Category: Nevin Manimala

J Am Heart Assoc. 2026 Apr 22:e042044. doi: 10.1161/JAHA.125.042044. Online ahead of print.

ABSTRACT

BACKGROUND: Although large studies and pooled analyses of individual patient data have demonstrated the safety of deferring coronary revascularization based on a nonischemic intracoronary pressure index result, conflicting findings have emerged in specific patient subsets and with varying follow-up. Thus, we conducted an updated comprehensive systematic review and meta-analysis to investigate the cardiovascular outcomes associated with deferred or performed coronary revascularization based on intracoronary physiology.

METHODS: Available studies were identified through a systematic search of PubMed, EMBASE, and CENTRAL. Efficacy outcomes investigated were major adverse cardiovascular events, all-cause death, cardiovascular death, noncardiovascular death, myocardial infarction, and unplanned revascularization.

RESULTS: A total of 24 studies enrolling 24 285 patients were included in the meta-analysis. After a mean±SD follow-up of 2.6±1.6 years, patients undergoing physiology-guided deferred revascularization show consistently better outcomes than patients who underwent revascularization, including all-cause death (incidence rate ratio [IRR], 1.14 [95% CI, 1.00-1.30]; P=0.05), cardiovascular death (IRR, 1.53 [95% CI, 1.17-2.00]; P=0.002), and unplanned revascularization (IRR, 1.38 [95% CI, 1.06-1.79]; P=0.01). For major adverse cardiovascular events (IRR, 1.15 [95% CI, 0.99-1.34]; P=0.07) and myocardial infarction (IRR, 1.24 [95% CI, 0.95-1.61]; P=0.11), the associations did not reach statistical significance.

CONCLUSIONS: Patients in whom revascularization was deferred based on intracoronary physiology show lower risk of adverse cardiovascular events compared with those who underwent revascularization. These findings suggest that pressure wire assessment has prognostic implications besides the indication for revascularization.

PMID:42017344 | DOI:10.1161/JAHA.125.042044

Stress Health. 2026 Apr;42(2):e70178. doi: 10.1002/smi.70178.

ABSTRACT

Childhood maltreatment has been associated with an increased risk of irritable bowel syndrome (IBS) in adulthood, but the longitudinal relationship and underlying mechanisms remain underexplored. Using data from the UK Biobank, this cohort study investigated the association between childhood maltreatment and the onset of IBS in adulthood and explored potential mediating pathways. A total of 108,365 participants (mean age: 34.57 [SD: 4.81] years; 57.2% were female) were followed up from age 30 onwards (or January 1, 1985, whichever was later) until the first IBS diagnosis, death, or the end of follow-up, whichever occurred first. Childhood maltreatment was assessed through self-reported data, and incident IBS cases were identified using ICD-10 codes, with subtypes classified by Rome III criteria. Cox proportional hazards, sequential mediation analyses, and multinomial logistic regression were performed. Over a mean follow-up of 35.6 years, 5806 incident IBS cases were recorded. A positive association was observed between cumulative childhood maltreatment and incident IBS (HR: 1.10; 95% CI: 1.07-1.12). Among individual maltreatment types, emotional neglect showed the strongest association with IBS (HR: 1.27; 95% CI: 1.20-1.35). Sequential mediation analyses indicated that psychological adversity accounted for the largest proportion of the indirect effect (15.3%-17.0%), followed by socioeconomic status, lifestyle behaviours, and biological alterations. These findings emphasise the need for prevention strategies to reduce childhood maltreatment and mitigate its long-term health impacts. Tailored interventions focussing on psychosocial support, addressing socioeconomic disparities, and promoting healthy lifestyle changes may further reduce IBS risk in affected individuals.

PMID:42017339 | DOI:10.1002/smi.70178

J Am Heart Assoc. 2026 Apr 22:e048080. doi: 10.1161/JAHA.125.048080. Online ahead of print.

ABSTRACT

BACKGROUND: Although public access defibrillation programs have expanded, real-world bystander automated external defibrillator (AED) use remains limited. The concept of functional accessibility, the realistic ability of bystanders to retrieve and use an AED within a time window that affects survival, has not yet been systematically evaluated. This study aimed to evaluate the functional accessibility of publicly installed AEDs by integrating factors influencing their usability in out-of-hospital cardiac arrest events.

METHODS: We conducted a population-based geospatial analysis of 39 563 out-of-hospital cardiac arrests in Gyeonggi-do, Korea (2021-2023). Each incident was matched to the nearest public AED using network-based walking routes. Functional accessibility was measured by walking time and distance, stratified by urbanization, time of day, and location of arrest. Multivariable logistic regression was used to assess the association of AED accessibility with bystander AED use and prehospital return of spontaneous circulation.

RESULTS: The median walking time to the nearest AED was 1.9 minutes; only 25.4% of rural arrests were within 3 minutes. Among 17 285 resuscitation-attempted cases, bystander AED use occurred in 2.9%. Shorter walking time was a statistically significant predictor of AED use and prehospital return of spontaneous circulation. Nighttime and residential arrests showed markedly reduced AED use irrespective of proximity. Moreover, although home arrests accounted for 70% of cases, bystander defibrillation occurred in <2%.

CONCLUSIONS: Functional accessibility determines both device use and survival outcomes. Policies should prioritize 24/7 external AED availability, integration of dispatcher-assisted public access defibrillation programs, and novel delivery systems, such as drones, to bridge the spatial and temporal gaps in access.

PMID:42017328 | DOI:10.1161/JAHA.125.048080

Phlebology. 2026 Apr 22:2683555261446155. doi: 10.1177/02683555261446155. Online ahead of print.

ABSTRACT

BackgroundEffective management of lower extremity lymphedema requires its recognition as a distinct clinical entity. This study aimed to evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L), a tool designed to assess both the severity and distress of symptoms in patients with lower limb lymphedema.AimsTo evaluate the validity and reliability of the Turkish version of the Lymphedema Symptom Intensity and Distress Survey-Lower Limb (LSIDS-L) in patients with lower extremity lymphedema.Study designDiagnostic Accuracy Study.MethodsThe LSIDS-L was translated and culturally adapted into Turkish using the forward-backward translation method. The final version was administered to 155 patients alongside the Lymphoedema Quality of Life Questionnaire-Leg (LYMQOL-Leg). Reliability was assessed using a 7-days test-retest approach. Descriptive statistics were used for demographic data. Construct validity was evaluated using Spearman’s rank correlation coefficient, while internal consistency and test-retest reliability were assessed via Cronbach’s alpha and the intraclass correlation coefficient (ICC), respectively.ResultsThe questionnaire demonstrated excellent test-retest reliability with ICC_1k = 0.9989 and r = 0.9970. Internal consistency was also high, with a Cronbach’s alpha of 0.9180 and a standardized alpha of 0.9145, indicating strong coherence among items.ConclusionThe Turkish version of the LSIDS-L (LSIDS-L-TR) is a valid and reliable instrument for assessing symptom intensity and distress in patients with lower extremity lymphedema. It offers a comprehensive tool for use in both clinical practice and research settings.

PMID:42017324 | DOI:10.1177/02683555261446155

J Am Heart Assoc. 2026 Apr 22:e047923. doi: 10.1161/JAHA.125.047923. Online ahead of print.

ABSTRACT

BACKGROUND: Combining PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors with statins significantly lowers low-density lipoprotein cholesterol and reduces cardiovascular events in patients with coronary heart disease versus statins alone. However, it remains unclear which monotherapy offers greater cardiovascular benefit.

METHODS: This prospective non-randomized real-world observational cohort study enrolled coronary heart disease inpatients from July 2020 to March 2024. Patients received either alirocumab (75 mg/2 weeks) or statins (atorvastatin 20 mg/day or rosuvastatin 10 mg/day). The primary outcome was a composite of cardiovascular death, myocardial infarction, stroke, heart failure hospitalization, or coronary revascularization. Cox proportional hazards models and restricted mean survival time analyses were used.

RESULTS: Among 1165 analyzed patients, 215 received PCSK9 inhibitors and 950 received statins. After 1 month, low-density lipoprotein cholesterol reduction was greater in the PCSK9 inhibitor group (from 2.57 to 0.75 mmol/L) than in the statin group (from 2.29 to 1.40 mmol/L; P<0.001). However, this difference was not significant at 12 months (1.44 versus 1.52 mmol/L; P=0.058). Multivariate Cox regression analysis revealed an adjusted hazard ratio of 0.74 (95% confidence interval, 0.49-1.12; P=0.152) for the primary outcome with statins versus PCSK9 inhibitors. The restricted mean survival time was 26.11 months for the PCSK9 inhibitor group and 26.48 months for the statin group. The results were consistent across key subgroups. No serious adverse events occurred during the follow-up.

CONCLUSIONS: PCSK9 inhibitor monotherapy showed no statistically significant difference from statin monotherapy in long-term lipid-lowering efficacy or cardiovascular risk reduction, suggesting it may be an effective alternative for secondary prevention in coronary heart disease.

PMID:42017316 | DOI:10.1161/JAHA.125.047923

Invest Ophthalmol Vis Sci. 2026 Apr 1;67(4):53. doi: 10.1167/iovs.67.4.53.

ABSTRACT

PURPOSE: To provide insight into rod pathway dysfunction in early-stage diabetic retinopathy (DR) by measuring dark-adapted ERGs and pupillary light reflexes (PLRs) across a broad range of stimulus luminance.

METHODS: Seventeen diabetics with no clinically apparent DR (NDR), 17 with mild nonproliferative DR (MDR), and 15 nondiabetic controls participated. Dark-adapted, full-field ERGs and PLRs were obtained. Achromatic (-4 to 1 log cd-s-m-2) and long-wavelength (-4.0 to 2.6 log cd/m2) flashes were used for ERG and pupillometry, respectively. The b-wave amplitudes and pupil diameters were fit with Naka-Rushton functions to obtain (1) maximum b-wave amplitude (Vmax), (2) maximum PLR (Pmax), (3) b-wave sensitivity (kb), and (4) PLR sensitivity (kp).

RESULTS: ERG a-wave amplitude was reduced (0.13 log µV averaged across stimulus luminance) in DR compared with the controls, but this was not statistically significant (F = 1.41; P = 0.25). ERG Vmax did not significantly differ among groups (F = 2.20, P = 0.12), whereas kb was elevated (reduced sensitivity) for both groups (both t > 2.40; P < 0.02). Pupil Pmax was reduced in MDR (t = 2.83, P = 0.01), but not NDR (t = 0.99, P = 0.33). Pupil kb was significantly elevated in NDR and MDR (both t > 2.1; P < 0.04).

CONCLUSIONS: Reduced b-wave amplitude may largely be accounted for by the reduced a-wave amplitude. By contrast, pupil sensitivity loss greatly exceeded the b-wave sensitivity loss, suggesting sites of abnormality beyond the bipolar cells contribute to pupil response deficits in diabetics.

PMID:42017306 | DOI:10.1167/iovs.67.4.53

Physiother Res Int. 2026 Apr;31(2):e70223. doi: 10.1002/pri.70223.

ABSTRACT

BACKGROUND AND PURPOSE: Obesity is a widespread global health problem linked to an elevated risk of falls, detrimental effects on both static and dynamic balance, and diminished quality of life (QOL). Despite these adverse effects of obesity, research on the effectiveness of Brain Gym exercises has been conducted in various populations, but their impact has never been studied among individuals with obesity.

METHODS: A pre-post randomized controlled trial aimed to examine the influence of Brain Gym exercises on fall risk, balance, as well as quality of life among obese individuals. Thirty-two subjects (15 males and 17 females) aged 18-50 years, with a Body Mass Index (BMI) of ≥ 30 kg/m² were randomly assigned to two equal groups, Group A (experimental): engaged in Brain Gym exercises for 30 min daily, three times weekly, for eight successive weeks, in addition to conventional balance training for 45 min throughout three sessions per week for eight weeks. Group B (control): received conventional balancing training. Outcome measures included: risk of falling assessed using the Modified Arabic version of the Activities-Specific Balance Confidence Scale (ABC); static balance evaluated via the Berg Balance Scale (BBS); dynamic balance assessed with the Balance Check 636 Stability Tester (Dr. Wolff, Arnsberg, Germany); as well as health-related quality of life determined through the Arabic version of the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF).

RESULTS: The results indicated substantial enhancements in all assessed outcomes, including risk of falling, static balance, dynamic balance, and quality of life domains, in both groups following treatment (p < 0.001). The experimental group demonstrated statistically and clinically significant improvements in all parameters relative to the control group (p < 0.001).

DISCUSSION: Brain Gym exercises combined with conventional training could have a further impact on the risk of fall, balance as well as quality of life among obese subjects than conventional balance training alone.

TRIAL REGISTRATION: NCT06587932.

PMID:42017295 | DOI:10.1002/pri.70223

Int J Audiol. 2026 Apr 22:1-33. doi: 10.1080/14992027.2026.2650827. Online ahead of print.

ABSTRACT

OBJECTIVE: To propose a comprehensive audiological-vestibular test battery for characterising age-related hearing loss, enabling precise phenotyping of suprathreshold functional, physiological, and vestibular factors beyond audibility. To establish age- and audibility-dependent reference data in age-appropriate normal-hearing controls.

DESIGN: Multidisciplinary consensus about test battery composition; Statistical analysis of centre effects to assess comparability of the test battery measured at two centres (Germany and France); Statistical analysis of age and pure-tone average (PTA) effects per test to identify potential covariates.

SAMPLE: n = 55 (39 German and 16 French) participants with hearing thresholds better than the age-dependent median of the PTA, aged 40 years or older.

RESULTS: Due to negligible centre effects, all data were pooled across centres. Age- and PTA-dependent reference data were derived. Age and PTA effects were identified for some tests, especially for audiological-functional tests. No age effects were found for vestibular tests.

CONCLUSIONS: Normative values for a clinically feasible, multidimensional audiological-vestibular test battery were provided, including several measures whose age and PTA dependencies were previously unclear. Age and PTA should be considered as covariates for interpretation of these tests in future applications such as, e.g. phenotype-genotype relations in specified cohorts. Extensive data documentation and verification are essential for cross-centre comparability.

PMID:42017292 | DOI:10.1080/14992027.2026.2650827

Rev Esp Cir Ortop Traumatol. 2026 Apr 17:S1888-4415(26)00076-7. doi: 10.1016/j.recot.2026.04.002. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Knee arthroscopy has become an essential diagnostic and therapeutic tool in children and adolescents. However, data on temporal trends, indications, and surgical techniques in Spain remain limited. This study aimed to analyse the epidemiological and surgical evolution of knee arthroscopy in patients under 18 years of age between 1998 and 2023.

PATIENTS AND METHODS: This single-centre retrospective observational study including 416 patients under 18 years who underwent knee arthroscopy. Demographic, diagnostic, and surgical variables were collected. Descriptive statistics, the Kruskal-Wallis test, the Cochran-Armitage trend test, and Spearman’s correlation were used for analysis.

RESULTS: The median age was 14 years, with a predominance of females (59%). The most frequent indications were meniscal tears (33%), anterior cruciate ligament (ACL) injury (22%), and osteochondral lesions (14%). Diagnostic arthroscopy (38%) and meniscectomy (27%) were the most common procedures, both showing a progressive decline since 2015, whereas meniscal repair and surgery for patellofemoral instability showed a slight increase. A sustained rise in arthroscopies was observed among adolescents over 11 years of age, with a gradual equalisation between sexes in recent years.

CONCLUSION: Paediatric knee arthroscopy has progressively increased over the last two decades, with meniscal, ACL, and osteochondral lesions being the most frequent indications. A trend towards meniscal preservation and reconstructive procedures is also evident, reflecting evolving clinical practice and patterns of sports participation.

PMID:42017281 | DOI:10.1016/j.recot.2026.04.002

Aging Cell. 2026 May;25(5):e70498. doi: 10.1111/acel.70498.

ABSTRACT

Aging is associated with significant alterations in systemic metabolism across species. We employed targeted metabolomics to investigate the effects of losartan, an angiotensin II receptor blocker, on the serum metabolome of aged mice and pre-frail older men. Losartan treatment resulted in a shift in serum metabolome aging signature to a more youthful state. This rejuvenation effect appears to be contingent on the presence of functional angiotensin II receptors, with receptor knockout mice showing no rejuvenation effect with treatment. Additionally, we observed a similar rejuvenation effect of losartan in the cardiac proteome of aged mice, with the most pronounced changes occurring in proteins involved in oxidative phosphorylation. While our study did not encompass a full lifespan analysis, in alignment with previous reports of lifespan extension in other models, we noted a statistically significant improvement in survival among geriatric mice treated with losartan. In parallel, we analyzed serum metabolomics data from pre-frail older men from a phase 2 randomized placebo-controlled trial of losartan, which indicated a dose-dependent metabolic rejuvenation effect. Correlation network analysis revealed divergent aging effects between species, with mice exhibiting broad decreases in metabolite concentrations and humans showing increases, particularly across lipid species. Principal component analysis further highlighted a global shift in metabolite levels, potentially linked to changes in lipoprotein metabolism, plasma volume, and amino acid metabolism with age. In summary, our results suggest that losartan can partially reverse age-related metabolomic changes in both male mice and humans, with distinct species-specific responses.

PMID:42017270 | DOI:10.1111/acel.70498