Category: Nevin Manimala

BMC Health Serv Res. 2026 Jul 6. doi: 10.1186/s12913-026-15065-1. Online ahead of print.

ABSTRACT

BACKGROUND: The National Volume-Based Procurement (NVBP) policy was implemented in China in 2018 to address escalating pharmaceutical expenditures. This study aimed to describe long-term price trends, regional variations in bid-winning drug prices, and supply stability during the 2018-2024 implementation period.

METHODS: Data were obtained from the Shanghai Sunshine Pharmaceutical Procurement Platform and the Comprehensive Service Platform for NVBP. Price trends of bid-winning and alternative drugs were analyzed using monthly procurement data for Batches 1-7, excluding the insulin-specific sixth batch.Laspeyres, Paasche, and Fisher price indices were calculated using January 2018 as a common index anchor to standardize long-term price comparisons, rather than as a batch-specific pre-policy baseline. Regional disparities in bid-winning drug prices were examined using official bid-winning results for Batches 1-5 and Batches 7-10, with purchasing power parity indices estimated by the national product dummy method. Supply shortages were measured as monthly regional order-delivery gaps during the first post-implementation year of each included batch and classified into five severity levels.

RESULTS: Bid-winning drugs showed substantial price declines after implementation, with Laspeyres, Paasche, and Fisher indices decreasing by approximately 55%-85%, 60%-85%, and 50%-80%, respectively. Prices remained stable at low levels without obvious rebound. Alternative drugs showed smaller and more fluctuating declines of approximately 5%-40%, 5%-40%, and 10%-40%, respectively. Supplementary interrupted time-series analysis of the Fisher index showed significant negative immediate level changes for bid-winning drugs across all included batches, whereas alternative drugs showed smaller and less consistent immediate changes. Regional PPP point estimates were generally lower in economically developed regions than in the western region, although many individual batch-region comparisons were not statistically significant. First-year supply shortages ranged from approximately 17% to 33% across batches. Lower-priced drugs were more frequently observed in higher shortage-severity categories, with drugs priced below 0.5 CNY accounting for 77.6% of severe shortages.

CONCLUSION: This nationwide descriptive study documented sharp and sustained price declines for bid-winning drugs, smaller and heterogeneous declines for alternative drugs, persistent regional price disparities, and supply shortages under China’s NVBP. These findings suggest a policy tension between price reduction, regional equity, and supply security.If these descriptive associations reflect underlying procurement mechanisms, future policy refinements may consider regional price-differential monitoring, dynamic price-adjustment mechanisms for extremely low-priced drugs, supply guarantee requirements, and reward-penalty mechanisms for procurement participants.

PMID:42410444 | DOI:10.1186/s12913-026-15065-1

Lipids Health Dis. 2026 Jul 6. doi: 10.1186/s12944-026-02991-6. Online ahead of print.

ABSTRACT

BACKGROUND: Growing evidence suggests that metabolic disturbances underlie pregnancy losses, imposing a substantial public health burden among young women of reproductive age. Glycolipid metabolism 7 factors (GLM7) is a composite glycolipid metabolism index derived from routinely measured metabolic indicators; however, its relevance to pregnancy loss in young women remains unexamined.

METHODS: The present study analyzed publicly available data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES) cycles. Participants were categorized as having no pregnancy loss, single pregnancy loss, or recurrent pregnancy loss (≥ 2 losses). GLM7 was calculated as the logarithm of the product of age, body mass index, fasting blood glucose, fasting insulin, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels. The association between GLM7 and pregnancy loss categories was evaluated, potential dose-response patterns were explored, and effect modification by selected sociodemographic and behavioral factors was assessed.

RESULTS: Of the 736 women included in the analysis, 300 (37%) reported a history of pregnancy loss. In binary analyses, higher GLM7 was initially associated with pregnancy loss (OR = 1.21, 95% CI: 1.03-1.44); however, the association was attenuated after adjustment for the number of pregnancies (OR = 1.19, 95% CI: 0.99-1.44). In multinomial analyses, higher GLM7 levels were not significantly associated with single pregnancy loss. In contrast, higher GLM7 remained independently associated with recurrent pregnancy loss after adjustment for all covariates (OR = 1.17, 95% CI: 1.02-1.42; P = 0.046). Women in the second to fourth quartiles had significantly higher odds of recurrent pregnancy loss than those in the lowest quartile. No significant nonlinearity was observed in the association between GLM7 and recurrent pregnancy loss (P for nonlinearity = 0.265). No statistically significant interaction was observed across the subgroups.

CONCLUSIONS: In this nationally representative sample of U.S. women aged 18-35 years, higher GLM7 levels were more robustly associated with recurrent rather than isolated pregnancy loss. The findings suggested that cumulative glycolipid metabolic burden may be particularly relevant to repeated reproductive failures and serve as indicators to improved strategies for early reproductive risk identification and preventive healthcare for women.

PMID:42410437 | DOI:10.1186/s12944-026-02991-6

BMC Med Educ. 2026 Jul 7. doi: 10.1186/s12909-026-09834-z. Online ahead of print.

ABSTRACT

BACKGROUND: Following the transition of the United States Medical Licensing Examination Step 1 to Pass/Fail scoring, research productivity and the ability to communicate scholarly work effectively are increasingly important for residency applicants. While medical schools have expanded access to research opportunities, structured training that prepares students for research dissemination remains limited. To address this gap, the Student Opportunities for Advancement in Research Office implemented and evaluated the Medical Student Research Presentation (MSRP) series, a feedback-rich program designed to support research communication skill development and presenter confidence among medical students.

METHODS: The MSRP was hosted monthly from December 2024 to November 2025 to support medical students across two campuses. Student participants delivered 7-minute research presentations followed by a 3-minute question-and-answer session with reviewers, who provided feedback using a standardized rubric. Program evaluation was conducted using a 33-item post-session survey guided by the Kirkpatrick Evaluation Model. Data were analyzed using descriptive statistics to summarize presenter motivations, perceived usefulness of the session, changes in confidence across presentation skills, and application of feedback to scholarly products.

RESULTS: Twenty-eight medical students presented during the study period, with 17 (60.7%) completing the post-session survey. All respondents agreed or strongly agreed that the MSRP provided actionable feedback and would recommend the program to peers. The most frequently reported areas of improvement included communication (76.5%), confidence (70.6%), and responding to audience questions (70.6%). Directional confidence gains were observed across presentation skills, with first-time presenters showing the largest gains in explaining research clearly and answering audience questions, and presenters with prior presentation experience demonstrating the strongest gains in engaging the audience. Most participants reported incorporation of feedback into revised presentations (64.7%), manuscripts (41.2%), or conference presentations (35.3%). Thirteen participants (76.5%) reported applying to present their MSRP talk at other conferences. Among those who applied (n = 13), 76.9% were accepted to present.

CONCLUSIONS: The MSRP is a transferable research presentation program that supports medical students’ confidence, communication skills, and early scholarly dissemination. By providing structured, feedback-rich presentation practice prior to formal conferences, the MSRP addresses a gap between project execution and scholarship in the undergraduate medical education research pipeline.

PMID:42410434 | DOI:10.1186/s12909-026-09834-z

BMC Med Genomics. 2026 Jul 6. doi: 10.1186/s12920-026-02423-5. Online ahead of print.

ABSTRACT

BACKGROUND: The lncRNA/circRNA-miRNA-mRNA interaction constructs a competing endogenous RNAs (ceRNAs) network, which is closely related to inflammation. However, their roles in allergic rhinitis (AR) remain unclear. In this study, we investigated the regulatory role of ceRNA networks in AR pathogenesis by analyzing long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs), then constructing a lncRNA/circRNA-miRNA-mRNA interaction network.

METHODS: An AR mouse model was established using ovalbumin (OVA). Pathological examination was performed on the nasal mucosa of the mice, and ELISA was conducted on the mouse serum. High-throughput sequencing was used to analyze the expression profiles of lncRNAs, circRNAs, miRNAs, and mRNAs in the nasal mucosa of AR mice. A fold change > 2 and a q-value < 0.05 were used to identify the significantly differentially expressed (DE) lncRNAs, circRNAs, miRNAs, and mRNAs in AR. Then, bioinformatics and statistical methods were used to construct ceRNA networks, while RT-PCR was employed to validate RNA seq results.

RESULTS: A total of 216 mRNAs, 241 lncRNAs, 659 circRNAs, and 19 miRNAs were identified as significantly differentially expressed. Among them, 145 mRNAs were up-regulated and 71 were down-regulated; 138 lncRNAs were up-regulated and 103 were down-regulated; 304 circRNAs were up-regulated and 355 were down-regulated; 16 miRNAs were up-regulated and 3 were down-regulated. Additionally, 223 miRNA -mRNA pairs, 50 miRNA-lncRNA pairs, and 17 circRNA-miRNA pairs were obtained, and a network diagram of lncRNA/circRNA-miRNA-mRNA pairs was drawn. Functional enrichment analysis based on the ceRNA network confirmed that lncRNAs are involved in the regulation of the Wnt signaling pathway, ECM-receptor interaction, and the PI3K-Akt signaling pathway. In contrast, circRNAs are implicated in the modulation of adipocyte lipolysis, as well as ECM-receptor interactions and protein digestion and absorption. Some DE-lncRNAs and DE-mRNAs determined by RNA sequencing were verified by RT-PCR, and their trends were similar to those observed in RNA seq.

CONCLUSION: We established a ceRNA network based on lncRNA/circRNA-miRNA-mRNA interactions for AR, providing a solid foundation for future investigations into its underlying molecular mechanisms and the identification of novel drug targets.

PMID:42410433 | DOI:10.1186/s12920-026-02423-5

BMC Biol. 2026 Jul 6. doi: 10.1186/s12915-026-02674-9. Online ahead of print.

ABSTRACT

BACKGROUND: Austrofundulus limnaeus is an extremophile vertebrate native to small temporary ponds of Venezuela. Embryos of A. limnaeus must survive variable and often extreme conditions, including long periods of anoxia. Neuroepithelial cells derived from these embryos, WS40NE cells, provide a unique tool to understand how the proteome changes in response to anoxic stress.

RESULTS: Using label-free proteomics, 19,604 peptides and 3487 proteins were quantified in normoxic, 4d anoxic, and 24 h recovery WS40NE cells. Of these, 2612 proteins (74.9%) were statistically significantly differentially abundant in at least one comparison: 1988 comparing normoxia to 4 days anoxia (57.0%), 923 comparing 4 days anoxia to 24 h recovery (26.5%), and 1814 comparing normoxia to 24 h recovery (52.0%). Further, interaction networks of proteins with similar expression patterns suggest that relative mitochondrial capacity may increase during anoxia, including upregulation and/or preferred stabilization of proteins involved in mitochondrial metabolism and mitochondrial transcription and translation. This is in sharp contrast to trends in proteins that support cytoplasmic translation.

CONCLUSIONS: These data support an active role for mitochondria in mediating the survival of the anoxia-tolerant WS40NE cell line and highlight the value of this non-traditional vertebrate model for uncovering novel mechanisms of cellular resilience.

PMID:42410428 | DOI:10.1186/s12915-026-02674-9

J Transl Med. 2026 Jul 6. doi: 10.1186/s12967-026-08570-8. Online ahead of print.

ABSTRACT

BACKGROUND: Lipid metabolism reprogramming is a hallmark of cancer, yet its systemic manifestations and functional implications in bladder cancer (BC) remain poorly understood. This study aimed to identify plasma lipidomic profiles with diagnostic, staging, and prognostic value in BC, and to explore their associations with thromboinflammatory mechanisms, particularly NETosis and thrombin generation.

METHODS: Plasma lipidomics was characterized by ultra-high-performance liquid chromatography high-resolution mass spectrometry from 87 BC patients (non-muscle-invasive BC, NMIBC, and muscle-invasive BC, MIBC) and 30 controls. NETosis markers, active DNaseI concentration, C-reactive protein, fibrinogen, IL-6, prothrombin F1+2, thrombin-antithrombin (TAT) complexes, and thrombin generation tests (TGT) were assessed in parallel. Statistical analyses in R included PCA, ROC curve analysis, elastic net penalized logistic regression, Cox regression, natural cubic spline modeling for survival analyses, and pathway enrichment analyses.

RESULTS: BC patients exhibited increased total lipid load and distinct lipidomic signatures. Phosphatidylcholine (PC) levels decreased with disease severity and were independently associated with poor overall survival (up to 85% reduction in MIBC). Multivariable elastic net models integrating lipidomic and clinical variables achieved high diagnostic accuracy for discriminating BC patients from controls (AUC = 0.943) and for distinguishing MIBC from NMIBC (AUC = 0.860). BC patients displayed increased NETosis, inflammation, and thrombin formation, while decreased active DNaseI. Potentially diagnostic lipids correlated with NETosis, inflammatory markers and TAT, and inversely with active DNaseI and TGT parameters. Given the cross-sectional and observational design, these findings should be interpreted as hypothesis-generating and do not allow causal inference.

CONCLUSIONS: Plasma lipidomic profiling identifies biomarkers with diagnostic and prognostic potential in BC and reveals associations with NETosis, active DNaseI dysfunction, and thrombin generation. While causality cannot be inferred from this exploratory study, these findings support lipidomics as a minimally invasive tool for BC stratification and as a window into cancer-associated immunothrombosis, providing a rationale for future longitudinal and mechanistic studies targeting lipid-neutrophil interactions.

PMID:42410426 | DOI:10.1186/s12967-026-08570-8

BMC Med. 2026 Jul 6. doi: 10.1186/s12916-026-05032-2. Online ahead of print.

ABSTRACT

BACKGROUND: Hepatocellular carcinoma (HCC), the third leading cause of cancer deaths, urgently requires innovative early detection strategies. This prospective study aimed to evaluate the feasibility of cell-free DNA (cfDNA) methylation, mutation, and/or alpha-fetoprotein (AFP) for HCC early detection model development.

METHODS: Peripheral blood samples were prospectively collected from 635 participants (288 HCC, 347 non-HCC), who were randomly assigned (6:4) to the training and validation sets to develop and validate a multi-omics early detection (MOED) model. The model was externally validated on 797 subjects (160 HCC, 637 non-HCC) and further blindly tested on 452 community-recruited high-risk individuals.

RESULTS: The methylation-based model showed superior performance over AFP and mutation-based models in the training set. In the validation set, the MOED model, integrating methylation with AFP levels ≥ 400 ng/mL, slightly increased sensitivity from 87.1% (95% CI: 79.6%-92.6%) to 88.8% (95% CI: 81.6%-93.9%) at 95.7% specificity (95% CI: 91.0%-98.4%), whereas adding mutation data did not improve the performance. In the independent validation set, the locked MOED exhibited 91.9% (95% CI: 86.5%-95.6%) overall sensitivity, 83.3% (95% CI: 51.6%-97.9%) stage 0 sensitivity, and 98.4% overall specificity (95% CI: 97.1%-99.2%). In high-risk individuals, the model demonstrated 92.9% (95% CI: 64.2%-99.6%) sensitivity, 90.6% (95% CI: 87.4%-93.1%) specificity, 24.1% (95% CI: 13.9%-37.9%) positive predictive value (PPV) and 99.7% (95% CI: 98.4%-100.0%) negative predictive value (NPV).

CONCLUSIONS: The MOED model, integrating cfDNA methylation and AFP, is highly effective for HCC detection and promising for screening in high-risk populations.

PMID:42410425 | DOI:10.1186/s12916-026-05032-2

BMC Nurs. 2026 Jul 6. doi: 10.1186/s12912-026-04983-4. Online ahead of print.

ABSTRACT

BACKGROUND: Social media addiction is common among university students and may have consequences for their physical activity. This study examines the relationship between nursing students’ social media addiction and both their engagement in physical activity and their perceptions of the benefits and barriers of exercise.

METHODS: This cross-sectional study involved 346 nursing students enrolled at three universities in different regions of Türkiye. Participants completed a demographic questionnaire, the Social Media Addiction Scale (SMAS), and the Exercise Benefit/Barrier Scale (EBBS), which measure social media addiction and perceptions of exercise benefits and barriers, respectively. Data were analyzed with t tests, one-way ANOVA, Pearson correlation, and linear regression, with sex, year of study, and body mass index treated as comparison or control variables.

RESULTS: A weak but statistically significant negative correlation was found between social media addiction and exercise benefit perception (r = – 0.188, p < 0.01), and this association persisted after adjusting for age, sex, year of study, and BMI (β = -0.164, p = 0.001). Longer daily social media use was associated with higher addiction scores (heaviest-use group 107.30 ± 35.26; p < 0.001), and students who exercised regularly scored lower than those who did not (p = 0.046). No significant difference in social media addiction was found between female and male students.

CONCLUSION: Because the design is cross-sectional, these findings reflect an association rather than a causal link: higher social media addiction was weakly related to a less favorable perception of exercise benefits. Approaches that encourage physical activity may be worth evaluating in future longitudinal and interventional studies.

PMID:42410422 | DOI:10.1186/s12912-026-04983-4

BMC Med Educ. 2026 Jul 6. doi: 10.1186/s12909-026-09878-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Digitalization, which is rapidly increasing its influence across many fields, has also led to a significant transformation in dentistry, evolving into a fundamental component that dentists are expected to master alongside traditional practices. Within this transformation in digital dentistry, teledentistry and artificial intelligence applications have emerged as prominent areas of focus. This study aimed to evaluate dental students’ knowledge, attitudes, and perceptions regarding teledentistry and artificial intelligence-supported systems. It also investigated their views on the future applications of these technologies and compared the awareness and expectations of preclinical and clinical students.

METHODS: This descriptive cross-sectional study was conducted among dentistry students at the Faculty of Dentistry, Sakarya University, including both preclinical and clinical levels. Data were collected using an 18-item structured questionnaire developed by the researchers and administered online via Google Forms. The internal consistency of the questionnaire was assessed using Cronbach’s Alpha, and multiple linear regression analysis was performed to identify predictors of teledentistry knowledge levels. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 22.0. Descriptive statistics (frequencies and percentages) were calculated, and Chi-square tests were used to compare categorical variables. A p-value of < 0.05 was considered statistically significant.

RESULTS: A total of 368 students participated in the study, of whom 237 were female and 131 were male; 156 were preclinical and 212 were clinical students. Clinical students demonstrated significantly higher knowledge regarding the purpose of artificial intelligence-based system usage in teledentistry compared with preclinical students (p < 0.05). Additionally, a significant difference was found in the sources of information about teledentistry between the two groups (p < 0.05). Social media was the most common information source for both groups, while a higher proportion of preclinical students reported having no prior knowledge of teledentistry (64.7%). Most participants identified artificial intelligence and big data analytics as the most influential technologies for the future development of teledentistry.

CONCLUSIONS: Integrating teledentistry and artificial intelligence more extensively into undergraduate dental education may enhance future dentists’ competence in digital dentistry and better prepare them to adapt to rapidly evolving technological advancements in the profession. The findings also indicate that dental students generally demonstrate positive attitudes toward AI-supported teledentistry despite having limited knowledge levels, with clinical students showing higher levels of awareness compared with preclinical students.

PMID:42410419 | DOI:10.1186/s12909-026-09878-1

BMC Surg. 2026 Jul 6. doi: 10.1186/s12893-026-03942-9. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant therapy (NAT) has become the recommended treatment approach for patients with borderline resectable or locally advanced pancreatic cancer. However, pancreatic peritumoral fibrosis and proximity of the tumor to major vessels make surgery after NAT challenging. The feasibility and safety of robotic approaches remain unclear.

METHODS: A retrospective analysis was conducted on consecutive pancreatic cancer patients who underwent either open pancreatic surgeries (OPS) or robotic pancreatic surgeries (RPS) following NAT between February 2017 and April 2025. Outcomes, including R0 resection rates, postoperative complication rates, disease-free survival (DFS), and overall survival (OS), were compared between the two groups.

RESULTS: The rate of combined vascular resection and reconstruction was significantly higher in OPS group compared to RPS group following NAT. A total of 43 patients underwent surgical resection which did not require venous segmental resection and reconstruction, including 23 RPS and 20 OPS, were finally included in the analysis. The two groups were well balanced in baseline characteristics, except for BMI. In the RPS group, one case (4.3%) was converted into laparotomy. The RPS group was associated with longer operative time (340.0 min vs. 254.0 min, p = 0.015). The number of harvested lymph nodes was significantly higher in the RPS group compared to the OPS group(25 vs. 18, p = 0.049). There were no significant differences in R0 resection rates between the groups. The overall complication rate was significantly lower in the RPS group (21.7% vs. 55.0%, p = 0.024), while the rates of severe complications, clinically relevant pancreatic fistula, and postoperative hemorrhage did not differ between groups. Postoperative hospital stay was slightly shorter in the RPS group, though not statistically significant. There were no significant differences in DFS or OS.

CONCLUSION: In carefully selected patients with pancreatic cancer following neoadjuvant therapy who did not require vascular segmental resection and reconstruction, a robotic approach appeared technically feasible and was associated with favorable short-term postoperative outcomes and a greater lymph node yield. These findings should be considered exploratory, and further prospective studies are warranted to better define the role of robotic surgery in this setting.

PMID:42410418 | DOI:10.1186/s12893-026-03942-9