Category: Nevin Manimala

J Cachexia Sarcopenia Muscle. 2026 Aug;17(4):e70331. doi: 10.1002/jcsm.70331.

ABSTRACT

BACKGROUND: Body composition is a major determinant of health, yet the role of fat-free mass, a key component of body composition, in mortality remains unclear.

METHODS: A PRISMA-guided systematic review and meta-analysis (PROSPERO: 321722) of observational cohort studies in community-dwelling adults was conducted. PubMed was searched from inception to 25 October 2025, and Web of Science and Embase were searched from inception to 31 July 2025. Eligible studies assessed fat-free mass using computed tomography, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) or anthropometry. Studies involving hospitalized participants were excluded. Maximally adjusted effect estimates were pooled using random-effects models to calculate summary risk ratios (RRs) and 95% confidence intervals (CIs). Publication bias was assessed using graphical and statistical methods; influence analyses evaluated robustness; E-values quantified potential unmeasured confounding; and meta-regression explored between-study heterogeneity.

RESULTS: Of 7741 screened records, 49 studies met the inclusion criteria (1 149 807 participants; 83 798 deaths). Low versus high fat-free mass was associated with higher all-cause mortality (RR: 1.42, 95% CI: 1.30-1.55). Trim-and-fill analysis indicated publication bias (adjusted RR: 1.31, 95% CI: 1.20-1.44). Sensitivity analyses confirmed robustness (leave-one-out RR range: 1.39-1.43; E-value: 2.19). Associations were consistent across age (p_{difference; within-study} = 0.133), geographic region (p_difference = 0.983) and cause of death (p_{difference for cardiovascular diseases; within-study} = 0.240, p_{difference for cancer; within-study} = 0.136). Effect sizes varied by sex (men RR: 1.56, 95% CI: 1.32-1.85; women RR: 1.25, 95% CI: 1.11-1.39; p_difference < 0.0001) and measurement method: strongest for calf circumference (RR: 2.19, 95% CI: 1.50-3.20), moderate for DXA (RR: 1.52, 95% CI: 1.29-1.79) and weakest for BIA (RR: 1.23, 95% CI: 1.07-1.41).

CONCLUSIONS: Low fat-free mass is associated with a 42% higher risk of all-cause mortality in community-dwelling adults. Routinely assessing fat-free mass provides clinical value in identifying high-risk individuals and informing preventive care strategies.

PMID:42430205 | DOI:10.1002/jcsm.70331

J Med Internet Res. 2026 Jul 10;28:e85290. doi: 10.2196/85290.

ABSTRACT

BACKGROUND: Online health communities (OHCs) are important channels for families of children with autism spectrum disorder to obtain health information and psychosocial support. Differences between an open forum platform and the physician-patient consultation platforms may shape caregiver decisions, yet comparative evidence from China remains limited. A large language model (LLM) provides a scalable approach for systematic content annotation in large OHC datasets.

OBJECTIVE: This study proposes and validates a standardized LLM-assisted annotation framework under a unified classification schema and compares topic distributions and poster identities across an open forum platform (Baidu Tieba) and physician-patient consultation platforms (Chunyu Doctor and Haodf).

METHODS: We implemented an LLM-assisted annotation framework. A unified taxonomy of topics and poster identities was first developed through human open coding. Poster identities in Baidu Tieba were annotated through a double-blind manual procedure. For topic classification, interannotator and human-LLM agreement were evaluated on a manually labeled subset to benchmark models of varying sizes. The best-performing LLM was selected for full-dataset topic annotation, followed by statistical and cross-platform analysis.

RESULTS: When metrics were arithmetically averaged across all annotation tasks, the best-performing LLM achieved agreement levels comparable to human annotation (accuracy=79.18%, SD 0.20%; κ=0.736, SD 0.003; F₁-score=0.727, SD 0.006), approaching interannotator agreement (accuracy=81.65%; κ=0.767; F₁-score=0.758), demonstrating strong stability and scalability. Full-dataset analysis yielded 3 main findings. First, model performance increased with parameter scale but plateaued beyond 14B, indicating diminishing marginal returns from further scaling. Second, clear cross-platform differences in poster identity were observed: the open forum platform was dominated by family members of patients (caregivers: 2377/3516, 67.61%), with substantial participation from commercial rehabilitation practitioners (commercial posters: 427/3516, 12.14%), resulting in a more heterogeneous participation structure. Third, topic distributions reflected both shared high demand for resource-related information and differentiated help-seeking pathways: both platform types demonstrated consistently high demand for resource recommendation and evaluation; the open forum platform was primarily characterized by diagnosis-related discussions (1183/7535, 15.70%), whereas the physician-patient consultation platforms were centered on intervention-related consultation (2864/7687, 37.26%).

CONCLUSIONS: The LLM-assisted annotation framework proposed in this study enables reliable large-scale annotation of OHC data while maintaining high human-LLM agreement and operational stability. Midsized models (eg, 14B) demonstrated favorable cost-performance efficiency. The findings reveal 2 key aspects: the open forum platform exhibits a complex participation structure, and the influence of commercially affiliated actors should not be overlooked; users on both platform types show sustained demand for resource-related information but follow different help-seeking pathways, emphasizing diagnostic exploration and professional intervention, respectively. These results suggest that platform structure and governance mechanisms may shape caregivers’ information access and decision-making. The framework provides a transparent, reproducible, and cost-effective approach for OHC research. All data were deidentified and handled in accordance with relevant platform policies and ethical standards.

PMID:42430199 | DOI:10.2196/85290

JMIR Form Res. 2026 Jul 10;10:e84089. doi: 10.2196/84089.

ABSTRACT

BACKGROUND: Understanding how medical students learn is critical for improving teaching strategies in clinical education. Despite the widespread use of learning style frameworks, such as visual, aural, read/write, and kinesthetic (VARK), evidence from sub-Saharan Africa remains limited, and the use of learning style approaches is debated in the literature. In clinical and health sciences education, aligning teaching with learners’ preferences can enhance knowledge retention, procedural competence, and ultimately the quality of patient care.

OBJECTIVE: This study aimed to determine the predominant learning style preferences of clinical students at a Nigerian medical school and to examine how demographic and academic factors influence these preferences, with explicit attention to implications for clinical pedagogy.

METHODS: A cross-sectional survey was conducted among 200 clinical students (400-600 level) at Niger Delta University between October 2021 and December 2021, using the validated VARK inventory (version 7.8). Descriptive statistics summarized distributions, and the Pearson chi-square tests or Fisher exact tests assessed bivariate associations with sex, age group, and year of study. A multivariable modeling strategy was prespecified but not performed due to the categorical structure of the primary outcomes, sparse cells for some modality categories, and the sample size limitations for multinomial modeling.

RESULTS: Of 200 participants (mean age 25.1, SD 3.9 y; n=107, 53.5% male), 105 (52.5%) preferred unimodal learning, and 95 (47.5%) preferred multimodal learning. Kinesthetic (n=121, 60.5%) and auditory (n=110, 55%) were the most common dominant preferences, followed by read/write (n=68, 34%) and visual (n=36, 18%). Visual preference was significantly higher among male participants (χ21=4.49; P=.03). Read/write preference varied by year of study (χ22=8.29; P=.02). No significant associations were found with age. The pedagogical implications for clinical teaching were discussed, including bedside instruction, skills laboratory, simulation, small-group teaching, and audio-visual learning resources.

CONCLUSIONS: Clinical students in this Nigerian setting predominantly favored kinesthetic and auditory learning, with nearly half reporting multimodal preferences. Medical educators should adopt blended instructional designs that include hands-on, discussion-based, and audio-visual elements to better prepare students for clinical practice. These insights can inform faculty development, curriculum design, and national medical education policies to foster adaptive, learner-centered training that improves clinical competency and readiness for professional service.

PMID:42430124 | DOI:10.2196/84089

Int Urol Nephrol. 2026 Jul 10. doi: 10.1007/s11255-026-05235-9. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to characterize ferroptosis heterogeneity within the tumor microenvironment (TME) of clear cell renal cell carcinoma (ccRCC) and investigate its impact on immune remodeling and clinical prognosis.

METHODS: Single-cell transcriptomic analysis was performed using the GSE159115 dataset to classify cell phenotypes. Functional enrichment, immune infiltration, and pathway analyses (GSEA) were conducted. Validation utilized the GSE312695 and TCGA-KIRC cohorts.

RESULTS: ccRCC tissues were enriched with ferroptosis-resistant cells, whereas normal tissues contained ferroptosis-sensitive cells. Eight core genes regulating ferroptosis susceptibility were identified. Resistant cells established an immunosuppressive “immune desert” TME, with significant suppression of T-cell and macrophage pathways. The ferroptosis resistance signature demonstrated generalizability across cohorts, and medium-high resistance scores showed a trend toward poorer survival in specific subgroups, although overall survival differences did not reach statistical significance.

CONCLUSION: Ferroptosis heterogeneity contributes to ccRCC progression by shaping an immunosuppressive TME. The identified molecular features offer potential targets for therapy and highlight the complexity of utilizing ferroptosis signatures for prognostic assessment in ccRCC.

PMID:42430097 | DOI:10.1007/s11255-026-05235-9

Int Urol Nephrol. 2026 Jul 10. doi: 10.1007/s11255-026-05267-1. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess whether simple quantitative multiparametric magnetic resonance imaging (mpMRI) measurements add diagnostic value to Vesical Imaging-Reporting and Data System (VI-RADS) scores for preoperative identification of muscle-invasive bladder cancer (MIBC).

METHODS: Tumor diameter, tumor-wall contact length, and VI-RADS scores were evaluated. The primary outcome was pathological MIBC. Diagnostic performance was assessed using receiver operating characteristic analysis, logistic regression, bootstrap internal validation, reclassification indices, calibration, and decision curve analysis.

RESULTS: The combined model including VI-RADS score (overall), average tumor diameter, and average tumor-wall contact length achieved an AUC of 0.808 (95% CI 0.739-0.876), compared with 0.769 (95% CI 0.702-0.836) for VI-RADS alone (DeLong P = 0.023). Continuous net reclassification improvement was 0.370 (95% CI 0.046-0.734), and integrated discrimination improvement was 0.034 (95% CI 0.003-0.116). Decision curve analysis suggested a modest gain in net benefit across threshold probabilities of 0.20-0.80.

CONCLUSION: Quantitative mpMRI measurements provided a modest, statistically significant but clinically limited incremental value beyond VI-RADS for identifying MIBC, although VI-RADS remained the main predictor.

PMID:42430096 | DOI:10.1007/s11255-026-05267-1

Behav Genet. 2026 Jul 10. doi: 10.1007/s10519-026-10276-y. Online ahead of print.

ABSTRACT

Caffeine intake may be influenced by both genetic and environmental factors. This study aimed to examine the genetic contribution to variation in coffee and tea drinking, as well as total caffeine intake. A total of 1,106 Korean twins, comprising 456 monozygotic and 97 dizygotic twin pairs aged 30 years or older, from the Healthy Twin Study were included. Structural equation models were used to assess heritability estimates and their 95% confidence intervals (CIs). Heritability (95% CI) was estimated at 0.29 (0.21, 0.37) for coffee drinking, 0.11 (0.02, 0.20) for tea drinking, and 0.27 (0.16, 0.38) for total caffeine intake, with the remaining variance in each trait attributed to unique environmental factors. The unique environmental factors contributed more substantially to coffee drinking than genetic factors during early adulthood, while the genetic contribution to tea drinking remained consistently low across all ages. In conclusion, coffee drinking, tea drinking, and total caffeine intake were partly heritable, with unique environmental factors playing a predominant role.

PMID:42430071 | DOI:10.1007/s10519-026-10276-y

Lasers Med Sci. 2026 Jul 10;41(1):145. doi: 10.1007/s10103-026-04946-w.

ABSTRACT

Fractional microneedle radiofrequency (FMR) has been proven effective and safe for acne scar and skin rejuvenation, but the treatment outcomes vary across different FMR devices. The face of each participant was randomly assigned as treatment side (treated with the Peninsula Timerevert Needle) and control side (treated with the EndyMed) along the midline. Outcome measures include melanin index (MI), erythema index (EI), stratum corneum hydration (SCH), sebum and dermal density on all facial sites. The treatment duration, participant’s satisfaction score and physician’s global assessment (PGA) score, pain score, bleeding score, erythema score and other side effects were evaluated. A total of 20 participants completed the entire course. The participant’s satisfaction score and PGA score increased progressively over time. Compared with the control side, the treatment side exhibited a shorter treatment time and lower pain score, but higher bleeding score. Dermal density increased gradually following FMR treatment and was statistically significant higher at 3 months than that at other follow-up time points. There were no statistically significant differences between the treatment and control sides in participant’s satisfaction score, PGA score, erythema score, erythema duration and edema duration, MI, EI, SCH, sebum and dermal density at the forehead, cheek and chin of at any follow-up time point. FMR is effective and safe for skin photoaging and acne scar. Peninsula Timerevert Needle ^TM offers the advantages of less pain and shorter treatment duration comparing with EndyMed, but is associated with a higher incidence of bleeding.

PMID:42430070 | DOI:10.1007/s10103-026-04946-w

Endocrine. 2026 Jul 10;91(1):221. doi: 10.1007/s12020-026-04706-4.

ABSTRACT

OBJECTIVE: Cardiovascular diseases (CVD) are the most common cause of death in the world. A number of scoring systems have been proposed to predict CVD risk. In this study, we aimed to assess the cardiovascular risk scores of transgender men receiving gender-affirming hormone therapy (GAHT).

METHODS: A total of 73 participants were included in this cross-sectional study: 43 transgender men, 15 cisgender men, and 15 cisgender women. For each participant, sociodemographic data were collected, glucose, lipid profiles and total testosterone levels were measured and the atherogenic index of plasma (AIP) and visceral adiposity index (VAI) were calculated.

RESULTS: The mean age of transgender men was 29.1 ±5.7. The neck circumference (NC), waist-to-hip ratio (WHR) and Waist-to-Height Ratio (WtHR) of transgender men was statistically higher than that of cis-women (p < 0.001, for all). Also, AIP was significantly higher in transgender men compared to cis- women (p = 0.003).

CONCLUSION: In conclusion, transgender men receiving GAHT exhibited differences in several cardiometabolic and anthropometric markers compared with cisgender women, with a profile more closely resembling that of cisgender men. These findings should be interpreted as descriptive differences rather than evidence of increased cardiovascular risk, particularly in the context of a cross-sectional design. The observed reduction in HDL cholesterol may be of clinical interest. Further longitudinal studies are warranted to better elucidate the long-term cardiometabolic effects of GAHT.

PMID:42430065 | DOI:10.1007/s12020-026-04706-4

Invest New Drugs. 2026 Jul 10. doi: 10.1007/s10637-026-01630-2. Online ahead of print.

ABSTRACT

Lazertinib is a third-generation, brain-penetrant, mutant-selective EGFR tyrosine kinase inhibitor approved for first-line treatment of EGFR-mutated non-small cell lung cancer, including in combination with amivantamab. Post-market safety surveillance is important given its recent approval and evolving real-world use. All FAERS reports with lazertinib as the primary suspect drug were extracted. Proportional Reporting Ratios (PRR), Reporting Odds Ratios (ROR), and chi-squared statistics were calculated for each adverse event. Disproportionality signals were defined by PRR ≥ 2, chi-squared ≥ 3.841, and a minimum of 3 reports. A total of 141 lazertinib reports were identified in the FAERS database. Twenty-six adverse events met all signal detection criteria. The strongest signals were observed for paronychia (PRR 132.90, n = 3), dermatitis acneiform (PRR 118.59, n = 4), peripheral sensory neuropathy (PRR 91.97, n = 3), and peripheral neuropathy (PRR 50.09, n = 28). Dermatologic and neurologic adverse events predominated, consistent with the mechanism of EGFR inhibition. FAERS disproportionality analysis identifies a signal profile for lazertinib dominated by EGFR inhibitor-class dermatologic and neurologic toxicities, alongside an infusion-related reaction signal reflecting combination use with amivantamab. The modest report volume warrants cautious interpretation; however, the signal patterns are mechanistically coherent and consistent with the known toxicity profile of third-generation EGFR TKIs.

PMID:42430026 | DOI:10.1007/s10637-026-01630-2

Mol Biol Rep. 2026 Jul 10;53(1):1132. doi: 10.1007/s11033-026-12338-0.

ABSTRACT

OBJECTIVE: Integrin αVβ3 has been implicated in oocyte membrane organization and sperm-oocyte interaction. This study investigated the effects of vitrification on post-warming survival and on the surface expression of integrin αV and β3 subunits in mouse oocytes at the germinal vesicle (GV) and metaphase II (MII) stages.

MATERIALS AND METHODS: A total of 400 oocytes were collected from NMRI mice and allocated into four equal groups: non-vitrified GV, vitrified GV, non-vitrified MII, and vitrified MII (n = 100 per group). Vitrification was performed using the Cryotop method, followed by one month of storage in liquid nitrogen at – 196 °C. Post-warming survival was assessed morphologically. Integrin αV and β3 expression was evaluated at the protein level by immunocytochemistry and at the transcript level by quantitative real-time reverse-transcription PCR (RT-qPCR).

RESULTS: Vitrification did not significantly affect post-warming survival rates in GV or MII oocytes compared with their non-vitrified counterparts (90% vs. 88%, P > 0.05). Immunocytochemical analysis demonstrated that both αV and β3 surface protein expression was significantly higher in MII oocytes than in GV oocytes, irrespective of vitrification status. Vitrification significantly reduced αV and β3 protein expression in MII oocytes compared with non-vitrified MII oocytes (P < 0.05 and P < 0.001, respectively), whereas reductions in GV oocytes were not statistically significant (P > 0.05). Quantitative RT-PCR broadly corroborated these findings: non-vitrified MII oocytes exhibited the highest transcript levels for both subunits, and β3 mRNA was significantly decreased in vitrified MII oocytes (P < 0.05). Although αV transcript levels showed a downward trend following vitrification, these reductions did not reach statistical significance in either stage (P > 0.05).

CONCLUSION: Despite preserving post-warming morphological survival, vitrification induced significant alterations in αV and β3 integrin expression in a maturation stage-dependent manner, with MII oocytes being disproportionately affected. These findings suggest that molecular analysis of membrane-associated proteins may provide information complementary to morphological criteria when assessing oocyte quality following cryopreservation.

PMID:42430017 | DOI:10.1007/s11033-026-12338-0