Nevin Manimala

Clin Ophthalmol. 2026 May 23;20:561121. doi: 10.2147/OPTH.S561121. eCollection 2026.

ABSTRACT

PURPOSE: To investigate the possible influence of repeated anti-VEGF injections on vascular metrics measured by optical coherence tomography angiography (OCTA) in patients with age-related macular degeneration (AMD).

METHODS: This retrospective longitudinal study included AMD patients with a follow-up time of at least 18 months from 2019 to 2024. Swept-source OCTA was performed on all eyes. Based on whether an eye received injections or not during follow-up, all eyes were divided into two groups (non-injection group only included non-exudative AMD). Vessel density, Vessel skeleton density in the superficial, deep, and retina slab, as well as foveal avascular zone (FAZ) size, circularity and perimetry of Angio 6mm×6mm were calculated. Change in vascular metrics between baseline and last follow-up were compared between the two groups using t-test or Mann-Whitney U-test. Correlation between change in vascular metrics and visual acuity was investigated by Spearman’s Rank Correlation test.

RESULTS: A total of 164 eyes from 107 patients were included. The average follow-up time was 34 months. No statistically significant difference in baseline vascular metrics was detected between the injection group (57 eyes) and non-injection (107 eyes) group. The injection group received 12.56 injections during follow-up. Among all the parameters, only change in FAZ size during follow-up showed a statistically significant difference between the two groups (0.03 vs. 0.02 mm², P=0.043). No correlation was found between change in vascular metrics and change in visual acuity (P>0.05).

CONCLUSION: In this retrospective longitudinal study of 164 eyes, repeated intravitreal anti-VEGF injections were associated with no relevant significant changes in OCTA vascular metrics over time.

PMID:42221036 | PMC:PMC13217431 | DOI:10.2147/OPTH.S561121

Front Pediatr. 2026 May 14;14:1819033. doi: 10.3389/fped.2026.1819033. eCollection 2026.

ABSTRACT

BACKGROUND: In pediatric oncology, randomized clinical trials are an integral part of standard treatment. Because enrollment typically must occur before therapy begins, families receive trial information shortly after diagnosis and must provide consent within a brief time frame. The informed consent process therefore often takes place while parents are experiencing emotional stress, have limited medical knowledge, and have little opportunity to reflect on or discuss the available treatment options, as stipulated by good clinical practice.

OBJECTIVE: To gain insight into parents’ experiences of the informed consent process and their motivations for participating in a randomized clinical trial.

METHODS: A Nordic survey using a study-specific questionnaire was conducted. Parents of children enrolled in the NOPHO-DBH AML 2012 and B-NHL 2013 protocols responded. A multimethod approach was applied. Quantitative data were analyzed using descriptive statistics and factor analysis, while qualitative data were analyzed thematically.

RESULTS: In total, parents of 72 children (60 single mothers, 32 single fathers, and 8 couples) participated, yielding 100 complete questionnaires. The two protocol groups were similar in sample size, with 49 participants from AML 2012 and 51 from B NHL 2013. Factor analysis identified three factors and one single-item indicator. No statistically significant differences were found between the protocols for any of the variables examined: Influence of information provided (Factor 1; p = .570), Emotional influences (Factor 2; p = .308), Influence on decision-making (Factor 3; p = .017), and Perceived impact on care in the event of non-participation (Indicator; p = .174). The qualitative results illuminate the parents’ motivation for enrollment which comprise three themes: Opportunities and risks associated with new treatment, Contributing to research and helping others, Information and strain in the situation.

CONCLUSION: This study contributes to a broader understanding of parents’ experiences of the informed consent process within the context of standard treatment practice in pediatric oncology. Despite making decisions under considerable emotional pressure, most parents reported satisfaction with the information provided and did not express regret regarding their enrollment decision. The findings underscore the importance of communication practices that support parents’ comprehension and decision-making during the consent process.

PMID:42221007 | PMC:PMC13216218 | DOI:10.3389/fped.2026.1819033

Front Pediatr. 2026 May 14;14:1814290. doi: 10.3389/fped.2026.1814290. eCollection 2026.

ABSTRACT

BACKGROUND: Acquired external auditory canal stenosis (EACS) is a major cause of conductive hearing loss in children and adults, with multiple etiologies including otological surgical procedures, blunt trauma, and chronic inflammatory diseases, which can lead to persistent hearing loss and other adverse outcomes. Due to children’s unique anatomical fragility and strong tissue proliferative capacity, the clinical management of EACS remains challenging.This study aims to explore the clinical characteristics, optimal surgical approaches and prognostic factors of traumatic EACS in children, so as to provide evidence-based references for clinical practice.

METHODS: A retrospective medical record review was conducted for patients diagnosed with EACS who received treatment at The Second Xiangya Hospital between November 2020 and November 2025. Data were collected regarding age, gender, etiology, clinical symptoms, surgical methods, and postoperative outcomes. Descriptive statistics and Fisher’s exact test were used for data analysis.

RESULTS: The findings indicated that the characteristics of EACS in children were unilateral involvement (100%), with the primary etiologies being associated with prior ear surgeries (86%) and isolated hearing loss (100%). The postoperative recurrence rate was 57%, and all recurrent cases were accompanied by restenosis. In pediatric surgeries, the temporoparietal fascial flap was the most frequently utilized graft (43%), 43% of patients underwent conchal cartilage resection, and 86% received absorbable drug-eluting stent (DES) implantation. All patients adhered to a unified DES implantation and postoperative care protocol. Type I tympanoplasty (Wullstein classification) was carried out in one pediatric case and one adult case for tympanic membrane repair. The adult cohort exhibited multiple etiologies (50% related to prior ear surgeries, 17% post-trauma, 25% post-inflammation), frequent accompanying symptoms (25% with tinnitus, 50% with otorrhea, 17% with earache), a recurrence rate of 25%, and no postoperative restenosis. Statistical analysis verified that the restenosis rate in pediatric patients was significantly higher than that in adults (P = 0.012), and there was no significant correlation between recurrence and flap selection, cartilage resection, or DES implantation (all P > 0.05).

CONCLUSION: This study tentatively indicates that there exist disparities in the clinical characteristics of acquired external auditory canal stenosis between children and adults. The risk of postoperative restenosis in children is notably elevated, and this tendency might be associated with the inherent anatomical fragility and robust tissue proliferation capacity in children. Comprehensive preoperative imaging assessment, individualized surgical plan development, standardized drug-eluting stent implantation, structured long-term postoperative follow-up, and postoperative care may be conducive to enhancing the prognosis of acquired external auditory canal stenosis in children. Multicenter prospective studies with a larger sample size are required to further validate the optimal treatment strategy for acquired external auditory canal stenosis in children.

PMID:42220998 | PMC:PMC13216209 | DOI:10.3389/fped.2026.1814290

J Food Sci. 2026 Jun;91(6):e71164. doi: 10.1111/1750-3841.71164.

ABSTRACT

This study explored pandan (Pandanus amaryllifolius Roxb.) infusion as a novel substrate for kombucha fermentation and examined the impact of symbiotic culture of bacteria and yeast (SCOBY) geographical origin on flavor development. Kombucha samples fermented using SCOBYs sourced from three regions in China: Jining, Shandong (SJ); Hangzhou, Zhejiang (ZH); and Hefei, Anhui (AH), were systematically characterized by headspace solid-phase microextraction coupled with gas chromatography-mass spectrometry (HS-SPME/GC-MS), electronic nose, electronic tongue, sensory evaluation, and multivariate statistical analyses. In total, 50 volatile organic compounds (VOCs) were identified across all samples. The SJ sample exhibited the highest total VOC concentration (29.42 µg/g) and a balanced, floral, and fruity profile, linked to key compounds like 2-buten-1-one, 1-(2,6,6-trimethyl-1,3-cyclohexadien-1-yl)-, (E)-, linalool, ethyl acetate, and phenethyl acetate. The ZH sample (27.24 µg/g) showed intense sour notes from acetic acid and butanoic acid, along with astringent notes from 4-ethylphenol and malty notes from 3-methyl-1-butanol. The AH sample had the lowest VOCs (10.32 µg/g) and malt-like, sour, and bitter characteristics. Odor activity value (OAV) analysis identified 2-buten-1-one, 1-(2,6,6-trimethyl-1,3-cyclohexadien-1-yl)- as the most influential aroma-active compound across all samples. Furthermore, orthogonal partial least squares-discriminant analysis screened 19 key differential aroma compounds contributing to sample discrimination. Overall, these findings demonstrate that SCOBY origin plays a decisive role in shaping the aroma composition, taste attributes, and sensory quality of pandan kombucha, providing a scientific basis for substrate innovation and starter culture selection in kombucha production.

PMID:42219551 | DOI:10.1111/1750-3841.71164

J Ultrasound Med. 2026 May 31. doi: 10.1002/jum.70316. Online ahead of print.

NO ABSTRACT

PMID:42219536 | DOI:10.1002/jum.70316

BMC Glob Public Health. 2026 Jun 1;4(1):54. doi: 10.1186/s44263-026-00283-w.

ABSTRACT

BACKGROUND: Poor diet quality related to common mental disorders contribute to global health syndemics. However, there is no synthesis quantifying associations specifically in Low- and Middle-Income Countries (LMIC) where these concomitant health burdens are most prevalent.

METHODS: We drew on a systematic Evidence and Gap Map (EGM) of > 3,000 records from Medline, CAB Global Health and PsycINFO (2000-2024). We selected LMIC studies quantifying healthy diets (validated dietary indices or factor-analytic methods) against validated screening measures of depression, anxiety, and stress, with a healthy versus unhealthy diet comparator. Effect sizes were standardised as mean differences from Hedges’ g and pooled using three-level meta-analysis with robust variance estimation (RVE). Risk of bias was assessed, and sensitivity analyses showed robustness across study designs, dietary measures, and country income strata.

RESULTS: Eighty-three eligible studies from 23 countries (depression n = 69; anxiety n = 43; stress n = 26), and 65 LMIC sample populations, reported statistical measures for 633,317 unique individuals. The Standardized Mean Differences (SMD) comparing healthy diets to unhealthy diets were -0.29 for depression (95% CI -0.35 to -0.23), -0.25 for anxiety (95% CI -0.35 to -0.16), and -0.24 for stress (95% CI -0.33 to -0.14). Results remained robust when restricted to low Risk of Bias studies. Findings were similar in direction and magnitude across study designs, dietary measurements, diagnostic tools, country income levels, and estimates adjusted for socio-economic status. Methodological limitations (e.g., cross-sectional design) and few studies from low-income countries created evidence gaps.

CONCLUSIONS: Healthy diets were consistently associated with lower depression, anxiety, and stress symptoms in LMIC. These findings call for integrated dietary and mental health programming in LMIC (and in any setting with disproportionate health vulnerabilities), and for longitudinal and intervention research across diverse low-income settings beyond Iran and China.

PMID:42219528 | DOI:10.1186/s44263-026-00283-w

Arthroplasty. 2026 Jun 1;8(1):39. doi: 10.1186/s42836-026-00393-8.

ABSTRACT

BACKGROUND: Extensor mechanism disruption following total knee arthroplasty (TKA) significantly impairs knee function and quality of life. Extensor mechanism reconstruction (EMR) is effective but carries risks, including post-operative falls due to persistent quadriceps weakness and extensor lag. We sought out to answer the following four questions: What is the incidence of traumatic events following EMR after TKA using different grafting and reconstruction techniques? Are there significant differences in the rate of traumatic events based on the type of graft used (allograft vs. mesh graft) in EMR? What is the association between post-operative extensor lag and the occurrence of traumatic events in patients who have undergone EMR? Does the use of assistive devices influence the occurrence of traumatic events post-EMR?

METHODS: This retrospective cohort study at an academic center included 41 patients (mean age: 67.8 ± 10.1 years; 61% female) who underwent EMR post-TKA at a single academic center. Reconstructions included allograft (n = 25) and synthetic mesh grafts (n = 16). Patient demographics, ASA Score, type of EMR, and post-operative extensor lag were documented. The primary outcome was the occurrence of traumatic events post-EMR. Statistical analysis involved Fisher’s exact test, with p < 0.05 considered significant.

RESULTS: Of the 41 patients, 16 (39%) experienced post-operative falls leading to traumatic injuries. No significant differences were found in traumatic event rates between the allograft (36%) and mesh graft (43.75%) groups. The mean extensor lag was 7° ± 14°, with no statistically significant association observed between the degree of extensor lag and traumatic events. The use of assistive devices did not significantly influence the occurrence of traumatic events.

CONCLUSION: More than one-third of patients experienced traumatic events following EMR after TKA, highlighting the need for comprehensive post-operative management and patient counseling. The study found no statistically significant association between graft type, extensor lag, or use of assisted devices and the occurrence of these events. Further research is required to understand the risk factors and improve patient outcomes in this clinically challenging domain.

PMID:42219522 | DOI:10.1186/s42836-026-00393-8

J Pharm Health Care Sci. 2026 Jun 1. doi: 10.1186/s40780-026-00590-2. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common surgical complication that delays recovery and increases healthcare costs. Although U.S. guidelines recommend multimodal, risk-stratified prophylaxis, Japan lacks unified national guidelines, resulting in practice variation. Despite expanded insurance coverage for 5-HT₃ receptor antagonists, sustained adherence to best practices requires a multidisciplinary framework. We implemented a pharmacist-led, multidisciplinary PONV prevention protocol and evaluated its impact on PONV incidence among adults undergoing elective surgery across multiple specialties.

METHODS: We developed a pharmacist-led multidisciplinary PONV prevention protocol based on U.S. guideline algorithms, recommending ≥ 2 and ≥3 prophylactic agents for medium- and high-risk patients, respectively. Pharmacists in the admission support center collected preoperative risk factors, while operating room pharmacists relayed assessments to anesthesiologists and nurses. We conducted a retrospective observational study of patients aged ≥ 18 years undergoing elective gastrointestinal or gynecological surgery under general anesthesia. We compared 110 and 255 patients in the pre- and post-intervention groups, respectively, focusing on patients at medium to high risk. For primary analysis, we performed 1:1 propensity score matching (PSM) using five covariates to control for confounding. Conditional logistic regression evaluated intervention effects while accounting for the matched design.

RESULTS: The final analysis included 106 controls and 243 intervention patients. PSM produced 103 well-balanced matched pairs (standardized differences < 0.1). Conditional logistic regression showed that the pharmacist-led intervention significantly reduced PONV occurrence (odds ratio [OR] 0.308, 95% confidence interval [CI], 0.139-0.680). Prophylactic agent use increased significantly after the intervention (OR 3.95, 95% CI 2.43-6.54), with dexamethasone (OR 5.92, 95% CI 3.03-11.60) and 5-HT₃ receptor antagonists (OR 4.98, 95% CI 2.69-9.22) showing the largest increases. Dopamine antagonists and total intravenous anesthesia administration also showed upward trends, though without statistical significance.

CONCLUSIONS: The implementation of a pharmacist-led multidisciplinary PONV prevention protocol was associated with a lower incidence of PONV in medium- to high-risk patients. Pharmacist-conducted preoperative risk assessment improved the implementation of risk-based prophylaxis within a multidisciplinary framework. These findings suggest that pharmacist-driven collaborative approaches may facilitate more consistent PONV prophylaxis in clinical settings lacking unified guidelines.

PMID:42219521 | DOI:10.1186/s40780-026-00590-2

Stat Med. 2026 Jun;45(13-14):e70611. doi: 10.1002/sim.70611.

ABSTRACT

Trials with recurrent event responses are frequently encountered during clinical trials. Benefits have been demonstrated in previous studies when trials were conducted with a doubly biased coin design (DBCD). However, there is a lack of discussion about sample size determination. In this paper, we provide the methods to compute the required sample size with a given test power when DBCD is used. More importantly, our proposed sample size determination procedure also allows unequal follow-up time due mainly to possible patient dropout. Without considering patient dropout, it is shown that the required sample size to reach the prespecified test power is underestimated. Theoretical results are derived to measure the impact of dropouts on the required sample size and treatment allocation proportions. A simulation study is conducted to illustrate the usefulness of our proposed procedure. Finally, a clinical example is used to illustrate the advantages of our proposed procedure in practice.

PMID:42219516 | DOI:10.1002/sim.70611

Res Integr Peer Rev. 2026 Jun 1;11(1):14. doi: 10.1186/s41073-026-00198-y.

ABSTRACT

BACKGROUND: The Patient-Centered Outcomes Research Institute (PCORI) reviews research applications using a process that includes preliminary review by primary reviewers, followed by panel discussion where primary reviewers and other reviewers on the panel (panelists) discuss and score the most competitive applications. PCORI switched from in-person to virtual panel discussions during the COVID-19 pandemic. This study compared reviewers’ scores and perceptions of panel interactions for virtual and in-person review panels and assessed reviewers’ perspectives about virtual panels. PCORI uniquely includes patients and other stakeholders as reviewers alongside scientists; thus, differences between reviewer types were also explored.

METHODS: This observational study utilized repeated cross-sectional data from PCORI funding cycles before and after switching to virtual review, including reviewer score data and closed- and open-ended responses from reviewer surveys. The study team used linear and logistic regression to examine reviewer scores and quantitative survey responses and conducted thematic analysis of open-ended survey responses.

RESULTS: There were no statistically significant differences between in-person and virtual panels in primary reviewers’ post-discussion scores or the magnitude of score change from pre- to post-discussion. In contrast, panelists gave stronger post-discussion scores in virtual panels, and this difference between formats was greater for stakeholder reviewers compared to scientists. Reviewers’ ratings of panel interactions appeared to be similar between formats. While reviewers noted challenges of virtual panels, including challenges related to discussion quality and social interactions, they also noted benefits, such as lack of travel.

CONCLUSIONS: Overall, this study suggests that virtual and in-person review panels were largely comparable on reviewer scores and some key aspects of reviewer experiences in a multi-stakeholder review process. Despite having some challenges, virtual review processes may be a viable approach for funders during times of necessity and beyond. Practical considerations and recommendations for virtual panels are discussed.

PMID:42219512 | DOI:10.1186/s41073-026-00198-y