Nevin Manimala

Spec Care Dentist. 2026 Jan-Feb;46(1):e70135. doi: 10.1111/scd.70135.

ABSTRACT

AIMS: Malnutrition is common among individuals with intellectual disabilities, and behavioral resistance may limit access to routine oral care. This study examined the association between refusal of oral care and poor nutritional status.

METHODS: In this cross-sectional study, conducted between February and March 2025, we assessed 55 adults with intellectual disabilities living in two designated residential support facilities for persons with disabilities in Fukuoka, Japan. Nutritional status was evaluated using the Mini Nutritional Assessment-Short Form. Oral care refusal was identified from staff records. Functional and body composition data were obtained using the Functional Independence Measure, Barthel Index, and bioelectrical impedance analysis.

RESULTS: The at-risk/malnourished group had significantly lower BMI, fat mass, and functional scores, and a higher rate of oral care refusal (p = 0.007). Logistic regression showed that oral care refusal [OR = 9.23 (95% confidence interval (CI): 1.10-77.33], lower fat mass [OR = 0.78 (0.66-0.92)] were independently associated with poor nutritional status (FIM-Eating [OR = 0.86 (0.53-1.39)], gender [OR = 0.44 (0.08-2.27)], age [OR = 0.96 (0.90-1.02)]). AUC was 0.90 (0.81-0.98).

CONCLUSION: Oral care refusal may indicate increased risk of malnutrition among adults with intellectual disabilities. Larger, longitudinal studies are needed to confirm these findings.

PMID:41482509 | DOI:10.1111/scd.70135

J Appl Clin Med Phys. 2026 Jan;27(1):e70447. doi: 10.1002/acm2.70447.

ABSTRACT

BACKGROUND: Progress in mitigating plan degradation due to intrafraction patient motion may involve the identification and management of specific control points that are sensitive to motion. Robust planning in this manner could improve deliverable dosimetry and support advancements toward reducing planning target volume (PTV) margins.

PURPOSE: To improve radiotherapy plan quality robustness in the presence of intrafraction motion by identifying the control-point-specific dosimetric sensitivities. This work explores control-point-specific plan characteristics that impact dosimetry by retrospectively assessing the consequence of simulated patient scenarios for cranial radiotherapy.

METHODS: Single target cranial volumetric modulated arc therapy (VMAT) treatment plans (n = 30) were converted into static field plans and reconstructed by applying 3D control-point-specific motion traces (n = 100) using our in-house MATLAB application. PTV coverage (volume covered by 100% of the prescription isodose, VRx) and the differences in minimum dose delivered to 99% (D_99%) of the gross tumor volume (GTV) were examined across the patient cohort as these are pertinent metrics for each structure. To identify the individual control points where motion led to target coverage loss, three patient plans (5 and 14 were randomly chosen, and 19 with the greatest range in prescription dose coverage) were selected for an area under the curve (AUC) analysis of control point dose volume histograms (DVHs). The mean dose difference in the area under the curve of control point DVHs (mAUC), and the standard deviation of differences (sAUC) were the metrics used in the investigation. Multileaf collimator (MLC) aperture areas were also explored as a function of these metrics.

RESULTS: Under conditions of simulated intrafraction motion, PTV coverage spanned from -2.8% to +0.73% of target volume with 78.6% of the three thousand motion traces resulting in coverage loss. There were no changes in GTV D_99% that exceeded ± 1.5%. For the in-depth control point analysis, MLC aperture areas formed weak to moderately weak correlations with sAUC (r = -0.19, r = -0.42, and r = -0.32, p < 0.01 for patient plans 5, 14, and 19 respectively). In addition, two statistically distinct sub-populations of MLC aperture areas were confirmed by Welch corrected t-tests (p < 0.0001, p = 0.02, p = 0.005 for cases 5, 14 and 19) across a threshold of ± 0.05 mGy in mAUC.

CONCLUSION: This work has demonstrated that the dosimetric impact of intrafractional motion reflects the inherent motion sensitivity of specific control points. Our findings suggest that motion sensitive control points could be selectively targeted for gating to enhance robustness against intrafraction motion and improve dosimetry in support of a PTV margin reduction strategy. Single target cranial plans serve as ideal cases to characterize the consequences of motion at the control point level with the aim of expanding the analysis to other anatomical regions.

PMID:41482505 | DOI:10.1002/acm2.70447

BJU Int. 2026 Jan 2. doi: 10.1111/bju.70130. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the cost-effectiveness of proficiency-based progression (PBP) training compared to conventional surgical training approaches, and to determine whether PBP training implementation is economically justified when scaled to large numbers of trainees.

METHODS: Economic analysis was performed using data from the prospective, randomised, and blinded Orsi Surgical Skills E-learning Trial (OSSET; ClinicalTrials.gov identifier: NCT04541615) at ORSI Academy (Belgium), where 47 medical trainees without prior robotic surgery experience were randomised into four groups, each with progressively reduced adherence to the PBP methodology. All trainees completed simulation-based training on a validated bladder-urethra anastomosis model, ranging from full PBP training with metric-based assessment and proficiency benchmarks (Group 1) to a traditional apprenticeship model (Group 4). The primary outcome was training cost, evaluated per trainee and based on programme scalability (12-500 trainees), including expenses for accommodation, laboratory time, and metric development. Cost equivalence points and scalability thresholds were identified to compare the financial impact of the four training strategies.

RESULTS: The PBP training was more expensive than conventional methods for small cohorts (e.g. €14 139 vs €7067 per trainee for 12 trainees), but became significantly more cost-effective beyond 25 trainees (equivalence point). At 500 trainees, total PBP training cost was €1.69 million compared to €3.53 million for conventional training, a 110% cost advantage. All differences were statistically significant (P < 0.001).

CONCLUSIONS: We conclude that PBP training is significantly more effective and becomes increasingly cost-efficient as the number of trainees increases. These findings support its integration into high-volume national training programmes, offering a scalable and economically sustainable alternative to apprenticeship-based surgical education.

PMID:41482504 | DOI:10.1111/bju.70130

Aust Vet J. 2026 Jan 2. doi: 10.1111/avj.70055. Online ahead of print.

ABSTRACT

INTRODUCTION: Dietary supplements (DS) are increasingly used in pet care, yet their use in cats remains underexplored, particularly in Southeast Asia. Understanding owner motivations, usage patterns and perceptions is essential for informing veterinary guidance and regulatory policies. This study aims to investigate the prevalence, usage patterns and associated factors of DS use for pet cats among Malaysian cat owners, while comparing perceptions between users and nonusers.

METHODS: A cross-sectional online survey was conducted from March to April 2024 among Malaysian cat owners aged ≥18 years. A structured, content-validated questionnaire assessed sociodemographics, DS usage, perceptions and decision-making. Descriptive statistics, Chi-squared tests and univariate and multivariate logistic regression analyses were used to examine factors associated with DS use.

RESULTS: Among 352 respondents, 58.0% reported administering DS to their cats, with multivitamins (73.0%), omega-3 fatty acids (37.3%), probiotics (26.5%) and fibre supplements (22.1%) being the most common. Key motivations included health maintenance (81.9%) and disease prevention (62.3%). In multivariate logistic regression, DS use was more likely among female owners, those aged 30-39 years, suburban and urban residents, owners of four or more cats and those who had owned cats for more than 5 years. Veterinarians (68.6%) and social media (64.7%) were major information sources. While most users perceived DS as beneficial and accessible, nonusers cited product quality, safety concerns and cost as major barriers.

CONCLUSION: DS use for cats is widespread among Malaysian owners, and selected sociodemographic and ownership characteristics are independently associated with use. Nevertheless, concerns about quality, safety and professional oversight persist. Greater regulatory scrutiny, public education and veterinary-pharmacist collaboration are needed to ensure responsible supplement practices and protect feline health.

PMID:41482486 | DOI:10.1111/avj.70055

Phys Occup Ther Pediatr. 2026 Jan 2:1-19. doi: 10.1080/01942638.2025.2607054. Online ahead of print.

ABSTRACT

AIMS: Identify occupational therapy service models in Chilean schools and explore the factors that influence these models, and how they align with inclusive practices.

METHODS: This was a mixed-methods study that included a cross-sectional survey that obtained 241 valid responses from Chilean OTs working in schools, which were analyzed using descriptive statistics. Eighteen of these participants subsequently participated in four online focus groups, discussions that were analyzed using a thematic approach.

RESULTS: Participants provided more frequent direct pull-out services (68.3%) with weekly 45 min sessions, conducted mainly in an OT room or mainstream classroom. Five factors were perceived to influence services: institutional constraints, the educational community’s perspectives on OTs, characteristics of students, a persistent structural demand for a deficit-based approach, and the impact of the COVID-19 pandemic.

CONCLUSIONS: The service model of OTs in Chilean schools was characterized by difficulty aligning with inclusive practices. This reveals a praxis with a markedly medical focus, making it difficult to distinguish it from clinical practice, an essential aspect for the development of OT services in schools.

PMID:41482483 | DOI:10.1080/01942638.2025.2607054

Gut. 2026 Jan 2:gutjnl-2025-337154. doi: 10.1136/gutjnl-2025-337154. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent acute pancreatitis (RAP) or acute-on-chronic flares in chronic pancreatitis (CP) have limited preventive options beyond addressing the underlying aetiology. Statins, due to their anti-inflammatory properties, have been proposed as a potential prophylactic treatment.

OBJECTIVE: We aimed to evaluate whether simvastatin could reduce the recurrence of pancreatitis.

DESIGN: At 23 centres, we conducted a triple-blind, randomised, controlled, superiority trial enrolling patients with at least two episodes of RAP or CP flares in the previous 12 months. Participants were randomly assigned to receive simvastatin or placebo for 1 year. The primary endpoint was the recurrence of pancreatitis. The target sample size was 144 patients; however, an interim analysis was planned in the event of slow recruitment.

RESULTS: A total of 85 patients (42.1% women) were included in the interim analysis. In the intention-to-treat analysis, no significant differences were observed regarding recurrence: 46.2% simvastatin versus 44.4% placebo; OR 1.07, 95% CI 0.43 to 2.66; p=0.88, or time to recurrence. No statistically significant differences were observed in recurrence in per-protocol analysis (35.5% simvastatin vs 41.9% placebo; OR 0.76, 95% CI 0.27 to 2.12; p=0.60). Development of diabetes mellitus was more frequent in the simvastatin group (4 vs 0 patients; OR not calculable, p=0.04).

CONCLUSION: This trial, evaluating simvastatin versus placebo for the prevention of pancreatitis, did not demonstrate a reduction in recurrence rate, although results might be underpowered due to early termination. The relationship between statins in these patients and new-onset diabetes requires further investigation.

TRIAL REGISTRATION NUMBER: NCT04021498.

PMID:41482454 | DOI:10.1136/gutjnl-2025-337154

BMJ Sex Reprod Health. 2026 Jan 2:bmjsrh-2025-202984. doi: 10.1136/bmjsrh-2025-202984. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine geographical variation in utilisation of hormonal long-acting reversible contraceptives (LARCs), namely the hormonal intrauterine device (IUD) and implant.

STUDY DESIGN: Cross-sectional study of Australian women aged 15-54 years using Pharmaceutical Benefits Scheme (PBS) dispensing data from 2018 to 2021. We calculated age-standardised rates of LARC dispensing per 1000 women across each Statistical Area Level 3 (SA3) according to remoteness and socioeconomic status (SES) indices. Differences between minimum and maximum rates of LARC utilisation in SA3s were used to determine magnitude of variation.

RESULTS: Between 2018 and 2021, hormonal IUD dispensing rates increased from 18.4 to 21.6 per 1000 women in major cities, 25.2 to 30.6 per 1000 in inner regional, 25.4 to 28.7 per 1000 in outer regional, and 17.7 to 20.0 per 1000 in remote areas. This corresponded to decreases in implant dispensing rates from 14.6 to 12.6 per 1000 women in major cities, 25.3 to 23.1 per 1000 in inner regional, 28.0 to 25.3 per 1000 in outer regional, and 20.7 to 19.6 per 1000 in remote areas. Rates of LARC utilisation varied considerably across SA3s, ranging from 10.9 to 37.8 per 1000 women. Increasing SES was associated with increasing hormonal IUD rates in major cities (incidence rate ratio (IRR) 1.06, 95% CI 1.04 to 1.08), inner regional (IRR 1.06, 95% CI 1.03 to 1.09) and remote (IRR 1.44, 95% CI 1.12 to 1.85) areas, but decreasing implant rates in major cities (IRR 0.89, 95% CI 0.86 to 0.91) and inner regional areas (IRR 0.91, 95% CI 0.88 to 0.94).

CONCLUSION: Given observed variation in LARC utilisation, efforts to identify and address barriers towards more equitable access to LARC methods appear warranted.

PMID:41482450 | DOI:10.1136/bmjsrh-2025-202984

In Vivo. 2026 Jan-Feb;40(1):640-649. doi: 10.21873/invivo.14226.

ABSTRACT

BACKGROUND/AIM: A variety of actions implicated in diabetic nephropathy (DN) are attributed to inflammatory cytokines and apoptosis of tubular epithelial cells. Building on our previous research demonstrating the role of different phosphodiesterase inhibitors (PDEIs) in improving renal microcirculation, glucose lowering, and antioxidant effects in rats with DN, this study aims to further explore the anti-inflammatory and anti-apoptotic properties of PDEIs by measuring their effects on renal expression of pro-inflammatory cytokines in streptozocin (STZ)-induced diabetic nephropathic rats.

MATERIALS AND METHODS: Out of 50 adult male Sprague-Dawley rats, diabetes was induced in 40 rats by a single injection of STZ (45 mg/kg) dissolved in citrate buffer. Ten days after induction of diabetes, rats were divided into five groups (10/group): normal control, diabetic control, and 3 diabetic groups treated with pentoxifylline, sildenafil, and milrinone via drinking water for 15 successive days. Serum and kidney tissue samples were collected to evaluate the effect of treatment with PDEIs on diabetes-induced histopathological changes and expression levels of tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), apoptotic marker Bcl-2 Associated X-protein (Bax) and anti-apoptotic marker B cell lymphoma-2 (Bcl-2) in rat’s kidneys.

RESULTS: A significant increase in pro-inflammatory cytokines (TNF-α and IL-6), and apoptosis marker (Bax), with a concomitant decrease in anti-apoptotic protein (Bcl-2) were observed in diabetic rats. Treatment with PDEIs resulted in a significant decrease in renal expression of Bax, TNF-α, and IL-6, with an increase Bcl-2 expression, with slight, though not statistically significant, differences among the PDEI-treated groups.

CONCLUSION: The tested PDEIs, pentoxifylline, sildenafil, and milrinone, exhibit significant anti-inflammatory and anti-apoptotic effects, highlighting their potential in slowing the progression of diabetic nephropathy.

PMID:41482414 | DOI:10.21873/invivo.14226

In Vivo. 2026 Jan-Feb;40(1):123-135. doi: 10.21873/invivo.14178.

ABSTRACT

BACKGROUND/AIM: Pancreatic adenocarcinoma (PAAD) is an aggressive cancer type with high mortality rates. The Argonaute (AGO) gene/protein family is an evolutionary conserved family, which is responsible for post-transcriptional regulation of gene expression. Despite the fact that this family members (AGO1-4) have been linked to prognosis in some cancers, they have not been comprehensively investigated in PAAD. Therefore, this study investigates the role of AGO family members on PAAD.

MATERIALS AND METHODS: In our research, bioinformatics analyses were performed to study gene, protein and methylation levels, prognostic importance, gene-gene and protein-protein interactions, enrichment analysis, and immune infiltration analysis, using online and publicly available platforms. Additionally, real-time PCR was used to check mRNA levels in the pancreatic cell line BxPC-3.

RESULTS: mRNA (p<0.05), protein (p<0.001) and methylation (p<0.001) levels of AGO2 were statistically different between normal and tumor samples in the in silico and laboratory analyses, and high AGO2 levels were found to be linked to poor prognosis (p=0.037). Additionally, immune infiltration analysis demonstrated a close relationship between AGO2 mRNA expression and immune cells. In contrast to the consistent results of AGO2, other AGO family members (AGO1, AGO3, or AGO4) differed at the protein or methylation levels but had non-significant prognostic values.

CONCLUSION: The findings of this study indicate the potential importance of AGO2 in terms of biological functions and prognostication in PAAD.

PMID:41482412 | DOI:10.21873/invivo.14178

In Vivo. 2026 Jan-Feb;40(1):39-49. doi: 10.21873/invivo.14171.

ABSTRACT

BACKGROUND/AIM: The hypothesis that elimination of cigarette smoke-derived acetaldehyde in the saliva by slow-release L-cysteine would eliminate acetaldehyde-enhanced nicotine addiction among smokers has been tested in two randomized controlled trials (RCT) using Acetium^® lozenge (Biohit Oyj, Helsinki, Finland). Both RCTs showed a similar direction and magnitude of the effect size, but only the larger study was adequately powered to reach statistical significance.

MATERIALS AND METHODS: The two published RCTs on Acetium^® in smoking intervention included in this formal meta-analysis include: a cohort of 423 cigarette smokers, randomly allocated to intervention (n=212) and placebo arms (n =211) in Study 1, as well as a cohort of 1,998 smokers, with 996 and 1,002 subjects in the intervention and placebo arms, respectively, in Study 2. Both studies analyzed the results for intention-to-treat (ITT) and per protocol (PP) compliance groups. Random-effects (RE) meta-analysis was used to compute the summary effect size.

RESULTS: In the ITT group of Study 1, Acetium^® was more effective than placebo, with OR=1.48 (95% CI=0.87-2.54), and in Study 2, the respective OR=1.26 (95% CI=0.99-1.59). In the PP groups, the success rates in both studies were better: OR=1.65 (95% CI=0.75-3.62) and OR=1.51 (95% CI=1.12-2.02), respectively. In RE meta-analysis, the summary estimates of Acetium^® efficacy were statistically significant in both the ITT (n=2,421) and PP (n=863) analysis: OR=1.29 (95% CI=1.04-1.60, p=0.018) and OR=1.53 (95% CI=1.16-2.01, p=0.0025), respectively.

CONCLUSION: Although meta-analyses with a limited number of studies should be interpreted with caution, these data provide clear support to the concept that Acetium^® lozenge significantly (1.5-fold) increases the likelihood of successful smoking cessation as compared to placebo.

PMID:41482382 | DOI:10.21873/invivo.14171