Nevin Manimala

Pain Res Manag. 2026;2026(1):e6521682. doi: 10.1155/prm/6521682.

ABSTRACT

PURPOSE: The aim of this study is to compare the clinical efficacy and safety of platelet-rich plasma (PRP) and hyaluronic acid in the treatment of hip osteoarthritis.

METHODS: Data were collected from the PubMed, Embase, Cochrane Library, and Web of Science databases. The outcomes selected included the Visual Analog Scale (VAS) score, the Harris Hip Score (HHS), the Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) and its relevant subscores. A standardized mean difference (SMD) was used as the combined effect size, and a random-effects model was applied for analysis. The magnitude of the effect size was interpreted according to Jacob Cohen’s criteria.

RESULTS: A total of seven studies involving 465 patients were included. The meta-analysis results indicated that in terms of pain relief, the PRP group showed a statistically significant advantage in VAS scores at 6 months (SMD = -0.38 and p = 0.01). Subgroup analysis revealed that LP-PRP yielded significant improvement (SMD = -0.32 and p = 0.02), whereas LR-PRP did not (SMD = -0.46 and p = 0.18). Similarly, multiple injections (SMD = -0.43 and p = 0.02) demonstrated superiority compared to a single injection (SMD = -0.12 and p = 0.63).Regarding WOMAC-pain scores, the PRP group exhibited statistical differences at 6 months (SMD = -0.45 and p = 0.0006) and 12 months (SMD = -0.36 and p = 0.03). In terms of functional impairment, no significant differences were found in the HHS (SMD = 0.13 and p = 0.64) or WOMAC subscores (WOMAC-stiffness: SMD = 0.01 and p = 0.97 and WOMAC-function: SMD = -0.24 and p = 0.06) at any follow-up time point. However, the WOMAC total score indicated that the overall health status of patients in the PRP group was superior to that in the HA group after treatment (SMD = -0.42 and p = 0.009).

DISCUSSION: The findings of this study indicate that compared with HA, PRP demonstrates a statistically significant advantage in alleviating pain (VAS and WOMAC-pain) and improving overall symptoms (WOMAC total score) in patients with hip osteoarthritis (HOA) although the effect size was found to be moderate. However, regarding the improvement of joint function (HHS and WOMAC-function), no significant differences were observed between the two groups. In summary, while PRP presents a statistical benefit over HA in the treatment of HOA, the effect size is limited; therefore, further high-quality studies are warranted to definitively confirm its clinical superiority.

PMID:42287090 | DOI:10.1155/prm/6521682

World J Surg. 2026 Jun 13. doi: 10.1002/wjs.70462. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with locally advanced breast cancer (LABC) undergoing axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NACT) face substantial risk of arm morbidity and lymphedema. Axillary reverse mapping (ARM) may preserve upper-limb lymphatic drainage; however, evidence in post-NACT LABC particularly from resource-constrained settings is limited. This phase I study evaluated the feasibility of a low-cost dual-dye ARM and its impact on arm-related quality of life using LYMPH-Q.

METHODS: In this prospective study, 32 patients with LABC undergoing axillary surgery after NACT were included: 16 underwent standard ALND and 16 underwent ALND with ARM. ARM was performed using fluorescein sodium injected into the ipsilateral first web space and methylene blue injected subareolarly. ARM structures were preserved when oncologically safe. LYMPH-Q Upper Extremity scores were assessed at baseline, 6 months, and 12 months. Arm circumference and lymphedema incidence were recorded.

RESULTS: Baseline clinico-pathologic characteristics were comparable between groups. ARM did not significantly increase operative time (p = 0.166) or compromise nodal yield (p = 0.239). Fluorescent lymphatic channels were identified and preserved in 15/16 ARM cases. At 12 months, LYMPH-Q Symptoms scores were significantly higher in the ARM group (p = 0.039), with greater improvement from baseline p = 0.017). Lymphedema incidence was lower with ARM, though not statistically significant (p = 0.600). Increases in mid-upper arm and forearm circumference were significantly lower.

CONCLUSION: Low-cost dual-dye ARM is feasible following NACT in LABC and may improve patient-reported arm symptoms while maintaining comparable operative and pathological outcomes.

PMID:42287082 | DOI:10.1002/wjs.70462

Health Serv Res. 2026 Jun;61(3):e70141. doi: 10.1111/1475-6773.70141.

ABSTRACT

OBJECTIVE: To estimate the prevalence of Medicaid estate recovery in North Carolina.

STUDY SETTING AND DESIGN: We descriptively analyzed the number of estates, amount recovered, and hardship waiver applications using North Carolina public records data.

DATA SOURCES AND ANALYTIC SAMPLE: The data contained information on the number of estates and amount recovered through Medicaid estate recovery between 2017 and 2021 (n = 2975). Additionally, we analyzed hardship waiver application data for residents who applied and had their application processed between 2018 and 2021 (n = 301).

PRINCIPAL FINDINGS: We found approximately $83 billion was recovered from beneficiaries between 2017 and 2021, or 0.6% of the total cost of North Carolina’s annual Medicaid program and just 0.9% of the fee-for-service annual long-term services and supports Medicaid budget. We found that Black homeowners were more likely to have lower value estates recovered, and overall, more money was recovered from white estates.

CONCLUSION: While states hope Medicaid estate recovery may balance Medicaid spending through increased revenue, our findings demonstrate that these efforts may be insufficient. Policymakers should opt for strategies outside of the Medicaid program that can more precisely target high-net-worth individuals instead of policies like estate recovery that disproportionately impact low-income families.

PMID:42287075 | DOI:10.1111/1475-6773.70141

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):650-657.

ABSTRACT

OBJECTIVE: To investigate the etiology of chronic sialadenitis, and to analyze their clinical and imaging characteristics.

METHODS: This retrospective analysis reviewed the clinical and imaging data of patients with chronic sialadenitis who underwent sialendoscopy at the Peking University Hospital of Stomatology between January 2021 and August 2023.

INCLUSION CRITERIA: (1) with a history of recurrent swelling of major salivary glands; (2) complete medical records with detailed information about potential causes; (3) sialography images were available; and (4) patients had undergone interventional endoscopy.

EXCLUSION CRITERIA: (1) salivary stones; (2) juvenile recurrent parotitis; (3) IgG4-related sialadenitis; (4) Sjögren syndrome; and (5) neoplastic diseases. Based on the latest research results and clinical data, chronic sialadenitis was classified into radioactive iodine-induced sialadenitis (RAIS), allergy-related sialodochitis (ARS), adult chronic recurrent parotitis (ACRP), sialadenosis with sialodochitis, and idiopathic sialadenitis. Idiopathic sialadenitis was defined as a type of chronic sialadenitis with duct stenosis of unknown etiology (allergic causes, autoimmune disorders, radioactive iodine exposure, history of “parotitis” in childhood, etc.). The proportions of five types of sialadenitis were calculated, and their relationships with age, gender, type of affected glands, number of affected glands, duration of symptoms, and imaging characteristics were statistically analyzed.

RESULTS: A total of 544 consecutive patients diagnosed with chronic sialadenitis were enrolled in this study. They consisted of 192 males and 352 females, and their ages ranged from 14 to 83 years [mean age: (47.44±13.52) years]. Idiopathic sialadenitis accounted for the largest proportion (71.7%, 390 cases), followed by ARS (12.5%, 68 cases), RAIS (6.4%, 35 cases), ACRP (4.8%, 26 cases), and sialadenosis with sialodochitis (4.6%, 25 cases). Among the 2 176 available glands of the 544 patients, 1 120 (51.5%) glands were affected, including 880 (78.6%) parotid glands and 240 (21.4%) submandibular glands. These five types of sialadenitis exhibited significant differences in gender, age, type and number of affected glands, and duration of symptoms (P < 0.05). Among them, RAIS patients showed the lowest male to female ratio (male ∶ female=1 ∶ 4.83), ARCP patients were the youngest [(32.50±8.60) years], and RAIS and ARS patients had relatively higher number of affected glands. Sialography showed ductal atresia in 23.2% of affected glands with ARIS, “snowflake” pattern in 46.5% of affected glands with ARS, “punctate and globular” ectasia of terminal ducts in 80.4% of affected glands with ARCP, and clustered branch ducts in 71.4% of affected glands with sialadenosis with sialodochitis. Moreover, stenosis and/or dilatation of the main and branch ducts represented the most typical sialography appearance of idiopathic sialadenitis.

CONCLUSION: Idiopathic sialadenitis, RAIS, ARS, ACRP, and sialadenosis with sialodochitis are the five common types of chronic sialadenitis. Among these, idiopathic sialadenitis is the most common type of chronic sialadenitis. Clarification of the etiology, clinical manifestations and imaging characteristics of chronic sialadenitis is important for clinicians to develop personalized treatment plans and improve treatment outcomes.

PMID:42287062

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):641-649.

ABSTRACT

OBJECTIVE: To explore the promotion of dynamic distraction on osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMMSCs) in three-dimensional culture.

METHODS: Dynamic stretching in a three-dimensional culture for hBMMSCs was achieved with proportions set at 5%, 10%, and 20%, a frequency of 0.5 Hz, and a dynamic stretching duration of 2 hours per day. Static culture was used as the control group. Deformation of hBMMSCs induced by dynamic stretching was observed through cytoplasmic fluorescence staining. After 7 days of dynamic stretching culture, the impact of dynamic stretching on the viability of hBMMSCs was observed through cell live/dead staining. The effect of dynamic stretching on the osteogenic differentiation of hBMMSCs was observed through alkaline phosphatase (ALP) staining and the expression of osteogenic related genes and proteins after 7 days of dynamic stretching culture.

RESULTS: Dynamic stretching in a three-dimensional culture for hBMMSCs was successfully constructed, which could achieve different durations, frequencies, and ratios of dynamic stretching. Dynamic stretching led to deformation of hBMMSCs, and the greater the stretching ratio, the more pronounced the cell deformation, transitioning from a circular to a flat oval shape. After 7 days of dynamic stretching culture, hBMMSCs in the static control group and dynamic stretching groups were mostly green stained live cells, with only a few red stained dead cells. The difference in the proportion of live cells between the groups was not statistically significant (P>0.05). The ALP staining in the dynamic stretching group was deeper than that in the static control group, and the number of ALP staining positive cells observed under the microscope was higher. The expression of osteogenic related genes and proteins increased after 7 days of dynamic stretching culture, and the difference was statistically significant (P < 0.05). Among them, the dynamic stretching group with 10% had the deepest ALP staining, the highest number of positive cells, and the most significant increase in the expression of osteogenic related genes and proteins compared with the static control group.

CONCLUSION: Dynamic stretching caused deformation of hBMMSCs without a significant impact on cell viability, and it could effectively promote the osteogenic differentiation of hBMMSCs.

PMID:42287061

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):631-640.

ABSTRACT

OBJECTIVE: Next-generation sequencing (NGS) technology was used to analyze the gene mutation profile of lymph node metastases in renal cell carcinoma, and the molecular characteristics associated with poor prognosis were found, providing new ideas for mechanism research and treatment.

METHODS: Retrospective clinical data collection was conducted on 31 patients with lymphoid metastatic renal cell carcinoma and 21 patients with non-metastatic renal cell carcinoma. A total of 81 formalin-fixed paraffin-embedded tissue samples were retrieved from the Department of Pathology, including primary tumor, lymph node metastasis, and distant metastasis samples. The gene mutation profiles of the patients were examined using next-generation sequencing technology. The patients were followed up to analyze the correlation between lymph node metastasis and patient prognosis.

RESULTS: The lymph node metastasis group showed differences in tumor size (P=0.006), World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grade (P=0.002), T stage (P=0.003) and tumor thrombus (P=0.025) compared with non-metastatic renal cell carcinoma. The most commonly mutated genes in our cohort were the tumor suppressor genes VHL (38%), PBRM1 (22%), and SETD2 (20%). More-over, copy number variations were associated with tumor metastasis, and some mutation features were highly similar to known mutation patterns. There was a difference in mutation frequency between the patients in the metastasis group and samples in the non-metastasis group. The mutation frequency of most genes in the metastasis group was higher, however, Reactome pathway enrichment analysis did not show statistically significant differences in the shared enriched pathways between the two groups. There was a strong degree of concordance between the tumor’ s primary and metastatic foci in the same patient, and genomic indicators [such as purity, ploidy, weighted-genomic integrity index (WGII), and intra-tumor heterogeneity (ITH)] as well as clonal and subclonal composition analysis further supported this consistency. The overall survival (OS) was higher in the patients without metastases (P=0.041), and specific gene mutations (such as IGF2R, JUN, EPHA5, and FH) were associated with poorer prognosis. To facilitate distant metastasis, lymph nodes might function as a “metastatic pool”.

CONCLUSION: The multigene NGS evaluates multiple relevant markers simultaneously, revealing several genetic alterations in the patients with lymphatic metastatic renal cell carcinorma. NGS-based molecular analysis can assist clinicians in assessing a patient’ s prognosis and identifying novel, potentially therapeutic mechanisms.

PMID:42287060

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):624-630.

ABSTRACT

OBJECTIVE: To delineate differences in lymphocyte subset expression between patients with infectious pneumonia and immune-related interstitial lung disease (IRILD), to assess the immune status across distinct pneumonia types, and to provide novel laboratory markers through immunological profiling to effectively differentiate pneumonias.

METHODS: A total of 78 patients sequentially enrolled from Peking University People’ s Hospital between January 2023 and March 2024 were stratified into three groups: 27 with infectious pneumonia, 27 with isolated immune-related interstitial lung disease (IRILD), and 24 with IRILD complicated by infection. Fifty age-matched healthy individuals undergoing routine physical examinations during the same period served as controls. Peripheral lymphocyte subsets were quantified in all subjects by multiparametric flow cytometry.

RESULTS: There was no statistically significant difference in age between the pneumonia patients and the healthy control group in this study (P>0.05). Analysis of laboratory parameters revealed that compared with the IRILD group, the infectious pneumonia group demonstrated significantly elevated levels of neutrophils, C-reactive protein, procalcitonin (PCT), erythrocyte sedimentation rate (ESR), D-dimer, and fibrinogen (P < 0.05), while the IRILD with superimposed infection group exhibited significantly increased levels of PCT, ESR, and immunoglobulin G (P < 0.05). At the lymphocyte subset level, compared with the control group, the infectious pneumonia group exhibited significantly decreased counts of T cells, B cells, natural killer (NK) cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Similarly, compared with the control group, the IRILD group showed significantly reduced counts of T cells, B cells, CD4⁺T cells, and the CD4⁺/CD8⁺ ratio (P < 0.05). Furthermore, compared with the control group, the IRILD-with-infection group demonstrated significantly lower counts of T cells, B cells, NK cells, CD4⁺T cells, and CD8⁺T cells (P < 0.05). Compared with the IRILD group, the infectious pneumonia group had a significantly lower NK cell count (P < 0.05). Additionally, compared with the IRILD group, the IRILD-with-infection group displayed significantly reduced counts of NK cells and CD8⁺T cells (P < 0.05).

CONCLUSION: The study revealed significant variations in lymphocyte subset profiles among the distinct pneumonia groups, providing novel insights with potential diagnostic value for differentiating between pneumonia types.

PMID:42287059

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):616-623.

ABSTRACT

OBJECTIVE: To investigate the effect of long non-coding RNA (LncRNA) differentiation antagonizing non-protein coding RNA (DANCR) on the immune microenvironment of glioma cells by regulating the miR-656/bone morphogenetic protein receptor type 1A (BMPR1A) axis.

METHODS: The expression levels of DANCR, miR-656 and BMPR1A in glioma cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The U87 cells were transfected or co-transfected to form the following groups: sh-DANCR (transfected with sh-DANCR), overexpression (pcDNA 3.1) DANCR (transfected with pcDNA 3.1 DANCR), NC sh (transfected with negative control sh), pcDNA 3.1 (transfected with pcDNA 3.1 vector), sh-DANCR + miR-656 inhibitor (co-transfected with sh-DANCR and miR-656 inhibitor), sh-DANCR + NC inhibitor (co-transfected with sh-DANCR and NC inhibitor), sh-DANCR + pcDNA 3.1 BMPR1A (co-transfected with sh-DANCR and pcDNA 3.1 BMPR1A), and sh-DANCR + pcDNA 3.1 (co-transfected with sh-DANCR and pcDNA 3.1 BMPR1A). The untreated U87 cells were used as the blank group. The proliferation of U87 cells was detected by CCK-8; invasion and migration were detected by Transwell assay; apoptosis was detected by flow cytometry; the expression of DANCR, miR-656, and BMPR1A mRNA in cells was detected by qRT-PCR; the targeting relationship between DANCR and miR-656 was verified by dual-luciferase; and BMPR1A and immune escape factors [programmed death receptor 1 (PD-1) and programmed death-ligand 1 (PD-L1)] were detected by Western blot.

RESULTS: The mRNA expressions of DANCR and BMPR1A in U87, A172, LN229 and U251 cells were significantly increased, while the expression of miR-656 was significantly decreased compared with those in NHA cells (P < 0.05). Compared with the blank group and sh-DANCR group, the proliferation rate, invasion, migration number, DANCR, BMPR1A mRNA, BMPR1A, PD-1, PD-L1 expression of U87 cells in the sh-DANCR group were obviously reduced, while the apoptosis rate and miR-656 expression were obviously increased (P < 0.05). Compared with the pcDNA 3.1 group, the proliferation rate, invasion, migration number, DANCR, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the pcDNA 3.1 DANCR group were obviously increased, while the apoptosis rate and miR-656 expression were obviously reduced (P < 0.05). Compared with the sh-DANCR +NC inhibitor group, the proliferation rate, invasion, migration number, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the sh-DANCR+miR-656 inhibitor group were obviously increased, and the apoptosis rate and miR-656 expression were obviously reduced (P < 0.05), while the expression of DANCR was not obvious (P>0.05). Compared with the sh-DANCR+pcDNA 3.1 group, the proliferation rate, invasion, migration number, BMPR1A mRNA, BMPR1A, PD-1, and PD-L1 expression of U87 cells in the sh-DANCR+pcDNA 3.1 BMPR1A group obviously increased, and the apoptosis rate obviously decreased (P < 0.05), while here was no statistically obvious difference in miR-656 expression and DANCR expression (P>0.05). DANCR and miR-656 had a targeted negative regulatory relationship.

CONCLUSION: LncRNA DANCR improves the immune microenvironment of glioma cells and inhibits the malignant behavior development of cancer cells by regulating the miR-656/BMPR1A axis.

PMID:42287058

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):584-591.

ABSTRACT

OBJECTIVE: To examine the impact of effective health information acquisition on hemophilia-related health literacy among adult caregivers of children and adolescents with hemophilia in China, and to provide evidence-based recommendations for improving adult caregivers’ hemophilia-related health literacy.

METHODS: Data were derived from the 2024 nationwide multicenter cross-sectional survey, “Health Literacy Survey of Hemophilia Patients in China”. A total of 856 adult caregivers of children and adolescents with hemophilia were recruited through convenience sampling. To explore the differences in hemophilia-related health literacy and effective health information acquisition levels among caregivers across different demographic characteristics, univariate ANOVA and independent-samples t test were adopted for statistical analysis. The bootstrap method was employed to test the mediating role of effective health information acquisition in the relationship between hemophilia-related health literacy and its influencing factors.

RESULTS: The overall level of hemophilia-related health literacy among caregivers of minor patients with hemophilia was relatively low, with an average score of 11.87±2.92. Only 20.68% of the caregivers for underage patients with hemophilia had acquired hemophilia-related health literacy. Univariate ANOVA analysis indicated that marital status, educational attainment, annual household income, registered residence location, and employment status significantly influenced adult caregivers ‘ hemophilia-related health literacy (P < 0.05). The utilization rate of various health information channels by caregivers of underage hemophilia patients exceeded 70%. Over 95% of the caregivers reported obtaining hemophilia-related health information from medical staff and hemophilia patient organizations. While, the caregivers demonstrated relatively low overall effective health information acquisition (34.43±16.50). The level of effective health information acquisition was related to educational attainment, place of household registration and employment status. Caregivers with higher educational attainment, urban household registration and full-time employment had a higher level of effective health information acquisition, and the differences were statistically significant (P < 0.05). The mediation analysis showed that the level of effective health information acquisition was positively correlated with hemophilia health literacy (P < 0.01), and effective health information acquisition played a partial mediating role between “education attainment” and “hemophilia health literacy”, “employment status” and “hemophilia health literacy”, and “place of household registration” and “hemophilia health literacy” (P < 0.05). Higher educational attainment and favorable employment status not only directly improved health literacy, but also indirectly enhanced it by promoting effective information acquisition. Compared with urban household registration, rural household registration had a negative impact on health literacy in patients with hemophilia. Meanwhile, effective information acquisition also exerted a partial mediating effect between registered residence location and health literacy.

CONCLUSION: The hemophilia-related health literacy among caregivers of underage hemophilia patients is relatively low. Enhancing adult caregivers’ effective health information acquisition of health information will improve their hemophilia-related health literacy. Tailored strategies to optimize effective health information acquisition for adult caregivers with varying sociodemographic characteristics could indirectly contribute to improved health literacy outcomes.

PMID:42287054

Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Jun 18;58(3):575-583.

ABSTRACT

OBJECTIVE: Based on protection motivation theory (PMT), this study aimed to examine the current status of e-cigarette cessation intention and cessation behavior, as well as their associated factors, among adult e-cigarette users in China.

METHODS: This was a cross-sectional study. The data were derived from a nationwide “E-cigarette Use Survey” conducted in 2023, covering 31 provinces (municipality, autonomous region) in China. A total of 550 current e-cigarette users aged 18-44 years were selected as the study population. After adjusting for sociodemographic variables, multiple linear regression models were used to identify factors associated with e-cigarette cessation intention, while binary Logistic regression models were applied to examine factors associated with e-cigarette cessation behavior. In addition, subgroup analyses were conducted according to smoking status to explore potential differences among exclusive e-cigarette users and dual users of e-cigarettes and combustible cigarettes.

RESULTS: The mean score of e-cigarette cessation intention was 3.52±0.96, and 31.64% of participants reported having attempted to quit e-cigarettes. After adjustment for covariates, cessation intention was associated with both the threat appraisal and coping appraisal pathways within the PMT framework. Specifically, in the threat appraisal pathway, severity (β=0.14) and vulnerability (β=0.12) were positively associated with cessation intention, whereas perceived extrinsic rewards (β=-0.12) were negatively associated. In the coping appraisal pathway, both response efficacy (β=0.26) and self-efficacy (β=0.28) were positively associated with cessation intention. Regarding cessation behavior, only severity (OR=1.58) in the threat appraisal pathway was positively associated, and cessation intention was also positively associated with cessation behavior. Subgroup analyses further showed that, regardless of smoking status, cessation intention was positively associated with both the threat appraisal pathway (β=0.20, β=0.31) and the coping appraisal pathway (β=0.23, β=0.21).

CONCLUSION: PMT provides a valuable theoretical framework for understanding e-cigarette cessation among adults. Factors related to the threat appraisal pathway are associated not only with cessation intention but also with actual cessation behavior. More-over, the associations of PMT-related factors vary across different smoking status subgroups. These findings suggest that future e-cigarette control policies and interventions could focus on enhancing risk perception and cognitive awareness, and develop more targeted cessation strategies for specific subgroups.

PMID:42287053