Nevin Manimala

Am J Otolaryngol. 2026 Jul 2;47(5):104882. doi: 10.1016/j.amjoto.2026.104882. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the efficacy, optimal timing, procedure and influencing factors of non-invasive correction for various congenital auricular deformities in newborns.

METHODS: Retrospective study of 68 congenital auricular deformities in newborns (117 ears), including morphological and structural defects (2024-2025). Patients were divided into four groups: simple treated with self-made support strips, and others including those helical rim deformities with cartilage adhesions, microtia group and other deformities group corrected with EarWell system. Statistical analysis was performed using SPSS 23.0.

RESULTS: The average age at initial correction was 22.38 days. No complications occurred in the self-made strip group, while mild adverse reactions in other groups were relieved after symptomatic treatment. The overall excellent rate reached 80.34%, with higher rates in helical rim groups and lower in microtia group. The average correction duration was 6.9 weeks. Notably, the self-made strip group had a significantly shorter correction duration (P = 0.0087).

CONCLUSION: Satisfactory correction outcome can be achieved with a simple helical support strip for mild helical rim abnormalities without skin or cartilage adhesion. The EarWell Infant Ear Correction System effectively addresses external ear abnormalities and minor malformations. Earlier treatment initiation correlates with a shorter correction duration, superior clinical outcomes, and fewer complications.

PMID:42480176 | DOI:10.1016/j.amjoto.2026.104882

Eur J Radiol. 2026 Jul 17;204:113090. doi: 10.1016/j.ejrad.2026.113090. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the clinical feasibility of using the non-zero-calcification-risk Multi-Ethnic Study of Atherosclerosis (nzcr-MESA) score, a simplified risk calculator that includes only age, sex, and ethnicity, for predicting the extent of coronary artery calcification (CAC) as measured by computed tomography (CT).

METHODS: In this retrospective study, 241 Caucasian patients underwent coronary CT angiography (CCTA) for the assessment of coronary artery disease. The objective extent of coronary calcification was quantified using Agatston scores. The nzcr-MESA score was calculated based on patient demographics and compared to the extent of calcification. Statistical analysis involved Spearman correlation coefficients and regression models to determine the relationship between nzcr-MESA and CAC. Significance was set at P < 0.05.

RESULTS: A positive correlation was found between nzcr-MESA scores and the degree of CAC (P < 0.0001, females R = 0.56, males R = 0.39) as well as to disease severity according to the coronary artery disease-reporting and data system (CAD-RADS) scores (P < 0.0001, females R = 0.45, males R = 0.42), suggesting that the simplified score is a predictor of calcification and coronary disease. The optimal nzcr-MESA cutoff values for preselecting patients with severe coronary artery calcification (Agatston Score ≥ 400) were 90 % for females and 95 % for males.

CONCLUSION: The nzcr-MESA score offers a clinically feasible, simplified method for estimating CAC extent, with significant implications for CT coronary imaging. Given its ease of use and its capability to correctly predict severe CAC, nzcr-MESA can be useful to preselect suitable diagnostic protocols. Integrating nzcr-MESA into clinical routine may help to streamline diagnostic workflows.

PMID:42480173 | DOI:10.1016/j.ejrad.2026.113090

J Pediatr Nurs. 2026 Jul 21;90:641-648. doi: 10.1016/j.pedn.2026.07.019. Online ahead of print.

ABSTRACT

BACKGROUND: First-degree relatives (FDRs) of type 1 diabetes (T1D) patients are at high risk for T1D. Early screening enables timely intervention, yet participation remains suboptimal, missing opportunities in this high-risk group. Understanding determinants of screening participation and translating them into actionable, theory-informed, family-centered strategies is essential to optimize preventive care.

METHODS: In this qualitative study in China, semi-structured interviews were conducted with 21 adult T1D probands or parents of pediatric T1D patients who have unaffected children. The Theoretical Domains Framework (TDF) guided data collection and analysis. Barriers were mapped to Behavior Change Techniques (BCTs).

RESULTS: We identified 18 facilitators, 11 barriers, and 2 neutral factors, mapped across 12 TDF domains. Key barriers included limited awareness, misconceptions, cost, restricted medical resources, insufficient publicity, and anxiety; key facilitators included perceived benefits, optimism, health beliefs, and social support. Through TDF-BCT mapping, 34 intervention strategies were categorized into 13 categories targeting knowledge enhancement, environmental adaptation, social and emotional support, and self-efficacy building.

CONCLUSIONS: This study provides a systematic, theory-based analysis of factors influencing screening participation for T1D. The resulting strategy map offers a set of theory-informed, family-centered suggestions to guide nurses and educators in supporting parents and improving early detection in clinical practice, subject to future empirical validation.

IMPLICATIONS FOR PRACTICE: Nurses and educators should develop localized, family-centered screening promotion programs guided by theory-driven frameworks and BCTs. Concurrently, systemic enablers-such as resource allocation, financial support, and routine follow-up guidance-must be established to comprehensively address barriers to participation in screening.

PMID:42480168 | DOI:10.1016/j.pedn.2026.07.019

Tissue Cell. 2026 Jul 16;104(Pt 1):103791. doi: 10.1016/j.tice.2026.103791. Online ahead of print.

ABSTRACT

Osteoporosis, a prevalent skeletal condition defined by diminished bone density and disrupted microarchitecture, dramatically elevates fracture risk. Its pathophysiology is now understood to extend beyond classic remodeling imbalances to include a pivotal shift in bone marrow mesenchymal stem cell (BMSC) differentiation, where adipogenesis is favored over osteogenesis-a key feature of aging and estrogen deficiency. The emerging “gut-bone axis” suggests that microbiota-derived metabolites can systemically influence skeletal homeostasis, presenting new therapeutic possibilities. This research uncovers the direct osteoanabolic and anti-adipogenic properties of Reuterin (3-hydroxypropionaldehyde, Reut), a principal antimicrobial metabolite from Lactobacillus reuteri. In vitro, Reut (5-20 μM) showed excellent cytocompatibility, dose-dependently boosting osteogenic differentiation (increased ALP activity and mineralization) while effectively suppressing adipogenic differentiation (decreased lipid accumulation) in BMSCs. Mechanistically, Reut specifically activated the canonical BMP-Smad pathway, demonstrated by the rapid phosphorylation and nuclear translocation of Smad1/5/9 and the upregulated expression of its direct targets (ID1, ID2). This activation was crucial, as the BMP receptor inhibitor LDN-193189 completely negated Reut’s effects. In an ovariectomized (OVX) rat model, systemic Reut administration (10 mg/kg, every other day for 8 weeks) not only mitigated trabecular bone loss and enhanced biomechanical properties but also markedly reversed the OVX-induced expansion of marrow adipose tissue (MAT). Remarkably, the bone-preserving efficacy of Reut was statistically equivalent to that of teriparatide (TPTD), a clinically approved anabolic agent, while both treatments similarly and significantly countered the pathological marrow adiposity. These results establish Reut as a novel, gut microbiome-derived therapeutic metabolite that rectifies the fundamental lineage imbalance in osteoporosis by directly engaging the BMP-Smad pathway, offering a distinct postbiotic strategy for anabolic bone therapy.

PMID:42480125 | DOI:10.1016/j.tice.2026.103791

Ann Med. 2026 Dec;58(1):2705685. doi: 10.1080/07853890.2026.2705685. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a noninvasive surrogate of right ventricular-pulmonary arterial coupling. Previous evidence focused mainly on in-hospital, 90-day, or 1-year outcomes; long-term prognostic value across heart failure phenotypes remains unclear.

METHODS: This cohort included 440 chronic heart failure patients admitted between 2019 and 2021. Median age was 67 years; 31.1% were female; median follow-up was 41 months. Restricted cubic spline analysis assessed association between TAPSE/PASP and major adverse cardiovascular events (MACEs), defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, or heart failure rehospitalization. Kaplan-Meier and multivariable Cox regression analyses evaluated associations. Incremental value was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS: During follow-up, 193 patients experienced MACEs. TAPSE/PASP showed an approximately linear inverse association with MACE risk, with an exploratory cut-off of 0.036. After adjustment including natriuretic peptides, each 0.01-unit increase in TAPSE/PASP was associated with lower MACE risk (HR 0.75, 95% CI 0.66-0.87; p = 6.02 × 10^-5), whereas TAPSE/PASP ≤0.036 was associated with higher risk (HR 1.98, 95% CI 1.37-2.85; p = 2.57 × 10^-4). Adding TAPSE/PASP modestly improved discrimination (C-statistic 0.80 vs. 0.77), reclassification (NRI 0.31), and IDI (0.04) (all p < 0.05). Associations were consistent across prespecified subgroups.

CONCLUSIONS: In chronic heart failure patients, lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes. TAPSE/PASP may provide complementary prognostic information, but its clinical utility requires prospective external validation.

PMID:42480114 | DOI:10.1080/07853890.2026.2705685

Pulmonology. 2026 Dec;32(1):2704379. doi: 10.1080/25310429.2026.2704379. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Accurate prognostication of malignant pleural effusion (MPE) is essential to guide management decisions and provide patients with meaningful survival estimates. LENT and PROMISE scores are widely recognised MPE-specific prognostic tools, although with limited uptake in clinical practice. More objective, serum-based indices such as the Prognostic Index for Cancer Outcomes (PICO) and Modified Glasgow Prognostic Score (mGPS) have shown robust prognostic value in oncology and may offer advantages by allowing reproducible, treatment-responsive reassessment.

METHODS: Retrospective cohort study including patients with MPE, defined by cytological and/or histopathological confirmation, between 2012-2022 at a Portuguese tertiary hospital. Demographic, clinical and biochemical data were extracted from medical records, enabling calculation of LENT, PROMISE, mGPS and PICO scores, as well as a novel serum-based index (SIMPLE).

RESULTS: 678 patients were included in the cohort. LENT and PROMISE prognostic scoring models underperformed when compared with their serum-based counterparts. PROMISE showed the lowest area under the curve [AUC = 0.735 (95% CI 0.675-0.794)], followed by LENT [AUC = 0.758 (95% CI 0.710-0.808)], PICO [AUC = 0.781 (95% CI 0.725-0.837)] and mGPS [AUC = 0.819 (95% CI 0.745-0.893)]. The most significant serum-based factors (albumin, white blood cell counts and C-reactive protein) were selected for a new prognostic model. SIMPLE showed the highest numerical discriminatory performance [AUC = 0.852 (95% CI 0.782-0.921)], statistically outperforming MPE-specific scores, while demonstrating comparable discrimination to general oncology scores.

CONCLUSION: SIMPLE is a promising, accessible prognostic tool for patients with MPE, demonstrating strong discriminatory performance and outperforming LENT and PROMISE in our sample. External validation is required before routine clinical implementation.

PMID:42480101 | DOI:10.1080/25310429.2026.2704379

Prehosp Emerg Care. 2026 Jul 21:1-12. doi: 10.1080/10903127.2026.2706747. Online ahead of print.

ABSTRACT

OBJECTIVES: Signs of life are observed during out-of-hospital cardiac arrest (OHCA) resuscitation, but their frequency, timing relative to return of spontaneous circulation (ROSC), and prognostic significance remain incompletely described. We evaluated the prevalence of signs of life during resuscitation and their association with survival.

METHODS: We performed a retrospective observational cohort study of all OHCAs treated by a single urban emergency medical services system from January 1 through December 31, 2022. Data were abstracted from prospectively maintained OHCA and airway management registries. Signs of life include respiratory effort, eye opening or tracking, body movement, and verbal response. Each sign was classified as occurring before or after initial ROSC. We used descriptive statistics, binomial confidence intervals, and unadjusted and adjusted logistic regression to evaluate associations between signs of life, OHCA etiology, and survival.

RESULTS: Among 617 treated OHCAs, 156 patients (25.3%) had at least one sign of life. Respiratory effort was most common (148 patients, 24.0%), followed by any body movement (69, 11.2%), eye opening (55, 8.9%), and any verbal response (43, 7.0%). Most documented signs occurred after ROSC, although 44 patients (7.1%) had at least one pre-ROSC sign of life. Patients with signs of life were more likely to have witnessed arrest and initial shockable rhythm and were less likely to receive intra-arrest epinephrine or prehospital advanced airway management. Survival occurred in 91 of 156 patients (58.3%) with signs of life compared with 25 of 461 patients (5.4%) without signs of life. In adjusted analysis, any sign of life was associated with survival (adjusted odds ratio [aOR] 10.3, 95% confidence interval [CI] 5.4-19.9); this relationship held when restricted to signs of life after ROSC (aOR 6.7, 95% CI 3.4-13.3). Among overdose-related OHCA, any body movement (aOR 2.44, 95% CI 1.05-5.67) and any verbal response (aOR 8.06, 95% CI 2.71-24.01) were more frequent than in the non-overdose OHCA cohort.

CONCLUSIONS: One in four treated OHCA patients displayed at least one sign of life during resuscitation. Signs of life, particularly those after ROSC, were strongly associated with survival and may provide clinically useful information during prehospital resuscitation.

PMID:42480096 | DOI:10.1080/10903127.2026.2706747

Am J Clin Pathol. 2026 Jul 6;166(1):aqag081. doi: 10.1093/ajcp/aqag081.

ABSTRACT

OBJECTIVES: We sought to assess the real-world impact of the Genius Digital Diagnostics System (Genius Dx [Hologic, Inc]) on workload, efficiency, and turnaround time in a high-volume cervical cytology laboratory.

METHODS: The laboratory information system was retrospectively queried for all Papanicolaou test cases performed between January 1, 2023, and March 31, 2025. A total of 512 177 cases (655 468 reviews) were included. Genius Dx was implemented on August 1, 2024, and cases were classified as preimplementation or postimplementation. Daily caseload, number of reviewers, number of cases per reviewer, and accession-to-sign-out times were compared using independent-samples t tests. Diagnostic distributions were compared using ꭓ2 tests.

RESULTS: Average daily cytologist (CT) reviews were similar before and after Genius Dx (747.8 vs 758.4 cases) but required fewer CTs per day (10.4 vs 8.1; P < .001), increasing cases per CT per day from 74.5 to 94.7 (P < .001). Pathologist reviews per day increased (106.0 vs 145.3; P < .001) with fewer pathologists (4.4 vs 3.4; P < .001). Average daily CT case workload increased by 53.5% after implementation. Accession-to-sign-out times decreased for all diagnoses (P < .001). A small but statistically significant shift in diagnostic proportions was observed, with a decrease in negative results and an increase in atypical squamous cells of uncertain significance or higher (ASC-US+) findings with negligible effect size.

CONCLUSIONS: Implementation of Genius Dx substantially increased reviewer efficiency and reduced turnaround times without compromising diagnostic performance. The increased detection of ASC-US+ findings observed in this study are in line with results from the Genius Dx clinical trial and other published literature.

PMID:42480093 | DOI:10.1093/ajcp/aqag081

J Nurs Adm. 2026 Aug 1;56(8):450-454. doi: 10.1097/NNA.0000000000001765. Epub 2026 Jul 20.

ABSTRACT

OBJECTIVE: This study investigated links between incivility and intention to leave (ITL) employment among new graduate nurses (NGNs) during residency.

BACKGROUND: As an undesirable characteristic of workplace environments, incivility may predispose inexperienced nurses to leave employment.

METHODS: Surveys of NGN residents conducted 6 months after hire from 2022 through 2024 were analyzed.

RESULTS: Incivility from physicians and unit leaders significantly increased ITL scores but did not predict termination within 2 years. Long-term retention was related to having positive role models and satisfaction with work schedules.

CONCLUSIONS: Fostering supportive leadership and cultivating strong role models could improve retention and reduce early career distress among NGNs.

PMID:42480089 | DOI:10.1097/NNA.0000000000001765

J Nurs Adm. 2026 Aug 1;56(8):427-432. doi: 10.1097/NNA.0000000000001762. Epub 2026 Jul 20.

ABSTRACT

OBJECTIVE: This study sought to examine differences in nursing-sensitive patient outcomes among Magnet® hospitals, Pathway To Excellence® (PTE) hospitals, and non-American Nurses Credentialing Center’s (ANCC®) designated hospitals.

BACKGROUND: The ANCC Magnet Recognition Program® and PTE Program provide frameworks that foster nursing excellence, although limited research has examined the differences of nursing-sensitive patient outcomes among recognition programs.

MATERIALS AND METHODS: A cross-sectional comparative analysis was conducted using 2023 data from the National Database of Nursing Quality Indicators® (NDNQI).

RESULTS: Magnet hospitals reported significantly lower fall rates compared with non-ANCC hospitals (P=0.01). PTE hospitals exhibited significantly lower central line-associated bloodstream infection rates than non-ANCC hospitals (P<0.04). No statistically significant differences in catheter-associated urinary tract infection rates or hospital-acquired pressure injury prevalence were observed.

CONCLUSIONS: ANCC designations were inconsistently associated with better nurse-sensitive patient outcomes in this study. The absence of consistent differences across outcomes may reflect unbalanced sample distribution across designation groups in this sample.

PMID:42480085 | DOI:10.1097/NNA.0000000000001762