Nevin Manimala

BMC Public Health. 2026 Jun 4. doi: 10.1186/s12889-026-27958-1. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to evaluate oral health parameters and health-related quality of life (HRQoL) in children and adolescents with chronic kidney disease (CKD), and compare them with non-CKD peers. Additionally, the impact of various sociodemographic, health-related, and oral health parameters on HRQoL was examined within the CKD group.

METHODS: In this cross-sectional observational study, 82 children with CKD were compared to 85 non-CKD controls within the same age range. Participants were evaluated through a comprehensive clinical assessment that included sociodemographic and health-related characteristics, oral hygiene habits, and oral health parameters including dental caries, oral hygiene status, gingival health, and developmental enamel defects. Both child self-report and parent proxy-report versions of the KINDL questionnaire were used to assess HRQoL. Statistical analyses were conducted to evaluate group differences and associations between variables.

RESULTS: Children with CKD had significantly lower HRQoL scores across all domains (p < 0.05). They also exhibited higher rates of enamel defects, gingival inflammation, and poorer oral hygiene. Although DMFT/dft scores were lower in the CKD group, ICDAS II showed a higher prevalence of early carious lesions. Multiple regression analysis revealed that HRQoL was significantly associated with CKD status, number of siblings, oral hygiene, and gingival health (p < 0.001).

CONCLUSIONS: Oral health is strongly associated with HRQoL in children with CKD. Public health strategies should prioritize regular HRQoL monitoring and early preventive dental care to improve overall well-being in this vulnerable population.

PMID:42243776 | DOI:10.1186/s12889-026-27958-1

BMC Cancer. 2026 Jun 4. doi: 10.1186/s12885-026-16296-5. Online ahead of print.

ABSTRACT

BACKGROUND: Acute lymphoblastic leukemia (ALL) remains a significant challenge in pediatric malignancies, particularly in cases of relapse and treatment resistance. This study aimed to investigate the expression patterns of ferroptosis-related genes, GPX4 and LINC00618, across different disease phases in pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL).

METHODS: This case-control study analyzed 82 samples from pediatric BCP-ALL patients comprising 14 new cases, 29 in remission, and 17 relapsed cases alongside 22 healthy controls. Expression levels of GPX4 and LINC00618 were evaluated using quantitative real-time PCR. The relationship between gene expression and clinical parameters was assessed. Statistical analyses were performed employing parametric or nonparametric tests.

RESULTS: GPX4 expression was significantly elevated in ALL patients compared to controls (p < 0.01), with notably higher levels in new cases (p < 0.01) and relapsed patients (p < 0.05). Similarly, LINC00618 exhibited significant upregulation in ALL patients (p < 0.05), particularly in new cases (p < 0.01) and relapsed patients (p < 0.05). Both genes demonstrated reduced expression during the remission. External validation using the GSE13159 dataset demonstrated a consistent direction of increased GPX4 expression in ALL samples compared to controls.

CONCLUSIONS: Our findings suggest phase-associated expression patterns of GPX4 and LINC00618 in pediatric BCP-ALL. The consistent direction of GPX4 expression observed in external validation supports its potential relevance in leukemic biology. These results provide a basis for further studies to clarify the role of ferroptosis-related pathways in disease progression and therapeutic response.

PMID:42243765 | DOI:10.1186/s12885-026-16296-5

BMC Nephrol. 2026 Jun 4. doi: 10.1186/s12882-026-05078-7. Online ahead of print.

ABSTRACT

BACKGROUND: Patients receiving maintenance hemodialysis (MHD) experience multiple concurrent symptoms with substantial heterogeneity in symptom burden. However, a reproducible evidence framework to translate symptom interdependencies into intervention priorities is lacking. To address this gap, we use model-based in silico perturbation simulations to quantitatively rank modifiable symptom targets, providing non-causal decision support for symptom-focused management in resource-constrained settings.

METHODS: We used convenience sampling to recruit adults receiving MHD from 13 hemodialysis centers in Southwest China between February and June 2025. Symptoms were assessed using the modified Dialysis Symptom Index. We identified symptom clusters using exploratory factor analysis and estimated symptom networks to characterize interconnections and centrality. Latent profile analysis defined symptom-burden subgroups. To explore interventions, we performed in silico perturbation analyses with NodeIdentifyR, simulating both alleviating and aggravating interventions. Changes in the total number of active symptoms served as the primary outcome for comparing effects on symptom network structure.

RESULTS: A total of 962 participants were included. Seven symptom clusters were identified: emotional, sexual and cardiopulmonary dysfunction; gastrointestinal; musculoskeletal; sleep disturbance; neurologic; and skin discomfort. Two symptom-burden profiles were identified by latent profile analysis, representing Profile 1 (lower-burden groups) and Profile 2 (high-burden group), with clear clinical interpretability. Feeling nervous showed the highest centrality, and fatigue demonstrated the strongest bridging role across clusters. Model-based perturbation analyses ranked candidate priorities. Simulated alleviation of feeling anxious, worrying, and feeling nervous was associated with estimated reductions in overall burden of 17.3%, 16.0%, and 14.4%, respectively. Simulated exacerbations of feeling irritable, nervous, and sad were associated with estimated increases in overall burden of 21.2%, 19.4%, and 18.5%, respectively.

CONCLUSIONS: Our findings suggest emotional symptoms are priority candidates for intervention in patients receiving MHD. They may provide non-causal decision support for symptom management and resource allocation. Future longitudinal studies and intervention trials are needed to further evaluate both their effectiveness and generalizability.

PMID:42243764 | DOI:10.1186/s12882-026-05078-7

BMC Oral Health. 2026 Jun 4. doi: 10.1186/s12903-026-08698-5. Online ahead of print.

ABSTRACT

BACKGROUND: Dental pulp calcifications, including pulp stones and diffuse calcific changes, can complicate endodontic access, canal negotiation, and treatment planning. Artificial intelligence may support radiographic detection of these findings, but the available evidence remains limited and methodologically heterogeneous. This scoping review mapped peer-reviewed studies that applied artificial intelligence to detect, classify, or segment dental pulp calcifications on two-dimensional radiographs and cone-beam computed tomography.

METHODS: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar were searched for English-language studies published from 1 January 2015 to 29 September 2025. After duplicate and ineligible records were removed, 450 records underwent title and abstract screening, 32 full-text reports were assessed, and seven peer-reviewed studies were included. Data were charted descriptively according to imaging modality, artificial intelligence architecture, task type, validation design, annotation approach, and reported performance. Owing to heterogeneity in tasks, datasets, and outcome metrics, no meta-analysis or inferential statistical testing was performed.

RESULTS: The included studies were retrospective, single-centre investigations published between 2023 and 2025. Two-dimensional radiographic studies using detection or classification pipelines reported high internal performance, with accuracy ranging from 95.4% to 96.5% and F1 scores ranging from 78.9% to 96.6%. One panoramic segmentation study reported Dice scores of 0.84 for pulp and 0.759 for pulp stones. In cone-beam computed tomography, one three-dimensional U-Net study reported accuracy of 72.8% and an area under the curve of 0.74, with reduced sensitivity for micro or diffuse calcifications. No study used external validation, and public code or datasets were generally unavailable.

CONCLUSIONS: Artificial intelligence methods show technical potential for detecting dental pulp calcifications, particularly in internally validated two-dimensional radiographic studies. However, the evidence is still preliminary. Clinical translation is limited by single-centre designs, small and heterogeneous datasets, lack of external validation, inconsistent reporting, and limited reproducibility. Future research should prioritize multicentre datasets, lesion-size stratification, standardized reporting, open benchmarking, calibration assessment, and prospective workflow-based evaluation.

TRIAL REGISTRATION: Not applicable. This study was a scoping review and did not involve a clinical trial.

PMID:42243743 | DOI:10.1186/s12903-026-08698-5

BMC Gastroenterol. 2026 Jun 4. doi: 10.1186/s12876-026-04987-z. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health burden. Identifying robust prognostic biomarkers is crucial for early risk stratification. The red blood cell distribution width to albumin ratio (RAR) has emerged as a potential biomarker reflecting inflammation and nutritional status. This study aimed to evaluate the association between RAR and both all-cause and cardiovascular mortality among adults with MASLD.

METHODS: Data from the National Health and Nutrition Examination Survey 1999-2018 were analyzed. MASLD was defined using the United States Fatty Liver Index (USFLI ≥ 30), combined with cardiometabolic criteria. Participants were categorized into RAR quartiles. Weighted Cox proportional hazards models, Fine-Gray competing risk models, and restricted cubic splines were employed to the association between RAR and mortality. Stratified and sensitivity analyses were conducted to test robustness.

RESULTS: Among 6,287 MASLD patients (mean age 51.39 years, 42.69% female), there were 1,161 all-cause deaths and 324 cardiovascular deaths over a median follow-up of 9.2 years. In the fully adjusted Model 3, individuals in the highest RAR quartile had a higher risk of all-cause mortality (hazard ratio [HR] = 2.41, 95% confidence interval [CI] = 1.87-3.10, P < 0.001) and cardiovascular mortality (HR = 3.39, 95% CI = 2.17-5.31, P < 0.001) compared to those in the lowest quartile. Each unit increase in RAR was associated with a 93% increase in all-cause mortality (HR = 1.93, 95% CI = 1.62-2.30, P < 0.001) and a 130% increase in cardiovascular mortality (HR = 2.30, 95% CI = 1.83-2.90, P < 0.001). No significant nonlinear associations were found. A significant age interaction was observed in all-cause mortality (P for interaction < 0.05), with stronger associations seen among younger individuals. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS: Higher RAR levels were significantly associated with increased all-cause and cardiovascular mortality in adults with MASLD. RAR holds potential as a risk stratification tool for MASLD adults in clinical practice.

PMID:42243742 | DOI:10.1186/s12876-026-04987-z

Vision Res. 2026 Jun 4;246:108853. doi: 10.1016/j.visres.2026.108853. Online ahead of print.

ABSTRACT

In the present study, we introduce an image database created with a simple digital line-drawing tool to represent the expected and unexpected action-place relationships. This database consists of 70 drawings. We validated the dataset with 207 participants. They evaluated the actions, places, and the probability of an action taking place in the respective location. The comprehensibility of each drawing was evaluated using three measures: H-statistics (entropy), which is a measure of the uncertainty of the definition; the definition similarity percentages which is a measure of the naming agreement that is consistent among participants; and the mean probability of the depicted action taking place in the depicted location. Each drawing includes different agents and environments, providing researchers with the opportunity to use this dataset in various fields of cognitive neuroscience, including visual recognition memory, predictive coding, and novelty detection.

PMID:42241800 | DOI:10.1016/j.visres.2026.108853

J Nutr Health Aging. 2026 Jun 4;30(7):100888. doi: 10.1016/j.jnha.2026.100888. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate the effect of an Intervention Food for Special Medical Purposes (FSMP) on the nutritional status and muscle function of middle-aged and older adults at risk of malnutrition.

DESIGN: A multicenter, randomized, active-controlled, parallel-group study.

SETTING: Two clinical centers located in China.

PARTICIPANTS: 135 adults aged 45-80 years at risk of malnutrition (Mini Nutritional Assessment [MNA] score ≤ 23.5).

INTERVENTION AND MEASUREMENTS: Participants were randomized to one of three groups for a 12-week nutritional intervention: Intervention FSMP (one daily sachet of a novel high-protein FSMP plus dietetic counseling); Active Control (one daily sachet of an established FSMP plus dietetic counseling); and Control (dietetic counseling alone). The primary outcome was the change in MNA score. Secondary outcomes were body weight, handgrip strength, calf and mid-upper arm circumferences, and SARC-F score.

RESULTS: Linear mixed-effects models showed significant group-by-time interactions for MNA score, body weight, BMI, handgrip strength, and calf circumference. At week 12, both FSMP groups demonstrated greater improvements in MNA score compared with Control (Intervention FSMP: adjusted difference 2.3, 95% CI 1.4-3.2; Active Control: adjusted difference 3.1, 95% CI 2.2-4.0; both P < 0.001). The between-FSMP comparison for MNA was not statistically significant (adjusted difference -0.8, 95% CI -1.7 to 0.1; P = 0.087). The Intervention FSMP group showed greater gains in body weight than Control (adjusted difference 1.2 kg, 95% CI 0.8-1.7; P < 0.001). Compared with Control, handgrip strength improved in both FSMP groups (adjusted differences 2.2-3.0 kg for left hand and 2.8 kg for right hand; all P < 0.001). Across groups, no significant differences were noted in adverse events and gastrointestinal tolerability.

CONCLUSION: Targeted 12-week nutritional intervention with a high-protein FSMP was associated with improvements in nutritional status and handgrip strength in adults at risk of malnutrition.

PMID:42241799 | DOI:10.1016/j.jnha.2026.100888

Pediatr Neurol. 2026 May 12;181:76-82. doi: 10.1016/j.pediatrneurol.2026.05.005. Online ahead of print.

ABSTRACT

BACKGROUND: Although not routinely recommended, computed tomography (CT) head are frequently performed in children presenting to emergency department (ED) with seizures. Racial and ethnic disparities have been reported in pediatric ED imaging. Our objective was to evaluate the association of demographic factors, including race and ethnicity, with CT head utilization in children presenting to ED with an unprovoked seizure.

METHODS: We conducted a retrospective cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey from 2016 to 2022, including ED visits by patients ≤18 years of age whose first three listed reason-for-visit or diagnosis codes indicated epilepsy or unspecified convulsions. We collected patient demographics, CT head utilization and disposition. Complex samples-adjusted analyses included Pearson chi-square tests and multivariable logistic regression.

RESULTS: A total of 479 visits (weighted N = 3,936,090) met inclusion criteria. Majority was female (52.0%), publicly insured (62.9%), and non-Hispanic White (45.7%). CT head was performed in 23.6% of visits. CT utilization was higher among adolescents (38.8%). Adolescents had significantly higher odds of CT utilization compared with preschool and school-aged children (odds ratio: 3.28; 95% confidence interval: 1.87-5.74). No significant association was found between race/ethnicity and CT utilization in either bivariate or multivariate analysis.

CONCLUSIONS: In this nationally representative sample, CT head was performed in 23.6% of ED visits for unprovoked seizures. Age was associated with differences in CT utilization. No racial or ethnic disparities in CT utilization were observed. However, as multivariable estimates for race and ethnicity did not meet National Center for Health Statistics statistical reliability standards, these findings must be interpreted with caution.

PMID:42241796 | DOI:10.1016/j.pediatrneurol.2026.05.005

Mult Scler Relat Disord. 2026 May 26;112:107283. doi: 10.1016/j.msard.2026.107283. Online ahead of print.

ABSTRACT

INTRODUCTION: Cognitive impairment (CI) is a significant burden for patients with multiple sclerosis (MS). However crucial its assessment is, longitudinal measurement of cognitive performance is susceptible to learning effect, making the results of repeated evaluations difficult to interpret. Reliable change index (RCI) and standardized regression based norms (SRB) are accepted statistical methods to assess the reliability of a difference score between two observations. Thus, our aims were to provide RCIs and SRBs for all three subtests of the Brief International Cognitive Assessment for MS (BICAMS) battery and to measure the prevalence of true cognitive worsening and improvement.

METHODS: We retrospectively evaluated the first interim analysis data of the longitudinal follow-up or our BICAMS prevalence study-cohort after 1-year. We analyzed the data of 242 MS patients.

RESULTS: We calculated both the RCIs and the SRBs for all three subtests of the BICAMS battery. According to the RCI, 5.4%, 6.9% and 14.6% worsened while 12.3%, 34.3% and 10.6% improved on the SDMT, BVMT-R and CVLT-II respectively. In case of SRB method, 3.8%, 8.3% and 19.7% worsened while 3.8%, 7.6% and 0.0% improved. The κ values revealed a mild-to-moderate agreement (κ=0.391-0.540; p<0.001). In case of the BVMT-R and the CVLT-II assessments the baseline scores influenced this outcome significantly (BVMT-R: OR: 1.068; 90%CI: 1.001-1.138; CVLT-II: OR: 1.096; 90%CI: 1.041-1.153).

CONCLUSION: Comparing the methods, RCI seems to be better in cases with already established CI, while SRB, the more complex method, seemingly detects change better in cognitively intact patients.

PMID:42241785 | DOI:10.1016/j.msard.2026.107283

Poult Sci. 2026 May 20;105(9):107156. doi: 10.1016/j.psj.2026.107156. Online ahead of print.

ABSTRACT

The type VI secretion system (T6SS) is an important fitness determinant of Salmonella enterica serovar Typhimurium (S. Typhimurium) during host colonization and bacterial competition. Tldi1 has been identified as an immunity protein associated with a T6SS antibacterial toxin-immunity module, but its contribution to avian infection remains unclear. This study investigated whether Tldi1 affects the infection outcome of S. Typhimurium in young chickens. Three-day-old Hy-Line Brown chickens were challenged with the wild-type strain SL1344, a tldi1 deletion mutant, or a complemented strain. Clinical signs, body weight, liver and spleen indices, splenic bacterial loads, tissue pathology, cecal mucin staining, inflammatory cytokine expression, intestinal barrier-related gene expression, and cecal microbiota composition were evaluated. Compared with wild-type infection, the tldi1 deletion mutant caused milder clinical signs, lower liver and spleen indices, reduced splenic bacterial loads, and attenuated histopathological lesions in the liver, spleen, ileum, and cecum. The mutant also induced lower expression of several pro-inflammatory cytokine genes and partially alleviated the downregulation of intestinal barrier-related genes. Complementation of tldi1 largely restored the wild-type infection phenotype. Cecal 16S rRNA sequencing showed that tldi1 deletion was associated with altered microbial community features and reduced inter-individual dispersion; however, overall beta-diversity differences were not statistically significant. These findings indicate that Tldi1 contributes to the in vivo fitness and infection-associated pathology of S. Typhimurium in chickens. The results provide a basis for further investigation of T6SS toxin-immunity modules as potential targets for controlling Salmonella infection in poultry.

PMID:42241763 | DOI:10.1016/j.psj.2026.107156