Nevin Manimala

Front Med (Lausanne). 2026 Jul 29;13:1871179. doi: 10.3389/fmed.2026.1871179. eCollection 2026.

ABSTRACT

BACKGROUND: Sarcopenia and frailty are common issues faced by individuals suffering from liver cirrhosis. These ailments greatly diminish life quality and increase the likelihood of death. Engaging in physical activity is a popular method to improve sarcopenia. Consequently, this systematic review and meta-analysis seeks to assess the effectiveness of exercise programs for addressing sarcopenia in those with liver cirrhosis.

PURPOSE: This study evaluated the efficacy of exercise interventions on sarcopenia in patients with liver cirrhosis through a meta-analysis of randomized controlled trials (RCTs).

METHODS: A comprehensive literature search was conducted across five databases: PubMed, Embase, CINAHL, CNKI, and the Cochrane Library, up to March 2026. Manually search for references in review articles that may meet the requirements. Two researchers independently carried out the literature search and review, data extraction and assessment of risk of bias. The analysis of results includes 6-min walk distance (6MWD), thigh circumference, knee extensor strength, gait speed, thigh muscle thickness, Chronic Liver Disease Questionnaire (CLDQ), Model for End-Stage Liver Disease (MELD) scores and handgrip strength. Statistical analyses were performed using Rev Man 5.3 and STATA 14.0.

RESULTS: This meta-analysis included 16 studies involving a total of 942 patients. The results demonstrated that exercise significantly enhanced various physical and clinical metrics in patients suffering from liver cirrhosis and sarcopenia. Notably, significant improvements were recorded in the 6MWD (MD = 54.35, 95% CI = 34.56-74.14, P < 0.001), thigh circumference (MD = 1.83, 95% CI = 0.92-3.38, P = 0.020), knee extensor strength (MD = 8.06, 95% CI = 2.59-13.53, P = 0.004), thigh muscle thickness (MD = 0.09, 95% CI = 0.05-0.14, P < 0.001), and scores on the CLDQ (MD = 0.75, 95% CI = 0.51-0.99, P < 0.001). Additionally, gait speed exhibited a significant increase (MD = 1.17, 95% CI = 0.09-2.26, P = 0.030). However, no significant changes were observed in grip strength, or MELD scores. Subgroup analysis indicates that aerobic exercise, or Resistance exercise, appear to improve physical activity levels in patients with cirrhosis.

CONCLUSION: Exercise may improve selected indicators of muscle mass and physical performance in patients with cirrhosis. Exercise improves thigh muscle thickness, thigh circumference, and knee extension strength in patients with sarcopenia and cirrhosis, while also enhancing their physical activity capacity and quality of life. In terms of exercise type, both aerobic and resistance training appear to improve physical activity levels in patients with cirrhosis. However, further research is needed to confirm this.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420261326379.

PMID:42591090 | PMC:PMC13461329 | DOI:10.3389/fmed.2026.1871179

Front Physiol. 2026 Jul 29;17:1860201. doi: 10.3389/fphys.2026.1860201. eCollection 2026.

ABSTRACT

BACKGROUND: Cerebral hyperperfusion syndrome (CHS) after revascularization for moyamoya disease (MMD) represents a failure of cerebrovascular autoregulation-a system-level vascular physiological process. Non-invasive tools to quantify autoregulatory reserve and support early risk stratification remain limited. This study aimed to evaluate whether postoperative perfusion volume measured by territorial arterial spin labeling (tASL) provides an exploratory risk signal for cerebrovascular autoregulation failure after MMD revascularization and to identify candidate physiological factors associated with this complication.

METHODS: This prospective cohort study enrolled 116 adult MMD patients who underwent combined revascularization (suprasylvian approach, n=60; infrasylvian approach, n=56). All patients underwent 3D pseudo-continuous arterial spin labeling (3D-pCASL) preoperatively and postoperatively, and tASL on postoperative day 1. Postoperative perfusion volume and regional cerebral blood flow (CBF) were quantified. Firth’s penalized multivariable logistic regression was used to evaluate candidate factors associated with autoregulation failure (CHS) while avoiding statistical overfitting due to rare events (13 CHS cases). Receiver operating characteristic analysis determined exploratory threshold values. CHS was diagnosed contemporaneously during hospitalization by integrating new neurological symptoms, blood-pressure/hemodynamic context, and ASL evidence of focal postoperative hyperperfusion.

RESULTS: In the Firth penalized multivariable model, hypertension and Stage IV angiographic disease were associated with postoperative CHS, while Stage V showed a positive but statistically imprecise estimate. Age and tASL-derived postoperative perfusion volume showed exploratory ROC signals, with cutoffs of 61 years and 104.45 cm³, respectively. The suprasylvian approach showed a numerically higher early CHS rate than the infrasylvian approach (16.7% vs. 5.4%; Fisher exact P = 0.077), while showing higher regional CBF at postoperative day 30 and lower postoperative mRS scores at POD30. The low overall CHS incidence (13/116, 11.2%) should be interpreted in the context of standardized inpatient monitoring and active postoperative blood-pressure management.

CONCLUSION: Quantitative tASL perfusion volume provides a non-invasive, exploratory physiological marker of postoperative cerebrovascular autoregulatory stress after MMD revascularization. In this cohort, the suprasylvian approach was associated with greater POD30 CBF improvement and lower POD30 mRS scores, but also a numerically higher early CHS rate; these findings should be interpreted as early postoperative associations rather than evidence of long-term surgical superiority. The 104.45 cm³ tASL threshold requires internal and external validation before it can be used as a stand-alone clinical decision rule.

PMID:42591086 | PMC:PMC13461402 | DOI:10.3389/fphys.2026.1860201

Jpn J Nurs Sci. 2026 Oct;23(4):e70071. doi: 10.1111/jjns.70071.

ABSTRACT

AIM: To evaluate the benefits and harms of bathing during the first stage of labor among healthy women with uncomplicated singleton cephalic pregnancies at ≥ 36 weeks’ gestation.

METHODS: Randomized controlled trials comparing warm-water bathing during the first stage of labor with no bathing were included. MEDLINE (PubMed), Cochrane Database of Systematic Reviews, CENTRAL, and Ichu-shi Web (updated to December 2024) were searched for English- and Japanese-language studies. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 1.0 tool, and evidence certainty was appraised with GRADE. Random-effects meta-analyses reported risk ratios (RRs) or mean differences with 95% prediction intervals (PIs), and I² statistics.

RESULTS: Nine studies from eight countries (1994-2018; n = 1823) met inclusion criteria. Bathing did not significantly affect regional analgesia use (RR 0.91, 95% PI 0.82-1.01; I² = 0%), perineal trauma, spontaneous vaginal birth, intact perineum, caesarean section, abnormal fetal heart rate patterns, neonatal infection, or episiotomy. Instrumental vaginal birth was reduced (RR 0.78, 95% PI 0.61-0.98; I² = 0%). Satisfaction tended to be higher in the bathing group, though evidence was limited to two small heterogeneous trials.

CONCLUSIONS: Evidence certainty was low to very low because of risk of bias, imprecision, lack of blinding, and limited woman-reported outcomes. Bathing appears safe for mothers and infants and may reduce instrumental delivery, but a clear analgesic-sparing effect was not shown. Implementation should ensure tub hygiene, water temperature regulation, and regular maternal and fetal monitoring.

TRIAL REGISTRATION: Register name: Effect of Bathing for Pain Relief During the First Stage of Labor: A protocol for a systematic review and meta-analysis. Registration DOI: https://doi.org/10.17605/OSF.IO/J9GTS.

PMID:42591025 | DOI:10.1111/jjns.70071

Int Endod J. 2026 Aug 13. doi: 10.1111/iej.70248. Online ahead of print.

ABSTRACT

AIM: To prospectively compare treatment outcomes for orthograde canal obturation using Ortho MTA III (OMTA) with the continuous wave of compaction (CWC) using gutta-percha (GP) and AH Plus sealer, and to identify associated predictive factors.

METHODOLOGY: Informed consent was obtained (110 patients), and single- or two-rooted permanent teeth (n = 120) diagnosed with pulp necrosis (or previously treated) and asymptomatic apical periodontitis or chronic apical abscess (periapical index, PAI ≥ 3) were randomly assigned to two groups (n = 60/group). The canals were prepared to a minimal apical size #40 (ISO) based on their initial file size, disinfected and obturated by either CWC or OMTA using an enhanced disinfection protocol (GP disinfected, new gloves after each intraoperative radiograph and before starting obturation). Clinical and periapical radiographic examinations were conducted by two calibrated, independent endodontists during follow-up periods of at least 12 months. Success rates and associated predictive factors (tooth-, operator- and patient-related) were analysed statistically using binary and multiple logistic regression (p < 0.05).

RESULTS: The median recall period was 30 months (14-48 months), and 104 teeth were finally analysed (recall rate: 86.67%). No significant differences in success rate were observed between the groups (p > 0.05) under both loose (OMTA: 88.24%, CWC: 83.02%) and strict criteria (OMTA: 64.71%, CWC: 58.49%). Multivariate analysis revealed that age (OR = 5.735, 95% CI: 1.286-25.577, p = 0.022), periapical lesion size (OR = 6.596, 95% CI: 1.397-31.138, p = 0.017) and PAI score (OR = 2.081, 95% CI: 1.047-4.136, p = 0.036) were significant predictors of treatment failure.

CONCLUSIONS: Orthograde obturation of infected canals with Ortho MTA III demonstrated comparable success and treatment outcomes to those filled with GP and sealer by CWC, supporting its potential as a clinically viable alternative for the obturation of infected root canals.

TRIAL REGISTRATION: cris.nih.go.kr registration number: KCT00099939.

PMID:42591012 | DOI:10.1111/iej.70248

Pharmacoepidemiol Drug Saf. 2026 Sep;35(9):e70450. doi: 10.1002/pds.70450.

ABSTRACT

BACKGROUND: Overuse of antibiotics contributes to antibiotic resistance, and may result in gut microbiome dysbiosis, potentially increasing the risk of chronic childhood conditions.

OBJECTIVES: To examine patterns of antibiotic dispensing in utero and during the first 5 years of life.

METHODS: We conducted a retrospective cohort study of all children (n = 315 786) born in New Zealand from 2005 to 2010 using linked pharmaceutical dispensing data to ascertain antibiotic use during the mother’s pregnancy and for the first 5 years of life. Descriptive analyses were conducted as well as negative binomial regression controlled for potential confounders.

RESULTS: In total, 96% of children had been dispensed ≥ 1 course of antibiotics by age five; for pregnant women this was 30%. Penicillin, particularly Amoxicillin, was most frequently dispensed during both periods. Postnatal antibiotic dispensing was higher for males (adjusted IRR 1.09, 95% CI 1.08-1.10); Māori (1.16, 1.15-1.17), Pacific peoples (1.32, 1.30-1.33), and Middle East Latin American and African (MELAA) ethnicities (1.07, 1.04-1.10); children in the highest deprivation quintile (1.16, 1.15-1.17) and those born pre-term (1.05, 1.04-1.05); and urban children (1.21, 1.20-1.22). Low and high birthweight and caesarean deliveries were also associated with higher antibiotic dispensing. Similar patterns were observed for antibiotic dispensing for mothers during pregnancy. Dispensing rates were highest during winter months.

CONCLUSION: Antibiotic dispensing is high in New Zealand children and pregnant women, with significant ethnic and socioeconomic differences, suggesting that current antibiotic stewardship programmes are not fully effective.

PMID:42591009 | DOI:10.1002/pds.70450

J Am Coll Clin Pharm. 2026 Sep;9(9):e70269. doi: 10.1002/jac5.70269.

ABSTRACT

BACKGROUND: Large language models (LLMs) are increasingly explored for drug information support, yet their reliability and clinical applicability remain uncertain. This study evaluated multiple LLMs in responding to real-world drug information questions retrieved from a university hospital in Thailand, focusing on clarity in Thai, concordance with pharmacist responses, relevance, context awareness, and citation credibility.

METHODS: A total of 102 drug information questions were submitted to seven LLMs, generating 714 responses. In the inter-rater reliability phase, 10 pilot questions were submitted to all seven LLMs, and the resulting 70 responses were evaluated by three assessors, yielding 210 rating instances. Agreement was measured using intra-class correlation coefficient and Fleiss’ kappa. Following satisfactory agreement, the 102 questions were divided into three subsets, each assessed by one assessor using a predefined rubric. Binary outcomes were coded to calculate sensitivity and domain fulfillment rates, with pharmacist-provided answers serving as the reference standard for concordance. Model performance was compared using Cochran’s Q test, and citation-related issues were identified from qualitative comments.

RESULTS: Inter-rater reliability demonstrated substantial to almost perfect agreement, with coefficients ranging from 0.79-0.86. Overall, most LLMs performed well in clarity, relevance, and context awareness. Clarity scores ranged from 85.25%-92.75%, while fulfillment rates ranged from 0.97-1.00 for relevance and 0.90-0.99 for context awareness. Concordance was more variable, ranging from 0.70-0.86, whereas citation credibility was consistently weak, ranging from 0.03-0.36. A significant difference between LLMs was observed only in the concordance, with post hoc analyses identifying a significant difference between ChatGPT-5.2 Thinking (OpenAI, San Francisco, CA, USA) and Copilot Think Deeper (Microsoft, Redmond, WA, USA). (McNemar test, adjusted p = 0.0178).

CONCLUSIONS: LLMs show potential as tools for preliminary drug information retrieval and rapid responses generation in drug information services. However, variable concordance and persistent limitations in citation credibility indicate the need for continued pharmacist oversight.

PMID:42591004 | DOI:10.1002/jac5.70269

J Educ Eval Health Prof. 2026;23:26. doi: 10.3352/jeehp.2026.23.26. Epub 2026 Aug 13.

ABSTRACT

PURPOSE: When instructors address students by name, this may be associated with students’ engagement and sense of inclusion in higher education. However, name-based instructor-student interaction has rarely been conceptualized as a multidimensional construct, and no psychometrically evaluated instrument is available for medical education. This study developed and psychometrically evaluated a pilot questionnaire assessing students’ perceived experiences of being addressed by name in medical teaching contexts.

METHODS: Questionnaire development followed a multistep exploratory approach that included qualitative input, iterative item refinement, and expert content review. An initial pool of 59 items was administered to medical students (n=270) from semesters 2-10 at a German medical faculty. Factor structure was examined using exploratory factor analysis based on Pearson correlations, oblique rotation, and predefined item-reduction criteria. Internal consistency was assessed using McDonald’s ω and Cronbach’s α, discriminant validity using the heterotrait-monotrait ratio, and generalized partial credit models were estimated separately for each factor.

RESULTS: Exploratory factor analysis yielded a parsimonious 3-factor solution comprising 15 items: cognitive activation, appreciation & social belonging, and social evaluative anxiety. The final model showed good fit, and all factors demonstrated strong internal consistency (ω=0.84-0.88), good measurement precision (expected a posteriori reliability=0.83-0.88), adequate discriminant validity (heterotrait-monotrait ratio <0.85), and acceptable item fit.

CONCLUSION: The pilot questionnaire captures 3 distinct dimensions of name-based instructor-student interaction and provides promising initial psychometric evidence for medical education research. It may support confirmatory validation and further study of relational teaching practices.

PMID:42590989 | DOI:10.3352/jeehp.2026.23.26

ANZ J Surg. 2026 Aug 13. doi: 10.1111/ans.70906. Online ahead of print.

ABSTRACT

BACKGROUND: Anatomical variants of the cystic duct impair attainment of the critical view of safety during laparoscopic cholecystectomy, predisposing to bile duct injury, bile leak, and conversion to open surgery. No prior synthesis has examined their prevalence across all detection modalities.

OBJECTIVES: To determine the pooled prevalence of cystic duct anatomical variants and their association with surgical outcomes.

DATA SOURCES: MEDLINE/PubMed, Embase, and Cochrane CENTRAL were searched from January 2000 to November 2025. Reference lists were hand-searched for additional eligible studies.

REVIEW METHODS: PRISMA 2020-compliant systematic review and meta-analysis. Pooled prevalence estimates were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Quality was assessed using the JBI Prevalence checklist. Prospectively registered: PROSPERO (CRD420251178103).

RESULTS: Fifty-three studies (n = 18 875 patients; 22 countries) were included. The pooled prevalence of any cystic duct variant was 19.1% (95% CI 13.2%-25.7%). Variant-specific estimates were: high insertion 16.6% (9.2%-25.6%; k = 16), medial insertion 7.3% (4.0%-11.5%; k = 19), low insertion 6.5% (4.2%-9.2%; k = 29), spiral/posterior course 14.6% (8.2%-22.5%; k = 17), and right hepatic duct insertion 1.3% (0.7%-2.1%; k = 15). Heterogeneity was considerable (I² = 79.6%-99.4%), attributable to variation in detection modality and classification systems. Only 11 studies (20.8%) reported surgical outcomes; pooled conversion to open surgery rate was 11.0% (95% CI 6.9%-15.2%). No significant publication bias was detected (Egger’s test p = 0.208).

CONCLUSION: Cystic duct anatomical variants affect approximately one in five patients undergoing biliary imaging or cholecystectomy. The lack of a universal system and the paucity of outcome data stratified by variant subtype represent a major gap. Prospective studies using standardised nomenclature and systematically reporting surgical outcomes are urgently needed.

PMID:42590983 | DOI:10.1111/ans.70906

Acta Orthop. 2026 Aug 13;97:538-543. doi: 10.2340/17453674.2026.46527.

ABSTRACT

BACKGROUND AND PURPOSE: Hip fracture treatment with (hemi)arthroplasty carries a risk of periprosthetic joint infection (PJI), which may be reduced by using dual antibiotic-loaded bone cement (ALBC). We aimed to compare the rate of all-cause revision, revision for infection, and mortality following single or dual ALBC use in hip fracture arthroplasty.

METHODS: From the Dutch Arthroplasty Register, we identified all cemented hemiarthroplasties (HA) and total hip arthroplasties (THA) performed in the period 2007-2024 for proximal femoral fracture. Crude cumulative incidences of all-cause and infection revision were estimated using competing risk survival analyses with death as competing event. Mortality was estimated using Kaplan-Meier analysis. Cause-specific Cox regression models adjusting for age, year of surgery, history of previous surgeries, and American Society of Anesthesiologists (ASA) classification estimated hazard ratios (HRs).

RESULTS: We analyzed 56,434 hip arthroplasties, of which 1,651 used dual ALBC. 1-year crude cumulative incidences were similar across groups for all-cause revision, infection revision, and mortality. After adjustment, dual ALBC was not associated with a reduced rate of all-cause revision (HR 1.2, 95% confidence interval [CI] 0.9-1.5]) compared with single ALBC. Dual ALBC was associated with a modestly higher revision for infection (HR 1.6, CI 1.0-2.5) and mortality in HA (HR 1.2, CI 1.1-1.2).

CONCLUSION: Dual ALBC was not associated with lower revision rates compared with single ALBC but a modestly higher revision rate was noted for infection and mortality following hip arthroplasty after hip fracture.

PMID:42590963 | DOI:10.2340/17453674.2026.46527

J Endovasc Ther. 2026 Aug 13:15266028261477039. doi: 10.1177/15266028261477039. Online ahead of print.

ABSTRACT

PURPOSE: To compare the efficacy and safety of transradial (TR) versus transfemoral (TF) access in peripheral arterial angioplasty and stenting, providing evidence to guide clinical decision-making in endovascular interventions.

METHODS: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) and cohort studies comparing TR and TF approaches in patients with peripheral artery disease (PAD) were included. Databases (PubMed, Embase, and Cochrane Library) were searched up to May 10, 2025. Risk of bias was assessed using the Cochrane tool, and RevMan 5.3 was used for statistical analysis. Outcomes included technical success, fluoroscopy time, hospital stay, minor/major bleeding, and access site complications.

RESULTS: Seventeen studies (13 210 patients) were analyzed. No significant difference was found in technical success (odds ratio [OR] = 1.48, P = .36, 95% CI, 0.64, 3.54). However, TR access was associated with a shorter hospital stay (mean difference = -0.09 days, P = .01, 95% CI, -0.16, -0.02) and a trend toward fewer access site complications (OR = 0.49, P = .07, 95% CI, 0.23, 1.06), with significant reduction in lower extremity interventions (P < .01). Transradial also showed lower bleeding risks, with a trend in minor bleeding (P = .09) and significant reduction in major bleeding (P = .03).

CONCLUSION: Transradial access for peripheral angioplasty and stenting offers advantages over TF, including reduced hospital stay, fewer complications, and lower bleeding risks. As TR techniques advance, TR may become the preferred approach, particularly when TF access is not feasible.Clinical ImpactThis study provides clinically relevant evidence supporting transradial (TR) access as a practical alternative to transfemoral (TF) access for peripheral arterial interventions. TR access showed fewer access-site complications, shorter hospitalization, and a trend toward reduced bleeding, suggesting benefits for both patient recovery and healthcare resource use. Although TF access remains preferable in certain femoropopliteal interventions, the growing availability of TR-specific devices and robotic technologies may further expand the role of TR access. These findings can guide access-site selection and improve procedural safety in clinical practice.

PMID:42590943 | DOI:10.1177/15266028261477039