Nevin Manimala

Eur J Sport Sci. 2026 Jul;26(7):e70210. doi: 10.1002/ejsc.70210.

ABSTRACT

Activities of daily living (ADL) are associated with declines in physical fitness and subjective health. However, it remains unclear as to whether ADL impairments are related to specific components of physical fitness and health variables. Therefore, we examined differences between community-dwelling older persons with versus without ADL impairments with regard to various physical fitness components, physical complaints as well as subjective and objective health outcomes. Cross-sectional study among 254 participants aged ≥ 55 years [51% female; 84 with ADL impairments; mean (SD) age 62.1 (6.6) years] enrolled in the population-based “Gesundheit zum Mitmachen” study in Southwestern Germany. ADL, physical complaints and subjective health status were assessed using a self-report questionnaire, physical fitness (cardiorespiratory fitness, strength, gross motor coordination, flexibility, and functional mobility) was assessed using a fitness test battery, and objective health status was derived from health exam performed by a physician. We ran analyses of covariance, adjusted for age, sex, body mass index and education. Participants with ADL impairments had statistically significantly worse subjective (p < 0.001) and objective (p < 0.001) health and reported more physical complaints (p < 0.001) compared to those without ADL impairments. Regarding physical fitness, ADL-impaired participants performed worse in 10 out of 12 variables. The findings provide additional evidence that ADL impairments are related to decreased objective and subjective health and physical fitness in older community-dwelling adults. Future studies employing more comprehensive, preferably objective, ADL assessments and considering cognitive impairments, which may also impact ADL performance, are warranted.

PMID:42332358 | DOI:10.1002/ejsc.70210

Clin Transl Sci. 2026 Jul;19(7):e70640. doi: 10.1111/cts.70640.

ABSTRACT

This was a Phase 1, open label, randomized, crossover study to evaluate the safety and pharmacokinetics of multiple doses of intranasal naloxone (NCT05377255). Twenty-four healthy participants were enrolled at a single site in the US to one of two sequences. Participants received four doses of 4 mg intranasal (IN) naloxone using two two-dose devices (AP003; single dose at 0, 2.5, 5.0, and 7.5 min) or two doses of 4 mg naloxone using two one-dose devices (single dose at 0 and 2.5 min). Treatments were separated by a 48-h washout, the order being driven by the crossover sequence. Blood samples were collected predose and at defined timepoints post-dosing for analysis of free and total naloxone, which were used for the noncompartmental PK analysis. Safety was assessed through physical exams, vital signs, electrocardiograms, continuous cardiac monitoring, clinical labs, olfactory assessments, rhinoscopy, and treatment emergent adverse events. Of the 24 participants, most were Female (n = 14, 58.3%), White (n = 20, 83.3%), and Hispanic or Latino (n = 24, 100%), with a mean age of 38.1 years and baseline body mass index of 26.2 kg/m². Naloxone concentrations increased similarly over 15 min and doubled for the AP003 group at 20 min, thereby meeting the primary objective. There was a dose-dependent increase in C_max, AUC_0-inf, pAUC, and AUC_0-t; however, statistical significance for dose proportionality was not seen in AUC_0-inf, AUC_0-t, and C_max. All treatment emergent adverse events were mild or moderate in severity and no serious adverse events were reported.

PMID:42332351 | DOI:10.1111/cts.70640

Musculoskeletal Care. 2026 Jun;24(2):e70237. doi: 10.1002/msc.70237.

ABSTRACT

BACKGROUND: Frozen shoulder, also known as adhesive capsulitis, is a common and disabling condition that causes shoulder pain and progressive stiffness. Patient information leaflets (PILs) are produced by UK National Health Service (NHS) Trusts to help patients understand frozen shoulder and treatment options. However, the content and consistency of these PILs and their alignment with national clinical guidance are currently unclear.

OBJECTIVES: This study aimed to identify, analyse and describe the non-surgical management recommendations presented in publicly available NHS Trust PILs for frozen shoulder and to assess their alignment with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary and British Elbow and Shoulder Society (BESS) best practice resources.

METHODS: An online search was undertaken by one reviewer to identify publicly available PILs produced by NHS Trusts detailing non-surgical management of frozen shoulder. Relevant data were extracted and analysed by one reviewer and verified by five reviewers. Descriptive statistics were used to summarise findings.

RESULTS: Thirty-eight PILs were identified from 38 NHS Trusts with publication dates ranging from April 2013 to March 2025. Considerable variation was observed in the content, including reference to analgesia, activity modification, exercise prescription and corticosteroid injections. No single PIL reflected all key elements recommended in the NICE Clinical Knowledge Summary and BESS best practice.

CONCLUSION: The findings demonstrate substantial variation in content, frequent misalignment with current national guidance and best practice exercise recommendations. Such variation may limit and may reduce the clarity, consistency and usefulness of information provided to patients.

PMID:42332346 | DOI:10.1002/msc.70237

J Neurol. 2026 Jun 22;273(7):413. doi: 10.1007/s00415-026-13941-8.

ABSTRACT

INTRODUCTION: Endothelial activation and stress index (EASIX) is a biomarker of endothelial dysfunction and has been validated previously as a prognostic score for mortality in various diseases, including oncologic diseases, sepsis, and cardiac disease. Since endothelial dysfunction is an established mediator of adverse outcomes in acute ischemic stroke, this study investigates the prognostic value of EASIX for risk of mortality in these patients.

PATIENTS AND METHODS: We analyzed data from the Heidelberg (n = 4,188) and Vienna (n = 2,273) prospective acute ischemic stroke registries. EASIX was calculated as creatinine [mg/dL] × LDH [U/L] / platelet count [10⁹/L]. An EASIX cut-off was established using maximal Youden index. Validation was performed using Brier score and C-statistics.

RESULTS: Higher EASIX was associated with higher risk of mortality in the training cohort in a multivariable Cox regression (HR of all-cause mortality per log2 increase: 1.20 (95% CI 1.12-1.28), p < 0.001). An optimal EASIX cut-off value of 1.211 was identified in the derivation cohort. In the independent validation cohort, this cut-off was associated with risk of 3-month mortality in a multivariable binary logistic regression model (OR 1.86 (1.28-2.70), p < 0.01). Brier score and C-statistics validated the superior predictive performance of EASIX in the multivariable model.

DISCUSSION AND CONCLUSION: EASIX predicts mortality in acute ischemic stroke patients and retained prognostic validity across two heterogeneous European cohorts. Incorporation of EASIX improved risk stratification beyond established clinical scores. EASIX may serve as a useful tool for risk stratification and outcome prediction in acute ischemic stroke patients.

PMID:42332326 | DOI:10.1007/s00415-026-13941-8

Acta Neurol Belg. 2026 Jun 23. doi: 10.1007/s13760-026-03120-x. Online ahead of print.

ABSTRACT

BACKGROUND: Deep Brain Stimulation (DBS) is an established treatment for advanced Parkinson’s disease (PD), yet registry-based data from developing countries remain limited. This study reports the establishment and feasibility of the Iranian Deep Brain Stimulation Registry for Parkinson’s Disease (IDBSR-PD).

METHODS: We conducted a single-center feasibility study at the Research Center for Neuromodulation and Pain, including all PD patients undergoing DBS implantation since 2014. Primary feasibility outcomes included patient enrollment coverage, follow-up adherence, data completeness, multidisciplinary implementation, and the sustainability of technical infrastructure. Secondary outcomes included descriptive patient characteristics. Only descriptive statistics were performed; no hypothesis testing or longitudinal outcome analyses were conducted.

RESULTS: A total of 208 patients were enrolled (65.4% male; mean age 58.4 ± 10.2 years). Enrollment increased progressively over time, peaking in 2024 (n = 41). Patients were referred from multiple provinces across Iran. Data validation mechanisms and regular surveillance ensured acceptable data completeness.

CONCLUSIONS: The IDBSR-PD demonstrates the feasibility and sustainability of a web-based DBS registry in a developing country. These findings confirm the viability of structured data collection and provide a foundation for future multicenter and longitudinal outcome research.

PMID:42332325 | DOI:10.1007/s13760-026-03120-x

J Neurovirol. 2026 Jun 22;32(4):21. doi: 10.1007/s13365-026-01318-6.

ABSTRACT

Brain health disorders (BHDs) remain a concern for people with HIV (PWH) despite antiretroviral therapy access and viral suppression. The contribution of HIV to brain health is often obscured by comorbidities in high-income settings which are less prevalent in sub-Saharan Africa. Neurofilament light chain (NfL), a biomarker of axonal injury, may offer insight into underlying mechanisms. 338 virally-suppressed PWH and 250 people without HIV (PWoH) completed a Research Domain Criteria-informed battery assessing cognitive, sensorimotor, and social processing systems. Demographically-adjusted norms were derived from PWoH. Serostatus differences in impairment (≥ 1SD below the mean) were examined using multivariable logistic regression. Additional models examined associations between NfL (plasma, cerebrospinal fluid [CSF]) and task performance. PWH were similar to PWoH in age (43.9 vs. 43.5yrs), sex (female, 54 vs. 46%), and education (6.1 vs. 5.8yrs). PWH had higher odds of impairment in the cognitive control and attention (Color Trails, Symbol Digit) and sensorimotor (Grooved Pegboard) domains. Plasma NfL was associated with sensorimotor impairment in both groups. Similar trends held in CSF NfL but did not reach statistical significance, likely due to sample size (n = 85). Cognitive and sensorimotor difficulties are common in PWH in Rakai, independent of typical Western confounders. The profile of impairment differs from reports in high-income settings where declarative memory deficits are often observed. NfL was associated with sensorimotor impairment, suggesting that NfL may capture ongoing axonal injury and motor system vulnerability in PWH and PWoH. These findings suggest NfL’s potential as a biomarker of sensorimotor impairment in sub-Saharan Africa.

PMID:42332320 | DOI:10.1007/s13365-026-01318-6

Aesthetic Plast Surg. 2026 Jun 22. doi: 10.1007/s00266-026-06020-w. Online ahead of print.

ABSTRACT

BACKGROUND: Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap.

METHODS: This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty.

RESULTS: Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251).

CONCLUSION: The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42332315 | DOI:10.1007/s00266-026-06020-w

Aesthetic Plast Surg. 2026 Jun 22. doi: 10.1007/s00266-026-05982-1. Online ahead of print.

ABSTRACT

BACKGROUND: Migration is one of the most feared complications following lip filler. The use of a specific filler with a high degree of elasticity and cohesiveness could be the key to solve the problem if injections are performed in the correct anatomical plane. The purpose of this study was to describe the authors’ 5-year experience with a new concept of lip filling, iLips. This reproducible approach combines elasticity and cohesiveness of a 25,5 mg/ml filler injected through superficial micro-tunnels in a virtual space between orbicularis muscle and mucosa creating a tridimensional net that respects lip dynamic also leading to a low risk of filler migration.

METHODS: A total of 4583 consecutive patients who underwent lip filler with iLips technique were enrolled in this prospective study. An objective evaluation on the aesthetic results was obtained by a jury composed of 3 external plastic surgeons using Lip Fullness Merz scale. PROMs were investigated through FACE-Q administration to the patients (“Psychological function”, “Satisfaction with outcome” and “Satisfaction with lips” scales). Statistical analysis was performed through Prism10. Complications were reported.

RESULTS: t-test with Welch’s correction showed an improvement in Lip Fullness Merz score both in upper and lower lip (p<0.05). A similar trend was shown also for “Psychological function”, “Satisfaction with outcome” and “Satisfaction with lips” mean values after the procedure. Just 2 cases of major vascular complications were reported.

CONCLUSION: iLips ® seem to be a safe, highly reproducible, effective and satisfying approach for lip augmentation positively impacting also the patient’s psychological sphere.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42332314 | DOI:10.1007/s00266-026-05982-1

Surg Endosc. 2026 Jun 22. doi: 10.1007/s00464-026-13034-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Contemporary abdominal wall reconstruction places a strong emphasis on optimizing extraperitoneal mesh placement. When the posterior layer is insufficient for closure, adjuncts such as hernia sac, omentum, or Vicryl mesh have been described. The outcomes of various posterior layer supplementation (PLS) materials, both autologous and non-autologous, have not been well examined. We aim to evaluate the outcomes of patients undergoing ventral hernia repair with extraperitoneal mesh placement who undergo PLS and compare how PLS materials impact these outcomes.

METHODS: All patients who underwent a retromuscular hernia (RM) repair with PLS between Jan 2021 and Jan 2025 at a single center were reviewed. Patient demographics, preoperative characteristics, intraoperative factors, and postoperative outcomes were evaluated. Descriptive statistics and comparative tests including Mann-Whitney U test, Student’s t-test, and Fisher’s exact test were utilized.

RESULTS: Sixty-seven patients underwent RM repair with PLS. Supplement materials used included hernia sac, omentum, falciform ligament, prior mesh, new biologic, and biosynthetic coated mesh. Fifty-two percent (n = 35) of the repairs were retrorectus only and 48% (n = 32) were transversus abdominus releases. The average length of follow-up was 189 days with a recurrence rate of 3%. Sixty percent of PLS was performed with autologous material with 40% utilizing new biologic or biosynthetic coated meshes. SSI, SSO, and SSOPI were similar between the autologous and non-autologous supplementation groups (p = 1, p = 0.16, p = 0.29, respectively). There were more postoperative bowel obstructions in the non-autologous group (n = 4) as compared to the autologous group (n = 0) (p = 0.02). All the bowel obstructions were managed nonoperatively.

DISCUSSION: Our findings suggest that outcomes are acceptable with minimal morbidity when comparing autologous tissue to biologic and biosynthetic coated mesh for PLS. The low recurrence rates observed, regardless of the material used, support the continued adoption of this approach. Proactive supplementation of the visceral sac may decrease need for lateral myofascial release.

PMID:42332310 | DOI:10.1007/s00464-026-13034-7

Eur J Pediatr. 2026 Jun 22;185(7):513. doi: 10.1007/s00431-026-07192-y.

ABSTRACT

Atopic dermatitis (AD) is a heterogeneous disease often preceding food allergy (FA). However, it remains unclear how different developmental trajectories of AD/eczema influence the risk of FA. This study aimed to characterize longitudinal AD/eczema phenotypes from infancy to early adolescence and evaluate their specific associations with FA risk. We analyzed data from the Longitudinal Survey of Newborns in the 21st Century in Japan, including 23,767 participants followed from age 0.5 to 12 years. Distinct AD/eczema phenotypes were identified using group-based trajectory modeling derived from healthcare visit histories. Multivariable logistic regression examined the association between AD/eczema phenotypes and cumulative FA healthcare visit history, adjusting for sociodemographic factors and asthma comorbidity. Five AD/eczema phenotypes were identified: “Early-onset transient” (6.4%), “Early-onset persistent” (23.2%), “Toddler-onset persistent” (17.3%), “Late-onset” (2.1%), and “No/minimal symptoms” (51.0%). Compared with the “No/minimal symptoms” group, all AD/eczema phenotypes were associated with increased FA risk. The “Early-onset transient” (adjusted odds ratio [aOR], 2.33; 95% CI, 1.98-2.74) and “Early-onset persistent” (aOR, 2.33; 95% CI, 2.10-2.59) groups showed the strongest associations. The “Late-onset” phenotype was also associated with increased risk (aOR, 1.42; 95% CI, 1.04-1.93), with elevated risk observed in early childhood preceding the peak of overt skin symptoms.

CONCLUSION: Distinct developmental trajectories of AD/eczema are differentially associated with FA risk. While early-onset phenotypes confer the highest risk, the elevated risk in “Late-onset” trajectories before peak symptoms suggests shared underlying susceptibility or subclinical pathology. Monitoring FA development is important across all clinical trajectories of AD/eczema.

WHAT IS KNOWN: • Atopic dermatitis (AD) is a primary precursor for the atopic march, but how different longitudinal trajectories influence food allergy (FA) risk remains unclear. • Early-onset persistent AD is considered to pose the highest risk for FA.

WHAT IS NEW: • Early-onset transient AD/eczema carries a high FA risk comparable to persistent cases, indicating that timing of onset is more critical than disease duration for FA development. • Late-onset AD/eczema trajectories show elevated FA risk in early childhood preceding peak skin symptoms, suggesting shared underlying susceptibility or subclinical pathology.

PMID:42332302 | DOI:10.1007/s00431-026-07192-y