Nevin Manimala

J Math Biol. 2026 Aug 1;93(2):29. doi: 10.1007/s00285-026-02428-9.

ABSTRACT

We study mechanisms and effects of ideal free distributions (IFDs) on an ecological community consisting of n prey and m predator species, for any positive integers n and m, by considering the corresponding diffusive Lotka-Volterra system with time-periodic coefficients. We define a notion of joint IFD in a time-periodic environment, and give necessary and sufficient conditions for it to be achieved by a subcollection of prey and predator species with suitable dispersal strategies. Next, we show, via construction of a Lyapunov functional, that such dispersal strategies are evolutionarily stable, in the sense that if a subcollection of prey and predator species adopts an ideal free dispersal strategy, then the total community must converge to an IFD for large time; if a unique combination of prey-predator species adopts an ideal free strategy, then it can drive all other species to extinction. Conversely, if a combination of prey-predator species adopts a non-ideal free dispersal strategy, then it can be invaded by some suitable mutant strategies. Our results provide insight into the evolution of spatial distribution of ecological communities with predator-prey interactions.

PMID:42542498 | DOI:10.1007/s00285-026-02428-9

Pain Ther. 2026 Aug 1. doi: 10.1007/s40122-026-00872-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Persistent postoperative low back pain remains a concern after unilateral biportal endoscopic (UBE) surgery, but the impact of surgery-related interspinous ligament edema is unclear. This study investigated whether magnetic resonance imaging (MRI)-detected interspinous ligament region edema (ISLRE) was associated with delayed pain recovery and persistent postoperative low back pain after UBE surgery.

METHODS: This retrospective cohort study included patients who underwent single-level UBE surgery between October 2021 and October 2024. On the basis of MRI within 3 days postoperatively, ISLRE was graded as grade 0 (no/minimal edema), grade 1 (localized edema), or grade 2 (diffuse or confluent edema involving most of the operated interspinous region). Clinical outcomes included visual analogue scale scores for low back pain (VAS-LBP), Oswestry disability index (ODI), and persistent postoperative low back pain, defined as 12-month VAS-LBP > 3. Multivariable linear and logistic regression analyses were performed to assess independent associations, and linear mixed-effects modeling was used to evaluate longitudinal pain recovery trajectories.

RESULTS: A total of 245 patients were included (grade 0: n = 117; grade 1: n = 74; grade 2: n = 54). Interobserver agreement for MRI grading was substantial (κ = 0.802). At 12 months, VAS-LBP scores increased progressively across edema grades (1.66 ± 1.20, 2.34 ± 1.45, and 3.54 ± 1.65 for grades 0-2, respectively; P < 0.001), while persistent postoperative low back pain occurred in 21.4%, 41.9%, and 68.5% of patients, respectively (P < 0.001). Compared with grade 0 edema, grade 2 edema was independently associated with higher 12-month pain scores (β = 1.78, 95% confidence interval [CI] 1.34-2.22; P < 0.001) and more than eightfold increased odds of persistent postoperative low back pain (odds ratio [OR] 8.90, 95% CI 4.01-19.76; P < 0.001). Linear mixed-effects modeling demonstrated significantly delayed pain recovery trajectories in higher-grade edema groups. Although statistically significant, the magnitude of ODI differences at 12 months was below the minimal clinically important difference (MCID) threshold, suggesting limited clinical relevance.

CONCLUSIONS: The extent of postoperative ISLRE, particularly grade 2 edema, may be useful for postoperative risk stratification and targeted patient management after UBE surgery.

PMID:42542473 | DOI:10.1007/s40122-026-00872-5

Evid Based Dent. 2026 Aug 1. doi: 10.1038/s41432-026-01239-7. Online ahead of print.

ABSTRACT

A COMMENTARY ON: Awawdeh L, Almesleh B, Hammouri H, Al-Qudah A. The outcome of pulp revascularization of necrotic mature permanent teeth with periapical lesions using platelet-rich fibrin versus induced bleeding: a prospective preliminary randomized clinical trial. Clinical Oral Investigations. 2026; https://doi.org/10.1007/s00784-026-06877-w .

DESIGN: A single-centre, prospective, two-arm parallel randomised clinical trial presented as a preliminary (early-phase) investigation.

CASE SELECTION: Fifty adults presenting with mature permanent teeth where the pulpal status was diagnosed as necrotic with associated periapical lesions were included. The pool of patients was allocated to one of two regenerative endodontic treatment protocols, each containing 25 patients. In one group, 25 patients underwent a procedure where a canal scaffold was generated by deliberately provoking bleeding from the periapical tissues (induced bleeding, IB). In the second group of patients, an autologous platelet-rich fibrin (PRF) membrane was placed to serve as a biological barrier. A clinical and radiographic review was done at baseline, 6 months, and 12 months after treatment completion.

DATA ANALYSIS: Pre-specified endpoints were set to determine, firstly, tooth survival and overall treatment success and secondly, periradicular healing through radiographic evaluation. Within- and between-group comparisons were made using the appropriate statistical tests and statistical significance was set at p < 0.05.

RESULTS: At the one-year mark, 98% of teeth had survived (47/48). Interestingly, survival did not differ meaningfully between the two treatment groups (p = 0.166). Both treatment options produced healing with a statistically significant reduction in periradicular pathology compared with baseline at the six- and twelve-month reviews (p < 0.001). Also, a statistically significant impact was found on the overall success rate at the endpoint (p = 0.022). In the IB group, a 100% success rate was achieved (23/23) compared to 75% in the PRF group (18/24), with a combined overall success of 85.4%.

CONCLUSIONS: Whichever treatment pathway was followed, all teeth survived the chosen regenerative endodontic procedure after 12 months. The preliminary results indicated that results and clinical outcomes were comparable. Although the IB option showed a higher overall success rate, this finding should be interpreted with caution as the results fall within the early phase clinical evidence framework. Further investigations are required to determine the superiority of one method over the other.

PMID:42542468 | DOI:10.1038/s41432-026-01239-7

Evid Based Dent. 2026 Aug 1. doi: 10.1038/s41432-026-01245-9. Online ahead of print.

ABSTRACT

BACKGROUND: Ozonated water is increasingly being explored as a gentler alternative to chlorhexidine for chemical plaque control because of its antimicrobial and anti-inflammatory properties and the absence of common side effects such as staining or altered taste. However, the evidence on its effectiveness-especially in healthy individuals-remains unclear. This systematic review and meta-analysis aimed to determine whether ozonated water is more effective than placebo or chlorhexidine mouthwash in reducing dental plaque.

METHODS: An extensive literature search was carried out across PubMed, Cochrane Library, Scopus, Web of Science, LILACS, ScienceDirect, EBSCOhost, and Google Scholar up to August 5, 2025. Randomized controlled trials involving healthy participants and comparing ozonated water with placebo or chlorhexidine were included. In total, five studies were selected for qualitative synthesis, of which four were included in the meta-analysis. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was applied to calculate standardized mean differences (SMDs) with 95% confidence intervals.

RESULTS: The meta-analysis suggested that ozonated water may provide slightly better short-term plaque reduction than placebo or chlorhexidine (SMD = -1.35; 95% CI: -2.77 to 0.06). However, as the confidence interval crossed the line of no effect, this difference was not statistically significant. Risk of bias was high in one study, unclear in three studies, and low in one study. The overall certainty for plaque reduction was rated as “low”.

CONCLUSION: While ozonated water appears to be a promising short-term option for plaque control-especially for individuals unable to tolerate chlorhexidine-the current evidence is not strong enough to confirm that it works better than standard rinses or even plain water. Well-designed, longer-term clinical trials are needed before ozonated water can be recommended for routine daily use.

PMID:42542467 | DOI:10.1038/s41432-026-01245-9

Eur J Orthop Surg Traumatol. 2026 Aug 1;36(1):314. doi: 10.1007/s00590-026-04883-y.

ABSTRACT

PURPOSE: Renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), are commonly prescribed antihypertensive medications with proposed antifibrotic and bone-protective effects. Their impact on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study evaluates the association between perioperative RAAS inhibitor exposure and postoperative outcomes after TSA.

METHODS: A retrospective cohort study using the TriNetX network identified patients undergoing primary shoulder arthroplasty (2005-2025), stratified by ACEi or ARB use. One-to-one propensity score matching was performed. Outcomes included 90-day medical complications and 1-year mechanical complications and revision.

RESULTS: Post-matching, 27,938 patients per cohort (ARB vs. control) and 30,602 per cohort (ACEi vs. control) were included. Neither ARB nor ACEi use reduced rates of manipulation under anesthesia or capsular release at one year. Both cohorts had higher 90-day rates of emergency department visits, readmission, myocardial infarction, and acute renal failure. ACEi use was additionally associated with pulmonary embolism, deep-vein thrombosis, transfusion, and sepsis. At one year, both cohorts showed higher rates of periprosthetic joint infection, aseptic loosening, and revision. Dislocation risk was increased with ACEi use only.

CONCLUSION: Perioperative RAAS inhibitor use was not associated lower rates of antifibrotic procedures following TSA. Instead, RAAS inhibitor use was associated with higher rates of several perioperative medical complications and longer-term surgical events, including infection and revision. ACE inhibitor exposure demonstrated a broader complication profile compared with ARB exposure. However, because patients receiving RAAS inhibitors often have greater comorbidity burden, these findings should be interpreted as associative rather than causal.

LEVEL OF EVIDENCE III: Retrospective Cohort Study.

PMID:42542466 | DOI:10.1007/s00590-026-04883-y

Support Care Cancer. 2026 Aug 1;34(8):820. doi: 10.1007/s00520-026-11054-6.

ABSTRACT

BACKGROUND AND AIM: The increasing incidence of cancer and the fact that the family is an important factor in cancer care; attention to the positive mental health of cancer patients should be sought to provide solutions to improve the mental health of these caregivers. The present study aimed to investigate the effect of web-based education on positive mental health of family caregivers of breast cancer patients undergoing chemotherapy in educational and treatment centers of Zahedan University of Medical Sciences.

MATERIALS AND METHODS: This study is a semi-experimental study. The statistical population of the study included all family members of breast cancer patients undergoing chemotherapy who referred to Imam Ali Hospital in Zahedan in 1402. The samples included 70 people who were randomly assigned to two groups: the intervention group and the control group. Caregivers in the intervention group received the necessary training and education for 20 days through a website prepared by the researcher. Data collection was carried out using the demographic information formula and the 9-question positive mental health questionnaire of Lockett before the intervention and 30 days after the intervention. The data were analyzed using descriptive and analytical tests using SPSS 27 statistical software and independent t-tests, paired t-tests, and chi-square tests.

RESULTS: Before the intervention, there was no significant difference between the two groups in terms of positive mental health (p = 0.43). However, after web-based training, the results of the analysis of covariance (ANCOVA) with adjustment for pre-test scores showed that the positive mental health score in the intervention group was 19.02 ± 3.05, compared to 15.94 ± 2.61 in the control group (p = 0.0001).

CONCLUSION: The findings of this study suggest that web-based educational programs can enhance the positive mental health of family caregivers of breast cancer patients undergoing chemotherapy. Accordingly, such interventions may be considered an effective supportive approach for family caregivers in oncology care settings.

PMID:42542461 | DOI:10.1007/s00520-026-11054-6

Diabetologia. 2026 Aug 1. doi: 10.1007/s00125-026-06807-1. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to evaluate hepatic, pancreatic and abdominal fat depots across glycaemic categories in Asian Indians with matched BMI, and to identify predictors of dysglycaemia.

METHODS: In this cross-sectional study, 45 adults (15 each with normoglycaemia or living with prediabetes and newly diagnosed type 2 diabetes) were matched for BMI. Fat fractions in the liver and pancreas were quantified on the basis of the proton density fat fraction (PDFF) measured using multi-echo chemical-shift-encoded MRI (CSE-MRI). We quantified the cross-sectional area of following abdominal fat compartments by MRI: subcutaneous adipose tissue (SCAT) (anterior, posterior, superficial, deep), intra-abdominal adipose tissue (IAAT), intra-peritoneal adipose tissue, retroperitoneal adipose tissue etc. Total body fat (%) and total fat mass (g) were measured using dual-energy x-ray absorptiometry (DEXA). Insulin sensitivity and beta cell function were derived from HOMA indices.

RESULTS: The hepatic fat fraction (HFF) was nearly twofold higher in the prediabetes group (10.78 ± 6.50%) and the type 2 diabetes group (10.35 ± 9.95%) compared with the normoglycaemia group (5.34 ± 4.69%), with significant differences for both comparisons (p=0.009 and p=0.026, respectively). The fat fractions in the pancreas were similarly elevated in individuals living with prediabetes (5.83 ± 4.73%) and type 2 diabetes (5.35 ± 4.75%) compared with the normoglycaemic group (2.97 ± 3.56%, p<0.05). IAAT, superficial SCAT, posterior SCAT and retroperitoneal adipose tissue were significantly higher in individuals living with prediabetes and those with type 2 diabetes than in the normoglycaemic group (p<0.05). Superficial SCAT and posterior SCAT were also significantly higher in individuals living with prediabetes compared to those with type 2 diabetes (p<0.05). After adjustment for age and BMI, only fat fractions in the liver remained an independent predictor of dysglycaemia (OR 1.11 per 1% increase; p=0.023). Each 1% increase in the fat fraction in the liver increased odds of prediabetes by 16% and those of overall dysglycaemia by 11%. HOMA-β was preserved or elevated in individuals living with prediabetes but decreased in those with type 2 diabetes.

CONCLUSIONS/INTERPRETATION: Asian Indians living with prediabetes or type 2 diabetes at a modestly increased BMI of approximately 25 kg/m² exhibit marked ectopic fat. The fat fraction in the liver independently predicted dysglycaemia. These findings highlight the need for early and aggressive interventions at the stage of normoglycaemia and prediabetes to avert beta cell decline and diabetes progression in Asian Indians.

TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/06/054228).

PMID:42542458 | DOI:10.1007/s00125-026-06807-1

Eur J Pediatr. 2026 Aug 1;185(8):632. doi: 10.1007/s00431-026-07286-7.

ABSTRACT

Sudden Unexplained Death in Youth (SUDY) requires thorough investigation to identify underlying causes and guide prevention strategies. In the Netherlands, cases are investigated using the standardized Postmortem Evaluation of Sudden Unexplained Death in Infants and Children (PESUDIC), in which autopsy is offered as a standard component. However, its invasive nature and associated time burden may limit parental acceptance. This study evaluated to what extent the cause of death can be established using a limited set of diagnostic tests compared to the standard procedure including autopsy. In this observational study, children > 2 years of age who died suddenly and unexpectedly and underwent PESUDIC, including imaging and autopsy, were included. Two expert panels, consisting of a forensic and a pediatric specialist, independently assessed early diagnostic tests available before autopsy. Cases were classified by level of diagnostic certainty and need for autopsy. Panel conclusions were compared with the reference standard: a multidisciplinary audit incorporating all available information, including autopsy findings. Sixty-six cases were included (median age 12 years (IQR 4-14.7), 63% male). Panels identified indicative information for a cause of death in 60 patients (91%). Nevertheless, autopsy was required in most cases (n = 59) to confirm the diagnosis. In 7 cases (10.6%), panels were sufficiently confident to establish the cause of death without autopsy with complete agreement with the reference standard. Causes included obstructive gastrointestinal pathology (n = 5) and diabetic ketoacidosis with dehydration (n = 2).

CONCLUSIONS: Only a small proportion of children > 2 years of age with sudden unexpected death have a cause of death that can be established with sufficient certainty at an early stage. In the vast majority of cases, the cause of death remains uncertain, supporting the recommendation to perform an autopsy.

WHAT IS KNOWN: • Autopsy in sudden unexplained death in youth is worldwide recognized as the gold standard for postmortem examination. However, its invasive nature and associated time burden may limit parental acceptance.

WHAT IS NEW: • In 7 of 60 sudden and unexplained deceased minors (10%), sufficient certainty regarding the cause of death can be obtained by other minimal invasive diagnostic test, so without the need of an autopsy. Causes without the need of an autopsy included obstructive gastrointestinal pathology and diabetic ketoacidosis with dehydration.

PMID:42542442 | DOI:10.1007/s00431-026-07286-7

Eur J Pediatr. 2026 Aug 1;185(8):633. doi: 10.1007/s00431-026-07295-6.

ABSTRACT

Obesity is a chronic relapsing disease leading to weight-related health risks for disorders such as cardiovascular diseases, type 2 diabetes, osteoarthritis, and depression. Many studies focus on these weight-related health risks. However, research on current self-reported social impacts and health complaints is limited. This study aims to investigate self-reported social impact and health complaints, received care aiming at lifestyle change, and perceived effectiveness of this care, by children with obesity and their parents. Secondarily, differences concerning sex, age, obesity-severity and frequency of received care were studied. Questionnaires were collected from children and adolescents aged 0-18 years visiting Obesity Center CGG. Data were analyzed regarding their social impacts, health complaints, received care, and perceived care effectiveness (0-10 scale). Children were categorized into sex, age, BMI, and care categories. Descriptive statistics were performed using chi-square tests and post hoc analyses to examine differences between categories. 86.8% of the patients self-reported experiencing social impact and 92.3% reported health complaints. Most frequently reported social impacts were difficulty to find fitting clothes (70.1%), problems in mobility and sports (63.7%), and bullying (41.6%); most reported health complaints were abdominal pain (38.8%), headache (34.8%), and musculoskeletal pain (34.1%). The dietician (64.1%) was most frequently reported as received care, and effectiveness scores ranged between 0 and 4 out of 10.

CONCLUSIONS: A substantial percentage of patients experience social impacts and health complaints affecting their well-being and quality of life. Low perceived effectiveness of interventions calls for a more innovative and comprehensive care framework incorporating these children’s needs.

WHAT IS KNOWN: • Children with overweight and obesity face a wide range of adverse health consequences and social challenges. • However, the number and types of health issues experienced by children themselves and studying per range of age, BMI-stage or care trajectory have not been systematically investigated.

WHAT IS NEW: • A high percentage of children experience social impacts (87%) and health complaints (70%) aff ecting their well-being and quality of life, and perceived eff ectiveness of lifestyle interventions is low. The main reported healthcomplaints abdominal pain, headache, musculoskeletal pain and snoring loudly were mostly observed in girls withobesity aged 12-18 years, who received three or more care types. • The study demonstrated that perceived treatment effectiveness by children and parents declined with increasingobesity severity.

PMID:42542436 | DOI:10.1007/s00431-026-07295-6

Int J Gynecol Cancer. 2026 Jul 3:104852. doi: 10.1016/j.ijgc.2026.104852. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence on the clinical utility of baseline human epididymis protein 4 levels and their kinetics in recurrent ovarian cancer remains limited. This study evaluated longitudinal human epididymis protein 4 dynamics in real-world patients treated with platinum-based chemotherapy, aiming to determine the prognostic significance of human epididymis protein 4 kinetic parameters compared with CA125 response and established prognostic factors for progression-free and overall survival.

METHODS: This retrospective analysis included 220 patients with recurrent epithelial ovarian cancer treated with second-line platinum-based chemotherapy between 2000 and 2020. Four mathematical models were tested to describe human epididymis protein 4 kinetics, with model selection based on goodness of fit, visual predictive checks, and prognostic performance. The prognostic value of the most informative human epididymis protein 4 kinetic parameter (the modeled residual human epididymis protein 4 level), was assessed in univariable and multi-variable analyses.

RESULTS: Among the 93 assessable patients, no clear associations were observed between baseline human epididymis protein 4 levels and disease characteristics. Longitudinal human epididymis protein 4 kinetics differed from those of CA125 and showed an initial decline followed by a plateau at approximately 40 days. The best-fitting model was a mono-exponential decline incorporating the modeled residual human epididymis protein 4 parameter, which was subsequently evaluated as a prognostic factor. Baseline human epididymis protein 4 levels lacked prognostic significance for progression-free or overall survival. In contrast, a higher modeled residual human epididymis protein 4 level was significantly associated with shorter progression-free and overall survival in univariable analyses (residual human epididymis protein 4 ≥median vs <median; median progression-free survival: 7.2 vs 12.6 months, p =.002; median overall survival: 16.5 vs 34.9 months; p =.001) and in multi-variable models (overall survival: hazard ratio 2.65; 95% confidence interval 1.23 to 5.71, p =.012) alongside CA125 response.

CONCLUSIONS: In this study, we identified residual HE4 levels in patients treated with second-line platinum-based chemotherapy as an independent dynamic marker of overall survival, with higher levels indicating poorer outcomes and potential chemoresistance.

PMID:42542430 | DOI:10.1016/j.ijgc.2026.104852