Nevin Manimala

Am J Clin Dermatol. 2026 Jul 28. doi: 10.1007/s40257-026-01060-z. Online ahead of print.

ABSTRACT

BACKGROUND: Alopecia areata is an autoimmune disorder characterised by T-cell-mediated damage of hair follicles, resulting in non-scarring hair loss that can progress to complete scalp (alopecia totalis) or body hair loss (alopecia universalis). While long-term systemic options were historically limited, the emergence of Janus kinase (JAK) inhibitors has revolutionised the treatment of alopecia areata, even in patients with moderate-to-severe disease.

OBJECTIVE: We aimed to evaluate the efficacy and safety of oral JAK inhibitors compared with placebo in adults and adolescents with moderate-to-severe alopecia areata.

METHODS: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials databases were searched from inception to 28 November, 2025. Randomised controlled trials evaluating oral JAK inhibitors in adolescents and adults (aged ≥12 years) with alopecia areata were included. Data extraction and risk of bias assessment were performed independently by multiple reviewers. Primary outcomes were the proportion of patients who achieved Severity of Alopecia Tool (SALT) scores of ≤10 and ≤20, and 50%, 75% and 90% reductions in SALT scores from baseline, as well as treatment-related adverse events (AEs). Data were synthesised using random-effects models to calculate odds ratios (ORs) and mean differences with 95% confidence intervals (CIs).

RESULTS: Twelve randomised controlled trials involving 4141 participants (mean age 35.8 years, mean baseline SALT score 86.0) met the inclusion criteria. All trials enrolled adult participants, with the exception of one randomised controlled trial in which adolescents comprised 15% of the study population. Six trials were rated as having a low risk of bias, while six had “some concerns” primarily because of missing outcome data. Oral JAK inhibitors were significantly more effective than placebo across all primary efficacy endpoints. At week 24, the odds of achieving SALT ≤10 were 5.69 times higher for JAK inhibitors than placebo (95% CI 3.58-9.03); by week 36, this effect increased to an OR of 9.40 (95% CI 4.58-19.29). For SALT ≤20, the OR was 7.99 (95% CI 5.13-12.44) at week 24. Patients treated with oral JAK inhibitors were significantly more likely to achieve SALT50, SALT75 and SALT90 across all timepoints (weeks 12-36). Regarding safety, JAK inhibitors were associated with a higher risk of total AEs (OR 1.60; 95% CI 1.33-1.94), but no statistically significant difference was found for serious AEs (OR 1.04; 95% CI 0.69-1.57) or treatment discontinuation because of AEs (OR 1.22; 95% CI 0.84-1.76).

CONCLUSIONS: Oral JAK inhibitors are effective in promoting scalp, eyebrow and eyelash hair regrowth in adults and adolescents with moderate-to-severe alopecia areata, with a trend of higher response rates at later timepoints across studies. The favourable safety profile of these agents is reassuring. Future research should prioritise head-to-head randomised controlled trials and long-term pharmacovigilance to define comparative efficacy and safety.

PMID:42521957 | DOI:10.1007/s40257-026-01060-z

Geroscience. 2026 Jul 28. doi: 10.1007/s11357-026-02416-3. Online ahead of print.

ABSTRACT

Nonhuman primates are widely used in preclinical biomedical research, with hematobiochemical values serving as key clinical pathology parameters for assessing health status. In this study, we collected and analyzed 2973 blood samples from 566 cynomolgus macaques and 193 rhesus macaques, along with anthropometric measurements such as BMI, body weight, and waist circumference. Corresponding human data were obtained from the NHANES database and incorporated into the study. Regarding white blood cell composition, neutrophil percentages increased while lymphocyte percentages declined with age, with relatively sharp changes observed during both the early stage near sexual maturity and the late stage near aging onset in our macaque and human datasets. The inflammatory indices, calculated based on these compositions, showed similar age-related trends, reflecting age-associated immune modulation in primates. The inflection points approximately correspond to the ages of sexual maturation and aging onset. The statistical analyses predicted a divergence: human aging is primarily defined by metabolic syndrome caused by excess waste accumulation, whereas aging in cynomolgus macaques is fundamentally linked to nutrient deficiency and physical frailty. Despite this contrast, our findings also revealed convergent aging markers across primates. In summary, this study establishes reference indices for hematological and biochemical parameters in macaques, providing valuable insights into age-related changes in primate blood profiles.

PMID:42521934 | DOI:10.1007/s11357-026-02416-3

Environ Monit Assess. 2026 Jul 28;198(8):889. doi: 10.1007/s10661-026-15736-w.

ABSTRACT

Urban expansion modifies land surface characteristics and can influence local climatic conditions, particularly in arid coastal cities where urban processes interact with regional atmospheric forcing. This study investigated long-term relationships among land cover change, population growth, and summer climate variability in Jeddah, Saudi Arabia, using Landsat-derived Normalized Difference Vegetation Index (NDVI), Normalized Difference Built-up Index (NDBI), annual population estimates, and meteorological observations spanning 1992-2022. Temporal trends were evaluated using linear regression, while Pearson correlation and multiple regression analyses were applied to assess associations between urbanization indicators and climatic variables. The results show significant increases in vegetation cover and population together with a significant decline in NDBI over the study period, indicating substantial changes in the urban landscape. In contrast, July air temperature and relative humidity exhibited comparatively weak long-term trends. Built-up intensity showed a significant negative association with July relative humidity, whereas relationships with temperature were weak and statistically nonsignificant. Multiple regression analyses further indicated that land cover characteristics and population explained only a modest proportion of climatic variability. These findings suggest that urban land cover change influences atmospheric moisture more strongly than summer air temperature, while regional atmospheric and coastal processes remain the dominant controls on climate variability in Jeddah. The study provides empirical evidence to support climate-responsive urban planning and sustainable adaptation strategies in rapidly urbanizing arid coastal cities.

PMID:42521932 | DOI:10.1007/s10661-026-15736-w

Biol Trace Elem Res. 2026 Jul 29. doi: 10.1007/s12011-026-05262-8. Online ahead of print.

ABSTRACT

The zinc-to-copper ratio (ZCR) reflects essential metal balance and may be relevant to cardiovascular regulation, yet its association with hypertension in populations exposed to environmental heavy metals remains unclear. We conducted a cross-sectional study of 966 adults (≥ 30 years, recruited in 2008) comprising an exposed group (n = 564) residing within 4 km of the Janghang copper smelter and a non-exposed control group (n = 402) from a rural area approximately 15 km away. Serum zinc, copper, and nickel, along with blood lead, mercury, and urinary cadmium and arsenic were measured. Associations between ZCR and blood pressure were examined using multivariable linear regression, logistic regression, Bayesian kernel machine regression (BKMR), and restricted cubic spline (RCS) analyses, with sensitivity analyses. Higher ZCR was associated with increased systolic and diastolic blood pressure in fully adjusted linear models (SBP: β = 1.75, p = 0.002; DBP: β = 1.47, p < 0.001), with consistent associations in both exposed and control groups. In logistic regression, participants in the highest ZCR tertile had higher odds of hypertension than those in the lowest tertile (adjusted OR = 1.91; 95% CI: 1.25-2.93; p = 0.003). When stratified, the association was more pronounced in the non-exposed group (OR = 2.29; 95% CI: 1.18-4.45; p = 0.014) and somewhat attenuated but still suggestive in the exposed group (OR = 1.71; 95% CI: 0.96-3.06; p = 0.069); the formal interaction test was not statistically significant (p = 0.561). Sensitivity analyses, including exclusion of antihypertensive medication users, yielded consistent findings (OR = 1.83; 95% CI: 1.19-2.80), and the E-value (1.97) indicated limited-to-moderate robustness to unmeasured confounding. Higher ZCR is consistently associated with hypertension across analytical approaches and subgroups, with a suggestive but not statistically significant pattern of effect modification by environmental metal exposure. These findings support ZCR as a potentially informative indicator of essential metal imbalance relevant to blood pressure, warranting further investigation in prospective settings.

PMID:42521928 | DOI:10.1007/s12011-026-05262-8

Biol Trace Elem Res. 2026 Jul 28. doi: 10.1007/s12011-026-05261-9. Online ahead of print.

ABSTRACT

This study aimed to systematically investigate the relationship between mixed heavy metal exposure and serum C-reactive protein (CRP) level using an integrated multi-model statistical strategy. This study included 568 participants from the Manganese-Exposed Workers Healthy Cohort. Serum CRP and 20 blood metal concentrations were measured. Key metals were selected via LASSO regression and overall mixture effects and metal contributions were quantified by Quantile g-computation; and joint effects, nonlinearity, and interactions were evaluated using Bayesian Kernel Machine Regression (BKMR). LASSO regression identified 9 key metals (Calcium, Nickel, Copper, Titanium, Tin, Vanadium, Selenium, Arsenic, Rubidium). GLM revealed inverse linear associations for Ca, Se, Rb, and Ni, and a positive association for Cu with CRP. Quantile g-computation showed the overall mixture was significantly inversely associated with CRP (HR = 0.955, 95% CI: 0.918, 0.996), with calcium contributing the largest negative weight (-0.31). BKMR indicated that the overall mixture effect showed a monotonic decreasing trend across exposure quantiles, with a significant positive association at lower quantiles (0.25-0.5). BKMR also identified a significant positive interaction for tin (posterior mean = 0.051, 95% CI: 0.004, 0.098), with calcium showing the highest posterior inclusion probability (PIP = 0.972). This study suggests that metal mixtures exert exposure-level-dependent effects on CRP with complex interactions. Calcium may act as a central regulator, while tin shows amplified effects at higher co-exposure levels. These findings advance mechanistic understanding of mixture toxicology and inform exposure-level-specific risk assessment.

PMID:42521926 | DOI:10.1007/s12011-026-05261-9

Hematol Transfus Cell Ther. 2026 Jul 28;48(4):106490. doi: 10.1016/j.htct.2026.106490. Online ahead of print.

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplantation is the sole therapeutic approach that can provide a complete cure for thalassemia. However, this procedure is associated with complications that may have life-threatening consequences. To date, long-term survival outcomes after transplantation in thalassemia have not been systematically synthesized. This study aims to specifically evaluate long-term overall survival in patients with thalassemia undergoing hematopoietic stem cell transplantation.

METHODS: A comprehensive search was conducted across multiple databases, including PubMed, CENTRAL, Europe PMC (incorporating medRxiv and bioRxiv), EBSCOHost (Medline), and ProQuest. The search spanned from the inception of each database through July 10, 2024, using a combination of predefined keywords: ‘Hematopoietic Stem Cell Transplantation’, ‘Thalassemia’, ‘Survival Rates’, and synonyms. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Heterogeneity was evaluated via I² statistics, while pooled effect estimates were calculated using the DerSimonian-Laird inverse-variance random-effects model. Statistical significance was defined as p < 0.05. Additionally, a leave-one-out sensitivity analysis was performed to ensure the robustness of the findings.

RESULTS: Out of an initial 690 records identified, four articles involving a total of 616 transplanted thalassemia patients were included in this study. The survival rates were 86.8% (95% CI: 80.1%- 92.3%) in 15 years, 89.2% (95% CI: 82.2%-96.2%) in 20 years, 82.6% (95% CI: 79.9%-85.3%) in 30 years, and 81.4% (95% CI: 74.5%-88.9%) in 39 years. The pooled survival rate was 85% (95% CI: 81%-89%; I² = 40%). The pooled survival rate showed no significant differences in leave-one-out sensitivity analysis.

CONCLUSION: The present meta-analysis shows relatively high long-term overall survival rates in patients with thalassemia after hematopoietic stem cell transplantation. Nonetheless, the relatively small patient population, heterogeneity in anti-thymocyte globulin implementation, and potential confounding risks intrinsic to the study necessitate cautious interpretation of the findings.

PMID:42520329 | DOI:10.1016/j.htct.2026.106490

Int J Pharm Pract. 2026 Jul 28:riag100. doi: 10.1093/ijpp/riag100. Online ahead of print.

ABSTRACT

OBJECTIVES: This study describes an elective pharmacy entrepreneurship course and reports on students’ satisfaction, knowledge, and perceptions of the course’s effectiveness.

METHODS: An observational, cross-sectional study design was used to analyze retrospective data on direct and indirect assessments from first- and second-year professional pharmacy students who completed the course between 2017-2018 and 2024-2025. Students completed end-of-course surveys assessing their satisfaction with course structure, instructional methods, and perceived attainment of the course’s learning objectives, using Likert-scale responses. Direct assessment data were obtained by mapping examination items and graded assignments to course learning objectives. Qualitative data were collected and analyzed from the students’ survey comments. Descriptive statistics were used for data analysis.

KEY FINDINGS: The course used a project-based learning approach, including a semester-long entrepreneurial project and an individual case analysis. Overall, 362 students (62% of 8 class years) completed the course across 12 sessions. Survey results showed high student satisfaction, with 89%-98% of respondents agreeing or strongly agreeing in various areas. Direct assessment confirmed significant achievement of learning objectives, with normalized mean scores from 4.44 to 4.53 (out of 5) and 88%-100% of students earning at least 80% of the points. Indirect assessment results were similar, with 76%-84% of students expressing satisfaction with the course’s coverage of its learning objectives. Students praised the course’s relevance, value, and instruction, but found the workload and projects excessive.

CONCLUSIONS: A project-based elective course in pharmacy entrepreneurship effectively supports student learning and satisfaction, highlighting the value of incorporating entrepreneurship education into the pharmacy curriculum.

PMID:42520325 | DOI:10.1093/ijpp/riag100

Radiat Prot Dosimetry. 2026 Jul 28:ncag085. doi: 10.1093/rpd/ncag085. Online ahead of print.

ABSTRACT

Long-term standardized personal dose monitoring is essential for occupational radiation protection and health risk assessment of radiation workers. This study aimed to analyse the distribution characteristics, major causes, and actual exposure risks of abnormal individual dose monitoring results among radiation workers in Beijing from 2021 to 2025. A 5-year large-sample analysis of abnormal individual dose data among local radiation workers was performed to systematically explore the key problems in daily dose monitoring management. A total of 286 339 person-times of occupational external exposure monitoring (Hp(10)) were included, and 313 records exceeding the quarterly investigation level of 1.25 mSv were selected for retrospective investigation and statistical analysis. The overall 5-year abnormal rate was 0.11%, with no significant annual variation. Most abnormal cases were concentrated in medical institutions, especially in diagnostic radiology and interventional radiology. Non-standard behaviours such as improper placement and irregular wearing of dosemeters were the main causes of false abnormal doses, accounting for the majority of over-threshold records. Only 46 cases were confirmed as actual occupational exposure, and all quarterly doses were below 3 mSv. Interventional radiology personnel had a significantly higher actual exposure fraction than other radiation worker groups, with both the highest proportion of exposed individuals and the largest collective occupational exposure dose. The overall occupational exposure level of radiation workers in Beijing remained under effective control during the study period. In conclusion, inappropriate dosemeter management is the primary factor leading to abnormal monitoring data. Targeted radiation protection training and standardized dose supervision should be strengthened for high-risk groups, especially interventional radiology workers, to improve the authenticity and effectiveness of occupational dose monitoring and optimize regional radiation protection management.

PMID:42520320 | DOI:10.1093/rpd/ncag085

Mil Med. 2026 Jul 28:usag348. doi: 10.1093/milmed/usag348. Online ahead of print.

ABSTRACT

INTRODUCTION: Upper extremity injuries, particularly those involving the hand, are a significant source of morbidity and reduced operational readiness within military populations. Hand and finger trauma are among the most common musculoskeletal injuries encountered across deployed and non-deployed military settings, frequently affecting the ability to perform mission-essential tasks. In austere and resource-constrained environments, early stabilization strategies must balance protection of injured structures with preservation of function and operational capability. Current military trauma systems emphasize prolonged management in environments where evacuation may be delayed, increasing the importance of rapid, reproducible interventions that support continued function. Traditional immobilization techniques such as plaster splinting are time-intensive, operator-dependent, and often restrict functional hand use. This pilot study evaluates a rapid, motion-permissive hand stabilization system (GRASP Hand) designed to achieve intrinsic-plus positioning while allowing controlled motion, with potential application across Tactical Combat Casualty Care (TCCC) and Prolonged Casualty Care (PCC) settings.

MATERIALS AND METHODS: A pilot feasibility study was conducted in a controlled outpatient setting following institutional review board approval. Eight surgeons with varying levels of experience applied both the GRASP Hand and a traditional plaster splint to a single healthy subject in randomized sequence. The primary outcome was application time. Secondary outcomes included index finger metacarpophalangeal joint (MPJ) flexion angle immediately after application and again at 10 minutes. During the observation period, the subject performed light functional tasks to approximate low-demand activity. Paired t-tests were used for statistical comparison.

RESULTS: The GRASP Hand demonstrated significantly reduced application time compared to plaster splinting (23.5 ± 5.1 seconds vs. 359 ± 81.4 seconds, P < .001). Both methods achieved intrinsic-plus positioning; however, the GRASP Hand produced more consistent initial MPJ flexion (73.9° ± 3.8° vs. 64.4° ± 11.4°) with reduced inter-user variability. Maintenance of positioning over 10 minutes was comparable between groups (angle change: 4.3° ± 1.4° vs. 3.9° ± 5.0°, P = .863). No complications or device failures were observed.

CONCLUSIONS: A motion-permissive hand stabilization system enabled rapid, reproducible achievement of intrinsic-plus positioning while maintaining short-term positional stability comparable to plaster splinting. These findings support the feasibility of rapid functional hand stabilization in operational environments where evacuation delays, limited resources, and preservation of functional capability are critical considerations. Emerging evidence supporting controlled motion and functional hand-based stabilization suggests that early protected mobilization may reduce stiffness and improve functional recovery while maintaining fracture alignment in appropriately selected injuries. This approach may represent a complementary strategy within the military trauma care continuum for select hand injuries not requiring rigid immobilization.

CLINICAL TRIAL REGISTRATION: Identifier: NCT06592040.

PMID:42520311 | DOI:10.1093/milmed/usag348

Animal Model Exp Med. 2026 Jul 28. doi: 10.1002/ame2.70268. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic and behavioral traits in mice exhibit substantial variability across strains, ages, and disease states, which can confound preclinical study outcomes. However, systematic characterization of these parameters (e.g., energy metabolism, activity, and feeding behavior) across diverse experimental conditions remains limited.

METHODS: Core metabolic and behavioral parameters were assessed via metabolic cages in five 8-week-old mouse strains (ICR, C57BL/6J, BALB/c, BALB/c-nude, NOD-SCID), six C57BL/6J age groups (3 weeks to 18 months), and four mouse disease models (LPS-induced pneumonia, chronic kidney disease, acute myocardial infarction, and type 1 diabetes). Data were stratified by light/dark cycles and statistically compared.

RESULTS: Herein, metabolic and behavioral phenotypes of mice were systematically characterized across different strains, ages, and four disease models (three organ-specific, one systemic). Distinct strain- and age-related differences in basal metabolism, activity, and energy expenditure were observed. Specifically, ICR mice displayed higher basal aerobic metabolism, whereas C57BL/6J mice exhibited greater locomotor activity; metabolism and energy balance also underwent marked shifts during development, pregnancy, and aging. Furthermore, all disease models presented unique metabolic rearrangements: LPS-induced acute pneumonia reduced aerobic metabolism and locomotor activity; CKD caused hypometabolism, polydipsia, and a substrate shift to carbohydrate oxidation; AMI increased respiratory exchange ratio (RER) and water intake; and T1DM induced polyphagia and polydipsia, with normal metabolism but impaired energy utilization.

CONCLUSIONS: Mouse metabolic and behavioral phenotypes are highly dependent on strain, age, and disease state. These findings highlight the need to standardize experimental conditions (e.g., age, strain, disease state) and account for baseline variability when designing preclinical studies.

PMID:42520300 | DOI:10.1002/ame2.70268