Nevin Manimala

Hand (N Y). 2026 Aug 26:15589447261476242. doi: 10.1177/15589447261476242. Online ahead of print.

ABSTRACT

BACKGROUND: Threaded intramedullary nails offer a fixation option for proximal phalanx fractures with the advantage of immediate mobilization, avoiding secondary hardware removal, and decreased complications associated with exposed pins. There are currently limited data comparing the strength of intramedullary devices across various configurations with the traditional fixation method of Kirschner wires (K-wires). This study compared the biomechanical strength of intramedullary nail fixation (INF) in an “I,” “Y,” or “X” configuration or 2 Kirschner wires in an “X” configuration for transverse proximal phalanx fractures.

METHODS: Forty cadaveric proximal phalanges with simulated transverse fractures were randomized to 1 of 4 fixation groups: INF in an “I,” “Y,” or “X” configuration or 2 K-wires in an “X” configuration. The specimens were subjected to apex dorsal 3-point bending to failure using servohydraulic testing. Peak load to failure and stiffness were recorded. Analysis of variance was used to compare means between groups.

RESULTS: No statistically significant differences in mean peak load to failure were detected between groups. Stiffness differed among groups, with the INF “X” configuration producing the stiffest construct (mean stiffness, 210 N/mm), significantly stiffer than all other groups. The second stiffest construct was the INF “Y” configuration (150.9 N/mm), which was significantly higher than both the INF “I” construct (107.7 N/mm) and the K-wire construct (91.8 N/mm). There was no significant difference between the INF “I” construct and the K-wire construct.

CONCLUSION: Threaded INF in “X” or “Y” configurations offers superior stiffness compared to K-wire and “I” INF for proximal phalanx fractures.

PMID:42648891 | DOI:10.1177/15589447261476242

Anal Chim Acta. 2026 Oct 22;1420:345982. doi: 10.1016/j.aca.2026.345982. Epub 2026 Jul 16.

ABSTRACT

BACKGROUND: Untargeted LC-MS metabolomics converts chromatographic ion signals into feature tables used for downstream comparison, annotation, and biomarker discovery. However, widely used preprocessing workflows often return discordant feature lists and missingness patterns from the same raw data, limiting reproducible quantitative interpretation. Continuous wavelet transform (CWT)-based peak detection is central to several workflows, yet its scale-normalization convention was inherited from energy-preserving signal analysis rather than area-oriented chromatographic integration. The problem addressed here is whether CWT normalization itself creates scale-selection and integration-boundary bias in LC-MS feature-table construction.

RESULTS: Under a Gaussian reference peak model with a Mexican-hat wavelet, amplitude-preserving 1/a normalization produced a defined optimum at a = √2σ and model-derived integration boundaries at ±3σ, supporting area-oriented peak integration. We implemented this correction in MetaboQuality with shape-driven grouping and anchor-guided recovery, then evaluated it using authentic standards, pooled-QC replicates, public QC data, component ablation, comparator sensitivity, decoy controls, non-Gaussian simulations, and chemical-reference validation. In the primary pooled-QC benchmark before post-detection filling, MetaboQuality produced 4029 complete groups with RSD <30%, compared with 2461 for XCMS and 1672 for MZmine 4. At the stricter RSD <10% threshold, MetaboQuality yielded 931 complete groups before filling versus 526 for the XCMS reference branch; after filling, MetaboQuality yielded 973 groups, compared with 678 for XCMS and 748 in the XCMS fitgauss sensitivity run.

SIGNIFICANCE AND NOVELTY: The novelty lies in defining CWT normalization as an LC-MS-specific peak-integration determinant rather than a generic signal-processing detail. MetaboQuality links amplitude-preserving integration, shape-driven grouping, and anchor-guided recovery into a coordinated workflow, providing a principled route to more complete and reproducible feature tables without relying on unconstrained statistical imputation. This clarifies where algorithmic design can improve measurement consistency.

PMID:42648851 | DOI:10.1016/j.aca.2026.345982

Anal Chim Acta. 2026 Oct 22;1420:345957. doi: 10.1016/j.aca.2026.345957. Epub 2026 Jul 13.

ABSTRACT

Currently, there is an increasingly urgent need of high-efficient chemosensors for detecting highly toxic chromium ions (Cr³⁺ and Cr₂O₇^2-). Herein we propose an innovative lanthanide-based fluorescence sensing material, i.e., terbium coordination hybrid nanoparticles (6-MP)_0.01CF_0.004/Tb₁ that are obtained based on the coordination self-assembly strategy. Its terbium luminescence is strongly associated with the ligand-assisted terbium sensibilization energy transfer approach that is sensitive to specific inorganic stimuli. It is further revealed that (6-MP)_0.01CF_0.004/Tb₁ can be served as a real-time, selective, competitive and quantitative fluorescence chemosensor to detect Cr³⁺, Cr₂O₇^2-, and NO₂^– in aqueous solutions based on the quenched fluorescence of hybrid. Using statistical analysis methods, the hybrid (6-MP)_0.01CF_0.004/Tb₁ even can discriminate several groups of cation or anion analogues, especially Cr³⁺ and Cr₂O₇^2- that are distinguished from each other by the pH regulation. Moreover, this hybrid enables operators to monitor different contents of Cr³⁺, Cr₂O₇^2-, and NO₂^– in real water samples. This study not only develops a novel luminescent lanthanide-based hybrid but also provides a promising fluorescence sensing platform for multianalyte detection of toxic Cr³⁺, Cr₂O₇^2-, and NO₂^– in potential fields.

PMID:42648834 | DOI:10.1016/j.aca.2026.345957

Anal Chim Acta. 2026 Oct 22;1420:345951. doi: 10.1016/j.aca.2026.345951. Epub 2026 Jul 9.

ABSTRACT

BACKGROUND: Mesenchymal stem cells (MSCs) are often used in bone tissue engineering. However, for optimized MSC osteogenic commitment to be achieved, a deeper understanding of the cellular molecular mechanisms underlying osteodifferentiation is required. In this paper we show that this can be provided by Fourier Transform Infrared (FTIR) spectroscopy in tandem with microscopy (micro-FTIR), a methodology which may also aid the rapid early evaluation of differentiation outcomes.

RESULTS: We report a micro-FTIR time-course characterization of human adipose tissue mesenchymal stem cell (hAMSCs) osteodifferentiation (for 21 days), considering different independent experiments and biological replicates to account for cell heterogeneity, under both differentiation and proliferation (control) conditions. Despite extensive spectral variability in both groups, multivariate statistical methods revealed time-dependent spectral changes and potential spectral signatures of proliferation and osteodifferentiation extension. Under proliferation alone, spectral changes reflecting helical proteins and lipids were seen up to day 14, stabilizing thereafter. Osteodifferentiating cells exhibited higher inter- and intra-replicate variability and a distinct spectral time-course trajectory. Evidence was found of both helical and β-sheet protein structures, with a relative increase of the former from day 6, although masked by increasing sample variability. Other osteo-specific changes were noted in lipid moieties and at lower wavenumbers (1030-1115 cm^-1). The latter were found to relate to different degrees of hydroxyapatite maturity between and even within samples.

SIGNIFICANCE: Specific spectral FTIR signatures have been identified as markers of the extent of hAMSC proliferation and osteodifferentiation, potentially enabling the rapid and non-invasive evaluation of hAMSCs osteodifferentiation outcome and of inter- and intra-sample variability.

PMID:42648828 | DOI:10.1016/j.aca.2026.345951

Anal Chim Acta. 2026 Oct 22;1420:345933. doi: 10.1016/j.aca.2026.345933. Epub 2026 Jul 6.

ABSTRACT

Supercritical fluid extraction coupled on-line with supercritical fluid chromatography creates a powerful multidimensional analysis platform, but its adoption is limited by the resource-heavy process of method development. This research presents a surrogate optimization approach as a better alternative to traditional design of experiments and response surface methodology. Unlike fixed experimental designs, the surrogate model iteratively updates the response surface after each run, facilitating effective global optimization through continuous exploration and exploitation. The study adjusts both SFE- and SFC-specific variables-such as back-pressure regulation and split flow-to reduce peak FWHM and enhance extraction efficiency. Analytes, specifically reserpine, vigabatrin, hydromorphone, and hydrocodone, covering diverse physicochemical profiles, were optimized sequentially, guided by a molecular similarity metric, to broaden the design space. The surrogate model identified critical factors, including modifier concentration, chromatography pressure, dynamic extraction time, and flow rate, with adjusted coefficient of determination (R²) values reaching 0.97 as more data was collected and the model was refined. Response surface and parallel coordinate analyses showed that hydrocodone, hydromorphone, and vigabatrin favored high modifier concentrations, while reserpine had a distinct optimum more sensitive to static extraction time. Sensitivity analysis over 62.5-1000 ng mL^-1 yielded detection limits/quantification limits of 6.9/23.0 and 2.4/8.1 ng mL^-1 for hydrocodone and reserpine, respectively. Sequential optimization enhanced sensitivity by 15%, demonstrating the scalability and transferability of the surrogate optimization framework for developing SFE-SFC methods.

PMID:42648811 | DOI:10.1016/j.aca.2026.345933

BMJ Open. 2026 Aug 26;16(8):e116200. doi: 10.1136/bmjopen-2026-116200.

ABSTRACT

BACKGROUND: Health research ethics committees (HRECs) provide the administrative backbone of ethical governance by safeguarding the rights, safety and well-being of research participants and ensuring the ethical conduct of health research. Effective ethical oversight depends not only on rigorous protocol review but also on robust governance, competent personnel, adequate infrastructure, sustainable institutional support and efficient administrative systems. Despite their critical role, evidence on the administrative functionality of HRECs in Tanzania remains limited.

OBJECTIVE: To assess the administrative functionality of HRECs in mainland Tanzania, with emphasis on governance, operational procedures, human resource capacity, training, infrastructure, documentation systems and institutional support.

DESIGN: Quantitative descriptive cross-sectional study.

SETTING: All active registered HRECs in clinical, research and training institutions in mainland Tanzania.

PARTICIPANTS: 10 administrative representatives responsible for HREC secretariat functions, one from each of the 10 active registered HRECs.

METHODS: A census approach included all 10 active registered HRECs in mainland Tanzania, with one administrative representative purposively selected from each committee. Data were collected using a semi-structured questionnaire and a document review checklist adapted from the Research Ethics Committee Assessment Toolkit. The assessment covered governance, committee membership, independence, training, decision-making procedures, administrative operations, financing, documentation practices and infrastructure. Document reviews verified standard operating procedures, meeting minutes, protocol-tracking systems, approval records and archival practices. Data were analysed using descriptive statistics.

RESULTS: All 10 HRECs participated. Administrative functionality was the highest for administrative operations (94%) and decision-making procedures (93%), followed by membership standards (86%). Compliance was lower for committee independence (75%) and training (50%). Key gaps included limited structured training, inadequate institutional financing, insufficient dedicated administrative staff, weak transparency mechanisms and inconsistent administrative and digital infrastructure. Electronic protocol-tracking systems were available in 60% of HRECs.

CONCLUSIONS: Tanzanian HRECs have established a solid administrative foundation for ethical governance. However, persistent gaps in training, committee independence, financing, staffing, infrastructure and digital systems may compromise the effectiveness, transparency and sustainability of ethical oversight. Strengthening administrative standards, institutional investment, continuous professional development and digital infrastructure is essential to reinforce the administrative backbone of ethical governance and improve research ethics oversight in Tanzania and other low-income and middle-income countries.

PMID:42648778 | DOI:10.1136/bmjopen-2026-116200

BMJ Open. 2026 Aug 26;16(8):e118374. doi: 10.1136/bmjopen-2026-118374.

ABSTRACT

Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster, characterised by persistent pain after the rash subsides with a particularly high incidence among the elderly population. Its pathological mechanism involves peripheral and central sensitisation, often leading to severe pain, sleep disturbances, emotional issues and a decline in quality of life, posing a significant burden on healthcare and society. Current clinical treatments primarily rely on pharmacological and interventional therapies yet their efficacy remains suboptimal. Stellate ganglion block (SGB), as an interventional technique targeting the sympathetic nervous system, is believed to alleviate PHN by modulating neurovascular function, inhibiting inflammatory responses and blocking pain transmission pathways. However, evidence-based data on its efficacy and safety remain insufficient and existing study results are inconsistent. Therefore, this study aims to comprehensively evaluate the effectiveness and safety of SGB in treating PHN through a systematic review and meta-analysis.

METHODS: This systematic review and meta-analysis will be conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search will be performed for relevant randomised controlled trials published from the inception of each database until 31 December 2025, in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database and VIP Database. Two researchers will independently complete the literature screening, data extraction and cross-verification. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool. Statistical analysis will be performed using RevMan V.5.4 software: continuous variables will be analysed by calculating the mean difference and 95% CI, and dichotomous variables will be analysed by calculating the OR and 95% CI. Based on the results of heterogeneity testing (I² statistic), either a fixed-effects model or a random-effects model will be employed for data synthesis. Subgroup analyses and sensitivity analyses will be conducted to explore sources of heterogeneity, and a grading system will be used to assess the quality of the evidence.

ETHICS AND DISSEMINATION: Ethical approval is not required for this study, as it does not involve the collection of primary data from individual patients. Findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO REGISTRATION NUMBER: CRD420251128909.

PMID:42648776 | DOI:10.1136/bmjopen-2026-118374

BMJ Open. 2026 Aug 26;16(8):e117159. doi: 10.1136/bmjopen-2026-117159.

ABSTRACT

OBJECTIVES: To investigate real-world healthcare experiences of individuals in the UK who consulted health and care professionals for nocturia. The study explored the assessments, management strategies, referrals and follow-up patterns received by patients experiencing lower urinary tract symptoms (LUTSs), as well as their level of satisfaction with those. The association of sociodemographic factors with these patterns was also analysed.

DESIGN: A cross-sectional online survey.

SETTING: Community-based, UK.

PARTICIPANTS: From 2012 completers, 453 (22.5%) reported consulting healthcare professionals for LUTS (55.0% female, 75.5% White; aged 18-65+ years; convenience sampling via online panels/networks).

INTERVENTIONS: None (observational survey study).

PRIMARY AND SECONDARY OUTCOME MEASURES: Healthcare provider consulted; assessments (eg, history, bladder diary, examinations, tests); management (eg, behavioural, pharmacological); referrals/follow-up; satisfaction; associations via χ² tests.

RESULTS: Among 453 respondents who sought professional advice for LUTS, 211 reported nocturia and 143 had nocturia confirmed through the survey’s follow-up questions. General practitioners were the most consulted providers (73.1%), but guideline-recommended tools such as bladder diaries were underutilised (13.9%). Only 12.1% were referred to specialists. Satisfaction with care was mixed: 59% were satisfied with assessment and 54% with treatment, but dissatisfaction was common around referrals, follow-up and cause explanation. Long-term conditions and disability were associated with greater unmet needs. Participants consistently called for more accessible information, clinician training and better self-management support.

CONCLUSIONS: These findings suggest that patients’ reported experiences of assessment and management varied, which may reflect differences in actual practice, recall or communication during consultations, particularly in relation to nocturia. However, because the data are cross-sectional and self-reported, these results should be interpreted cautiously. They highlight areas where patient assessment, communication and follow-up could potentially be improved.

PMID:42648773 | DOI:10.1136/bmjopen-2026-117159

BMJ Open. 2026 Aug 26;16(8):e111823. doi: 10.1136/bmjopen-2025-111823.

ABSTRACT

BACKGROUND: Approximately 96% of rifampicin resistance/multidrug-resistant tuberculosis (RR/MDR-TB) cases in Rwanda result from direct transmission rather than acquired resistance. However, the nationwide spatial distribution and transmission dynamics of RR/MDR-TB remain poorly characterised. This study aims to analyse spatial patterns of RR/MDR-TB in Rwanda and explore relationships between spatial proximity and RR/MDR-TB strains’ genetic relatedness.

METHODS: We conducted a retrospective analysis of 249 confirmed RR-TB cases across Rwanda from 2017 to 2024, using the known geolocations of patients’ residences. Spatial and space-time clustering was assessed using Kulldorff’s scan statistics. Demographic and socioeconomic determinants were evaluated using multivariable regression. For 201 cases with whole-genome sequencing data, we performed transmission analysis using a 5-SNP threshold to define recent transmission clusters and investigated spatial relationships within genetically related strains.

RESULTS: Significant spatial clustering of RR/MDR-TB was identified in 21 sectors, mainly in Nyarugenge, southern Gasabo and western Kicukiro (relative risk: 10.06; p<0.001). Our multivariable analysis showed that population density is positively associated with case notification rates. Molecular analysis revealed 88.5% of cases belonged to genotype clusters defined using a 12-SNP threshold, with 73.6% forming clusters at a strict 5-SNP threshold. Spatial K-function analysis of the six major clusters revealed heterogeneous transmission patterns, characterised by both tightly clustered outbreaks and regional transmission networks that spanned administrative boundaries. Most clusters (5/6) extended beyond Kigali, indicating that transmission networks operate across administrative divides.

CONCLUSION: RR/MDR-TB in Rwanda shows significant spatial clustering with transmission occurring through both localised and regional networks. Integrating genomic and spatial data reveals transmission patterns that extend beyond household contacts and administrative boundaries. These findings underscore the need to implement geographically targeted interventions that address community-level transmission to control RR/MDR-TB in Rwanda effectively.

PMID:42648769 | DOI:10.1136/bmjopen-2025-111823

BMJ Glob Health. 2026 Aug 26;11(8):e025404. doi: 10.1136/bmjgh-2026-025404.

ABSTRACT

INTRODUCTION: This study evaluated the operational status of Ukrainian radiotherapy (RT) centres to characterise wartime capacity following the Russian invasion and to identify priorities for improving RT delivery and resilience.

METHODS: This cross-sectional study integrated two data sources: (1) a 38-item survey conducted by Help Ukraine Group (HUG) in August 2025 across all Ukrainian RT departments, assessing patient volumes, waiting times, equipment status, cobalt-60 (Co-60) source replacement, staffing, training needs and operational challenges; and (2) International Atomic Energy Agency DIRAC datasets collected by the Grigoriev Institute (2021-2025), tracking equipment, staffing and patient volumes. Descriptive and comparative analyses were performed.

RESULTS: In December 2021, before the full-scale invasion, Ukraine operated 41 RT departments with 82 megavoltage (MV) machines (38 linear accelerators, 44 Co-60 units), 53 orthovoltage units and 36 brachytherapy afterloaders. During the first 3 months of war, four centres were occupied, most departments experienced service disruptions averaging 26 days and patient volume declined by 27.5%. Volumes recovered to baseline in 2023 and increased by 8.9% in 2024 and 9.3% in 2025 relative to 2021.In December 2025, Ukraine operated 42 RT departments with 96 MV machines (68 linear accelerators, 28 Co-60 units), 38 orthovoltage units and 34 afterloaders. However, 56% of departments still relied on Co-60 and 94.1% reported future source replacement would be unfeasible because sources were historically procured from Russia. Consequently, 78.6% of Co-60 users planned the transition to linear accelerators. Workforce shortages remain critical, with reported deficits of 41.4% for medical physicists, 33.6% for RTTs and 21.1% for radiation oncologists. Average waiting times increased from 6.4 days in 2021 to 10.3 days in 2025.

CONCLUSION: Despite ongoing war, Ukraine is actively modernising RT services, with a rapid transition from Co-60 to linear accelerators. Workforce development and targeted training are now urgently needed to convert equipment investment into sustainable clinical capacity.

PMID:42648756 | DOI:10.1136/bmjgh-2026-025404