Tag: nevin manimala

Eur J Heart Fail. 2026 May 28:xuag110. doi: 10.1093/ejhf/xuag110. Online ahead of print.

ABSTRACT

AIMS: In patients with heart failure with reduced ejection fraction (HFrEF) and sleep-related breathing disorders, the predominant apnoea type may influence prognosis. The ADVENT-HF trial, which enrolled stable HFrEF patients with newly diagnosed obstructive (OSA) or central (CSA) sleep apnoea, provides a unique opportunity to perform a post-hoc analysis to test this hypothesis. We aimed to compare event rates between those with OSA and those with CSA following randomisation over the course of the trial.

METHODS: Cox-proportional hazard ratios (HR) were compared for: the primary composite endpoint (PE); all-cause; and cardiovascular mortality. Proportional-hazards assumption was assessed by Schoenfeld residuals’ method.

RESULTS: Relative to OSA (n = 533), in unadjusted analyses, over the trial duration, the PE rate was greater in those with CSA (n = 198) (HR 1.38, 95%CI 1.10-1.73; P = .01), as were rates of all-cause (HR 1.72, 95%CI 1.26-2.36; P < .001) and cardiovascular mortality (HR 2.00, 95%CI 1.40-2.85; P < .001). These HRs were not statistically significant after adjustment for clinical characteristics associated with worse prognosis. Importantly, HRs varied over time, with an inflection point at one year. Adjusted HRs before and after 1 year were respectively 1.41 (95%CI 1.00-2.01, P = .051) and .91 (95%CI .65-1.26, P = .562) for the PE, 3.44 (95%CI 1.61-7.36, P = .001) and .89 (95%CI .58-1.37, P = .603) for all-cause mortality and 3.58 (95%CI 1.58-8.12, P = .002) and .92 (95%CI 0.56-1.51, P = 0.741) for cardiovascular mortality.

CONCLUSION: Detection of CSA in patients with stable HFrEF identifies a population at increased 1-year risk of adverse events who may benefit from earlier evaluation for advanced therapies or transplantation.

PMID:42206383 | DOI:10.1093/ejhf/xuag110

Philos Trans R Soc Lond B Biol Sci. 2026 May 28;381(1951):20250111. doi: 10.1098/rstb.2025.0111.

ABSTRACT

Understanding how urbanization affects plant interactions with pathogens and herbivores is important for clarifying how changes in land use, climate and biodiversity affect ecological and evolutionary processes, and for managing urban plants to maximize ecosystem services. We performed a systematic literature review of relationships between urbanization and pathogens or pests of wild and cultivated plants. We identified k = 171 relationships from n = 54 studies in which pathogen or pest abundance was quantified in both urban and non-urban areas and summarized their distribution across taxa, geographic regions and directions and mechanisms of effects proposed by the authors. Most studies featured tree hosts and their arthropod pests or fungal pathogens. Grasses and forbs were the next most commonly studied hosts, followed by crops and shrubs. We then performed a meta-analysis limited to trees, which had the most studies with sufficient statistical information (k = 55 relationships, n = 14 studies). In that meta-analysis, we found no overall effect of urbanization on tree pest or pathogen abundance. However, there was a significant effect of pest/pathogen, with arthropod pests trending towards lower abundance in urban areas and fungal pathogens trending towards higher abundance. Drawing on literature from the broader fields of urban ecology, disease ecology and plant pathology, we synthesize our findings and offer insights into mechanisms by which urbanization influences disease and herbivory in wild and cultivated plants. We conclude by identifying research gaps, with the goal of informing management strategies that prioritize food security, environmental health and global biodiversity. This article is part of the theme issue ‘Wild plant pathosystems’.

PMID:42206332 | DOI:10.1098/rstb.2025.0111

Philos Trans R Soc Lond B Biol Sci. 2026 May 28;381(1951):20250110. doi: 10.1098/rstb.2025.0110.

ABSTRACT

Plant diseases occurring across wild and crop plants present modelling and management challenges. Wild plant and crop pathosystems differ in ecological structure, evolutionary dynamics and responsiveness to human intervention. At the interface, pathogens may spill over, spill back, persist or evolve, shaped by host diversity, dispersal processes and landscape connectivity. The potential importance of factors including pathogen dispersal, host life history and spatial configuration are examined through a qualitative comparison of case studies: Puccinia graminis, Phakopsora pachyrhizi, Xylella fastidiosa, Pyricularia oryzae Triticum lineage and Austropuccinia psidii. These examples illustrate how wild hosts may function as reservoirs, recombination partners or spillover targets, and how their role influences management efficacy and evolutionary risk. We explore the consequences of this wild-crop interface through two central questions: (i) how should plant diseases involving wild and cultivated pathosystems be managed, and (ii) what proportion of management effort should be allocated to each system? We show the principles underpinning answers to these questions via a conceptual framework based on a generic compartmental model incorporating asymmetric transmission and system-specific interventions, thereby accounting for key aspects of pathogen spread within and between wild host and crop populations. Finally, we identify critical data needs and modelling directions to better inform disease management on the wild plant-crop interface and argue for a more integrative approach bridging ecological and anthropogenic drivers of epidemics. This article is part of the theme issue ‘Wild plant pathosystems’.

PMID:42206329 | DOI:10.1098/rstb.2025.0110

Nurs Ethics. 2026 May 28:9697330261449299. doi: 10.1177/09697330261449299. Online ahead of print.

ABSTRACT

BackgroundJapan has been promoting the use of medical and long-term care robots to reduce the workload of healthcare professionals. In home-visit nursing, where the number of older adults and patients with dementia is increasing, robots may provide benefits, such as supporting infection control and physically demanding care. However, implementing these technologies may also generate new ethical challenges.ObjectiveTo clarify home-visiting nurses’ perceptions and the ethical issues regarding the introduction of medical and caregiving robots into home-visiting nursing field in Japan.MethodsA mixed-methods design was employed. A questionnaire survey was distributed to one nurse from each of 1012 home-visit nursing stations in Prefecture A. Descriptive statistics were used for quantitative analysis. To gain deeper insights, interviews were conducted with eight nurses who consented to participate.Ethical considerationsThis study was approved by the institutional review board (Approval No.: 2022N-026). Participation was voluntary, and informed consent was obtained. Data were anonymized to ensure confidentiality.Results and discussionThe questionnaire response rate was 17%. Simple tabulation showed that visiting nurses had positive expectations regarding the introduction of medical care robots but lacked confidence in their specific usefulness and safety. Only “disinfection of equipment” was identified as a task that could be fully shifted to robots. Twenty-six tasks, including “rehabilitation,” “massage,” “bathing and shower care,” and “relaxation,” were considered shareable between nurses and robots. Fifteen tasks-such as “suctioning,” “enema and fecal disimpaction,” “postmortem care,” and “explanations and communication with family”-were regarded as nurse-exclusive. Interview findings suggest that medical and nursing care robots may help reduce workload and supplement care for individuals living alone or requiring intensive support. However, key challenges include device safety and reliability, user and family acceptance, privacy protection, and implementation costs. Ethical consideration and clinical effectiveness must be carefully evaluated after clarifying target users, purpose, and scope of intervention.

PMID:42206328 | DOI:10.1177/09697330261449299

Health Serv Res. 2026 Jun;61(3):e70134. doi: 10.1111/1475-6773.70134.

ABSTRACT

OBJECTIVE: To examine how patient engagement with SMS text reminder scan mediate cancer screening completion among patients at Federally Qualified Health Center clinics (FQHCs).

STUDY SETTING AND DESIGN: Patients overdue for cancer screening were randomly assigned to one of two groups: a 3-week interactive SMS intervention or a 6-week theory-informed SMS intervention. The binary outcome was cancer screening completion after 90 days of SMS intervention. A mediation model was used to assess associations between text-message response rates and cancer screening completion. Exposure variables included sociodemographic characteristics, type of SMS intervention, type of cancer screening needed, and health status variables.

DATA SOURCES AND ANALYTIC SAMPLE: Data were obtained from two large FQHC networks in Texas and California in 2023. We included 4,344 patients who participated in the 3-week or 6-week intervention groups, successfully received all interactive messages, had unique phone numbers, and did not opt out of the intervention.

PRINCIPAL FINDINGS: Overall effects were statistically significant, indicating partial mediation. Full mediation was observed for insurance type: compared with Medicaid, private insurance was associated with a 5-percentage-point (PP) higher predicted probability of screening completion (Average marginal effect [AME] = 5.0 PP, 95% CI [0.01, 0.09]). Partial mediation was observed for Medicare (AME = 7.0 PP, 95% CI [0.02, 0.13]), uninsurance (AME = 5.0 PP, 95% CI [0.01, 0.09]), patient with diabetes (AME = -4.0 PP, 95% CI [-0.08, -0.01]), non-primary English language (AME = 8.0 PP, 95% CI [0.05, 0.10], p < 0.001), and large-city residence (AME = 9.0 PP, 95% CI [0.07, 0.10]), all of which were associated with higher predicted probabilities of screening completion.

CONCLUSIONS: Engagement with SMS reminders was a significant mediator of cancer screening completion, suggesting that increasing message interactivity may improve cancer screening uptake. Theory-informed interactive messaging may promote greater patient engagement.

PMID:42206315 | DOI:10.1111/1475-6773.70134

Clin Cosmet Investig Dent. 2026 May 22;18:611537. doi: 10.2147/CCIDE.S611537. eCollection 2026.

ABSTRACT

INTRODUCTION: Sickle cell disease is caused by a point mutation in the β-globin gene, resulting in the production of abnormal hemoglobin. Various oral radiographic changes have been documented in the literature, though they are less frequently reported in patients with severe disease. This study aimed to evaluate specific radiographic features in pediatric patients with severe sickle cell disease.

METHODS: This retrospective comparative study was conducted at the Dental Department of King Faisal Specialist Hospital and Research Centre. A total of 72 pediatric patients (aged 6-14 years) with genetically confirmed severe sickle cell disease and 96 age-matched healthy controls were included. Dental radiographs were evaluated by four calibrated examiners for the presence of radiopaque areas, increased spacing of bony trabeculae, absence of mandibular canal corticalization, faint lamina dura, spiky roots, taurodontism, and haziness of the maxillary sinuses. Statistical analysis was performed using Chi-square test, with significance set at p < 0.05.

RESULTS: The sickle cell group showed a significantly higher prevalence of increased trabecular spacing (58.3% vs. 19.8%), absence of mandibular canal corticalization (68.1% vs. 16.7%), faint lamina dura (19.4% vs. 2.1%), taurodontism (15.3% vs. 9.4%), and haziness of the maxillary sinuses (69.4% vs. 43.8%) (p < 0.05 for all comparisons).

CONCLUSION: Pediatric patients with severe sickle cell disease demonstrated a higher prevalence of specific radiographic changes, particularly increased trabecular spacing, loss of mandibular canal corticalization, and haziness of the maxillary sinuses. This study highlights the importance of recognizing these imaging features in the assessment of disease severity.

PMID:42206307 | PMC:PMC13209138 | DOI:10.2147/CCIDE.S611537

Front Neurol. 2026 May 12;17:1826373. doi: 10.3389/fneur.2026.1826373. eCollection 2026.

ABSTRACT

BACKGROUND: Real-world evidence comparing Tenecteplase and Alteplase for acute ischemic stroke (AIS) remains limited. This study aimed to evaluate the comparative efficacy and safety of these thrombolytic agents in an unselected patient cohort.

METHODS: This single-center retrospective study analyzed AIS patients undergoing reperfusion therapy. Propensity score matching (PSM) was employed to balance baseline covariates between Tenecteplase and Alteplase groups. The primary outcome was functional independence (modified Rankin Scale 0-2) at 90 days. Safety endpoints included symptomatic intracranial hemorrhage (sICH) and mortality.

RESULTS: Among 371 eligible patients, 68 (18.3%) received Tenecteplase. In the matched cohort, Tenecteplase demonstrated comparable efficacy to Alteplase regarding functional independence (p > 0.05). Although the incidence of sICH was numerically higher in the Tenecteplase group, the difference was not statistically significant (p = 0.449). Workflow efficiency, measured by door-to-needle time, was similar between groups.

CONCLUSION: Tenecteplase exhibits a non-inferior efficacy and safety profile compared to Alteplase in a real-world setting characterized by high baseline stroke severity. These findings support Tenecteplase as a practical and effective therapeutic alternative for routine AIS management.

PMID:42206304 | PMC:PMC13201182 | DOI:10.3389/fneur.2026.1826373

Adv Radiat Oncol. 2026 Apr 15;11(7):102059. doi: 10.1016/j.adro.2026.102059. eCollection 2026 Jul.

ABSTRACT

PURPOSE: This study investigates the association between radiation dose to the heart base and other cardiac substructures and overall survival (OS) following stereotactic body radiation therapy (SBRT) for central and ultracentral lung tumors.

METHODS AND MATERIALS: A retrospective analysis was performed on patients treated within the SBRT registry (2011-2023). Autosegmentation was used to contour the whole-heart and cardiac substructures, whereas the heart base-overlapping the ascending aorta and including coronary origins and the sinoatrial node-was manually contoured. Mean (Dmean) and near-maximum doses (D0.03, highest dose to 0.03 cm³) were converted to equivalent 2 Gy fractions (EQD₂, α/β = 3 Gy). Optimal dose cut-points were defined to stratify patients into high- and low-dose groups. Cox regression models, adjusted for age, sex, tumor type, and volume, assessed the association between cardiac dose and OS; additional sensitivity analyses included bronchial Dmax.

RESULTS: Among 82 treated patients, 66 were evaluable for dosimetry of cardiac structures and survival analysis. Median age was 67 years; 68% were male. Most lesions were metastases (62.5%) and evenly split between central (54.5%) and ultracentral (45.5%) locations. Higher EQD₂ Dmean to the left atrium (hazard ratio [HR], 2.89; P = .04) and superior vena cava (HR, 2.56; P = .03), and higher D0.03 to the superior vena cava (HR, 3.12; P = .004) and right ventricle (HR, 2.23; P = .04) were independently associated with worse OS. After sensitivity analysis, associations for the superior vena cava remained significant, whereas others were attenuated to statistical trends. A higher mean dose to the heart base showed a strong trend toward reduced survival (HR, 3.70; P = .05).

CONCLUSIONS: Higher radiation doses to the left atrium, superior vena cava, and right ventricle were independently associated with worse OS after SBRT for central and ultracentral lung tumors, underscoring the importance of cardiac-substructure-specific dose constraints in SBRT planning. Moreover, a clear trend toward reduced survival with higher doses to the base of the heart underscores the importance of this region as a potential target for future dose-sparing strategies.

PMID:42206292 | PMC:PMC13202019 | DOI:10.1016/j.adro.2026.102059

JPRAS Open. 2026 Apr 22;50:258-269. doi: 10.1016/j.jpra.2026.04.008. eCollection 2026 Jul.

ABSTRACT

INTRODUCTION: An axial pattern flap is a single pedicled flap with anatomically recognized blood vessels running along its long axis, allowing it to be harvested with a considerably longer length than a random pattern flap. Distal necrosis is a concern when designing elongated flaps beyond the midline to cover large tissue defects. However, imaging modalities that visualize subcutaneous microvessels preoperatively in three dimensions with sufficient resolution are lacking, individual vessel anatomy is ignored and flaps are designed based on past anatomical research. In this preliminary study, we evaluated the feasibility of harvesting flaps, including an axial artery running across the midline delineated by photoacoustic tomography and its effect on flap viability.

METHODS: Six rats were divided into two groups: MCA group (flaps including the midline-crossing artery visualized by photoacoustic tomography running across the midline, n = 3) and non-MCA group (flaps not including the midline-crossing artery beyond the midline visualized by photoacoustic tomography, n = 3). In both groups, the flaps were designed beyond the midline with the flap pedicle based on the right deep circumflex iliac artery perforator. Flap viability was analyzed on postoperative day 7.

RESULTS: Preoperative photoacoustic tomography revealed the subcutaneous arteries crossing the midline and identified the location of the deep circumflex iliac perforator. The viability of flaps with MCA was better than that in the non-MCA group, although this difference was not statistically significant (p = 0.40).

CONCLUSIONS: This proof-of-concept study suggests that photoacoustic tomography is a useful imaging modality for designing elongated free style flaps.

PMID:42206263 | PMC:PMC13202538 | DOI:10.1016/j.jpra.2026.04.008

JAC Antimicrob Resist. 2026 May 26;8(3):dlag095. doi: 10.1093/jacamr/dlag095. eCollection 2026 Jun.

ABSTRACT

BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) is practised worldwide due to the benefits it provides to patients and healthcare systems. However, its full potential remains unrealized due to different implementation challenges. This study aims to identify barriers and facilitators that influence the routine implementation of current practices in the OPAT programme.

METHODS: An international, multi-centre electronic survey was conducted among healthcare facilities providing OPAT services in Australia, Malaysia, the UK, Spain, Turkey and Middle East countries. The survey instrument was developed based on the Consolidated Framework for Implementation Research and guideline recommendations for OPAT. Statistical analyses were performed using SPSS version 30.

RESULTS: The survey received responses from 150 healthcare facilities across 10 countries offering OPAT services. The majority (11 879.7%) of healthcare facilities implement OPAT through a formal structure. The majority (92.2%) had a designated team lead. Most facilities (12 685.7%) reported the implementation of antimicrobial toxicity monitoring. Only 58 facilities (39.5%) reported implementation of regular audits of their OPAT programmes. The most reported barriers to OPAT implementation included wide geographic distribution of patients (50.7%), lack of financial support (42.7%) and the dosing frequency of antimicrobials (40.6%). Facilitators to OPAT implementation include hospital bed savings, clinical safety and efficacy, cost-effectiveness and patient satisfaction.

CONCLUSIONS: The majority of healthcare facilities implement OPAT through a formal structure. However, several challenges continue to hinder its routine implementation. Ongoing efforts to address implementation barriers are crucial for strengthening existing services and supporting the expansion of new services.

PMID:42206239 | PMC:PMC13201090 | DOI:10.1093/jacamr/dlag095