Category: Nevin Manimala

Brain Behav. 2026 Mar;16(3):e71276. doi: 10.1002/brb3.71276.

ABSTRACT

BACKGROUND: Cerebrovascular disease (CVD) remains a leading cause of death, with obesity exacerbating stroke risk through multiple metabolic pathways. However, long-term trends in CVD-related mortality among obese adults in the United States remain inadequately defined.

METHODS: We analyzed national mortality data from 1999 to 2020 using the CDC WONDER database. Deaths were included if CVD (ICD-10 I60-I69) was the underlying cause and obesity (E66) a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated, and temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC).

RESULTS: From 1999 to 2020, 26,410 CVD-related deaths occurred among obese adults. The overall AAMR was 0.53 per 100,000, with an AAPC of 4.59% (95% CI: 3.94 to 5.24). A statistically significant change in trend slope was observed after 2008, with accelerated mortality increases. Females had higher AAMRs (0.56) than males (0.49), though males experienced steeper increases (AAPC 5.98% vs. 3.64%). American Indian/Alaska Native and Black adults had the highest AAMRs (1.11 and 1.01, respectively). Mortality increased in all racial/ethnic groups, most rapidly among White individuals (AAPC 4.66%). Non-metropolitan areas showed higher mortality than metropolitan areas (0.71 vs. 0.50), with a widening urban-rural gap. Regionally, the West and Midwest had the highest AAMRs (0.59 and 0.57, respectively). Mortality rose across all age groups, with the steepest increases in younger adults aged 25-54 years. Most deaths occurred in hospitals (56%), followed by home (22.8%) and nursing facilities (15.7%).

CONCLUSIONS: CVD-related mortality among obese adults has increased significantly since 1999, with substantial disparities across sex, race, geography, and age, highlighting the need for focused public health strategies.

PMID:41764043 | DOI:10.1002/brb3.71276

J Cardiothorac Vasc Anesth. 2026 Feb 5:S1053-0770(26)00111-4. doi: 10.1053/j.jvca.2026.02.004. Online ahead of print.

ABSTRACT

OBJECTIVES: The prognostic value of the leuko-glycemic index (LGI) as a marker of postoperative outcomes in pediatric cardiac patients is not known. This study aimed to determine the predictive value of LGI in predicting composite outcomes, including prolonged mechanical ventilation, after the repair of a complete atrioventricular septal defect in infants with Down syndrome.

DESIGN: An ambidirectional cohort study.

SETTING: A single tertiary cardiac care center.

PARTICIPANTS: Patients with Down syndrome and a complete atrioventricular septal defect.

INTERVENTIONS: All patients underwent primary intracardiac repair of a complete atrioventricular septal defect and received standard perioperative anesthesia and hemodynamic management.

MEASUREMENTS AND MAIN RESULTS: A total of 110 patients were enrolled, of whom 104 completed the study and were included in the final analysis. Prolonged mechanical ventilation was defined as a duration ≥24 hours. We found a statistically significant correlation between postoperative LGI and prolonged mechanical ventilation (p = 0.042). A postoperative LGI cutoff value >1,640.16 was associated with the need for prolonged mechanical ventilation. The area under the receiver operating characteristic curve (AUC) was 0.659 (95% CI, 0.548-0.771) with a sensitivity of 47.50% and a specificity of 81.25% (p = 0.005). A cutoff LGI value >2,657.88 was found to differentiate between patients who developed renal failure and those who did not, with an AUC of 0.723 (p = 0.019).

CONCLUSIONS: The LGI, a cost-effective and easily measured index, could be a valuable prognostic tool to stratify children with Down syndrome in the immediate postoperative period after complete atrioventricular septal defect correction. High LGI values may identify patients who could benefit from greater monitoring and early therapeutic strategies to reduce the duration of mechanical ventilation and the incidence of acute kidney injury.

PMID:41764019 | DOI:10.1053/j.jvca.2026.02.004

J Voice. 2026 Feb 27:S0892-1997(25)00507-7. doi: 10.1016/j.jvoice.2025.11.027. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the predictive capacities of the University of Rhode Island Change Assessment of voice (URICA-VOICE) questionnaire and completion rate in assessing adherence, and their impact on therapeutic outcomes of voice therapy in patients with voice disorders.

METHOD: At the Voice Treatment Center of Sun Yat-sen Memorial Hospital, 127 patients with voice disorders were recruited between April and September 2023. Initial adherence was gauged using the URICA-VOICE questionnaire. Following voice therapy, adherence was assessed by examining the actual completion rate. The concordance between the two evaluations and their influence on treatment outcomes, including voice handicap index (VHI), Jitter, and Shimmer, was scrutinized.

RESULTS: Notable discrepancies arose between both assessment methodologies. The predicted poor adherence, as delineated by URICA-VOICE, stood at 62.99%, surpassing the actual poor adherence rate of 56.69% indicated by the completion rate. Considering the completion rate as the benchmark, 72 participants demonstrated actual poor adherence. Of these, 54 were precisely pinpointed by URICA-VOICE, achieving a sensitivity of 75.00%. Evaluation strategies divergently impacted outcome appraisal. With the completion rate, the enhancements in VHI, Jitter, and Shimmer were statistically superior for the 55 actually good adherent individuals compared to the 72 actually poor adherent ones (P < 0.01). In contrast, the URICA-VOICE discerned no significant variances between its 47 subjects with predicted good adherence and 80 subjects with predicted poor adherence (P > 0.05).

CONCLUSIONS: While completion rate portrays tangible behavioral adherence, URICA-VOICE gauges prospective behavioral adherence via the evaluation of mental readiness. The latter can detect those prone to diminished adherence pre-training, but falls short in predicting end results. Direct adherence assessment via completion rate is congruent with tangible treatment efficacy. Enhancing adherence is pivotal for optimizing therapeutic results and voice quality.

PMID:41764018 | DOI:10.1016/j.jvoice.2025.11.027

J Voice. 2026 Feb 27:S0892-1997(26)00057-3. doi: 10.1016/j.jvoice.2026.02.003. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to make a comparison between the short-term effects of low- and high-resistance water phonation exercises, adjusted using the DoctorVox® device, on acoustic parameters and voice self-perception in healthy adults.

METHOD: Forty-seven healthy adults (37 females, 10 males) performed both low- and high-resistance exercises in a comparative experimental design. Low resistance was achieved with 3 cm of water in the DoctorVox® device, whereas high resistance was achieved by adjusting the DC-Valve® to a 3-mm opening at the same water depth. Acoustic voice recordings (fundamental frequency [F0], jitter, shimmer, harmonics-to-noise ratio [HNR], and acoustic voice quality index) and self-perception ratings (voice quality, phonatory comfort, and vocal fatigue) were collected at baseline, immediately post exercise, and 30 minutes post exercise. The analysis employed both parametric and nonparametric statistical tests.

RESULTS: The low-resistance condition resulted in a significant immediately post exercise increase in F0 and HNR, and a significant decrease in jitter; however, these effects largely disappeared by the 30-minute mark. In the high-resistance condition, only HNR demonstrated a significant change over time, but subsequent pairwise comparisons were not significant. The only significant difference between the two conditions was a higher HNR in favor of the high-resistance condition at 30 minutes post exercise. Despite the absence of any significant difference between the conditions in self-perception ratings, participants in both groups exhibited a tendency to report heightened voice quality and comfort, alongside diminished fatigue, subsequent to the exercises.

CONCLUSION: The findings suggest that low-resistance exercises may produce immediate acoustic trends in specific parameters and may be useful as a voice warm-up in healthy individuals. Although the effects of high-resistance exercises appear more limited, the results suggest a potential trend toward more sustained changes in certain acoustic parameters. This study highlights the importance of individualizing resistance levels in voice therapy based on specific goals and provides foundational data to guide clinical practice.

PMID:41764016 | DOI:10.1016/j.jvoice.2026.02.003

J Prosthet Dent. 2026 Feb 27:S0022-3913(26)00097-1. doi: 10.1016/j.prosdent.2026.02.013. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Additively manufactured (AM) polymethyl methacrylate (PMMA) crowns exhibit limited color stability, suboptimal surface texture, and insufficient strength. The development of effective reinforcement strategies is essential to overcome these shortcomings.

PURPOSE: The purpose of this in vitro study was to evaluate the effects of incorporating silica (SiO₂) and titanium dioxide (TiO₂) nanoparticles on the fabrication trueness and the optical, surface, and mechanical properties of AM PMMA crowns.

MATERIAL AND METHODS: Mandibular first molar AM PMMA crowns (N=80) were fabricated using 4 materials (n=20 per group): unmodified PMMA (control; FREEPRINT), PMMA with 1 wt% SiO₂ (S), PMMA with 2 wt% TiO₂ (T), and PMMA with a combination of 1 wt% SiO₂ and 2 wt% TiO₂ nanoparticles (ST). Fabrication trueness was evaluated as the root mean square (RMS) surface deviation of the marginal and intaglio surfaces (µm) and their total. Color stability (ΔE₀₀) was assessed using spectrophotometry, and surface roughness (Ra) was measured via noncontact optical profilometry. Wear was assessed by occlusal RMS (µm) after thermomechanical aging; fracture resistance was recorded as peak load to failure (N) on a universal testing machine. Statistical analyses were performed using 1-way ANOVA followed by Bonferroni-adjusted post hoc tests (α=.05).

RESULTS: Fabrication trueness differed among groups (marginal, intaglio, and total RMS; all P<.001), ranking ST<T<S<Control. ΔE00 differed (P=.004): T highest, ST lowest; Control, S, and T exceeded the 0.8 perceptibility threshold, and no group exceeded the 1.8 acceptability threshold. Ra differed (P=.001): Control highest; T higher than S and ST; S and ST not different. Wear differed (P<.001) with the hierarchy Control>S>T>ST; qualitative joint evaluation technique (JET) heatmaps showed the same pattern. Fracture load differed (P<.001): T and ST were higher than Control and S, with no significant difference between T and ST.

CONCLUSIONS: Incorporating SiO₂ and TiO₂ nanoparticles into PMMA formulations synergistically enhanced the overall performance of AM crowns.

PMID:41764005 | DOI:10.1016/j.prosdent.2026.02.013

Int J Gynecol Cancer. 2025 Nov 21:102821. doi: 10.1016/j.ijgc.2025.102821. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic and para-aortic lymphadenectomy remains the standard procedure for nodal staging in apparent early-stage ovarian cancer, but it is associated with considerable morbidity and lacks clear evidence of improving survival. Sentinel lymph node mapping may offer a less invasive alternative while still enabling accurate upstaging in a sub-set of patients with occult lymph node metastasis.

PRIMARY OBJECTIVE: This study aims to evaluate the negative predictive value of the sentinel lymph node technique for detecting lymphatic metastases in early-stage ovarian cancer compared with systematic pelvic and para-aortic lymphadenectomy (gold standard).

STUDY HYPOTHESIS: The sentinel lymph node technique is non-inferior to systematic lymphadenectomy for detecting lymphatic metastasis.

TRIAL DESIGN: This is a multi-center phase III clinical trial. Eligible patients with confirmed early-stage ovarian cancer will undergoing sentinel lymph node mapping and a subsequently complete staging surgery, including systematic lymphadenectomy. The concordance between both methods will be analyzed.

MAJOR INCLUSION/EXCLUSION CRITERIA: Inclusion: Women aged ≥18 years, with histologically confirmed epithelial ovarian malignancy in apparent International Federation of Gynecology and Obstetrics I to II stage, planned for staging surgery either at the time of initial surgery (after intra-operative frozen section confirmation) or after a deferred histologic diagnosis.

EXCLUSION: Age <18 years, previous vascular or lymphatic pelvic/aortic surgery, previous lymphoma or abdominopelvic tumors, allergy to Technetium-99m or indocyanine green, pregnancy/lactation.

PRIMARY ENDPOINT: Negative predictive value of the sentinel lymph node technique compared to systematic lymphadenectomy for lymph node metastasis.

SAMPLE SIZE: The planned sample size is 100 patients with negative sentinel lymph node results to ensure adequate statistical power (80%) to detect a negative predictive value for the sentinel lymph node technique above 95%. An interim analysis will be performed once 50% of the recruitment has been reached to adjust the exact total sample size. Recruitment period is estimated at 24 to 36 months in 11 high-volume Spanish centers.

ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Patient accrual: November 2025 to November 2028.

FINAL RESULTS EXPECTED: January 2029.

TRIAL REGISTRATION: NCT06963268.

PMID:41763980 | DOI:10.1016/j.ijgc.2025.102821

Transplant Proc. 2026 Feb 27:S0041-1345(26)00090-4. doi: 10.1016/j.transproceed.2026.01.025. Online ahead of print.

ABSTRACT

PURPOSE: The aims of this study were to evaluate outcomes and impact on quality of life (QoL) for patients undergoing abdominal wall reconstruction (AWR) and to describe the establishment of a pathway for renal transplant recipients.

METHODS: A retrospective study of renal transplant recipients undergoing AWR for incisional hernia repair from 2015 to 2024, which included the transition point when the AWR pathway for renal transplant recipients was initiated at a large teaching hospital. Baseline characteristics, operative variables and postoperative complications were collected from electronic patient records. QoL was assessed through the distribution of standardized Hernia-related Quality-of-Life surveys (HerQLes).

RESULTS: There were 34 patients with renal transplants who underwent AWR, and 26 were eligible to complete Hernia-related Quality-of-Life survey, with17 responding. Indications for transplantation varied; the most common was polycystic kidney disease (N = 7, 21%), and most patients had comorbidities (N = 33, 97%) and were overweight. Complications occurred in 13 patients (38%), most of which were Clavien-Dindo grades I/II (53%), and there was one death that prompted the formation of the pathway. Key pathway features discussed include prehabilitation, meticulous operative planning, and multidisciplinary input throughout. Following the establishment of the pathway, patients reported statistically significant improvements in all domains of QoL including psychological, physical, and sexual parameters.

CONCLUSIONS: Incisional hernias negatively impact QoL; this is the first study to provide insight into the change in QoL for patients receiving renal transplants following AWR and demonstrates how a multidisciplinary pathway can improve outcomes. Patient selection is crucial, and future work should identify risk factors for the development of incisional hernias after renal transplantation.

PMID:41763943 | DOI:10.1016/j.transproceed.2026.01.025

Transplant Proc. 2026 Feb 27:S0041-1345(26)00089-8. doi: 10.1016/j.transproceed.2025.12.020. Online ahead of print.

ABSTRACT

BACKGROUND: To assess the patients’ satisfaction and health-related quality of life after the penetrating keratoplasty (PK).

METHODS: 100 consecutive patients who had undergone PK participated in a 16-question survey in our clinic. Quality of life, expectancy, mood, and satisfaction of the patients were graded.

RESULTS: The average age of 100 patients (45 female, 55 male) who responded to the survey was 47.2 ± 21.5 (10-85) years. The average follow-up period of the patients was at least 12 months. The indications of the patients were keratoconus (35%), bullous keratopathy (22%), keratitis sequela (18%), trauma sequelae (15%), and corneal dystrophy (10%). While the average preoperative visual acuity was counting fingers at 2 meters (Light sensation- 0.2), the postoperative visual acuity was 0.5 (Light sensation – 1.0). While visual acuity remained constant in 8 cases, it increased in 92 cases. As a result, visual acuity was the only parameter that was statistically significant (p < .01). When patients’ satisfaction was grouped according to indications, they were listed as follows: keratoconus, corneal dystrophies, keratitis sequelae, trauma, and bullous keratopathy. In general, corneal transplant patients were satisfied with the results and were happy.

CONCLUSIONS: The only significant parameter in terms of patient satisfaction after the PK was found to be the outcome of visual acuity. For this reason, patients who will undergo corneal transplantation should be provided with clear and understandable information about their diseases and complications that may develop after transplantation.

PMID:41763942 | DOI:10.1016/j.transproceed.2025.12.020

Transplant Proc. 2026 Feb 27:S0041-1345(26)00114-4. doi: 10.1016/j.transproceed.2026.02.012. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and hematologic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as other biochemical parameters, in patients who underwent renal transplantation due to chronic kidney disease (CKD).

METHODS: This study included 304 adult renal transplant recipients followed at a single transplant center between January 2015 and June 2025. Patients were divided into 2 groups according to serum 25(OH)D levels: deficient (<20 ng/mL) and nona-deficient (≥20 ng/mL). Demographic, clinical, and laboratory data-including NLR, PLR, C-reactive protein (CRP), parathyroid hormone (PTH), erythrocyte sedimentation rate (ESR), and procalcitonin-were retrospectively reviewed. Statistical analyses were performed using the Mann-Whitney U test, chi-square test, and Pearson correlation analysis.

RESULTS: Vitamin D deficiency was detected in 84.2% (n = 256) of patients. Serum 25(OH)D levels were significantly and inversely correlated with PTH levels (r = -0.241, p < .001), and the deficient group had higher PTH concentrations (p = .002). Weak positive correlations were observed between 25(OH)D and both procalcitonin (r = 0.122, p = .034) and ESR (r = 0.117, p = .041). However, no significant associations were found between vitamin D levels and NLR, PLR, CRP, lipid profile, or other parameters.

CONCLUSION: Vitamin D deficiency is highly prevalent among renal transplant recipients and is significantly associated with elevated PTH levels. The weak correlations observed with inflammatory markers suggest the multifactorial nature of inflammation in this population. Routine monitoring and appropriate replacement of vitamin D may contribute to improved bone metabolism and overall health in renal transplant patients.

PMID:41763939 | DOI:10.1016/j.transproceed.2026.02.012

Vasc Dis (Paris). 2026 Feb 27:S3050-6581(26)00179-2. doi: 10.1016/j.vasdi.2026.02.007. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular diseases (CVD) remain the leading global cause of mortality. Approximately 50% of the CVD burden is attributable to five modifiable risk factors, including dyslipidemia. Effective management of low-density lipoprotein cholesterol (LDL-C) through accurate cardiovascular (CV) risk stratification is fundamental to prevention. However, in daily practice, significant variability exists in how clinicians assess CV risk and determine appropriate LDL-C targets, potentially leading to suboptimal patient care.

OBJECTIVE: This cross-sectional survey aimed to evaluate the consistency and alignment with current guidelines of CV risk assessment and LDL-C target selection among clinicians working at Avicenne University Hospital, Assistance publique-Hôpitaux de Paris (Bobigny, France), when presented with diverse and challenging clinical scenarios, that formal risk calculation tools cannot assess.

METHODS: Between September and November 2025, a questionnaire-based cross-sectional survey was conducted at Avicenne University Hospital. Thirty doctors and residents from five departments (internal medicine, vascular-thoracic surgery, cardiology, geriatrics, endocrinology) participated. They were presented with six clinical vignettes designed to probe CV risk assessment in complex contexts such as heart failure, atherosclerotic cardiovascular disease (ASCVD), recurrent events, and chronic kidney disease. Responses were categorized into CV risk groups (low to extreme) based on the proposed LDL-C target, in accordance with the 2025 ESC/EAS dyslipidemia guidelines. Responses without a specific target were classified as “No category.”

RESULTS: Analysis revealed significant heterogeneity in responses. The “no category” response was the most frequent overall (29.4% of all answers), indicating substantial clinician uncertainty. Key discrepancies from guidelines included: high uncertainty (43.3% “no category”) in assigning risk after heart failure; underestimation of risk in confirmed ASCVD (most answers were moderate or high risk, not very high); reluctance to use the Extreme-risk category (<40mg/dL) for recurrent events; and insufficient recognition of moderate CKD as a High-risk factor. Vascular surgeons most frequently gave “no category” answers (54.8% of their responses) however, there was no statistically significant difference in the proportion of “no category” responses across departments (P=0.093).

CONCLUSION: This survey identified a notable gap between guideline recommendations and clinical practice in CV risk assessment at the hospital level. Clinicians demonstrated a tendency to underestimate risk in key areas like ASCVD and CKD, and exhibited significant uncertainty in complex scenarios such as heart failure and recurrent events. These findings underscore the need for targeted educational initiatives and strategies to promote more consistent, guideline-concordant CV risk stratification to optimize preventive therapy.

PMID:41763907 | DOI:10.1016/j.vasdi.2026.02.007