Category: Nevin Manimala

J ISAKOS. 2026 Aug 29:101211. doi: 10.1016/j.jisako.2026.101211. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to objectively identify and describe intraoperative patellar tracking patterns in osteoarthritic knees and examine their relationship with coronal alignment according to the Coronal Plane Alignment of the Knee (CPAK) classification.

METHODS: A retrospective analysis was performed on 252 knees that underwent robotic-assisted primary total knee arthroplasty (TKA). Intraoperative patellar tracking was assessed prior to any bone cuts. Patellar tracking was recorded using a previously described technique with the CORI robotic system. Preoperative full-length standing radiographs were used to assess coronal alignment parameters. Knees were classified according to the CPAK classification. Associations between patellar tracking patterns and radiographic parameters were analyzed.

RESULTS: The mean age of the cohort was 71.4 ± 7.1 years. Pre-implantation patellar tracking was classified into three patterns: central tracking in 58% (n = 147), lateral tracking in 35% (n = 89), and medial tracking in 7% (n = 16). A statistically significant association was observed between coronal alignment category (varus, neutral, valgus) and coronal patellar tracking pattern (p = 0.006). Central tracking was more frequently observed in varus knees, whereas lateral tracking showed a relative predominance in neutral-to-valgus alignment. Consistently, lateral patellar tracking was associated with more valgus limb alignment.

CONCLUSION: Three distinct native coronal patellar tracking patterns were identified using robotic intraoperative assessment prior to implantation. Patellar tracking pattern was associated with coronal limb alignment, with lateral tracking relatively more frequent in neutral-to-valgus knees. The clinical significance of these passive intraoperative tracking patterns requires further investigation.

LEVEL OF EVIDENCE: Level III, Retrospective Comparative Cohort Study.

PMID:42668065 | DOI:10.1016/j.jisako.2026.101211

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2026 Aug 29:500348. doi: 10.1016/j.remnie.2026.500348. Online ahead of print.

ABSTRACT

PURPOSE: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by persistent symptoms. Fibroblast activation protein (FAP), expressed on activated fibroblasts during tissue remodeling, can be visualized with [⁶⁸Ga]Ga-FAPI PET/CT. This study investigated lung and muscle fibroblastic activity in patients with post-acute sequelae of COVID-19 (PASC) following moderate-to-severe COVID-19 pneumonia more than two years after the acute infection, using [⁶⁸Ga]Ga-FAPI PET/CT.

METHODS: In this pilot prospective observational study, we enrolled patients with PASC following severe acute COVID-19 requiring high-flow nasal cannula or mechanical ventilation and age- and sex-matched controls without pulmonary pathology between September 2023 and February 2024. PASC patients underwent high-resolution CT (HRCT), pulmonary function tests (PFTs), and [⁶⁸Ga]Ga-FAPI PET/CT. SUVmax and SUVmean were measured for each lung lobe. HRCT abnormalities were scored using a semi-quantitative scale (0-20) and categorized as ground-glass opacities, reticulations, parenchymal bands, traction bronchiectasis, or subpleural cysts. These findings were statistically compared and correlated with PET parameters, PFTs, and clinical symptoms. In addition, [⁶⁸Ga]Ga-FAPI uptake in the paravertebral muscles was assessed at the level of the L3 vertebra.

RESULTS: Twenty patients with PASC and 10 control subjects were included (median ages: 64 and 58.5 years, respectively). The mean interval between hospitalization for acute COVID-19 and study imaging was 25 ± 4.5 months. PASC patients exhibited significantly increased [⁶⁸Ga]Ga-FAPI uptake in the lungs compared with controls. Lung [⁶⁸Ga]Ga-FAPI uptake was markedly increased in patients with traction bronchiectasis. No correlations were observed between lung [⁶⁸Ga]Ga-FAPI SUVmax and PFTs or symptom burden. However, lung [⁶⁸Ga]Ga-FAPI SUVmean demonstrated moderate inverse correlation with DLCO (r = -0.455, p = 0.044). In addition, [⁶⁸Ga]Ga-FAPI SUVmax in muscle was significantly higher in PASC patients than in controls, with particularly elevated uptake observed in patients with a history of mechanical ventilation.

CONCLUSIONS: [⁶⁸Ga]Ga-FAPI PET/CT demonstrated increased lung tracer uptake in patients with PASC more than two years after moderate to severe COVID-19, supporting persistent fibroblast-related tissue activity. Limited associations between lung SUVmean and DLCO suggest a potential link between tracer uptake and functional impairment. Increased muscle [⁶⁸Ga]Ga-FAPI uptake was also observed as an exploratory finding requiring further functional and histopathological validation.

PMID:42668009 | DOI:10.1016/j.remnie.2026.500348

Am J Med Sci. 2026 Aug 29:S0002-9629(26)00357-5. doi: 10.1016/j.amjms.2026.08.025. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiorenal syndrome (CRS), characterized by cardiac-renal interplay, imposes a substantial clinical burden. Biological aging (BA), a comprehensive indicator for evaluating the overall aging status of an organism, is linked to individual cardiac or renal diseases, while its association with mortality in the CRS population remains unclear.

METHODS: We utilized data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. CRS was defined as chronic cardiorenal comorbidities, specifically the coexistence of self-reported cardiovascular disease and calculated chronic kidney disease. BA was calculated using 12 clinical biomarkers, including the Klemera-Doubal method BA (KDM-BA) and Phenotypic Age (PhenoAge). BA acceleration (BAA), quantified as residuals from linear regression of BA on chronological age, includes KDM-BAA and PhenoAge acceleration (PhenoAgeAccel). Cox proportional hazards model and restricted cubic spline were performed to investigate these associations. Results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS: 1,100 CRS participants were included in the final analysis. A 10-year increase in KDM-BA and PhenoAge in CRS participants was associated with 1.14-fold and 1.63-fold higher all-cause mortality risk, respectively. CRS participants with KDM-BAA (HR: 1.40, 95% CI: 1.13-1.73) or PhenoAgeAccel (HR: 1.54, 95% CI: 1.20-1.96) had elevated all-cause mortality risk. Meanwhile, these positive associations were more pronounced in males. Moreover, KDM-BA was associated with mortality from heart disease and cerebrovascular disease in the CRS population, with a non-linear relationship observed in cerebrovascular disease.

CONCLUSIONS: As composite indicators for aging, KDM-BA, PhenoAge, KDM-BAA, and PhenoAgeAccel are significantly associated with all-cause mortality among the CRS population. These measures may serve as potential prognostic biomarkers in this population.

PMID:42667983 | DOI:10.1016/j.amjms.2026.08.025

Death Stud. 2026 Aug 29:1-22. doi: 10.1080/07481187.2026.2723779. Online ahead of print.

ABSTRACT

The hypothesis based on terror management theory and fear of death was that higher state ageism is associated with lower state suicide rates among the 48 contiguous U.S. states. Ageism scores were based on responses of 331,056 adults to an implicit association test between 2002 and 2020. Age-adjusted suicide rates for 2018-2022 pertained to four different age categories: 20 years and over, 20-39 years, 40-64 years, and 65 years and older. Statistical controls were socioeconomic status, income inequality, urbanization, Black population percent, religiosity, political conservatism, distress, and depression. Pearson correlations between ageism and the four age-based suicide rates ranged from -.55 to -.62. Multiple regressions with the eight controls and ageism as predictors produced βs for ageism ranging from -.52 to -.59. Multicollinearity and spatial autocorrelation were not problematic. Explanatory speculation focuses on higher fear of death, which is integrally associated with higher ageism, serving as a deterrent to suicide.

PMID:42667693 | DOI:10.1080/07481187.2026.2723779

J Clin Psychol. 2026 Aug 29. doi: 10.1002/jclp.70216. Online ahead of print.

ABSTRACT

OBJECTIVES: Mindfulness is increasingly being implemented in child and adolescent therapy. However, little is known about its effectiveness in individual settings within a clinical outpatient context. We investigated the effects of session-introducing mindfulness interventions (IG-M) compared to session-introducing relaxation interventions (CG-R) and no standardized session-introduction (CG) on symptomatic outcome and therapeutic alliance in cognitive-behavioral therapy using a randomized controlled design.

METHOD: One thousand four hundred and seventy-eight of 90 outpatient adolescents (11-19 years) diagnosed with depression, an anxiety disorder, or a hyperkinetic disorder were assessed. Symptomatic outcome was assessed by the German version of the Youth Self-Report 11-18R at five measurement time points (pre, 3rd, 10th, 17th therapy session, post), therapeutic alliance was assessed by the German version of the Therapeutic Alliance Scales for Children after every therapy session (1st-24th therapy session). Statistical analyses were conducted using multilevel modeling. The RCT was registered at ClinicalTrials.gov (NCT04034576).

RESULTS: Multilevel modeling revealed a significant decrease of symptomatic outcome in IG-M compared to CG, but not compared to CG-R, over time. A significant increase in therapeutic alliance over time was observed from the therapists’ perspective with no group differences. Therapeutic alliance from patients’ perspective significantly increased in IG-M and significantly decreased in CG. There was no statistically meaningful change in therapeutic alliance from the patients’ perspective in CG-R.

CONCLUSION: IG-M had positive effects on symptomatic outcome and therapeutic alliance compared to CG, but did not outperform CG-R. Future studies that control confounding variables are highly relevant to understand the role of mindfulness in individual youth psychotherapy.

PMID:42667691 | DOI:10.1002/jclp.70216

Int J Epidemiol. 2026 Aug 18;55(5):dyag164. doi: 10.1093/ije/dyag164.

ABSTRACT

BACKGROUND: Synthetic data hold substantial potential to address practical challenges in epidemiology due to restricted data access and privacy concerns. However, many current methods suffer from limited quality, high computational demands, and complexity for non-experts. Furthermore, common evaluation strategies for synthetic data often fail to directly reflect statistical utility and measure privacy risks sufficiently. Against this background, a critical underexplored question is whether synthetic data can reliably reproduce key findings from epidemiological research while preserving privacy.

METHODS: We propose adversarial random forests (ARF) as an efficient and convenient method for synthesizing tabular epidemiological data. To evaluate its performance, we replicated statistical analyses from six epidemiological publications covering blood pressure, anthropometry, myocardial infarction, accelerometry, loneliness, and diabetes, from the German National Cohort (NAKO Gesundheitsstudie), the Bremen STEMI Registry U45 Study, and the Guelph Family Health Study. We further assessed how dataset dimensionality and variable complexity affect the quality of synthetic data, and contextualized ARF’s performance by comparison with commonly used tabular data synthesizers in terms of utility, privacy, generalization, and runtime.

RESULTS: Across all replicated studies, results on ARF-generated synthetic data consistently aligned with original findings. Even for datasets with relatively low sample size-to-dimensionality ratios, replication outcomes closely matched the original results across descriptive and inferential analyses. Reduced dimensionality and variable complexity further enhanced synthesis quality. ARF demonstrated favourable performance regarding utility, privacy preservation, and generalization relative to other synthesizers and superior computational efficiency.

CONCLUSIONS: In summary, ARF reliably generates high-quality synthetic data that replicate diverse epidemiological analyses while offering a competitive privacy-utility trade-off.

PMID:42667682 | DOI:10.1093/ije/dyag164

Vet Med Sci. 2026 Sep;12(5):e71204. doi: 10.1002/vms3.71204.

ABSTRACT

BACKGROUND: Mastitis in dairy animals is a major economic and public health concern in Nepal, exacerbated by the emergence of antimicrobial-resistant pathogens. This study aimed to determine the prevalence and antibiotic resistance patterns of Staphylococcus aureus isolated from bovine milk in Bardaghat Municipality, Nepal.

RESULTS: A cross-sectional survey screened 196 milk samples from lactating cows and buffaloes using the California Mastitis Test (CMT). The overall prevalence of S. aureus was 39.79%. Strikingly, 100.00% of isolates exhibited resistance to oxacillin, indicating the widespread presence of methicillin-resistant Staphylococcus aureus (MRSA). Moreover, 25.64% of isolates were multidrug-resistant (resistant to n 3 antibiotic classes), and 18% had a multiple antibiotic resistance (MAR) index > 0.2. No statistically significant associations were found between the prevalence of S. aureus and evaluated risk factors.

CONCLUSIONS: These findings underscore an urgent need for improved mastitis management, including routine bacterial screening, judicious antibiotic use and public health measures to mitigate transmission of resistant S. aureus to humans.

PMID:42667655 | DOI:10.1002/vms3.71204

J Man Manip Ther. 2026 Aug 29:1-12. doi: 10.1080/10669817.2026.2720771. Online ahead of print.

ABSTRACT

BACKGROUND: Road Traffic Injuries affect more than 50 million people each year. Whiplash-associated disorders (WAD) are among the most common musculoskeletal conditions resulting from these injuries, affecting up to 83% of individuals exposed to this type of trauma. Approximately 50% of affected individuals experience incomplete recovery. Although specific neck exercises are recommended, the effectiveness of device-guided craniocervical training administered via telerehabilitation for subacute grade I-II WAD remains unknown.

OBJECTIVE: To evaluate the preliminary effectiveness and feasibility of a device-guided craniocervical exercise program delivered via telerehabilitation on pain and disability in individuals with subacute grade I-II WAD.

METHODS: A multicentre, assessor-blinded, randomized pilot feasibility trial with a 1:1:1 allocation ratio was conducted. Thirty-three participants were randomized into three groups: device-guided training, active exercise or usual care. The exercise groups received 12 supervised online sessions over a 6-week period. Disability, pain, and eight self-reported outcome measures were assessed at baseline, 6 weeks, and 12 weeks.

RESULTS: Statistical analysis showed significant between-group differences in disability and pain intensity at T1 and T2 in favor of the device-guided training group (p < 0.05). No statistically significant between-group differences were found for secondary outcomes. Recruitment rate was 3.3 participants per month, adherence was 77%, and 16 mild transient adverse events were reported (27%). The estimated sample size for a future definitive trial was 94 participants.

CONCLUSIONS: A device-guided craniocervical exercise program delivered via telerehabilitation appears feasible, safe, and associated with greater reductions in disability and pain than conventional specific neck exercise and usual care in subacute WAD. While findings are preliminary, they support progression to a definitive multicentre randomized controlled trial currently underway to confirm effectiveness.Registration: ClinicalTrials.gov – NCT06580990.

PMID:42667605 | DOI:10.1080/10669817.2026.2720771

Eur J Prev Cardiol. 2026 Aug 29:zwag448. doi: 10.1093/eurjpc/zwag448. Online ahead of print.

ABSTRACT

INTRODUCTION: Sex differences in treatment with Statins after Myocardial Infarction (MI) are widely recognised. This study aimed to assess differences in statin treatment initiation after MI by sex, age groups, and year of MI.

METHOD: We conducted a cohort study in Denmark using registries for patients with a first-time MI between 1st January 2000 and 31st December 2024, excluding patients already treated with lipid lowering drugs up to 180 days before their MI. Descriptive statistics and multivariable Poisson regression were used to explore the effect of sex on treatment initiation.

RESULTS: A total of 154,591 patients were included in the study (37% females, median age 75 years for females and 65 years for men). Overall, 54% of females versus 72% of males had initiated statin treatment within 180 days (p < .001). For females ≥40 years, significantly lower proportions were found in every year interval (p < .001 for all). Within the age groups, the relative difference between the sexes increased from 2000-2002 until 2015-2019, whereafter a decrease was found from 2015-2019 to 2020-2024, except among 60-69-year-olds for whom the decrease began earlier, starting in 2010-2014. Females had a 25% lower relative risk (RR 0.75 [0.74;0.76]) of initiating treatment. These differences remained after adjusting for age groups and year interval (RR 0.87 [0.86;0.87]) and after further adjustment for baseline characteristics (RR 0.91 [0.85;99]).

CONCLUSION: A smaller proportion of females received statins than males after a MI. Disparities in treatment persisted over the years.

PMID:42667599 | DOI:10.1093/eurjpc/zwag448

J Clin Monit Comput. 2026 Aug 29. doi: 10.1007/s10877-026-01490-4. Online ahead of print.

ABSTRACT

Automated pupillometry provides a standardised, quantitative, highly reproducible measurement of the pupillary light reactivity and other pupillary variables. The Neurologic pupillary index (NPi) has shown good prognostic value in patients with acute brain injury and cardiac arrest. However, few data on the comparison of NPi with a recently introduced index (quantitative pupillary index, QPI) are available. To compare the performance of two commercially available automated pupillometry devices, and in particular QPI and NPi, in a cohort of neuro-critically ill patients. Single-center observational study, including adult (> 18 years) patients admitted to a neuro-intensive care unit over a 6-month period. Pupillary reactivity was assessed in both eyes of each patient using the two pupillometers currently available, the Neuroptics NPi-300 (Neuroptics, Irvine, CA, USA) and the NeuroLight (ID-Med, Marseilles, France). A total of 73 patients were included in the final analysis, with a median age of 65 years (interquartile range [IQR] 54-77). The mean bias between the two pupillometers was 0.44 mm (95% Limit of Agreement [LoA] – 0.43 mm to 1.31 mm) for pupil diameter, 0.57% (95% LoA – 7.63% to 8.77%) for pupillary reactivity, and – 0.82 (95% LoA – 2.70 to 1.05) for NPi vs. QPI comparison. A very strong correlation was found between the two devices in terms of pupil diameter measurement (ρ = 0.91; 95% Confidence Interval [CI] 0.86 to 0.95; p < 0.0001) and pupil reactivity (ρ = 0.92; 95% CI 0.87 to 0.95; p < 0.0001). NPi and QPI were well correlated (ρ = 0.75; 95% CI, 0.62-0.84; p < 0.0001). In this cohort study, a significant statistical correlation between the measurements provided by two available pupilometers was found; however, NPi and QPI might not be clinically interchangeable.

PMID:42667581 | DOI:10.1007/s10877-026-01490-4