Tag: nevin manimala

Clin Transplant. 2026 Feb;40(2):e70484. doi: 10.1111/ctr.70484.

ABSTRACT

INTRODUCTION: There are no effective therapeutic agents for preventing or treating delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs). Donor and recipient factors are important to predicting DGF and associated outcomes, which we hypothesize differed over time.

METHODS: DDKTRs were stratified by transplant year into four eras-E1 (2000-2005), E2 (2006-2011), E3 (2012-2017), and E4 (2018-2021). We analyzed risk factors for DGF, along with one-year uncensored graft failure (UCGF), death-censored graft failure (DCGF), death with a functioning graft (DWFG), and acute rejection (AR) by era.

RESULTS: A total of 3085 DDKTRs were included (E1: 804, E2: 882, E3: 909, E4: 490). The proportion of patients with DGF differed significantly by era. Duration of DGF and median dialysis count were lower in recent eras. In E1-E4, donation after circulatory death, higher donor terminal serum creatinine, and pretransplant duration of dialysis were risk factors for DGF, while preemptive transplant was associated with lower odds of DGF. Other factors were not consistently associated with DGF across eras. The risk of one-year AR was significantly lower in E3 (aHR: 0.46; 95% CI: 0.30-0.69, p < 0.001) and E4 (aHR: 0.16; 95% CI: 0.07-0.36, p < 0.001) compared to E1. There were trends towards decreased risk for UCGF and DWFG in E2, E3, and E4.

CONCLUSION: Some risk factors for DGF remained consistent, while others differed. Likely due to improved management, the risk for AR in the DGF setting improved in recent eras. There were trends of improved uncensored graft and patient survival in recent eras.

PMID:41691637 | DOI:10.1111/ctr.70484

Clin Transplant. 2026 Feb;40(2):e70476. doi: 10.1111/ctr.70476.

ABSTRACT

BACKGROUND: Sarcopenia and obesity are prevalent in end-stage-liver-disease (ESLD) patients undergoing Liver Transplantation (LT), contributing to morbidity and mortality. Although LT restores liver function, sarcopenia and obesity often persist. Body mass index (BMI) is unreliable in ESLD for assessing adiposity, necessitating alternative measures. Visceral-to-subcutaneous adipose tissue (VAT/SAT) ratio affects outcomes, with VAT associated with poorer cardiovascular health and survival. This study investigated long-term changes in body composition post-LT and their associations with survival and hospital/ICU stay.

METHODS: A single-center retrospective cohort analyzed 81 adults undergoing LT (2009-2015). Body composition was assessed via CT/MRI at L3 level pre-LT and longitudinally up to 10y post-LT. Sarcopenia was defined using sex-specific skeletal muscle index (L3-SMI) thresholds. VAT and SAT areas quantified fat distribution. Outcomes included ICU/hospital stay and survival. Longitudinal changes were modeled using linear mixed models. Associations resulted from survival analysis and Spearman correlations.

RESULTS: Pre-LT, 61% were sarcopenic, 53% had BMI ≥ 25 kg/m², and 19% had sarcopenic obesity. Post-LT, L3-SMI declined, partially recovered, but remained below baseline. BMI decreased initially, then increased. VAT rose for 2-4y, then declined; SAT increased steadily. VAT/SAT ratio increased modestly early, then declined after ∼4.5y. Pre-LT sarcopenia predicted lower survival; post-LT didn’t. Higher pre-LT VAT was associated with prolonged ICU stay. Elevated pre-LT VAT/SAT ratio correlated with longer ICU/hospital stays.

CONCLUSIONS: Sarcopenia persists long after LT and is associated with reduced survival. Unfavorable fat distribution was associated with longer hospital/ICU stay. Early diagnosis and targeted management of sarcopenia and visceral adiposity seem promising to improve post-LT outcomes.

PMID:41691622 | DOI:10.1111/ctr.70476

Clin Transplant. 2026 Feb;40(2):e70477. doi: 10.1111/ctr.70477.

ABSTRACT

INTRODUCTION: Donor age is a key determinant of liver transplant (LT) outcomes, but its impact varies across recipient age groups. Specific donor age thresholds associated with excess risk remain undefined.

METHODS: Using data from the Scientific Registry of Transplant Recipients (2011-2021; follow-up through 2024), we analyzed first-time, single-organ LT recipients. Donors and recipients were stratified by age. Outcomes included patient, graft, and death-censored graft survival. Multivariable Cox regression models adjusted for liver disease severity, comorbidities, graft type, and transplant year were used to identify donor age thresholds associated with increased risk in each recipient age group.

RESULTS: Among 70 078 recipients (median age, 57 years), mean donor age rose from 39.6 to 40.9 years (p = .004), while recipient age increased from 50.7 to 51.9 years (p = .003). Donor age ≥50 years was associated with a sixfold increase in mortality in pediatric recipients (aHR, 6.48; 95% CI, 1.92-21.83; p = .003). For adults aged 18.1-30 years, excess mortality and graft loss were observed with donors >55 years (aHRs >2.5). In recipients aged 40.1-60 years, risk increased progressively with donor age. Among recipients ≥65 years, donor age was not significantly associated with outcomes. These thresholds were consistent across outcomes and robust in sensitivity analyses.

CONCLUSIONS: This is the first national study to define recipient age-specific donor age thresholds associated with post-LT risk. These findings support the development of age-informed allocation strategies and call for a reassessment of organ discard practices as donor and recipient ages continue to rise.

PMID:41691620 | DOI:10.1111/ctr.70477

Cancer Med. 2026 Feb;15(2):e71566. doi: 10.1002/cam4.71566.

ABSTRACT

PURPOSE: Identify factors influencing audiological care for chemotherapy-induced ototoxicity from the perspectives of oncology providers in the Veterans Health Administration (VA), and quantify audiology service use among Veterans receiving ototoxic chemotherapies.

METHODS: We surveyed VA oncology providers to identify barriers and facilitators to ototoxicity management (OtoM). We also conducted a VA-wide retrospective cohort analysis over a 5-year period to quantify audiology service use among Veterans who received cisplatin, carboplatin, or oxaliplatin chemotherapy.

RESULTS: A total of 30,643 Veterans received platinum-based chemotherapy from 2014 to 2019. Few of them (< 10% on cisplatin, < 5% on carboplatin or oxaliplatin) accessed audiology services within a year of treatment. Of the 8702 patients on cisplatin, only 9.6% had two or more audiology encounters. Thirty-six oncology providers completed our survey. Most providers believed OtoM should be routine for patients on cisplatin (97%) or carboplatin (70%), but they overestimated audiology service provision levels relative to our analysis. Most providers would consider giving a different chemotherapy drug (73%) or decrease the dose (56%) for patients with ototoxicity, yet only 36% routinely referred patients to audiology. Access, perceived need, and resources were major barriers to OtoM, while care coordination was a primary facilitator.

CONCLUSIONS: OtoM is a care-gap for Veterans with cancer, despite its perceived value to VA oncology providers. Cisplatin and carboplatin frequently add hearing loss and tinnitus to survivors’ treatment burdens. This study offers insights into oncology providers’ views on OtoM, guiding efforts to address the identified care gap.

PMID:41691610 | DOI:10.1002/cam4.71566

Arch Gynecol Obstet. 2026 Feb 15;313(1):97. doi: 10.1007/s00404-026-08344-z.

ABSTRACT

OBJECTIVE: To analyze the correlation between lipid levels and the severity of polycystic ovary syndrome (PCOS) and its predictive value for pregnancy outcome.

METHODS: This retrospective study included 275 PCOS patients treated with ovulation induction therapy and 234 healthy controls (used only for baseline comparisons). Lipid levels were correlated with disease phenotype and sex hormones using Spearman/Pearson coefficients. Binary logistic regression and ROC curves assessed the predictive value of lipid levels for pregnancy failure.

RESULTS: There were statistically significant differences between the two groups in glycemic indexes (fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR)) and sex hormone indexes (testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), anti-Müllerian hormone (AMH)). The levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo B) were significantly elevated in patients with PCOS and were closely correlated with the severity of the disease. In addition, these four lipid parameters were significantly positively correlated with T, LH, FSH, and AMH, and significantly negatively correlated with E2. Elevated levels of T, LH, TG, LDL-C, and Apo B were independent risk factors for pregnancy failure after ovulation induction treatment. TG assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.861 (sensitivity 75.61%, specificity 85.53%); LDL-C assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.868 (sensitivity 75.61%, specificity 83.55%); and Apo B assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.836 (sensitivity 74.80%, specificity 86.84%).

CONCLUSION: Lipid levels were significantly correlated with the severity of disease in PCOS patients, and TG, LDL-C, and Apo B levels assisted in predicting the occurrence of pregnancy failure after ovulation induction therapy.

PMID:41691582 | DOI:10.1007/s00404-026-08344-z

Discov Oncol. 2026 Feb 15. doi: 10.1007/s12672-026-04670-5. Online ahead of print.

ABSTRACT

INTRODUCTION: There is a need to assess the potential of blood-based biomarkers to detect treatment outcomes of cervical lesions. We determined the association between serum P16ink4A and FOXP3 concentrations and treatment outcomes of cervical lesions at a clinic in Southwestern Uganda.

METHODS: In this prospective cohort study, participants with cytologically and/or histologically confirmed cervical intraepithelial neoplasia (CIN) (n = 90) and cervical cancer (CC) (n = 90) were monitored for 12 months. After consent, clinical and demographic data were recorded, blood was collected, and serum P16ink4A and FOXP3 were measured (quantitative ELISA) at baseline and 12 months post-treatment. With multinomial logistic regression, we determined the association between treatment outcomes and serum P16ink4A and FOXP3 concentrations in STATA 17 using P-values of < 0.05 as statistically significant.

RESULTS: Of the 180 participants initially enrolled, 62 returned for the 12-month follow-up assessment. At this time point, 47 participants presented with cleared lesions, 6 with persistent lesions, and 9 with progressed lesions. All participants exhibiting disease progression (n = 9) were CC cases, while 82.98% (39/47) of those with cleared lesions had LSIL. For raised (> 0.0545 ng/ml), relative to reduced serum FOXP3 (≤ 0.0545 ng/ml), the risk of progression relative to clearance of invasive cervical cancer would increase by 27.82. Also raised (> 0.946 ng/ml) relative to reduced (≤ 0.946 ng/ml) serum P16INK4A, the risk of persistence relative to clearance of low grade cervical lesions would increase by 5.16 times, given other variables remain constant.

CONCLUSION: Though results are not statistically significant and imprecise, serum FOXP3 and P16ink4A concentrations are likely associated with persistence and progression of cervical lesions. Their measurement may benefit the prognostic monitoring of cervical lesions.

PMID:41691576 | DOI:10.1007/s12672-026-04670-5

Orv Hetil. 2026 Feb 15;167(7):265-273. doi: 10.1556/650.2026.33467. Print 2026 Feb 15.

ABSTRACT

INTRODUCTION: Childhood injuries are among the leading causes of mortality worldwide and in Hungary. The quality of first aid provided by laypeople has a fundamental impact on survival rates.

OBJECTIVE: To assess parents’ knowledge of first aid, to explore their need for further practical training, and to determine whom they consider the most reliable source of such knowledge.

METHOD: During our quantitative research conducted in Győr-Moson-Sopron county, we used a self-designed, online, anonymous questionnaire (n = 545) and performed descriptive statistical analyses. Associations were examined using the chi-square test and binary logistic regression (p<0.05).

RESULTS: The majority of parents (94.3%) possess basic, primarily theoretical first aid knowledge; however, this knowledge is often incomplete or outdated. The greatest deficiencies were in the practical application of cardiopulmonary resuscitation and in the airway obstruction caused by foreign bodies. The majority of respondents (93.4%) would be willing to learn from paramedics (84.9%), health visitor (60%), registered nurses (57.6%), physicians (56.4%). Based on the association analyses, first aid experience gained in real-life emergency situations was significantly associated with self-reported willingness to intervene (p = 0.012) as well as with a more favorable self-assessment of first aid competence (p<0.001). According to the results of the binary logistic regression, having an official, examination-based first aid qualification was an independent predictor of having provided first aid in a real-life emergency situation; among respondents without such qualification, the odds of providing first aid were reduced by approximately half (OR = 0.516; p = 0.001; 95% CI: 0.345-0.774).

CONCLUSION: The goal is to clarify the knowledge of parents and provide training in practical skills from professionals. Both formal first aid training and practical experience play a decisive role in shaping the willingness to intervene in real-life emergency situations as well as self-confidence. These findings support the need for structured, practice-oriented first aid education among parents. Orv Hetil. 2026; 167(7): 265-273.

PMID:41691563 | DOI:10.1556/650.2026.33467

Reproduction. 2026 Feb 15:xaag025. doi: 10.1093/reprod/xaag025. Online ahead of print.

ABSTRACT

Evidence suggest that lipotoxicity can cause hyperandrogenesis, but little is known about the intra-ovarian environment of women with polycystic ovary syndrome (PCOS) and whether it displays features associated with lipotoxicity. The objective of this secondary analysis was to compare follicular fluid concentrations of testosterone, markers of lipid, lipid metabolism and inflammation between women with PCOS and without PCOS. We conducted a controlled cross-sectional study on 80 participants. Medical records were used to determine PCOS diagnosis: 15 women were identified as having PCOS, while 65 had a negative diagnosis. Inclusion criteria were 18 and 40 years old with a body mass index raging between 18 and 40 kg/m2. Follicular fluid was analysed for total testosterone, non-esterified fatty acids (NEFA), triglycerides, NEFA metabolites (acylcarnitines and C16/C13 ratio) and inflammatory cytokines. Compared to women without PCOS, women with PCOS had increased follicular fluid levels of testosterone (7.08 nM vs 0.29 nM), triglycerides (0.30 nM vs 0.17 nM), palmitoylcarnitine (43.7 nM vs 28.4 nM) IL-6 (13.04 pg/mL vs 8.9 pg/mL), while TNF-α remained similar. These differences remained statistically different after adjustment for BMI, except for IL-6. These group differences were also confirmed in paired analyses of 13 BMI-matched pairs of PCOS vs non-PCOS women, exception made for IL-6. In conclusion, intra-ovarian inflammation, but more importantly, lipid overexposure, may play a role in the pathogenesis of PCOS, probably through lipotoxic effects.

PMID:41691561 | DOI:10.1093/reprod/xaag025

J Nurs Educ. 2026 Feb 18:1-4. doi: 10.3928/01484834-20250925-01. Online ahead of print.

ABSTRACT

BACKGROUND: Developing skills at each step of the research process is essential for understanding and utilizing evidence as a graduate nursing student. Opportunities to build these skills may be limited by a lack of structured research experiences and heavy clinical course loads. Incorporating a practice research project as part of the research class assists in achieving these competencies.

METHOD: Graduate nursing students in a research course used the Newest Vital Sign, a validated health literacy measure. Students formulated research questions, examined ethical considerations, conducted data collection and descriptive analysis, presented their findings, and recommended interventions.

RESULTS: Students reported enhanced research competencies in data collection and statistical analysis, and a deeper appreciation for health literacy’s implications in clinical practice.

CONCLUSION: This approach, aligned with the American Association of Colleges of Nursing competency-based education domains, effectively integrates health literacy assessment to strengthen graduate students’ research skills, offering a replicable model for nursing education.

PMID:41691546 | DOI:10.3928/01484834-20250925-01

Clin Transl Sci. 2026 Feb;19(2):e70493. doi: 10.1111/cts.70493.

ABSTRACT

Project Optimus has been reforming the dose selection and optimization paradigm in oncology. In this context, model-informed drug development (MIDD) approaches were utilized to validate the optimal dose selection of 6 mg/kg every 3 weeks (Q3W) for datopotamab deruxtecan (Dato-DXd) in patients with HR-positive/HER2-negative breast cancer (HR+/HER2- BC). A Tumor Growth Inhibition (TGI)-Progression-Free Survival (PFS) modeling framework was developed to assess the relationship between Dato-DXd PK exposure, tumor dynamics, and PFS, and support virtual trial simulations at different Dato-DXd dose levels. Simulations suggested that Dato-DXd at 6 mg/kg Q3W provide superior tumor control and improved PFS compared to a lower dose in patients with HR+/HER2- BC. This work underscores the importance of integrating advanced modeling techniques into the dose optimization paradigm.

PMID:41691539 | DOI:10.1111/cts.70493