Category: Nevin Manimala

J Am Coll Cardiol. 2026 Jul 30:S0735-1097(26)07131-7. doi: 10.1016/j.jacc.2026.07.014. Online ahead of print.

ABSTRACT

BACKGROUND: Inhaled cannabis is widely legal in the United States. Data regarding cardiovascular effects are conflicting and generally arise from observational studies.

OBJECTIVES: The goal was to evaluate the acute effects of cannabis inhalation on cardiac ectopy.

METHODS: We conducted a prospective, randomized, crossover trial to assess effects of inhaled cannabis on cardiac ectopy, mean glucose levels, step counts, and sleep durations. Adults who smoked or vaped cannabis on a regular basis without a history of cardiac arrhythmias were enrolled. Participants were randomly assigned each day to inhale vs abstain from cannabis via text messages for 14 days. Adherence was assessed using time-stamped Zio patch button presses at the time of cannabis use, daily surveys, and, in a subset, salivary mass spectrometry. The primary outcome was daily cardiac ectopy (daily premature atrial contractions and premature ventricular contractions).

RESULTS: Of 108 participants (mean age 32 ± 10 years, 59% women, and 37% non-Hispanic White) experiencing a total of 713 days randomized to inhaled cannabis and 616 days randomized to abstinence, randomization adherence was imperfect but generally supportive of assignment adherence. Inhaled cannabis resulted in a statistically significant 9% reduction in ectopic beats (rate ratio [RR]: 0.91; 95% CI: 0.85-0.98; P = 0.02). Daily premature atrial contractions decreased by 10% (RR: 0.90; 95% CI: 0.82-0.97; P = 0.012), whereas premature ventricular contractions showed no significant change. Each cannabis inhalation was associated with a 2% reduction in ectopic beats (RR: 0.98; 95% CI: 0.97-0.99; P = 0.043). No significant differences were observed for step counts, sleep duration, or glucose levels.

CONCLUSIONS: In a pragmatic crossover design including habitual cannabis users, randomization to inhaled cannabis was associated with less cardiac ectopy, driven by fewer premature atrial contractions. Potential withdrawal effects, moderate adherence, and co-intervention limit interpretation of causal mechanism. (Marijuana and Acute Risk of Arrhythmia-Joint Abstinence and Exposure [MARY-JANE]; NCT06021613).

PMID:42584385 | DOI:10.1016/j.jacc.2026.07.014

J Am Coll Cardiol. 2026 Jul 30:S0735-1097(26)07071-3. doi: 10.1016/j.jacc.2026.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Nicorandil, an adenosine triphosphate-sensitive potassium-channel opener with nitrate-like properties, may reduce reperfusion injury and microvascular obstruction in ST-segment elevation myocardial infarction (STEMI), but large-scale randomized evidence on long-term clinical outcomes is inconclusive.

OBJECTIVES: The CLEAN trial aimed to assess whether adjunctive intravenous nicorandil improves 12-month clinical outcomes in patients with STEMI undergoing primary percutaneous coronary intervention.

METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial conducted at 49 hospitals in China, patients aged 18 to 80 years with STEMI within 12 hours of symptom onset were randomly assigned (1:1) to receive intravenous nicorandil (6 mg bolus before reperfusion followed by 6 mg/h infusion for 48 h) or matching placebo. Oral nicorandil was prohibited during follow-up. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, target vessel revascularization, or unplanned hospitalization for heart failure within 12 months.

RESULTS: Between January 2021 and December 2023, 1,503 patients were enrolled and randomly assigned to nicorandil (n = 748) or placebo (n = 755). The primary composite outcome occurred in 98 patients (13.1%) in the nicorandil group (113 events over 717.2 person-years) and 99 (13.1%) in the placebo group (136 events over 710.3 person-years), with no significant difference between groups (rate ratio: 0.869; 95% CI: 0.650-1.162; P = 0.3429). Among secondary outcomes, nominal reductions were observed in cardiovascular death (1.9% vs 3.6%; HR: 0.515; 95% CI: 0.269-0.983) and target-vessel revascularization (1.1% vs 3.0%; HR: 0.322; 95% CI: 0.143-0.727), whereas rates of nonfatal myocardial infarction and unplanned hospitalization for heart failure were similar between groups. Adverse events did not differ between groups.

CONCLUSIONS: In patients with STEMI undergoing primary percutaneous coronary intervention, adjunctive intravenous nicorandil did not significantly reduce the 12-month primary composite outcome. These findings do not support routine use of intravenous nicorandil in unselected patients with STEMI. (Clinical Efficacy and sAfety of Intravenous Nicorandil; NCT04665648).

PMID:42584383 | DOI:10.1016/j.jacc.2026.07.005

Nurs Crit Care. 2026 Sep;31(5):e70621. doi: 10.1111/nicc.70621.

ABSTRACT

BACKGROUND: Parenteral nutrition provides vital nutrients and serves as a lifesaving therapy for individuals unable to utilize their gastrointestinal tract. Inadequate provision contributes to undernutrition, increased co-morbidity, poor wound healing and prolonged hospital stays. Despite its importance, there is limited research examining how nurses’ knowledge, adherence to guidelines, monitoring and patient-centred practices influence the safe administration of parenteral nutrition and its impact on patient outcomes.

AIM: The aim was to assess nurses’ parenteral nutrition provision knowledge and associated factors in two teaching hospitals of Amhara region, Ethiopia.

STUDY DESIGN: An institution-based cross-sectional study design was used and the study was conducted from April 15 to May 30, 2023. The data were collected by trained data collectors. Simple random sampling was used to select the study participants, and a structured self-administrated questionnaire was used to collect data. Data entered into Epi-data 4.2 and exported to Stata Version 17. The knowledge of nurses was assessed by knowledge-related questions and a nurse who scored ≥ 50% of the total knowledge-related questions considered having adequate knowledge. Logistic regression model was used to identify association of variables. p value ≤ 0.05 and 95% confidence interval were considered to declare statistically significant factors.

RESULTS: A total of 390 nurses participated, and 73.6% (95% CI: 68.9-77.9) of nurses had adequate knowledge. Training, internet access, presence of guidelines/protocol, graduating university and educational level were significantly associated factors. Training (AOR = 1.33, 95% CI: 1.02, 1.73, p value = 0.03), internet access (AOR = 0.61, 95% CI: 0.36, 1.02, p value = 0.05), graduating from a governmental institution (AOR = 2.04, 95% CI: 1.30, 3.22, p value = 0.02), availability of guidelines (AOR = 1.75, 95% CI: 1.05, 2.92, p value = 0.03) and educational background (AOR = 1.64, 95% CI: 1.01, 2.67, p value = 0.04) were significantly associated with adequate knowledge.

CONCLUSION: The study revealed that the majority of nurses had an adequate level of knowledge towards parenteral nutrition provision. Training about parenteral nutrition, availability of guidelines on parenteral nutrition, access to internet in units, educational background and graduating college were the positive predictors for good knowledge of nurses about parenteral nutrition. The findings underscore the importance of continued education and implementation of standardized nutritional guidelines to insure optimal patient care, particularly for patients with compromised nutritional intake.

RELEVANCE TO CLINICAL PRACTICE: Strengthening nurse knowledge through training, internet access and clear clinical guidelines can enhance patient care and improve outcomes.

PMID:42581824 | DOI:10.1111/nicc.70621

BJU Int. 2026 Aug 12. doi: 10.1111/bju.70409. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe contemporary trends in kidney stone disease (KSD)-related inpatient episodes, procedures, and costs in England and Scotland, with emphasis on post-coronavirus disease 2019 (COVID-19) service recovery, socioeconomic variation in Scotland, comparison with other urological procedures, and 10-year healthcare demand and cost projections.

MATERIALS AND METHODS: Retrospective descriptive analyses were conducted using English Hospital Episode Statistics (2020-2025) and Public Health Scotland data (2019-2024). KSD-related finished consultant inpatient episodes and procedures were identified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision and Operation and Procedures fourth edition codes, respectively. Procedures were categorised as extracorporeal shockwave lithotripsy, ureterorenoscopy (URS), percutaneous nephrolithotomy, or open. Trends were compared with uro-oncological resections and benign prostate obstruction procedures. Socioeconomic variation was assessed using the Scottish Index of Multiple Deprivation. The 10-year healthcare demand and cost projections, accounting for National Health Service (NHS) cost uplift factors, were modelled using historical data.

RESULTS: The COVID-19 pandemic disproportionately reduced KSD-associated activity compared with procedures for bladder and kidney cancer. Although volumes now exceed pre-pandemic levels, inpatient episodes remain below baseline and waiting times remain prolonged. Between 2020 and 2025, inpatient episodes increased by 27.4% in England and 17% in Scotland, with URS accounting for >50% of interventions. KSD procedural volumes are comparable to the combined volume of uro-oncological resections and benign prostatic obstruction procedures. In Scotland, 44% of procedures were performed in the two most deprived socioeconomic quintiles versus 37% in the two least deprived. In England, KSD-associated episodes are projected to increase by 33% to 111 907 (95% confidence interval 96 057-130 373) by 2034-2035, with an estimated cumulative NHS cost of £1.82 billion over the next decade.

CONCLUSION: Kidney stone disease exacts a growing burden on healthcare services with incomplete recovery of inpatient care following the COVID-19 pandemic, socioeconomic disparities, and rising healthcare demand. These findings can inform service planning and prioritise evaluation of strategies to improve efficiency, equity, and prevention.

PMID:42581823 | DOI:10.1111/bju.70409

Clin Transl Sci. 2026 Aug;19(8):e70701. doi: 10.1111/cts.70701.

ABSTRACT

Pharmacogenomics has the potential to improve medication responses for the public; however, its adoption in clinical practice has been slow. Consumer representation and engagement are crucial for pharmacogenomics implementation, since it is their data that is central to testing. This study investigated the Australian public’s awareness, knowledge, and perceptions of pharmacogenomics via a mixed-methods approach. Firstly, a cross-sectional survey with a nationally representative sample of 772 members of the Australian general public assessed the frequency of pharmacogenomics awareness, knowledge, perceived benefit and concern. Subsequent semi-structured interviews with 21 members of the Australian public provided deeper insights into perceptions through thematic analysis. Over three-quarters (76.3%) of participants were unaware of pharmacogenomics, while 6.2% categorized themselves as aware and knowledgeable about the topic. Interviews found five major themes: (1) Knowledge and Understanding, (2) Trust, (3) Personalized and Holistic Care, (4) Clinical Utility, and (5) Accessibility. Overall, participants highlighted several key steps for pharmacogenomics integration into clinical practice and to increase awareness. These include the importance of simplifying the terminology, providing education and transparency to overcome apprehension, addressing cost concerns, communicating the value clearly and increasing community engagement.

PMID:42581820 | DOI:10.1111/cts.70701

NMR Biomed. 2026 Sep;39(9):e70370. doi: 10.1002/nbm.70370.

ABSTRACT

The aim of this study was to develop and apply an exploratory country-level Helium-MRI Vulnerability Index (HMVI) to assess structural vulnerability of MRI services to helium supply-chain disruption. This cross-sectional ecological study used publicly available country-level data from the World Health Organization, World Bank, Organisation for Economic Co-operation and Development and US Geological Survey. The global HMVI combined three components: MRI infrastructure dependence, helium supply exposure and health-system resilience. MRI dependence was scored by tertiles of MRI units per million population, helium exposure by national helium production status and resilience by tertiles of current health expenditure per capita. Scores ranged from 0 to 6 and were categorised as low (0-2), moderate (3 and 4) or high (5 and 6) vulnerability. A secondary full HMVI incorporating MRI examinations per 1000 population was calculated for countries with available examination volume data. The global analysis included 140 countries; China and India could not be included because MRI-density data were unavailable. The mean global HMVI was 3.94 ± 0.70, with a median of 4 and an observed range of 2-5. Six countries were classified as low vulnerability, 110 as moderate vulnerability and 24 as high vulnerability. HMVI scores differed significantly across WHO regions (Kruskal-Wallis H = 15.150, p = 0.0097) and World Bank income groups (H = 13.396, p = 0.0039). High-vulnerability countries had lower median health expenditure per capita than non-high-vulnerability countries (240.70 vs. 556.28 USD, p = 0.0051), whereas MRI density did not differ significantly (1.17 vs. 1.51 MRI units per million population, p = 0.3751). The full HMVI subgroup included 24 countries, of which eight were classified as high vulnerability. Sensitivity analysis, excluding countries with 2013 MRI-density data, retained 52 countries and identified five as high vulnerability. The HMVI provides an exploratory framework for characterising structural vulnerability of MRI services to helium supply-chain disruption. Vulnerability was shaped not by MRI density alone, but by the interaction between imaging capacity, helium supply exposure and health-system financial resilience. Updated scanner-level data, including helium consumption and low-helium system adoption, are needed to refine future assessments.

PMID:42581817 | DOI:10.1002/nbm.70370

J Magn Reson Imaging. 2026 Aug 12. doi: 10.1002/jmri.70485. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) are prevalent but frequently remain unrecognized. While bone mineral density (BMD) is the primary assessment tool, MRI-based parameters associated with bone and muscle quality may offer additional value, yet sex-specific analyses are limited, despite sex differences in incidence and hormones.

PURPOSE: To explore the associations between MRI-based vertebral bone quality (VBQ) score, psoas muscle index (PMI), and paravertebral muscle fat infiltration (FI) fraction with OVCFs, and to assess the potential diagnostic performance of MRI parameters across sexes.

STUDY TYPE: Retrospective.

POPULATION: 260 subjects (≥ 50 years); 130 OVCF patients (73.0 years (67.0-80.0), 89 females) and 130 non-fracture (NF) patients (64.5 years (58.0-73.0), 76 females).

FIELD STRENGTH AND SEQUENCES: 3 T and 1.5 T. T1-weighted TSE and T2-weighted TSE (Siemens) and T1-weighted FSE and T2-weighted FSE (United Imaging).

ASSESSMENT: VBQ was calculated on sagittal T1-weighted MRI; PMI and FI were quantified on axial T2-weighted MRI at the L3 endplate by ImageJ. BMD was derived from CT using QCT PRO software. Two trained observers, blinded to clinical data, performed all MRI measurements.

STATISTICAL TESTS: Significance level was set at p < 0.05. t-test/Mann-Whitney U test, chi-squared test (χ²), Spearman’s rank correlation coefficient, multivariate logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). Bootstrap resampling (1000 iterations) for internal validation.

RESULTS: The OVCF group exhibited significantly elevated VBQ (3.71 ± 0.55 vs. 3.25 ± 0.58) and FI (24.11% (21.66-28.92) vs. 20.31% (18.90-22.14)), while PMI (3.42 ± 1.02 vs. 4.08 ± 1.14) and BMD (55.82 mg/cm³ (38.75-70.90) vs. 89.24 mg/cm³ (67.80-110.00)) were reduced. FI was independently associated with OVCFs exclusively in females (OR = 1.566). The combined MRI model (VBQ + FI + PMI) yielded a significantly higher AUC in females (AUC = 0.896) than in males (AUC = 0.720).

DATA CONCLUSION: VBQ, PMI, and FI reveal significant sex-specific correlations with OVCFs. The multi-parametric MRI model shows considerable potential as a diagnostic aid for OVCFs in individuals aged over 50, particularly in females.

TECHNICAL EFFICACY STAGE: 2 (Diagnostic Accuracy).

PMID:42581773 | DOI:10.1002/jmri.70485

Brain Behav. 2026 Aug;16(8):e71669. doi: 10.1002/brb3.71669.

ABSTRACT

OBJECTIVE: Early language development forms the foundation for cognitive, social, and academic skills. This study aimed to compare the language, speech, and communication skills of twins and singleton children aged 24-36 months and to explore associations with sociodemographic, biological, and environmental factors in the Turkish population METHOD: The study was conducted with 100 children, comprising 30 twin pairs (60 children, 30 male, 30 female) and 40 singletons (23 male, 17 female), with a mean age of 33.4 ± 5.26 months. Receptive and expressive language skills were evaluated using the Test of Early Language Development-Third Edition, Turkish Version (TEDIL), parent-reported language skills were assessed with the Adapting the Language Development Survey to Turkish (DILTAR), communication skills were evaluated with the Children’s Communication Checklist-2 (CCC-2), and speech development was assessed with the Ankara Articulation Test (AAT). Sociodemographic (maternal age, education), biological (birth weight, gestational age), and environmental (television viewing time) factors were analyzed through correlational analyses.

RESULTS: Twins exhibited significantly lower birth weights and earlier gestational age at birth compared to singletons. Twins demonstrated lower performance in TEDIL receptive language scores and AAT scores compared to singletons (p < 0.05). In the CCC-2 subscales of speech, syntax, semantics, use of context, and social relationships, twins scored significantly lower than singletons. A negative correlation was found between TEDIL receptive language scores and television viewing time across all children (r = -0.603). In twins, statistically significant correlations were observed between language-related scores and maternal age, maternal gestational age, birth weight, and maternal education (p < 0.05).

CONCLUSION: This study provided culturally grounded evidence from Turkish children and demonstrated that 24-36-month-old twins are at increased risk for delays in language, speech, and communication skills compared to singleton peers. The findings suggest that the twinness effect in early toddlerhood reflects the combined influence of biological maturity at birth (e.g., lower birth weight and earlier gestational age), sociodemographic characteristics (e.g., maternal education and age), and environmental factors (e.g., television viewing time). Rather than being attributable to a single determinant, early language and communication outcomes in twins appear to emerge from dynamic interactions between biological and environmental conditions. These results underscore the importance of early, multidimensional screening and comprehensive assessment of twins’ communication development to facilitate the timely identification of potential delays. Early intervention approaches that combine speech-language therapy with enriched environmental support strategies may help mitigate developmental risk and promote optimal communication outcomes.

PMID:42581767 | DOI:10.1002/brb3.71669

Surg Innov. 2026 Aug 12:15533506261477024. doi: 10.1177/15533506261477024. Online ahead of print.

ABSTRACT

PurposeLiver transection techniques in robotic liver resection (RLR) have not yet been standardized. We introduced robotic ultrasonic shears (longitudinal clustered shears [LCS]); however, the lack of an articulating joint limits operative angles. To overcome this, we implemented strategic surgical maneuvers. This study aimed to evaluate the liver transection efficiency of the robotic ultrasonic shears in RLR.MethodsFifty-three patients who underwent RLR concurrently between 2023 and 2025 were retrospectively analyzed (LCS group, n = 23; conventional [CONV] group using Maryland bipolar forceps, n = 30). We compared liver transection speed, total ischemia time, and short-term outcomes.ResultsDespite a lower proportion of low-difficulty cases in the LCS group, it demonstrated significantly higher transection speed (median: 0.71 vs 0.38 cm²/min, P < .001) and shorter total ischemia time (63 vs 78 min, P = .011). Postoperative albumin levels on days 3 and 5 were significantly higher (P = .004), and the complication rate (Clavien-Dindo grade ≥ II) was significantly lower (8.7% vs 30.0%, P = .049) in the LCS group. Multivariate analysis identified the use of LCS (P = .003) as an independent predictor of higher transection speed. Exploratory subgroup analyses confirmed that the LCS group had significantly higher transection speed in non-anatomical resections (P < .001) and significantly shorter ischemia time in anatomical resections (P = .021), although the higher transection speed in anatomical resections did not reach statistical significance.ConclusionsRobotic ultrasonic shears with optimized maneuvers significantly improve transection speed and reduce ischemia time, enhancing the efficiency of RLR.

PMID:42581764 | DOI:10.1177/15533506261477024

J Magn Reson Imaging. 2026 Aug 12. doi: 10.1002/jmri.70500. Online ahead of print.

ABSTRACT

BACKGROUND: Placental MRI has shown T2* decreases during contractions and increases during maternal hyperoxia. However, how contraction-induced placental oxygenation and deformation relate to uterine deformation and differ from hyperoxia-induced responses remains unknown.

PURPOSE: To quantify placental T2* and deformation changes during spontaneous non-labor uterine contractions and maternal hyperoxia, testing the hypothesis that contractions produce mechanically mediated placental responses distinct from hyperoxia.

STUDY TYPE: Retrospective.

POPULATION: Forty-nine MRI datasets from 46 pregnant participants with singleton pregnancies (24-39 weeks gestation).

FIELD STRENGTH/SEQUENCE: 3 T; dynamic multi-echo gradient-echo echo-planar imaging.

ASSESSMENT: Non-labor uterine contractions were defined as events lasting ≥ 0.5 min with peak uterine volume reduction > 2.5%. Placental T2* and deformation of the uterus, myometrium, placenta, fetus and amniotic fluid were quantified during normoxia (normal air, 21% O₂, 5 min) with and without contractions, and maternal hyperoxia (100% FiO₂, 4 min). Regional analyses were performed within and outside imaging-defined placental cotyledons.

STATISTICAL TESTS: Linear regression, linear mixed-effects models, Pearson correlation and paired t-tests (p < 0.05).

RESULTS: Complete contractions during normoxia were identified in 22 datasets, reducing placental T2* by 4.64 ± 0.75 ms. Maternal hyperoxia increased placental T2* by 11.36 ± 0.62 ms relative to normoxia. Significant gestational age-by-duration interactions were observed for contraction-associated placental deformation (β = 2.47 ± 1.04% points/min/week) and T2* reduction (β = 1.50 ± 0.44 ms/min/week). At baseline, cotyledons exhibited higher T2* than surrounding placental tissue (β = -11.56 ± 0.95 ms). Contractions significantly reduced the inside-outside cotyledon T2* difference (β = 3.14 ± 1.34 ms), whereas hyperoxia preserved regional heterogeneity (p = 0.48).

DATA CONCLUSION: Spontaneous non-labor uterine contractions induced coordinated decreases in placental volume and oxygenation that intensified with gestational age and contraction duration. In contrast, maternal hyperoxia produced larger, more uniform increases in oxygenation.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 3.

PMID:42581746 | DOI:10.1002/jmri.70500