Nevin Manimala

Womens Health Issues. 2026 Aug 13:S1049-3867(26)00105-2. doi: 10.1016/j.whi.2026.06.010. Online ahead of print.

ABSTRACT

OBJECTIVES: We sought to assess current and former intrauterine device (IUD) users’ interest in and experiences with IUD self-removal and to examine associations between participant characteristics, past experiences with removal, and future interest in self-removal.

STUDY DESIGN: We conducted a cross-sectional follow-up survey of HER Salt Lake participants who had ever used an IUD and consented to follow-up. Participants completed an electronic survey assessing interest in receiving self-removal information, past self-removal attempts and outcomes, and experiences with provider removal. We used descriptive statistics and χ² tests to explore self-removal interest and experiences, and differences in interest by characteristics and past removal experiences.

RESULTS: More than one-half of the 621 participants (57%) expressed an interest in IUD self-removal. Among current IUD users, 49% reported willingness to try self-removal. One in 10 participants had attempted self-removal; 68% were successful and most (61%) reported no problems. Among those who attempted self-removal, the most commonly reported problems were experiencing more pain than they felt comfortable with (21%) and being unable to feel their IUD strings (9%). Participants who faced prior barriers to provider removal, including cost, scheduling delays, discomfort with care, or distrust of the health care system, were more likely to express interest in self-removal (p < .05). Those interested were also more often nulliparous, current IUD users, those not married or cohabitating with their partners, and those who did not identify as heterosexual.

CONCLUSION: In our sample, interest in self-removal was high, and most participants who had attempted self-removal did so successfully and without problems. Providing accessible information about self-removal in preferred formats may help to reduce barriers to IUD discontinuation and support reproductive autonomy.

PMID:42595607 | DOI:10.1016/j.whi.2026.06.010

Chin J Traumatol. 2026 Jun 29:S1008-1275(26)00128-8. doi: 10.1016/j.cjtee.2025.10.008. Online ahead of print.

ABSTRACT

PURPOSE: The ankle is the main interface between the ground and body during ambulation, standing, and any sports exercise. Ankles should be able to absorb impact-loading forces from body weight and exercise pressure, adapt to uneven ground, and allow efficient propulsion. The estimated lifetime incidence of ankle injuries is 1 out of every 10 people. Most ankle injuries occur during sports activities. The epidemiologic trends associated with chronic ankle instability suggest that current rehabilitation approaches may be inadequate. Therefore, it is uttermost important to seek alternative rehabilitation modalities, as the current conventional rehabilitation is not effective.

METHODS: This retrospective study utilized a single-blinded 3-arm parallel-randomized controlled clinical trial to assess the efficacy of various rehabilitation modalities for ankle injuries. Seventy-five participants with ankle injuries were randomly assigned to 1 of 3 groups: a control group receiving standard rehabilitation, a virtual reality (VR) group utilizing VR technology, and a mixed group combining VR with kinesiotape interventions. Each group included 25 participants who underwent 2 weeks of rehabilitation activities specific to their assigned treatment. The single-blinded design ensured that participants were unaware of their treatment assignment, minimizing bias in their responses. This methodology facilitates a comparative analysis of rehabilitation strategies, offering insights into the effectiveness of innovative approaches such as VR and kinesiotaping for ankle injury recovery. The R statistical software was used to complete the analysis. One-way ANOVA analysis was utilized to compare the statistical differences between the 3 groups.

RESULTS: Seventy-five ankle injury patients were recruited, and 96% of them finished the study. The ANOVA results show that ankle injury rehabilitation via VR and/or kinesiotape application had significant effects on reducing ankle pain, ankle edema, and anthropometric measurements compared with the control group. The VR treatment modality has positive effects on reducing the distal edema limb circumference compared to both control and mixed groups at p < 0.05.

CONCLUSION: Physical rehabilitation via immersive VR and/or kinesiotape application is considered the main rehabilitation modality for ankle injury compared to conventional physical rehabilitation.

PMID:42595598 | DOI:10.1016/j.cjtee.2025.10.008

Ultrasound Med Biol. 2026 Aug 13:S0301-5629(26)00294-2. doi: 10.1016/j.ultrasmedbio.2026.07.020. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Accurate quantification of fibroglandular tissue volume (FGV) and the fibroglandular ratio which is the ratio of FGV to the total breast volume (TBV) (FGR = FGV/TBV) is critical for assessment of a patient’s lifetime breast cancer risk and personalized screening strategies. Magnetic resonance imaging (MRI) is considered the research standard for volumetric breast composition analysis but is limited by cost, availability, and contraindications. This study evaluates the capability of quantitative transmission (QT) imaging technology to measure FGV and FGR and compares these results with MRI-derived metrics, establishing quantitative equivalence between the two modalities.

MATERIALS AND METHODS: A retrospective analysis included 53 breasts from 29 women imaged using QT scan and MRI within 30 days as part of the ACCRUE Study (ClinicalTrials.gov NCT03052166). QT data were acquired with the QT Scanner 2000 Model A and reconstructed into 3D speed-of-sound maps and respective reflection maps via a full-wave inverse scattering algorithm. FGV and FGR were computed using a fuzzy c-means segmentation as applied to the quantitative tissue maps. MRI datasets were segmented using a validated template-based method. Statistical comparisons included Pearson correlation (r), intraclass correlation coefficient (ICC), and Bland-Altman analysis.

RESULTS: QT and MRI measurements demonstrated strong correlations for both FGV (r = 0.893) and FGR (r = 0.915, p < 0.0001). Mean biases were -13.2 cm³ for FGV and +12.7% for FGR. Regression slopes were 0.63 and 1.35, respectively, with significant proportional bias for both (p < 0.0001). Systematic differences were consistent with modality-specific contrast mechanisms and field-of-view definitions; the strong correlation and stable, predictable bias support quantitative concordance between the modalities.

CONCLUSION: QT technology provides accurate, reproducible, and volumetric quantification of breast fibroglandular tissue, demonstrating strong concordance with MRI. These results supported FDA clearance of the QT FGR feature, establishing it as a validated quantitative imaging biomarker for clinical breast density assessment.

PMID:42595593 | DOI:10.1016/j.ultrasmedbio.2026.07.020

Surgeon. 2026 Aug 13:S1479-666X(26)00049-1. doi: 10.1016/j.surge.2026.08.002. Online ahead of print.

ABSTRACT

AIMS: Distal radius fractures (DRFs) are prevalent injuries, particularly among the elderly and young active individuals. Recent studies have emphasized the timing of surgical intervention, which may influence complication rates and functional outcomes. While some reviews have found no significant differences in outcomes between early and late surgery, others have suggested benefits from early intervention. Current guidelines from the British Orthopaedic Association Audit Standards for Trauma (BOAST) recommend surgical fixation within specific timeframes, yet optimal timing remains a topic of ongoing debate. This systematic review and meta-analysis aimed to assess the impact of surgical timing on complication rates and functional outcomes in closed DRFs.

METHODS: A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE, and the Cochrane Library, to identify relevant studies. Eligible studies included randomized control trials and observational studies which compared early versus late surgical treatment. Meta-analyses were conducted on pooled data from compatible studies.

RESULTS: Fourteen studies involving 2104 patients were included in this analysis. Meta-analysis revealed late surgical intervention was associated with an 8% increase in complication rates (95% CI 4% to 13%). Functional outcomes demonstrated that early surgery led to improved range of motion in flexion, pronation, and supination; however, no statistically significant differences were observed in extension. Further, Patient-Reported Outcome Measures did not exhibit significant differences between early and late surgical interventions.

CONCLUSION: Early surgical intervention for DRFs is associated with lower complication rates and improved range of motion, however it does not improve patient reported outcomes.

PMID:42595586 | DOI:10.1016/j.surge.2026.08.002

Arch Bronconeumol. 2026 Aug 13:S0300-2896(26)00276-0. doi: 10.1016/j.arbres.2026.07.002. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) predominantly affects older adults. Frailty is increasingly recognized as an important feature of IPF, although its prognostic value remains uncertain. This study aimed to assess the prevalence of frailty and concordance among validated instruments, characterize the principal domains of vulnerability identified through comprehensive geriatric assessment (CGA), and evaluate the prognostic value of integrating frailty with indices of respiratory disease severity in older adults with IPF.

METHODS: We conducted a prospective, single-center study of patients aged 65 years or older with confirmed IPF. Frailty was assessed using the Fried frailty phenotype (FFP), a CGA-derived Frailty Index (CGA-FI), and the Clinical Frailty Scale (CFS). The primary outcome was a composite of all-cause mortality or acute exacerbation during follow-up. Cox proportional hazards models and bootstrap-derived concordance indices were used to evaluate prognostic associations and model discrimination.

RESULTS: Among the 140 patients included, the prevalence of frailty ranged from 16.4% according to the CGA-FI to 22.3% according to the FFP, whereas 19.3% were classified as frail according to the CFS. During a median follow-up of 465 days (IQR, 221-1076 days), 35 patients (25.0%) experienced the composite outcome. Frailty assessed using the CFS (CFS ≥5: HR, 3.94; 95%CI, 1.81-8.58) and a higher Gender-Age-Physiology (GAP) stage (GAP II-III: HR, 3.11; 95%CI, 1.39-7.00) were independently associated with the composite outcome. The integrated GAP-CFS model showed good discrimination, with a bootstrap-derived Harrell C index of 0.72 (95%CI, 0.62-0.81). Patients who experienced events also had higher Strength, Assistance in Walking, Rising From a Chair, Climbing Stairs, and Falls (SARC-F) scores and greater functional impairment.

CONCLUSIONS: Frailty is common and clinically relevant in IPF. Integrating frailty measures with pulmonary indices improves prognostic stratification and supports the use of the CFS and CGA to guide personalized, multidimensional care.

PMID:42595561 | DOI:10.1016/j.arbres.2026.07.002

Zhonghua Zhong Liu Za Zhi. 2026 Aug 23;48(8):1016-1022. doi: 10.3760/cma.j.cn112152-20251121-00580.

ABSTRACT

Objective: To evaluate the efficacy of different chemotherapy regimens in children with high-risk hepatoblastoma (HB). Methods: A retrospective cohort study was conducted on 99 patients under 18 years old with high-risk HB treated at Sun Yat-sen University Cancer Center between December 2004 and July 2024. The patients were divided into three groups: the PLADO regimen (cisplatin in combination with doxorubicin, n=27), the C5VD/IIV regimen (alternating cycles of cisplatin/5-flourouracil/vincristine/doxorubicin with irinotecan/ifosfamide/vincristine, n=29), and the modified SIOPEL-4 regimen (the original SIOPEL-4 regimen with omitted high-dose cisplatin on day15, n=43). Short-term efficacy, adverse effects, and long-term survival were compared among the three groups. Results: The objective response rates for the PLADO, C5VD/IIV, and modified SIOPEL-4 groups were 73.9% (17/23), 70.8% (17/24), and 88.6% (31/35), respectively, with no statistically significant difference among the three groups (P=0.190). The disease control rates were 82.6% (19/23), 83.3% (20/24), and 100.0% (35/35), the 3-year progression-free survival (PFS) rates were 19.2%, 37.0%, and 56.7%, and the 3-year overall survival (OS) rates were 69.2%, 55.6%, and 79.0%, respectively. The modified SIOPEL-4 group showed significantly better disease control rate and PFS rate compared withthe other two groups (both P＜0.05). After merging the PLADO and C5VD/IIV groups, the modified SIOPEL-4 group demonstrated significantly superior PFS and OS rates (both P＜0.05). Conclusions: The efficacy of modified SIOPEL-4 regimen in treating high-risk HB is superior compared with those of PLADO and C5VD/IIV regimens, but there remains room for further improvement in efficacy. Intensifying supportive care and pursuing aggressive local therapies, especially upfront liver transplantation for locally inoperable tumors, may further improve outcomes.

PMID:42595556 | DOI:10.3760/cma.j.cn112152-20251121-00580

Zhonghua Zhong Liu Za Zhi. 2026 Aug 23;48(8):1008-1015. doi: 10.3760/cma.j.cn112152-20250913-00456.

ABSTRACT

Objective: To compare the efficacy and safety of different-sized drug eluting beads preloaded with irinotrcan (DEBIRI) used in transarterial chemoembolization (TACE) as second-line therapy for colorectal cancer liver metastases (CRC-LM). Methods: A retrospective analysis was conducted on 65 patients with CRC-LM who received TACE at Yantai Yuhuangding Hospital from November 2020 to November 2022. All patients had progressed after first-line therapy. After excluding 5 lost-to-follow-up cases, 30 patients treated with 100-300 μm DEBIRI (small-size group) and 30 patients treated with 300-500 μm microspheres (large-size group) were included. Short- and long-term efficacy and adverse reactions were compared between the two groups. Univariate and multivariate Cox regression analyses were performed to identify factors influencing progression-free survival (PFS) and overall survival (OS). Results: In the small-size group, the objective response rates (ORR) at 1, 3, 6, and 12 months after treatment were 56.7%, 50.0%, 40.0%, and 30.0%, respectively, and the disease control rates (DCR) were 93.3%, 90.0%, 80.0%, and 66.7%, respectively. In the large-size group, the ORR at the same time points were 36.7%, 26.7%, 23.3%, and 16.7%, respectively, and the DCR were 86.7%, 76.7%, 76.7%, and 60.0%, respectively. None of the differences between the two groups were statistically significant (all P＞0.05). The median PFS and OS in the small-size group were 15.0 and 26.0 months, respectively, while in the large-size group they were 13.8 and 21.5 months, respectively, with no statistically significant differences between groups (all P＞0.05). The overall incidence of adverse reactions was 76.6% in the small-size group and 70.0% in the large-size group (P=0.559). The incidence of grade ≥3 adverse reactions was 23.3% and 16.7%, respectively (P=0.519). No treatment-related deaths occurred in either group. Multivariate Cox regression analysis showed that Child-Pugh grade, Eastern Cooperative Oncology Group (ECOG) score, and number of liver metastases were independent influencing factors for both PFS and OS. Conclusion: There was no significant difference in efficacy between 100-300 μm and 300-500 μm drug eluting beads preloaded with irinotrcanused in TACE for the treatment of CRC-LM, and both demonstrated good safety profiles.

PMID:42595555 | DOI:10.3760/cma.j.cn112152-20250913-00456

Zhonghua Zhong Liu Za Zhi. 2026 Aug 23;48(8):998-1007. doi: 10.3760/cma.j.cn112152-20251210-00608.

ABSTRACT

Objective: To investigate the clinical value of dynamic monitoring of plasma circulating tumor DNA (ctDNA) in evaluating the efficacy of immunotherapy for esophageal squamous cell carcinoma (ESCC). Methods: Plasma samples were collected at baseline and after every 2-3 treatment cycles from 94 patients with advanced ESCC receiving second-line sintilimab monotherapy in the ORIENT-2 study. Targeted sequencing was performed to analyze somatic variants in ctDNA, and the molecular tumor burden index (mTBI) was calculated to assess dynamic changes in ctDNA. Imaging examinations were conducted synchronously with plasma sample collection, and treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). Results: A total of 614 somatic mutations were detected in 93 eligible baseline plasma samples, with a median of 6 mutations per sample. Missense mutations were the most frequent mutation type. The baseline mutational profile revealed frequently mutated genes including TP53 (82%), CDKN2B (23%), and NOTCH1 (22%). In the 68 patients with both baseline and post-2-cycle plasma samples, no significant changes were observed in the variant allele frequencies (VAFs) of core driver genes before and after treatment (all P＞0.05), and no newly emerged core driver gene mutations were identified. CCND1 copy number variation was associated with shorter progression-free survival (PFS) (HR=1.88, 95% CI: 1.08-3.27), while mutations in other genes, including TP53 and NOTCH1, showed no association with PFS (all P＞0.05). None of the frequently mutated genes were associated with overall survival (OS) (all P＞0.05). Among the 68 patients, 11 (15.9%) achieved ctDNA clearance, none of whom showed tumor progression on concurrent imaging evaluation. The remaining 57 patients had ctDNA that became positive or remained persistently positive, of whom 30 (52.6%) showed tumor progression on imaging, with a statistically significant difference between groups (P=0.002). Compared with patients whose ctDNA became or remained positive, those with ctDNA clearance exhibited significantly delayed tumor progression (HR=2.05, 95% CI: 1.06-3.96), but ctDNA status after 2 cycles did not significantly affect OS (HR=1.38, 95% CI: 0.62-3.09). After 2 cycles of treatment, patients in the low mTBI group had a higher disease control rate (DCR) than those in the high mTBI group [73.5% (25/34) vs. 38.2% (13/34), P=0.007], as well as superior PFS (HR=2.80, 95% CI: 1.65-4.75) and OS (HR=3.54, 95% CI: 1.95-6.42). Dynamic changes in mTBI were highly consistent with concurrent imaging response assessments. The molecular response group had a significantly higher DCR than the non-response group [87.5% (21/24) vs. 42.2% (19/45), P＜0.001], as well as superior PFS (HR=2.39, 95% CI: 1.41-4.06) and OS (HR=2.77, 95% CI: 1.46-5.22). Among 32 patients with stable disease (SD) at the first imaging evaluation after 2 cycles, those in the molecular response group had comparable PFS with the non-response group (HR=1.03, 95% CI: 0.51-2.08, P=0.942), but significantly longer OS (HR=3.12, 95% CI: 1.20-8.06). Conclusion: Dynamic monitoring of the ctDNA-based molecular tumor burden index (mTBI) provides real-time and sensitive molecular information for evaluating the efficacy of immunotherapy in advanced ESCC, demonstrating definite clinical value for personalized treatment management.

PMID:42595554 | DOI:10.3760/cma.j.cn112152-20251210-00608

Zhonghua Yu Fang Yi Xue Za Zhi. 2026 Aug 6;60(8):1357-1363. doi: 10.3760/cma.j.cn112150-20260112-00029.

ABSTRACT

This study aims to explore the clinicopathological and immunological characteristics of Talaromyces marneffei (TM) infection in patients with acquired immunodeficiency syndrome-related diffuse large B-cell lymphoma (AIDS-DLBCL), and to analyze the risk factors and prognostic impact. This study was designed as a retrospective cohort study, clinical data of 73 patients with AIDS-DLBCL admitted to the First Hospital of Changsha from January 2020 to December 2021 were collected and analyzed, and the patients aged 26 to 84 years, including 63 males and 10 females.Patients were divided into a TM infection group (n=17) and a non-TM infection group(n=56) based on the presence or absence of TM infection.The clinical and pathological characteristics as well as therapeutic effects of the two groups of patients were compared using the χ² test and Fisher’s exact test. Survival curves were plotted using the Kaplan-Meier method, and the association between AIDS-DLBCL specific variables and TM infection was analyzed using the binary logistic regression model. The results showed that a total of 73 patients with AIDS-DLBCL were included. Among them, 23.3% had TM infection(17/73). The histopathological examination of biopsy tissues showed that TM appeared as yeast-like round or oval spores under special staining, some of which were sausage-shaped or joint-like, with a septum in the middle, and existed within or outside macrophages. Comparative analysis between the two groups showed that the proportions of patients with HIV-RNA>200 copies/ml [88.24% (15/17) vs. 58.93% (33/56), χ²=4.260, P=0.039], CD4⁺ T cell count<50 cells/μl [41.18% (7/17) vs. 8.93% (5/56), χ²=9.553, P=0.004], occult blood (OB) positivity [47.06% (8/17) vs. 17.86% (10/56), χ²=5.173, P=0.023], and Mycobacterium tuberculosis (MTB) positivity [29.41% (5/17) vs. 3.57% (2/56), Fisher’s exact test, P=0.006] were significantly higher in the TM infection group than in the non-TM infection group, with statistically significant differences between the groups (all P<0.05). Survival curve analysis showed that the 2-year overall survival rate of the TM infection group was significantly lower than that of the non-TM infection group [52.94% (9/17) vs. 92.85% (52/56), χ²=17.670, P<0.001]. The binary logistic regression model analysis showed that CD4⁺T cell count<50 cells/μl (OR=8.29, 95%CI:1.47-46.81), positive tuberculosis (OR=17.70, 95%CI:2.21-148.01), and positive occult blood (OR=5.19, 95%CI:1.14-23.57) were risk factors affecting the occurrence of TM infection in AIDS-DLBCL. In conclusion, CD4⁺ T cell count<50 cells/μl, occult blood positivity, and tuberculosis positivity may be risk factors for TM infection in patients with AIDS-DLBCL.

PMID:42595546 | DOI:10.3760/cma.j.cn112150-20260112-00029

Zhonghua Yu Fang Yi Xue Za Zhi. 2026 Aug 6;60(8):1294-1299. doi: 10.3760/cma.j.cn112150-20250830-00844.

ABSTRACT

Objective: To understand the influencing factors of the second dose of varicella vaccine for children aged 1-12 years in 10 provinces of China. Methods: In December 2022, a multistage random sampling method was employed to recruit children aged 1-12 years who had received one dose of varicella vaccine and their guardians from 180 vaccination clinics in 10 provinces of China. Questionnaire surveys were conducted to collect information on children’s characteristics, guardians’ demographic characteristics, and vaccination status. Chi-square test and multivariate logistic regression were used to identify independent factors associated with receipt of the second dose of varicella vaccine. Compared with children who had received only one dose, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Results: A total of 1 947 questionnaires were included, with 1 081 (55.5%) who received two doses of varicella vaccine. Multivariate logistic regression showed that children whose guardians were aged 30 years or older (OR=1.220, 95%CI: 1.007-1.479), whose guardians were medical professionals (OR=1.457, 95%CI:1.054-2.014), and whose annual household income was 100 000 yuan or more (OR=1.739, 95%CI:1.395-2.168) had a higher proportion of receiving the second dose of varicella vaccine. Conclusion: Among children aged 1-12 years in 10 provinces of China who had received only one dose of varicella vaccine, the proportion of receiving the second dose remains suboptimal. Guardians’ age, occupation, and annual household income might be the main influencing factors.

PMID:42595537 | DOI:10.3760/cma.j.cn112150-20250830-00844