Nevin Manimala

Medicine (Baltimore). 2026 May 1;105(18):e48510. doi: 10.1097/MD.0000000000048510.

ABSTRACT

The link between salt intake and the risk of gastric cancer remains uncertain, and a causal relationship has not been established. Therefore, clarifying the causal effect of salt intake on the risk of gastric cancer using reliable causal inference methods is necessary. The aim of this study was to assess the causal association between salt intake and cancer by integrating summary-level genome-wide association study (GWAS) data. Two-sample Mendelian randomization (MR) analyses were performed using summary statistics from a GWAS. Inverse-variance weighted (IVW) regression, Mendelian randomization-Egger (MR-Egger) regression, and weighted median analyses were used to evaluate the causal relationship between salt intake and gastric cancer. Moreover, Mendelian Randomization Pleiotropy RESidual Sum of Squares and Outliers and MR-Egger analyses were used to evaluate the level of multipotency, and “leave-one-out” sensitivity analysis was assessed. The IVW method estimate indicated that salt intake was not correlated with gastric cancer incidence. The IVW (β = 0.1008, standard error [SE] = 0.1510, odds ratio [OR] = 1.1061, 95% confidence interval [CI], 0.82-1.48, P = .5042), MR-Egger regression (β = 0.059, SE = 0.5318, OR = 1.0612, 95% CI, 0.37-3.01, P = .9111), and weighted median (β = 0.2639, SE = 0.2298, OR = 1.3020, 95% CI, 0.82-2.04, P = .2508) analyses revealed no causal relationship between salt intake and gastric cancer risk (P > .05). In addition, the funnel plot and MR-Egger analysis (P = .6694 > .05) did not indicate horizontal pleiotropy or heterogeneity. GWAS data from public databases were used in this study, and the causal relationship between salt intake and gastric cancer risk was analyzed via a two-sample MR method. The results revealed no genetic causal relationship between salt intake and gastric cancer.

PMID:42065187 | DOI:10.1097/MD.0000000000048510

Medicine (Baltimore). 2026 May 1;105(18):e48373. doi: 10.1097/MD.0000000000048373.

ABSTRACT

BACKGROUND: Epicanthus, a prevalent aesthetic concern in Asian populations, can be surgically corrected using various techniques. The skin redraping method and Z-plasty are 2 widely adopted approaches. This study aimed to conduct a systematic meta-analysis to comprehensively compare the clinical efficacy and outcomes of these 2 dominant surgical methods for epicanthus correction.

METHODS: A systematic literature search was performed across PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases from their inception through December 2025. Randomized controlled trials (RCTs) and cohort studies directly comparing skin redraping and Z-plasty for congenital epicanthus were eligible. Primary outcomes included postoperative change in intercanthal distance (ICD), scar assessment via the Vancouver Scar Scale at 6 months, patient satisfaction, recurrence rate, and incidence of complications. Study quality was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for cohort studies. Statistical synthesis was performed using Review Manager 5.4 and R metafor package, employing fixed-effect or random-effects models based on heterogeneity (I2 statistic).

RESULTS: Fourteen studies (1539 patients) were included. All included studies were published in Chinese. Meta-analysis showed no significant difference in postoperative ICD reduction (mean difference = 0.56 mm, 95% confidence interval [CI]: -1.20 to 2.33, P = .53, I2 = 98%). Z-plasty yielded significantly better 6-month Vancouver Scar Scale scores (mean difference = 0.44, 95% CI: 0.31-0.57, P < .00001) and higher patient satisfaction (odds ratio [OR] = 0.39, 95% CI: 0.18-0.84, P = .02). Recurrence was significantly lower with Z-plasty (OR = 13.73, 95% CI: 2.53-74.49, P = .002), although this analysis was based on only 3 studies. Complication rates were similar (OR = 1.45, 95% CI: 0.65-3.23, P = .36).

CONCLUSION: Both techniques effectively reduce ICD with comparable safety. Within the limited follow-up period of the included studies (up to 6 months), Z-plasty was associated with better scar appearance, higher satisfaction, and lower recurrence. The high heterogeneity and exclusive inclusion of Chinese studies necessitate cautious interpretation. Future multicenter RCTs with longer follow-up and standardized technique reporting are warranted.

PMID:42065185 | DOI:10.1097/MD.0000000000048373

Medicine (Baltimore). 2026 May 1;105(18):e48553. doi: 10.1097/MD.0000000000048553.

ABSTRACT

We performed a single-center observational cohort study on patients with COVID-19. We retrospectively analyzed 54 patients with confirmed SARS-CoV-2 infection, diagnosed as critically ill. Severely ill patients have a poor prognosis and it is a matter of great interest to identify these cases for an adequate management. Current findings revealed that altered levels of some blood markers might be linked with the degree of severity and mortality of patients with COVID-19. Our study aimed to assess the relationship between inflammation and coagulation in SARS-CoV-2 infection and to find out if pro-inflammatory markers are correlated with coagulation parameters in COVID-19. Pro-inflammatory markers included leptin and classical biomarkers. This paper highlights the results obtained. We found statistically significant associations between blood levels of various biomarkers including leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and the presence of coagulopathy, as indicated by the Pearson Chi-Square and Likelihood Ratio tests. The relationships are not linear, as indicated by the nonsignificant Linear-by-Linear Association test. The correlations between some biomarkers such as leptin, IL-6, ferritin, neutrophil-lymphocyte ratio, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and lactate dehydrogenase and coagulopathy are weak and not statistically significant and the correlation between IL-6 levels and coagulopathy is very weak and negative and not statistically significant. Different crosstabulations between serum leptin levels and D-dimers, Prothrombin time, Prothrombin activity, International-normalized-ratio and activated partial thromboplastin time have been performed including the analysis of a potentional correlation. There are statistically significant associations between serum leptin levels and coagulation parameters, including D-dimers, prothrombin time, prothrombin activity and activated partial thromboplastin time, as indicated by the Pearson Chi-Square test. There is also a statistically significant association between serum leptin levels and international-normalized ratio (INR) as indicated by the Pearson Chi-Square test. The Linear-by-Linear Association test indicates a significant linear relationship between Leptin levels and international-normalized ratio. Pearson R shows a moderate positive correlation, which is statistically significant.

PMID:42065184 | DOI:10.1097/MD.0000000000048553

Medicine (Baltimore). 2026 May 1;105(18):e48549. doi: 10.1097/MD.0000000000048549.

ABSTRACT

The efficacy and adverse reactions of Maren Runchang Pills among patients of different genders remain unclear. This study aims to analyze the efficacy and safety differences of Maren Runchang Pills in patients of different genders, providing a basis for the implementation of gender-precise treatment in clinical practice. Gender-stratified analysis was adopted to include constipation-predominant irritable bowel syndrome (IBS-C) patients who met the syndrome of intestinal heat and accumulation. The efficacy and safety of Maren Runchang Pills were evaluated after 4 weeks of treatment. The main evaluation indicators include the complete spontaneous bowel movement response rates, visual analogue scale scores for abdominal pain and distension, traditional Chinese medicine syndrome scores, irritable bowel syndrome-symptom severity scale/irritable bowel syndrome-quality of life scale scores, and safety indicators. A total of 126 patients were included, among whom 101 were female and 25 were male. After 4 weeks of treatment, the proportion of female patients with a complete spontaneous bowel movement response rate of ≥75% was significantly higher than that of male patients (71.29% vs 48%, P = .0270), and the improvement in abdominal distension visual analogue scale score was also significantly better in females (decrease of 2.78 points vs 1.84 points, P = .0199). However, the total score of traditional Chinese medicine syndromes in male patients was higher than that in female patients (7.08 points vs 5.09 points, P = .0341). There were no statistically significant differences in the scores of the irritable bowel syndrome-symptom severity scale, irritable bowel syndrome-quality of life scale and safety indicators between the 2 groups. Maren Runchang Pills can effectively alleviate the constipation symptoms of patients with IBS-C, and the therapeutic effect is even better in female patients. The research results support considering gender factors in the clinical treatment of IBS-C to achieve individualized and precise intervention.

PMID:42065180 | DOI:10.1097/MD.0000000000048549

Medicine (Baltimore). 2026 May 1;105(18):e48582. doi: 10.1097/MD.0000000000048582.

ABSTRACT

This study aimed to comprehensively assess the prognostic value of routinely obtained blood-based systemic inflammatory indices in predicting all-cause mortality among individuals with chronic obstructive pulmonary disease (COPD). This retrospective cohort study analyzed data from the National Health and Nutrition Examination Survey (NHANES) cycles 2007-2010. A total of 1109 eligible adults with COPD were included, with 333 deaths recorded during the follow-up period. Eleven systemic inflammatory indices were derived from baseline hematological parameters. The associations between these indices and all-cause mortality were initially evaluated using multivariate Cox proportional hazards models. To manage high-dimensional data and identify complex patterns not captured by conventional statistical methods, machine learning (ML) algorithms were applied for feature selection, model development, and performance evaluation. Model discrimination and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Among the 1109 participants (mean age 57.9 ± 15.5 years, 52.2% male), non-survivors (n = 333) were significantly older and had a higher baseline burden of comorbidities. After full adjustment for covariates, several inflammatory indices showed statistically significant associations with all-cause mortality. The neutrophil percentage-to-albumin ratio (NPAR) and neutrophil-to-lymphocyte ratio exhibited the strongest associations, with HRs of 2.46 (95% CI: 1.64-3.69) and 2.14 (95% CI: 1.42-3.22), respectively, in the highest quartile (Q4) compared to the lowest (Q1). The neutrophil-to- high-density lipoprotein ratio also demonstrated a significant positive association (HR for Q4 vs Q1: 1.79, 95% CI: 1.18-2.70). In contrast, higher levels of the C-reactive protein-albumin-lymphocyte index index were associated with reduced risk, indicating a protective effect (HR for Q4 vs Q1: 0.49, 95% CI: 0.33-0.72). The ML-derived NPARTEST model, based on the NPAR index, achieved an AUC of 0.828 for predicting all-cause mortality, demonstrating good discriminative performance and clinical utility. Systemic inflammatory indices, particularly the NPAR and neutrophil-to- high-density lipoprotein ratio, are independently associated with all-cause mortality in patients with COPD, often exhibiting nonlinear relationships. The ML-based NPARTEST model demonstrates promising predictive performance. These findings underscore the potential of cost-effective, routinely measured blood-based biomarkers to enhance risk stratification in COPD management. External validation in diverse populations is warranted to confirm the generalizability of these results.

PMID:42065179 | DOI:10.1097/MD.0000000000048582

Medicine (Baltimore). 2026 May 1;105(18):e48381. doi: 10.1097/MD.0000000000048381.

ABSTRACT

To explore the risk factors and predictive value of Mycoplasma pneumoniae (MP) infection in children. A total of 2042 children with suspected Mycoplasma pneumoniae infection who were treated for the first time at Civil Aviation General Hospital from October 2023 to December 2023 were selected as the study subjects. Among them, 1637 cases were confirmed as Mycoplasma pneumonia-infected and were included in the pneumonia group, while the remaining 405 cases were non-Mycoplasma pneumonia-infected and were included in the non-Mycoplasma pneumonia group. The clinical data of the 2 groups of children (including gender, age, initial symptoms, laboratory indicators, etc) and the risk factors of MP infection in children were compared, and the receiver operating characteristic curve was analyzed. This study showed that the percentage of neutrophils in the non-MP infection group was significantly lower than that in the MP infection group, and the difference was statistically significant (P < .001). When comparing the percentages of lymphocyte percentage (LY) and hemoglobin in the 2 groups of children, the Mycoplasma pneumonia-infected group was lower than the non-Mycoplasma pneumonia-infected group, and the differences were both statistically significant (P < .05). Logistic regression analysis revealed that white blood cell and neutrophil-to-lymphocyte ratio (NLR) might be valuable markers for predicting MP infection. The Spearman correlation indicated that LY was collinear with the occurrence of MP infection, and Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis demonstrated that both LY and NLR might be valuable markers for predicting MP infection (P < .05). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR for diagnosing MP infection was 0.624, with a cutoff value of 1.36 (sensitivity of 0.798 and specificity of 0.558). In the diagnosis of MP infection, the consistency between the RNA method and the immunogold colloidal method was poor (Kappa = 0.108, P < .05). The consistency between the RNA method and the immunogold colloidal method in the diagnosis of MP infection is poor. Both the white blood cell and NLR are valuable markers for MP infection.

PMID:42065166 | DOI:10.1097/MD.0000000000048381

Medicine (Baltimore). 2026 May 1;105(18):e48424. doi: 10.1097/MD.0000000000048424.

ABSTRACT

BACKGROUND: Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by tear film instability and inflammation. Rebamipide 2% ophthalmic suspension, a mucin secretagogue, has been investigated as a potential treatment due to its unique mechanism targeting mucin deficiency and ocular surface repair.

METHODS: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between January 2013 and March 2025. Non-randomized and randomized controlled trials evaluating topical 2% rebamipide in patients with DED were included. Outcomes assessed included tear breakup time, Schirmer I test, fluorescein staining scores, ocular surface disease index, and adverse events. Data were synthesized using standard meta-analytic techniques and subgroup analyses.

RESULTS: Thirteen studies, including both randomized and non-randomized trials, were analyzed, comprising a total of 575 participants. Meta-analysis showed that rebamipide nonsignificantly increased tear breakup time at 2 weeks (standardized mean difference [SMD] = 1.04; 95% confidence interval (CI):-0.94 to 3.03; P = .30; I2 = 89.3%), significant at 4 weeks (SMD = 1.19; 95% CI: 0.74-1.64; P < .0001; I2 = 85%) and nonsignificant at 12 weeks (SMD = 0.97; 95% CI:-0.15 to 2.08; P = .09; I2 = 80.1%) indicating enhanced tear film stability. Schirmer I test values showed no significant improvement (SMD = 0.04; 95% CI: -0.35-0.43; P = .83), suggesting limited effect on aqueous tear production. Fluorescein staining scores showed a reduction approaching statistical significance (SMD = -0.68; P = .051), while symptom scores measured by ocular surface disease index trended toward improvement, also approaching significance (SMD = -1.17; P = .055). Subgroup analyses revealed greater efficacy in contact lens wearers and postsurgical patients. Safety analysis indicated excellent tolerability, with a high adherence rate (96.8%) and only mild adverse effects such as dysgeusia and nasopharyngitis.

CONCLUSION: Rebamipide 2% ophthalmic suspension improves tear stability and ocular surface health in mucin-deficient DED with a favorable safety profile. Further high-quality trials in diverse populations are warranted to confirm its role in global clinical practice.

PMID:42065158 | DOI:10.1097/MD.0000000000048424

Medicine (Baltimore). 2026 May 1;105(18):e48516. doi: 10.1097/MD.0000000000048516.

ABSTRACT

BACKGROUND: Peripherally inserted central catheters (PICCs) are commonly used vascular access devices in clinical practice. Due to their numerous advantages, PICCs are widely used globally. However, after decades of iteration and clinical application, while benefiting patients, PICCs also face new opportunities and challenges. Therefore, this study systematically analyzes the current status of global PICCs research through bibliometric methods and predicts future research directions and hotspots, aiming to provide references for further development and innovation of PICCs.

METHODS: CiteSpace, VOSviewer, and the bibliometrix R-package were used to perform descriptive statistics and data visualization analyses on literature from the Web of Science Core Collection. A total of 2102 articles were selected, originating from 2722 institutions across 105 countries.

RESULTS: The United States has the greatest influence in the field of PICC research, with the Michigan Health System being the most prolific institution, and Vineet Chopra being the most influential scholar. Keyword and co-citation analysis reveal hot topics: PICC catheterization techniques, complications, and clinical quality control of PICCs.

CONCLUSION: Research on PICCs is showing trends of global collaboration and interdisciplinary approaches. Artificial intelligence and other medical auxiliary technologies demonstrate great potential in addressing PICC complications and insertion challenges. Establishing efficient vascular access teams and solving PICC care issues based on evidence-based practices are crucial for ensuring quality control during PICC usage.

PMID:42065152 | DOI:10.1097/MD.0000000000048516

Medicine (Baltimore). 2026 May 1;105(18):e48551. doi: 10.1097/MD.0000000000048551.

ABSTRACT

Coronary artery disease is a major cause of mortality worldwide, particularly in developing countries. Treatments such as coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are common; however, their long-term effects on patient quality of life (QoL), particularly in developing nations, are not well understood. This study assessed and compared the QoL of cardiac patients 6 months after post-angioplasty and bypass surgery. A prospective cohort study was conducted over 5 months in 100 patients with Coronary artery disease who underwent PTCA or CABG at the Cardiology Follow-up Clinic of the same hospital. The data were collected using structured questionnaires. The result of this study shows baseline characteristics were similar between PTCA and CABG groups, except for a higher SYNTAX score in the CABG group (29.1 ± 8.6 vs 22.5 ± 7.4; P = .002). At 6 months, symptom relief was reported by 98% (PTCA) and 94% (CABG), with return-to-work rates of 94% and 88%, respectively. The rates of dyspnea, angina, and hospitalization were low and did not differ significantly between the groups. Both groups showed significant improvements in SF-36 and WHO-QoL Physical domain scores (P < .05). No deaths were recorded during follow-up period. Both PTCA and CABG significantly improved patients’ QoL at 6 months, particularly in the physical health domain. While CABG showed slightly more consistent improvements in angina and dyspnea, this was not statistically significant during the short-term follow-up.

PMID:42065151 | DOI:10.1097/MD.0000000000048551

Medicine (Baltimore). 2026 May 1;105(18):e48318. doi: 10.1097/MD.0000000000048318.

ABSTRACT

Improving the ability of humanistic care can enhance the professional identity of nursing students and establish a harmonious nurse-patient relationship. This study aims to explore the current status and influencing factors of the humanistic care ability of undergraduate nursing students. The results of this study will provide the scientific basis for cultivating nursing students with high humanistic care ability, increasing clinical nurses, and improving nursing quality. This is a cross-sectional study. From September 2024 to November 2024, we conducted a questionnaire survey on 367 nursing undergraduate students from 3 medical colleges in China. Participants self-reported general demographic questionnaires, care ability assessment scales, emotional intelligence scales, and self-efficacy scales. The collected data were analyzed using various statistical methods, including descriptive analysis, independent sample t-tests, 1-way analysis of variance tests, and multiple linear regression analysis. All analyses were performed using the SPSS (IBM Corp., Armonk) software (version 27.0). P < .05 indicated that the difference was statistically significant. In this study, the humanistic care ability score of 367 undergraduate nursing students was (194.99 ± 33.31). Cognition is the dimension with the highest score, while patience is the dimension with the lowest score. Multiple regression analysis showed that emotional intelligence, gender, and self-efficacy were the main factors affecting undergraduate nursing students’ ability to provide humanistic care (P < .05). The humanistic care ability level of undergraduate nursing students in this study is at a moderate level. To improve this level, nursing educators should develop targeted intervention measures for various influencing factors. It is recommended that nursing education personnel strategically incorporate training on humanistic care abilities into practical teaching projects, stimulate nursing students to practice the virtue of humanistic care in their daily lives, and ultimately improve the quality of nursing services in clinical practice.

PMID:42065148 | DOI:10.1097/MD.0000000000048318