Nevin Manimala

Phys Imaging Radiat Oncol. 2026 Feb 11;37:100923. doi: 10.1016/j.phro.2026.100923. eCollection 2026 Jan.

ABSTRACT

BACKGROUND AND PURPOSE: Adaptive radiotherapy (ART) manages anatomical variations through real-time plan adjustments. Herein, we aimed to evaluate the efficacy of ART in improving target coverage and reducing organ-at-risk (OAR) irradiation doses in cervical cancer.

MATERIALS AND METHODS: A prospective single-arm study enrolled 15 patients with cervical cancer. Participants received definitive chemoradiotherapy (45-50 Gy/25Fractions) using cone-beam computed tomography-guided online ART workflow. Endpoints included geometric miss volume (target volume underdosed), planning target volume (PTV) coverage (V_100%), OAR sparing (generalized equivalent uniform dose [gEUD] and normal tissue complication probability [NTCP]), and dose homogeneity/conformity parameters (coefficient of variation [CV], Paddick Index [PI]). Mixed-effects models compared ART and simulated image-guided radiotherapy (IGRT) plans, with Wilcoxon signed-rank and Mann-Whitney U tests for statistical analysis.

RESULTS: Among 375 adaptive sessions, ART outperformed IGRT, reduced geometric miss volume by 85.1% (0.28 cm³ vs. 1.88 cm³; P < 0.001) and achieved V_100% ≥ 99% in 99.2% of fractions (vs. 75.0% with IGRT; P < 0.001). ART improved PTV dose homogeneity (median CV: -0.29% vs. 3.89%; P < 0.001) and conformity (median PI: 0.75 vs. 0.60; P < 0.001). Additionally, ART reduced rectum gEUD by 4.39% (P < 0.001) and NTCP by 52.27% (P < 0.001), with similar benefits for other OARs (P < 0.001). ART maintained robustness against intrafractional anatomical changes, with minimal target coverage loss and stable OAR doses despite bladder/rectum volume fluctuations. Patients exhibited 100% complete response and mild acute side effects (no grade ≥ 3 enteritis; no cystitis).

CONCLUSIONS: Online ART with 3-mm isotropic margins is feasibile for cervical cancer, achieved high target coverage while reduced OAR doses and NTCP.

PMID:41732733 | PMC:PMC12925179 | DOI:10.1016/j.phro.2026.100923

PeerJ. 2026 Feb 19;14:e20779. doi: 10.7717/peerj.20779. eCollection 2026.

ABSTRACT

BACKGROUND: Mexico has high levels of adolescent obesity (40.4%), with an increase from 17.6 to 18.1% between 2020 and 2023. Technological advancement and early access to electronic devices and video games after the COVID-19 pandemic, along with morbid lifestyles, contribute to this problem.

OBJECTIVE: To determine the association between video game use, lifestyle, and obesity in adolescents.

METHODS: A cross-sectional, analytical study was conducted. Subjects with and without video game use and percentiles >5 and <95 were included. Those with metabolic, hormonal, neurological, and autoimmune diseases were excluded. Questionnaires were administered regarding lifestyle and video game use. A multiple binary logistic regression model including the variables male sex, morbid lifestyle, video game use, and physical inactivity was developed, yielding exponential B coefficients, 95% CI, and p-values.

RESULTS: Of 272 subjects, males predominated with 51.8%, and obesity of 75.7%. The use of video games and morbid lifestyle showed an OR 10.67 (95% CI [5.33-20.58]) and 3.55 (95% CI [1.99-6.36]), respectively. In the adjusted model, the use of video games and physical inactivity obtained an exponential of B of 6.89 (95% CI [3.17-14.94]) and B of 3.12 (95% CI [1.49-6.50]).

CONCLUSIONS: The importance of family physician intervention on obesogenic factors in adolescents and their families to reduce the risk of harmful behaviours by promoting physical activity and a healthy lifestyle.

PMID:41732729 | PMC:PMC12925410 | DOI:10.7717/peerj.20779

PeerJ. 2026 Feb 19;14:e20554. doi: 10.7717/peerj.20554. eCollection 2026.

ABSTRACT

The way people perceive health risks is often assumed to influence how they adopt precautionary measures. However, people’s assessment of a given phenomenon’s risk may vary over time, and the relationship between perceived risk and compliance with protective measures may be dynamic and bi-directional. We measured the perceived risk of COVID-19 and compliance with infection control measures for a large representative sample at four time-points during the first year of the COVID-19 pandemic in Norway. We employed a cross-lagged panel analysis to investigate both the cross-sectional and the temporal association between perceived risk and compliance. We found cross-sectional associations between perceived risk and compliance at one of the time points. There were no temporal associations between risk at one time-point and compliance at the subsequent time-point. Neither was compliance associated with risk at the subsequent time-point. The results suggest that the relationship between perceived risk and compliance with COVID-19 infection control measures is negligible and stable over time. A multiverse analysis showed that the absence of a relationship between perceived risk and compliance was robust to different operationalizations of perceived risk. This highlights the need for a nuanced understanding of how risk perceptions impact behavior during a pandemic.

PMID:41732725 | PMC:PMC12925416 | DOI:10.7717/peerj.20554

Crit Care. 2026 Feb 23. doi: 10.1186/s13054-026-05867-4. Online ahead of print.

ABSTRACT

BACKGROUND: The role of Enterococcus spp. and the need for specific anti-Enterococcus therapy in Intensive Care Unit (ICU) patients with peritonitis remain debated.

METHODS: We conducted a retrospective multicentre cohort study including all consecutive adults admitted to the ICUs of four hospitals in western France with peritonitis between 2020 and 2022. Outcomes were compared according to Enterococcus spp. isolation and, among Enterococcus-positive cases, according to early administration (< 48 h) of active antimicrobial therapy. Propensity-weighted Cox models were used to estimate 90-day survival.

RESULTS: Among 392 patients, Enterococcus spp. were isolated in 161 (41.1%). Enterococcus-positive patients were older and more frequently had postoperative and diffuse peritonitis. ICU mortality rates were 29.8% vs 28.1% in patients with and without Enterococcus infection (p = 0.805). In multivariable analysis, postoperative peritonitis (aOR 2.56 [1.67-3.95], p < 0.001), diffuse peritonitis (aOR 1.78 [1.10-2.89], p = 0.020) and solid organ transplantation (aOR 5.82 [1.18-28.76]; p = 0.031) were independently associated with Enterococcus isolation. Among the 155 patients with documented Enterococcus peritonitis and available antimicrobial treatment data, 95 (61%) received early active therapy. Early anti-Enterococcus treatment was not associated with improved 90-day survival either in the raw population (HR 0.71 [95% CI 0.39-1.27]; p = 0.241) or after weighted Cox regression (HR 0.66 [95% CI 0.37-1.18]; p = 0.160).

CONCLUSIONS: Enterococcus spp. isolation appears common in ICU peritonitis but not independently associated with higher mortality. Early targeted antimicrobial therapy was not associated with a statistically significant improvement in outcomes.

PMID:41731517 | DOI:10.1186/s13054-026-05867-4

BMC Med. 2026 Feb 24. doi: 10.1186/s12916-026-04700-7. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults (> 65 years) residing in long-term care facilities (LTCFs) are at elevated risk of severe outcomes from respiratory infections. Infections often remain undetected or present atypically in this population, leading to underdiagnosis. Our study aimed to estimate the respiratory virus infection burden, independent of symptom presentation, among older adults in Swedish LTCFs in the post-pandemic period (2021-2024).

METHODS: We leveraged capillary blood samples and coupled national registry data from 1622 LTCF residents (median age = 87). A multiplex platform was used to quantify antigen-specific IgG and IgM responses to RSV (pre-/post-F, strain A-specific G-protein), influenza-A (H1N1 and H3N2 HA), influenza-B (HA) and SARS-CoV-2 (spike). Linear mixed-effects models were used to demonstrate the dynamics of antibody levels over time, adjusted for age, sex and comorbidities.

RESULTS: RSV-specific antibody responses peaked in spring 2022 (p < 0.001), suggesting an impact of relaxed COVID-19-related restrictions on RSV exposure at LTCFs. RSV-specific antibodies subsequently declined over time until an increase during autumn 2023 (p < 0.001). Geographic variation in pre-F antibody levels suggested localised RSV outbreaks. The total estimated RSV burden at LTCFs was markedly higher than official reports of the Swedish Public Health Agency. Influenza antibody dynamics reflected seasonal trends and were strongly influenced by annual vaccination. A random forest classifier incorporating serological profiles with demographics, location and comorbidities significantly outperformed a model without serological data (AUC-ROC = 0.67 vs. 0.58), although discriminatory performance remained modest. Higher levels of RSV pre-F antibodies in autumn 2021 were associated with increased one-year mortality in logistic regression (OR = 1.43, p = 0.024). Exploratory survival analysis indicated a trend that elevated levels of RSV pre-F antibodies during low population immunity may confer a transiently elevated early hazard of death, although this did not reach statistical significance (HR = 4.50, p = 0.087).

CONCLUSIONS: We observed substantial respiratory virus circulation among older adults in Swedish LTCFs and show that RSV burden is under-reported. The results highlight a need for further research into the role of RSV pre-F antibody levels in preventing severe outcomes, potentially via vaccination of LTCF residents. Our scalable serological surveillance system is a valuable approach to detect respiratory infections in LTCFs, independent of symptom presentation or healthcare-seeking behaviour.

PMID:41731510 | DOI:10.1186/s12916-026-04700-7

BMC Womens Health. 2026 Feb 24. doi: 10.1186/s12905-026-04347-9. Online ahead of print.

NO ABSTRACT

PMID:41731481 | DOI:10.1186/s12905-026-04347-9

BMC Musculoskelet Disord. 2026 Feb 23. doi: 10.1186/s12891-026-09544-z. Online ahead of print.

ABSTRACT

BACKGROUND: The proximal femur is a common site for benign bone tumors and tumor-like lesions, which often lead to pathological fractures and structural instability. However, these lesions are highly heterogeneous, and in some cases, conventional internal fixation cannot adequately meet surgical requirements. Currently, there is no consensus on the optimal surgical strategy for such conditions. This study aimed to evaluate whether a lesion-categorization-based surgical approach could improve postoperative functional recovery and to explore the feasibility of joint-preserving treatment in cases with severe structural destruction.

METHODS: A retrospective analysis was conducted on 100 patients who underwent surgical treatment for benign tumors of the proximal femur between 2020 and 2024. Tumors were classified based on lesion location, size, extent of femoral head destruction, and the presence of deformities. Surgical strategies were selected according to this classification. Postoperative function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. A Bayesian linear regression model and intergroup comparisons were employed to evaluate the impact of the classification on clinical outcomes.

RESULT: In this study, a modified surgical strategy was proposed to categorize benign proximal femoral bone lesions into five types, with corresponding surgical strategies developed for each type. Type 1 and 2 lesions were characterized by mild cortical involvement and relatively stable structures suitable for curettage, bone grafting, with or without internal fixation. Type 3-5 showed progressive bone loss and deformity requiring limited internal fixation combined with external fixation (LIFEF), corrective osteotomy, or endoprosthetic replacement (EPR). The cohort had a mean age of 37.3 years (range 17-69) and a mean follow-up duration of 25.0 ± 14.9 months (range 3-54 months). The MSTS-93 score at the final follow-up was 26.1 ± 1.0. Bayesian analysis revealed statistically credible differences in postoperative MSTS scores among the three groups: Type 1, Type 2, and “Other types” (Types 3-5). The overall complication rate was 5%, including mild limping, transient pain, and mild avascular necrosis.

CONCLUSIONS: The lesion-categorization-based surgical strategy provides a practical and effective framework for managing benign tumors of the proximal femur. This approach optimizes postoperative functional recovery, supports joint preservation where feasible, and may serve as a reference for standardized surgical decision-making.

LEVEL OF EVIDENCE: IV; Retrospective observational study.

PMID:41731472 | DOI:10.1186/s12891-026-09544-z

BMC Pregnancy Childbirth. 2026 Feb 23. doi: 10.1186/s12884-026-08818-7. Online ahead of print.

ABSTRACT

BACKGROUND: Gestational diabetes mellitus (GDM) may be associated with occult abnormalities in choroidal microcirculation.This study utilizes ultra-widefield swept-source OCTA (SS-OCTA) and introduces the three-dimensional choroidal vascularity index (3D-CVI) as a volumetric quantitative parameter to systematically characterize the choroidal microcirculatory characteristics in GDM.

METHODS: This cross-sectional study utilized SS-OCTA with a 24 × 20 mm scan range. A 3 × 3 grid (9 regions) was applied to assess an effective area of interest measuring 17 × 17 mm. Built-in automated algorithms quantified choriocapillaris plexus vascular density (CCP VD), 3D-CVI, and choroidal thickness (CT). Statistical analyses included one-way ANOVA and general linear models, with Pearson/Spearman correlation for association analysis.

RESULTS: 138 women were enrolled (n = 46/group), comprising the GDM, pregnant controls (PC), and non-pregnant controls (NC), with mean ages of 31.98 ± 4.43, 30.74 ± 3.66, and 31.00 ± 4.26 years.Significant differences were observed in macular grid CCP VD among the three groups (46.26 ± 1.41%, 46.28 ± 1.43%, and 45.41 ± 1.85%; P = 0.012), after adjusting for age and axial length(AL), at Age = 35.38 years, GDM was higher than both PC and NC (P = 0.005,P < 0.001), and PC was higher than NC (P = 0.033). In pregnancy, GDM showed significantly higher macular grid CCP VD than PC at longer AL (AL = 23.98 mm, P = 0.015). For 3D-CVI, significant differences were found in the macular grid (40.37 ± 3.30%,41.50 ± 3.23%,41.96 ± 2.70%,P = 0.043)/nasal-superior(39.59 ± 2.90%,40.65 ± 2.69%,41.43 ± 2.71%;P = 0.007);After adjustment, GDM remained lower than NC at the mean age level(macular grid: P = 0.047; nasal-superior: P = 0.012), while GDM and PC showed no significant difference.No significant differences were found in CT across regions (all P > 0.05).Correlation analysis showed inverse associations of age with mean CCP VD, 3D-CVI, and CT (r = – 0.56/-0.49/-0.47,all P < 0.05). Gestational age was negatively correlated with CCP VD and CT (r = – 0.46/-0.23,all P < 0.05). AL, mean ocular perfusion pressure, fasting plasma glucose, and glycated hemoglobin showed no significant correlations ( all P > 0.05).

CONCLUSIONS: Macular grid CCP-VD increased overall in pregnancy versus NC.In pregnancy, GDM exceeded PC at higher age or AL.3D-CVI differed only in macular grid and nasal-superior, lower in GDM than NC yet not from PC.Given the structural differences between mild-to-moderate GDM and PC may be subtle.3D-CVI may serve as an auxiliary indicator for regional choroidal remodeling, and combined with CCP, it can comprehensively assess the choroidal pathophysiology in GDM.Longitudinal gestation-to-postpartum follow-up is needed.

PMID:41731441 | DOI:10.1186/s12884-026-08818-7

BMC Palliat Care. 2026 Feb 23. doi: 10.1186/s12904-026-02014-2. Online ahead of print.

ABSTRACT

BACKGROUND: Despite major advances in neonatal intensive care, mortality in neonatal intensive care units (NICUs) remains a persistent reality. Most deaths now occur after withholding or withdrawing life-sustaining therapies (WWLST), yet some remain sudden or unanticipated. Understanding how and under which circumstances infants die is essential to improving anticipatory communication, ethical consistency, and family-centered support in neonatal end-of-life (EOL) care.

METHODS: We conducted a retrospective study including all infants who died in the tertiary NICU of Montpellier University Hospital, France, between May 2022 and May 2025. Demographic, perinatal, clinical, and end-of-life data were extracted from medical records. Deaths were classified as anticipated (following WWLST) or unanticipated (without WWLST). Statistical comparisons explored factors associated with unanticipated deaths.

RESULTS: Among 870 NICU admissions, 105 infants (12%) died. Mortality was concentrated in three groups: very premature infants (< 29 weeks’ gestation, 55%), infants with severe congenital or early-onset conditions (26%), and those with hypoxic-ischemic encephalopathy (19%). Seventy-six infants (72%) died after a WWLST decision-most often for poor neurological prognosis or perceived futility of care-whereas 23 (22%) died without a prior WWLST decision. Unanticipated deaths were mainly associated with multi-organ failure (≥ 3 organs 65% vs 40%; p=0.02), predominantly cardiovascular or respiratory failure, shorter illness trajectories (1 vs 6.5 days from complication to death; p<0.01), and reduced parental presence during EOL care (52% vs 80%; p<0.01), including fewer opportunities for parents to be present and to hold their infant at the time of death.

CONCLUSIONS: In this tertiary NICU, most deaths were anticipated and occurred following structured WWLST processes. Unanticipated deaths primarily reflected rapid clinical deterioration and were associated with more abrupt and less family-centered end-of-life circumstances. These findings underscore the importance of early recognition of dying trajectories and timely multidisciplinary discussions to support anticipatory, compassionate, and parent-centered end-of-life care in the NICU. Strengthening education in neonatal ethics and palliative care may foster more consistent, compassionate, and anticipatory EOL practices.

PMID:41731424 | DOI:10.1186/s12904-026-02014-2

BMC Med Imaging. 2026 Feb 23. doi: 10.1186/s12880-026-02240-3. Online ahead of print.

ABSTRACT

PURPOSE: To construct a radiomics nomogram model predicting the status of lymphovascular tumor embolus (LTE) in patients with lung invasive adenocarcinoma (LAC).

MATERIALS AND METHODS: This retrospective analysis enrolled 195 patients with pathologically-confirmed LAC, treated at Weifang People’s Hospital between January 2018 and April 2021, including 152 and 43 cases in the LTE and non-LTE groups, respectively. Regions of interest were manually delineated on preoperative CT images using 3D slicer. Subsequently, 850 radiomics features were extracted and subjected to feature reduction through least absolute shrinkage and selection operator regression. The effectiveness of the predictive model was evaluated using receiver operating characteristic curves, calibration, and decision curve analysis. The log-rank test was applied to data split into low-score and high-score groups to analyze early recurrence-free survival based on the optimal cutoff value established in the mixed model.

RESULTS: Five identified feature parameters were applied to establish a rad-score. Hybrid prediction model integrating smoking status and radiomics signature demonstrated better predictive efficacy than the radiomics models in the training cohort (area under the curve [AUC], 0.9210 vs. 0.8781) and validation cohort (AUC, 0.8807 vs. 0.8770), although without reaching statistical significance. The calibration curves of the nomogram illustrated the goodness-of-fit to predict LTE status in both cohorts. Kaplan-Meier survival curve analysis demonstrated a significant difference in recurrence-free survival rate between the low-score and high-score groups, as predicted based on the optimal cutoff value of the mixed model.

CONCLUSION: CT radiomics-based model, which could serve as a potential biomarker, demonstrated strong predictive value for LTE status in LAC.

PMID:41731409 | DOI:10.1186/s12880-026-02240-3