Nevin Manimala

J Hand Surg Asian Pac Vol. 2026 May 12. doi: 10.1142/S2424835526500244. Online ahead of print.

ABSTRACT

Background: Although ultrasonography is useful for assessing soft-tissue injuries, its role in classifying tendinous mallet injuries remains underdefined. This study aimed to propose a modified ultrasonographic classification system that combines Wang’s classification with additional subtypes emphasising lateral band involvement to improve diagnostic accuracy and prognostic assessment. Methods: A retrospective cross-sectional study was performed on 36 patients with acute closed tendinous mallet injuries of the fingers. All patients underwent ultrasonographic evaluation. Based on the modified classification, Wang Type B was subdivided into Subtype B1 (complete terminal tendon rupture) and Subtype B2 (rupture of either the radial or ulnar slip of the lateral band). Clinical outcomes were recorded at a minimum of 4 months of follow-up. Data on pinch strength, pain, extension lag and functional scores were analysed to compare outcomes across the three injury types. Results: Fifteen Type B1, eight Type B2, and 13 Type C injuries were identified. In all types, as the length of the injured tendon increased, pinch strength relative to the contralateral side was significantly weaker. Additionally, the injured tendon was significantly longer in Type C injuries than in Type B1 and B2 injuries. As the length of the injured tendon increased, pinch strength relative to the contralateral side decreased across all injury types. Nevertheless, the pain score, functional score and initial extension lag did not show statistically significant variations amongst injury types. Crawford criteria showed that Types B2 and C injuries were mostly graded as ‘excellent’ or ‘fair’, whereas Type B1 injuries were more often classified as ‘poor’ or ‘fair’. Conclusions: The modified ultrasonographic classification provides a more detailed framework for assessing tendinous mallet injuries by integrating Wang’s classification and distinguishing partial lateral band ruptures. This approach enhances diagnostic precision and may improve functional prognostication. Level of Evidence: Level IV (Diagnostic).

PMID:42117206 | DOI:10.1142/S2424835526500244

Australas J Dermatol. 2026 May 12. doi: 10.1111/ajd.70138. Online ahead of print.

ABSTRACT

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting over 200 million people globally. Emerging IL-4Rα-targeted monoclonal antibodies have demonstrated strong efficacy and safety in clinical trials, warranting comparison with dupilumab, the current systemic standard. This meta-analysis synthesises available evidence on their efficacy and safety. PubMed, Embase and Cochrane Library were systematically searched in April 2025 for randomised controlled trials (RCTs) comparing IL-4Rα-targeting monoclonal antibodies versus placebo in moderate-to-severe AD, with EASI-75 as the primary outcome. Non-RCTs and trials using concomitant corticosteroids were excluded. Risk of bias was assessed using the Cochrane RoB-2 tool. Analyses were performed in R (v4.5.0), with heterogeneity evaluated by Cochran Q and I² statistics. Nineteen RCTs comprising 4465 patients met inclusion criteria. At week 16, IL-4Rα inhibitors showed sustained efficacy across EASI-50/75/90, IGA 0/1 and pruritus reduction. Dupilumab remained the most validated agent, with durable effects, low heterogeneity and favourable safety. Among novel biologics, stapokibart and rademikibart demonstrated the most promising results, achieving superior EASI-90 and ≥ 4-point PP-NRS responses: stapokibart (OR 4.94; 95% CI 3.20-7.61) and rademikibart (OR 4.61; 95% CI 1.68-12.65), though the latter showed higher odds of adverse events. Other agents (MG-K10, GR1802, 611, AK120) provided encouraging but limited data. IL-4Rα inhibitors represent effective and safe therapies for moderate-to-severe AD. Dupilumab remains the reference standard, while stapokibart and rademikibart emerge as promising next-generation options. Further large, long-term, head-to-head RCTs are warranted to confirm their comparative performance. PROSPERO Registration: CRD420251129343.

PMID:42117199 | DOI:10.1111/ajd.70138

Psychometrika. 2026 May 12:1-22. doi: 10.1017/psy.2026.10109. Online ahead of print.

ABSTRACT

Large-scale assessment data typically include numerous variables, often affected by missing values. Motivated by the challenges arising in this framework, we extend the knockoffs method for selecting predictors to settings with missing values. Our proposal relies on a preliminary phase of multiple imputation (MI) of missing values. Each imputed dataset is then processed using a suitable knockoff filter. We evaluate the performance of the proposed method through simulation studies, showing satisfactory results consistent with a recently advocated cutting-edge method. We apply the method to large-scale assessment data collected by INVALSI on test scores of Italian students in grade 5, including many background variables. This case study is challenging, as most predictors have unordered categories, a setting not considered by traditional knockoff methods. In addition, some of the key predictors are affected by missing values. Our proposal to implement the knockoffs method within an MI framework is feasible, flexible, and effective.

PMID:42117181 | DOI:10.1017/psy.2026.10109

J Korean Med Sci. 2026 May 11;41(18):e81. doi: 10.3346/jkms.2026.41.e81.

ABSTRACT

BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) is a common but serious opportunistic infection after allogeneic hematopoietic cell transplantation (HCT). The preferred regimen for PJP prophylaxis is trimethoprim-sulfamethoxazole (TMP-SMX), but TMP-SMX can delay engraftment and has some toxicities. This study retrospectively analyzed the efficacy and safety of aerosolized pentamidine (AP) as an alternative to TMP-SMX for PJP prophylaxis after allogeneic HCT.

METHODS: One hundred and fifty-five patients received AP and 86 patients received TMP-SMX. Pentamidine isethionate 300 mg was nebulized every 4 weeks and double-strength TMP-SMX was administrated once-daily and 2 days per week.

RESULTS: Incidences of suspicious PJP and confirmed PJP were not statistically different between two groups (suspicious PJP, 4.5% vs. 3.5%, P = 1.000; confirmed PJP, 0.6% vs. 0.0%, P = 1.000). There were fewer adverse reaction in AP group than TMP-SMX group (10.3% vs. 26.7%, P < 0.001). Only 1 patient (0.6%) discontinued prophylaxis due to adverse reaction in AP group, while 17 patients (19.8%) in TMP-SMX group discontinued prophylaxis due to adverse reaction (P < 0.001). There was more incidence of graft failure in TMP-SMX group and the incidence of prolonged thrombocytopenia was significantly higher in TMP-SMX group. There was no deterioration of lung function in patients received AP prophylaxis.

CONCLUSION: In conclusion, AP is well tolerated without severe adverse events and effective in preventing PJP after allogeneic HCT.

PMID:42117147 | DOI:10.3346/jkms.2026.41.e81

J Multidiscip Healthc. 2026 May 5;19:578782. doi: 10.2147/JMDH.S578782. eCollection 2026.

ABSTRACT

OBJECTIVE: To assess the current level of knowledge, attitudes and practices (KAP) regarding Lewy Body dementia (LBD) among staff of all grades within long-term care (LTC) facilities.

METHODS: An anonymous online survey was developed, consisting of three sections assessing demographics, LBD knowledge, attitudes and practices. Questions were informed by analogous studies and were adapted following a trial phase. The survey was disseminated to all grades of staff members working in LTC facilities across the Republic of Ireland. Descriptive and inferential statistics are used to examine participant knowledge and attitudes, while a multivariable regression analysis is run to examine the drivers of knowledge.

RESULTS: 8.7% of people working in LTC facilities had never heard of LBD before. Staff in management positions and activity coordinator positions had a higher LBD knowledge score in comparison to non-clinical staff. Directors of nursing (DONs), assistant directors of nursing (ADONs) and clinical nurse managers (CNMs) were able to name more than one dementia subtype more frequently than other staff members. Vascular dementia was the most known dementia subtype outside of Alzheimer’s disease (AD). Activity coordinators and directors of nursing reported a higher level of comfort caring for residents with LBD, were more satisfied in their job role, and felt sufficiently trained to care for residents with different types of dementia. Over 75% of respondents were willing to undergo specialised LBD training.

CONCLUSIONS AND IMPLICATIONS: The findings support further role-specific, and practical LBD training for all LTC staff. Interdisciplinary training and knowledge-sharing across job roles may enhance team cohesion, and the willingness of staff to engage in training is promising.

PMID:42117116 | PMC:PMC13157695 | DOI:10.2147/JMDH.S578782

J Multidiscip Healthc. 2026 May 5;19:602533. doi: 10.2147/JMDH.S602533. eCollection 2026.

ABSTRACT

INTRODUCTION: Early identification of high-risk trauma patients in the prehospital setting is critical for optimizing emergency care and improving outcomes, particularly in resource-limited systems.

PURPOSE: To determine the 24-hour mortality rate and identify clinical predictors and resuscitative care indicators associated with early mortality among adult major trauma patients transported by emergency medical services (EMS) in Thailand.

METHODS: A retrospective registry-based cohort study included adult patients (≥18 years) with major trauma transported by EMS to a tertiary trauma center in Bangkok between January 2019 and December 2024. Eligible patients were classified under Thailand Emergency Medical Triage Protocol symptom groups 21-25 with red-level severity. Data were obtained from an EMS-based trauma registry integrating prehospital and early in-hospital variables. The primary outcome was all-cause mortality within 24 hours of hospital arrival. Survival was analyzed using Kaplan-Meier methods, and predictors were identified using multivariable flexible parametric survival models.

RESULTS: Among 197 patients, the 24-hour mortality rate was 25.9% (95% CI: 20.3-32.6). Severe neurological impairment (Glasgow Coma Scale 3-8) was independently associated with mortality (adjusted hazard ratio [aHR] 3.72, 95% CI: 1.56-8.87). Resuscitative care indicators, including chest tube insertion (aHR 6.82, 95% CI: 3.23-14.39) and central venous catheter placement (aHR 2.50, 95% CI: 1.21-5.17), were also associated with mortality and likely reflect underlying injury severity and physiological instability rather than direct causal effects. The model demonstrated good discrimination (C-statistic 0.848) and calibration.

CONCLUSION: One in four adult major trauma patients transported by EMS died within 24 hours of hospital arrival. Early mortality was associated with both clinical severity and resuscitative care indicators. These findings support the use of routinely available clinical variables to identify high-risk patients and inform early triage and escalation of care, while emphasizing cautious interpretation of care-related variables as markers of severity rather than modifiable risk factors.

PMID:42117115 | PMC:PMC13157350 | DOI:10.2147/JMDH.S602533

Allergol Immunopathol (Madr). 2026 May 1;54(3):17-23. doi: 10.15586/aei.v54i3.1564. eCollection 2026.

ABSTRACT

PURPOSE: House dust mite (HDM) allergy is a common cause of allergic rhinitis (AR) and allergic asthma (AA). Interleukin-27 (IL-27) is known to suppress Th2-mediated inflammation, a key driver of these diseases. This study aimed to assess regional sensitization to Dermatophagoides subspecies and to investigate the association between HDM-specific IgE responses and serum IL-27 levels.

METHODS: Fifty-eight children with HDM allergy were evaluated, of whom 53 were sensitized to D. Pteronyssinus. Serum Der p 1/Der p 2 specific IgE (sIgE) (FEIA) and IL-27, IL-5, and IL-13 levels (ELISA) were measured. Twenty-five healthy children served as controls.

RESULTS: Among patients (43% AR, 57% AA), Der p 1 and Der p 2 sensitization rates were 49% and 55%, respectively. Both Der p 1/Der p 2 sIgE levels were significantly elevated compared to controls (p < 0.001). Although IL-27 levels were lower in patients, the difference was not statistically significant (p = 0.98). However, IL-27 showed positive correlations with IL-5, IL-13, and Der p 1 sIgE (all p < 0.05). IL-27 levels were unexpectedly higher in Der p 1-sensitized patients (p = 0.006), particularly in AR (p = 0.02; r = 0.43), but not in AA.

CONCLUSIONS: This is the first clinical study to investigate the relationship between IL-27 and HDM-sIgE in children and to demonstrate a phenotype-specific interaction. IL-27 may act as a context-dependent immunomodulator rather than a simple Th2 suppressor. The positive correlation between IL-27 and Der p 1 sIgE in AR patients may indicate a compensatory feedback mechanism triggered by allergen-specific inflammation.

PMID:42115790 | DOI:10.15586/aei.v54i3.1564

Diabetes Obes Metab. 2026 May 11. doi: 10.1111/dom.70868. Online ahead of print.

ABSTRACT

AIMS: To evaluate the impact of long-term glycemic exposure and control status on cognitive function in older adults.

MATERIALS AND METHODS: Using repeated measurements of fasting blood glucose (FBG) from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project, we calculated 10-year time-weighted cumulative fasting blood glucose (cumFBG) and glycemic variability, and identified FBG trajectories using group-based trajectory modelling among 26 108 participants. In addition, diabetic patients were categorized as consistently controlled or not according to long-term FBG levels. Mini-Mental State Examination was used to evaluate global and domain-specific cognition, and cognitive impairment was defined according to education-specific cutoffs. Linear and logistic regression models were applied to assess associations between FBG-related indicators and cognition.

RESULTS: CumFBG was nonlinearly associated with global cognition and cognitive impairment (both P_{for nonlinearity} < 0.05). Compared with participants with cumFBG < 900 mg/dL × year, those with cumFBG ≥ 1260 mg/dL × year had a 0.091-point lower z-standardized global cognitive score (95% CI: -0.142, -0.040) and a 3% increased cognitive impairment risk (OR: 1.030; 95% CI: 1.010, 1.050). Among specific domains, attention appeared more susceptible, with declines emerging when cumFBG ≥ 900 mg/dL × year. Notably, among individuals with cumFBG ≥ 1260 mg/dL × year, increasing trajectory had a 21.2% increased cognitive impairment risk (OR: 1.212; 95% CI: 1.122, 1.310). Higher variability was associated with worse cognition. Furthermore, only diabetic participants with consistent control exhibited cognition comparable to those without diabetes.

CONCLUSION: Elevated cumFBG, especially in an increasing pattern, influenced cognition in older adults and sustained glycemic control appeared to mitigate these adverse impacts.

PMID:42115763 | DOI:10.1111/dom.70868

NPJ Precis Oncol. 2026 May 11. doi: 10.1038/s41698-026-01472-4. Online ahead of print.

ABSTRACT

Accurate prediction of recurrence risk is essential to devise effective and personalized treatment strategies for patients with soft tissue sarcoma (STS). This study aimed to develop and validate a multimodal deep learning framework that integrates clinical features, preoperative MR images, and hematoxylin and eosin-stained whole slide images (WSIs) to predict recurrence in patients with STS. A total of 323 patients with STS were retrospectively enrolled from two hospitals, serving as development and validation sets, respectively. The ShuffleNetV2 network was utilized to develop patch-level and WSI-level signatures. A convolutional neural network fusing the channel and spatial attention mechanisms was used to develop a radiology signature. The combined model was built by integrating clinical features, radiology signature score, and WSI-level signature score with Cox regression analysis. The combined model demonstrated superior performance in the validation set, achieving a C-index of 0.857 and a time-dependent area under the curve of 0.959. Class activation maps facilitated the monitoring of suspected regions to inform recurrence decisions. The recurrence-free survival times of the low- and high-risk cohorts were statistically different (p < 0.05). The proposed multimodal framework offers satisfactory accuracy for predicting recurrence risk in patients with STS and could guide the choice of treatment modality.

PMID:42115754 | DOI:10.1038/s41698-026-01472-4

Sci Rep. 2026 May 11. doi: 10.1038/s41598-026-52492-w. Online ahead of print.

ABSTRACT

This paper presents a statistical framework for early warning change-point detection in electrical grid frequency time series. Frequency deviations outside the tolerance band of 49.85-50.15 Hz are treated as error events. A high-volatility (HV) measure is computed using a rolling-window approach and compared against a Hoeffding-bound threshold to identify significant transitions that may precede hazardous excursions. A dataset of 1250 error-event sequences collected over six months is divided into training (34%), validation (33%), and testing (33%) subsets. To improve efficiency, k-means clustering and dynamic time warping (DTW) are used to select representative training sequences, and a mapping-with-regression procedure is applied to generate warning signals. Experimental results show that the proposed method achieves 98.04% accuracy and an F1-score of 98.06%, while maintaining a false-negative rate of 1.1%. Lead-time evaluation confirms consistent early detection, and baseline comparison against deep learning approaches, demonstrates competitive performance with low computational cost.

PMID:42115751 | DOI:10.1038/s41598-026-52492-w