Nevin Manimala

J Arrhythm. 2026 Jul 22;42(4):e70366. doi: 10.1002/joa3.70366. eCollection 2026 Aug.

ABSTRACT

BACKGROUND: Electrical storm (ES) is a life-threatening manifestation of ventricular tachycardia (VT) associated with highmorbidity and mortality. Catheter ablation is an established therapy for VT, but the impact of ES on ablation outcomes remains uncertain.

METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 to compare VT ablation outcomes in patients with and without ES. PubMed, Cochrane Library, and ScienceDirect were searched from inception through January 2026. Eligible studies were comparative cohorts reporting periprocedural or long-term outcomes. Random-effects models were used to pool odds ratios (ORs), hazard ratios (HRs), and mean differences (MDs), with heterogeneity assessed using the I² statistic.

RESULTS: Six observational cohort studies including 3531 patients (1183 with ES and 2348 without ES) were included. Acute procedural endpoints, including post-ablation VT non-inducibility and residual inducible VT, were similar between groups. Periprocedural or in-hospital mortality was significantly higher in the ES group (OR 4.71, 95% CI 2.76-8.06), whereas complication rates, procedural duration, radiofrequency ablation time, and need for hemodynamic support did not differ significantly. During follow-up, ES was associated with higher all-cause mortality (OR 1.67, 95% CI 1.19-2.35) and greater VT recurrence in both arm-based (OR 1.45, 95% CI 1.11-1.91) and time-to-event analyses (HR 1.35, 95% CI 1.16-1.57).

CONCLUSIONS: VT ablation showed comparable acute procedural success and procedural safety in patients with and without ES. However, ES was associated with higher early and long-term mortality and greater VT recurrence, supporting its role as a marker of adverse prognosis.

PMID:42495726 | PMC:PMC13392503 | DOI:10.1002/joa3.70366

Front Physiol. 2026 Jul 9;17:1835845. doi: 10.3389/fphys.2026.1835845. eCollection 2026.

ABSTRACT

INTRODUCTION: The plantar fat pad plays a key role in shock absorption and heel protection. In patients with controlled type 2 diabetes mellitus (cT2DM), advanced glycation end products (AGEs) may alter the structure of plantar tissue and affect its thickness and functionality. This study used ultrasound to compare the thickness of the plantar fat pad and plantar fascia between individuals with and without cT2DM and assessed the reliability of the ultrasound measurements.

METHODS: This prospective observational cross-sectional study examined 168 participants aged ≥60 years, including 84 with cT2DM and 84 without diabetes matched by sex. The plantar tissue thickness was measured in loaded and unloaded conditions using a portable ultrasound device. Intra-observer reliability was calculated using the intraclass correlation coefficient (ICC).

RESULTS: The ultrasound measurements showed excellent intra-observer reliability (ICC = 0.86-0.99). The groups showed no statistically significant differences in thickness of the heel plantar fat pad in loaded and unloaded conditions. However, the plantar fascia thickness showed significant differences between participants with diabetes and the control group in unloaded conditions (p = 0.040) and under load (p = 0.008). Differences between sexes were observed in height (p < 0.001) and weight (p < 0.001). Differences between the cT2DM group and the control group were also found in age (p = 0.001) and height (p = 0.010). After adjustment for age and height using linear regression analysis, the association between cT2DM and the plantar fascia thickness remained significant for only loaded conditions (p = 0.034).

DISCUSSION: Ultrasound demonstrated high intra-observer reliability, and the findings suggest a possible load-dependent association between cT2DM and plantar fascia thickness in the present study.

PMID:42495703 | PMC:PMC13392932 | DOI:10.3389/fphys.2026.1835845

Front Physiol. 2026 Jul 9;17:1838821. doi: 10.3389/fphys.2026.1838821. eCollection 2026.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effects of exercise training following the American College of Sports Medicine (ACSM) guidelines on exercise capacity, quality of life, and left ventricular function in patients with heart failure with preserved ejection fraction (HFpEF).

METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing exercise interventions with usual care in patients with HFpEF. Primary outcomes included exercise capacity (6-MWT, Peak VO₂, quality of life (total score of MLHFQ), LVEF, and diastolic function indicator (E/e’ ratio). The included studies were subgrouped for analysis into a high-adherence group (≥70%) and a low/uncertain-adherence group based on their compliance with the ACSM exercise recommendations.

RESULTS: A total of 19 RCT involving 1490 participants were included in this meta-analysis. Pooled results demonstrated that exercise training compliant with ACSM guidelines significantly improved exercise capacity, including the 6-MWT (SMD = 0.82, 95% CI: 0.34 to 1.30, P = 0.0008) and Peak VO₂ (SMD = 0.63, 95% CI: 0.36 to 0.91, P < 0.00001). The intervention also markedly enhanced patients’ quality of life reflected by the MLHFQ total score (SMD = -0.52, 95% CI: -0.84 to -0.20, P = 0.05). Marginally significant improvements were observed in left ventricular ejection fraction (SMD = 0.19, 95% CI: 0.00 to 0.38, P = 0.05) and E/e’ ratio (SMD = -0.14, 95% CI: -0.29 to 0.00, P = 0.05).Subgroup analyses stratified by adherence to ACSM recommendations (≥70% vs. <70%) showed that the high-adherence group achieved statistically greater improvements in 6-MWT (P = 0.03) and peak VO₂ (P = 0.003). Although the high-adherence group obtained larger effect sizes for MLHFQ scores and LVEF, the between-group differences did not reach statistical significance. No significant intergroup differences were found in other diastolic function indicators.

CONCLUSION: This study indicates that implementing the ACSM-recommended exercise regimen with high adherence can effectively improve exercise capacity, quality of life, and certain left ventricular function parameters in patients with HFpEF. Stratified analysis by ACSM adherence enriches evidence for individualized HFpEF exercise rehabilitation and guides clinical exercise strategy optimization.

PMID:42495702 | PMC:PMC13391323 | DOI:10.3389/fphys.2026.1838821

Earth Planets Space. 2026;78(1):166. doi: 10.1186/s40623-026-02497-6. Epub 2026 Jul 23.

ABSTRACT

In recent decades, the monitoring of volcanoes has been revolutionized by the launch of Earth-observing satellites and advances in thermal infrared remote sensing. These developments have revealed a wide range of thermal responses of volcanic surfaces to subsurface processes, even demonstrating that eruptions are often preceded by measurable thermal anomalies. This recognition highlights the need for robust tools to systematically detect and track such anomalies, making full use of existing satellite datasets and maximizing the value of current instruments in orbit. To address this challenge, we present the Subtle Surface Thermal Anomalies Recognizer (SSTAR), a versatile and user-friendly application designed to analyze diffuse thermal anomalies, i.e., subtle thermal unrest (~ 1 K) across large areas (several km²). SSTAR leverages data from NASA’s Terra and Aqua satellites, which host the Moderate Resolution Imaging Spectroradiometers (MODIS), and builds upon a robust statistical framework. By processing pixel-level data, SSTAR tracks the temporal evolution of diffuse thermal anomalies at specific target sites and maps their spatiotemporal distribution across extended areas. Key features include filtering tools that distinguish between long-term (years) and short-term (weeks) anomalies, as well as uncertainty quantification using bootstrapping. The application is standalone, features an interactive interface for streamlined analysis, and is accessible to newcomers to satellite-based thermal remote sensing. At the same time, specialized users can customize the underlying scripts for other specific research needs. As a demonstration, we apply SSTAR to Shishaldin volcano (Alaska), revealing the emergence of significant thermal anomalies around the summit crater and flanks prior to eruptions. We envision SSTAR as a valuable resource for studying subtle thermal unrest at active volcanoes and hydrothermal systems, where the detection of faint and spatially coherent anomalies may help identify subsurface fluid pathways. Its flexible design enables integration with additional satellite datasets, positioning SSTAR as a forward-looking tool for advancing space-based volcanic thermal monitoring. Building on this capability, daily updated diffuse thermal anomalies are provided for target volcanoes through an open web platform hosted at Geosciences Barcelona-CSIC (https://sstar.geo3bcn.csic.es/), to support surveillance agencies and expert committees in alert-level assessments.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40623-026-02497-6.

PMID:42495693 | PMC:PMC13391715 | DOI:10.1186/s40623-026-02497-6

Ann Gastroenterol Surg. 2026 Jun 26. doi: 10.1002/ags3.70242. Online ahead of print.

ABSTRACT

AIM: This study investigated nationwide trends, demographic characteristics, and seasonal patterns of rectal prolapse surgery in Japan, using healthcare claims databases.

METHODS: Surgical data were extracted from the National Database of Health Insurance Claims (NDB) from 2014 to 2023. Procedures were classified by surgical approach as conventional or laparoscopic. Crude and age-adjusted rates per 100 000 person-years were calculated. Temporal trends were assessed using linear and Poisson regression. Seasonal variations (April 2019-March 2024) were evaluated using one-way analysis of variance with post hoc comparisons, and correlations with meteorological variables were examined using Pearson’s correlation coefficients.

RESULTS: Over the decade, a total of 62 407 overall surgeries were performed, with an average annual rate of 4.7 per 100 000 person-years and an overall female-to-male ratio of 6.9:1. Overall surgery rates peaked at ages 85-89 in males (5.5 per 100 000 person-years) and females (59.1). While age-adjusted overall and conventional surgeries declined significantly, laparoscopic surgeries significantly increased (all p < 0.01). Age-adjusted overall surgery rates declined significantly in both sexes (RR = 0.960 for males, 0.983 for females, and 0.979 overall; each p < 0.0001), particularly among younger women aged 30-39 years (p < 0.0024). The mean seasonal overall surgeries exhibited distinct seasonal variation: 578.0 (SD 99.2) in spring, 440.0 (SD 85.9) in summer, 432.4 (SD 50.8) in autumn, and 544.4 (SD 71.8) in winter, and showed moderate negative correlations with temperature.

CONCLUSION: This study provides contemporary epidemiological insights into surgical management of rectal prolapse in Japan.

PMID:42495686 | PMC:PMC13394726 | DOI:10.1002/ags3.70242

Ann Gastroenterol Surg. 2026 Apr 6. doi: 10.1002/ags3.70220. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic-assisted rectal resection has expanded in Japan since national health insurance reimbursement began in 2018; however, its population-level regional distribution remains unclear. We evaluated temporal trends and contemporary regional disparities using the National Database (NDB) Open Data.

METHODS: We analyzed NDB Open Data for fiscal years 2014-2023. All patients undergoing rectal resection, irrespective of disease etiology, were included. Procedures were classified as open, laparoscopic, or robotic-assisted. We assessed temporal trends and age- and sex-stratified surgical volumes. For 2023, prefecture-level surgical rates per 100 000 population and robotic proportions were calculated. Standardized claim ratios (SCRs) were computed to adjust for age and sex. Population density was used as a proxy for urbanization. Prefectures were categorized into urban and rural groups using the highest and lowest population-density quartiles (middle two quartiles excluded), and robotic proportions were compared using the Mann-Whitney U test as an exploratory analysis.

RESULTS: Robotic-assisted rectal resections increased markedly after 2018, whereas open surgery declined. Substantial inter-prefectural variation was observed in surgical volume and robotic utilization, and heterogeneity persisted after age- and sex-standardization using SCRs. Urban prefectures exhibited a higher median robotic proportion than rural prefectures (29.3% vs. 19.0%), although this difference did not reach statistical significance (p = 0.09). Treating population density as a continuous measure, robotic proportion was positively associated with population density (Spearman ρ = 0.338, p = 0.020).

CONCLUSIONS: Robotic-assisted rectal resection expanded in Japan after reimbursement, yet marked inter-prefectural heterogeneity remained, underscoring the need for continued nationwide monitoring of geographic variation in adoption.

PMID:42495685 | PMC:PMC13394805 | DOI:10.1002/ags3.70220

Ann Gastroenterol Surg. 2026 Mar 24. doi: 10.1002/ags3.70218. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate identification of preoperative lymph node metastasis is essential for planning colon cancer treatment. Computed tomography (CT) is widely used for staging, but its diagnostic performance based on size criteria alone remains unclear. This study aimed to evaluate the diagnostic accuracy of preoperative CT for detecting lymph node metastasis in colon cancer.

METHODS: A systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted on June 12, 2025. Studies comparing preoperative CT with pathological evaluation and providing 2 × 2 contingency tables were included. Pooled sensitivity and specificity were calculated using a hierarchical summary receiver operating characteristic model and a bivariate random-effects model. Subgroup analyses were performed according to cancer location (colon only vs. colon plus rectal cancer) and diagnostic criteria (size alone vs. size plus morphology). Study quality was assessed using QUADAS-2.

RESULTS: Twenty-nine studies involving 5634 patients were included. The pooled sensitivity and specificity of CT for detecting lymph node metastasis were 0.693 (95% CI: 0.636-0.744) and 0.660 (95% CI: 0.581-0.731), respectively, with an area under the curve of 0.727. Meta-regression showed no statistically significant differences in diagnostic performance between colon-only studies and those including rectal cancer (p = 0.561 and 0.316), or between size-only and morphologic criteria (p = 0.822 and 0.536).

CONCLUSIONS: CT using size criteria alone for preoperative lymph node staging in colon cancer demonstrated only moderate diagnostic performance. These findings indicate that relying on lymph node size as the primary determinant may be insufficient for reliable clinical decision-making.

PMID:42495671 | PMC:PMC13393513 | DOI:10.1002/ags3.70218

Front Immunol. 2026 Jul 9;17:1864227. doi: 10.3389/fimmu.2026.1864227. eCollection 2026.

ABSTRACT

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the predominant histological subtype of oral cavity cancers, with a 5-year survival rate of approximately 50%. The tumour microenvironment, particularly macrophage infiltration and polarization, plays a critical role in tumour progression and patient prognosis. Models describing macrophages as either M1 (pro-inflammatory) or M2 (anti-inflammatory) are increasingly recognized as oversimplified, given the functional heterogeneity and plasticity of tumour-associated macrophages (TAMs). This study aims to evaluate the expression of macrophage markers CD68, CD163, CD11c, and CD115 in OSCC compared to normal oral mucosa (NOM), to assess their diagnostic and prognostic value.

METHODS: A cross-sectional study of 179 tissue samples (111 OSCC, 68 controls) analysed macrophage markers (CD68, CD163, CD11c, CD115) via real-time qPCR. Statistical tests included Mann-Whitney U, ROC analysis for diagnostic utility, Spearman’s ρ for correlations, and assessments of associations with prognosis and recurrence. Cut-offs for gene overexpression were based on ROC results and evaluated clinically.

RESULTS: All four markers showed significantly higher expression in OSCC compared to NOM (p < 0.001 for CD68, CD163, CD11c; p = 0.001 for CD115). ROC analyses demonstrated diagnostic AUCs of 0.69 (CD68), 0.78 (CD163), 0.81 (CD11c), and 0.66 (CD115), indicating poor, fair and good discriminative capacity, respectively. Overexpression of the genes defined by COP was significantly associated with malignancy (p < 0.01). Elevated CD68 and CD163 levels correlated with higher tumour grading (G2/G3), while increased CD11c expression was linked to nodal metastasis (p = 0.04). Strong positive correlations existed between CD115 and the other markers (ρ > 0.61, p < 0.001), supporting a model of macrophage heterogeneity and plasticity. Concurrent upregulation of pro-inflammatory (CD11c) and M2-associated (CD163) markers suggests a complex, dynamic TAM landscape rather than a simple M1/M2 dichotomy.

CONCLUSIONS: Altered RNA expression of the macrophage cell surface markers CD115, CD68, CD163 and CD11c in OSCC, and their respective association with tumour grading, N-status and perineural sheath infiltration, may serve as a basis for future single-cell sequencing or immunohistological – multiplex immunofluorescence – studies. Further investigation of these markers could lead to promising insights into the modulation of the tumour immune microenvironment.

PMID:42495621 | PMC:PMC13391827 | DOI:10.3389/fimmu.2026.1864227

Front Immunol. 2026 Jul 9;17:1868547. doi: 10.3389/fimmu.2026.1868547. eCollection 2026.

ABSTRACT

BACKGROUND: Combination therapy with PD-1 and CTLA-4 inhibitors improves survival in advanced cancers but is associated with heightened toxicity. Whether this represents additive toxicity from each drug or a distinct synergistic profile remains unclear. This study utilized the FDA Adverse Event Reporting System (FAERS) to systematically characterize the toxicity landscape of dual PD-1/CTLA-4 blockade.

METHODS: We analyzed FAERS database (2004-2024) for nivolumab, ipilimumab, and their combination. Disproportionality analysis was performed using Reporting Odds Ratios (RORs) and the Ω shrinkage measure model to detect drug-drug interactions signals. To explore potential synergistic signals, we used two exploratory criteria: 1) Emergent signals: adverse events (AEs) with a significant reporting association only for the combination; 2) Supra-additive reporting signals: combination ROR at least 50% higher than the higher monotherapy ROR.

RESULTS: We identified 15, 252 combination therapy reports. Disproportionality analysis revealed 23 emergent preferred terms (PTs) unique to the combination, including immune-related AEs like cardiotoxicity (ROR = 1.89). Strong supra-additive reporting signals were observed for immune-mediated hepatitis (ROR = 205.80) and endocrine toxicity (ROR = 557.95). The Ω shrinkage measure model detected statistical interaction signals for cytokine release syndrome (Ω=2.35) and immune-mediated dermatitis (Ω=2.48). Among cases with evaluable onset dates, the majority of severe AEs were reported within the first 90 days after treatment initiation, with descriptive differences observed across cancer types. Integrated analysis revealed hepatobiliary disorders were the most frequently reported AEs (28.1% of 675 cases), followed by endocrine disorders (14.2%).

CONCLUSIONS: Our findings are consistent with the hypothesis that dual PD-1/CTLA-4 blockade may be associated with a toxicity profile involving potential supra-additive reporting associations. These signals include emergent safety events not detected with monotherapies, reporting associations in specific organ systems, and observed temporal patterns. These results are hypothesis-generating and await confirmation in independent studies.

PMID:42495618 | PMC:PMC13391816 | DOI:10.3389/fimmu.2026.1868547

Front Immunol. 2026 Jul 9;17:1825905. doi: 10.3389/fimmu.2026.1825905. eCollection 2026.

ABSTRACT

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) remains one of the most aggressive and lethal cancers, with high incidence and mortality rates in East Asia. Neoadjuvant chemotherapy (NC) has traditionally been the standard approach for improving resectability in ESCC, but its limited efficacy in achieving complete pathological responses and enhancing survival has driven interest in combining it with immune checkpoint inhibitors (ICIs), resulting in neoadjuvant chemoimmunotherapy (NIC). Based on randomized controlled trials (RCTs), this meta-analysis compares the risks and clinical benefits of NIC versus NC in resectable ESCC patients.

METHODS: This meta-analysis systematically reviewed data from randomized controlled trials (RCTs) comparing NIC and NC in the treatment of resectable ESCC. Primary outcomes included pathological complete response (pCR) and major pathological response (MPR), while secondary outcomes focused on overall survival (OS), event-free survival(EFS), surgery rate, microscopically margin-negative resection(R0 resection), Intraoperative and hospitalization indicators, T Staging, Response evaluation criteria in solid tumors(RECIST), and adverse events (AEs).

RESULTS: Six high-quality RCTs (1070 patients) were included. NIC significantly improved major pathological response(MPR) (42.8% vs. 22.2%, Odds Ratio(OR) = 2.40, p = 0.0007) and pathological complete response(pCR) (22.2% vs. 8.0%, OR = 3.53, p < 0.00001). NIC was also associated with borderline statistically significant improvements in overall survival (OS) (HR = 0.57, p = 0.05) and R0 resection rate (OR = 2.56, p = 0.05). In addition, NIC enhanced surgical rate (OR = 1.57, p = 0.02), lymph node resection (Mean Difference (MD) = 1.76, P = 0.008), and NIC with a longer interval to surgery (MD = 4.73, p = 0.003, I2 = 95%), although this pooled estimate is less reliable because of considerable heterogeneity. However, immune-related adverse events (iRAEs) were higher in NIC (23.21% vs. 1.16%, p < 0.00001), though severe AEs were similar.

CONCLUSIONS: NIC significantly improves pathological response and other perioperative benefits (e.g., surgical rate and lymph node resection) in resectable ESCC compared with NC, with a trend toward improved survival, despite a higher incidence of irAEs. Further studies are needed to optimize treatment protocols and clarify the long-term impact of immune-related toxicities.

PMID:42495613 | PMC:PMC13391947 | DOI:10.3389/fimmu.2026.1825905