Nevin Manimala

Mediators Inflamm. 2026;2026(1):e7921309. doi: 10.1155/mi/7921309.

ABSTRACT

BACKGROUND: Patients with acute coronary syndrome (ACS) who have previously undergone coronary artery bypass grafting (CABG) represent a complex, high-risk population characterized by a substantial burden of atherosclerosis and a marked propensity for recurrent ischemic events. The pathophysiological interplay between systemic inflammation and insulin resistance serves as a key mediator driving the progression of atherosclerosis and the destabilization of atherosclerotic plaques. However, the prognostic impact of their combined effect, quantified by a novel composite biomarker-the C-reactive protein-triglyceride glucose index (CTI)-remains uncertain in this specific high-risk population.

METHODS: We enrolled 1195 ACS patients with prior CABG who underwent percutaneous coronary intervention (PCI). The CTI was calculated as 0.412 × ln (high-sensitivity C-reactive protein [mg/L]) + ln (fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL]/2). Patients were divided into three groups based on their CTI tertiles. The primary endpoint was defined as the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), which encompassed all-cause death, nonfatal stroke, nonfatal myocardial infarction (MI), and unplanned revascularization.

RESULTS: Over a median follow-up of 3 years, 366 patients experienced MACCE. The incidence of MACCE progressively increased across CTI tertiles (log-rank p < 0.001). In the multivariable Cox proportional hazards model adjusted for the GRACE (Global Registry of Acute Coronary Events) risk score and a comprehensive panel of clinical, procedural, and laboratory confounders, the highest CTI tertile remained an independent predictor of MACCE (adjusted hazard ratio [HR]: 3.864, 95% confidence interval [CI]: 2.710-5.511, p < 0.001). When CTI was analyzed as a continuous variable, each unit increase was found to confer an 80.1% greater risk of MACCE (adjusted HR: 1.801, 95% CI: 1.556-2.085, p < 0.001). This association remained consistent across all predefined subgroups. Adding CTI tertiles to the baseline model-which encompassed the GRACE risk score and other confounders-yielded a modest but statistically significant improvement in predictive performance (C-statistic increased from 0.605 to 0.655, p < 0.001; continuous net reclassification improvement [cNRI]: 0.740, p = 0.032; integrated discrimination improvement [IDI]: 0.145, p = 0.020).

CONCLUSIONS: The CTI-a composite biomarker that captures both systemic inflammation and insulin resistance-emerged as a significant and independent predictor of long-term MACCE in ACS patients with prior CABG who underwent PCI. Its integration into risk stratification models may improve prognostic assessment and potentially facilitate more personalized and intensive secondary prevention strategies.

PMID:42253126 | DOI:10.1155/mi/7921309

ANZ J Surg. 2026 Jun 8. doi: 10.1111/ans.70782. Online ahead of print.

ABSTRACT

PURPOSE: There is conflicting data in the literature regarding the optimal timing of curative surgery in incidental gallbladder cancer (IGBC). The aim of this study was to assess the impact of the timing of surgery in IGBC on disease-free (DFS) and overall survival (OS).

METHODS: Data of all patients of IGBC who underwent completion radical cholecystectomy from January 2012 to December 2022 was retrieved from a prospectively maintained electronic database. Patients were divided into two groups based on the interval between the cholecystectomy and completion radical cholecystectomy: early (≤ 4 weeks) and late (> 4 weeks). The groups were compared using appropriate statistical methods.

RESULTS: There were 44 and 47 patients in early and late groups respectively. Both groups were comparable in all demographic, preoperative, operative, postoperative, and histopathological characteristics. At a median follow-up of 36 months, median DFS and OS were not reached. There was no difference in early and late groups in mean DFS (41 vs. 43 months) and OS (47 vs. 46 months).

CONCLUSION: Timing of curative surgery did not have any impact on intraoperative blood loss, duration of surgery, hospital stay, complication rates, and lymph node retrieval. Early surgery was associated with better adjuvant therapy completion rates (95% vs. 77%, p = 0.04). Mean DFS and OS were similar in both groups. So timing of surgery in IGBC did not have any impact on short term and long term outcomes.

PMID:42253122 | DOI:10.1111/ans.70782

ACS Nano. 2026 Jun 8. doi: 10.1021/acsnano.6c01127. Online ahead of print.

ABSTRACT

Precise control over the photonic bandgap in Blue Phase Liquid Crystals (BPLCs) remains challenging due to the inherent limitations of existing tuning methods. Here, we present a 2-fold approach that synergistically combines internal and external effectors to enable controlled, fine modulation of the photonic bandgap across a wide spectral range of 200 nm. Internally, nanoparticles (NPs) embedded within the BPLC lattice enhance the thermal stability of the blue phase and reduce the cubic unit cell size, thereby shifting the reflection bandgap toward shorter wavelengths. Externally, the chemical structure of homogeneous alignment layers (ALs) affects the spectral position of the Bragg reflection. By systematically varying four ALs and three NP doping levels (0, 0.5, and 2 wt %), a cooperative influence of both effectors on spectral tuning is observed. These interactions are qualitatively explained by contact-angle measurements and chemical interactions at the LC-AL and LC-NP interfaces. Kossel diagram analysis, together with a factor based on the total tuning range and associated statistical descriptors, is used to confirm and quantify Bragg wavelength shifts. The results demonstrate that combined internal and external control provides an effective strategy for adjusting the optical response and thermal behavior of BPLCs, supporting their application in photonic devices.

PMID:42253115 | DOI:10.1021/acsnano.6c01127

J Laparoendosc Adv Surg Tech A. 2026 Jun 8:10926429261458126. doi: 10.1177/10926429261458126. Online ahead of print.

ABSTRACT

BACKGROUND: Periarterial divestment has emerged as an artery-preserving alternative to formal arterial resection for borderline resectable and locally advanced pancreatic cancer. However, the available evidence remains limited. This study aimed to evaluate the perioperative and oncologic outcomes of periarterial divestment in pancreatic cancer.

METHODS: A systematic review was conducted using PubMed, Scopus, Web of Science, and the Cochrane Central Register to identify studies’ data published up to March 2026. Continuous outcomes were pooled as means with 95% confidence intervals (CIs), and binary outcomes were pooled as proportions using random-effects models. Heterogeneity was assessed using the I² statistic and the Cochrane Q test. Sensitivity analyses were performed using leave-one-out methods. All analyses were conducted in R version 4.4.2.

RESULTS: Five retrospective observational studies comprising 474 patients were included, of whom 92.8% had locally advanced pancreatic cancer and 64.8% received neoadjuvant therapy. The pooled operative time was 333.0 minutes (95% CI: 232.6-433.4; I² = 99%), estimated blood loss was 620.6 mL (95% CI: 292.4-948.7; I² = 97%), and length of hospital stay was 12.4 days (95% CI: 9.1-15.6; I² = 99%). The pooled incidence of intraabdominal infection, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, reoperation, major complications (Clavien-Dindo grade ≥ III), and 90-day mortality was 10.57%, 8.72%, 8.56%, 14.13%, 3.36%, 11.27%, and 4.18%, respectively. The pooled rates of venous resection, arterial resection, and R0 resection were 36.18%, 3.56%, and 43.33%, respectively. The pooled 1-year and 3-year disease-free survival rates were 50.42% and 17.77%, respectively, while the corresponding overall survival rates were 75.99% and 29.11%.

CONCLUSION: Periarterial divestment has been applied in selected patients, with reported perioperative and oncologic outcomes across studies. However, the current evidence remains descriptive and does not allow comparative inference.

PMID:42253112 | DOI:10.1177/10926429261458126

Health Informatics J. 2026 Apr-Jun;32(2):14604582261450831. doi: 10.1177/14604582261450831. Epub 2026 Jun 8.

ABSTRACT

BackgroundStatistical analysis is crucial in clinical research, but many clinicians lack training or support. StatiCAL, a free and intuitive tool, was created to address this gap without needing coding skills. This study evaluates its effectiveness and usability by analyzing physicians’ performance and perceptions during real-world statistical tasks.MethodsWe conducted a cross-sectional study evaluating StatiCAL’s usability and effectiveness. Surgical physicians analyzed a clinical dataset using StatiCAL after completing a background questionnaire. Usability was measured with the French SUS, and all analyses were independently verified in R.ResultsFourteen physicians with limited prior experience in statistical analysis participated. All successfully completed the assigned tasks using StatiCAL, with an average completion time of 28 minutes. Interestingly, participants without prior experience completed tasks significantly faster than those with experience (p = 0.044). The average F-SUS score was 85.33, indicating high usability above the standard threshold.ConclusionsStatiCAL showed high usability and effectiveness, allowing clinicians, regardless of prior experience, to perform accurate statistical analyses efficiently. Its intuitive interface supports broader access to biostatistics, encourages collaboration with specialists, and simplifies research workflows. Further studies with larger, more diverse populations are needed to confirm and expand these findings.

PMID:42253109 | DOI:10.1177/14604582261450831

Appl Neuropsychol Child. 2026 Jun 8:1-10. doi: 10.1080/21622965.2026.2684724. Online ahead of print.

ABSTRACT

This study aimed to evaluate the psychometric properties of the Taiwanese Traditional Chinese Version of the Teenage Executive Functioning Inventory (TC-TEXI) in a sample of 784 Taiwanese high school students, their parents, and their teachers. Notably, this research is the first to establish the psychometric properties of teacher ratings across all language versions of the TEXI. The results of confirmatory factor analyses partially supported a two-factor model of executive functioning, namely working memory and inhibition, particularly for teacher ratings. The findings also supported adequate internal and test-retest reliability. Multiple regressions were implemented to explore how the scores from the three types of the TC-TEXI predicted positive mental health among high school students in Taiwan. The results revealed that while the data supported that the self-report TC-TEXI best correlated with the self-acceptance, human relationships, emotional balance, and optimism/enterprising aspects of their positive mental health, teacher-rating and parent-rating were also statistically significantly correlated with the family harmony aspect of positive mental health. Implications regarding the correlation pattern were suggested. The linear age effect commonly found with performance-based EF tasks was not supported in the current study. Future research involving randomly drawn samples from each grade or a longitudinal design should help reconfirm the non-linear effect.

PMID:42253085 | DOI:10.1080/21622965.2026.2684724

J Palliat Med. 2026 Jun 8:10966218261452339. doi: 10.1177/10966218261452339. Online ahead of print.

ABSTRACT

BACKGROUND: Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur.

OBJECTIVES: Our primary aim was to assess the associations of specialty palliative consults (SPC) or documented goals of care conversations (GOCC) with in-hospital mortality among patients with CMO orders.

DESIGN: We completed a retrospective cross-sectional study of data from the electronic medical record.

SETTING/PARTICIPANTS: We assessed all adult patients with CMO orders admitted to four hospitals in the United States between 2022 and 2024.

MEASUREMENTS: We used descriptive statistics and multivariable logistic regression and linear regression models to identify the association of SPC and documented GOCC with patient outcomes.

RESULTS: Of 6789 hospitalized patients with CMO orders, 48% were female, and these patients had median age 71 years. Seventy-three percent died in-hospital, and 22% were discharged with hospice. SPC placed anytime during hospital admission were associated with lower in-hospital mortality (aOR 0.4, 95% CI 0.3-0.6, p < 0.0001) and higher discharge with hospice (aOR 2.4, 95% CI 1.8-3.2, p < 0.0001). In contrast, documented GOCC anytime during admission were associated with higher in-hospital mortality (aOR 1.8, 95% CI 1.3-2.4, p = 0.0004) and lower discharge with hospice (aOR 0.5, 95% CI 0.4-0.7, p = 0.0003).

CONCLUSIONS: For patients with CMO orders, SPC, rather than documented GOCC, were associated with lower in-hospital mortality and higher receipt of hospice. Future research should explore reasons why only SPC, and not documented GOCC, were associated with these findings.

PMID:42253054 | DOI:10.1177/10966218261452339

J Biopharm Stat. 2026 Jun 8:1-34. doi: 10.1080/10543406.2026.2670526. Online ahead of print.

ABSTRACT

Analysis of data from randomized controlled trials in vulnerable populations requires special attention when assessing treatment effect by a score measuring, e.g. disease stage or activity, together with onset of prevalent terminal events. In reality, it is impossible to disentangle a disease score from the terminal event, since the score is not clinically meaningful after this event. In this work, we propose to assess treatment interventions simultaneously on the terminal event and the disease score in the absence of a terminal event. Our proposal is based on a natural data-generating mechanism respecting that a disease score does not exist beyond the terminal event. We use modern semi-parametric statistical methods to provide robust and efficient estimation of the risk of terminal event and expected disease score conditional on no terminal event at a pre-specified landmark time. We also use the simultaneous asymptotic behavior of our estimators to develop a powerful closed testing procedure for confirmatory assessment of treatment effect on both onset of terminal event and level of disease score in the absence of a terminal event. A simulation study mimicking a large-scale outcome trial in chronic kidney patients as well as an analysis of that trial is provided to assess performance.

PMID:42253045 | DOI:10.1080/10543406.2026.2670526

Stat Med. 2026 Jun;45(13-14):e70633. doi: 10.1002/sim.70633.

ABSTRACT

When analyzing gait and other human movements, often one-dimensional (1D) functional data are considered, where a variable like joint angle changes smoothly over time from movement start to end. Interpretation of effect sizes in functional data like these generally follows the widely-cited Cohen/Sawilowsky rules of thumb. A key problem is that a given effect size occurs with greater probability for functional data than for the simple scalar (0D) case of Cohen/Sawilowsky. Here, we propose both (i) functional effect size rules of thumb that are probabilistically consistent with the Cohen/Sawilowsky guidelines for a benchmark, two-sample scenario, and (ii) a framework for adapting the benchmark interpretations to arbitrary experimental scenarios with probabilistic consistency. Analysis of an open total hip arthroplasty gait dataset showed that post-surgery effect sizes would be interpreted as ‘medium’ and ‘less than very small’ for the Cohen/Sawilowsky and proposed functional rules of thumb, respectively. Adapting the benchmark case to the actual experimental case (paired design with $n$ = 52 and highly smooth functional residuals) contrastingly yielded an effect size interpretation of ‘very large’. These stark interpretation contrasts suggest that a single set of interpretation guidelines should not be applied to arbitrary experimental scenarios. We recommend using the Cohen/Sawilowsky and proposed functional rules of thumb only for a priori power analysis, and only in the absence of information regarding population variance and smoothness. For all other cases, especially post hoc effect size interpretation, we recommend using the proposed framework to yield probabilistically consistent results, and thus more meaningful cross-study interpretations. Code replicating all results is available at https://github.com/0todd0000/esrot1d.

PMID:42253039 | DOI:10.1002/sim.70633

J Prev Interv Community. 2026 Jun 8:1-12. doi: 10.1080/10852352.2026.2676383. Online ahead of print.

ABSTRACT

Peer recovery counseling (PRC) programs increasingly incorporate structured goal-setting frameworks, such as SMART, yet the fidelity of goals produced in real-world mental health crisis settings remains under explored. This study evaluated 128 counseling sessions from 20 clients across two PRC programs using the SMART-GEM framework to assess goal quality. Nonparametric analyses indicated that goal fidelity scores significantly improved over time. A series of multilevel models (MLMs) confirmed that 27.4% of variance in fidelity scores was attributable to differences between clients. Session timing emerged as the strongest predictor. Session timing accounted for the majority of between-client variance, suggesting that sustained engagement drives goal quality. Staff identity also emerged as a modest but statistically significant predictor. In contrast, neither program site nor delivery modality predicted SMART goal quality. Implications include the need for targeted staff development and the integration of retention-focused interventions to optimize SMART goal use in recovery services.

PMID:42253029 | DOI:10.1080/10852352.2026.2676383