Category: Nevin Manimala

Circ Popul Health Outcomes. 2026 Jul 2:e013687. doi: 10.1161/CIRCOUTCOMES.126.013687. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies showed that the Pooled Cohort Equations substantially overestimate atherosclerotic cardiovascular disease (ASCVD) risk in older adults, and the recently published PREVENT equation offers better performance. Identifying markers that can further refine risk estimates is essential for personalized prevention in this age group. This study evaluates the clinical utility of 6 markers for reclassifying intermediate-risk older adults (10-year PREVENT-estimated ASCVD risk, 7.5% to 20%), with a focus on de-escalation.

METHODS: This post hoc analysis evaluated intermediate-risk older adults aged ≥70 years using data from ASPREE (Aspirin in Reducing Events in the Elderly; URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583). ASPREE was a randomized trial of low-dose aspirin versus placebo in healthy older adults who were free of prior cardiovascular events at enrollment. Six markers were evaluated: the lowest quartile (Q1) of NT-proBNP (N-terminal pro-B-type natriuretic peptide), hs-TnI (high-sensitivity troponin I), and hs-CRP (high-sensitivity C-reactive protein), polygenic risk for lipoprotein(a) and polygenic risk for coronary artery disease, and absence of family history of ASCVD. Incident ASCVD events were adjudicated by expert panels. Statistical performance of each marker was assessed using diagnostic likelihood ratios, change in Harrell C statistic (ΔC), and net reclassification index relative to a baseline model incorporating variables included in the PREVENT equation.

RESULTS: The study included 7764 participants (48% female; median age, 74 years [interquartile range, 72-77]), with a median follow-up of 10.3 years. During follow-up, 725 participants (9.3%) experienced ASCVD events. Q1 polygenic risk for coronary artery disease was the most powerful marker for down-grading risk, providing 37% risk reduction (diagnostic likelihood ratio: 0.627) and improving discrimination (ΔC: +1.44%; P=0.004) when compared with the baseline model, and correctly reclassifying 25.9% of nonevents downward (net reclassification index: 0.101). Q1 hs-TnI showed second-best performance (diagnostic likelihood ratio: 0.727; ΔC: +0.71%, net reclassification index: 0.075).

CONCLUSIONS: Adding polygenic risk for coronary artery disease to the PREVENT equations may further personalize risk estimates and support clinical decision-making for older adults at intermediate risk for ASCVD events.

PMID:42389765 | DOI:10.1161/CIRCOUTCOMES.126.013687

Front Physiol. 2026 Jun 17;17:1854908. doi: 10.3389/fphys.2026.1854908. eCollection 2026.

ABSTRACT

INTRODUCTION: The glenohumeral joint plays a key role in force generation during tennis strokes. Neuromuscular adaptations in this joint are critical for performance and injury prevention, particularly during rapid phases of movement. However, there is limited research on these adaptations in young female tennis players. Therefore, this study aimed to examine differences in glenohumeral neuromuscular performance between female tennis players and untrained girls aged 11-14 years.

METHODS: A cross-sectional study included 67 participants: 33 female tennis players (aged 11-12 and 13-14) and 34 age-matched controls. Isometric peak torque (PKTQ), rate of torque development (RTD), and surface electromyography (SEMG) were assessed for internal (IR) and external (ER) rotation. A two-way ANOVA and MANOVA were used for statistical analysis.

RESULTS: Tennis players showed significantly higher normalized PKTQ during IR (18.1%, p < 0.01) and ER (10.1%, p < 0.05), and greater RTD during ER (absolute: 28.4%, p < 0.01; normalized: 32.2%, p < 0.01) compared to controls. A group-by-age interaction showed greater normalized peak RTD during ER in 11-12-year-old tennis players compared with their untrained counterparts. SEMG revealed greater posterior deltoid activation during ER at 50% MVIC (+15.7%, p < 0.05) and lower pectoralis major coactivation during ER at 50% MVIC (-40.4%, p < 0.01) in tennis players. Additionally, tennis players exhibited a higher IR/ER ratio (13.3%, p < 0.05).

CONCLUSIONS: Long-term tennis training may be associated with specific neuromuscular adaptations in the glenohumeral joint, particularly higher RTD during ER in younger athletes. These findings may be relevant to stroke velocity and shoulder stability and highlight the importance of age-specific training for the development of optimal glenohumeral strength and injury prevention.

PMID:42389756 | PMC:PMC13318655 | DOI:10.3389/fphys.2026.1854908

Parkinsons Dis. 2026 Jun 30;2026:1443255. doi: 10.1155/padi/1443255. eCollection 2026.

ABSTRACT

BACKGROUND: There is limited literature describing rehabilitation utilization among the Parkinson’s disease (PD) population across the world and especially in Africa, despite ample evidence and clinical guidelines in support of rehabilitation for persons with PD (PwPD).

OBJECTIVES: To describe the characteristics of PwPD, the types of rehabilitation services and treatment parameters used, and the factors associated with rehabilitation utilization in southern Ghana.

METHODS: A descriptive cross-sectional survey was conducted among PwPD receiving care at one primary and two tertiary hospitals selected from southern Ghana. The MDS-UPDRS Part III, PDQ-8, and modified ICF Checklist Clinician Form were used to assess motor function, health-related quality of life, and rehabilitation use. Descriptive and inferential statistics were conducted with significance set at p < 0.05.

RESULTS: Seventy-five PwPD were included, with 61.3% being males. Engagement in physiotherapy and/or gymnasium activities was reported by 40.0% of participants. The most common indication for physiotherapy was gait difficulties. No participant had used occupational therapy or speech therapy. Nonreferral by neurologists and participants’ poor knowledge of rehabilitation benefits and needs were the main reasons for nonuse of rehabilitation. Gait retraining and strengthening exercises were the most common physiotherapy interventions received by 73.7% of the participants. Longer PD duration was associated with physiotherapy utilization. A total of 42.4% of participants discontinued physiotherapy services, primarily due to transportation challenges and high treatment cost.

CONCLUSION: Rehabilitation services are underutilized by PwPD in southern Ghana due to limited referrals, poor awareness of benefits, and related barriers. This highlights the need for more accessible and integrated services.

PMID:42389742 | PMC:PMC13318674 | DOI:10.1155/padi/1443255

Bone Rep. 2026 Jun 22;30:101934. doi: 10.1016/j.bonr.2026.101934. eCollection 2026 Sep.

ABSTRACT

BACKGROUND: Concomitant use of vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) and bone resorption inhibitors (BRIs) may increase the risk of medication-related osteonecrosis of the jaw (MRONJ). The relative contribution of VEGFR-TKI, BRI type, and patient-related risk factors remains unclear.

METHODS: We retrospectively reviewed patients treated with BRIs, with or without concomitant VEGFR-TKIs. The primary endpoint was MRONJ-free survival, defined as time from BRI initiation to MRONJ diagnosis. Secondary endpoints included MRONJ incidence and skeletal-related events (SREs).

RESULTS: Overall, 233 patients received BRI/VEGFR-TKI combination (study group) and 986 received BRI alone (control group). Median MRONJ-free survival was shorter in the study group than in controls (79 vs 202 months). However, after adjustment for smoking status, age, sex, and BRI type, concomitant VEGFR-TKI use was not independently associated with MRONJ-free survival (HR 1.3, 95% CI 0.8-2.1; p = 0.2), whereas denosumab use and active smoking remained independent predictors. VEGFR-TKI therapy was associated with earlier MRONJ occurrence among BP-treated patients (adjusted HR 3.22, 95% CI 1.08-9.56; p = 0.03), but not among denosumab-treated patients. MRONJ-incidence did not differ between BRI/VEGFR-TKI and BRI groups (14.6% vs 12.0%; p = 0.3), but BRI-exposure was shorter in the combination group. SRE occurrence was 69.5%, similar between BP- and denosumab-treated patients; however, denosumab-treated patients had longer exposure, resulting in a lower SRE rate (0.13 vs 0.39 events/month).

CONCLUSION: MRONJ risk depends on BRI type and individual patient profile. VEGFR-TKIs may accelerate MRONJ onset in BP-treated patients, whereas denosumab showed higher MRONJ risk independently of VEGFR-TKI use. Treatment choices should balance MRONJ risk against skeletal disease burden.

PMID:42389736 | PMC:PMC13320502 | DOI:10.1016/j.bonr.2026.101934

Front Nutr. 2026 Jun 17;13:1865377. doi: 10.3389/fnut.2026.1865377. eCollection 2026.

ABSTRACT

BACKGROUND: The bladder health rehabilitation process depends on dietary choices and drinking patterns, which determine diet quality and hydration levels. Previous studies have suggested that dietary patterns and hydration levels affect urodynamic measurements, yet research on how combined dietary and fluid intake affects bladder rehabilitation outcomes remains limited.

OBJECTIVE: The study aims to assess the effects of dietary quality and fluid intake on urodynamic outcomes, symptom reduction, and functional recovery in patients undergoing a structured bladder rehabilitation program.

METHODOLOGY: The study tracked 2,400 bladder rehabilitation patients in a retrospective cohort study, which divided participants into three dietary quality groups (low, moderate, and high) and three fluid intake groups (low, moderate, and high). The study collected data on baseline demographics and clinical characteristics, as well as nutritional intake and urodynamic parameters. Post-rehabilitation outcomes included bladder capacity, detrusor pressure, compliance, urinary frequency, urgency, incontinence, nocturia, and quality-of-life (QoL) measures. The study analyzed nutrient-specific associations, diet-fluid interactions, and adherence rates. The researchers used multivariate regression analysis to determine which factors predicted functional improvement.

RESULTS: The post-rehabilitation study showed major urodynamic and symptomatic advancements, which included increased bladder capacity of 34 mL (p < 0.001) and decreased detrusor pressure of 3.4 mmHg (p = 0.002) and reduced urinary frequency of 1.3 episodes per day (p < 0.001) and improved quality of life by 5.8 points (p < 0.001). The study found that high diet quality, combined with moderate-to-high fluid intake, led to greater functional improvement, with both factors statistically significant (β = +0.21, p = 0.004; β = +0.18, p = 0.009). The combined high-diet and moderate-fluid groups achieved the best results, with improved bladder compliance, reduced urgency, and higher clinical success rates. The nutrient-specific analysis showed that fiber, potassium, and protein intake were positively associated with improvements in capacity and flow, whereas sodium and evening fluid timing were negatively associated.

CONCLUSION: The bladder rehabilitation process requires both dietary quality and fluid intake, as these factors determine functional improvement. The study found that optimizing nutrition, hydration, and compliance with behavioral interventions led to better urodynamic results, improved symptom management, and enhanced quality of life. The findings demonstrate that individual lifestyle-change methods are essential components of bladder rehabilitation programs.

PMID:42389697 | PMC:PMC13318740 | DOI:10.3389/fnut.2026.1865377

Front Vet Sci. 2026 Jun 17;13:1816115. doi: 10.3389/fvets.2026.1816115. eCollection 2026.

ABSTRACT

Artificial intelligence (AI), especially generative AI and large language models, is increasingly influencing higher education and health professions training. However, there is still limited empirical evidence about what veterinary students know about AI, how they use it, and how they perceive it. The aim of this study was to evaluate self-perceived AI-related knowledge, use, and attitudes among veterinary students in Spain and Portugal, and to analyze the influence of institutional context, prior AI training, and digital engagement. A cross-sectional survey was conducted during the 2023-2024 academic year with 340 undergraduate and postgraduate veterinary students from public and private institutions in Spain and Portugal. The questionnaire included sociodemographic questions and nine Likert-scale items assessing self-perceived AI knowledge, use, and attitudes. Composite scores were calculated and transformed using the Percentage of Maximum Possible (POMP) method (0-100 scale). Internal consistency of the instrument was high (ω = 0.842; α = 0.835). Data was analyzed using MANOVA, one-way ANOVA, independent samples t-tests, and Pearson correlation analyses. Significant differences were observed between institutions in self-perceived AI knowledge, use, and attitudes. Students who had received prior AI training showed higher self-perceived knowledge and use scores (p < 0.001) and more positive attitudes toward AI (p < 0.001). Although formal AI training was limited in many institutions, students with any type of prior exposure-self-directed, university-based, or external-reported greater engagement and felt more prepared to use AI tools. Daily social media use showed a small but statistically significant positive correlation with self-perceived AI knowledge and use (r = 0.115, p = 0.034) and with positive attitudes (r = 0.157, p = 0.004). Categorized analyses showed a gradual increase in AI-related outcomes with higher levels of digital engagement. Veterinary students in the Iberian Peninsula are already using AI, mainly through informal learning pathways, while structured institutional integration remains uneven. Structured exposure to AI is consistently associated with higher self-perceived knowledge, greater use, and more positive attitudes. These results suggest that deliberate curricular integration and guided AI literacy initiatives are important to prepare future veterinarians for responsible and effective use of AI technologies.

PMID:42389691 | PMC:PMC13318702 | DOI:10.3389/fvets.2026.1816115

Front Vet Sci. 2026 Jun 17;13:1816404. doi: 10.3389/fvets.2026.1816404. eCollection 2026.

ABSTRACT

Effective immunosuppression in large animal models is essential for successful preclinical assessment of cell-based therapies in the allo- or xeno-transplantation setting. Pigs, due to their physiological and immunological similarity to humans, are widely used in translational research. However, direct, longitudinal comparisons of immunosuppressive strategies in swine are scarce, limiting the development of safe and reliable protocols. To address this gap, we performed a head-to-head comparison of two immunosuppressive regimens in pigs (n = 8; 4 animals per group) to identify a protocol that achieves robust immune modulation with minimal systemic toxicity. Protocol I consisted of an intravenous induction with mycophenolate mofetil (MMF) and methylprednisolone, followed by oral MMF and tacrolimus. Protocol II included intravenous abatacept and methylprednisolone, two booster doses of abatacept, and daily oral cyclosporine A. Both regimens were administered for 6 weeks, followed by a four-week recovery period. Statistical analyses included normality testing (Shapiro-Wilk), multiple t-tests or Mann-Whitney tests with false discovery rate correction for between-group comparisons, and two-way repeated measures ANOVA or mixed-effects models for longitudinal analysis. Both protocols induced lymphopenia without systemic toxicity but exhibited distinct immunological profiles. Protocol I promoted rapid and reversible lymphocyte suppression, whereas Protocol II induced a slower onset with sustained inhibitory signaling. Phenotypic analysis revealed dynamic shifts within lymphocyte populations, including a decline in the CD4/CD8 ratio that did not reach statistical significance. CD21⁺ lymphocytes were differentially affected: Protocol I maintained higher levels after an initial transient decrease, while Protocol II showed a progressive reduction with significant differences at multiple time points. These findings highlight that co-stimulation blockade combined with calcineurin inhibition enforces deeper functional suppression, whereas MMF/tacrolimus-based therapy allows partial recovery of immune compartments. This direct comparative analysis provides a critical framework for designing targeted immunosuppressive strategies for translational models.

PMID:42389690 | PMC:PMC13318597 | DOI:10.3389/fvets.2026.1816404

Proc Mach Learn Res. 2025 Dec;297:136-151.

ABSTRACT

Clinical decisions often require balancing conflicting priorities rather than simply selecting a single “correct” answer. We present an evaluation framework that probes the value judgments embedded in large language models (LLMs) by testing how they assess quality of glycemic control from continuous glucose monitoring (CGM) data. Using synthetic type 1 diabetes profiles, we asked five commercial LLMs to perform pairwise comparisons of CGM summary statistics and derived a percentile ranking for each profile. We then quantified alignment with two reference metrics: time in range (TIR) and the expert-derived Glycemia Risk Index (GRI), which was developed with clinician input regarding preferences across glycemic ranges. Across three insulin therapy modalities, newer models showed stronger correlation with GRI than older models, suggesting a generational shift toward expert consensus. However, a perturbation analysis revealed instances of disagreement around the weighting of mild hypoglycemia and mild hyperglycemia relative to the GRI. These results demonstrate that high average agreement with clinical metrics can mask clinically meaningful misalignments in how LLMs prioritize risks. Our proposed framework reveals how LLM outputs reflect competing priorities in clinical contexts.

PMID:42389650 | PMC:PMC13322355

JSES Rev Rep Tech. 2026 Jun 3;6(3):100791. doi: 10.1016/j.xrrt.2026.100791. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: Rotator cuff (RC) tear size is known to influence post-operative outcomes and recovery following arthroscopic rotator cuff repair (ARCR). However, the trajectory of recovery has not been fully explored. This study aims to evaluate patient-reported outcomes pre-operatively, 6 months (6ms) and 2 years (2ys) after ARCR, stratified according to tear size.

METHODS: A retrospective cohort study evaluated outcomes of 136 patients who underwent ARCR. RC tear size was categorized into small (<1 cm), medium (1-3 cm), and large (3-5 cm) groups. Outcome measures included range of movement forward flexion and range of movement abduction, visual analog scale (involved shoulder), Constant score, University of California, Los Angeles score and Oxford Shoulder Score. Paired t-tests were conducted within each tear-size group, comparing pre-operative with 6m outcomes and 6m with 2y outcomes. Between-group differences in change scores were examined using one-way analysis of variance, and multivariate regression analysis was performed to identify independent predictors of outcome. Effect size analysis using Cohen d was performed to complement primary statistical findings, given the underpowered cohort sizes.

RESULTS: All groups displayed significant improvement in all measured outcomes from baseline to 6 months (P < .05). Small and medium tears demonstrated continued significant improvements in several outcomes from 6 months to 2 years (Constant score +7.6 and +7.4, respectively, P < .05; Oxford Shoulder Score +4.3 and 0.017, respectively, P < .05) while large tears did not (P > .05). Between-group analysis of variance demonstrated no significant difference in the degree of change scores for both time intervals (P > .05). Multivariate regression analysis concluded that tear size is not an independent predictor of 2-year outcomes (P > .05). Effect size analysis revealed predominantly moderate-to-large early effect sizes across all groups.

CONCLUSION: ARCR are associated with substantial early improvement across all tear sizes at 6 months, with diminishing returns thereafter. Although larger tear sizes have lower post-operative readings, the equally low pre-operative baseline readings result in similar net numerical improvements across all groups.

PMID:42389647 | PMC:PMC13321195 | DOI:10.1016/j.xrrt.2026.100791

JSES Rev Rep Tech. 2026 May 15;6(3):100778. doi: 10.1016/j.xrrt.2026.100778. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate clinical outcomes in patients with mild-to-moderate concentric glenohumeral osteoarthritis (GHOA) treated with arthroscopic surgery according to the Comprehensive Arthroscopic Management (CAM) procedure combined with intra-articular injection of autologous microfragmented adipose tissue (mFAT) (Lipogems). Since there was no CAM-only control group, the study does not assess the independent contribution of mFAT.

METHODS: In this retrospective study, 19 patients (mean age 52 years; 17 males, 2 females) with Samilson-Prieto grade 1-3 GHOA were included. All patients underwent arthroscopic CAM surgery followed by intra-articular injection of autologous mFAT. Primary outcomes were assessed using the visual analog scale for pain and the American Shoulder and Elbow Surgeons score at baseline (T⁰) and at 1 (T¹), 3 (T³), 6 (T⁶), 12 (T¹²), and 24 months (T²⁴) post-operatively.

RESULTS: Significant improvements in both visual analog scale and American Shoulder and Elbow Surgeons scores were observed at 1 month and maintained up to 24 months (P < .05). Patients aged ≤50 years or with grade 1-2 GHOA tended to experience greater clinical improvements. The observed improvements in pain and function exceeded published thresholds for the Minimal Clinically Important Difference and fell below the Patient Acceptable Symptom State, indicating that changes were not only statistically significant but also clinically meaningful. No major adverse events occurred, and no patients required conversion to shoulder arthroplasty. The combination of CAM and mFAT was safe and feasible, providing sustained pain relief and functional improvement over a 2-year follow-up.

CONCLUSION: The CAM procedure combined with intra-articular mFAT injection represents a safe and minimally invasive approach associated with durable improvements in pain and shoulder function in patients with mild-to-moderate GHOA. However, the study design does not allow conclusions regarding the specific contribution of mFAT beyond the CAM procedure alone. Further controlled studies are needed to clarify potential additive benefits.

PMID:42389646 | PMC:PMC13320478 | DOI:10.1016/j.xrrt.2026.100778