Tag: nevin manimala

JNCI Cancer Spectr. 2026 Apr 9:pkag037. doi: 10.1093/jncics/pkag037. Online ahead of print.

ABSTRACT

Thyroid nodule ultrasound (US) images and their features are of great importance in thyroid nodule diagnosis, and can be helpful for radiologists’ clinical decision-making. To evaluate whether an AI-assisted system can accurately characterize thyroid nodule ultrasound features and assist radiologists in diagnosing thyroid cancer. The AI-assisted system (MDT-TC) was trained and internally validated on B-mode US images from 7204 lesions in 6884 patients in Southwest Hospital (SW). The model performance was validated using three independent external validation cohorts. Echogenicity (ECH) and shape (SHA) are features of high importance for model recognition, and these features lead to excellent model performance. The model achieved up to 87.56% accuracy in determining ECH attributes and 69.21% in identifying shape categories. The AUC of the internal validation cohort and three independent external validation cohorts for MDT-TC were 0.951, 0.837, 0.816, and 0.871, respectively. The sensitivity values were 98.7%, 91.2%, 90.3%, and 85.6%, respectively. The AUC for the accurate diagnosis of radiologists with MDT-TC assistance was significantly higher than that of radiologists without MDT-TC assistance (p < 0.001). In addition, the AUC for the accurate diagnosis of junior doctors with MDT-TC assistance was significantly higher than that for those who did not (p < 0.01). MDT-TC incorporates radiomic features extracted from thyroid lesion US images, and can significantly improve the diagnostic performance of radiologists. This result was particularly strong for junior doctors. Therefore, our data support the idea that MDT-TC can help to identify patients with thyroid cancer and could greatly benefit clinical practice.

PMID:41967078 | DOI:10.1093/jncics/pkag037

J Sex Med. 2026 Apr 9;23(5):qdag086. doi: 10.1093/jsxmed/qdag086.

ABSTRACT

INTRODUCTION: Mid-urethral slings (MUS) are widely used to treat urinary incontinence. However, there is limited evidence of their long-term effects on female sexual function.

OBJECTIVES: To address this gap, this meta-analysis of randomized controlled trials evaluates changes in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores at 6, 12, 24, and 36 months postoperatively.

METHODS: We systematically searched PubMed, Cochrane Central, and Embase for studies evaluating the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores 6, 12, 24, and 36 months after MUS surgery. We performed a single-arm meta-analysis of single means along with their 95% confidence intervals (CIs) by applying a random-effects model. Subgroup analyses based on MUS types (single-incision, retropubic, and transobturator) were performed to evaluate their specific impacts on sexual function outcomes. Statistical analyses were conducted using Review Manager v5.4 and R v4.3.3.

RESULTS: We included 11 randomized controlled trials comprising a total of 2909 patients, of whom 1747 (60.1%) received a transobturator sling, 505 (17.4%) underwent retropubic sling placement, and 657 (22.6%) were treated with a single-incision sling. At 6 months, pooled analysis showed an improvement in sexual function, with a mean change from baseline of 4.49 points (95% CI 3.51 to 5.46). By 12 months, a decrease of 2.68 points (95% CI 0.67 to 4.70) was observed compared with the 6-month assessment. At 24 months, sexual function also declined slightly of -0.52 points (95% CI -2.71 to 1.68; P = 0.31), while at 36 months, there was a slight increase of 0.11 points (95% CI -1.95 to 2.17; P = 0.53). Regarding subgroup analysis, no significant differences among sling types, except at 12 months, when the transobturator group showed greater decline.

CONCLUSIONS: Our findings indicate that MUS are associated with an initial improvement in sexual function, particularly at 6 months. However, this improvement is not maintained in long-term follow-up, with scores declining or stabilizing at later time points. These findings are important for patient education and for setting realistic expectations regarding postoperative sexual function.

PMID:41967068 | DOI:10.1093/jsxmed/qdag086

J Antimicrob Chemother. 2026 Apr 3;81(5):dkag127. doi: 10.1093/jac/dkag127.

ABSTRACT

OBJECTIVES: Aminopenicillin associated with parenteral cephalosporins provides synergistic activity against Enterococcus faecalis. Oral consolidation treatment is an option for infective endocarditis E. faecalis (EFIE), but optimal oral regimen remains under debate. We aimed to assess the in vitro activity of combinations based on amoxicillin plus an oral cephalosporin, namely, cephalexin or cefixime, against E. faecalis strains.

METHODS: MIC and MBC values were determined against 6 clinical isolates of endocarditis-associated E. faecalis. Time-kill (TK) experiments were performed using amoxicillin (½MIC) plus cephalexin or cefixime at different concentrations (Cmax, ½Cmax and Cmin). Comparator regimens were amoxicillin/cefazolin and amoxicillin/ceftriaxone. TK experiments were carried out at standard (∼5 × 105 cfu/mL) and high inoculum (∼108 cfu/mL).

RESULTS: Using amoxicillin combined with Cmax, ½Cmax or Cmin of oral cephalosporin at standard inoculum, synergy or additivity was observed in 66, 33 and 0% of E. faecalis isolates with adjunctive cephalexin; and in 83, 50 and 33% of isolates with adjunctive cefixime, respectively. In comparator regimens, synergy was found in all isolates at standard inoculum. At high inoculum, amoxicillin/cefixime at Cmax had similar efficacy to amoxicillin/ceftriaxone, showing synergy in 50% of E. faecalis isolates, while amoxicillin/cephalexin at Cmax and amoxicillin/cefazolin only achieved synergy in 17% of isolates.

CONCLUSIONS: The combination of amoxicillin/cefixime exhibits synergy in most E. faecalis strains at standard inoculum. Cefixime could represent an interesting adjunctive therapy to amoxicillin for oral consolidation treatment of EFIE.

PMID:41967057 | DOI:10.1093/jac/dkag127

Age Ageing. 2026 Apr 4;55(4):afag084. doi: 10.1093/ageing/afag084.

ABSTRACT

BACKGROUND: Polypharmacy is a major concern among older adults in long-term care facilities (LTCFs), as it increases the risk of potentially inappropriate medications (PIMs) and related adverse outcomes. Medication review and deprescribing interventions may help optimise therapy and reduce harm.

DESIGN: Systematic review and meta-analysis.

METHODS: This study was conducted according to PRISMA guidelines (PROSPERO: CRD42023486056). PubMed, Embase and Scopus were searched up to 27 August 2024, for experimental studies evaluating the impact of medication review/deprescribing interventions in older LTCF residents with polypharmacy. Outcomes included medication appropriateness indexes, falls, hospitalisations and mortality. We calculated risk ratios for dichotomous data and mean differences for continuous data [with 95% confidence intervals (CIs)]. The quality of the studies was assessed using RoB 2 for the randomised controlled trials (RCTs) and the ROBINS-I for non-randomised studies.

RESULTS: From 3548 records, 38 studies (22 RCTs, 16 quasi-experimental) were included. Pooled analyses demonstrated significant reductions in the number of drugs per patient [within 12 months: -0.89 (95% CI -1.46, -0.32); at ≥12 months: -1.60 (95% CI -2.68, -0.52)] and in PIMs [at 6 months: -0.48 (95% CI -0.74, -0.22); at ≥12 months: -0.26 (95% CI -0.40, -0.13)]. No significant effects were observed on falls, hospitalisations or mortality. Studies showed wide methodological heterogeneity and had moderate to high risk of bias (23 moderate, 14 high, 1 low).

CONCLUSIONS: Comprehensive medication review interventions improved prescribing appropriateness in older LTCF residents with polypharmacy but did not significantly affect clinical outcomes (i.e. falls, hospitalisations and mortality). Further high-quality studies using standardised approaches are needed.

PMID:41967033 | DOI:10.1093/ageing/afag084

Dis Esophagus. 2026 Mar 2;39(2):doag032. doi: 10.1093/dote/doag032.

ABSTRACT

Esophageal dilation is a cornerstone therapeutic intervention in managing esophageal narrowing, using various types of dilation devices. While highly effective, it carries risks, including patient-related adverse events (PRAE) and device-related failures (DRF). Analysis of these complications is imperative for decision-making with the goal of enhancing procedural safety. Reports from the Manufacturer and User Facility Device Experience (MAUDE) database from January 2014 to June 2024 were analyzed. Although circulation numbers are unknown, event occurrence per device was compared using weighted averages of events and Poisson regression. A total of 1418 reports were identified, yielding 117 PRAE and 1845 DRF. The overall weighted average of PRAE was 0.07 (95% CI: 0.03, 0.11) per report, while DRF were 1.24 (95% CI: 1.13-1.36) per report. The most common PRAE was perforation (n = 32; 27%), with the most reports attributed to Rigiflex Pneumatic II (n = 13) and Savary-Giliard/American (n = 9). The most common DRFs pertained to material integrity issues which occur at relative rates 2.4 to 3.9 times higher than other device-related complications. About 117 PRAE reports were identified in the entire cohort. After excluding pneumatic dilation cases, it was determined that 70% (n = 71) of all PRAEs co-occurred with a material integrity issue. MAUDE analysis suggests variability in safety profiles across esophageal dilators. Perforation is the most reported PRAE across esophageal dilation procedures in general and may be linked to the co-occurrence of material integrity issues and aberrant guidewires in certain wire-guided polyvinyl dilators. To reduce PRAE occurrences, we encourage operators to recognize these patterns and their potential impact on adverse patient outcomes.

PMID:41967027 | DOI:10.1093/dote/doag032

Dis Esophagus. 2026 Mar 2;39(2):doag029. doi: 10.1093/dote/doag029.

ABSTRACT

In the absence of a mechanical stricture, oropharyngeal dysphagia following esophageal cancer surgery, and swallowing physiology more broadly, is poorly understood. This study investigated oropharyngeal dysphagia within the first year following curative open esophageal resection. A prospective cohort study was conducted (January 2022 to January 2024) at the National Esophageal Cancer Centre in Ireland. Participants were recruited between 6 to 12 months post-esophagectomy. A standardized videofluoroscopy was completed. Outcome measures included the Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), and Penetration-Aspiration Scale (PAS). Functional Oral Intake Scale (FOIS) was used to identify oral intake status. To evaluate the trajectory of oropharyngeal dysphagia, long-term data were compared to previously published acute data findings. Seventeen participants (12 males; mean age 65 years, range 46-80) were included. The cohort comprised transthoracic (2-stage n = 7, 3-stage n = 3) and transhiatal (n = 7) resections. 11 participants (65%) had persistent oropharyngeal dysphagia (DIGESTv2), and 2 (12%) continued to aspirate greater than 6-months, both of whom had a transhiatal resection. 10 (59%) continued to modify their diet (abnormal FOIS <7). MBSImP revealed impaired initiation of swallow (82%), anterior hyoid excursion (82%), tongue base retraction (100%), pharyngeal residue (100%) and neo-esophageal clearance (82%). When comparing acute to longer term data, there was a statistically significant difference in aspiration based on PAS (P = 0.016), but not dysphagia based on the DIGESTv2 (P = 0.500). Oropharyngeal dysphagia is prevalent within the first year following open esophageal cancer surgery. The study informs the need for structured guidelines and a swallowing care pathway.

PMID:41967025 | DOI:10.1093/dote/doag029

J Gerontol B Psychol Sci Soc Sci. 2026 Apr 9:gbag062. doi: 10.1093/geronb/gbag062. Online ahead of print.

ABSTRACT

OBJECTIVE: Generative artificial intelligence (GenAI) could be used to write text message content in physical activity behavior change interventions for middle-aged and older adults. Yet, biases in GenAI systems could lead to culturally insensitive or low-quality messages. Evaluating the acceptability of GenAI-authored messages is crucial before use in interventions. This research examined middle-aged and older adults’ perceptions of the cultural sensitivity and quality of GenAI-authored messages for promoting physical activity, and the person- and message-level factors influencing these perceptions.

METHODS: In a cross-sectional survey, middle-aged and older adults (≥ 40 years of age; N = 630; Mean age = 56.8 years; SD = 10.1) read 80 text messages written by GenAI and identified those that were culturally insensitive or had other problems. Descriptive statistics identified the proportion of GenAI-authored messages labeled as having issues. Separate negative binomial regressions examined the participant (zero-inflated) and message factors associated with message issues.

RESULTS: Of 49,859 cultural sensitivity and 49,894 quality message ratings, only 4.9% and 6.1% of the messages, respectively, were labeled as having issues. Knowledge of AI-authorship and more favorable attitudes towards AI were associated with identifying more messages as culturally insensitive. Messages generated by prompts that targeted sitting less (compared to moving more) or that described preparing for activity (compared to performing physical activity) received more labels as containing quality issues.

DISCUSSION: GenAI can be prompted to write high-quality, culturally sensitive text messages for promoting physical activity for middle-aged and older adults. Message content and participants’ knowledge of AI use could influence perceptions.

PMID:41967012 | DOI:10.1093/geronb/gbag062

J Burn Care Res. 2026 Apr 9:irag049. doi: 10.1093/jbcr/irag049. Online ahead of print.

ABSTRACT

Electrical injuries represent a small proportion of burn admissions but are associated with substantial morbidity. Prior studies suggest demographic and regional disparities in burn injury incidence and outcomes. This study aimed to compare electrical versus non-electrical burn injuries and assess regional differences in patient and burn characteristics, and outcomes using the American Burn Association’s Burn Care Quality Platform (BCQP). We conducted a retrospective cohort study using adult admissions from 2020 to 2022 to compare electrical to other types of burns. Outcomes included length of stay, mortality, discharge disposition, and insurance status. Regional analyses were based on the five ABA regions in the USA. Statistical comparisons used multivariate analyses, including propensity score matching. . Of a total of 63,269 patients, 2,042 (3.3%) sustained electrical injuries. These patients were younger (average age 40), predominantly male (92.2%), more likely to be injured at work (61.9%) and disproportionately Hispanic/Latino (21.9%). In the Southern region, electrical injuries resulted in significantly shorter median hospital stays than non-electrical injuries (2 vs. 3 days, p < 0.0001) shorter ICU stays (3 vs. 4 days, p ≤ 0.001). Mortality was consistently lower among electrical injury patients (2.2% vs. 3.7%, p ≤ 0.012). 52.7% of patients in the sample were treated in the Southern region, which also had the highest rate of electrical injuries in the country.The ABA Southern region bears a disproportionate burden, particularly among Hispanic/Latino and uninsured patients. These findings highlight the need for region-specific prevention, improved safety training, and equitable access to care.

PMID:41966997 | DOI:10.1093/jbcr/irag049

Eur Urol Oncol. 2026 Apr 10:S2588-9311(26)00078-7. doi: 10.1016/j.euo.2026.03.019. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Most patients with high-risk localized prostate cancer (HRLPC) do not undergo stereotactic body radiotherapy (SBRT) in part because of the limited evidence of long-term outcomes. We report long-term efficacy and toxicity outcomes for men treated with SBRT for HRLPC.

METHODS: Individual patient data from ten prospective clinical studies evaluating SBRT for HRLPC across nine institutions were pooled in the Stereotactic Body Radiotherapy for High-Risk Localized Carcinoma of the Prostate consortium. The Kaplan-Meier method was used to estimate 5-yr biochemical recurrence (BCR) and distant metastasis (DM), stratified by receipt of intensified treatment (≥12 mo of androgen deprivation therapy [ADT] with extremely dose-escalated [≥8 Gy/fraction] prostate-directed SBRT). The impact of intensified treatment on BCR-free survival and DM-free survival was evaluated using multivariable Cox proportional hazards models. Late Common Terminology Criteria for Adverse Events grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity was analyzed using time-to-event models.

KEY FINDINGS AND LIMITATIONS: In 440 patients with a median follow-up time of 60.4 mo, 5-yr BCR and DM rates were 22% (95% confidence interval [CI] = 17-26%] and 9.2% (95% CI = 6.2-12%), respectively. In the 93 patients (21%) who received intensified treatment, 5-yr BCR and DM rates were 7.4% (95% CI = 1.7-13%) and 3.7% (95% CI = 0-7.9%), respectively. Receipt of intensified therapy was associated with a significant reduction in both BCR (hazard ratio [HR] = 0.38 [95% CI = 0.20-0.74], p = 0.005) and DM (HR = 0.43 [95% CI = 0.18-0.99], p = 0.049). For the overall cohort, 5-yr rates of grade ≥2 GU and GI toxicity were 23% (95% CI = 19-27%) and 10% (95% CI = 7-13%), respectively. Limitations include heterogeneous treatment techniques and the nonrandomized nature of the study.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The safety and efficacy profile of SBRT for HRLPC remains favorable at long-term follow-up, and SBRT should be integrated into shared decision-making for treatment of HRLPC.

PMID:41966956 | DOI:10.1016/j.euo.2026.03.019

Eur Urol Oncol. 2026 Apr 10:S2588-9311(26)00062-3. doi: 10.1016/j.euo.2026.03.003. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cancer of the Prostate Risk Assessment (CAPRA) score and its postsurgical variant (CAPRA-S) predict biochemical recurrence (BCR) after radical prostatectomy (RP) but do not capture tumor biology. We developed two integrated clinical scores, CAPRA-G and CAPRA-SG, combining CAPRA or CAPRA-S with Genomic Prostate Score (GPS).

METHODS: We analyzed 955 patients with Oncotype DX testing before RP. Associations between GPS, CAPRA, and CAPRA-S scores, and BCR were assessed using Cox models. CAPRA-G and CAPRA-SG were derived from β-coefficient weighting. Model discrimination was evaluated using Harrell’s C-index (3000 bootstrap resamples); differences were assessed with a nonparametric U-statistic. Decision-curve analysis compared CAPRA with CAPRA-G and CAPRA-S with CAPRA-SG.

KEY FINDINGS AND LIMITATIONS: Median follow-up was 60 mo (IQR 36-72). GPS predicted BCR independent of CAPRA or CAPRA-S (p < 0.001). Using log-hazard β-coefficients, one CAPRA and CAPRA-S point corresponded to » 6 and 10 GPS points, respectively, yielding CAPRA-G = CAPRA + GPS/6 and CAPRA-SG = CAPRA-S + GPS/10. Compared with CAPRA and CAPRA-S, CAPRA-G and CAPRA-SG showed a statistically significant improvement in C-indices, increasing from 0.67 to 0.76 (p < 0.001) and from 0.81 to 0.84 (p = 0.041), respectively. Decision-curve analysis demonstrated higher net benefit for CAPRA-G and CAPRA-SG at clinically relevant thresholds (» 0.05-0.45). Limitations included lack of external validation and under-representation of high-risk disease due to selective GPS prescription.

CONCLUSIONS AND CLINICAL IMPLICATIONS: GPS integration enhances BCR risk stratification in the RP setting. CAPRA-G and CAPRA-SG scores quantify genomic risk and translate GPS into simple, clinically applicable tools with improved clinical utility. External validation is warranted.

PMID:41966955 | DOI:10.1016/j.euo.2026.03.003