Tag: nevin manimala

Stat Med. 2026 Mar;45(6-7):e70461. doi: 10.1002/sim.70461.

ABSTRACT

One major bias source in causal inference for clinical trials is unmeasured confounding. We propose an innovative, practical Bayesian modeling approach to adjust for unmeasured confounding effects and obtain precise causal average treatment effect estimates for two-arm randomized controlled clinical trials. This approach includes model reparameterization and an iterative algorithm, with a causal inference framework incorporated with unmeasured confounders and related statistical distributions. Model non-identifiability resulting from adjusting for unmeasured confounding is a major inferential problem. Reparameterization transforms one or multiple unmeasured confounders into a single reparameterized unmeasured confounder and can remove model non-identifiability from the model specification of unmeasured confounders. The iterative algorithm consists of detailed steps for inference after model reparameterization and can remove model non-identifiability from prior sensitivity to unmeasured confounders. It includes iterating the prior distribution of the reparameterized unmeasured confounder by certain rules, aggregating posterior means and variances over different prior choices, and obtaining posterior estimates for the average treatment effect. Its essential idea is to make unreliable prior information on unmeasured confounders as close to data information as possible. Compared with usual methods, our approach produces robust effect estimates and correctly concludes statistical significance. From an example using real clinical data, this approach effectively adjusts for confounding effects when we do not adjust for measured confounders. Our approach is also generalizable to other clinical study designs and may be beneficial to applications where data collection is difficult for certain variables or causal relationships are not well understood.

PMID:41761686 | DOI:10.1002/sim.70461

Pediatr Transplant. 2026 Apr;30(3):e70283. doi: 10.1111/petr.70283.

ABSTRACT

INTRODUCTION: Kidney transplantation remains the optimal treatment for children with end-stage renal disease (ESRD), 25%-40% of which are estimated to be caused by congenital malformations and genetic syndromes. Given the widespread nature of this surgical procedure, ocular complications may arise from the operation itself or from subsequent medical treatments. The aim of this study is to determine whether there are postoperative refractive changes in pediatric patients who have undergone kidney transplantation and to detect the presence of refractive changes that may cause amblyopia in patient follow-ups.

METHODS: The electronic medical records of 1144 patients who underwent kidney transplantation at the Akdeniz University Hospital Organ Transplant Center between January 2019 and January 2024 were reviewed retrospectively. Of these, 84 pediatric patients who had undergone a complete ophthalmologic examination at least 1 year after kidney transplantation and had no missing data were included in the study. For both eyes, all data were recorded, including Best Corrected Visual Acuity (BCVA), refractive error (measured with the KR-8900; Topcon, Tokyo, Japan), spherical equivalent refractions (SER), slit-lamp examination of the anterior segment, and a dilated fundus examination.

RESULTS: The average age of patients who underwent kidney transplantation in the study is 13.01 ± 3.43 (6-18). The average follow-up period was 51.81 ± 33.5 (45-129) months. Thirty-five (41.7%) of the patients are female, and 49 (58.3%) are male. Cataracts were observed in 9 (10.7%) patients during follow-up after transplantation. Cataract development was observed on average in 5.6 years. Posterior subcapsular cataracts were observed in seven patients, cortical cataract in one patient, and anterior polar cataract in one patient. The mean preoperative visual acuity value in patients who developed cataracts after kidney transplantation was 0.00 logMAR, while it was measured as 0.19 logMAR in the postoperative period, and this decrease is statistically significant (p = 0.027). In patients who did not develop cataracts during the follow-up period, there was no statistically significant change in visual acuity in both eyes (p = 0.109). When all eyes are evaluated, the change in SER after kidney transplantation is not statistically significant compared with before (p = 0.689 for the right eye, p = 0.596 for the left eye).

CONCLUSION: Although children receive longer-term immunosuppressive treatment, their cataract development rates are lower than those of adults. Despite intensive and prolonged immunosuppression therapy after kidney transplantation, cataract development and refractive changes in the pediatric age group are at an acceptable level. Especially in children who are too young to express themselves clearly, monitoring refractive changes is crucial to prevent permanent vision loss.

PMID:41761679 | DOI:10.1111/petr.70283

Stress Health. 2026 Apr;42(2):e70159. doi: 10.1002/smi.70159.

ABSTRACT

Tuberculosis (TB) remains a leading global infectious cause of illness and death, despite being preventable and curable, with the highest burden in low- and middle-income countries, particularly in Southeast Asia and Africa. TB is closely linked with mental health, as psychological distress manifested by anxiety, depression, and somatic symptoms is a common and significant comorbidity. However, nationally representative data on the prevalence of psychological distress among TB patients are limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of psychological distress and identify associated factors in TB patients in Ethiopia. A systematic review and meta-analysis of five studies involving 2117 participants was conducted, showing very high heterogeneity (I² = 99.8%). A comprehensive search of PubMed, Scopus, Web of Science, Google Scholar, PsycINFO, and AJOL identified studies published from June 2000 to August 1, 2025. The review followed PRISMA 2020 guidelines, and study quality was assessed using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies. Data were analysed in STATA version 16 using a random-effects model with 95% confidence intervals. Heterogeneity was evaluated using the I² statistic (p < 0.05 indicating significance). Publication bias was assessed using a funnel plot with asymmetry distribution and Egger’s test revealed a statistically significant result (p = 0.007) and meta-regression was conducted to explore potential sources of heterogeneity. The pooled prevalence of psychological distress among 2117 adult tuberculosis patients was 47.47% (95% CI; 11.95, 82.98). In this review, stigma (AOR = 2.21, 95 CI: 1.49, 3.26), and co-infection (AOR = 2.89, 95% CI: 1.57, 5.35) were statistical significant associated with psychological distress. Psychological distress affecting nearly half adult tuberculosis patients in Ethiopia. Stigma and co-infection are statistically significant with psychological distress. Therefore, integrate mental health screening and psychosocial support into tuberculosis programs, strengthen community-based stigma reduction strategies, and provide tailored care for TB-HIV co-infected patients, especially in rural areas with limited resources is essential.

PMID:41761667 | DOI:10.1002/smi.70159

Med Phys. 2026 Mar;53(3):e70361. doi: 10.1002/mp.70361.

ABSTRACT

BACKGROUND: Breath-hold PET imaging helps reduce respiratory motion artifacts in thoracoabdominal scans. However, its clinical application is limited by the short acquisition time, which results in significant image noise and poor lesion detectability. Enhancing image quality under such conditions remains a technical challenge.

PURPOSE: To improve the image quality of 15-s breath-hold PET scans, we investigated a deep learning-based framework using a diffusion probabilistic model. The goal was to suppress noise and enhance lesion visibility while maintaining quantitative accuracy under severely limited acquisition durations.

METHODS: We propose TAM-DiffPET, a denoising diffusion probabilistic model (DDPM) augmented with Temporal Attention Modulation (TAM) to refine intermediate feature representations by injecting diffusion time-step embeddings and temporal contextual cues. The model was trained on paired PET datasets comprising 15-s breath-hold scans and 5-min free-breathing scans from 230 patients at Ren Ji Hospital; 180 cases were used for training and 50 for quantitative and qualitative evaluation. Performance was assessed using PSNR, SSIM, and voxel-wise SUV distributions within lesion ROIs. Visual and statistical comparisons were conducted against U-Net, CycleGAN, and a vanilla DDPM.

RESULTS: The proposed method demonstrated superior performance compared to existing deep learning-based approaches. Quantitatively, it achieved the highest PSNR (40.2 ± 1.2 dB) and SSIM (0.995 ± 0.004), significantly outperforming previous deep learning based methods such as U-Net, CycleGAN, and DDPM. Voxel-wise SUV error distributions showed lower standard deviation and mean absolute error within lesion ROIs. Visual assessments revealed enhanced lesion contrast, sharper anatomical boundaries, and reduced background noise. Difference maps confirmed minimal deviation from the 5-min reference scans. Furthermore, SUV distribution analysis across representative patients confirmed that the proposed method preserves tracer uptake consistency, offering improved fidelity in clinical lesion quantification.

CONCLUSION: Our diffusion-based framework effectively denoises breath-hold PET images acquired under ultrashort durations, offering improved visual clarity and quantitative fidelity. These results support its clinical utility in motion-prone scenarios, such as thoracic or abdominal imaging, and suggest its potential for enhancing diagnostic accuracy while reducing scan time and radiation burden on patients.

PMID:41761600 | DOI:10.1002/mp.70361

J Gerontol A Biol Sci Med Sci. 2026 Feb 27:glag062. doi: 10.1093/gerona/glag062. Online ahead of print.

ABSTRACT

BACKGROUND: The INVEST in Bone Health Trial examined the effects of weight loss (WL), WL plus resistance training (WL+RT), or WL plus weighted vest use (WL+VEST) on musculoskeletal health. This secondary analysis evaluated changes in muscle area and density using computed tomography (CT) and lean and fat mass using dual-energy X-ray absorptiometry (DXA).

METHODS: 150 participants (50/group) were randomized to 12-months of WL, WL+RT, or WL+VEST, undergoing CT and DXA scans at baseline, six- and 12-months. DXA measured lean and fat mass, while CT assessed muscle and intermuscular adipose tissue (IMAT) cross-sectional area (CSA) and density. Mixed linear models evaluated changes and treatment effects, and partial Pearson’s correlations examined relationships between weight change and CT/DXA outcomes.

RESULTS: Participants (66.4±4.6 years,75% female,69% white) were living with overweight (14.7%) or obesity (85.3%). All groups achieved similar and significant weight loss (∼10%). At 12-months, WL+RT increased mid-thigh muscle CSA (0.5%, p < 0.05), improved muscle density (3.7-5.9%, p < 0.03), and reduced IMAT (20-22%, p < 0.05) and fat masses (22-26.8%, all p < 0.061). At the trunk, WL+VEST showed a trend toward muscle preservation and improved density (4.2%, p = 0.08) compared to WL, but had minimal impact on other measures. Differences between WL+VEST and WL were insignificant (all p > 0.05), but group comparisons showed improvements for WL+RT. Weight loss correlated with increased muscle density (r < 0, p < 0.001) but reduced muscle CSA and IMAT (r > 0, p < 0.001), indicating improved quality but reduced quantity.

CONCLUSION: Our findings underscore the significance of weight loss-associated muscle loss, highlighting progressive RT as a minimally effective preservation strategy.

PMID:41761582 | DOI:10.1093/gerona/glag062

Wound Repair Regen. 2026 Mar-Apr;34(2):e70136. doi: 10.1111/wrr.70136.

ABSTRACT

High-frequency ultrasound (HFUS) allows non-invasive visualization of skin microarchitecture, offering quantitative assessment of dermal composition and vascularity, but its systematic use to track temporal changes in postoperative wound healing is still limited. This study aimed to describe and validate HFUS morphologic and vascular features corresponding to the biological phases of cutaneous surgical wound healing. A total of 730 patients who underwent surgical excision of skin lesions were evaluated at different postoperative intervals using high- and ultra-high-frequency ultrasound (48-70 MHz). Dermal thickness, echogenicity and vascularity were analysed with B-mode and colour Doppler imaging through quantitative and semi-quantitative methods and reproducibility was assessed using intraclass correlation coefficients (ICC) and Cohen’s κ statistics. Cross-sectional analysis demonstrated a progressive structural and vascular evolution consistent with canonical healing phases: dermal thickness decreased from 2.45 ± 0.38 mm at T0 to 1.58 ± 0.21 mm at T4, while echogenicity increased from 0.5 [0-1] to 2.5 [2, 3], reflecting collagen compaction and maturation. Vascularity peaked at T2 (2.2 ± 0.5) and declined to 0.8 ± 0.3 by T4, paralleling the regression of angiogenesis. Measurement reproducibility was excellent (ICC = 0.91; κ = 0.82). HFUS morphologic patterns closely mirrored the biological sequence from inflammatory oedema through granulation and fibroplasia to collagen remodelling, providing real-time in vivo correlates of tissue repair. These findings support HFUS as a reliable, quantitative and reproducible tool for monitoring postoperative wound healing and as a potential imaging biomarker framework for early detection of abnormal scar evolution.

PMID:41761379 | DOI:10.1111/wrr.70136

Hum Genomics. 2026 Feb 28. doi: 10.1186/s40246-026-00913-2. Online ahead of print.

NO ABSTRACT

PMID:41761370 | DOI:10.1186/s40246-026-00913-2

Perioper Med (Lond). 2026 Feb 28. doi: 10.1186/s13741-026-00664-7. Online ahead of print.

NO ABSTRACT

PMID:41761352 | DOI:10.1186/s13741-026-00664-7

J Neuroeng Rehabil. 2026 Feb 27. doi: 10.1186/s12984-025-01819-1. Online ahead of print.

ABSTRACT

BACKGROUND: Home exercise programs prescribed to children with cerebral palsy (CP) are often associated with low adherence. Interactive technologies can help motivate and guide children through exercise programs at home, reducing onus on parents. This study sought to understand the impact of movement-tracking feedback on children’s engagement and parents’ experiences within an interactive computer play home exercise program (ICP-HEP), Bootle Boot Camp.

METHODS: A multi-case mixed methods study was conducted with three children with CP and their parents. In the quantitative single case experimental design with alternating treatments phase, children used the ICP-HEP with and without movement-tracking feedback for four weeks, and exercise adherence, exercise fidelity (movement performance quality), perceived level of fun and helpfulness for the body (i.e., 5-point rating scales and survey) were evaluated. The version (feedback/no feedback) with the highest exercise adherence was carried out for two additional weeks. Dyadic (child/parent) qualitative interviews followed. Quantitative data were analyzed using visual and statistical approaches. Qualitative data were analyzed using directed content analysis. Quantitative and qualitative results were merged through narrative weaving and joint displays.

RESULTS: Accuracy of the movement tracking and feedback provided varied among children, exercises, and play environments. Feedback may have contributed positively to exercise adherence for two children, with a significant enhancement (p < 0.001) for one of these children, and no observed negative impacts for the third child. Parents and one child perceived feedback as generally being useful for learning about movement quality, however when perceived to be inaccurate, it may have been ignored. While children had varied perspectives on how fun and helpful feedback was, it was valued by all parents. All children experienced some frustration due to sporadic technical issues. All children/parents preferred Bootle Boot Camp over conventional home programs, and suggested game refinements to enhance this ICP-HEP experience.

CONCLUSION: Use of an interactive therapy game has the potential to support children’s adherence to and children’s/parents’ experiences with home exercise, with feedback impacting children differently based on personal and environmental factors. This study serves as a foundation for future game refinements and larger-scale testing that will continue to explore the impact of feedback within an ICP-HEP.

TRIAL REGISTRATION: NCT05998239.

PMID:41761323 | DOI:10.1186/s12984-025-01819-1

Hum Genomics. 2026 Feb 27. doi: 10.1186/s40246-026-00928-9. Online ahead of print.

ABSTRACT

BACKGROUND: The interplay between genetic factors and COVID-19 susceptibility and severity underscores the critical roles of genetic variations in the responses to the virus. Specifically, genetic variations in genes such as AAK1 and ADAM17 may influence the molecular pathways that determine how the virus enters cells and how the immune system responds, thereby affecting disease outcomes. Identifying these potential genetic variants clarifies individual responses to infectious diseases and helps aid in developing effective targeted therapeutic strategies.

METHODS: We performed targeted next-generation sequencing focusing on specific single-nucleotide variants (SNVs) in AAK1, ADAM17, and CD209 genes, which are implicated in the entry of SARS-CoV-2 into host cells. The study was conducted in a Middle Eastern cohort, comprising 96 COVID-19 patients with varying disease severities and 69 healthy controls. The correlation between the prevalence of the investigated genetic variants and the serum level of inflammatory cytokines within the studied cohort was also evaluated.

RESULTS: Our analysis revealed statistically significant differences in genetic variants between COVID-19 patients and healthy controls. Notably, a 5’UTR variant, rs12692386: chr2:9695906, A > G, in the ADAM17 gene showed a significant association (p = 0.039). Additionally, two variants in the AAK1 gene, an intronic variant chr2:69732672, C > A (p = 0.029) and a missense variant rs1275698668: chr2:69747984, G > C (p = 0.017), were identified, suggesting their potential role in influencing disease susceptibility and severity. The gender-stratified analysis between the two groups showed a significant difference in the AAK1-SNV-rs1275698668 (p = 0.027) in female susceptibility, suggesting a protective effect against SARS-CoV-2 infection. The AAK1-SNV-rs1275698668 showed a significant difference between the three severity groups (p = 0.045). Prediction in-silico tools suggest that 2:g.69747984G > C and 2:g.9,695,906 A > G have potential functional/regulatory impacts on the ADAM17 and AAK1 genes, respectively. Moreover, different correlation patterns between the identified genetic variants and inflammatory cytokine levels (including CD40 ligand, IL-1b, GM-CSF, and IL-4) were observed in COVID-19 patients.

CONCLUSIONS: Our findings suggest potential genetic biomarkers in AAK1 and ADAM17 genes that could affect the disease severity and circulating cytokine levels in COVID-19 patients.

PMID:41761307 | DOI:10.1186/s40246-026-00928-9