Nevin Manimala

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

Antonie Van Leeuwenhoek. 2026 Apr 7;119(5):90. doi: 10.1007/s10482-026-02297-8.

ABSTRACT

Airborne microbes from animal confinement facilities not only amplify the risk of disease spread among livestock but also pose substantial health threats to animals and farm workers. The objective of this study was to investigate the microbial counts in cattle sheds and their relationship with meteorological factors, including temperature, relative humidity, and air velocity, as well as microbial diversity. Sampling was carried out both indoors and outdoors of two cattle sheds throughout three seasons (summer, rainy, and winter), at fortnightly intervals. Results showed that bacterial and fungi counts ranged from 0.0 to 1.60 × 10³ CFU/m³ inside the sheds and from 0.0 to 1.08 × 10³ CFU/m³ outside, with significant variation between areas and seasons. The predominant microbial count was mesophilic bacteria followed by staphylococci, fungi and Enterobacteriaceae. The mesophilic bacteria, Enterobacteriaceae and fungi showed statistically significant positive correlation with air temperature while air velocity with Enterobacteriaceae bacteria. No significant correlation exists between relative humidity and microbial concentration. The bacterial families Staphylococcaceae and Bacillaceae from the mesophilic group of bacteria were identified as the most prevalent, whereas the dominant fungi taxa in the cattle sheds were Aspergillus spp. and Penicillium spp. The microbial environment within cattle sheds under loose housing systems was found to be well-regulated, with airborne bacteria and fungi levels remaining within recommended limits.

PMID:41945156 | DOI:10.1007/s10482-026-02297-8

Arch Gynecol Obstet. 2026 Apr 7;313(1):154. doi: 10.1007/s00404-025-08283-1.

ABSTRACT

PURPOSE: Recent studies have reported that embryos diagnosed as aneuploid by preimplantation genetic testing (PGT) can still result in successful live births after transfer. This suggests that, in addition to mosaic embryos, fully aneuploid embryos may also carry a risk of diagnostic error, potentially reducing the overall accuracy of PGT. Therefore, thoroughly investigating the risk and characteristics of aneuploidy misdiagnosis is crucial for optimizing PGT strategies and improving clinical outcomes in assisted reproductive technology (ART).

METHODS: Relevant studies published from January 2000 to December 2024 were identified through PubMed and Web of Science. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). A diagnostic meta-analysis was conducted using a random-effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs), combining sensitivity and specificity. Results were visualized using forest plots.

RESULTS: A total of 22 studies were included to assess the discordance between trophectoderm (TE) biopsy and inner cell mass (ICM) or whole blastocyst (WB) results. The discordance rate for euploid embryo diagnosis was low (2.6%), whereas it was significantly higher for aneuploid embryos (9.2%). Segmental aneuploidies showed the highest discordance rate (17.4%). In the PGT-A population, misdiagnosis of segmental aneuploid embryos was particularly prominent (OR = 10.04, 95% CI: 7.60-13.27, I² = 0%, P < 0.001).

CONCLUSION: The results indicate that embryos with segmental aneuploidies have a significantly higher risk of misdiagnosis, especially in the PGT-A population. This highlights the need for caution when interpreting trophectoderm (TE) biopsy results involving segmental aneuploidies, to avoid misdiagnosis and the inadvertent discard of potentially viable embryos.

PMID:41945151 | DOI:10.1007/s00404-025-08283-1

Abdom Radiol (NY). 2026 Apr 7. doi: 10.1007/s00261-026-05492-3. Online ahead of print.

ABSTRACT

OBJECTIVES: This study conducted a natural language processing feasibility analysis aimed at comparing four large language models (LLMs) in terms of (a) reproducibility and (b) predictive accuracy for International Society of Urological Pathology Grade Groups (ISUP GGs) based on structured text reports from prostate multiparametric magnetic resonance imaging (mpMRI).

METHODS: The study first used LLMs to perform the initial round of ISUP GGs predictions based solely on the mpMRI text reports. This was followed by a second round of predictions that incorporated clinical information. Each prediction round was repeated three times to assess consistency. Three radiologists independently completed the first two rounds of ISUP GG predictions and then performed a third round of assessment after reviewing the LLMs’ predictions. The study recorded the response times.

RESULTS: The study included 150 patients (median age, 69 years). Statistically significant differences were observed among different ISUP GGs in terms of age, PSA levels, prostate volume, PSA density, and PI-RADS scores. The four LLMs demonstrated good to excellent reproducibility (Kappa 0.671-0.861). ChatGPT-4.1 had the shortest response time (0.95-17.19 s). Furthermore, the study found that the accuracy of the LLMs (32.7-50.0%) was significantly lower than that of senior radiologist (72.7-76.0%) and intermediate-level radiologist (66.0-68.7%), but was comparable to that of junior radiologist (59.3-65.3%).

CONCLUSION: General-purpose LLMs demonstrate excellent reproducibility. While ChatGPT-4.1 outperforms other LLMs in ISUP GGs prediction and response time, its predictive accuracy remains inferior to that of intermediate and senior radiologists. Therefore, specific fine-tuning of this technology is necessary before general-purpose LLMs can be applied in clinical practice.

PMID:41945149 | DOI:10.1007/s00261-026-05492-3

Skeletal Radiol. 2026 Apr 7. doi: 10.1007/s00256-026-05217-z. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore regional and depth-dependent associations between subchondral bone metabolic activity and adjacent cartilage composition in individuals with mild-to-moderate hip osteoarthritis using simultaneous [¹⁸F]-sodium fluoride (NaF) positron emission tomography (PET) and quantitative magnetic resonance (MR) imaging.

METHODS: In this exploratory cross-sectional study, 14 participants (28 hips) underwent [¹⁸F]-NaF PET/MR imaging. Subchondral bone metabolic activity was quantified using standardized uptake values (SUV); cartilage composition was assessed using T_1ρ and T₂ relaxation times. PET/MR images were registered to a reference space allowing regional cartilage and adjacent bone analysis across subregions and depths (4-16 mm from the articular surface). Linear mixed-effects models adjusted for age were used to explore regional differences and cartilage-bone relationships with false discovery rate (FDR) correction.

RESULTS: Higher T_1ρ and T₂ relaxation times were observed in the overall femoral cartilage compared with the acetabular cartilage, whereas higher SUV was observed in the acetabulum than in the femur. Within the femur, elevated SUV was observed in the femoral neck. No cartilage-bone relationships remained statistically significant after FDR correction. Exploratory analyses without the FDR correction suggested positive and negative regression coefficients between cartilage relaxation times and adjacent femoral bone SUV in the posterior and anterior femoral head regions. The magnitude and direction of these coefficients were consistent across increasing bone depths.

CONCLUSIONS: This preliminary study presents an exploratory framework for assessing region and depth-specific interactions between subchondral bone metabolic activity and cartilage composition in the hip. The observed patterns are hypothesis-generating and warrant confirmation in larger, longitudinal studies.

PMID:41945142 | DOI:10.1007/s00256-026-05217-z

Clin Res Cardiol. 2026 Apr 7. doi: 10.1007/s00392-026-02907-5. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate radiation exposure during pediatric cardiac catheterization over a 10-year period at a central European tertiary center and to establish contemporary, procedure-specific dose benchmarks and conversion factors for estimating effective dose (ED).

METHODS: All cardiac catheterization procedures in patients < 18 years performed between 2015 and 2024 were retrospectively reviewed. For procedures with multiple components, cumulative dose area product (DAP) was proportionally allocated using weight-adjusted (DAP/BW) median values from single-intervention cases. ED was estimated in silico in randomly selected examinations using Monte Carlo simulation. Dose conversion factors between DAP and ED were derived. Additionally, a structured review of the literature on recently published data on radiation doses was performed.

RESULTS: A total of 3683 procedures in 2494 patients (median age 3.8 years) were included. Body weight showed a stronger association with DAP than age. Median DAP/BW was 11.7 cGy·cm²/kg for diagnostic and 9.7 cGy·cm²/kg for interventional procedures. For most procedure types, DAP/BW was substantially lower than previously published benchmarks. Simulated conversion factors declined logarithmically with increasing body weight and differed only slightly between posterior-anterior and lateral projections. Only 0.9% of patients exceeded a cumulative ED of 30 mSv.

CONCLUSION: Radiation exposure in contemporary pediatric cardiac catheterization is markedly lower than in earlier reports, with procedure complexity being the primary determinant of effective dose.

PMID:41945132 | DOI:10.1007/s00392-026-02907-5

Surg Today. 2026 Apr 7. doi: 10.1007/s00595-026-03291-3. Online ahead of print.

NO ABSTRACT

PMID:41945103 | DOI:10.1007/s00595-026-03291-3

CPT Pharmacometrics Syst Pharmacol. 2026 Apr;15(4):e70232. doi: 10.1002/psp4.70232.

ABSTRACT

This work aimed to assess the correctness of covariate clinical relevance (CCR) assessment using SCM+, FFEM, and FREM within a high-dimensional covariate framework with varying effect sizes and correlations. A clinical trial simulation inspired by the dupilumab case study was conducted (200 datasets of 300 patients each), using a 2-compartment PK model with 12 covariates having small, medium, or high effect size. Covariate analysis was based on a 70 covariate-parameter relationships predefined set including 12 continuous and 7 binary covariates sampled from the NHANES database, spanning high to low correlations. The simulated reference model (RM) was fitted for comparison. Parameter estimation was performed in NONMEM/PsN using FOCEi (SCM+, FFEM) or IMPMAP (FREM), with SE derived from the S matrix. CCR assessment followed a forest plot-inspired approach: 90% confidence intervals with a [0.8-1.25] reference area for clinical relevance; 5% type I error for statistical significance. Parameter estimates and SE were always obtained, allowing full CCR evaluation. For covariates with simulated effects, all methods were consistent with RM. SCM+ missed up to 9% of small-effect covariates, whereas FFEM/FREM more often indicated insufficient information to conclude across all effect sizes. For covariates without any effect, SCM+ mostly did not select them, while FFEM/FREM was more informative by classifying them as non-relevant or with insufficient information. As non-selection may reflect a lack of power rather than no effect, robust CCR assessment should begin with FFEM/FREM for a comprehensive exploration, followed by SCM+ to build a parsimonious predictive model.

PMID:41944131 | DOI:10.1002/psp4.70232

Microrna. 2026 Apr 6. doi: 10.2174/0122115366434903260330072807. Online ahead of print.

ABSTRACT

BACKGROUND: About 80-90% of all oral cancers worldwide are Oral Squamous Cell Carcinomas (OSCCs), making them the most common type of oral malignancy. Due to its propensity for lymph node metastasis, lack of accurate prognostic indicators, and delayed diagnosis, OSCC remains linked to high morbidity and mortality despite advancements in surgical and therapeutic approaches. A mucin-type transmembrane glycoprotein, Podoplanin (PDPN), is well known as a lymphatic endothelial marker and plays roles in metastasis, Epithelial-Mesenchymal Transition (EMT), and tumor progression and growth. The goal of the current study was to determine whether podoplanin’s immunohistochemistry expression in OSCC and its association with other clinicopathological parameters could serve as a biomarker for the course and outcome of the disease.

METHODS: This observational study was conducted over one year in the Department of Pathology in collaboration with the Department of Surgical Oncology, King George’s Medical University, Lucknow. A total of 110 histopathologically confirmed, treatment-naïve cases of OSCC were included. Detailed clinical and demographic data were collected. Tumour specimens were processed and evaluated as per the College of American Pathologists (CAP) guidelines. Immunohistochemistry was performed using anti-podoplanin (D2-40 clone) monoclonal antibody. The expression of podoplanin was assessed semi-quantitatively using the German Immunoreactive Score (IRS), which combines staining intensity and percentage of positive tumour cells.

RESULTS: The age of patients ranged from 23 to 75 years, with a mean of 45.3 years; the predominant age group was 31-40 years (35.5%). Males constituted 83.6% of the study population, and 89.1% had a history of tobacco, smoking, or alcohol use. The most commonly affected sites were the buccal mucosa (33.6%) and anterior tongue (30.9%). Most tumours were larger than 2.5 cm (58.2%) and exhibited a depth of invasion exceeding 10 mm (54.5%). Advanced pathological stage (Stage III-IV) was observed in 79.1% of cases, and 64.5% had nodal metastasis. Welldifferentiated tumours were most common (48.2%). Podoplanin expression ranged from weak (IRS 0-6) in 35.5% to strong (IRS &gt;6) in 64.5%. Strong podoplanin expression correlated positively with larger tumour size, moderate to well-differentiated tumours, and nodal metastasis (N1-N3), although no significant association was found with early vs. late pathological stage. Interestingly, T4-stage and poorly differentiated tumours showed a tendency toward weak expression.

DISCUSSION: The study confirms that strong podoplanin expression correlates with parameters indicative of tumour aggressiveness, including size, differentiation, and nodal involvement. These findings align with several prior studies, though the lack of significant association with pathological stage or overall survival underscores the complexity of podoplanin’s role in tumour biology. The expression pattern-predominantly peripheral and membranous-suggests podoplanin may be involved in tumour invasion fronts and early carcinogenic events.

CONCLUSION: The study findings suggest that podoplanin overexpression is significantly associated with tumour size, differentiation, and lymph node metastasis in OSCC, indicating its potential utility as a prognostic biomarker. Although the survival analysis did not demonstrate a statistically significant correlation with podoplanin expression, the trend toward higher mortality in patients with strong expression warrants further exploration. This study adds to the growing body of evidence supporting podoplanin’s role in tumour progression and highlights its promise as a diagnostic and prognostic adjunct in oral cancer. Multicentric studies with larger cohorts and long-term follow-up are recommended to validate these observations.

PMID:41944122 | DOI:10.2174/0122115366434903260330072807

Popul Health Manag. 2026 Apr 7:19427891261437477. doi: 10.1177/19427891261437477. Online ahead of print.

ABSTRACT

In 2015, the Centers for Medicare and Medicaid Services started reimbursing chronic care management (CCM) services for patients with multiple chronic conditions. This study used 2015-2020 Medicare claims data from Illinois, Iowa, Minnesota, and Wisconsin and conducted a retrospective cohort study of 885,132 beneficiaries with an evaluation and management visit, following a diabetes diagnosis with other co-occurring chronic conditions. A competing-risk model was estimated to analyze factors associated with patients’ receipt of their first CCM services and a Cox proportional hazard model was estimated to assess the risk of death post-CCM initiation. Diabetic patients with multiple chronic conditions had mean age of 70 years (SD = 10.3), 50.7% were female, and 81.3% were white. 1.0% (9,075 beneficiaries) had CCM claims. Excluding chronic conditions, variables associated with a higher likelihood of CCM initiation included age (sub-distribution hazard ratios [SHR] = 1.003 for each additional year, 95% CI:1.00-1.01), female (SHR = 1.10, 95%CI:1.05-1.15), Black (SHR = 1.27, 95% CI:1.19-1.36) or Hispanic (SHR = 1.40, 95% CI:1.23-1.58), receiving care at home (SHR = 5.00, 95% CI:4.55-5.51) or skilled nursing facilities (SHR = 1.60, 95% CI:1.48-1.73), being a non-Iowa resident, and getting a diabetes diagnosis post-2015. However, patients in non-urban areas were less likely to receive such services. No statistical difference was found in the likelihood of mortality with CCM initiation vs. non-CCM. After accounting for CCM initiation, variables associated with a higher likelihood of death included age, American Indian/Alaska Native, residing in non-urban areas, getting a diabetes diagnosis in 2020, and receiving care in non-outpatient settings. CCM remains largely underutilized among Medicare beneficiaries. Addressing barriers, including improving access in non-urban areas and managing chronic condition earlier, may enhance adoption and decrease the risk of death for patients with multimorbidity.

PMID:41944097 | DOI:10.1177/19427891261437477