Category: Nevin Manimala

Int J Med Robot. 2026 Feb;22(1):e70131. doi: 10.1002/rcs.70131.

ABSTRACT

BACKGROUND: The comparative perioperative outcomes of totally intracorporeal robot-assisted ileal ureteral replacement (TI-RAIUR) versus that of RAIUR with extracorporeal ileal segment preparation (RAIUR-EI) remain undefined. This study pioneers a comparative analysis between these approaches to guide clinical individualised therapy.

METHODS: Thirty-four patients who underwent RAIUR (22 via RAIUR-EI and 12 via TI-RAIUR) were included. Baseline characteristics, perioperative outcomes, and follow-up data were systematically compared.

RESULTS: There were no between-group differences in baseline characteristics. The RAIUR-EI approach significantly reduced the reoperation time for initial failed procedures. Both groups achieved 100% 1-year subjective success and stable long-term renal function. The complication rates were statistically similar, although one Clavien-Dindo III incisional hernia occurred in the RAIUR-EI group. In addition, the TI-RAIUR approach demonstrated better aesthetic outcomes.

CONCLUSIONS: Both techniques achieve reliable outcomes for long-segment ureteral reconstruction. The RAIUR-EI approach may optimise efficiency in more complex cases, whereas the TI-RAIUR technique results in better aesthetic outcomes.

PMID:41485112 | DOI:10.1002/rcs.70131

Rheumatology (Oxford). 2026 Jan 2:keaf670. doi: 10.1093/rheumatology/keaf670. Online ahead of print.

ABSTRACT

OBJECTIVES: Cardiac involvements in idiopathic inflammatory myopathies (IIM) is rare but potentially severe. Anti-mitochondrial M2 antibody (AMA-M2) has been implicated in cardiac involvements, but the association remains under-explored. This study aims to evaluate the clinical, pathological, and prognostic features of AMA-M2 IIM.

METHODS: This historic prospective cohort included IIM patients hospitalized at Peking Union Medical College Hospital between 2008 and 2020. Outcomes were prospectively collected through the PROMIS registry. Cox regression models were employed to identify risk factors of cardiac involvements and mortality.

RESULTS: Among 987 IIM patients, 55 (6%) were AMA-M2 positive. These patients exhibited higher rates of polymyositis (56% vs 23.5%, p< 0.001), and elevated baseline gamma-glutamyl transferase (GGT) (78.0 vs 35.0, p< 0.001) and alkaline phosphatase (ALP) (85.0 vs 64.0, p< 0.001). Throughout disease courses, AMA-M2 positive patients had significantly higher rates of cardiac involvements (60% vs 12.9%, p< 0.001), including arrhythmias (56%), heart failure (44%), and pulmonary hypertension (31%). Some of the muscle biopsies showed features consistent with immune-mediated necrotizing myopathy (IMNM), cardiac biopsies demonstrating structural degeneration with minimal inflammation, and liver biopsies confirming early-stage primary biliary cholangitis (PBC). Multivariate COX analysis identified AMA-M2 positivity as an independent risk factor for cardiac involvements (HR 3.156, p< 0.001). Despite frequent cardiac manifestations, long-term survival did not differ between AMA-M2 positive and negative patients (mean survival: 103.9 months vs 98.0 months, p= 0.86).

CONCLUSION: AMA-M2 positivity defines an IIM subgroup with significant cardiac involvements, an immune-mediated inflammatory muscle histology, but not necessarily worse long-term survival. These findings highlight the need for early recognition and tailored management of AMA-M2 IIM.

PMID:41485097 | DOI:10.1093/rheumatology/keaf670

J Orthop Surg Res. 2026 Jan 3;21(1):1. doi: 10.1186/s13018-025-06507-3.

ABSTRACT

OBJECTIVE: The purpose of this retrospective study was to investigate the differences in clinical efficacy and radiographic outcomes of the double-triangle locking compression plate (DT-LCP) and the T-shaped locking compression plate (T-LCP) fixation systems in open-wedge high tibial osteotomy (OWHTO).

METHODS: A retrospective analysis was conducted on the clinical data of 127 patients who underwent OWHTO at the Affiliated Hospital of Qingdao University between January 2019 and May 2020. Patients were divided into two groups based on the different steel plate fixation systems used: the DT-LCP group with 65 patients and the T-LCP group with 62 patients. Both groups underwent clinical and radiographic assessments preoperatively and at 5 years postoperatively. Clinical assessments were performed using the Visual Analog Scale (VAS), the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic evaluations included measurements of the hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), and tibial posterior slope (PTS) to assess lower limb alignment correction postoperatively. The compensatory changes in adjacent joints were evaluated by measuring the hip abduction angle (HAA), talar tilt angle (TIA), and Carton-Deschamps index (CDI) in both groups. Complications were also analyzed for both groups.

RESULTS: At the 5-year follow-up, the complication rate was 20% in the DT-LCP group and 24.19% in the T-LCP group (χ² = 0.324, p = 0.569). All radiographic measures of coronal alignment (HKA, MPTA, WBLR and JLCA) improved significantly from baseline in both groups (p < 0.001). After adjustment for pre-operative values, ANCOVA showed no between-group difference in HKA or JLCA (p = 0.319 and p = 0.287, respectively). MPTA and WBLR reached statistical significance, but with small effect sizes (MPTA: 0.89°, 95% CI 0.28-1.51; WBLR: 0.06, 95% CI 0.03-0.08). PTS increased similarly in both groups (effect – 0.80°, 95% CI – 1.95 to 0.34, p = 0.114). Compensatory changes in adjacent-joint parameters (HAA, TIA and CDI) did not differ between groups: HAA 0.21° (95% CI – 0.13 to 0.55, p = 0.226), TIA – 0.50° (95% CI – 1.43 to 0.42, p = 0.151), and CDI 0.08 (95% CI – 0.01 to 0.17, p = 0.225). Peri-operatively, the DT-LCP group outperformed the T-LCP group, with smaller incision, shorter operative time, less intra-operative blood loss (all p < 0.001) and lower hospitalization cost (p = 0.014). Clinical scores (VAS, WOMAC and Lysholm) improved markedly in both cohorts (p < 0.001), with no significant between-group differences in the magnitude of improvement (all p > 0.05).

CONCLUSION: This study demonstrates that both DT-LCP and T-LCP achieve favorable clinical outcomes after OWHTO, as evidenced by significant reductions in mean VAS scores and improvements in WOMAC and Lysholm ratings. The two fixation systems provide reliable correction in both the coronal and sagittal planes, with good alignment of lower-limb parameters such as HKA and MPTA, showing excellent durability and safety. Satisfactory functional results were obtained with either implant. However, the DT-LCP group demonstrated superior peri-operative performance, with a significantly lower incidence of implant-related irritation, thereby reducing the need for secondary hardware removal and resulting in a lighter economic burden.

PMID:41485088 | DOI:10.1186/s13018-025-06507-3

BMC Pediatr. 2026 Jan 3;26(1):2. doi: 10.1186/s12887-025-06151-0.

ABSTRACT

BACKGROUND: Laughter yoga is a non-pharmacological and non-invasive therapeutic approach that integrates voluntary laughter with controlled breathing exercises. This systematic review aimed to evaluate research investigating the impact of laughter yoga on children’s health outcomes.

METHODS: This systematic review included studies with randomized controlled trial (RCT) and quasi-experimental designs, adhering to the PRISMA guidelines. This systematic review, conducted between December 18, 2023, and October 31, 2024, was guided by the PRISMA guidelines and a predefined protocol based on the PICOS-based protocol. Eligible studies included randomized controlled trials (RCTs) and quasi-experimental designs. A comprehensive literature search was conducted in Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, and OVID databases. Study selection was based on the PICOS framework, and methodological quality was assessed using the Joanna Briggs Institute-Meta Analysis Statistical Assessment and Review Instrument (JBI-MAStARI). Based on the inclusion criteria, six studies were incorporated into the review.

RESULTS: The total sample across the included studies was 305 participants, with 66% of the studies involving at least 50 participants. Findings indicated that laughter yoga contributed to a reduction in anxiety and stress levels in children (p < 0.05), while no statistically significant effect was observed on depression scores (p > 0.05). Although no substantial improvement in self-esteem was reported, positive changes in self-concept were noted. Furthermore, laughter yoga was associated with an increase in salivary IgA levels (p < 0.01), whereas no significant influence on cortisol levels was found (p > 0.05). Additionally, the intervention was reported to alleviate pain, fatigue, and burnout while enhancing hope and overall happiness.

CONCLUSIONS: Study results showed that laughter yoga promoted the increase in happiness and self-concept in children and improved their ability to cope with stress. It also provided a physiological improvement by positively affecting pain and fatigue. In light of these results, it is recommended that laughter yoga be used more widely in children’s daily lives and clinical practices.

PMID:41485062 | DOI:10.1186/s12887-025-06151-0

J Exp Clin Cancer Res. 2026 Jan 2. doi: 10.1186/s13046-025-03619-w. Online ahead of print.

ABSTRACT

BACKGROUND: Metastatic colorectal cancer (CRC) harboring KRAS mutations presents a major therapeutic challenge due to its aggressive nature, poor prognosis, and resistance to EGFR-targeted therapies. This study aimed to identify novel drivers of metastasis specifically in KRAS-mutant CRC and to elucidate the underlying molecular mechanisms to undercover new therapeutic vulnerabilities.

METHODS: We integrated data from clinical databases (TCGA, CPTAC) with experimental validation using human CRC cell lines, a tissue microarray, and two distinct in vivo metastasis models (liver and lung colonization). ZBTB20 expression and function were analyzed by IHC, Western blotting, Transwell assays, and RNA-seq integrated with ChIP-seq data. The mechanism of ZBTB20 regulation was investigated via co-immunoprecipitation, mass spectrometry, truncation analysis, site-directed mutagenesis, and luciferase reporter assays. Statistical significance was determined using Student’s t-tests, ANOVA, and survival analysis.

RESULTS: ZBTB20 expression was significantly upregulated with metastatic progression specifically in KRAS-mutant CRC patients and correlated with reduced overall survival. Functionally, ZBTB20 promoted CRC cell migration, invasion, EMT in vitro, and drove metastatic colonization in vivo. Mechanistically, KRAS/ERK signaling directly phosphorylated ZBTB20 at Threonine 138, 142, and 232, a step essential for its nuclear localization and pro-metastatic activity. Integrating transcriptomic and cistromic data, we identified TGFBR2 as a direct transcriptional target of activated ZBTB20. Notably, pharmacological degradation of TGFBR2 with the inhibitor ITD-1 potently abrogated metastatic outgrowth in both liver and lung colonization models.

CONCLUSIONS: Our findings delineate a novel KRAS-ERK-ZBTB20-TGFBR2 signaling axis that is a critical driver of metastasis colonization in KRAS-mutant CRC. The robust efficacy of a TGFBR2 degrader in multiple in vivo models validates this axis as a viable therapeutic target, offering a promising strategy to inhibit metastatic progression in patients with this aggressive disease.

PMID:41485060 | DOI:10.1186/s13046-025-03619-w

BMC Med Educ. 2026 Jan 3. doi: 10.1186/s12909-025-08514-8. Online ahead of print.

NO ABSTRACT

PMID:41485041 | DOI:10.1186/s12909-025-08514-8

BMC Womens Health. 2026 Jan 3. doi: 10.1186/s12905-025-04203-2. Online ahead of print.

ABSTRACT

BACKGROUND: Women’s ability to refuse unwanted sex is a fundamental dimension of gender equality and a key determinant of overall well-being. Despite its importance, there is limited evidence on the prevalence and factors influencing this ability in Tanzania. This study therefore aimed to investigate the prevalence and determinants of women’s ability to refuse sex among reproductive-age women in the country.

METHOD: This study analyzed secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS), using a weighted sample of 9,090 women aged 15-49. Descriptive statistics summarized socio-demographic characteristics, while binary logistic regression identified factors associated with women’s ability to refuse sex. Both unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals were reported, with statistical significance set at p < 0.05.

RESULTS: The study found that 69.6% of Tanzanian women of reproductive age had the ability to refuse sex (95% CI: 68.5%-70.4%). After adjusting for confounders, women’s ability to refuse sex was associated with their education, primary (aOR = 1.354, p < 0.001), secondary (aOR = 1.74, p < 0.001), higher (aOR = 2.253, p = 0.024), and their partners’ education, secondary (aOR = 1.269, p = 0.015), higher (aOR = 1.756, p = 0.009). Wealth (aOR = 1.241, p = 0.017), awareness of sexually transmitted infections (aOR = 1.368, p < 0.001), prior HIV testing (aOR = 1.714, p < 0.001), media access, low (aOR = 1.273, p < 0.001), medium (aOR = 1.612, p < 0.001), high (aOR = 1.954, p < 0.001), and contraceptive use, calendar-based (aOR = 1.311, p < 0.001) or other methods (aOR = 1.525, p < 0.001), were also positively associated. Women from Unguja (aOR = 0.425, p < 0.001) and Pemba (aOR = 0.376, p = 0.004) were less likely to refuse sex.

CONCLUSION: The study found that a majority of Tanzanian women have the ability to refuse sex and that the ability to refuse sex is significantly linked to education, economic status, partner’s education, access to media, STI awareness, HIV testing, and contraceptive use. However, women in Unguja and Pemba had lower ability to refuse sex compared to those in mainland urban areas. The findings highlight the need for targeted interventions to address regional disparities and promote equitable access to resources that support women’s ability to refuse sex.

PMID:41485040 | DOI:10.1186/s12905-025-04203-2

BMC Public Health. 2026 Jan 3. doi: 10.1186/s12889-025-25928-7. Online ahead of print.

ABSTRACT

BACKGROUND: Child undernutrition remains a major public health concern in Ethiopia, influenced by multiple and interacting household and community factors. Despite large-scale initiatives such as the Productive Safety Net Program, Emergency Aid Program, and Health Extension Program, evidence is still needed on how these interventions affect the determinants of child nutritional status over time.

METHODS: We applied a Dynamic Copula Bayesian Network (DCBN) to model time-varying associations between program participation and key determinants of child undernutrition: food security (FS), household wealth (WQ), and mother subjective well-being (MSW). Data were drawn from the Young Lives-Ethiopia surveys (waves 2009, 2013, 2016) with baseline information from 2002 and 2006. The DCBN framework incorporated 26 copula families, Kendall’s τ for dependence measures, and Markov Chain Monte Carlo (MCMC) for parameter estimation. Model performance was evaluated using root mean square error (RMSE) and Nash-Sutcliffe efficiency (NSE). We further accounted for program spillovers through a community program intensity proxy and assessed robustness with baseline conditioning and inverse probability weighting (IPW).

RESULTS: Program participation was positively associated with household food security and wealth. Both FS → CUS and WQ → CUS edges showed negative and strengthening dependencies across waves, indicating that improvements in food security and wealth are associated with reductions in child undernutrition. These associations were robust to baseline conditioning, spillover adjustments, IPW weighting, and estimation method (MCMC vs. local optimization).

CONCLUSIONS: The study demonstrates the utility of DCBNs for mapping dynamic, nonlinear associations between social protection and health programs and child undernutrition determinants. The results highlight that strengthening household food security and wealth plays a central role in reducing child undernutrition. Although findings are associational, the transferable dependence map can be re-estimated with contemporary data to guide program targeting, monitoring, and policy decisions in Ethiopia.

PMID:41485035 | DOI:10.1186/s12889-025-25928-7

BMC Gastroenterol. 2026 Jan 2. doi: 10.1186/s12876-025-04570-y. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the care practices of adult patients with percutaneous endoscopic gastrostomy and the care burden of individuals who provide care for these patients in this regard.

METHODS: The study was carried out in a descriptive and cross-sectional research design. The sample of the study consisted of 139 patients with percutaneous endoscopic gastrostomy and 139 primary caregivers. The research data were collected through face-to-face interviews with the patients and their caregivers using patient and caregiver information forms, a percutaneous endoscopic gastrostomy care questionnaire, and the Zarit care burden scale. The data obtained in the study were analyzed using the SPSS 23.0 program. Independent samples t-test, one-way analysis of variance, Mann-Whitney U test and Kruskal-Wallis test were used in data analyzing. Statistical significance was assumed at p < 0.05.

RESULTS: It was determined that 59.7% of patients were female and 60.4% were aged 65 and over. 59.7% of carers were male and 50.4% were aged between 45 and 64. The mean score on the Zarit care burden scale of the caregivers was 34.21 ± 21.37. The average care burden score for caregivers of patients aged 65 and over was 38.45 ± 22.73, which was statistically significantly higher than that of caregivers of patients under the age of 65 (p = 0.004). Other factors that affecting caregivers’ burden of care include percutaneous endoscopic gastrostomy control status, the duration of care, maintenance of percutaneous endoscopic gastrostomy care, the status of closing the percutaneous endoscopic gastrostomy area, the type of feeding, the type of equipment used in feeding, the patient’s education for percutaneous endoscopic gastrostomy care, and the amount of daily food given (p < 0.05).

CONCLUSIONS: This study showed that the caregivers of patients with percutaneous endoscopic gastrostomy had a moderate care burden. In addition, this study showed that caregivers who had training on percutaneous endoscopic gastrostomy care had a higher care burden.

PMID:41485022 | DOI:10.1186/s12876-025-04570-y

BMC Geriatr. 2026 Jan 3. doi: 10.1186/s12877-025-06938-x. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia, defined as progressive loss of skeletal muscle mass and function, is a major health issue with economic consequences in aging societies. Physical activity is recognized as preventive, but its long-term impact across different life stages is not well established. This study examined the association between lifetime physical activity and sarcopenia prevalence using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS: Data from the 2014 CHARLS Life History Survey were matched with 2015 cross-sectional health assessments. After excluding participants younger than 60 years or with missing data, a final sample of 6,696 individuals was analyzed. Physical activity at different life stages was assessed using a self-reported questionnaire in the 2014 Life History Survey. Sarcopenia was classified according to the AWGS 2019 criteria. Multivariate logistic regression was conducted to evaluate the association between physical activity at different life stages and sarcopenia prevalence. A significance level of 0.05 was adopted for hypothesis testing.

RESULTS: Among the study participants, 51.7% were without sarcopenia, 36.0% had possible sarcopenia, and 12.3% had sarcopenia. Across all life stages, individuals with sarcopenia were less likely to have engaged in regular physical activity. After adjusting for all covariates, engaging in physical activity for at least one year at any life stage was associated with a 47% lower odds of sarcopenia (OR = 0.53, 95% CI: 0.40-0.69). The strongest protective effect was observed for physical activity during middle adulthood (41-65 years) (OR = 0.36, 95% CI: 0.19-0.69), whereas physical activity in young adulthood (≤ 40 years) and older adulthood (> 65 years) showed no significant associations.

CONCLUSION: Our findings highlight that maintaining physical activity, particularly during middle adulthood, is associated with reduced risk of sarcopenia. Because physical activity was self-reported, future research should employ objective measures and longitudinal designs to confirm these associations.

PMID:41485020 | DOI:10.1186/s12877-025-06938-x