Nevin Manimala

Clin Breast Cancer. 2026 Mar 10;26(5):11-18. doi: 10.1016/j.clbc.2026.03.006. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative MRI is used for staging breast cancer and is considered particularly useful in invasive lobular carcinoma (ILC).

PURPOSE: The aim of this retrospective study was to compare diagnostic, operative and long-term outcomes in ILC patients who underwent preoperative breast MRI to those who did not.

MATERIAL AND METHODS: Between 2010 and 2012, 361 patients with postoperative diagnosis of ILC were enrolled in this study.

RESULTS: Preoperative MRI was performed for 245 (67.9%) women. MRI identified 21 additional cancers and resulted in 62 benign findings. Reoperation rate due to insufficient margins was lower in the MRI group 11 (8.8%) compared to no-MRI group 14 (21.9%), P = .014. Mastectomy rates were equal, 131 (53.5%) and 62 (53.4%), P = 1.000. No statistical difference was found in local recurrences; 2 (1.8%) versus 2 (3.8%), P = .596, nor in 10-year disease-free survival, 88.5% compared to 84.5%, P = .295. The 10-year overall survival was 79.0% and 74.5%, P = .351. Preoperative MRI did not decrease the risk of breast cancer recurrence nor increase survival in ILC patients. The reoperation rate was lower in the MRI-group, but the preoperative MRI had a large proportion of false positive findings.

CONCLUSION: Preoperative MRI did not affect long-term outcomes in ILC patients; however, recurrence rates were low in both groups. ILC patients may benefit from preoperative MRI, as the reoperation rate was lower.

PMID:41924820 | DOI:10.1016/j.clbc.2026.03.006

Epidemics. 2026 Mar 28;55:100902. doi: 10.1016/j.epidem.2026.100902. Online ahead of print.

ABSTRACT

Since the COVID-19 pandemic, many jurisdictions have adopted wastewater-based surveillance for various pathogens. Indeed, monitoring pathogen concentration in wastewater, usually measured in RNA or DNA copies per milliliter, can efficiently assess the prevalence of infections in entire communities. However, wastewater-based surveillance does not provide a directly interpretable and actionable metric for public health. Here, we propose a statistical framework that assesses the relationship between COVID-19 hospital admissions and SARS-CoV-2 concentrations in wastewater for several large urban centres in Canada between 2021 and 2024. We also use this analysis to categorize early into an infection wave the clinical severity of future SARS-CoV-2 epidemics.

PMID:41924781 | DOI:10.1016/j.epidem.2026.100902

Poult Sci. 2026 Mar 3;105(6):106734. doi: 10.1016/j.psj.2026.106734. Online ahead of print.

ABSTRACT

Causes of normal mortality in laying hens have received relatively little scientific attention, despite health, welfare, economic and environmental implications. Targeting control and preventative measures to currently relevant flock-specific mortality causes is essential for successful outcomes in commercial flocks. Monitoring of mortality causes is a prerequisite. However, diagnostic criteria are not consistently reported and terminology varied between previous studies. The objective of this study was to investigate associations between pathological findings in dead laying hens with an explorative approach applied to a previously obtained dataset on pathological findings in Danish laying hens from seven non-caged commercial flocks. This approach may provide new insights compared to descriptive analysis of predefined diagnoses. A dataset with pathological findings across 49 pathological variables in 1,648 laying hens was analyzed with multiple correspondence analysis to explore multidimensional associations between pathological findings in laying hens and how patterns in combinations of findings of individual hens may cluster as diagnoses or tentative causes of death. Unlike descriptive statistics, the multivariate approach enabled us to illustrate the complexity of pathological processes. The first four dimensions of the multiple correspondence analysis were retained, accounting for 20.2% of the variance. The results indicated clustering of hens suggesting diagnoses of similar expected chronicity and general etiology (infectious versus non-infectious). The most dominant clusters corresponded to the two most common causes of mortality diagnosed on the same hens and reported in previous studies: salpingitis-peritonitis and cannibalism. In addition, the results suggested at least two different clusters of hens that died due to cannibalism (acute or prolonged course with concurrent pathologies). These may point to relevant differences in etiology and pathogenesis that should be explored in future studies. We suggested recommendations for time-efficient field necropsies and preventative and control measures to target the most common causes of mortality in laying hens. The results may be used by farmers and their advisors to improve monitoring of health and welfare of laying hen flocks in non-cage housing systems.

PMID:41924760 | DOI:10.1016/j.psj.2026.106734

Front Med (Lausanne). 2026 Mar 17;13:1772299. doi: 10.3389/fmed.2026.1772299. eCollection 2026.

ABSTRACT

OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD), Acute Exacerbation of Asthma(AEA), and acute bronchitis (AB) are known as the common acute airway inflammatory illnesses. This study seeks to systematically assess the effective rate and safety of Qingke Pingchuan Granules (QKPC) in treating these three illnesses in order to give evidence-based recommendations for therapeutic practice.

METHODS: Web of Science, PubMed, Cochrane Library, Elsevier ScienceDirect, CNKI, Wanfang Data, and VIP databases were all thoroughly scoured between their creation and November 2025. Leveraging the Cochrane Risk of Bias tool, two reviewers independently sifted through the reports, retrieved study data, and assessed the methodological rigor. RevMan 5.4 and Stata 17.0 software were used for statistical analyses, and effect sizes were reported as RR or MD with 95% CIs. The Cochrane Q test and the I² statistic were used to evaluate heterogeneity.

RESULTS: 21 RCTs with 2087 individuals were incorporated into this study. The findings demonstrated that QKPC in conjunction with conventional treatment considerably improved clinical outcomes, including overall response rate, FEV₁%, and FVC, as compared to conventional Western medicine alone. Additionally, it decreased the inflammatory factor (CRP). QKPC significantly improved the CAT score, mMRC score, 6MWT distance, and PaO₂ for AECOPD-specific outcomes (all p < 0.05). It decreased serum IgE and increased PEF for AEA. It reduced the time it took for AB to resolve their cough, and also reduced TNF-α and IL-1β levels. The incidence of adverse events (mainly gastrointestinal reactions and skin rashes) did not differ significantly between the two groups (RR = 0.73, 95% CI [0.49, 1.09]), with no significant abnormalities in liver or kidney function observed. The results’ robustness was validated by sensitivity analysis, and publication bias adjustment had no effect on the importance of the main conclusions.

CONCLUSION: In patients with AECOPD, AEA, and AB, QKPC in conjunction with traditional Western medicine treatment can dramatically enhance clinical efficacy, lung function, and inflammatory status without raising the risk of adverse reactions. For these acute airway inflammatory illnesses, it is a safe and effective adjuvant therapy alternative that indicated to significantly improve symptoms, lung function, and quality of life in individuals with AECOPD.

SYSTEMATIC REVIEW REGISTRATION: Unique Identifier (CRD420251229191), (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251229191).

PMID:41924750 | PMC:PMC13036208 | DOI:10.3389/fmed.2026.1772299

Front Med (Lausanne). 2026 Mar 20;13:1761997. doi: 10.3389/fmed.2026.1761997. eCollection 2026.

ABSTRACT

BACKGROUND: Children’s minds are immature, making them more susceptible to severe anxiety when separated from their parents before surgery. Alleviating preoperative anxiety in children is essential for providing comfort-oriented healthcare. Remimazolam is a novel ultra-short-acting benzodiazepine. Existing studies have identified the effective dose for 50% of patients (ED₅₀) when administering intravenous remimazolam to alleviate preoperative anxiety in children. However, the 90% effective dose (ED₉₀) is clinically more meaningful. This study aims to determine the ED₉₀ of intravenous remimazolam in alleviating preoperative anxiety in pediatric patients aged 1-6 years.

METHODS: From April to August 2025, pediatric patients undergoing elective surgery under general anesthesia were enrolled and stratified into two age groups: a younger group (YG, aged 1 to <4 years) and an older group (OG, aged 4-6 years inclusive). We employed the biased coin design (BCD) to determine target doses, defining a positive response as effective relief of preoperative anxiety [Parent Separation Anxiety Scale (PSAS) score < 3]. The initial dose for the first patient was 0.2 mg/kg. For subsequent pediatric patients, the dose was adjusted by increasing or decreasing by 0.05 mg/kg based on sedation response of the previous case. Isotonic regression and bootstrapping methods were used to estimate the ED₉₀ and 90% confidence interval (CI), respectively.

RESULTS: Eighty children completed the study, 40 in YG group and 40 in OG group. Statistical analysis indicated that the ED₉₀ (90% CIs) values for remimazolam used for alleviating preoperative anxiety in pediatric patients were 0.20 mg/kg (0.17-0.24) in the YG group and 0.15 mg/kg (0.11-0.17) in the OG group. Given that the 83% CIs for the ED₉₀ showed no overlap between the YG group (0.18-0.24) and the OG group (0.12-0.17), the difference between the two groups is considered statistically significant.

CONCLUSION: The ED₉₀ of intravenous remimazolam for preoperative anxiolysis was 0.20 mg/kg in children aged 1 to <4 years and 0.15 mg/kg in those aged 4-6 years. Notably, older children require even lower weight-based doses.

CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn/bin/project/edit?pid=252632, identifier ChiCTR2500098747.

PMID:41924742 | PMC:PMC13036471 | DOI:10.3389/fmed.2026.1761997

Front Med (Lausanne). 2026 Mar 17;13:1752369. doi: 10.3389/fmed.2026.1752369. eCollection 2026.

ABSTRACT

OBJECTIVE: Clavicle hook plates are widely used for internal fixation of clavicle fractures, yet little biomechanical evidence exists to guide optimal plate contouring, screw selection, and screw-hole management. This study aimed to systematically evaluate the biomechanical effects of plate bending configuration, screw type, empty hole location, and invalid hole placement on clavicle hook plate fixation strength to optimize surgical strategies for clavicle fracture fixation.

METHODS: This was a controlled bench-top biomechanical study. A series of biomechanical tests were conducted using an electronic universal testing machine. Clavicle hook plates were fixed onto synthetic clavicle models under different experimental conditions: (1) plate bending (forward bend, no bend, reverse bend), (2) screw type (common screws vs. locked screws), (3) empty screw hole location (distal vs. proximal), and (4) invalid hole placement (under the plate vs. beyond the plate). Axial force was applied to the distal hook until fracture occurred, and the maximum fracture force was recorded. One-way ANOVA with post-hoc Bonferroni correction was used for statistical analysis (p < 0.01 considered significant).

RESULTS: Plate bending significantly influenced fixation strength, with the forward bend group exhibiting the highest fracture force (202.75 N), significantly greater than the no bend and reverse bend groups (p < 0.01). Common screws provided greater mechanical stability than locked screws, with significantly higher fracture force (204.08 N vs. 145.76 N, p < 0.0001). Distal empty screw holes significantly reduced fixation strength (135.38 N) compared to proximal empty holes (160.3 N, p < 0.0001). Invalid holes beyond the plate weakened structural integrity more than holes under the plate (144.75 N vs. 169.27 N, p < 0.0001).

CONCLUSION: The study demonstrates that forward bending of the plate, the use of common screws, and avoiding distal empty screw holes or invalid holes beyond the plate significantly improve fixation strength in clavicle hook plate fixation. These findings provide critical biomechanical insights to enhance surgical decision-making and reduce the risk of implant failure. Future research should focus on clinical validation, multi-axial loading analysis, and long-term fatigue testing to further refine fixation techniques for optimal patient outcomes.

PMID:41924735 | PMC:PMC13035774 | DOI:10.3389/fmed.2026.1752369

Front Med (Lausanne). 2026 Mar 17;13:1710087. doi: 10.3389/fmed.2026.1710087. eCollection 2026.

ABSTRACT

STUDY OBJECTIVE: The study aimed to explore the potential of routinely collected pre-procedural clinical and ultrasonographic parameters (age, classification, baseline fibroid volume, and baseline Doppler score) in predicting treatment response following transvaginal radiofrequency ablation (RFA). We employed a combined machine learning-based feature ranking and regression interpretability approach to provide a proof-of-concept for future data-driven predictive models.

DESIGN: This study was designed as a single-center retrospective case series.

SETTING: The study was conducted at a public hospital in Romania, where RFA was introduced as a minimally invasive alternative for uterine fibroid treatment.

PATIENTS: Twenty-two fibroids were treated in women aged 28-52 years (mean age 38), who were selected based on the presence of symptoms or documented fibroid growth.

INTERVENTIONS: Transvaginal ultrasound-guided radiofrequency ablation was performed using the VIVA RF system. Baseline and post-procedural measurements included fibroid size and volume, vascularity as measured by Doppler score, and anatomical classification according to FIGO criteria.

MEASUREMENTS AND MAIN RESULTS: Fibroid volume decreased from a mean of 60.82 cm³ to 28.3 cm³ (-54.0%), while the Doppler score decreased from 3.59 to 1.41 (-59.8%). An exploratory feature-based analysis using four pre-procedural variables (age, FIGO classification, baseline fibroid volume, and baseline Doppler score) was conducted as a proof-of-concept, highlighting the challenges of robust modeling in small cohorts. In the multivariable logistic regression analysis, no statistically significant association was observed between treatment outcome and patient age or FIGO classification.

CONCLUSION: This proof-of-concept study demonstrates the potential of using routinely collected pre-procedural data for predictive analytics in RFA of uterine fibroids. The successful outcomes observed in two submucosal fibroids (G0 and G1) suggest that RFA followed by hysteroscopic myomectomy may serve as a viable two-step fertility-preserving treatment approach. However, the small sample size and class imbalance highlight the critical need for larger, prospective, multicentric studies to develop clinically valid predictive models for minimally invasive fibroid treatment.

PMID:41924728 | PMC:PMC13036101 | DOI:10.3389/fmed.2026.1710087

Front Vet Sci. 2026 Mar 17;13:1807749. doi: 10.3389/fvets.2026.1807749. eCollection 2026.

ABSTRACT

INTRODUCTION: Respiratory diseases are a major health concern in intensive lamb production, leading to significant economic losses and compromised animal welfare. This study aimed to characterize the hematological and biochemical profiles of lambs affected by ovine respiratory complex according to disease severity assessed by clinical, ultrasonographic, and post-mortem scoring systems.

METHODS: 89 Lacaune lambs from a single farm were evaluated using a clinical respiratory score, lung ultrasound examination, and macroscopic post-mortem lung assessment, with severity classified into four categories, scores 0 to 3. Blood samples were collected for complete blood count and serum biochemistry analysis. Statistical comparisons were performed using one-way ANOVA and Tukey’s post hoc test.

RESULTS: Diseased lambs showed significant increases in WBC counts and NEU percentages, with concurrent lymphocytopenia and eosinophilia. RBC parameters varied with disease stage, showing anemia in moderate cases and compensatory increases in severe chronic cases. Biochemically affected lambs exhibited hypoglycemia, decreased ALP activity, hypoalbuminemia, hyperglobulinemia, and hypophosphatemia. Ultrasonographic scores demonstrated greater concordance with post-mortem findings and blood profile alterations compared to clinical scores.

DISCUSSION: These results indicate that combining lung ultrasound with hematological and biochemical analysis provide a more efficient evaluation of respiratory disease severity in lambs than a clinical evaluation.

PMID:41924725 | PMC:PMC13035490 | DOI:10.3389/fvets.2026.1807749

Front Health Serv. 2026 Mar 13;6:1774099. doi: 10.3389/frhs.2026.1774099. eCollection 2026.

ABSTRACT

INTRODUCTION: Obesity has emerged as a global public health epidemic with far-reaching health consequences. While metabolic bariatric surgery (MBS) is an established therapeutic modality for moderate-to-severe obesity and associated metabolic disorders, enabling rapid weight reduction and metabolic improvement, postoperative weight regain remains a critical barrier to sustaining long-term treatment efficacy. Indeed, the durability of surgical outcomes is heavily contingent upon patients’ ability to engage in sustained self-management behaviors.

AIMS: To characterize the patterns of self-management behavior among patients after metabolic bariatric surgery using latent profile analysis, and to examine the relationships among these latent profiles.

METHODS: A cross-sectional study was carried out at one general hospital. A total of 242 patients after metabolic bariatric surgery completed the socio-demographic questionnaire, Bariatric Surgery Self-Management Questionnaire, General Self-efficacy Scale, and International Physical Activity Questionnaire.

RESULTS: Three latent profiles were identified: high self-management behavior group (n = 28, 11.57%), moderate self-management behavior group (n = 156, 64.46%) and low self-management behavior group (n = 58, 23.97%). The ANOVA and chi-square tests demonstrated significant differences among three groups concerning age and educational level. Multinomial logistic regression analysis indicated that employment condition, smoking and drinking history significantly predicted self-management behavior.

CONCLUSIONS: The statistical analysis indicated that the majority of patients fall into the moderate self-management group. Further regression analysis demonstrated significant associations between self-management proficiency and both age and educational level. These findings highlight the need for tailored interventions targeting specific patient profiles.

PMID:41924715 | PMC:PMC13036972 | DOI:10.3389/frhs.2026.1774099

Front Psychiatry. 2026 Mar 17;17:1785988. doi: 10.3389/fpsyt.2026.1785988. eCollection 2026.

ABSTRACT

INTRODUCTION: The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) largely relies on clinical interviews and parent/teacher-report rating scales, which are vulnerable to subjective bias. Therefore, there is an increasing need for objective measures to complement existing assessment approaches. The aim of this study was to objectively quantify children’s body movement during a controlled, semi structured interaction, to examine differences between children with and without ADHD, and to evaluate the cross-sectional discriminative capacity of these movement-based features using machine learning methods.

METHODS: This study employed a cross-sectional, observational case-control design including 37 children diagnosed with ADHD and 29 typically developing children aged 7-11 years. Psychiatric diagnoses were established using the DSM-5-based K-SADS PL interview. Video recordings were obtained during a standardized 5-minute instructional interaction using a researcher-worn point-of-view (POV) camera. Body movement measures of the head, upper limbs, and lower limbs were extracted from the video recordings using MediaPipe Pose. Movement data were statistically compared between groups, followed by classification analyses using machine learning algorithms.

RESULTS: The global activity index was significantly higher in the ADHD group compared to the control group (p = 0.003). Regional analyses revealed significant group differences in shoulder, elbow, ankle, foot, and head movements. A significant positive correlation was found between the global activity index and parent-reported hyperactivity scores (r = 0.28, p = 0.025). In the machine learning analyses, the AdaBoost classifier demonstrated the highest performance, achieving an accuracy of 81.82% and a ROC-AUC value of 0.85.

DISCUSSION: This study demonstrates that video-based movement analyses obtained during controlled, semi-structured interactions may capture motor activity patterns associated with ADHD. The findings are expected to contribute to the development of digital behavioral markers that may complement existing clinical assessment approaches in the context of ADHD evaluation.

PMID:41924709 | PMC:PMC13035793 | DOI:10.3389/fpsyt.2026.1785988