Nevin Manimala

J Magn Reson Imaging. 2026 Mar 15. doi: 10.1002/jmri.70297. Online ahead of print.

ABSTRACT

BACKGROUND: Biparametric MRI (bpMRI) was interpreted using Prostate Imaging Reporting and Data System (PI-RADS) version 2.1, a system associated with relatively low specificity. Selective size imaging using filters via diffusion times MRI (SSIFT-MRI) is a novel imaging technique that may improve diagnostic performance.

PURPOSE: To compare the diagnostic performance of bpMRI versus SSIFT-MRI for diagnosing clinically significant prostate cancer (csPCa).

STUDY TYPE: Prospective.

POPULATION: Hundred and eighteen men (age: 70 ± 7 years) with suspected csPCa.

FIELD STRENGTH/SEQUENCE: Pulsed and oscillating gradient spin-echo sequences at 3 T. BpMRI included three-plane T2-weighted imaging and diffusion-weighted imaging.

ASSESSMENT: csPCa status was pathologically determined via ultrasound-guided biopsy or prostatectomy. Three radiologists assessed bpMRI and SSIFT-MRI for identifying csPCa lesions, and we further compared the performance of combining PI-RADS with SSIFT-MRI against that of bpMRI.

STATISTICAL TESTS: Area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnostic performance; bootstrap resampling for comparing AUC; McNemar’s test for comparing sensitivity, specificity, PPV, NPV, and accuracy. A p-value < 0.05 was considered significant.

RESULTS: Per-patient accuracy was significantly higher for SSIFT-MRI (reader 1: 85% vs. 68%; reader 2: 80% vs. 64%; reader 3: 77% vs. 65%). Per-patient specificity (reader 1: 71% vs. 27%; reader 2: 58% vs. 11%; reader 3: 58% vs. 20%) and PPV (reader 1: 84% vs. 67%; reader 2: 78% vs. 64%; reader 3: 77% vs. 65%) were significantly higher for SSIFT-MRI. Combining PI-RADS with SSIFT-MRI yielded significantly higher AUCs and accuracy than bpMRI alone (AUC and accuracy for reader 1: 0.89% and 83%; reader 2: 0.80% and 73%; reader 3: 0.75% and 72%).

DATA CONCLUSION: SSIFT-MRI for csPCa had similar or higher diagnostic performance compared with bpMRI. The combination approach provided significantly higher AUC and accuracy than bpMRI.

EVIDENCE LEVEL: 1.

STAGE OF TECHNICAL EFFICACY: 2.

PMID:41833541 | DOI:10.1002/jmri.70297

Eur J Dent Educ. 2026 Mar 15. doi: 10.1111/eje.70133. Online ahead of print.

ABSTRACT

INTRODUCTION: The “Code Blue” system is a standardised emergency response protocol designed to ensure rapid intervention in critical medical situations, particularly cardiopulmonary arrest. Although mandatory in Türkiye since 2011, inappropriate activations still occur, often due to limited awareness among healthcare staff, including dental students. This pilot project aimed to assess dental students’ knowledge and awareness regarding Code Blue and to examine whether these outcomes differ according to the level of clinical training.

MATERIALS AND METHODS: A cross-sectional survey was conducted among 186 dental students at Akdeniz University, including 3rd-year (preclinical) and 5th-year (clinical) students. A structured 10-item multiple-choice questionnaire was used to evaluate participants’ knowledge of Code Blue indications, activation procedures, and response expectations. Descriptive and comparative statistical analyses were performed.

RESULTS: Of the 186 students analysed, 53.2% were female and 46.8% were male. The most recognised emergency code was Code White (82.26%), followed by Code Blue (70.43%). Code Blue awareness was significantly higher among fifth-year students (77.3%) than third-year students (62.9%) (p < 0.05). Fifth-year students also demonstrated greater knowledge of Code Blue indications and were less likely to choose “don’t know.” However, common misinterpretations were observed: 70.49% incorrectly identified vasovagal syncope as a Code Blue condition, and only 7.38% correctly rejected all non-indicated scenarios. Knowledge of basic life support (BLS) content did not significantly differ between groups (p = 0.8153).

CONCLUSIONS: Code Blue knowledge and awareness were higher among students with greater clinical exposure; however, overall awareness remained limited. These findings support earlier and more structured integration of institutional emergency code training, simulation-based reinforcement, and practical emergency preparedness training within the dental curriculum. Further multi-center studies are recommended to enhance generalizability and guide educational interventions.

PMID:41833538 | DOI:10.1111/eje.70133

Influenza Other Respir Viruses. 2026 Mar;20(3):e70238. doi: 10.1111/irv.70238.

ABSTRACT

BACKGROUND: Quantifying the burden of respiratory syncytial virus (RSV) in adults is challenging compared to influenza, and data among older adults remain scarce in Japan. Country-specific evidence is essential to support RSV vaccination policy.

METHODS: This prospective, multicenter study (APSG-J2) targeted hospitalized adults with community-acquired pneumonia (CAP) and other acute respiratory infections (ARI) in seven community hospitals across four catchment areas in Japan between September 2022 and August 2024. Respiratory samples were analyzed using a multiplex polymerase chain reaction (PCR) kit to detect RSV and influenza. Incidence rates of RSV- and influenza-associated hospitalizations were estimated using study data and national statistics, stratified by age and region.

RESULTS: Among 3047 hospitalized patients with CAP/ARI, 1499 (49.2%) underwent multiplex PCR testing. RSV and influenza were detected in 2.8% and 3.3% of tested patients, respectively. The incidences of RSV-associated CAP/ARI hospitalizations among adults aged ≥ 65 years were 29 and 36 per 100,000 person-years in the first and second years, respectively, with higher incidences among those aged ≥ 85 years (150 and 131 per 100,000 person-years). Influenza incidence increased markedly in the second year (from 11 to 71 per 100,000 person-years for adults age ≥ 65 years), possibly reflecting post-COVID-19 transmission changes.

CONCLUSIONS: In this multicenter study, we estimated the incidence of RSV- and influenza-associated hospitalizations among adults in Japan. The findings indicated that the incidence increased with age, and influenza-associated hospitalizations increased in the second year. Continued surveillance is essential to accurately assess RSV burden in the adult population.

PMID:41833535 | DOI:10.1111/irv.70238

Med Phys. 2026 Mar;53(3):e70385. doi: 10.1002/mp.70385.

ABSTRACT

BACKGROUND: The integration of artificial intelligence into image-guided intraoperative interventions holds considerable promise for deriving 3D geometric information from 2D imaging. 2D/3D registration establishes the spatial relationship between preoperative computed tomography (CT) and intraoperative X-rays. However, existing methods are often limited by the image domain gap and imprecise feature extraction, causing coarse registration to provide inadequate initial poses and subsequent fine registration to fall into local optima, thereby reducing accuracy.

PURPOSE: We aim to develop a robust single-view lumbar spine 2D/3D registration framework that balances high clinical accuracy with intraoperative efficiency requirements by aligning preoperative CT with intraoperative X-rays.

METHODS: We propose utilizing vertebral body edges in X-rays as novel semantic features to guide 2D/3D registration. For robust edge extraction, we develop ESegMamba, an efficient U-shaped Mamba network incorporating Group multi-axis Hadamard Product Attention (GHPA) and Group Aggregation Concatenation (GAC) modules. Experiments for semantic edge extraction were performed on a dataset of 710 images (comprising X-rays and Digitally Reconstructed Radiographs) derived from 10 patients. The dataset was partitioned using a 4:1 patient-specific split, resulting in 568 training and 142 test images. The training set was further utilized via 5-fold cross-validation for network fine-tuning. ESegMamba was benchmarked against SegMamba, SwinUNETR, and UNETR using Dice and mIoU metrics. For 2D/3D registration, experiments were conducted separately on 300 simulated samples and 90 real clinical samples, following the same patient-specific split. The proposed framework was compared with landmark-based, intensity-based, and learning-based methods using mean Target Registration Error (mTRE). Statistical significance was assessed using the Wilcoxon signed-rank test with a significance level of 0.05, applying Bonferroni correction for multiple comparisons.

RESULTS: ESegMamba outperforms representative networks with fewer parameters (99.18 M), achieving 90.36% Dice and 85.49% mIoU on the test set. Compared to the strong baseline SegMamba, ESegMamba demonstrated a large effect size in Dice improvement (Cohen’s $d=2.05$ , ). For 2D/3D registration, the proposed method demonstrated superior performance over representative benchmarks. Specifically, compared to Xreg and PSSS, our method achieved large practical improvements in mTRE ( $d=1.04$ and $d=2.12$ , respectively; ). On real clinical data, the method achieved a mean in-plane translation error of approximately 1.5 mm and an average registration time of approximately 10 s.

CONCLUSIONS: The proposed method, empowered by ESegMamba, yields statistically significant improvements over intensity-based benchmarks ( ). The achieved sub-2mm accuracy and 10 s processing time on clinical data confirm its efficacy for intraoperative spinal navigation. The code for the proposed method is available at github.com/shenao1995/lineReg.

PMID:41833531 | DOI:10.1002/mp.70385

J Am Geriatr Soc. 2026 Mar 15. doi: 10.1111/jgs.70386. Online ahead of print.

ABSTRACT

BACKGROUND: Prescribing cascades occur when cholinesterase inhibitor (ChEI)-induced urinary incontinence is misinterpreted as a new condition, leading to overactive bladder (OAB) antimuscarinic initiation. We evaluated whether the ChEI-OAB antimuscarinic prescribing cascade was associated with delirium or falls compared with mirabegron in older adults living with dementia.

METHODS: We conducted a retrospective cohort study using the Anlitiks All-Payor Claims database (2015-2020). Participants were adults aged ≥ 65 years with dementia newly prescribed a ChEI with no prior ChEI or OAB therapy (180 days). A 60-day window identified OAB treatment initiation after ChEI therapy. Exposures were OAB antimuscarinics or mirabegron. Outcomes were incident delirium and falls identified using diagnosis codes. Propensity score-based weighting balanced baseline characteristics.

RESULTS: Among 2693 patients (mean age 80 years; 66.3% female), 201 (7.5%) initiated antimuscarinics and 2492 (92.5%) started mirabegron. Over 1 year, 8 (4.0%) antimuscarinic users developed delirium versus 95 (3.8%) mirabegron users (adjusted HR 1.35; 95% CI, 0.64-2.86). Falls occurred in 3 (1.5%) antimuscarinic users and 63 (2.5%) mirabegron users (adjusted HR 0.66; 95% CI, 0.20-2.15).

CONCLUSIONS: In older adults living with dementia, the estimated association between initiation of OAB antimuscarinics following ChEIs and the risks of delirium or falls, compared with mirabegron, was statistically compatible with benefit, harm, or no clinically meaningful difference. These findings highlight the need to evaluate whether OAB antimuscarinics are prescribed in response to true clinical need or as part of a prescribing cascade. Given the limited number of outcome events and resulting wide 95% CIs, future studies are needed to more precisely estimate the risk.

PMID:41833520 | DOI:10.1111/jgs.70386

Chin J Traumatol. 2026 Feb 28:S1008-1275(26)00038-6. doi: 10.1016/j.cjtee.2025.11.002. Online ahead of print.

ABSTRACT

PURPOSE: Sarcopenia is a prevalent geriatric syndrome, particularly among the elderly with chronic musculoskeletal diseases, where it exacerbates the risk of functional decline and reduced quality of life. This study aimed to describe the prevalence of muscle weakness and wasting and to investigate some factors related to these 2 syndromes in the elderly with coexisting knee osteoarthritis and chronic spinal pain.

METHODS: A cross-sectional descriptive study enrolled 88 elderly patients (aged ≥60 years) at the musculoskeletal department of Thai Binh General Hospital between May 2024 and October 2024. Muscle weakness was defined according to the Fried criteria, and muscle wasting was diagnosed based on the criteria of the Asian Working Group for Sarcopenia. Data were collected via direct interviews and clinical examinations with measurements, including muscle strength measurement (handgrip strength using the InGrip device), walking speed (by the 15-foot walk test), and body composition analysis using the Inbody 770 machine (using the bioelectrical impedance analysis method). Statistical analysis was performed using SPSS 27.0 software, and multivariate regression was used to investigate a number of related factors, with p < 0.05 being considered statistically significant.

RESULTS: Among the 88 elderly patients, the overall prevalence of sarcopenia was 40.9% (including 23.9% sarcopenia and 17.0% severe sarcopenia), while the prevalence of frailty was 9.1%. Notably, the co-occurrence of both syndromes was significantly higher in men than in women (21.1% vs. 4.3%, p = 0.037), a novel and clinically important finding. After multivariate regression analysis, age was the only significant independent risk factor and those over 70 years old had a 9.0-fold higher risk of developing the condition compared to those aged 60 – 65 years (adjusted odds ratio = 9.0; 95% confidence interval: 2.4 – 33.6).

CONCLUSION: The high prevalence of sarcopenia, with advanced age identified as the most critical independent risk factor, underscores its significant burden in this patient population. These findings highlight the urgent need for early screening and the development of targeted intervention strategies, particularly for high-risk groups such as those aged over 70 years.

PMID:41833494 | DOI:10.1016/j.cjtee.2025.11.002

Eur Urol. 2026 Mar 11:S0302-2838(26)02002-6. doi: 10.1016/j.eururo.2026.02.011. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Studies reported to date indicate that local therapy may improve outcomes in men with de novo metastatic (M1) prostate cancer (PCa). The aim of this study was to evaluate the effect of local therapy to the primary tumor on progression-free survival (PFS) in men with M1 PCa.

METHODS: In a multicenter, randomized phase 2 trial, men with de novo M1 PCa, after receiving 6 mo of best systemic therapy (BST), were randomly assigned (1:1) to continue BST alone (arm 1) or BST with the addition of either radiotherapy or surgery to their primary tumor (arm 2). The primary endpoint was PFS, defined as the time from randomization to progression (Prostate Cancer Working Group 2) by prostate-specific antigen, radiographic or symptomatic progression, or the time to change systemic therapy as per physician discretion and/or clinical decision, or death, whichever occurred first. Immunohistochemistry for the tumor suppressors p53, RB1, and PTEN was performed on available prostate biopsies at baseline and 6 mo. The aggressive variant PCa molecular signature (AVPC-MS) was assigned if two or more of these tumor suppressors were abnormal. In the current intent-to-treat analysis, the Kaplan-Meier product-limit method was used to estimate the median PFS.

KEY FINDINGS AND LIMITATIONS: Between March 2013 and April 2018, 119 patients were randomized (arm 1: 59 and arm 2: 60). The median follow-up for patients who survived was 66 mo (64 mo for BST alone and 67 mo for BST plus local therapy groups). BST included androgen deprivation therapy (n = 119), with docetaxel (n = 37) or with androgen receptor pathway inhibitor agents (n = 9). Local therapy included surgery (n = 45), radiation (n = 13), or none (n = 2). At data analysis, 88 patients met Prostate Cancer Working Group 2 progression, and 53 patients had died. The median PFS was 17.9 mo (95% confidence interval [CI] 11.7-36.4) in arm 1 and 14.8 mo (95% CI 11.4-42.9) in arm 2 (hazard ratio [HR] 0.89, 95% CI 0.59-1.34, p = 0.6). Toxicity was limited in both arms, with grade 3 toxicities in four patients (6.7%) in arm 2 and zero patients in arm 1. Three patients required palliative intervention for symptomatic local progression in arm 1, while an additional six patients crossed over to receive local therapy after meeting castration-resistant PCa progression criteria. Predictors of worse overall survival (OS) for all comers included CHAARTED high-volume (HR 1.84, 95% CI 1.06-3.19) and clinical cT3b/T4 (HR 1.97, 95% CI 0.88-4.41) disease. Having the AVPC molecular profile (AVPC-MS) at baseline or 6 mo was significantly associated with worse PFS (HR 1.74, 95% CI 1.02-2.98, p = 0.04). However, there was no statistically significant association with OS (HR 1.83, 95% CI 0.94-3.56, p = 0.08).

CONCLUSIONS AND CLINICAL IMPLICATIONS: This phase 2 randomized study failed to demonstrate improved PFS in men with de novo M1 PCa treated with BST with the addition of local therapy to their primary tumor. Its effect on OS is being tested in an ongoing phase 3 trial (SWOG 1802). We identified biomarkers of potential prognostic value (CHAARTED volume status, cT3b/cT4 disease, and the AVPC-MS) that may serve to optimize therapy selection and stratification in this population, but these require further evaluation.

PMID:41833492 | DOI:10.1016/j.eururo.2026.02.011

Eur J Intern Med. 2026 Mar 14:106819. doi: 10.1016/j.ejim.2026.106819. Online ahead of print.

ABSTRACT

INTRODUCTION: Retinal vascular alterations were reported in patients with SSc suggesting a potential role for OCTA in the evaluation of SSc-related microangiopathy. The aim of the study is to evaluate the microangiopathic alterations in the retina of patients with SSc and to evaluate their correlation with the clinical manifestations of the disease and the capillaroscopic findings MATERIALS AND METHODS: This is a case-control study comparing SSc patients to healthy controls. OCTA acquisition consisted on scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of both the macula and the optic nerve, performed using Canon OCT. Vascular density (VD), vascular length density (VLD), foveal avascular zone (FAZ) and retinal thickness in the fovea and in the perifoveal region were obtained using dedicated software.

RESULTS: 41 SSc patients (11 were VEDOSS) were compared with 20 healthy controls. SSc patients showed reduced VD and VLD values ​​in all areas evaluated both in the SCP and DCP (p < 0.001 for both). At the optic nerve level, both VD and VLD values ​​were reduced at the SCP (p < 0.001 for both) and DCP levels (p = 0.009 and p < 0.001). Retinal thickness in the parafoveal region was increased in SSc patients (p = 0.013) and correlated with blood flow at nailfold videocapillascopy (p = 0.030). VD and VLD at the foveal level in DCP were associated with the presence of avascular areas (p = 0.018 and p = 0.019) and neoangiogenesis (p = 0.023 and p = 0.025).

CONCLUSION: Ocular microangiopathy is present in scleroderma patients since the early stages of the disease and is correlated with capillaroscopic alterations.

PMID:41833472 | DOI:10.1016/j.ejim.2026.106819

J Mass Spectrom. 2026 Apr;61(4):e70047. doi: 10.1002/jms.70047.

ABSTRACT

Mussel aquaculture has experienced substantial growth in recent decades, with global production exceeding 2.17 megatons (live weight), more than doubling since the early 21st century. Representing nearly 94% of the total mussel production, aquaculture plays a crucial economic and ecological role. Mussels accumulate xenobiotics through their filter-feeding behaviour, providing valuable insights into potential human exposure to the contaminants. However, the high lipid and protein content in their tissue can introduce analytical challenges, requiring rigorous clean-up procedures to mitigate matrix effects. Herein, we applied a QuEChERS-based extraction method coupled with high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to investigate the occurrence of emerging contaminants (ECs) in raw and boiled Mytilus galloprovincialis samples. Samples were collected from three aquaculture farms supplying mussels to fish markets in Liguria (Italy), aiming to provide a representative overview of contamination across different geographical sources. A total of 36 samples were analysed, detecting ECs in 26 samples. Caffeine was the most frequently detected contaminant, consistent with its widespread consumption. Additionally, UV filters were also commonly found in the samples, likely due to the sampling period at the end of summer, when sunscreen use is highest. This is the first study to investigate the impact of cooking on the concentrations of different classes of ECs in mussels, reflecting real consumption conditions. Box and whisker plots revealed consistently higher contaminant concentrations in boiled samples, suggesting that thermal processing may influence contaminant release. This study aims to offer insights into contaminants distribution and preliminary information for human exposure assessment of potential risks to human health.

PMID:41833453 | DOI:10.1002/jms.70047

J Sch Psychol. 2026 Apr;115:101528. doi: 10.1016/j.jsp.2025.101528. Epub 2026 Feb 12.

ABSTRACT

This paper proposes new data-analysis reporting guidelines for researchers conducting single-case experimental design (SCED) research. Statistical analyses of SCED data are being used with higher frequency and across a wider range of disciplines in the health sciences, behavioral sciences, and education. Building on prior reporting standards for other domains of quantitative intervention research, we present the role of visual and statistical analysis of SCED data, with specific tabled recommendations for professional reporting guidelines. We expand the Journal Article Reporting Standards (JARS) presented by Appelbaum et al. (2018) and the Single-Case Reporting Guideline In Behavioral Interventions (SCRIBE) 2016 Checklist (Tate et al., 2016). In particular, we feature expanded guidelines for visual and statistical analysis of SCED intervention methodology, including guidelines within both nonrandomized and randomized design domains. These recommendations are intended as a guide for conducting original research to establish evidence-based practices.

PMID:41833442 | DOI:10.1016/j.jsp.2025.101528