statistical framework is essential.

METHODS: This article is a structured, didactic tutorial that explains the core concepts of clinical prediction models. It covers the definition of a prediction model, the fundamental strategies for its construction, and the essential framework for its evaluation, illustrated through an applied example using real-world clinical data.

RESULTS: The tutorial illustrates model development using the GUSTO-I dataset (N = 40,830). Penalized methods (LASSO and Elastic Net) successfully identified clinical signals while eliminating engineered noise variables. The LASSO model (λ_1se) achieved excellent discrimination (AUC 0.818; 95 % CI: 0.803-0.832) and overall accuracy (Brier score 0.058). Calibration analysis revealed a slope of 1.28 and intercept of 0.63, identifying conservative bias and systematic risk underestimation inherent to λ_1se selection. Decision curve analysis confirmed significant clinical utility across relevant probability thresholds.

CONCLUSIONS: This guide equips clinicians with a rigorous methodological framework for the critical appraisal and interpretation of modern clinical prediction models.

PMID:41762231 | DOI:10.1515/dx-2025-0152

Scand J Gastroenterol. 2026 Feb 28:1-10. doi: 10.1080/00365521.2026.2636062. Online ahead of print.

ABSTRACT

BACKGROUND: Neurological and psychiatric morbidity has been associated with celiac disease but has been scarcely studied in dermatitis herpetiformis (DH), a cutaneous manifestation of celiac disease. Hence, this cohort study aimed to investigate neurological and psychiatric morbidity in patients with DH and celiac disease.

METHODS: The study comprised 368 DH patients and 1,072 celiac disease patients without DH and their 1,099 and 3,197 refences, matched 1:3 on age, sex, calendar period and place of residence. Their neurological and psychiatric morbidity was studied using the Care Register for Health Care and international classification of diseases codes. Hazard ratios (HR) were calculated using Cox proportional hazard model.

RESULTS: In DH the risk for any neurological disease was not statistically significantly increased (HR 1.27; 95% CI 0.94-1.71), but Alzheimer’s disease and extrapyramidal diseases were found to be more common in DH when compared with their references. In contrast, in celiac disease excess risks for any neurological disease (HR 1.31; 95% CI 1.09-1.56) and particularly for migraine and headaches were detected. The risk for any psychiatric disease was found to be decreased in DH (HR 0.65; 95% CI 0.47-0.90), as were the risks for anxiety and substance abuse. In celiac disease, increased risks for any psychiatric disease (HR 1.20; 95% CI 1.01-1.42), depression, and anxiety disorders were noted.

CONCLUSIONS: The neurological and psychiatric morbidity of patients with DH and celiac disease patients without DH seems to differ, but the reasons for this varying disease burden remain yet unidentified.

PMID:41761874 | DOI:10.1080/00365521.2026.2636062

J Intern Med. 2026 Feb 28. doi: 10.1111/joim.70079. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy and safety of extended interval (Q3-4W) enzyme replacement therapy (ERT) versus standard biweekly (Q2W) ERT in clinically stable type 1 Gaucher disease (GD) patients.

METHODS: We emulated a target trial with a sequential trial design, using data from the French Gaucher Disease Registry. Eligible patients were treated for ≥2 years biweekly without clinical events. Every 3 months, switchers to Q3-4W were matched to Q2W patients by age, sex, referral center follow-up, disease history (bone events, anemia, thrombocytopenia, splenectomy, and hepatosplenomegaly), and dose of ERT. The primary outcome was a composite of GD-related events (bone events, anemia, and thrombocytopenia). A 10% non-inferiority margin was prespecified. Secondary outcomes were biomarker changes and economic analyses.

RESULTS: Among 280 eligible GD patients, 63 switched to Q3-4W and were matched to a total of 215 Q2W patients, followed for an average of 6.3 years. No significant difference in the risk of clinical events was observed between groups (hazard ratio: 0.98 [95% confidence intervals (CI): 0.54-1.51]). During follow-up, absolute risk difference remained below the 10% non-inferiority threshold at all timepoints. Biomarkers remained stable or slightly decreased in the Q3-4W group. The dosing interval extension led to an average reduction of 55 infusions per patient, corresponding to approximately €450,000 saved per patient over 6 years.

CONCLUSION: In stable GD1 patients, extending ERT administration to every 3-4 weeks was non-inferior to the standard biweekly regimen, supporting personalized spacing strategies that may improve quality of life and reduce healthcare costs.

PMID:41761869 | DOI:10.1111/joim.70079

Eur Eat Disord Rev. 2026 Feb 28. doi: 10.1002/erv.70094. Online ahead of print.

ABSTRACT

OBJECTIVE: The early response effect, defined as a reliable symptomatic improvement during the initial phase of treatment, is the most robust predictor of recovery following eating disorder treatment. This study aimed to investigate which symptom domains mostly influence the early response effect.

METHODS: Data from N = 232 adult patients (90.8% females; mean age = 29.97, SD = 10.67) treated in an outpatient eating disorder psychotherapy service were randomly partitioned into training (N = 161) and test (N = 71) samples. A Bayesian network model was developed in the training sample, modelling early changes (sessions 1-4) and interactions among symptoms measured by the Eating Disorder Examination Questionnaire (EDE-Q). A variable selection approach was applied to include only the most important variables in the model (i.e., reliable predictors of recovery). The trained model was externally validated by applying it to predict post-treatment recovery status in the test sample. Prediction accuracy was evaluated using the AUC statistic.

RESULTS: The model identified a network of six interrelated eating disorder symptoms which were the most important predictors of recovery. The model was reliable in predicting recovery status and showed good generalisability to a test sample (training AUC = 0.81 vs. test AUC = 0.77). Early changes in six areas (ranked by importance) reliably predict recovery after therapy: [1] avoidance of body exposure; [2] feelings of ‘fatness’; [3] preoccupation with food, eating or calories; [4] fear of losing control over eating; [5] dissatisfaction with body shape; [6] dietary rules.

DISCUSSION: The identification of early response domains associated with eventual recovery could help to inform targeted interventions strategies for patients with eating disorders. Future replication is warranted in more diverse and larger samples, including the applicability of these findings to different diagnostic groups.

PMID:41761864 | DOI:10.1002/erv.70094