Nevin Manimala

Eur J Health Econ. 2026 Aug 3. doi: 10.1007/s10198-026-01979-4. Online ahead of print.

ABSTRACT

PURPOSE: Maintaining or improving the health-related quality of life (QoL) of lung cancer patients is essential throughout treatment. To support shared decision-making and improve patient-physician communication, patients’ preferences should be understood and considered in clinical decision-making; however, existing research indicates notable discrepancies between patient and physician priorities. This study therefore aims to elicit and compare their preferences regarding QoL dimensions in lung cancer care in Germany.

METHODS: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit the preferences of patients and treating physicians. In the DCE scenarios, both groups chose between alternative QoL profiles reflecting different health states during lung cancer treatment. Data were analyzed using multinomial logit models.

RESULTS: The final DCEs comprised five common attributes – activities of daily living, shortness of breath, anxiety, social life, and emotional impairment – and one group-specific attribute: financial difficulties in the patient DCE and severity of pain in the physician DCE. Overall, 162 patients (mean age: 60.39 years, SD 10.05) and 154 referring physicians (mean age: 51.26 years, SD 11.28) participated. All model coefficients were statistically significant (p < 0.001). Patients prioritized “Shortness of breath” (28.0%; level range of 1.417) and “Activities of daily living” (23.8%; level range of 1.207), while “Emotional impairment” (6.4%; level range of 0.323) ranked lowest. In contrast, treating physicians emphasized ”Shortness of breath” (26.0%; level range of 1.114) and “Severity of pain” (22.5%; level range of 0.962); again, “Emotional impairment” ranked lowest (4.8%; level range of 0.207).

CONCLUSIONS: Overall, patients and treating physicians showed broad agreement regarding the importance of several central QoL dimensions, particularly shortness of breath and activities of daily living. At the same time, differences in the weighting of selected attributes suggest that individual QoL priorities should be addressed explicitly in patient-physician communication.

PMID:42545648 | DOI:10.1007/s10198-026-01979-4

Lifetime Data Anal. 2026 Aug 3;32(3):46. doi: 10.1007/s10985-026-09725-x.

ABSTRACT

Dynamic prediction of future clinical outcomes based on longitudinally measured predictors plays a crucial role in disease management and patient counseling, particularly when conventional static models are inadequate. Joint modeling of longitudinal and time-to-event data provides a useful framework for addressing this challenge. In this paper, we present a comprehensive development of the recently proposed backward joint model (BJM; Shen and Li, 2021), which factorizes the likelihood into the distribution of time-to-event data and the conditional distribution of longitudinal data given the event time. This structure facilitates computation and is well-suited for multivariate longitudinal data. We introduce several novel developments to the BJM, including the extrapolation and two-part specifications, as well as the incorporation of competing risks. We also address an important yet underexplored problem in the literature: predicting future longitudinal trajectories conditional on predicted event times. Additionally, we explore the connection between BJM and existing joint modeling approaches. All these extensions preserve the computational advantages of the basic BJM formulation, including one-dimensional numerical integration, convex optimization via the EM algorithm, and a quick procedure for consistent estimation using standard software. We evaluate the method’s performance through simulation studies and illustrate its utility in a chronic kidney disease application.

PMID:42545639 | DOI:10.1007/s10985-026-09725-x

J Autism Dev Disord. 2026 Aug 3. doi: 10.1007/s10803-026-07469-z. Online ahead of print.

ABSTRACT

PURPOSE: Children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) may be especially sensitive to early screen exposure due to sensory and emotional vulnerabilities. This study examined whether early screen time differentially affects behavioral trajectories in ASD, ADHD, and neurotypical children.

METHODS: Using data from the Longitudinal Study of Australian Children, linear mixed-effects models assessed outcomes. Screen time before age 2 was categorized as ≥ 14 vs. <14 h/week. Hyperactivity and emotional problems were measured at ages 4, 6, and 8, with ASD and ADHD diagnoses tested as moderators.

RESULTS: ASD was linked to higher baseline hyperactivity and emotional problems and steeper increases in both outcomes over time. ADHD was associated with higher baseline hyperactivity and steeper symptom growth in hyperactivity and emotional problems over time. Greater early screen time was associated with steeper increases in emotional problems scores across all subgroups. However, no significant interaction between screen time, age, and diagnosis was found, indicating that screen exposure did not disproportionately worsen trajectories in ASD or ADHD compared to neurotypical peers.

CONCLUSION: Early screen exposure is associated with a statistically significant but small increase in emotional problem scores but does not uniquely amplify risks in ASD or ADHD. While both conditions independently show steeper behavioral symptom growth, these patterns are not exacerbated by screen time. Findings support universal, rather than disorder-specific, screen time guidelines.

PMID:42545633 | DOI:10.1007/s10803-026-07469-z

Clin Transl Oncol. 2026 Aug 3. doi: 10.1007/s12094-026-04530-2. Online ahead of print.

ABSTRACT

CONTEXT: Delirium is a frequent neuropsychiatric syndrome in patients with advanced cancer, particularly in acute palliative care settings, where its prevalence, reversibility, and prognostic implications remain incompletely characterized.

OBJECTIVES: To determine the prevalence of delirium in acute palliative care units (PCUs), identify associated clinical factors, evaluate reversibility, and assess its impact on overall survival (OS) in patients with advanced cancer.

METHODS: A prospective, longitudinal, observational study was conducted in acute PCUs at two tertiary hospitals. Adult patients with advanced cancer were assessed at admission and every 5 ± 2 days. Delirium was diagnosed according to DSM-5 criteria using the Memorial Delirium Assessment Scale (MDAS; cutoff ≥ 7). Univariate analyses were performed to explore associations with clinical variables. Overall survival was analyzed using Kaplan-Meier methods and Cox regression.

RESULTS: Among 355 eligible admissions, delirium occurred in 28% of patients, with 82% identified at admission. The hypoactive subtype was predominant, and reversibility was observed in 16%. Advanced age and poor functional status were significant predisposing factors, while infection, insomnia, fever, dehydration, immobility, and hypoglycemia were associated conditions. Median OS was significantly shorter in patients with delirium (24.5 95%CI 15-43 vs. 52 days, 95%CI 47-63). In unadjusted analyses, delirium was associated with increased mortality (HR = 1.51; 95%CI 1.19-1.92; p < 0.001). However, this association did not remain statistically significant after multivariable adjustment (adjusted HR = 1.28; 95%CI 0.98-1.66; p = 0.068).

CONCLUSIONS: Delirium affected one in four patients admitted to acute PCUs, showed limited reversibility, and was associated with reduced survival. These findings highlight delirium as a frequent and clinically meaningful syndrome and underscore the importance of systematic screening and early, proactive management in acute palliative care.

PMID:42545626 | DOI:10.1007/s12094-026-04530-2

Clin Transl Oncol. 2026 Aug 3. doi: 10.1007/s12094-026-04522-2. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate whether principal component analysis (PCA) of rectal and bladder dose-volume histograms (DVHs) identifies dose regions associated with late toxicity after prostate stereotactic body radiotherapy (SBRT).

METHODS/PATIENTS: This retrospective single-institution study included 106 patients with linked clinical and dosimetric data after prostate SBRT to 36.25 Gy in five fractions. PCA was applied separately to whole-organ and wall-based rectal and bladder DVHs. Associations with late grade ≥ 2 gastrointestinal (GI) and genitourinary (GU) toxicity at 12 months were explored using Spearman correlation, ROC analysis and deliberately limited logistic regression. Toxicity was extracted retrospectively from institutional follow-up records scored according to CTCAE v5.0.

RESULTS: Among 84 patients with 12-month follow-up in the DVH-linked dosimetric cohort, grade ≥ 2 toxicity was uncommon, with 3 GI events (3.6%) and 2 GU events (2.4%). Intermediate-dose rectal metrics showed the strongest exploratory signal for late GI toxicity, particularly rectal V18.1 Gy (AUC 0.868, 95% CI 0.740-0.997) and V29 Gy (AUC 0.827). These estimates are based on very few events and should not be interpreted as validated predictive performance or as evidence of a new planning threshold. No bladder or bladder-wall metric showed clinically meaningful discrimination for GU toxicity.

CONCLUSIONS: Intermediate whole-rectum dose was associated with late GI toxicity in this low-event SBRT cohort, but the findings are exploratory and require validation. No isolated dosimetric predictor of late GU toxicity was identified.

PMID:42545625 | DOI:10.1007/s12094-026-04522-2

Acta Neurol Belg. 2026 Aug 3. doi: 10.1007/s13760-026-03155-0. Online ahead of print.

ABSTRACT

OBJECTIVE: The glymphatic system is vital for metabolic waste clearance, and its impairment has been implicated in various neurological disorders. We investigated the relationship between structural perivascular space (PVS) burden and the DTI-ALPS index (A non-invasive proxy reflecting perivascular diffusion characteristics) in healthy young adults, to evaluate their utility as complementary markers of subclinical perivascular alterations.

METHODS: Twenty-four healthy volunteers (mean age: 32.3 ± 6.2 years) underwent 3T MRI including 64-direction diffusion tensor imaging. The DTI-ALPS index was calculated via an automated ROI method with visual quality control. Participants with Pittsburgh Sleep Quality Index (PSQI) > 5 were excluded. PVS burden (count and score) was assessed in the basal ganglia and centrum semiovale according to STRIVE criteria. Inter-rater agreement between two blinded neuroradiologists was assessed using Cohen’s weighted kappa (κw). Group differences based on enlarged PVS (EPVS > 3 mm) were analyzed using Mann-Whitney U tests with effect size calculations.

RESULTS: Strong negative correlations were found between the DTI-ALPS index and total PVS score (ρ = -0.869) and total PVS count (ρ = -0.888) (p < 0.001). Participants with EPVS (n = 11) exhibited significantly lower DTI-ALPS indices (p < 0.001; rank-biserial correlation = 0.972). Regression analysis revealed PVS load independently explained 76.3% of DTI-ALPS variance (R² = 0.763) after controlling for age. Post-hoc power analysis confirmed adequate statistical power for all primary analyses (1 – β > 0.99) despite the modest sample size, owing to the large observed effect sizes.

CONCLUSION: In healthy young adults, increased PVS burden and the presence of EPVS are strongly associated with reduced DTI-ALPS index values. This robust structure-diffusion coupling may hypothetically reflect subclinical alterations in glymphatic clearance capacity, though causal functional interpretation requires direct validation. PVS analysis may serve as a complementary, non-invasive radiological marker for monitoring perivascular integrity at its subclinical stages.

PMID:42545619 | DOI:10.1007/s13760-026-03155-0

Probiotics Antimicrob Proteins. 2026 Aug 3. doi: 10.1007/s12602-026-11161-0. Online ahead of print.

ABSTRACT

This study evaluated the in vitro antiviral-associated effects of prebiotics, probiotic-derived preparations, and synbiotic formulations against Herpes simplex virus type 1 (HSV-1) and vesicular stomatitis virus (VSV) in Vero cells. Lactobacillus acidophilus, L. rhamnosus, and L. plantarum preparations were tested as cell-free supernatants, cell sonicates, and combinations with plant-derived prebiotic extracts. Cytotoxicity was assessed using the MTT assay to determine non-cytotoxic concentrations, while antiviral activity was evaluated by cytopathic effect (CPE)-based TCID50 endpoint titration. Several preparations produced statistically significant reductions in viral infectivity compared with untreated controls (p < 0.05). Among the tested preparations, L. plantarum and L. acidophilus showed the greatest reductions in infectivity, with reductions reaching approximately 41.66% for HSV-1 and 38.88% for VSV under the tested experimental conditions. Selected synbiotic formulations also demonstrated measurable reductions in infectivity. These findings suggest that probiotic-derived preparations and synbiotic formulations may reduce infectivity of both DNA and RNA viral models in vitro and warrant further investigation as adjunct antiviral strategies.

PMID:42545606 | DOI:10.1007/s12602-026-11161-0

BioDrugs. 2026 Aug 3. doi: 10.1007/s40259-026-00801-0. Online ahead of print.

ABSTRACT

BACKGROUND: Continuous biologic therapy achieves psoriasis control but may be limited by cost, adherence burden, safety concerns, and patient preference. Evidence on outcomes after early, patient-driven discontinuation of secukinumab in routine practice is limited.

OBJECTIVE: The aim of this study was to describe clinical outcomes after voluntary secukinumab discontinuation among patients achieving predefined week-12 response targets and to explore factors associated with relapse.

METHODS: This prospective single-center cohort enrolled 172 adults with moderate-to-severe plaque psoriasis initiating secukinumab during 2022-2024. At week 12, patients achieving target response achievement 1 (TRA1: Psoriasis Area and Severity Index [PASI]75, Physician’s Global Assessment [PGA] 0/1, or body surface area [BSA] <3%) or nested TRA2 (PASI90, PGA 0/1, or BSA <1%) could discontinue secukinumab under supervision and continue topical therapy. Relapse was defined as loss of PASI75 at weeks 24 or 48.

RESULTS: By week 12, 82.6% of patients achieved TRA1 and 66.9% achieved TRA2. Relapse at week 24 and week 48 occurred in 35.9% (51/142) and 45.1% (55/122) of TRA1 patients and in 28.7% (33/115) and 36.7% (36/98) of TRA2 patients, respectively. Week-4 PASI75 responders had lower week-48 relapse rates than non-early responders in TRA1 (29.0 vs 50.5%) and TRA2 (27.6 vs 40.6%). Early response was associated with lower relapse odds in TRA1 at week 48 (adjusted OR 0.33; 95% CI 0.12-0.87). Higher BMI was associated with greater relapse risk, whereas smoking and comorbidities were not independently associated with relapse.

CONCLUSIONS: In selected patients achieving week-12 response targets and voluntarily discontinuing secukinumab, early response and BMI showed exploratory associations with relapse risk. These findings require validation before informing routine discontinuation decisions.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200066894).

PMID:42545602 | DOI:10.1007/s40259-026-00801-0

J Robot Surg. 2026 Aug 3;20(1):786. doi: 10.1007/s11701-026-03764-0.

ABSTRACT

BACKGROUND: Telesurgery has emerged as a transformative approach to address geographic disparities in surgical care, particularly in urology. However, robust real-world evidence specifically focused on renal procedures remains limited. We conducted this systematic review and single-arm meta-analysis to evaluate the safety, feasibility, and perioperative outcomes of remote robot-assisted renal surgery.

METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 1, 2026. Studies reporting robot-assisted telesurgery for renal procedures (partial nephrectomy, radical nephrectomy, or renal cyst decortication) were included. The Joanna Briggs Institute (JBI) Case Series Checklist was used for quality assessment. A single-arm meta-analysis with random-effects models was performed to pool surgical success rates, operative time, estimated blood loss (EBL), length of hospital stay (LOS), warm ischemia time (WIT), and network parameters. Subgroup analyses were conducted by sample size, study design, and robotic platform. Sensitivity analyses using the leave-one-out method were performed to test the robustness of the pooled estimates.

RESULTS: Eight studies comprising 98 patients were included. All studies were of moderate-to-high methodological quality (JBI scores: 8-10/10). The pooled surgical success rate was 100%, with a local surgeon take-over rate of 2.1% (2/98). No Clavien-Dindo grade III or IV complications were reported. The pooled estimates were: operative time 99.52 min (95% CI: 77.10-121.94; I² = 92.5%), EBL 28.30 mL (95% CI: 18.18-38.41; I² = 87.9%), LOS 5.31 days (95% CI: 3.29-7.33; I² = 98.0%), and WIT (for partial nephrectomy) 21.14 min (95% CI: 17.76-24.53; I² = 0.6%). Network parameters remained below the 200-300 ms safety threshold, with a mean round-trip time of 51.79 ms (95% CI: 1.25-102.34) and maximum latency of 128.26 ms (95% CI: 95.38-161.13). Subgroup analyses by robotic platform revealed significant between-group differences for operative time (p = 0.000) and EBL (p = 0.000), but not for LOS (p = 0.703). Sensitivity analyses confirmed the robustness of the pooled estimates for operative time and EBL, whereas the LOS estimate was sensitive to the inclusion of studies reporting extreme values.

CONCLUSIONS: Remote robot-assisted renal surgery demonstrates high technical success rates, low complication rates, and favorable perioperative outcomes, with network parameters well within established safety thresholds. These findings support the clinical implementation of telesurgery for appropriately selected renal surgery patients, particularly in underserved regions. However, the substantial heterogeneity observed highlights the need for large-scale, prospective comparative studies with standardized outcome definitions and longer follow-up.

PMID:42545600 | DOI:10.1007/s11701-026-03764-0

Radiol Phys Technol. 2026 Aug 3. doi: 10.1007/s12194-026-01111-4. Online ahead of print.

ABSTRACT

A high-fidelity electron-source Monte Carlo model of a mobile C-arm fluoroscopy system was developed using Particle and Heavy Ion Transport code system (PHITS) to evaluate scattered radiation and calculation acceleration. Electrons were injected into the X-ray tube target, and energy spectra, dose profiles, and scattered doses around the tube head and in the room were calculated. Simulated spectra Simulated spectra agreed with the measured spectra with a root mean square error of 0.06 or less, and the simulation-to-measurement ratios of the scattered air kerma from the electron-source simulations were within 20% at every measurement point. In the simulated two-dimensional distributions, the electron-source simulations showed higher scattered doses than the photon-source simulation at heights above 150 cm. The time required to reach 10% statistical uncertainty decreased from 168.28 h to 72.33 h using the dump technique and to 1.25 h, excluding the dump-generation stage, when combined with the weight window method. The method supports characterization of scattered air-kerma distributions relevant to occupational exposure.

PMID:42545599 | DOI:10.1007/s12194-026-01111-4