Nevin Manimala

Zhonghua Wai Ke Za Zhi. 2026 Aug 31;64(10):1115-1120. doi: 10.3760/cma.j.cn112139-20251120-00538. Online ahead of print.

ABSTRACT

Objective: To investigate the prevalence and the risk factors of gallstone in Xuhui District of Shanghai,providing a scientific basis for developing targeted prevention and control measures. Methods: This is a cross-sectional study,which was conducted on permanent resident elderly individuals aged 65 and above who had established health records and completed annual health examinations between January and December 2024,across 13 community health centers in Xuhui District,Shanghai. A total of 48 844 elderly participants were included in the study, including 21 483 males and 27 361 females, aged (72.0±6.1) years (range: 65 to 106 years). The gender, age, height, weight, results of fasting venous blood and ultrasound results were collected.The absolute standardized mean difference (ASMD) was calculated to assess the balance of covariates between groups.Based on the presence of gallbladder stones detected by ultrasonography, the participants were divided into the study group and the control group. Rank-sum test and χ² test were used for data analysis, and logistic regression analysis was performed to explore the risk factors for gallbladder stone formation. Results: The ASMD values of the total population and study sample were all≤0.2. The overall prevalence of gallstone in the study population was 14.44% (7 054/48 844), with a prevalence of 13.67% (3 741/27 361) in female and 15.42% (3 313/21 483) in males The prevalence of gallbladder polyps was 5.50%(2 682/48 844).The proportion of fatty liver was 45.50%(22 224/48 844). Additionally, a statistically significant difference in total cholesterol levels was observed between the gallstone group (range:4.34 to 5.77 mmol/L) and the non-gallstone groups (range: 4.39 to 5.82 mmol/L)(Z=-2.093, P<0.05). Multivariate Logistic regression analysis revealed that body mass index (BMI) ≥28 kg/m² (OR=1.19, 95%CI: 1.17 to 1.20) and fatty liver disease (OR=1.22, 95%CI: 1.05 to 1.41) were independent influencing factors for gallstone formation (both P<0.05). Compared with the 65 to 69 years group, the risks of gallstones were significantly higher in the 70 to 74 years group (OR=1.25, 95%CI: 1.05 to 1.48) and the group aged 80 years and above (OR=1.28, 95%CI: 1.03 to 1.61). Conclusions: The prevalence of gallstone is relatively high among the elderly population in Xuhui District, Shanghai. BMI ≥28 kg/m² and fatty liver disease are independent risk factors for gallstones. Compared with people aged 65 to 69 years, those aged 70 to 74 years and ≥80 years have an increased risk of developing gallstones.

PMID:42669448 | DOI:10.3760/cma.j.cn112139-20251120-00538

Zhonghua Wai Ke Za Zhi. 2026 Aug 31;64(10):1098-1105. doi: 10.3760/cma.j.cn112139-20260425-00167. Online ahead of print.

ABSTRACT

Objective: To analyze and evaluate the real-world clinical efficacy of immuno-targeted combined protocol as a neoadjuvant regimen for high-risk recurrent hepatocellular carcinoma. Methods: This is a retrospective case-series study. Real-world data from patients with high-risk recurrent HCC who received neoadjuvant therapy at Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center of Chinese People’s Liberation Army General Hospital, from January 2019 to September 2025, were analyzed. The cohort included 46 patients,among which there were 38 male patients (82.6%) and 8 female patients (17.4%), with an age at initial diagnosis(M(IQR)) of 56.5(15.0) years (range: 35 to 73 years). According to the Barcelona Clinic Liver Cancer staging system,there were 19 cases of stage A,15 cases of stage B and 12 cases of stage C. Survival curves were plotted using the Kaplan-Meier method,and comparisons were performed using the Log-rank test. A Cox regression analysis was performed on factors that may influence postoperative recurrence in patients. Results: Based on the modified Response Evaluation Criteria in Solid Tumors,the results of preoperative assessment were: 10 patients achieved complete response,30 patients achieved partial response,and 6 patients achieved stable disease. Based on the proportion of residual viable tumor cells in pathological specimens,there were 28 patients achieved major pathological response or above (60.9%). For the 46 enrolled patients,the recurrence-free survival(RFS) rates at 1,2,3 years were 74.7%,54.6%,45.5%,respectively,with a median recurrence-free survival of 28 months. The overall survival rates at 1,2,3 years were 97.6%,95.1%,91.8%,respectively. Cox regression analysis indicated that preoperative alpha-fetoprotein (AFP)≥400 μg/L was an independent high-risk factor for tumor recurrence. The 46 patients were divided into two groups based on their preoperative AFP levels. The 1-and 2-year RFS rates in the AFP<400 μg/L group were significantly higher than those in the AFP≥400 μg/L group, with a statistically significant difference (P<0.05). Conclusion: Immuno-targeted combined protocol as a neoadjuvant regimen can bring encouraging short-term and long-term survival outcomes to patients with high-risk recurrent hepatocellular carcinoma.

PMID:42669446 | DOI:10.3760/cma.j.cn112139-20260425-00167

Zhonghua Wai Ke Za Zhi. 2026 Aug 31;64(10):1090-1097. doi: 10.3760/cma.j.cn112139-20260616-00264. Online ahead of print.

ABSTRACT

Objective: To explore the optimal time window for evaluating gallbladder contraction function by oral standardized protein bar combined with olive oil, and verify the measurement stability of this novel method compared with the traditional fried egg test. Methods: This is a prospective, multicenter, single-blind, randomized crossover controlled trial. A total of 112 healthy volunteers from 4 centers (the First Hospital of Lanzhou University, First Hospital of Qinhuangdao, the Liaoning Jinqiu Hospital, and the Honghui Hospital Affiliated to Xi’an Jiaotong University) were enrolled and randomly assigned to two groups using a random number table, with a 1-week washout period between two intervention cycles. Group A received oral fried egg intervention in the first cycle and oral standardized protein bar plus 50 ml extra virgin olive oil in the second cycle; while group B received the interventions in reverse order. Gallbladder ultrasound was performed at fasting state and 30, 50, 70, 90 and 110 min after intervention to measure the long diameter, wide diameter and anteroposterior diameter of the gallbladder, and calculate the gallbladder volume and gallbladder contraction rate. The changing trends of gallbladder contraction rate at each time point were compared between the two interventions, the coefficient of variation (CV) was used to evaluate the measurement stability of the two methods, and paired t-test, repeated measures analysis of variance, and Feltz-Miller asymptotic test were used for statistical analysis. Results: Among the 112 subjects, 47 were male and 65 were female, with an age of (30.6±7.1) years(range:19 to 62 years) and a fasting gallbladder volume of (20.0±7.1) ml. Under both interventions, the gallbladder contraction rate of the subjects began to increase at 30 min after intervention, reached the peak at 50 to 70 min, and then gradually decreased. There was no significant difference in the level of gallbladder contraction rate between the two groups at the peak time point (t=0.421,P=0.674). The intragroup CV of gallbladder contraction rate at each time point in the oral protein bar plus olive oil group was significantly lower than that in the fried egg group (all P<0.05), indicating better measurement stability. No serious adverse events such as acute pancreatitis and gastrointestinal bleeding occurred in either group, and the incidence of mild gastrointestinal adverse events showed no significant difference between the two groups (χ²=0.269, P=0.604). Conclusions: The optimal measurement time window for evaluating gallbladder contraction function with oral protein bar combined with olive oil is 50-70 min after intervention. This method is easy to operate with favorable safety, and its measurement stability is significantly better than the traditional fried egg test, providing a new method option for standardized clinical evaluation of gallbladder contraction function.

PMID:42669445 | DOI:10.3760/cma.j.cn112139-20260616-00264

Clin Biochem. 2026 Aug 30:111186. doi: 10.1016/j.clinbiochem.2026.111186. Online ahead of print.

ABSTRACT

There is a lack of resources on how to prepare, execute, and sustain quality improvement (QI) initiatives in laboratory medicine. The project goal was to bridge this gap with the creation of a novel primer series. In this third and final primer, we discuss fundamental concepts related to project evaluation, dissemination, and sustainability. We also introduce useful tools to successfully assess and monitor QI project success over time, including run charts and statistical process control charts as well as a well established sustainability model. These concepts are illustrated by following through on the final results from our real-world clinical vignette related to serum protein electrophoresis (SPEP) utilization. The impact of interventions discussed in earlier articles of the primer series was evaluated over a one-year period. Data analysis showed there was a >99% reduction in repeat SPEP testing in less than 75 days. The secondary aim to reduce testing in patients <50 years was not met. By piecing together the central aspects of QI methodology and challenges encountered from project initiation to dissemination through a laboratory lens, this series aims to support engagement of clinical laboratory leaders in QI initiatives. This is essential to build a strong culture of QI within the clinical laboratory and beyond.

PMID:42669392 | DOI:10.1016/j.clinbiochem.2026.111186

J Affect Disord. 2026 Aug 30:122443. doi: 10.1016/j.jad.2026.122443. Online ahead of print.

ABSTRACT

Depressive disorders cause significant global disability, yet oral antidepressants often have systemic side effects and delayed onset. This systematic review and meta-analysis evaluated the efficacy and safety of facial injections of Botulinum toxin A (BoNT/A) compared with placebo and the active antidepressant sertraline. We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and PsycINFO for randomized controlled trials (RCTs) from inception to December 2025. Eight RCTs comprising 636 participants were included. Facial BoNT/A injection was associated with a significant reduction in depressive symptoms compared with control conditions (SMD = -0.81; 95% CI, -1.23 to -0.38; p < 0.001). Subgroup analysis revealed that BoNT/A was superior to placebo (SMD = -1.04) and demonstrated efficacy comparable to sertraline (SMD = -0.23). Regarding injection strategies, while standard glabellar protocols demonstrated significant antidepressant efficacy, the high-dose pan-facial subgroup showed no statistically significant difference compared to controls. Anxiety scores did not differ significantly between groups. While overall adverse event rates were similar to controls (RR = 1.04), BoNT/A was associated with transient local reactions, avoiding the systemic side effects observed with sertraline. Facial BoNT/A injection represent an effective, safe treatment for depression. These findings provide valuable insights into a non-systemic therapeutic alternative, particularly for patients intolerant to oral antidepressants or those with polypharmacy burdens. PROSPERO REGISTRATION NUMBER: CRD420261277524.

PMID:42669382 | DOI:10.1016/j.jad.2026.122443

Diabetes Res Clin Pract. 2026 Aug 30:113541. doi: 10.1016/j.diabres.2026.113541. Online ahead of print.

ABSTRACT

BACKGROUND: The associations and comparative discrimination of indices integrating inflammation, insulin resistance, and body shape within glycemic-status strata remain uncertain.

METHODS: We included 13,867 adults from the 1999-2010 and 2015-2018 National Health and Nutrition Examination Survey. Complex-survey weighted Cox models evaluated CTI, CTI-BMI, CTI-BRI, CTI-WWI, CTI-ABSI, and CTI-WHtR continuously and by weighted quartiles in participants with normal glycemia, abnormal glycemia, or diabetes. Restricted cubic splines, time-dependent receiver operating characteristic curves, interaction tests, and sensitivity analyses were performed.

RESULTS: During follow-up, 2,197 all-cause and 687 cardiovascular deaths occurred. Among participants with abnormal glycemia, the hazard ratios per weighted standard deviation for CTI-ABSI were 1.21 (95 % CI, 1.10-1.34) for all-cause mortality and 1.43 (95 % CI, 1.18-1.73) for cardiovascular mortality. Corresponding estimates for CTI-WWI were 1.19 (95 % CI, 1.07-1.33) and 1.49 (95 % CI, 1.20-1.85). CTI-ABSI and CTI-WWI had relatively higher single-marker AUCs in several analyses, but incremental improvements beyond clinical factors were small. Glycemic-status interactions were not statistically significant.

CONCLUSIONS: Several CTI-related indices were associated with mortality within glycemic-status strata. However, the findings do not establish effect modification, group-specific applicability, or validated clinical utility. These indices should be considered epidemiological markers.

PMID:42669380 | DOI:10.1016/j.diabres.2026.113541

Genomics. 2026 Aug 30:111311. doi: 10.1016/j.ygeno.2026.111311. Online ahead of print.

ABSTRACT

Host structural variations (SVs) are critical in cancer development but their landscape and interaction with HPV integration in cervical carcinogenesis remain unclear. In this study, we performed Nanopore long-read sequencing on five HPV-positive cervical cancer tissues and two cell lines to profile host SVs. We identified thousands of SVs and statistically demonstrated their significant enrichment in genomic windows ±25 to ±50 kb from HPV integration sites. Cross-sample analysis revealed 60 shared SVs, including a recurrent deletion within the PIAS1 gene. Multi-omics integration (Hi-C, H3K27ac ChIP-seq, and TCGA data) showed that this deletion is associated with reduced PIAS1 expression, disruption of local topologically associating domains, advanced pathological tumor stage, and poorer overall survival. Functional assays confirmed that PIAS1 deficiency inhibits cervical cancer cell proliferation and migration. Our findings identify a PIAS1 deletion as a candidate driver event, and underscore the pivotal role of host genomic instability in HPV-associated oncogenesis.

PMID:42669360 | DOI:10.1016/j.ygeno.2026.111311

J Pediatr Adolesc Gynecol. 2026 Aug 30:S1083-3188(26)00493-6. doi: 10.1016/j.jpag.2026.08.014. Online ahead of print.

ABSTRACT

OBJECTIVE: Menstrual hygiene management among adolescent schoolgirls in low-income settings is shaped by unequal access to menstrual materials and inadequate school sanitation infrastructure. Existing research has focused primarily on the prevalence and predictors of individual menstrual products, with limited attention to whether multi-material use constitutes a structured behavioral phenomenon. We examined patterns of multi-material menstrual product use among junior high school girls in the Ashanti Region of Ghana and assessed whether these patterns varied across economic, institutional, and infrastructural conditions.

METHODS: We employed a quantitative cross-sectional survey design involving 416 menstruating girls purposively selected from five junior high schools in the Ashanti Region. We collected data using structured questionnaires and analyzed them using frequencies, crosstabulations, Pearson chi-square tests, K-means cluster analysis, and one-way analysis of variance.

RESULTS: We found statistically significant associations between tissue and toilet roll use (χ² = 48.424, p < .001), cloth and toilet roll use (χ² = 45.779, p < .001), and tampon and cotton use (χ² = 201.393, p < .001), indicating structured patterns of co-use. Our cluster analysis identified three distinct behavioral profiles: Minimal Multi-Material Users (72.4%), High Multi-Material Users (19.5%), and Selective Multi-Material Users (8.2%). Access to private toilet facilities differed significantly across clusters (χ² = 7.317, p = .026), whereas access to personal financial resources and school support showed limited variation.

CONCLUSIONS/IMPLICATIONS: Menstrual health interventions should prioritize improvements in private sanitation infrastructure alongside material provision to support safer menstrual management experiences for adolescent girls.

PMID:42669358 | DOI:10.1016/j.jpag.2026.08.014

J Stroke Cerebrovasc Dis. 2026 Aug 30:108736. doi: 10.1016/j.jstrokecerebrovasdis.2026.108736. Online ahead of print.

ABSTRACT

INTRODUCTION: Carotid artery stenting (CAS) is an alternative revascularization method for patients with internal carotid stenosis in whom an endovascular approach is selected instead of carotid endarterectomy. In recent years, dual-layer stents have increasingly been employed due to their better plaque coverage compared to closed-cell stents. The aim of this study was to report the outcomes of these two stent types in a real-world clinical setting.

METHODS: Patients with internal carotid artery stenosis who underwent CAS between 2004 and 2023 at two high-volume centers were retrospectively analyzed. Plaques were classified as: type 1(lipid-rich), type 2(fibro lipid) and type 3(calcified). Primary endpoints included technical success (defined as residual stenosis <30% on completion angiography), and the incidence of stroke/death and TIA/stroke within 30 days comparing period of procedures and clinical manifestation (symptomatic and asymptomatic) comparing type of stent and type of plaque.

RESULTS: A total of 944 CAS procedures were performed. Most of patients were male (68%) and younger than 80 years (72%). Symptomatic stenosis was present in 236(25%) patients, while 708(75%) were asymptomatic, with calcified plaques being most common (60%). Technical success was achieved in 94% procedures. In 6%, CAS procedure was abandoned due to excessive arch/carotid tortuosity. Before and after 2014 technical success rates were 9.7% and 3.6% (p<0.001). The overall 30-day TIA/stroke and stroke/death rates were 6.4% and 2.4%, 10% and 4% in symptomatic and 5% and 2% in asymptomatic. Closed-cell stents (Wallstent, Boston Scientific Corporation, Massachusetts, USA) and dual-layer stents (Roadsaver, Terumo Corporation, Tokyo, Japan) were used in 64% and 36% of cases. Stroke/death and TIA/stroke occurred in 2.8%vs.0.8% (p=0.20) in asymptomatic, and in 14.2%vs.5.4%(p=0.05) in symptomatic. The 30-day stroke/death rate was 0.7%vs.0.8% (p=0.80) in asymptomatic, while the 30-day TIA/stroke rate was higher, but not statistically significant, in the Wallstent group (5.9%vs.4.2%p=0.30) in symptomatic. Patients with type 0-2 plaques treated with dual-layer stents had a significantly lower 30-day TIA/stroke rate (10%vs.3.7%, p=0.02). Asymptomatic status (OR:0.4,95%CI:0.2-0.8, p=0.008) and use of dual-layer stents (OR:0.5,95%CI:0.3-1, p=0.05) are independent protective factors for 30-day TIA/stroke.

CONCLUSION: Dual layer devices are associated with a significantly lower 30-day TIA/stroke rate in patients with vulnerable plaque types (1-2). Symptomatic status and stent design both influenced periprocedural outcomes, underscoring the value of tailoring device choice to plaque morphology.

PMID:42669335 | DOI:10.1016/j.jstrokecerebrovasdis.2026.108736

Photodiagnosis Photodyn Ther. 2026 Aug 30:105635. doi: 10.1016/j.pdpdt.2026.105635. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the intergroup differences in choroidal thickness (CT), choroidal vascularity index (CVI), and choroidal vascular volume (CVV) across non-autoimmune type 2 diabetes mellitus (T2DM) subtypes defined by beta-cell function and insulin resistance.

METHODS: This cross-sectional study enrolled 22 healthy controls (22 eyes) and 85 T2DM patients (85 eyes). T2DM patients were categorized into 4 groups using K-means clustering: Severe Insulin-deficient Diabetes (SIDD) =22, Severe Insulin-resistant Diabetes (SIRD)=26, Mild Obesity-related Diabetes (MOD)=16, and Mild Age-related Diabetes (MARD)=21. CT, CVI, CVV were measured by widefield swept-source optical coherence tomography angiography (WSS-OCTA) across three concentric annular regions(0 – 10 mm, 10 – 15 mm, and 15 – 20 mm), subdivided into 12 sectors. Linear mixed-effects and multivariate regression models were constructed to evaluate intergroup differences.

RESULTS: Compared with the control group, both CT and CVV decreased significantly in most of the 12 analyzed regions across all T2DM groups, whereas the MOD and SIRD groups exhibited no statistically significant global changes. In contrast, CVI exhibited pronounced spatial and subtype-specific heterogeneity. In the SIDD group, CVI decreased in most regions, with significant reductions in the nasal sector of the 0 – 10 mm annulus (P<0.01]), and in the nasal and inferior sectors of the 10 – 15 mm annulus (P<0.01] and -0.065 (P<0.01). Conversely, the SIRD group demonstrated a widespread increase in CVI, with significant increased in the nasal (P < 0.05), superior (P < 0.05), and temporal (P < 0.05]) sectors of the 15 – 20 mm annulus.

CONCLUSION: Compared with CT and CVV, CVI shows the highest spatial heterogeneity. This indicates that divergent metabolic drivers may exert opposing effects on choroidal vascular remodeling. This subtype-specific characterization enhances our understanding of diabetic choroidopathy pathophysiology and holds potential for guiding personalized screening and therapeutic strategies.

PMID:42669328 | DOI:10.1016/j.pdpdt.2026.105635