Nevin Manimala

Biomed Eng Online. 2026 Feb 6. doi: 10.1186/s12938-026-01532-7. Online ahead of print.

ABSTRACT

BACKGROUND: The use of lower limb exoskeletons in clinical rehabilitation has expanded in recent years, offering potential benefits for walking recovery. However, current clinical evidence on their effectiveness remains inconclusive. Additionally, the way individuals adapt to these robotic devices and how this adaptation contributes to functional improvements is not yet fully understood. This study was intended to (1) investigate the safety and feasibility of the Fourier X2 exoskeleton for walking rehabilitation and (2) examine its effect on walking function following a rehabilitation program.

METHODS: A randomized controlled trial was undertaken with 46 individuals who had suffered a spinal cord injury (SCI) within the last year. Participants were randomly allocated into two groups: an intervention group (IG), which received gait training using the Fourier X2 exoskeleton, and a control group (CG), which underwent conventional gait training. Each participant completed 20 gait training sessions lasting one hour. The neurological impairment ranged from C2 to L4, with participants classified under the American Spinal Injury Association Impairment Scale (AIS) C or D. The treatment program involved 20 gait training sessions, each lasting one hour, utilizing the Fourier X2 exoskeleton. Safety was assessed by tracking adverse events, while pain and fatigue levels were measured using the Visual Analogue Scale (VAS). Functional outcomes were evaluated through the Lower Extremity Motor Score (LEMS), Walking Index for Spinal Cord Injury II (WISCI-II), Spinal Cord Independence Measure III (SCIM-III), and various walking assessments, including the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Timed Up and Go (TUG).

RESULTS: No major complications were observed during the study. Participants in the intervention group (IG) reported experiencing mild pain (1.7 cm, SD 1.1) and moderate fatigue (3.3 cm, SD 1.6) as measured by the Visual Analogue Scale (VAS, 0-10 cm range). Statistical analysis of WISCI-II scores showed notable progress in both the “group” effect (F = 17.82, p < 0.001) and the “group-time” interaction (F = 7.27, p = 0.03). Further post-hoc evaluations revealed that the IG achieved a significant improvement of 3.20 points (SD 2.16, p < 0.0001), whereas the control group (CG) demonstrated a minor, non-significant increase of 0.5 points (SD 1.31, p = 0.32). No other variables showed significant differences between the two groups.

CONCLUSIONS: The Fourier X2 exoskeleton is both safe and well-tolerated in clinical environments. Participants who received training with the device exhibited enhanced walking independence, as reflected in their WISCI-II scores.

TRIAL REGISTRATION: The Chinese Clinical Trial Register (ChiCTR) includes this study under registration number ChiCTR2000041186, dated December 21, 2020.

PMID:41652436 | DOI:10.1186/s12938-026-01532-7

Parasit Vectors. 2026 Feb 6. doi: 10.1186/s13071-026-07284-6. Online ahead of print.

ABSTRACT

BACKGROUND: Angiostrongylus cantonensis (rat lungworm) infection causes neuroangiostrongyliasis, a parasitic disease characterized by eosinophilic meningitis and meningoencephalitis. Within the central nervous system (CNS), larval migration and degeneration provoke neuroinflammation involving microglia and astrocytes. Albendazole (ABZ) is the mainstay treatment but may exacerbate inflammation through antigen release from dying worms. Doxycycline (DOX), a tetracycline antibiotic with anti-inflammatory and neuroprotective properties, can attenuate glial activation and matrix metalloproteinase activity. As a follow-up to our previous work on ABZ-DOX treatment outcomes, this study evaluated whether ABZ-DOX co-therapy (co) provides antiparasitic and neuroprotective benefits associated with interleukin (IL)-33/glial fibrillary acidic protein (GFAP) regulation in A. cantonensis-infected mice.

METHODS: A laboratory-maintained Taiwan strain of A. cantonensis was used to infect 7-8-week-old C57BL/6 and BALB/c mice (50 third-stage larvae/mouse). For terminal analyses (histopathology, western blotting, and enzyme-linked immunosorbent assay [ELISA]), animals were allocated to eight groups: uninfected control, infected untreated, early ABZ (7-21 days post infection [dpi]), late ABZ (14-21 dpi), early DOX (7-21 dpi), late DOX (14-21 dpi), early ABZ-DOX co-therapy (co; 7-21 dpi), and late co-therapy (co; 14-21 dpi); all were euthanized at 21 dpi. Parasite recovery was performed in an independent cohort following the early-treatment schedule. Magnetic resonance imaging (MRI; 7.0 T) was conducted in a separate longitudinal BALB/c cohort (infected untreated versus early co) scanned up to 28 dpi. Statistical analyses were conducted using t-tests.

RESULTS: In an independent cohort treated using the early schedule (7-21 dpi), ABZ-containing regimens reduced worm recovery to near-zero levels in both strains. Histopathology showed eosinophilic meningitis, perivascular inflammation, and hemorrhagic changes in infected brains; these lesions were reduced in treated groups, with the most consistent improvements observed in the early co-therapy group relative to infected untreated controls. In a separate longitudinal MRI cohort (BALB/c; infected untreated versus early co-therapy), T2-weighted images demonstrated reduced hyperintensity and edema-like signal changes after early co-therapy. Western blot analyses indicated infection-associated GFAP upregulation and IL-33 alterations across brain regions, whereas co-therapy shifted these markers toward uninfected levels in a region- and strain-specific manner. Serological ELISA showed increased A. cantonensis-specific immunoglobulin (Ig)A/G/M reactivity in infected mice, which was reduced in treated groups.

CONCLUSIONS: ABZ-DOX co-therapy was associated with reduced parasite recovery and multilevel improvements across pathology, MRI, and glial markers in mice neuroangiostrongyliasis. These findings support ABZ-DOX co-therapy as a candidate regimen for further investigation in the management of A. cantonensis-associated neuroinflammation.

PMID:41652430 | DOI:10.1186/s13071-026-07284-6

BMC Womens Health. 2026 Feb 6. doi: 10.1186/s12905-026-04330-4. Online ahead of print.

ABSTRACT

BACKGROUND: With the increasing public awareness of health, TikTok and Bilibili have become the domain source of short-video platforms for health-related information. This study aims to investigate the quality and reliability of short videos about endometrial cancer on two platforms.

METHODS: This cross-sectional study was conducted on TikTok and Bilibili to evaluate short videos related to endometrial cancer. The two platforms were searched using the term ‘endometrial cancer’ from 15:00 to 22:00 on 29 September 2025. The quality of related information was assessed by the Global Quality Score (GQS) and the modified DISCERN score (mDISCERN), and analyzed by descriptive statistics, inter-group comparison, and correlation analysis.

RESULTS: 200 initial endometrial cancer-related videos were searched, and finally, 174 videos were included from TikTok and Bilibili. The GQS and mDISCERN scores of both platforms were low (median 2/5), and the median(Q1-Q3) duration of these videos was 80 s (46.50-144.50), and the duration of Bilibili videos was longer (111 s to 63 s, P < 0.001). The engagement with TikTok videos was relatively high (median likes: 1342 to 6, P < 0.001). Expert-uploaded videos were longer than those from other origins (median 109 s) and of better quality (median mDISCERN 3/5, P < 0.001). The quality component was positively associated with the duration of short videos(r = 0.42-0.46). The five major dimensions of health demonstrated “fragmented content and insufficient depth”: the highest coverage rate of symptoms was 36.2%, while the lowest coverage rate of prevention was 3.5%; the coverage rates of etiology, diagnosis, and therapy were all below 20%.

CONCLUSIONS: Significant quality gaps exist in endometrial cancer videos. To enhance the structure and completeness of health information, professional participation should be strengthened in the future.

PMID:41652427 | DOI:10.1186/s12905-026-04330-4

BMC Urol. 2026 Feb 7. doi: 10.1186/s12894-026-02050-3. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the efficacy and safety of modified water vapor thermal therapy for large-volume benign prostatic hyperplasia (BPH).

METHODS: This prospective study enrolled 196 consecutive patients with prostate volume ≥ 80 mL who underwent modified water vapor thermal therapy at our institution between October 2023 and September 2024. All procedures were performed using the Rezum system.

RESULTS: The procedures were successfully completed in all 196 patients with a median prostate volume of 96 mL. The IPSS decreased from a preoperative mean of 21.2 ± 3.9 to 11.7 ± 3.4 at 3 months, and further improving to 10.8 ± 3.8 at 1 year. Median prostate volume reduced from 96 mL to 60 mL. The QoL score improved from 4.3 ± 0.9 to 1.7 ± 1.1, and Qmax increased from 8.3 ± 2.3 mL/s to 15.7 ± 3.5 mL/s at 3 months. All observed improvements were statistically significant compared to baseline (P < 0.01). The IIEF-5 score increased from 11.0 ± 3.6 to 14.1 ± 5.4 at 1 year, indicating a statistically significant improvement in erectile function (P < 0.05). The incidence of retrograde ejaculation was 3.1%. Only one patient (0.5%) required surgical retreatment during the follow-up period.

CONCLUSIONS: Modified water vapor thermal therapy demonstrates favorable efficacy and safety in the treatment of large-volume BPH. It is associated with significant symptom relief, functional improvement, and minimal complications.

PMID:41652420 | DOI:10.1186/s12894-026-02050-3

BMC Med Educ. 2026 Feb 9. doi: 10.1186/s12909-026-08699-6. Online ahead of print.

ABSTRACT

AIMS: To explore undergraduate dental students’ AI knowledge, perceptions, and concerns, and to identify their educational needs based on these findings.

METHODS: A cross-sectional, anonymous survey was conducted using a 30-item online questionnaire distributed to dental schools across multiple countries. The survey employed an exploratory, observational approach with convenience and snowball sampling methods. The population included dental students from all academic semesters, and participation in the survey was voluntary. The questionnaire consisted of multiple-choice and Likert-scale questions organized into five sections: consent form, demographic data, knowledge/awareness, perceptions/attitudes, and ethics-related questions. Data were analysed using Jamovi and R. Descriptive statistics summarised the demographic characteristics and responses to survey questions. Non-parametric correlation analysis was employed as a primary measure of association for relationships between ordinal variables. For regression analyses, ordinal logistic regression models were constructed to identify predictors for specific outcomes. For each Likert scale question, an ordinal logistic regression model was constructed (dependent variable), with the knowledge questions score as a covariate and the nominal answered questions as factors.

RESULTS: 508 students completed the questionnaire. Most students (76.2%) agreed they understood what AI entails, and 67.4% were familiar with generic AI tools; however, only 34.7% knew AI’s dental applications. 70.3% supported AI education during undergraduate studies, favoring case-based teaching, and 53.7% felt their current education had not adequately prepared them for AI technologies. Students declared that AI would be beneficial in diagnostic analysis (64.5%), enhance clinical practice (69.5%), and improve patient care (60.4%). Also, 41.7% believed that AI would cause a reduction in professionals’ skills and dehumanize healthcare (29.2%). 3/4 students agreed that AI ethics should be taught from a multidisciplinary perspective, and 65.3% declared AI in healthcare should be legally regulated.

CONCLUSIONS: This study establishes baseline data on dental students’ AI knowledge and educational requirements across multiple countries. Despite general AI familiarity, understanding of dental applications remains limited. The results highlight the need for structured AI education programs tailored to students’ knowledge gaps and learning preferences. Dental students’ understanding and perceptions of AI can effectively guide the identification of their learning needs and inform curriculum integration.

PMID:41652399 | DOI:10.1186/s12909-026-08699-6

BMC Oral Health. 2026 Feb 6. doi: 10.1186/s12903-026-07837-2. Online ahead of print.

ABSTRACT

BACKGROUND: To investigated the combined effect of adhesive type and film thickness on dentin bond strength by comparing one and two-step universal adhesives applied in single and double layers.

METHODS: Forty caries-free human third molars were collected and standardized Class I cavities were prepared. Specimens were restored using one-step (Clearfil Tri-S Bond Universal, Japan) and two-step (G2-Bond Universal, Japan) universal adhesive systems. Each group was subdivided into single and double-layer applications, light-cured, and restored with a universal composite resin. Sticks with a cross-sectional 1 × 1 mm² were prepared for testing. Adhesive film thickness was measured under a stereomicroscope at ×80 magnification. Micro-tensile bond strength (µTBS) was evaluated either immediately or after 5000 thermocycles (TC). Failure modes were assessed under ×40 magnification. Wilcoxon Signed Ranks Test was used for paired comparisons of immediate and after TC tensile bond strengths. Mann-Whitney U test compared single vs. double layers of the adhesives. For adhesive film thickness, Independent Samples t-test was applied for group comparisons (p < 0.05).

RESULTS: Double-layer application produced significantly thicker adhesive films for Clearfil Tri-S Bond and G2-Bond Universal compared with single-layer application (p < 0.05). However, no significant differences in µTBS were observed between single and double-layer groups of either adhesive, regardless of aging. Thermocycling significantly reduced bond strength for both systems (p < 0.05). Overall, the two-step adhesive demonstrated higher µTBS values than the one-step adhesive.

CONCLUSION: Although double-layer application increased adhesive film thickness, it did not improve dentin bond strength. The two-step universal adhesive system showed superior bonding performance compared with the one-step system, both immediately and after thermocycling.

PMID:41652397 | DOI:10.1186/s12903-026-07837-2

BMC Ophthalmol. 2026 Feb 6. doi: 10.1186/s12886-026-04651-w. Online ahead of print.

ABSTRACT

PURPOSE: Diabetic macular edema (DME) is a leading cause of vision loss in patients with diabetes. In developed countries, intravitreal (IVT) anti-vascular endothelial growth factor (VEGF) injections are the standard-of-care first-line treatment for DME. However, despite the efficacy of anti-VEGF and associated improvements in prognosis, some patients show only a partial response and continue to require monthly injections. The aim of this study was to investigate the effect of switching from aflibercept 2.0 mg to faricimab (which targets both angiopoietin-2 [Ang-2] and VEGF-A) on visual function, retinal anatomy and intraretinal fluid (IRF) dynamics in patients with refractory DME.

METHODS: A single-center, observational study of patients with aflibercept-resistant DME who switched to IVT faricimab treatment, comprising a 3-month loading phase, during which faricimab was administered monthly (total of four injections), followed by a treat-and-extend regimen. Visual acuity, anatomical parameters, and fluid dynamics were assessed from baseline to Month 6 in an interim analysis.

RESULTS: Fourteen eyes from 10 patients were included. At Month 6, mean best-corrected visual acuity improved by + 2.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (not statistically significant). Mean changes in central macular thickness and outer nuclear layer (ONL) thickness at Month 6 were not significant. However, ONL thickness was significantly reduced in multiples ETDRS macular grid subfields at Month 4. Subretinal fluid volume was negligible through Month 6, with most fluid located in the intraretinal layers (97.8-100%). Total IRF decreased by 22% at Month 4, reaching a nadir of – 37% at Month 2. There was no significant change in mean vascular density from Month 0 to Month 4.

CONCLUSION: Faricimab treatment led to modest early improvements in visual acuity and retinal anatomy overall in patients with refractory DME. The reduction in total IRF at Month 4 may be attributable to Ang-2 inhibition in these patients, who had previously not responded to anti-VEGF treatment alone. Longer-term studies are needed to evaluate the durability and long-term efficacy of faricimab for the treatment of refractory DME.

PMID:41652390 | DOI:10.1186/s12886-026-04651-w

BMC Nurs. 2026 Feb 6. doi: 10.1186/s12912-026-04387-4. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical training exposes nursing internship students to intense ethical challenges that may threaten their sense of meaning and contribute to psychological emptiness. Protective psychological and moral resources, such as purposefulness and moral resilience, may play a crucial role in mitigating this existential vulnerability.

OBJECTIVE: This study aimed to test a structural model examining the direct and indirect associations between purposefulness and psychological emptiness, with moral resilience as a mediating variable, among nursing internship students.

METHODS: A cross-sectional study was conducted among 215 nursing internship students in Tabriz, Urmia, and Ardabil, Iran. Data were collected using the Sense of Purpose Scale-Revised Persian Version (SOPS-2-PERS), the Rashed Moral Resilience Scale (RMRS), and the Psychological Emptiness Scale (PES). Descriptive and inferential analyses were performed using SPSS v14. Structural equation modeling (SEM) with bias-corrected bootstrap procedures (5000 resamples) was conducted in AMOS 24.0 to examine the hypothesized relationships.

RESULTS: The proposed structural model demonstrated a good fit to the data. Purposefulness was positively associated with moral resilience, and moral resilience was negatively related to psychological emptiness. Although the direct association between purposefulness and psychological emptiness was negative, it did not reach statistical significance. Bootstrap analysis confirmed a significant indirect effect of purposefulness on psychological emptiness through moral resilience, indicating that the association was transmitted mainly via moral resilience.

CONCLUSION: The findings suggest that moral resilience plays a key mediating role in the relationship between purposefulness and psychological emptiness. Enhancing students’ sense of purpose may reduce psychological emptiness, primarily by strengthening moral resilience during clinical training.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41652387 | DOI:10.1186/s12912-026-04387-4

BMC Public Health. 2026 Feb 6. doi: 10.1186/s12889-026-26516-z. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep represents a key modifiable risk factor for cardiovascular diseases (CVDs). Although previous studies have examined separate associations of nighttime sleep duration and napping duration with CVDs, few have investigated their combined effects or elucidated how this association differs across age or gender. This study aimed to assess how different sleep combinations influence the CVD risk.

METHODS: This study used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2020. Baseline information on sleep and other relevant variables was obtained through self-reported questionnaires, and incident CVDs were identified during follow-up. Cox proportional hazards regression models were applied to evaluate independent and combined effects of nighttime sleep duration and napping duration on CVD incidence. Stratified analyses by age and gender explored potential heterogeneity, and sensitivity analyses were conducted to test result robustness.

RESULTS: A total of 7,975 participants were included, of which 2,117 participants (26.55%) developed CVDs after follow up. After adjusting for confounders, insufficient nighttime sleep (< 6 h) was independently associated with a higher risk of CVDs (hazard ratio [HR]: 1.189, 95% confidence interval [CI]: 1.071-1.319). Compared with participants having moderate nighttime sleep without napping, those with < 6 h/night without napping (HR: 1.177, 95% CI: 1.021-1.357), < 6 h/night with napping duration ≤ 0.5 h (HR: 1.558, 95% CI: 1.236-1.962), and < 6 h/night with napping duration > 1 h (HR: 1.300, 95% CI: 1.020-1.655) had significantly higher CVD risk. Among these, the combination of < 6 h/night with napping duration ≤ 0.5 h was associated with the highest observed CVD incidence. Stratified analysis revealed significant heterogeneity by gender, with less pronounced associations between sleep combinations and CVD risk in men compared with those in women. Sensitivity analyses supported the robustness of findings.

CONCLUSIONS: Adequate nighttime sleep is associated with lower CVD risk. Most combinations of insufficient nighttime sleep and daytime nap increased CVD risk among middle-aged and older adults. However, the combination of insufficient nighttime sleep with moderate napping was not associated with increased CVD risk in this population. These results provide a scientific foundation for targeted sleep interventions and clinical guidance.

PMID:41652381 | DOI:10.1186/s12889-026-26516-z

BMC Pregnancy Childbirth. 2026 Feb 7. doi: 10.1186/s12884-026-08721-1. Online ahead of print.

ABSTRACT

BACKGROUND: Early pregnancy loss (EPL) is a global public health concern with significant physical and psychological effects on individuals and society. The specific etiology of many EPL cases is not well understood, and first trimester maternal diet may play a role in EPL occurrence. This study aimed to examine the differences in first trimester maternal nutrient intake, nutritional habits and nutritional knowledge levels between healthy pregnant women and women who experienced EPL.

METHODS: A single center retrospective case-control study was conducted at a public hospital in Istanbul, Turkey between May-October 2024. The case group comprised 65 women who experienced first-time pregnancy loss. The control group included 65 healthy pregnant women in the first trimester without a previous PL history, with both groups matched for age, body mass index (BMI) and parity. Data were collected from the participants regarding their general information, dietary habits, the Quantitative Food Frequency Questionnaire (QFFQ), and the Nutrition Knowledge Level Scale for Adults (NKLSA). Dietary nutrient intakes were evaluated on the basis of the Dietary Reference Intakes (DRI) values and compared between the two groups. To further investigate the link between specific dietary nutrient intakes and EPL risk, adjusted binary logistic regression models were employed.

RESULTS: The mean age of the participants was 28.5 years, and their mean BMI was 24.20 kg/m². The dietary intake of carbohydrates, dietary fiber, monounsaturated fatty acids, omega-3 fatty acids, folate, vitamin C, potassium, iodine and total minerals were statistically higher in the control group (p < 0.05). Dietary vitamin D and cholesterol intake and the omega-6/omega-3 ratio were greater in the case group without statistical significance (p > 0.05). The control group presented significantly higher proportions of dietary supplement use, regular consumption between meals, and higher daily meal number (p < 0.05). Adjusted binary logistic regression analysis revealed negative correlations between total dietary fiber intake (continuous and Q3/Q4) and EPL risk in all models, even after adjusting for all potential confounders (p < 0.05). There was no statistically difference regarding nutrition knowledge level between two groups (p > 0.05).

CONCLUSIONS: This study contributes to the literature by showing the protective role of maternal nutritional status in the first trimester against EPL risk.

PMID:41652374 | DOI:10.1186/s12884-026-08721-1