Nevin Manimala

Discov Oncol. 2026 May 21. doi: 10.1007/s12672-026-05247-y. Online ahead of print.

ABSTRACT

PURPOSE: Malnutrition is common among hospitalized cancer patients and has been linked to adverse clinical outcomes. Accurate nutritional risk screening is essential for rapid nutritional intervention. Although the NRS-2002 tool is widely used in clinical practice, its interrater reliability in oncologic settings has not been adequately examined. This study aimed to evaluate the interrater reliability of nutritional risk screening among hospitalized patients with cancer using the Nutritional Risk Screening 2002 (NRS-2002) tool.

DESIGN: Retrospective cross-sectional study.

METHODS: Thirty-five trained clinical nurses and one registered dietitian independently performed NRS-2002 assessments within 24 h of admission among 434 hospitalized cancer patients. Cohen’s kappa statistics were used to evaluate interrater reliability for each NRS-2002 component, including nutritional status, disease severity, and risk classification derived from the total score.

RESULTS: Nurses identified fewer patients at nutritional risk than the dietitian (73 vs. 211). In addition, the overall agreement between the registered dietitian and clinical nurses using the NRS-2002 was fair (kappa = 0.343, 95% CI: 0.275 to 0.411). Interrater reliability was fair for nutritional status (kappa = 0.241) but poor for disease severity (kappa = 0.198), whereas perfect agreement was observed for the age component (kappa = 1.000). Among cancer types, patients with breast cancer (n = 11) showed complete agreement (kappa = 1.000), though this finding should be interpreted cautiously because of the small sample size, followed by those with gastrointestinal tumors (kappa = 0.489, 95% CI: 0.289 to 0.689) and esophageal cancer (kappa = 0.408, 95% CI: 0.212 to 0.604). Nurses with junior professional titles (kappa = 0.347) showed slightly higher consistency with the dietitian than those with intermediate titles (kappa = 0.339).

CONCLUSION: Overall, this study demonstrated fair interrater reliability of the NRS-2002 for assessing nutritional risk among hospitalized patients with cancer. To improve the reliability of nutritional risk screening, we recommend standardizing the operational definitions of disease severity scores, implementing structured and periodic training programs for clinical nurses, and establishing regular audit and supervision mechanisms. These measures are essential for improving screening consistency and, in turn, patient assessment and subsequent care.

PMID:42168672 | DOI:10.1007/s12672-026-05247-y

J Epidemiol Glob Health. 2026 May 21. doi: 10.1007/s44197-026-00581-4. Online ahead of print.

ABSTRACT

BACKGROUND: Disabled people experienced disproportionately poor outcomes during the COVID-19 pandemic, but evidence remains uneven across disability status and across stages of the disease pathway. Few population-wide studies have simultaneously examined infection, hospitalisation, and mortality while distinguishing intellectual disability from physical disability. The aim of this study was to quantify associations between disability status and COVID-19 outcomes in a national Scottish cohort.

METHODS: This population-wide retrospective cohort study included 3,719,651 adults aged ≥ 16 years alive and resident in Scotland on 1 March 2020. Disability status was derived from the 2011 Scottish Census and categorised as intellectual disability (n = 17,354), physical disability (n = 377,706), or no recorded intellectual or physical disability (comparison group; n = 3,324,591). Participants were followed from 1 March 2020 until 30 April 2022 for first laboratory-confirmed SARS-CoV-2 infection, first COVID-19 hospitalisation, and COVID-19-related mortality. Associations were estimated using Cox proportional hazards models with sequential adjustment for demographic factors, socioeconomic factors, health-related factors, and COVID-19 vaccination status.

RESULTS: During follow-up, 306,343 participants had a first recorded SARS-CoV-2 infection, 22,945 experienced a first COVID-19 hospitalisation, and 12,893 died from COVID-19-related causes. Crude incidence rates for first recorded SARS-CoV-2 infection were highest among adults with intellectual disability, whereas crude incidence rates for COVID-19 hospitalisation and mortality were highest among adults with physical disability. In fully adjusted models, compared with adults with no recorded intellectual or physical disability, intellectual disability was associated with higher hazards of infection (HR 2.65, 95% CI 2.57-2.73), hospitalisation (HR 1.60, 95% CI 1.40-1.83), and mortality (HR 1.58, 95% CI 1.30-1.91). Physical disability was also associated with higher hazards of infection (HR 1.60, 95% CI 1.58-1.62), hospitalisation (HR 1.16, 95% CI 1.12-1.19), and mortality (HR 1.23, 95% CI 1.19-1.28). Across all three outcomes, hazards were higher for intellectual than physical disability.

CONCLUSIONS: Both intellectual and physical disability were independently associated with increased risk across the COVID-19 disease pathway, with stronger associations observed for intellectual disability. These findings support disability-inclusive pandemic preparedness and prevention strategies that recognise heterogeneity of risk within the disabled population and promote equitable access to timely care.

PMID:42168669 | DOI:10.1007/s44197-026-00581-4

Clin Oral Investig. 2026 May 22;30(6):242. doi: 10.1007/s00784-026-06916-6.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the impact of sagittal and vertical skeletal patterns as well as gender on temporomandibular joint (TMJ) morphology using Cone Beam Computed Tomography (CBCT).

METHODS: A cross-sectional analysis was conducted on CBCT scans of 126 adult patients (63 females, 63 males) aged 20 to 40 years, stratified into Class I, II and III sagittal classifications and further divided by vertical patterns: horizontal, normal and vertical. Measurements included condylar dimensions (length, height, and width) and glenoid fossa dimensions (depth and width). Left and right TMJs were assessed and average values were used due to the absence of significant side differences. A multiple linear regression model was used to examine the effects of sagittal and vertical patterns and Gender on the parameter. Gender was included as a covariate in all models. Both an interaction model (vertical × sagittal pattern) and a main-effects-only model were considered with interaction effects accounted for where present. Model selection was based on statistical significance and model fit criteria. Pairwise comparisons were conducted using Tukey’s Honest Significant Difference (HSD) test and estimated marginal means (EMMs) were calculated where applicable. Statistical significance was set at p < 0.05 with adjustments for multiple comparisons.

RESULTS: For Condyle Height, a significant difference was found between Class III and Class I within the vertical pattern (VP) subgroup (p = 0.011). In contrast, Gender significantly influenced Condyle Length (p = 0.009) and a significant difference was found between Class II and Class I (p = 0.01). Subgroup analysis revealed a significant difference between Class II and Class I in the VP group (p = 0.023). For Condyle Width, a significant interaction between VP and Class III was found (p = 0.029). Significant pairwise differences were observed between HP-Class II and VP-Class III (p = 0.023), NP-Class II and VP-Class III (p = 0.007), and HP-Class III and VP-Class III (p = 0.013). Within the NP subgroup, Class II differed significantly from Class I (p = 0.044). Analysis of Glenoid Fossa Width revealed a significant interaction between NP and Class III (p = 0.048). Multiple significant pairwise differences were identified, including NP-Class I versus HP-Class II (p = 0.002), NP-Class I versus NP-Class II (p = 0.004), and VP-Class II versus HP-Class III (p = 0.004). Regarding glenoid fossa depth, a significant interaction between VP and Class III was found (p = 0.037), but no pairwise subgroup differences reached statistical significance (all p > 0.05).

CONCLUSIONS: This study demonstrates that TMJ morphology is variably influenced by vertical and sagittal skeletal patterns and gender. Significant differences in condyle length and width as well as glenoid fossa width were primarily observed in individuals with vertical patterns and Class II or III skeletal relationships. Gender significantly affected condyle length. While glenoid fossa depth showed a high interaction between vertical pattern and sagittal skeletal relationships, no individual comparisons reached statistical significance. These findings underscore the nuanced interplay of sagittal and vertical skeletal patterns in shaping TMJ morphology.

PMID:42168666 | DOI:10.1007/s00784-026-06916-6

Neurol Sci. 2026 May 22;47(6):511. doi: 10.1007/s10072-026-09105-1.

ABSTRACT

BACKGROUND: Total cerebral small-vessel disease (cSVD) score is a well-established predictor of vascular risks. However, the specific type of recurrent stroke associated with cSVD scores remains unclear in hemorrhage-prone patients-those with cerebral microbleeds (CMBs) or prior intracerebral hemorrhage (ICH).

METHODS: This study was a post hoc analysis of 1,454 patients enrolled in a prospective, multicenter, randomized controlled trial. Patients were categorized by modified cSVD (m-cSVD) scores 1-3. One point was awarded for each of the following: white matter hyperintensities (WMH) above the median, ≥2 CMBs or 1 ICH, and ≥1 lacune. The primary outcome was any stroke; secondary outcomes were ischemic and hemorrhagic stroke; the tertiary outcome was major adverse cardiovascular events (MACE). Multivariable Cox regression analysis was used to investigate associations between m-cSVD scores and events.

RESULTS: During a mean 1.9-year follow-up, the incidence rate per 100 person-years for ischemic stroke increased significantly with m-cSVD scores (1.9, 2.8, and 5.7, respectively). Compared to score 1, m-cSVD score 3 was associated with a higher risk of ischemic stroke (adjusted HR 2.72; 95% CI 1.03-7.18) and MACE (adjusted HR 2.34; 95% CI 1.08-5.10). While the incidence of hemorrhagic stroke showed a numerical increase (0.5, 0.8, and 1.5), this association did not reach statistical significance (unadjusted HR 3.05; 95% CI 0.66-14.14).

CONCLUSION: A high m-cSVD burden was independently associated with recurrent ischemic stroke, but not hemorrhagic stroke, in patients with high bleeding risk. High cSVD burden may reflects elevated ischemic risk, warranting careful consideration of ischemic stroke prevention even in patients with hemorrhagic potential.

PMID:42168664 | DOI:10.1007/s10072-026-09105-1

Sci Rep. 2026 May 21. doi: 10.1038/s41598-026-53110-5. Online ahead of print.

ABSTRACT

Machine Learning (ML) and Artificial Intelligence (AI) are important tools for modelling drying processes to reduce moisture and preserve food products. This study investigated the drying performance of an industrial infrared conveyor belt drying system on onion slices under different drying conditions. The effects of drying temperature, infrared intensity, and airflow rates were evaluated. The results demonstrated that increasing IR power and air temperature significantly reduced drying time by 44.23%. Effective moisture diffusivity increased from 0.238 × 10⁻¹⁰ to 0.457 × 10⁻¹⁰ m²/s, indicating enhanced internal moisture transport at elevated thermal inputs. The lowest Sect. (10.72 kWh/kg) was achieved at 600 W, 65 °C, and 0.3 m/s, while the highest (22.26 kWh/kg) occurred at low temperature and high airflow conditions. Thermal efficiency improved with increasing temperature and radiation intensity, reaching a maximum of 21.92%. However, the Artificial Neural Network model exhibited excellent predictive capability with a correlation coefficient (R) of 0.999, accurately estimating key drying parameters. Self-Organizing Map (SOM) analysis identified distinct operational clusters, revealing that higher air temperature and IR power reduced drying time and energy consumption, whereas increased airflow increased energy usage. Therefore, the study demonstrates that integrating AI and statistical tools provides a robust framework for optimizing industrial drying systems, enabling reduced energy consumption and improved process efficiency.

PMID:42168663 | DOI:10.1038/s41598-026-53110-5

Nat Neurosci. 2026 May 21. doi: 10.1038/s41593-026-02302-3. Online ahead of print.

ABSTRACT

Multiple sclerosis (MS) is a chronic neuroinflammatory disease in which demyelinating white matter lesions accumulate and expand, driving irreversible disability. Here we identify a distinct population of foamy GPNMB⁺ microglia/macrophages associated with lesion expansion in secondary progressive MS. Using integrated lipidomic, transcriptomic, proteomic, chemical proteomic and histological analyses of human postmortem MS lesions, we show that lesions containing foamy microglia/macrophages exhibit disrupted lipid metabolism, lysosomal stress and markers associated with heightened phagocytosis and antigen presentation without classical pro-inflammatory signatures. These lesions are enriched for oxylipins, bismonoacylglycerolphosphates and cholesterol esters, and are associated with increased B cell infiltration and IgG1. Monoacylglycerol lipase (MAGL), a lipid-metabolizing enzyme enriched in lesions with foamy microglia/macrophages, emerged as a potential therapeutic target. Inhibition of MAGL promoted lesion recovery and reduced microgliosis in a mouse model of demyelination. Finally, oxylipins in cerebrospinal fluid correlate with the proportion of foamy lesions, suggesting potential biomarkers for progression. Our findings implicate disturbed lipid metabolism in chronic MS pathology and suggest that foamy microglia/macrophages are an interesting cell type to target for progressive disease.

PMID:42168651 | DOI:10.1038/s41593-026-02302-3

Eur J Nucl Med Mol Imaging. 2026 May 22. doi: 10.1007/s00259-026-07886-3. Online ahead of print.

ABSTRACT

PURPOSE: The 2024 Alzheimer’s Association Workgroup research framework designates tau proteinopathy (T₂) as a key element for Alzheimer’s disease (AD) staging, but optimal staging approaches have yet to be determined. Here, we compared visual and quantitative tau-PET-based Braak staging as candidate strategies to implement T₂ biological staging in vivo.

METHODS: We included 140 participants from the TRIAD cohort who underwent [¹⁸F]MK6240 tau-PET. Quantitative Braak staging (qBraak) was derived from regional SUVR thresholds, whereas visual Braak staging (vBraak) was independently performed by three nuclear medicine physicians using an adapted interpretation algorithm. Inter-rater and inter-method agreement were assessed using Cohen’s and Fleiss’ κ statistics. Associations with clinical severity, cortical thickness, plasma pTau217, and cortical tau extent were examined. Diagnostic performance for identifying amyloid-positive cognitively impaired individuals was evaluated.

RESULTS: vBraak demonstrated substantial to nearly perfect inter-rater agreement (κ = 0.65-0.93). Agreement between vBraak and qBraak was moderate when stages were treated categorically (κ = 0.51), but substantial when their ordinal nature was considered (weighted κ up to 0.73). Both strategies showed comparable associations with clinical severity and neurodegeneration. vBraak was more sensitive to amyloid-β-positive cognitive impairment and identified intermediate-stage involvement at lower global tau extent. Visual-quantitative discordant cases were primarily attributable to off-target binding or spatially heterogeneous tau patterns.

CONCLUSION: Both vBraak and qBraak staging provide complementary and largely concordant approaches for operationalizing T₂ staging. Quantitative methods enable scalable, group-level analyses, whereas visual assessment remains essential for identifying atypical tau patterns and informing clinically relevant decision-making.

PMID:42168643 | DOI:10.1007/s00259-026-07886-3

Rheumatol Int. 2026 May 21;46(6):95. doi: 10.1007/s00296-026-06134-z.

ABSTRACT

Hypermobile Ehlers-Danlos Syndrome (hEDS) is associated with joint hyperflexibility, pain, and connective tissue frailty. Patients are at high risk for fracture due to poor proprioception. This study reports on the mental and physical health, pain, physical activity, and kinesiophobia in patients with hEDS, and explores bone mineral density and fracture risk. This single-center, cross-sectional prospective study was approved by the IRB (HHC-2022-0143). Patients with diagnosed hEDS were consented and completed demographic forms, activity levels, PROMIS-10 Global Health Assessments, and the Tampa Kinesiophobia Scale, prior to DXA (Dual-energy X-ray absorptiometry) scans. Descriptive and inferential statistics were conducted including correlations and univariate regression analyses. All patients were female and pre-menopausal with a mean age of 36 (range: 19-55). Patients maintained an overall adequate bone mineral density (Spine: 1.16 ± 0.12 g/cm³, Femur: 0.961 ± 0.09 g/cm³ ) though three patients were identified as osteopenic and 50% had fractured as an adult. The PROMIS-10 mental health T-score and pain were strongly negatively correlated (r_s = -0.87, p < 0.001) as were the PROMIS-10 physical function T-score and pain (r_s = -0.78, p < 0.001). Kinesiophobia was negatively correlated with low mental health (r_s = -0.56, p = 0.03) and with physical function T-scores (r_s = -0.75, p < 0.001). This study illustrates the association of mental health, physical function, chronic pain, and kinesiophobia in this unique patient population. Patients had higher fracture incidence without a significant reduction in bone mineral density. Future interventions could be directed at exploring disease-specific rehabilitation programs.

PMID:42168630 | DOI:10.1007/s00296-026-06134-z

Surg Endosc. 2026 May 21. doi: 10.1007/s00464-026-12921-3. Online ahead of print.

ABSTRACT

BACKGROUND: Although endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC), its role in managing undifferentiated-type EGC (UD-EGC) is still debated. This multicenter study aimed to compare the short- and long-term outcomes of ESD and surgery in patients with UD-EGC.

METHODS: We retrospectively analyzed patients with UD-EGC who underwent ESD or surgery at 11 tertiary centers in Taiwan between 2007 and 2025. Inclusion criteria included intramucosal tumors ≤ 20 mm without ulceration or lymphovascular invasion. Demographic, endoscopic, and pathological data were collected, and long-term outcomes were compared.

RESULTS: A total of 37 ESD and 42 surgery patients were analyzed. En bloc resection was achieved in all cases. R0 resection rates were 86% for ESD and 98% for surgery in unadjusted analysis (P = 0.06), while propensity score-weighted analysis showed significantly higher R0 resection in the surgery group (85.8% vs. 98.7%, P = 0.017). The ESD group demonstrated significantly shorter procedure times (84.6 vs. 285.7 min, P < 0.001) and hospital stays (6.8 vs. 17.6 days, P < 0.001). Complication rates were comparable between groups (11% for ESD vs. 14% for surgery, P = 0.74). In unadjusted analyses, the cumulative incidence of recurrence was higher in the ESD group than in the surgery group (P = 0.03), whereas overall survival (OS) was similar between groups (5-year OS: 93% for ESD vs. 90% for surgery; log-rank P = 0.12). After propensity score overlap weighting, the difference in recurrence between groups was attenuated and no longer statistically significant (P = 0.22).

CONCLUSIONS: Although ESD is less invasive with shorter procedure time and hospital stay, its lower R0 resection rate and higher recurrence risk require careful patient selection and close surveillance. Similar OS supports the potential role of ESD in selected UD-EGC patients, although further validation is needed.

PMID:42168610 | DOI:10.1007/s00464-026-12921-3

Sci Rep. 2026 May 21. doi: 10.1038/s41598-026-51501-2. Online ahead of print.

ABSTRACT

Cell type markers have been instrumental to physiological and molecular investigation of the human brain and remain essential for annotating cell type clusters in single-cell expression data and for target validation studies. However, expression of canonical markers in the target cell type (which we termed as the expression ‘fidelity’) as well as expression in unrelated cell types (which we termed as the ‘background expression’) across cortical regions remains poorly characterized. Here, leveraging nearly 500,000 high-quality single-nucleus and single-cell profiles from 19 studies, we quantified marker fidelity, revealing substantial regional variability. We developed a statistical framework that aggregates annotated barcodes into pseudo-bulk profiles, applied rigorous performance metrics, and identified markers with high fidelity, low background, and consistent expression across regions. This approach extended the canonical marker set for six major brain cell types and yielded superior subtype-specific markers. The resulting marker lists, and a user-friendly analysis interface, provide a valuable resource for cell type annotation and validation in neuroscience research.

PMID:42168596 | DOI:10.1038/s41598-026-51501-2