Nevin Manimala

United European Gastroenterol J. 2026 Apr;14(3):e70199. doi: 10.1002/ueg2.70199.

ABSTRACT

INTRODUCTION: Resection of intraductal papillary mucinous neoplasm (IPMN) aims to prevent progression to invasive pancreatic cancer. However, the risks of pancreatic surgery and frequent findings of low-grade dysplasia (LGD) raise concerns about overtreatment. This EAHPBA-endorsed multinational study evaluated short- and long-term overall survival (OS) following preventive resection for IPMN (without pre-operative signs of cancer).

METHODS: Adult patients with resected IPMN showing LGD, high grade dysplasia (HGD) or T1-staged invasive carcinoma from 2008-2023 were identified from the OPTIMAL-IPMN database. Estimated OS rates at one, five and 10 years in patients undergoing preventive pancreatic resection were assessed using Kaplan-Meier analyses and predictors for mortality were evaluated using parametric survival regressions.

RESULTS: Among 2275 patients in the OPTIMAL-IPMN database, 1728 (77%) had undergone preventive pancreatic resection for IPMN. Of those were 61% resected without prior surveillance. Final pathology revealed LGD in 63%, HGD in 27% and T1a-c-staged invasive cancer in 10% (7.3% T1a-b, 2.8% T1c). Estimated 1-year OS rate was 97%. Estimated 5-year OS rates (landmark analysis at 1 year) for LGD, HGD, T1a-b, and T1c was 97%, 99%, 96% and 91% respectively. Independent predictors for long-term mortality included age ≥ 75 versus < 75 years (HR 1.97) and T1c versus LGD (HR 8.12).

CONCLUSION: This multinational study confirms excellent survival after preventive IPMN resection but reveals many upfront resections yielding LGD with unknown survival benefit. Future studies should aim to determine which patients can be followed safely with monitoring to avoid unnecessary immediate resection.

PMID:41874453 | DOI:10.1002/ueg2.70199

Int J Pharm Pract. 2026 Mar 24:riag004. doi: 10.1093/ijpp/riag004. Online ahead of print.

ABSTRACT

OBJECTIVES: The healthcare sector is evolving with a growing emphasis on remote services and patient-centred care. Medication Home Delivery (MHD) service has become essential in enhancing accessibility, allowing patients to receive medications at home. This study evaluates the perceptions, practices, challenges, and benefits of the MHD service among community pharmacists in the United Arab Emirates (UAE), providing insights for policy and practice improvements.

METHODS: A cross-sectional survey was conducted among 403 licensed community pharmacists in the UAE. Participants completed a self-administered questionnaire assessing their awareness, perceptions, and experiences with the MHD service. Data analysis included descriptive statistics and logistic regression to identify factors influencing service provision.

KEY FINDINGS: Among respondents, 83.6% offered the MHD service, primarily through online platforms. Main factors influencing service provision included participants’ age, employment status, pharmacy type, and location (P < .05). Pharmacists raised concerns about patient counseling quality, communication, and medication security, highlighting the need for training to improve regulatory adherence. Major challenges included staffing shortages (51.6%), increased workload (36.5%), and limited time for patient counseling (41.2%). Despite these barriers, most pharmacists recognized MHD’s benefits in enhancing pharmacy efficiency (87.2%) and patient convenience (51.3%), particularly for elderly and disabled individuals (86.9%). Those not offering the MHD service cited unclear policies (24.2%) and logistical constraints as primary barriers (24.2%).

CONCLUSIONS: This study underscores both the opportunities and operational challenges of the MHD service in the UAE community pharmacies. Optimizing the service requires policy refinements, improved logistical frameworks, and targeted training programs to enhance service delivery, regulatory compliance, and patient care outcomes.

PMID:41874442 | DOI:10.1093/ijpp/riag004

Mol Omics. 2026 Mar 24:aaiag014. doi: 10.1093/molecular-omics/aaiag014. Online ahead of print.

ABSTRACT

Metaproteomics is an effective tool for characterizing the functional profiles of microbial communities by directly measuring protein expression. However, prospective power analysis and sample-size estimation are often overlooked at the study design stage in metaproteomics, which can result in underpowered experiments and reduced ability to detect biologically meaningful effects. In this study, we present a practical, end-to-end workflow for conducting power analysis prior to data collection. We focus on three common experimental designs: between-group comparisons, parallelized perturbation experiments, and beta diversity analyses. To tailored these experimental designs, we consider three major statistical approaches for power estimation: parametric tests (e.g., t-test, ANOVA), non-parametric tests (e.g., Wilcoxon rank-sum, Kruskal-Wallis), and distance-based multivariate methods (e.g., PERMANOVA using Bray-Curtis). By presenting detailed case studies, we provide practical guidance on how to calculate effect sizes, generate simulated datasets, and estimate statistical power across varying sample sizes. We also supply corresponding visualizations for each scenario to support sample-size determination and power assessment. This framework is intended to help researchers optimize sample size, improve experimental efficiency, and reduce costs, thereby enabling more reliable and interpretable biological insights from metaproteomic studies.

PMID:41874428 | DOI:10.1093/molecular-omics/aaiag014

United European Gastroenterol J. 2026 Apr;14(3):e70204. doi: 10.1002/ueg2.70204.

ABSTRACT

BACKGROUND: The low fermentable oligo-, di-, monosaccharide and polyol (FODMAP) diet (LFD) effectively manages irritable bowel syndrome (IBS), but predictors of treatment response remain unknown.

OBJECTIVE: This study investigated whether psychological factors predict symptom improvement and quality of life (QoL) outcomes following a LFD intervention.

METHODS: Adults with Rome IV-defined IBS underwent a three-phase LFD over 6 months. Primary outcomes were IBS symptom severity and QoL. Validated questionnaires assessed depressive, gastrointestinal-specific anxiety (GSA), and somatic symptoms, illness perceptions, and treatment expectations. Latent class growth analysis (LCGA) and cross-lagged panel models (CLPM) were used to identify symptom trajectories and examine directional relationships between psychological factors and outcomes, respectively.

RESULTS: 112 participants (89% female, median age 30 ± 17 years) completed the study. LCGA identified distinct IBS symptom severity and QoL trajectories during the LFD. Higher baseline treatment credibility and expectancy predicted favourable symptom improvements but were unrelated to membership in the QoL trajectory. Elevated GSA, psychological distress (depression, anxiety, stress), and negative illness perceptions increased the likelihood of poorer outcomes. CLPM revealed that lower GSA and higher personal control preceded subsequent symptom reductions. Higher treatment expectancy predicted improved QoL and symptom outcomes over time, while QoL improvements reduced stress and GSA.

CONCLUSION: Lower baseline GSA anxiety and higher treatment expectations consistently predict better response to all phases of the LFD. These findings will help clinicians identify optimal candidates for dietary intervention versus alternative treatments.

PMID:41874426 | DOI:10.1002/ueg2.70204

J Spinal Cord Med. 2026 Mar 24:1-9. doi: 10.1080/10790268.2025.2598981. Online ahead of print.

ABSTRACT

BACKGROUND: Infiltrations of the spine can be used to treat nociceptive or neuropathic pain. There is little data in the literature on the use of spinal injections in patients with paraplegia.

OBJECTIVE: The aim of this study is to determine whether patients with spinal cord injury experienced improvement in pain and spasticity following spinal injection.

METHODS: 19 (9 female, 10 male) patients (5 patients AIS A, 5 patients AIS C, 9 patients AIS D), including 9 tetraplegic and 10 paraplegic patients, with 22 injection techniques and a follow-up of 4.2 months (1-12 months) were retrospectively examined in our spinal cord injury Center in 2022 and 2023. The pain intensity on the NRS (Numerical Rating Scale), the MAS (Modified Ashworth Scale) for the graduation of muscle tone and the Spinal Cord Independence Measurement (SCIM) were assessed before infiltration and as part of the follow-up examination.

RESULTS: Image intensifier-assisted facet and sacroiliac joint infiltrations were performed in 12 patients, CT-guided nerve root infiltrations and epidural injections in 10 patients with corresponding symptoms and image morphological correlate without complications. In all patients, a statistically significant reduction in pain on the NRS could be achieved (4.05 ± 1.84; p < 0.0001). A trend towards improvement was documented in the analysis of the MAS (0.14 ± 0.35; p = 0.08), whereas a significant improvement was statistically detected in the analysis of the SCIM (-15.59 ± 18.23; p = 0.0006).

CONCLUSION: Our study represents the first retrospective exploratory analysis (phase I-style feasibility study) after spinal injection in patients with spinal cord injury. The primary results in terms of pain intensity, muscle tone and independence are promising and, in our view, represent a further therapeutic approach in addition to pharmacological and non-pharmacological therapy options. However, further investigations are necessary for this.

PMID:41874322 | DOI:10.1080/10790268.2025.2598981

Radiology. 2026 Mar;318(3):e250864. doi: 10.1148/radiol.250864.

ABSTRACT

Background Real-time methods are needed for intraprocedural detection of residual tumors and incomplete thermal ablation (TA) to allow immediate retreatment and tumor eradication. Purpose To validate a TA workflow for detecting and immediately ablating residual viable colorectal liver metastases (CLMs). Materials and Methods This prospective single-center trial enrolled participants who underwent PET/CT-guided microwave CLM ablation from November 2019 to February 2023. The minimal ablation margin (MM) was calculated in all directions. Biopsies were obtained from the ablation zone (AZ) center and margin, with rapid tissue assessment for viable tumor (VT) cells using imprint cytology and fluorescent viability staining. Immediate reablation was performed if any of the following criteria were met: MM less than 5 mm at contrast-enhanced CT, residual PET-avid tumor, and/or VT cells at rapid tissue assessment. Gray-model statistics quantified the MM and VT impact on local tumor progression subdistribution hazard amid the competing risk of death. Results Seventy-seven participants (median age, 56 years [IQR, 47-64.5 years]; 39 male participants) underwent ablation in 104 CLMs. Overall, 15 of 104 (14%) CLMs underwent immediate reablation per the criteria (12 of 15, VT; seven of 15, MM <5 mm; and four of 15, residual fluorodeoxyglucose avidity). After reablation, all 12 initially VT-positive AZs underwent repeat biopsies with negative findings. Five of seven MMs less than 5 mm in AZs increased to greater than 5 mm after reablation. All four CLMs that underwent reablation due to PET/CT findings had AZs positive for VT, and one had MM less than 5 mm. MM greater than 5 mm protected against local tumor progression (LTP) (subdistribution hazard ratio, 0.12; 95% CI: 0.05, 0.30; P < .001). There was no LTP for MMs greater than 10 mm. The cumulative LTP incidence at 1, 2, and 3 years for participants with biopsy-proven completely ablated CLMs with MM greater than 5 mm was 7%, 12%, and 12%, respectively. Conclusion MM remained a critical technical factor affecting tumor control; the proposed multimodal comprehensive AZ assessment enabled immediate onsite reablation of 14% of CLMs with initially insufficient ablation treatment and improved local tumor control after thermal ablation. ClinicalTrials.gov identifier: NCT04143516 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.

PMID:41874299 | DOI:10.1148/radiol.250864

J Trauma Acute Care Surg. 2026 Apr 1;100(4):595-604. doi: 10.1097/TA.0000000000004883. Epub 2026 Jan 9.

ABSTRACT

INTRODUCTION: Equity is the “sixth domain” of health care quality but is not explicitly assessed by the American College of Surgeons Trauma Quality Improvement Program (TQIP). We sought to assess equitable outcomes within hospitals for populations that experience health disparities.

METHODS: Retrospective analysis of 2018-2020 TQIP data from Level 1/2 trauma centers (TCs). Following TQIP methodology, we applied multivariable logistic regression to calculate hospital-level risk-adjusted mortality and observed versus expected (O/E) in-hospital mortality ratios to identify low- (O/E, 95% confidence interval <1), average-, and high-mortality (O/E, 95% confidence interval >1) TCs. Using stratified analyses, we evaluated within-hospital equity by race (Black vs. Non-Hispanic White), ethnicity (Hispanic vs. Non-Hispanic White), and insurance (uninsured, Medicaid vs. commercial) by assessing concordance with advantaged reference group and presence of low-mortality gap (<5% difference).

RESULTS: We analyzed 892,583 patients at 384 TCs. A total of 192 hospitals (50%) were classified as “low-mortality” (median O/E, 0.85 [0.76-0.93]), 22 (5.7%) as average, and 170 (44.3%) as “high-mortality” (median O/E, 1.13 [1.06-1.22]). Low-mortality TCs treated a higher proportion of White patients (75% vs. 68%) and blunt injuries (95% vs. 93%), with higher Medicaid population (43% vs. 35%) relative to high-mortality hospitals. In stratified analyses among low-mortality TCs, only 4 (2.1%) of hospitals satisfied both equity criteria for their Black patients, 10 (5.2%) for Hispanic patients, 14 (7.3%) for Medicaid patients, and 6 (3.1%) for uninsured patients.

CONCLUSION: A minority of low-mortality TCs achieve equitable outcomes, with both minoritized and socioeconomically vulnerable populations affected. Such inequities are masked in quality improvement reports of total populations. Equity measures including stratified analyses should be incorporated into standard quality improvement reports to inform hospital-level initiatives and purposefully improve care for populations that experience health disparities.

LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.

PMID:41874287 | DOI:10.1097/TA.0000000000004883

Bone Jt Open. 2026 Mar 24;7(3):417-424. doi: 10.1302/2633-1462.73.BJO-2025-0420.R1.

ABSTRACT

AIMS: The ability of a surgeon to provide accurate visual estimates of intraoperative gaps during total knee arthroplasty (TKA) is not well understood. This study evaluated: 1) the accuracy of gap estimation in extension and in flexion; 2) the accuracy of gap estimation in the medial and lateral compartments, also in extension and flexion; 3) the differences in accuracy among surgeons; and 4) the frequency of clinically significant errors in gap estimation, defined as greater than 1 mm.

METHODS: A posterior stabilized TKA was performed on seven cadaveric knees. Five fellowship-trained arthroplasty surgeons and one orthopaedic resident manually stressed each knee, and visually assessed the medial and lateral gaps in full extension and 90° of flexion. Gaps were objectively measured via a motion capture system. Gap estimation error was calculated as the difference between the surgeons’ visual assessment and the measured gaps.

RESULTS: Across all surgeons and knees, the mean gap estimation error was -0.4 mm (SD 0.7), with the majority (72%) of gaps being underestimated. Errors were greater in extension (-0.7 mm (SD 0.8)) than in flexion (-0.2 mm (SD 1.0)) (p < 0.001). Lateral gap error was less in flexion (-0.1 mm (SD 1.0)) than extension (-0.7 mm (SD 0.8)). Gap estimation error pooled for all assessments differed between surgeons, ranging from a mean error of -0.8 mm (SD 0.8) to 0.2 mm (SD 1.2) (p < 0.001). Clinically significant gap estimation errors (> 1 mm) occurred in 33% of assessments in extension and 26% in flexion (p = 0.315, not statistically different). The frequency of such errors varied by surgeon ranging from 18% to 42% (p = 0.370).

CONCLUSION: Surgeons tend to underestimate intraoperative gaps during TKA, particularly in extension. Clinically meaningful gap estimation errors (> 1 mm) occurred in up to 33% (26/78) of exams, supporting the need to enhance gap assessment accuracy.

PMID:41873594 | DOI:10.1302/2633-1462.73.BJO-2025-0420.R1

Ecol Appl. 2026 Mar;36(2):e70188. doi: 10.1002/eap.70188.

ABSTRACT

Forest-savanna mosaics are important for biodiversity, but the savannas in these mosaics are often considered degraded forests due to low tree cover, and are thus targeted for tree planting. Yet, these mosaics may be naturally bistable systems, wherein disturbance regimes such as fire and herbivory create alternative stable states of forest and savanna. Globally, forest-savanna mosaics have been present from pre-historic times and map to regions with high biodiversity today. Here, we conduct a meta-analysis of paleo-ecological studies in Central India-a highly biodiverse forest-savanna mosaic landscape threatened by tree plantations today-to understand the spatiotemporal antiquity and dynamics of the mosaics across this region. We find that alternate states of low and high tree cover have been present in Central India since the early Holocene and that the tree cover is explained by the interaction of mean annual precipitation (MAP) and the disturbance regime of fire. We find no statistical evidence for bimodality or hysteresis-conditions that are required for alternative stable states-although patterns suggestive of alternative stable states are present. Further, in contradiction to the hypothesis of high and low tree cover states being stable, this system transitions between alternate states of high and low tree cover at time periods ranging from ~40 to 220 years. Switching back and forth between alternate states is significantly more frequent in sites with higher richness of fire-resistant tree taxa. Our historical data thus lend support to the idea that low tree cover regimes have been created or maintained through interactions between climatic conditions and disturbance regimes such as fire, and that tree cover can increase when either of these factors changes. The study further suggests that restoration should focus on maintaining the ability to switch between low and high tree cover rather than increasing tree cover in Central India.

PMID:41873563 | DOI:10.1002/eap.70188

Inquiry. 2026 Jan-Dec;63:469580261433444. doi: 10.1177/00469580261433444. Epub 2026 Mar 24.

ABSTRACT

To investigate the predictive value of the C-reactive protein-triglyceride-glucose index (CTI) for liver disease events in a community-based middle-aged and older population. Based on data from 5 waves of the China Health and Retirement Longitudinal Study (CHARLS) database, this study utilized data from the 2011 and 2015 waves, which included blood samples. A time-dependent Cox regression model was employed to analyze the association between CTI and the risk of liver disease events. Rigorous model testing, along with robustness and heterogeneity analyses, were conducted. A total of 733 incident liver disease events were documented during the follow-up period. After full adjustment for confounding factors, each 1-unit increment in CTI was significantly associated with a 21.0% increased risk of liver disease (Hazard Ratio [HR] = 1.210, 95% Confidence Interval [CI]: 1.109-1.321). In addition, each quartile increase in baseline CTI was associated with a statistically significant 12.2% elevated risk of incident liver disease. This association remained robust in sensitivity analyses after excluding events with potential reverse causality and replacing biomarkers. Subgroup analyses further identified consistent patterns of this association across different populations. This study is the first to demonstrate, within a nationally representative community-based cohort of middle-aged and older adults, that the CTI is an independent and robust predictor of incident liver disease. As a composite metabo-inflammatory marker, the CTI model exhibited slightly better model fit (lower AIC/BIC) and marginally higher discriminatory ability (C-index) than the single-marker models of TyG index and CRP alone. It can be utilized to identify high-risk individuals in middle-aged and older populations, providing a novel epidemiological tool for the early warning of liver disease.

PMID:41873551 | DOI:10.1177/00469580261433444