Nevin Manimala

JAMA Netw Open. 2026 Jul 1;9(7):e2622218. doi: 10.1001/jamanetworkopen.2026.22218.

ABSTRACT

IMPORTANCE: Infants classified as small or large for gestational age can have different growth patterns compared with appropriate-for-gestational age counterparts. The association of birth weight percentiles beyond conventional thresholds with early-life growth remains unknown.

OBJECTIVE: To quantify the association of birth weight percentile range with infant and child growth.

DESIGN, SETTING, AND PARTICIPANTS: This is a prospective cohort study of singletons born between 1991 and 2011 in 7 birth cohort studies in Europe, Singapore, and the US and followed up with repeated growth measurements for 10 years. Five European cohorts were used for discovery analysis, and the Singapore and US cohorts were used for replication analyses.

EXPOSURES: Birth weight percentiles standardized for sex and gestational age using the INTERGROWTH-21st standards and classified into 10 decile groups, with the middle (fifth and sixth decile groups) as the reference group.

MAIN OUTCOMES AND MEASURES: The primary outcomes were infant height (centimeters per month) and weight (grams per month) growth velocity at 1, 6, 12, 24 months; body mass index (BMI; calculated as weight in kilograms divided by height in meters squared); age (months or years) at infant BMI peak and childhood BMI rebound; and overweight or obesity at 10 years. Associations were examined using regression models adjusted for sex and birth cohort.

RESULTS: The discovery cohort included 36 018 children (mean [SD] gestational age at birth, 39.7 [1.8] weeks; 17 238 girls [48%]). Compared with the reference group, higher decile groups had lower early infant height velocity that reversed by 24 months, higher weight velocity from 6 to 24 months, higher and earlier peak BMI, higher rebound BMI, and increased risk of overweight or obesity at age 10 years. Lower decile groups showed the opposite patterns. For example, mean differences for infant peak BMI were -0.38 (95% CI, -0.43 to -0.33) for the second decile birth weight group and 0.33 (95% CI, 0.29 to 0.38) for the ninth decile birth weight group compared with the fifth to sixth decile birth weight group. Mean differences for age at peak BMI were 0.22 months (95% CI, 0.12 to 0.33 months) for the second decile birth weight group and -0.21 months (95% CI, -0.30 to -0.11 months) for the ninth decile birth weight group compared with the fifth to sixth decile birth weight groups. Risk ratios for overweight or obesity at 10 years were 0.86 (95% CI, 0.76 to 0.97) for the second decile birth weight group and 1.25 (95% CI, 1.13 to 1.38) for the ninth decile birth weight group. Birth weight was not associated with age at rebound BMI. Replication analyses (2517 children; mean [SD] gestational age at birth, 39.2 [1.8] weeks; 1191 girls [47%]) supported these findings. Associations were typically linear and similar in boys and girls. Deciles provided only modest estimation gains over conventional categories.

CONCLUSIONS AND RELEVANCE: In this cohort study of 38 535 singletons, birth weight decile was associated with early-life growth patterns. Birth weight decile group may help identify high-risk children missed by conventional thresholds, although the benefit of analysis using decile group over traditional groups remains modest.

PMID:42418198 | DOI:10.1001/jamanetworkopen.2026.22218

JAMA Surg. 2026 Jul 8. doi: 10.1001/jamasurg.2026.2516. Online ahead of print.

ABSTRACT

IMPORTANCE: Preoperative localization is often required to achieve successful sublobar resection with adequate margins for computed tomography (CT)-detected pulmonary nodules suspicious for early-stage lung cancer. Conventional CT-guided localization involves a multiple-encounter workflow that may cause pain, radiation exposure, and complications.

OBJECTIVE: To determine whether a single-encounter augmented reality (AR)-guided percutaneous localization strategy is noninferior to standard multiple-encounter CT-guided localization for achieving successful sublobar resection.

DESIGN, SETTING, AND PARTICIPANTS: This randomized noninferiority trial was conducted at 5 centers in China between August 8, 2024, and September 30, 2025. Among 296 randomized patients, 270 were included in the modified intention-to-treat analysis (134 in AR; 136 in CT). Exclusion criteria included multiple nodules (≥2), unsafe percutaneous access, comorbidities limiting participation, or consent withdrawal.

INTERVENTIONS: Single-encounter AR-guided percutaneous localization performed in the operating room under general anesthesia vs multiple-encounter CT-guided percutaneous localization performed in the CT suite under local anesthesia followed by transfer to the operating room for surgery.

MAIN OUTCOMES AND MEASURES: The primary outcome was successful sublobar resection, defined as R0 resection with protocol-defined margin adequacy according to nodule type. Secondary outcomes included localization accuracy, radiation exposure, complications, patient-reported outcomes, and procedural efficiency.

RESULTS: The median (IQR) age of the population was 59 (50-67) years, and 172 participants (63.7%) were female. Successful sublobar resection occurred in 132 of 134 AR-guided procedures (98.5%) and 135 of 136 CT-guided procedures (99.3%) (risk difference, -0.8 percentage points; 95% CI, -2.7 to 3.9), meeting the noninferiority criterion. There was no statistically significant difference in localization error between groups (median [IQR]: AR group, 3.0 [0.0 to 5.0]; CT group, 3.0 [2.0 to 6.0]). AR guidance was associated with lower radiation exposure (median [IQR], 456.50 [378.75 to 631.85] vs 1260.11 [1026.48 to 1544.53] mGy · cm; P < .001), lower preoperative pain (median [IQR] numeric rating scale, 0 [0-0] vs 5 [4-6]; P < .001), shorter puncture time (median [IQR], 0.63 [0.50 to 0.83] vs 6.50 [5.00 to 8.75] minutes; P < .001), and shorter localization-to-incision interval (median [IQR], 2.00 [1.50 to 2.00] vs 33.50 [18.00 to 63.00] minutes; P < .001). Pneumothorax occurred in 40 of 136 CT-guided cases (29.4%).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, single-encounter AR-guided localization was noninferior to CT-guided localization for achieving successful sublobar resection and was associated with reduced radiation exposure, lower pain, shorter puncture time, and a shorter localization-to-incision interval, supporting its use as an alternative to CT-guided localization.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06548451.

PMID:42418181 | DOI:10.1001/jamasurg.2026.2516

JAMA Cardiol. 2026 Jul 8. doi: 10.1001/jamacardio.2026.2104. Online ahead of print.

NO ABSTRACT

PMID:42418169 | DOI:10.1001/jamacardio.2026.2104

Int J Pharm Pract. 2026 Jul 8:riag089. doi: 10.1093/ijpp/riag089. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate community pharmacists’ confidence in the management of inflammatory bowel disease (IBD) and to identify areas in which pharmacist-led patient education and counselling could be strengthened.

METHODS: This cross-sectional study was conducted in three phases; questionnaire development and review by an expert panel, reliability assessment, and dissemination to 100 community pharmacies selected through stratified random sampling across Malta. Pharmacists’ confidence across 29 items was assessed using mean rating scores (MRS) on a 5-point Likert scale. Non-parametric analyses examined associations between confidence, demographic variables, and perceived barriers (P < .05 statistically significant).

KEY FINDINGS: Ninety-four pharmacists completed the questionnaire; female (n = 65), > 5 years of community pharmacy experience (n = 56), worked 31-40 hours weekly (n = 39), Master of Pharmacy degree (n = 47). ‘High’ confidence (MRS ≥4/5) was reported for advice on diet and lifestyle, non-prescription medicines for symptom management, medicine storage/stability, and recognizing when referral was required. ‘Moderate’ confidence (MRS 3 to <4/5) was observed for adherence support, relapse, counselling on extraintestinal complications, dosage form administration, corticosteroids, methotrexate, aminosalicylates, and biologics. ‘Low’ confidence (MRS <3/5) was identified for counselling on thiopurines, non-prescription medicines associated with toxic megacolon, vaccines, and pregnancy and women of child-bearing age. The main reported barriers to providing advice were time constraints (n = 70) and patient-related communication challenges (n = 63). Years of experience, hours of practice, and inadequate private consultation space were not significantly associated with pharmacist confidence (P > .05).

CONCLUSIONS: Community pharmacists were more confident in general counselling and referral-related support than in medication-specific counselling and more complex aspects of IBD care.

PMID:42418153 | DOI:10.1093/ijpp/riag089

Biol Trace Elem Res. 2026 Jul 8. doi: 10.1007/s12011-026-05224-0. Online ahead of print.

ABSTRACT

Contamination of aquatic ecosystems by toxic metals and metalloids poses potential health risks to fishing communities with high fish consumption. This study assessed arsenic (As), mercury (Hg), chromium (Cr), and copper (Cu) concentrations in paired hair and nail samples from 50 fishermen on Lake Hawassa, Ethiopia, using MP-AES. Descriptive statistics, Wilcoxon signed-rank tests, correlation analyses, and multiple linear regression were applied to evaluate elemental concentrations, relationships between biomarkers, and the influence of age and fishing experience. Nails generally showed higher elemental levels than hair. Median concentrations in hair and nails were 0.15 and 0.42 µg/g for As, 0.18 and 0.35 µg/g for Hg, 0.43 and 0.70 µg/g for Cr, and 8.73 and 7.73 µg/g for Cu, respectively. Significant differences between biomarkers were found for As (p = 0.029) and Hg (p = 0.038), but not for Cr and Cu. Elevated levels above reference values were more frequent in nails, especially for As (36%), Hg (30%), and Cr (30%). Hair and nail concentrations correlated positively for As (R²=0.15, p = 0.005) and Hg (R²=0.22, p < 0.001). Age and fishing experience were not major determinants, though fishing experience negatively correlated with hair Cr (β=-0.547, p = 0.004), and age with nail Cu (β=-0.511, p = 0.034). The findings confirm measurable exposure to toxic elements and suggest nails may be a more sensitive long-term biomarker than hair. This establishes baseline data and underscores the need for ongoing environmental and health surveillance in the region.

PMID:42418129 | DOI:10.1007/s12011-026-05224-0

Pituitary. 2026 Jul 8;29(4):120. doi: 10.1007/s11102-026-01711-8.

NO ABSTRACT

PMID:42418114 | DOI:10.1007/s11102-026-01711-8

Clin Rheumatol. 2026 Jul 8. doi: 10.1007/s10067-026-08284-8. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the frequency and associated factors of impaired adrenal response on Synacthen test in patients with rheumatic diseases undergoing low-dose maintenance GC therapy.

METHODS: This single-center, retrospective, observational study included 48 patients with autoimmune rheumatic diseases on maintenance GC therapy (prednisolone ≤ 5 mg/day) who had previously received ≥ 5 mg/day for ≥ 3 months and underwent adrenal function testing between January 2021 and May 2023. Impaired adrenal response was defined by both low baseline cortisol and inadequate response to the standard-dose (250 μg) Synacthen test in this study. Daily dose, treatment duration, cumulative dose, and history of methylprednisolone pulse therapy were evaluated. Statistical comparisons were performed using Mann-Whitney U, Fisher’s exact, and receiver operating characteristic (ROC) analyses.

RESULTS: Impaired adrenal response on Synacthen test meeting the study-defined criteria was identified in 30 of 48 patients (62.5%). Compared with the normal adrenal response group, affected patients had significantly higher cumulative GC doses, lower baseline cortisol levels, and more frequent histories of methylprednisolone pulse therapy. Exploratory ROC analysis identified an optimal cumulative glucocorticoid dose cutoff of 10,371.5 mg associated with impaired adrenal response on Synacthen test (prednisolone equivalent).

CONCLUSIONS: Impaired adrenal response on Synacthen test was frequently observed among patients selected for adrenal function testing during maintenance GC therapy at ≤ 5 mg/day. Higher cumulative GC exposure and prior pulse therapy were associated with impaired adrenal response on Synacthen test, suggesting that a targeted, risk-based approach to adrenal evaluation may be useful even during low-dose treatment. Key Points • Impaired adrenal response on Synacthen test was detected in 62.5% of patients selected for adrenal function testing during maintenance glucocorticoid therapy at ≤ 5 mg/day. • A cumulative glucocorticoid dose ≥ 10,371.5 mg was associated with impaired adrenal response on Synacthen test. • Exploratory ROC analysis identified basal cortisol ≤ 6.1 μg/dL and daily glucocorticoid dose ≥ 3.5 mg as potential thresholds associated with impaired adrenal response on Synacthen test. • Adrenal suppression may occur even in clinically stable patients receiving low-dose therapy.

PMID:42418112 | DOI:10.1007/s10067-026-08284-8

Neurotox Res. 2026 Jul 8;44(4):32. doi: 10.1007/s12640-026-00810-5.

ABSTRACT

Background the deployment of fifth-generation (5G) wireless telecommunications infrastructure, incorporating millimeter-wave (mmWave, 24-100 GHz) and sub-6 GHz frequencies, has renewed scientific and public health interest in the potential neurobiological effects of radiofrequency electromagnetic fields (RF-EMF). While extensive research has examined lower-frequency RF-EMF from 2G/3G/4G technologies, the specific effects of mmWave frequencies on CNS cellular biology-including microglial polarization and intracellular calcium signaling-remain less characterized. This systematic review evaluates experimental evidence from in vitro and in vivo studies on the effects of high-frequency EMF (300 MHz-300 GHz) on neuroimmune responses, microglial function, CNS calcium homeostasis, and related outcomes. Methods PubMed, EMBASE, Web of Science, and the EMF-Portal were searched from inception to January 2026 following PRISMA 2020 guidelines. Experimental (in vitro and animal) studies reporting CNS-relevant outcomes after high-frequency RF-EMF exposure were eligible. Exposure must have been within the 300 MHz to 300 GHz range. Quality assessment used adapted OHAT risk-of-bias criteria. A narrative synthesis was conducted; quantitative pooling was performed where three or more studies reported the same outcome. Results forty-one studies met inclusion criteria (see PRISMA Flow Diagram, Fig. 1): 7 in vitro (cell culture), 29 in vivo (rodent model), and 5 reviews/meta-analyses. The detailed characteristics of all included studies are summarized in Table 1. At specific absorption rate (SAR) levels at or below the International Commission on Non-Ionizing Radiation Protection (ICNIRP) general public exposure guidelines (2 W/kg averaged over 10 g), the majority of studies (27/41, 66%) found no statistically significant effects on neuroinflammatory markers, microglial morphology, or calcium signaling. Eleven studies (27%) reported transient, low-magnitude increases in intracellular Ca²⁺ or pro-inflammatory cytokine expression at exposures near or exceeding guideline limits; these effects were not consistently reproducible across independent laboratories. Three studies (7%) reported effects below guideline thresholds that may warrant further investigation. No study identified neuropathological changes (neuronal death, axonal injury) attributable to RF-EMF at guideline-compliant exposures. Conclusions current experimental evidence does not establish that high-frequency RF-EMF at guideline-compliant exposure levels produces significant adverse effects on microglial polarization, CNS calcium homeostasis, or neuroinflammatory responses. Methodological heterogeneity, inadequate dosimetry, and limited independent replication constrain confidence in both positive and negative findings. Standardized, rigorously controlled experimental studies are needed, particularly for mmWave frequencies (> 6 GHz) where data are sparse. Our findings support the current scientific consensus that high-frequency RF-EMF below regulatory limits does not pose a clearly established neurobiological hazard.

PMID:42418111 | DOI:10.1007/s12640-026-00810-5

J Gastrointest Cancer. 2026 Jul 8;57(1):149. doi: 10.1007/s12029-026-01517-8.

ABSTRACT

PURPOSE: Neutrophils are at the forefront of innate immune response. The prognostic impact of tumour-associated neutrophils (TANs) remains unclear. This study aimed to evaluate the prognostic role of TANs in colorectal cancer (CRC).

METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus to identify studies correlating TANs with time-to-event survival analysis in patients with stages I-IV CRC from the date of inception until April 2024. Articles were included if they involved the identification of TANs through hematoxylin-eosin (HE) or immunohistochemistry (IHC) and reported survival analysis. Data was collected from the tumour core (TC) and invasive margin (IM). The hazard ratios (HRs) were extracted from the study results. Heterogeneity was evaluated using Cochran’s Q and I². Primary and secondary endpoints were overall survival (OS) and disease-free survival (DFS).

RESULTS: Of 4,292 citations found, 18 studies fulfilled eligibility criteria, encompassing 7,406 patients. IHC was used to identify TANs in 12 trials, while six performed HE. Five studies included patients with disease stages I-III, and 13 had stages I-IV. High TANs at the IM were associated with improved OS (HR = 0.64, 95% Confidence Interval [CI] 0.50-0.81, I² = 48%) and DFS (HR = 0.47, 95% CI 0.25-0.88, I² = 32%). At the TC, high TANs showed a trend towards better OS (HR = 0.82, 95% CI 0.61-1.10, I² = 83%) and DFS (HR = 0.48, 95% CI 0.21-1.07, I² = 93%), although not statistically significant and with high heterogeneity.

CONCLUSION: In this systematic review and meta-analysis, high TANs at the invasive margin (IM), the tumour-host interface, was associated with improved prognosis in CRC. In contrast, no statistically significant association was observed for high TANs at the tumour core (TC).

PMID:42418102 | DOI:10.1007/s12029-026-01517-8

Metabolomics. 2026 Jul 8;22(4):120. doi: 10.1007/s11306-026-02505-6.

ABSTRACT

INTRODUCTION: Cultivation of medicinal plants provides an opportunity for economic gain and health care accessibility. Ensuring consistent quality plant material is important for plants such as Pelargonium sidoides DC used for production of phytomedicines that are available in local and international markets. There is limited research on how agronomic factors affects phytochemicals in P. sidoides roots.

OBJECTIVE: To evaluate the effect of different irrigation regimes and harvesting age on metabolite accumulation in dried roots of P. sidoides.

METHODOLOGY: Irrigation was applied at 75%, 50% and 25% plant available water (PAW) corresponding to well- watered, moderate water deficit and severe water deficit respectively. P. sidoides, which were harvested at 6, 12 and 18 months after imposing the different water deficit treatments, roots dried and subjected to ultra-performance liquid chromatography -quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) coupled with multivariate statistical analysis.

RESULTS: Unsupervised multivariate analysis showed that irrigation did not affect the obtained metabolic features. Orthogonal partial least squares discriminant analysis (OPLS-DA) showed statistically significance difference between 6 versus 12- and 18- months harvest ages. Compounds such as umckalin, epigallocatechin dimer, and gallic acid were increased in 12 and 18 months compared to the 6 months harvest. Sucrose/trehalose was increased by 0.2431- and 0.560- fold in 6 months compared to 12- and 18-months harvest ages respectively. On quantification, umckalin increased from 260.40 mg/kg DW at 6 months to 431.61 mg/kg DW at 12 months, while epigallocatechin rose from 342.98 mg/kg DW to 505.58 mg/kg DW over the same period. Umckalin sulphate was highest at 6 months under 25% PAW (7110.32 mg/kg DW) and decreased at 12 months harvest under the same irrigation level (4522.05 mg/kg DW).

CONCLUSION: The results indicated that younger plants accumulated more primary metabolites and modified secondary metabolites, whereas older plants accumulate more secondary metabolites. Moreover, cultivation of P. sidoides in limited water is plausible.

PMID:42418094 | DOI:10.1007/s11306-026-02505-6