Tag: nevin manimala

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

Behav Sci Law. 2026 May 27. doi: 10.1002/bsl.70072. Online ahead of print.

ABSTRACT

This study examined and compared the prevalence and expression of psychopathic traits in a Portuguese sample of prisoners and community members, using the abbreviated version of the Self-Report Psychopathy Scale (SRP-SF). The sample consisted of 766 participants (41.5% prisoners, 58.5% community members) of both sexes. Results indicated that prisoners presented significantly higher levels in all four facets of psychopathy. Males presented higher levels in all facets, regardless of context. The interaction between sex and context was statistically significant only in the affective facet: female prisoners presented similar levels to male prisoners, while females in the community presented lower levels. 31.4% of inmates scored high on psychopathy (≥ 70), compared to 2.2% in the community, demonstrating the discriminant validity of the SRP-SF. The results support the dimensional conceptualization of psychopathy and illustrate the utility of the SRP-SF for forensic screening. Practical implications for forensic assessment, prison intervention, and community prevention are discussed.

PMID:42204381 | DOI:10.1002/bsl.70072

Chirality. 2026 Jun;38(6):e70107. doi: 10.1002/chir.70107.

ABSTRACT

The homochirality of life-the exclusive use of L-amino acids and the universal right-handedness of $\alpha$ -helices-stands as one of the most persistent asymmetries in biology. While often attributed to kinetic or energetic biases, the overwhelming statistical dominance of these chiral forms still lacks a fully compelling thermodynamic and geometric explanation. Here, we propose a geometric mechanism for the stabilization and amplification of biomolecular handedness in open, entropy-producing systems. By introducing a local chirality marker based on the sign of a scalar triple product (equivalently, the sign of a determinant built from atomic coordinate differences and the local helical axis), we show that right-handed $\alpha$ -helices can be can be represented as orientation-preserving sectors of the local configuration space in the local configuration space. Under physically admissible continuous backbone moves, chirality inversion requires crossing a degenerate subset where the marker vanishes, which constitutes a lower dimensional region of effectively zero measure in the feasible configuration manifold. Consequently, parity-inverting pathways are dynamically suppressed, and once a chiral sign becomes established, it tends to persist and amplify under irreversible evolution consistent with least-time free-energy dissipation. Our framework reframes biomolecular homochirality not as the consequence of a primordial energetic asymmetry but as an emergent, statistically stabilized standard arising from the interplay between nonequilibrium thermodynamics and the geometry of configuration space.

PMID:42204377 | DOI:10.1002/chir.70107

NPJ Digit Med. 2026 May 27. doi: 10.1038/s41746-026-02721-3. Online ahead of print.

ABSTRACT

Significant executive function deficits mark attention-deficit/hyperactivity disorder (ADHD). Digital therapeutics (DTx) targeting cognitive control offer promising non-pharmacological options but require rigorous validation. We evaluated the efficacy and safety of STAR RUCKUS, an adaptive multitasking DTx designed to strengthen cognitive control in children with ADHD. In this multicenter, randomized, single-blind, sham-controlled trial, 122 children aged 6-12 years with DSM-5/ICD-10-diagnosed ADHD were assigned 1:1 to STAR RUCKUS or a visually matched driving-only sham intervention and completed five daily sessions for 4 weeks. The primary outcome was the change in clinician-rated Korean ADHD rating scale (K-ARS) scores. Of 122 randomized children, 114 completed the trial. At Week 4, STAR RUCKUS produced greater symptom reduction than sham (-7.50 vs. -4.00; p = 0.009), with improvements in inattention (p = 0.024) and hyperactivity/impulsivity (p = 0.015). These findings suggest statistically significant improvements of small-to-moderate magnitude (ηp² = 0.05) in clinician-rated ADHD symptoms, along with favorable adherence and tolerability. Trial registration: ClinicalTrials.gov (NCT07173439).

PMID:42204362 | DOI:10.1038/s41746-026-02721-3

Sci Rep. 2026 May 27. doi: 10.1038/s41598-026-54614-w. Online ahead of print.

ABSTRACT

Hypertension is a chronic condition frequently requiring long-term pharmacotherapy, which may increase the risk of medication-related problems. Comprehensive Medication Management (CMM) has been associated with improvements in health outcomes in patients with hypertension; however, evidence from pragmatic randomized clinical trials in primary care settings remains limited. This study aimed to evaluate the association between pharmacist-led CMM on clinical, anthropometric, humanistic, and cardiovascular risk outcomes among patients with hypertension treated within the public health care network of Alegre, Espírito Santo, Brazil. A pragmatic, single-blind, randomized controlled clinical trial with a 12-month follow-up was conducted. A total of 128 adults with hypertension were randomized in a 1:1 ratio to the intervention group (CMM) or the control group (usual care). No statistically significant between-group differences were observed for clinical, anthropometric, or humanistic parameters; cardiovascular risk was the only outcome showing a statistically significant time × group interaction (p = 0.039; η²p = 0.026), indicating a trend toward a more favorable trajectory in the CMM group. Intention-to-treat analyses showed significant time effects for systolic blood pressure, lipid profile components, quality of life, hypertension-related knowledge, and cardiovascular risk in both groups. In exploratory intragroup analyses, the intervention group showed significant changes in systolic blood pressure (- 9.47 mmHg), total cholesterol, LDL cholesterol, non-HDL cholesterol, and cardiovascular risk, along with improvements in quality of life and hypertension-related knowledge, whereas the control group showed improvements limited to knowledge scores and self-rated quality of life. Per-protocol sensitivity analyses confirmed the consistency of these findings. Although between-group comparisons did not demonstrate clear statistical superiority of CMM over usual care for most outcomes, the results suggest that CMM may contribute to clinically relevant improvements in cardiovascular risk and patient-centered outcomes in real-world practice. These findings should be considered hypothesis-generating, and larger, adequately powered, multicenter pragmatic trials are warranted to confirm the effectiveness of CMM in hypertension management.

PMID:42204303 | DOI:10.1038/s41598-026-54614-w

Sci Rep. 2026 May 28. doi: 10.1038/s41598-026-54404-4. Online ahead of print.

ABSTRACT

We aimed to study the relationship between brain network measures and cognitive performance in this population, focusing on hub regions. A sub-cohort of young stroke survivors (ages 18-49) with confirmed cerebral ischemia from the ODYSSEY study underwent MRI and neuropsychological assessments at baseline (n = 60) and follow-up (n = 46) up to 2 years, the discovery cohort. Additionally, a validation cohort of young stroke survivors with confirmed cerebral ischemia who had baseline standard MRI protocol and neuropsychological assessment (n = 423), as well as follow-up neuropsychological assessment (n = 288), was included for validation analysis. We used diffusion tensor imaging (DTI) based connectivity matrices for graph analysis. Lesion impact scores (combining affected voxel percentage and mean betweenness centrality) and rich club scores (quantifying affected voxels in rich club areas) were calculated using a normative brain atlas derived from DTI data from 23 stroke-free controls. Participants were categorized having no/mild or major vascular cognitive disorder (VCD) and group differences were examined. Among 60 participants (median age: 39.2 years (IQR 27.9-46.2) and 52% women), 20 were classified as having major VCD. The major VCD group exhibited larger lesion volumes (p = 0.01), lower global efficiency (p = 0.03) and local efficiency (p = 0.05) compared to the no/mild VCD group at baseline and follow-up. However, after adjusting for network density in sensitivity analyses, these differences in global and local efficiency were no longer statistically significant. Univariable logistic regression analyses revealed that the Lesion Impact Score were a significant predictor for VCD at follow-up and the Rich Club Score predicted VCD at baseline and follow-up. However, in multivariable logistic regression, both the Lesion Impact Score and the Rich Club Score did not retain predictive significance. Following validation analysis, no predictive values were observed for any of these scores. Our findings indicate a significant association between brain network measures and cognitive function in young stroke survivors, indicating a role of network disruption in post-stroke cognitive impairment. However, our study did not reveal specific associations with hub regions.

PMID:42204300 | DOI:10.1038/s41598-026-54404-4

Sci Rep. 2026 May 27;16(1):16417. doi: 10.1038/s41598-026-54582-1.

NO ABSTRACT

PMID:42204267 | DOI:10.1038/s41598-026-54582-1

Sci Rep. 2026 May 27. doi: 10.1038/s41598-026-55008-8. Online ahead of print.

ABSTRACT

To investigate the frequency of pseudoexfoliation syndrome (PEXS), its ocular and systemic clinical features in patients scheduled for cataract surgery, and to evaluate surgical complications and outcomes. Data from 585 eyes that underwent cataract surgery were included in this retrospective study. Data retrieved from patient files and our hospital’s electronic medical records were reviewed, including the presence of PEXS, pupil dilation, cataract type, nuclear hardness according to Lens Opacities Classification System III, and glaucoma. Additionally, data on clinical characteristics of pre-existing systemic diseases, surgical outcomes, and intraoperative and postoperative complications were also noted. The data were analyzed between two groups: eyes with PEXS and eyes without PEXS. The frequency of PEXS was 10.7%. The most common type of cataracts in the PEXS group was nuclear cataracts. Nuclear cataracts were harder in eyes with PEXS than in eyes without PEXS. Mean intraocular pressure was significantly higher in eyes with PEXS than in eyes without PEXS (p = 0.001). The prevalence of glaucoma was significantly higher in the PEXS group (p = 0.001). There was no statistically significant difference between the two groups in terms of the frequency of intraoperative and postoperative complications. The non-PEXS group showed significantly better best-corrected visual acuity (BCVA) compared to the PEXS group at the first week postoperatively (p = 0.001). However, BCVA was comparable between groups at the one-month postoperative visit. The frequency of PEXS was relatively high in our study. Awareness of the potential risks associated with PEXS in cataract surgery is essential, and appropriate preparations, including necessary surgical tools and techniques, should be made to ensure optimal outcomes. Although no differences were observed in the rates of intraoperative complications between the groups, this finding should be interpreted cautiously and should not be considered as evidence of equivalent surgical risk.

PMID:42204261 | DOI:10.1038/s41598-026-55008-8