Nevin Manimala

J Am Geriatr Soc. 2026 Jul 15. doi: 10.1111/jgs.70552. Online ahead of print.

ABSTRACT

BACKGROUND: Family visits with nursing home residents have been shown to improve residents’ quality of life. However, little is known about the association between in-person family visits and physical (e.g., pain) and behavioral symptoms (e.g., agitation) among residents with cognitive impairment. Using data from a large clinical trial of a palliative care program in Maryland and Indiana, we examined the association between family visits and staff-reported resident symptom burden.

METHODS: Using cross-sectional baseline data from an ongoing multi-state clinical trial involving 194 nursing home residents with cognitive impairment, we conducted bivariate analyses to examine the association between in-person family visits (family involvement) as reported by family members and staff-reported resident symptom burden. Linear regression models assessed the association between symptom burden and family visits in an adjusted framework. The model controlled for other relevant covariates, including resident race, gender, and age, and the care partner’s relationship to the resident. Staff-reported symptom burden was measured using a modified version of the Comfort Assessment in Dying End of Life in Dementia (CAD-EOLD) scale. Family involvement was measured by the average weekly frequency of in-person visits reported by the family over the past month.

RESULTS: On average, spouses visited 5 days per week, children 2 days per week, and other family members 1.5 days a week. In bivariate analyses, there was a weak but statistically significant and positive correlation between family involvement and symptom burden (r = 0.16, p = 0.04). However, in the adjusted model, the association was not statistically significant (b = 0.16, p = 0.09).

CONCLUSION: Bivariate analyses suggest a significant and positive correlation between family visitation and symptom burden. However, this finding was not in the expected direction. Family visitation was associated with residents experiencing greater symptom burden. The association was not statistically significant in the adjusted model.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04520698.

PMID:42455515 | DOI:10.1111/jgs.70552

J Magn Reson Imaging. 2026 Jul 15. doi: 10.1002/jmri.70461. Online ahead of print.

ABSTRACT

BACKGROUND: A previous single-case study has demonstrated that a modified time-spatial labeling inversion pulse (Time-SLIP) technique, specifically Deep Abdominal Breathing-induced CSF Flow Imaging with Time-SLIP (DAB Time-SLIP), successfully visualized dynamic cerebrospinal fluid (CSF) flow during deep breathing with superior contrast compared to conventional Time-SLIP. However, it is unclear whether this occurs consistently across healthy individuals.

PURPOSE: To investigate CSF flow dynamics during deep breathing in healthy volunteers with the DAB Time-SLIP.

STUDY TYPE: Prospective.

POPULATION: 10 healthy participants (7 men; mean age, 29.5 years).

FIELD STRENGTH/SEQUENCE: 1.5-Tesla, Time-SLIP.

ASSESSMENT: Midsagittal Time-SLIP imaging was performed using a 9 s repetition interval. A labeling pulse was applied at four vertebral levels (Th11-L1-L3-L5 or Th12-L2-L4-S1), and images were acquired after a 2 s delay. Separate imaging sessions were conducted during shallow breathing and during a structured 8 s deep abdominal breathing cycle. During deep-abdominal-breathing, an intentional phase shift between the 9 s imaging interval and the 8 s respiratory cycle enabled visualization of CSF movement across the entire cycle within 72 s. This protocol for CSF dynamics during deep-breathing was designated as DAB Time-SLIP. Images acquired under these two breathing conditions were compared with the reference label images obtained during breath-holding, and CSF flow velocity and displacement range were quantified based on the resulting positional changes.

STATISTICAL TESTS: Wilcoxon signed-rank test and simple linear regression analysis. A p < 0.05 was considered significant.

RESULTS: Cranial flow occurred during inhalation, whereas caudal flow was observed during exhalation. Both the magnitude and the displacement range of CSF flow velocity and CSF movement of range progressively decreased toward the caudal direction (rS = -0.9479). Compared with free breathing, the range of CSF movement using DAB Time-SLIP was significantly greater.

DATA CONCLUSION: DAB Time-SLIP demonstrated cranial CSF flow during deep inspiration and caudal CSF flow during deep expiration.

TECHNICAL EFFICACY: Stage 1.

PMID:42455513 | DOI:10.1002/jmri.70461

FASEB J. 2026 Jul 31;40(14):e71920. doi: 10.1096/fj.202502143RRR.

ABSTRACT

Neuroblastoma (NB) remains a challenge due to the lack of robust prognostic biomarkers for risk stratification and treatment guidance. The β3-adrenergic receptor (β3-AR) is implicated in tumor progression and metastasis. The present study evaluates the detection of β3-AR in different tissues and its correlation with survival and clinical characteristics of NB patients. β3-AR expression was analyzed in bone marrow (BM), peripheral blood (PB), circulating tumor cells (CTCs), disseminated tumor cells (DTCs), and tumor biopsies by flow cytometric analysis and immunofluorescence. Receiver Operating Characteristic (ROC) curves, Fisher’s exact test, and Kaplan-Meier curves were used to investigate the validity of β3-AR as a prognostic marker. Statistical analyses were performed by R software and MedCalc. In our cohort of 45 NB patients, β3-AR expression in PB was significantly higher compared to healthy controls (p = 1.839e-07 at diagnosis; p = 0.0006 at follow-up, p < 0.001) and showed strong correlation across tissues (r > 0.72). High β3-AR expression in DTCs at diagnosis (≥ 96.5%) was associated with shorter event-free survival (p = 0.0005). Elevated β3-AR in BM at diagnosis predicted worse overall survival (p = 0.0076). At follow-up, increased β3-AR expression in PB correlated with shorter overall survival (27 months vs. not reached, p = 0.0015). These findings highlight β3-AR as a promising prognostic biomarker for NB risk stratification and disease progression.

PMID:42455511 | DOI:10.1096/fj.202502143RRR

J Obstet Gynaecol Res. 2026 Jul;52(7):e70404. doi: 10.1111/jog.70404.

ABSTRACT

AIM: This study aimed to determine general comfort levels and quality of recovery in women after hysterectomy and to examine the relationship between these variables.

METHODS: A total of 188 women who underwent hysterectomy for benign indications participated in this cross-sectional study. Data were collected using the Descriptive Characteristics Form, the General Comfort Scale (GCS), and the Quality of Recovery-40 Questionnaire (QoR-40). Descriptive statistics, Pearson correlation, and linear regression analyses were performed to evaluate the data.

RESULTS: The mean age of the participants was 50.9 ± 10.5 years, and 41.5% had undergone abdominal hysterectomy. The mean GCS score was 130.66 ± 9.72, and the mean QoR-40 score was 164.16 ± 20.33. A statistically significant moderate positive correlation was found between GCS and QoR-40 scores (r = 0.425, p < 0.001). In addition, higher general comfort scores were significantly associated with higher recovery quality scores (β = 0.403, p < 0.001).

CONCLUSION: Higher levels of general comfort were associated with better postoperative recovery in women undergoing hysterectomy. These findings highlight the importance of assessing and supporting patient comfort as part of postoperative care.

PMID:42455509 | DOI:10.1111/jog.70404

Fam Med. 2026 Jul;58(7):488-494. doi: 10.22454/FamMed.2026.495888.

ABSTRACT

BACKGROUND AND OBJECTIVES: Accelerated 3-year programs (A3YPs) for an MD degree offer a condensed medical education pathway to residency, often with directed pathways in primary care. Many programs aim to address workforce shortages and decrease debt. As these programs expand, assessing whether A3YP graduates are as prepared for residency as their peers from traditional 4 year programs is critical. This study evaluates milestone attainment of A3YP postgraduates in Year 1 (PGY-1s) compared to non-A3YP PGY-1s within family medicine residency programs.

METHODS: We analyzed the Accreditation Council for Graduate Medical Education milestone ratings for family medicine PGY-1s from 2021 to 2023. The study included 109 A3YP graduates across 51 family medicine programs and 1,638 non-A3YP PGY-1s (MD, DO, international medical graduate) in those same programs. PGY-1s were compared across milestone competency domains using mixed-effects regression that accounted for clustering by program and subcompetency.

RESULTS: At midyear, A3YP PGY-1s scored significantly higher in medical knowledge, systems-based practice, and practice-based learning and improvement. Differences were statistically significant but modest. Coefficients ranged from 0.05 for patient care and medical knowledge to 0.10 for practice-based learning and improvement (PBLI; P&lt;0.01). At end-year, A3YP PGY-1s maintained slightly higher scores in medical knowledge, professionalism, PBLI, and communication (coefficients ranged from 0.07 to 0.10; P&lt;0.01).

CONCLUSIONS: A3YP graduates demonstrate equal or minimally higher milestone attainment compared to non-A3YP peers during PGY-1, supporting the viability of accelerated pathways. These findings reassure residency programs of A3YP readiness and highlight their potential to address workforce shortages and reduce student debt without compromising educational outcomes.

PMID:42455502 | DOI:10.22454/FamMed.2026.495888

Obes Surg. 2026 Jul 15. doi: 10.1007/s11695-026-08731-0. Online ahead of print.

ABSTRACT

BACKGROUND: The pharmacokinetics of oral psychotropic drugs can change after metabolic and bariatric surgery (MBS), affecting drug exposure. Given the risk of psychiatric decompensation, patients using psychotropic medications constitute a high-risk group requiring careful post-MBS monitoring. In particular, lithium, tricyclic antidepressants (TCAs), and clozapine are of concern because of their well-established dose-effect relationships, susceptibility to MBS-related exposure changes, and suitability for therapeutic drug monitoring (TDM). This study aimed to examine the prevalence of treatment interventions related to these medications in bariatric patients to prevent drug-related problems such as under- or overexposure requiring dosage adjustments or drug discontinuation.

METHODS: In this retrospective study, patient records from January 2017 to December 2023 were reviewed. Patients who underwent MBS and were using lithium, TCAs (amitriptyline, clomipramine, dosulepin, doxepin, imipramine, maprotiline, nortriptyline), and/or clozapine were included. Baseline characteristics, treatment interventions, and available drug plasma concentrations were collected preoperatively and up to one year postoperatively.

RESULTS: A total of 163 patients were included. Psychotropic drug adjustments were observed in 27 patients (16.6%) within the first year following MBS. Both pre- and postoperative drug plasma concentrations were available for three patients (1.8%). Three patients experienced worsening of psychiatric symptoms that necessitated hospitalization or intensive monitoring. No statistically significant differences in intervention rates were observed among patients with psychiatric disorders or pain.

CONCLUSION: Although only a minority of patients required psychotropic drug treatment interventions, monitoring psychotropic drug treatment is essential for safe and effective treatment post-MBS. Greater attention is needed regarding altered drug exposure, and plasma concentration monitoring may help optimize psychotropic pharmacotherapy in these patients.

PMID:42455492 | DOI:10.1007/s11695-026-08731-0

CNS Drugs. 2026 Jul 15. doi: 10.1007/s40263-026-01314-8. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Lumateperone, a simultaneous modulator of serotonin, dopamine, and glutamate neurotransmission, demonstrated efficacy and safety as adjunctive therapy in two phase III, randomized, double-blind, placebo-controlled trials in patients with major depressive disorder with inadequate antidepressant therapy (ADT) response. The objective of this pooled analysis of Studies 501 and 502 was to investigate the safety and tolerability of lumateperone 42 mg + ADT.

METHODS: Data were pooled from two studies that enrolled adults (aged 18-65 years) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-defined major depressive disorder with inadequate response to one to two ADTs in the current depressive episode (Montgomery-Åsberg Depression Rating Scale Total score ≥ 24; Clinical Global Impression-Severity score ≥ 4). Patients were randomized to 6 weeks of oral lumateperone 42 mg + ADT or placebo + ADT. Safety measures included adverse events, body morphology, cardiometabolic parameters, prolactin levels, extrapyramidal symptoms (EPS), and suicidality.

RESULTS: The pooled population comprised 964 patients (lumateperone + ADT, n = 483; placebo + ADT, n = 481). Treatment-emergent adverse events (TEAEs) occurred in 68.1% and 45.1% of the lumateperone + ADT and placebo + ADT groups, respectively. Treatment discontinuation because of an adverse event occurred in 8.7% of the lumateperone + ADT group and 0.8% of the placebo + ADT group. The most common TEAEs (≥ 5%, greater than twice placebo + ADT) were dizziness, dry mouth, somnolence, nausea, fatigue, and diarrhea. Of patients experiencing TEAEs, the majority (96.3%) had events of mild or moderate severity. Potentially clinically significant weight increase (≥ 7%) occurred in 0.4% and 1.3% of the lumateperone + ADT and placebo + ADT groups, respectively. Changes in cardiometabolic parameters and prolactin levels were minimal and similar to placebo + ADT. No notable changes occurred in EPS-related scales. EPS-related TEAEs occurred in 5.8% and 1.7% of lumateperone + ADT and placebo + ADT groups, respectively. The most common EPS-related TEAE was tremor (lumateperone + ADT, 3.9%; placebo + ADT, 0.2%), which had a mean duration of 11.9 days in the lumateperone + ADT group. Emergence of suicidal ideation was infrequent (lumateperone + ADT, 1.6%; placebo + ADT, 2.5%).

CONCLUSIONS: Lumateperone 42 mg + ADT had a good safety profile and was generally well tolerated in this pooled analysis, with low risks of weight gain, cardiometabolic abnormalities, and EPS with short-term treatment but with higher discontinuation rates because of adverse events (8.7%) versus placebo + ADT, in patients with major depressive disorder with inadequate ADT response.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT04985942 (registered 22 July, 2021); NCT05061706 (registered 20 September, 2021).

PMID:42455478 | DOI:10.1007/s40263-026-01314-8

Matern Child Health J. 2026 Jul 15. doi: 10.1007/s10995-026-04306-8. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine the extent to which acknowledged fathers’ education attainment is associated with the infant mortality rate of term births to African-American and non-Hispanic White women. We hypothesized that African American (compared to non-Hispanic White) term births would have a greater percentage of first-year deaths attributable to low paternal education attainment.

METHODS: Stratified and multivariable regression analyses were performed on the 2018-2019 National Center for Health Statistics US cohort-linked live birth-infant death data files. Only term (37-42 weeks) singleton births to non-Hispanic White (n = 2,937,995) and African-American (n = 508,374) U.S.-born women with acknowledged fathers and a non-missing value for paternal education were included.

RESULTS: Paternal low education attainment was higher among births to African-American women compared to non-Hispanic White women. In both races, infant mortality rates decreased with higher levels of paternal education attainment. When controlling for traditional maternal risk factors, the relative risk of infant mortality for births to fathers with < 12 years of education compared to a bachelor’s degree or higher equaled 1.59 (1.18-2.14) and 1.55 (1.35-1.77) for African-American and non-Hispanic White births, respectively. A greater percentage of term infant mortality was attributable to low paternal education attainment (< 12 years) in births to African-American (compared to non-Hispanic White) women (6.5% vs. 5.4%).

CONCLUSIONS: Acknowledged fathers’ education attainment is a determinant of term infant first-year mortality.

PMID:42455459 | DOI:10.1007/s10995-026-04306-8

Trop Anim Health Prod. 2026 Jul 15;58(6):419. doi: 10.1007/s11250-026-05191-7.

ABSTRACT

Toxoplasma gondii, an important food-borne parasite, has been reported in a wide range of food animals, including poultry. Dongan chicken, a native breed of Hunan province, subtropical China, is widely consumed, but its T. gondii infection status remains unknown. A total of 1,220 serum samples were collected from Dongan chickens intended for human consumption in Hunan province, China. Serum samples were tested for T. gondii IgG antibodies using an indirect hemagglutination assay (IHA). IgG antibodies against T. gondii were detected in 434 (35.6%; 95% CI: 32.9-38.3) of the examined serum samples. The seroprevalence of the six surveyed herds ranged from 31.7% to 39.8% (P > 0.05). Statistical analysis identified age, gender and farm model as significant risk factors for infection (P < 0.001). This is the first report of T. gondii seroprevalence in Dongan chickens in Yongzhou in Hunan province. The high seroprevalence suggests a potential risk for human and animal infection. Effective measures should be implemented to control T. gondii infection in Dongan chickens in Hunan province, subtropical China.

PMID:42455455 | DOI:10.1007/s11250-026-05191-7

Discov Oncol. 2026 Jul 15;17(1):1027. doi: 10.1007/s12672-026-05570-4.

ABSTRACT

INTRODUCTION: In gastrointestinal oncology, serum tumor markers such as CEA and CA19-9 are typically monitored over several weeks to assess therapeutic efficacy. The immediate impact of cytotoxic therapy on these serum tumor markers, however, remains poorly characterized.

METHODS: We analyzed a single-center cohort of patients with advanced gastrointestinal cancers (pancreatic, biliary, colorectal, and esophageal) treated with 5-fluorouracil-based regimens. Paired serum samples were collected immediately before the start of chemotherapy (0 h) and at the removal of the 48-h 5-FU continuous pump (48 h). The primary endpoint was the percentage change of tumor markers during this time window (∆CEA and ∆CA19-9). Secondary endpoints included the association of these acute kinetics with subsequent radiographic response.

RESULTS: 78 cycles of 5-FU-based chemotherapy were included (33 patients, median cycles per patient: 2). CA19-9 increased significantly after chemotherapy (median ∆CA19-9 + 4.8% per patient, Wilcoxon p = 0.015; mixed model p = 0.062; cycle-level range – 11% to + 92%), as did LDH (median ∆LDH + 12.8% per patient, both Wilcoxon and mixed model p < 0.001; cycle-level range – 39% to + 72%). CEA levels remained stable (median ∆CEA – 3.6% per patient, Wilcoxon p = 0.09; mixed model p = 0.05; cycle-level range – 20% to + 22%). There was no statistically significant association between early changes in serum tumor markers and radiographic outcome.

DISCUSSION: In this hypothesis-generating study, 5-FU-based therapy leads to a statistically significant increase in CA19-9 and LDH levels, but not in CEA, after 48 h. The magnitude of the increase did not predict radiographic response.

PMID:42455430 | DOI:10.1007/s12672-026-05570-4