Nevin Manimala

Lung India. 2026 Jan 1;43(1):45-51. doi: 10.4103/lungindia.lungindia_264_25. Epub 2026 Jan 1.

ABSTRACT

INTRODUCTION: Intravenous (IV) tranexamic acid (TXA), an antifibrinolytic agent, is routinely used in the treatment of non-massive haemoptysis. Topical TXA has shown haemostatic efficacy in surgical settings and epistaxis. Limited case reports have documented successful management of pulmonary bleeding using nebulised TXA. This study was conducted to evaluate the efficacy of nebulised TXA compared to IV TXA in non-massive haemoptysis.

MATERIALS AND METHODS: This single-centre, randomised controlled trial included 46 adult patients with non-massive haemoptysis presenting to the Emergency Medicine department. They were randomised into two groups: IV TXA (n = 23), receiving 500 mg TXA IV 8th hourly, and nebulised TXA (n = 23), receiving 500 mg TXA via nebulisation 8th hourly. The volume of haemoptysis was recorded at presentation and at 8-hour intervals. Haemoglobin, liver, and renal function tests were recorded at admission, and haemoglobin was monitored daily. Data were analysed using appropriate statistical tests.

RESULTS: Among the 46 patients, 30 were male. The mean age in the IV TXA group was 51.83 ± 12.58 years and 49.91 ± 13.87 years in the nebulised TXA group (P = 0.63). There were two smokers in the IV group and eight in the nebulised group. Pulmonary tuberculosis was the most common cause in both groups. The mean bleeding volume at presentation was 58.26 ± 49.69 ml (IV) and 46.96 ± 38.30 ml (nebulised) (P = 0.39). Complete cessation of haemoptysis was achieved in 7.39 ± 5.02 h (IV) and 5.70 ± 4.80 h (nebulised) (P = 0.25). Repeat doses were required in 6 (IV) and 3 (nebulised) patients (P = 0.40). No adverse effects were observed.

CONCLUSION: Nebulised TXA is as effective as IV TXA in managing non-massive haemoptysis.

PMID:41474427 | DOI:10.4103/lungindia.lungindia_264_25

Lung India. 2026 Jan 1;43(1):20-26. doi: 10.4103/lungindia.lungindia_136_25. Epub 2026 Jan 1.

ABSTRACT

BACKGROUND: Bronchiectasis is a chronic respiratory condition characterised by abnormal bronchial dilation, often accompanied by inflammation and infection. Tumour necrosis factor-alpha (TNF α) has been implicated in inflammatory processes, and its role in bronchiectasis severity remains underexplored. This study aimed to assess the correlation between serum TNF α levels and bronchiectasis severity using established scoring systems.

METHODS: A cross-sectional study was conducted among 96 patients diagnosed with bronchiectasis. Serum TNF α levels were measured and analysed in relation to clinical parameters, radiological features, and severity scores such as FACED and Bronchiectasis Severity Index (BSI). Statistical tests including the Mann-Whitney U-test and Kruskal-Wallis test were used to identify significant associations.

RESULTS: Elevated serum TNF α levels were significantly associated with fever, leukocytosis, recent hospital admissions, and bronchiectasis exacerbations. Patients with multi-lobar involvement and bilateral lung disease exhibited significantly higher TNF α levels (P = 0.01). Pseudomonas colonisation was linked to increased TNF α levels. Severity scoring demonstrated a strong association with TNF α levels, with higher values seen in patients categorised as moderate or severe by FACED and BSI scores.

CONCLUSION: Serum TNF α levels are a potential biomarker for assessing bronchiectasis severity. Elevated TNF α levels were notably linked to exacerbations, microbial colonisation, and severe disease presentations, underscoring its clinical relevance in guiding prognosis and management strategies.

PMID:41474423 | DOI:10.4103/lungindia.lungindia_136_25

Lung India. 2026 Jan 1;43(1):14-19. doi: 10.4103/lungindia.lungindia_141_25. Epub 2026 Jan 1.

ABSTRACT

INTRODUCTION: Antifibrotic therapies are widely used in both idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). We aim to compare the demographic, clinical characteristics, and long-term outcomes of IPF and PPF patients on antifibrotic treatment at 6-month and 1-year follow-ups.

METHODS AND MATERIALS: This was a retrospective single-center cohort study. Between January 2021 and January 2025, patients who initiated antifibrotic therapy were retrospectively included. Pulmonary function tests were recorded before treatment, at baseline, and at 6-month and 1-year follow-up visits. Additionally, baseline 6-minute walk test results and radiological data were also documented.

RESULTS: A total of 117 cases were included in the study, consisting of 76 IPF and 41 PPF. IPF patients were statistically significantly older than PPF patients (P < 0.001). The proportion of females was higher in the PPF group (P < 0.001). 52% of the cases used pirfenidone, while 48% used nintedanib. The most common subtype of PPF was connective tissue disease-associated ILD (48.8%), followed by nonspecific interstitial pneumonia (34.1%), and hypersensitivity pneumonitis (17.1%). In the PPF group, basal, 6-month, and 1-year follow-up FVC and DLCO values were statistically significantly lower compared to the IPF group. However, in both the IPF and PPF groups, no significant loss was observed in FVC and DLCO when comparing the 6-month and 1-year follow-up data with baseline values. No significant difference in mortality was found between the IPF and PPF groups.

CONCLUSIONS: Antifibrotic treatments showed a similar effect profile for both IPF and PPF. Our findings suggest that PPF patients with lower baseline pulmonary function require closer monitoring for early detection of progression.

PMID:41474422 | DOI:10.4103/lungindia.lungindia_141_25

J Psychosom Obstet Gynaecol. 2026 Dec 31;47(1):2610384. doi: 10.1080/0167482X.2025.2610384. Epub 2025 Dec 31.

ABSTRACT

PURPOSE: This systematic review synthesizes evidence on depressive symptoms and access to mental health care following miscarriage. It examines differences between women in general care settings and those with recurrent pregnancy loss to explore differential psychological vulnerability and care gaps.

METHODS: A search of four databases (inception-June 2025) followed PRISMA guidelines. Studies reporting depressive symptoms or barriers and facilitators to care were included. Given methodological heterogeneity, findings were synthesized narratively using a SWiM framework, stratifying populations by miscarriage history and assessing quality with risk-of-bias tools.

RESULTS: Of 1,140 records, 46 were included. Depressive symptoms were common, though prevalence varied by timing, tools, and characteristics. Evidence suggests a possible graded association between recurrent loss and symptoms, although this was inconsistent and often attenuated in acute assessments. Key correlates included childlessness, prior psychiatric history, repeated loss, and low social support. Barriers included insensitive communication, lack of follow-up, and financial constraints. Facilitators included empathetic interactions, clear information, and supportive networks.

CONCLUSIONS: Miscarriage is frequently associated with significant distress, yet evidence certainty varies regarding recurrence and intervention effectiveness. Findings highlight a persistent gap between women’s mental health needs and healthcare responses.

PMID:41474415 | DOI:10.1080/0167482X.2025.2610384

Anatol J Cardiol. 2025 Dec 31. doi: 10.14744/AnatolJCardiol.2025.5862. Online ahead of print.

ABSTRACT

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality, underscoring the need for improved early detection strategies for preclinical atherosclerosis. This study evaluated comprehensive multimodal cardiovascular risk predictors-clinical, biochemical, and vascular imaging parameters-in dyslipidemic adults without established ASCVD.

METHODS: A total of 847 adults underwent standardized clinical assessment, laboratory profiling, and duplex-based vascular imaging, including carotid intima-media thickness (IMT), plaque assessment, flow-mediated dilation (FMD), and ankle-brachial index. Statistical analyses included multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, model calibration metrics, and correlation matrices using Pearson or Spearman tests as appropriate. High-density lipoprotein cholesterol (HDL-C) exhibited a strong inverse correlation with AIP (r = -0.57, P < .001).

RESULTS: Triglycerides (TG) demonstrated a strong positive correlation with the atherogenic index of plasma (AIP) (r = 0.80, P < .001). Moderate correlations were observed between age and left ventricular mass index (r = 0.31, P < .001), age and fibrinogen (r = 0.32, P < .001), HbA1c and TG (r = 0.26, P < .001), and HbA1c and AIP (r = 0.30, P < .001). ASCVD and atherosclerosis total score positivity were independently associated with age, HbA1c, IMT, and FMD in multivariable analyses, while model discrimination remained robust (area under the curve values reported).

CONCLUSION: Multimodal integration of clinical, biochemical, and vascular imaging markers provides meaningful refinement of cardiovascular risk stratification and may enhance early detection of preclinical ASCVD.

PMID:41474414 | DOI:10.14744/AnatolJCardiol.2025.5862

CNS Neurosci Ther. 2026 Jan;32(1):e70729. doi: 10.1002/cns.70729.

ABSTRACT

OBJECTIVE: The mechanical thrombectomy (MT) strategy obviously differs for acute middle cerebral artery occlusion (MCAO) stroke caused by embolism or atherosclerosis. Our study aimed to develop and validate a simple and universally applicable score for predicting etiology [embolism or intracranial arteriosclerosis (ICAS)] before MT in patients with acute MCAO stroke.

METHODS: Between November 2019 and September 2022, we retrospectively enrolled eligible patients in our hospital as the training cohort. Additionally, consecutive patients between July 2023 and April 2024 were recruited as the validation cohort. Multivariate logistic regression analysis was used to identify the independent factors associated with etiology in the training group. Each factor was then point assigned based on β-coefficient, and a risk scoring system was developed. The scoring system was validated through the validation cohort. The C-statistic, Brier score, and Hosmer-Lemeshow test were used to assess model discrimination and calibration.

RESULTS: The training group and validation group finally included 277 patients (154 embolism-MCAO and 123 ICAS-MCAO) and 101 patients (59 embolism-MCAO and 42 ICAS-MCAO), respectively. A scoring system (AHOC score) covering four variables (atrial fibrillation, hyperdense middle cerebral artery sign, stenosis/occlusion in other arteries, and collateral status) was derived to help identify embolism-MCAO or ICAS-MCAO. The AHOC score showed good discrimination and calibration in the training cohort (C-statistic, 0.932 [0.902-0.963]; Brier score, 0.092 [0.070-0.115]; p value of the Hosmer-Lemeshow test, 0.604) and in the validation cohort (C-statistic, 0.933 [0.888-0.978]; Brier score, 0.102 [0.067-0.140]; p value of the Hosmer-Lemeshow test, 0.846). According to the AHOC score, patients with a score of 4-8 were identified as high-risk for the embolism-MCAO category. Conversely, a patient with a score of 0-3 was considered high-risk for the ICAS-MCAO category.

CONCLUSIONS: Our scoring system (AHOC score), consisting of atrial fibrillation, hyperdense middle cerebral artery sign, stenosis/occlusion in other arteries and collateral status, is a valid and applicable model for predicting the etiology in patients with acute MCAO before MT.

PMID:41474412 | DOI:10.1002/cns.70729

J Physiol. 2025 Dec 31. doi: 10.1113/JP290334. Online ahead of print.

NO ABSTRACT

PMID:41474389 | DOI:10.1113/JP290334

J Physiol. 2025 Dec 31. doi: 10.1113/JP289753. Online ahead of print.

ABSTRACT

Spontaneous tendon rupture occurs in a concerning number of individuals with chronic kidney disease (CKD); however almost no data exist regarding CKD-related tendon pathology. Given that tendon ruptures have a significant impact on health and well-being we sought to determine whether tendon mechanics are altered by kidney disease in an established rat model of CKD. Male and female Sprague-Dawley rats (age = 8 weeks) were equally divided into a control group (CON, n = 16) and a group fed a diet containing 0.25% adenine to induce kidney disease (_ADICKD). After 9 weeks, Achilles and tibialis anterior (TA) tendons were excised, and maximum tensile load (MTL), failure stress, modulus and cross-sectional area (CSA) were measured and evaluated by two-way ANOVA (main effects: CKD and sex). CKD was confirmed through elevated creatinine (1.99 vs. 0.61 mg/dl, CKD vs. CON, P < 0.001) and blood urea nitrogen (93.4 vs. 21.4 mg/dl, P < 0.001). Plantar flexor strength was 13% lower in _ADICKD (P = 0.0214), and femur yield force was decreased by 41% in male _ADICKD (P < 0.001). The failure stress of TA tendons was 24% lower in CKD vs. CON (P = 0.0383). There were no statistically significant differences in TA tendon MTL, modulus or CSA. There were no significant main effects for any parameter for the Achilles; however, post hoc testing following a finding of group-by-sex interactions revealed that in females Achilles failure stress was decreased in _ADICKD by 25% (P = 0.0283). To our knowledge this is the first direct evidence that tendon weakness is caused by kidney disease, providing a model for further evaluating mechanisms and interventions. KEY POINTS: Chronic kidney disease is well known to lead to musculoskeletal dysfunction, such as bone and muscle wasting. Numerous case reports suggest that chronic kidney disease may also predispose patients to catastrophic tendon injuries; however, there are no mechanistic studies or animal models addressing this phenomenon – and thus, no treatments. We determined whether a rat model of chronic kidney disease previously used to study muscle and bone dysfunction (0.25% adenine in the diet) would also cause impaired tendon function. Eight weeks of adenine-induced kidney disease caused tibialis anterior tendons to tear at 24% lower stress than in control animals, while also decreasing plantar flexor muscle strength by 13% and femur strength by 41% (males only). This is the first experimental evidence for a direct effect of chronic kidney disease on tendon function, establishing a comprehensive multitissue model for future research.

PMID:41474384 | DOI:10.1113/JP289753

Epilepsia. 2025 Dec 31. doi: 10.1002/epi.70084. Online ahead of print.

ABSTRACT

There is debate on the predictive value of multiday seizure cycles versus simple statistical baselines. Multidien seizure cyclicity is a prevalent, patient-specific phenomenon with promise for epilepsy management. We challenge the assertion that cycle tracking is no better than a moving average, which is an inherently retrospective model that lags changes in seizure likelihood. This commentary compared a causal cyclic forecast to a prospectively applied moving average across a large seizure diary cohort (n = 768) and two gold-standard chronic EEG cohorts (n = 24). For the EEG and diary cohorts, cycle tracking demonstrated significantly superior accuracy to the moving average for both hourly and daily forecasts (p < 0.0001), using multiple performance metrics. These results confirm that event-based cyclical models offer more accurate, simulated real-world forecasts. Robust forecasting tools must prioritize the detection and modeling of seizure cycles to move beyond simple baseline performance and provide actionable clinical utility.

PMID:41474376 | DOI:10.1002/epi.70084

FASEB J. 2026 Jan 15;40(1):e71400. doi: 10.1096/fj.202502393R.

ABSTRACT

Gastric cancer (GC) has a high incidence in China. There is a closed-loop structure in circRNAs, which is involved in various cellular biological processes such as tumor development. However, there is a lack of research on the function of circRNAs in GC. In this study, we aimed to explore the potential of circXPO1 as a diagnostic biomarker and the role of circXPO1 in the progression of GC. We screened out circXPO1 through circRNA sequencing. Using exonuclease digestion assay, agarose gel electrophoresis (AGE), Sanger sequencing, and gDNA experiment, we proved that circXPO1 contained a cyclic structure. Quantitative real-time fluorescent Polymerase Chain Reaction (qRT-PCR) was used to detect the expression of circXPO1 in plasma and GC tissues. The receiver operating characteristic curve (ROC curve) was established to evaluate the diagnostic efficacy of circXPO1. The role of circXPO1 was assessed in vitro. The binding sites between circXPO1 and miRNAs were predicted by CircBank, Circinteractome, CircAtlas and miRanda databases. CircXPO1 was up-regulated in 67 GC tissues compared with the adjacent normal tissues (p = 0.0002). It was stable and hard to be degraded, which made it an ideal tumor biomarker. Compared with the patients in the normal control group, the expression level of circXPO1 in plasma was higher in GC patients (p < 0.001) and those with benign lesions (p = 0.0031) with statistically significant differences. CircXPO1 was proved to have satisfactory diagnostic efficacy in distinguishing GC patients from healthy donors (AUC = 0.813, 95% CI: 0.749-0.877). Besides, the diagnostic efficacy, sensitivity, and specificity could achieve 0.853, 78% and 86%, respectively, when circXPO1, CEA and CA199 were used together in diagnosis. In addition, in vitro experiments indicated that circXPO1 knockdown significantly weakened the proliferation, invasion and migration of GC cells. It was also predicted that circXPO1 could serve as a sponge of miR-1248 to regulate the progression of GC.

PMID:41474375 | DOI:10.1096/fj.202502393R