Nevin Manimala

Crit Care. 2026 Jul 24;30(1):385. doi: 10.1186/s13054-026-06099-2.

ABSTRACT

BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) following cardiopulmonary bypass (CPB) remains a high-risk complication with limited effective management. Hemoadsorption is increasingly used as an adjunctive therapy due to its potent cytokines clearance in experimental settings, yet its clinical efficacy is debated. This study aimed to evaluate the effect of hemoadsorption versus standard care on CSA-AKI and other major outcomes in adult cardiac surgery patients.

METHODS: An updated systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to 8 February 2025. Eligible RCTs enrolled adult patients undergoing cardiac surgery and compared intraoperative hemoadsorption with standard care, with reported outcomes including CSA-AKI and other major endpoints. Pooled estimates were synthesized using inverse-variance random-effects models, with heterogeneity quantified by I² statistics. Subgroup, sensitivity and trial sequential analyses (TSA) were further performed.

RESULTS: Fifteen RCTs were included, of which nine reported CSA-AKI (947 patients). Hemoadsorption was not associated with a statistically significant reduction in CSA-AKI (RR 0.80, 95% CI 0.63-1.03, P = 0.08, I² = 40%, GRADE: very low). The finding was sensitive to model choice and the inclusion of two studies (Diab 2022 and Abou-Arab 2025). Subgroup analyses revealed no significant interaction by device type. TSA indicated that the required information size was not reached. No significant differences were observed for CSA-AKI Stage 1 (RR 0.72, 95% CI 0.49-1.05, P = 0.09, I² = 16%), Stage 2 (RR 0.66, 95% CI 0.30-1.43, P = 0.29, I² = 11%), Stage 3 (RR 0.43, 95% CI 0.17-1.05, P = 0.06, I² = 0%), or renal replacement therapy (RR 0.52, 95% CI 0.22-1.25, P = 0.15, I² = 0%). Mortality and other clinical endpoints were comparable between groups. Among exploratory outcomes, only an overall reduction in IL-8 was noted (MD -18.23, 95% CI -31.90 to -4.56, P = 0.009, I² = 40%).

CONCLUSIONS: Intraoperative hemoadsorption did not significantly reduce CSA-AKI or improve clinical outcomes in adult cardiac surgery. Although trends favored severe AKI, very low certainty evidence and insufficient information preclude definitive conclusions, warranting further large-scale RCTs.

REGISTRATION: PROSPERO identifier CRD420250651941.

PMID:42498964 | DOI:10.1186/s13054-026-06099-2

Cardiovasc Diabetol. 2026 Jul 24;25(1):210. doi: 10.1186/s12933-026-03292-z.

ABSTRACT

BACKGROUND: Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) provide cardiovascular and renal protection in both diabetic and non-diabetic patients at least in part independently of glycaemic control. Some underlying mechanisms for these clinically beneficial effects were suggested, but the picture is far from complete. In this study we aimed to apply untargeted metabolomics in order to identify new mechanistic leads.

METHODS: Plasma and 24-hour urine samples of 48 diabetic patients taken before and after 6 weeks of treatment from two prospective, randomized, double-blind, placebo-controlled, cross-over trials with dapagliflozin or empagliflozin were used. Additionally, plasma and urine samples of 24 diabetic patients from a prospective, randomized, controlled, parallel-arm, interventional, open-label, single centre study with either empagliflozin and linagliptin or metformin and insulin glargine for 12 weeks were used for confirmation. Changes of metabolite patterns in plasma and urine were determined by untargeted high-resolution mass spectrometry. Moreover, parameters of arterial stiffness and retinal vascular remodelling were correlated with treatment effects of the SGLT2 inhibitors on the modified nucleoside N4-acetylcytidine (ac4C), a potential biomarker for the activity of the enzyme N-acetyltransferase 10 (NAT10).

RESULTS: In accordance with previously reported results treatment with SGLT2 inhibitors led to a reduction of glucose (log₂fc: – 0.23, adj. p < 0.01) and uric acid (log₂fc: – 0.23, adj. p < 0.001), while 3-hydroxybutyric acid (log₂fc: 0.84, adj. p < 0.001) and 3-hydroxybutyrylcarnitine (log₂fc: 0.57, adj. p < 0.001) were increased in plasma. As a new finding, plasma concentrations of ac4C were reduced (log₂fc: – 0.32, adj. p < 0.001) by SGLT2 inhibitors but not by the non-SGLT2 inhibiting glucose lowering treatment. Reduction of urinary concentrations of ac4C corresponded to its reduction in plasma in groups treated with the SGLT2 inhibitors. Wall thickness of retinal arterioles and central systolic blood pressure were significantly correlated to ac4C in plasma.

CONCLUSIONS: Treatment with dapagliflozin and empagliflozin reduced plasma concentrations of ac4C, which was correlated with parameters for vascular health. These exploratory findings may indicate inhibition of NAT10 activity as a potential contributor to the beneficial effects on cardiovascular and renal health by SGLT2 inhibitors.

TRIAL REGISTRATIONS: http://www.

CLINICALTRIALS: gov : NCT02383238, NCT02471963, NCT02752113.

PMID:42498959 | DOI:10.1186/s12933-026-03292-z

BMC Psychiatry. 2026 Jul 23;26(1):564. doi: 10.1186/s12888-026-08423-0.

ABSTRACT

BACKGROUND: The Generalized Anxiety Disorder 7-item scale (GAD-7) could provide currently lacking data on anxiety levels among adolescents and young adults in Sweden. However, psychometric assessments of the scale are scarce in this population. Additionally, the structural validity of the scale needs to be examined further, given conflicting findings in other populations. The aim of this study was to psychometrically evaluate the GAD-7 among 15-29-year-olds using Rasch analysis and confirmatory factor analysis in a Swedish, general population sample. In addition, an iterative process explored if revised versions of the scale could be identified that fit the Rasch model in this sample.

METHODS: A random, age- and sex-stratified sample of 15-29-year-olds from the Swedish population register was drawn, from which stratified groups were randomly invited to participate. Data (n = 590) were collected through a study-specific app. Rasch analyses included investigation of item fit, local independence, principal components analysis of standardized Rasch model residuals, response category functioning, measurement invariance, scale-to-sample targeting, and reliability. In addition, confirmatory factor analyses (CFA) were conducted and interpreted using dynamic, data-adaptive cutoffs. An exploratory, iterative process was undertaken aiming at scale refinement based on results for the GAD-7.

RESULTS: No Rasch analyses provided support for the unidimensionality of the GAD-7, which also displayed issues with disordered response categories and measurement invariance. The CFA found substantial misfit for the one-factor model. The exploratory scale refinement resulted in two abbreviated scales warranting further investigation: Items 1-3 fit the Rasch model as a unidimensional scale and demonstrated acceptable to good reliability. Items 5-7 had good fit after merging the two highest response categories, although demonstrated poor reliability.

CONCLUSIONS: No analyses provided support for the unidimensionality of the GAD-7 among 15-29-year-olds in Sweden. While these findings do not support the use of a single sum score, they require confirmation in independent samples. Future research should evaluate whether the abbreviated, candidate scale comprising items 1-3 could be useful to assess anxiety in this population, including examination of criterion validity and the potential benefits of adding a response category to enhance both reliability and scale-to-sample targeting.

PMID:42498940 | DOI:10.1186/s12888-026-08423-0

BMC Oral Health. 2026 Jul 23;26(1):1348. doi: 10.1186/s12903-026-09303-5.

ABSTRACT

BACKGROUND: Conventional plate osteosynthesis is the corner stone for management of displaced parasymphyseal mandibular fractures that necessitate open reduction and internal fixation (ORIF). Yet, the conventional workflow is labor-intensive, time consuming and limited by variable reduction accuracy as it relies solely on surgeon experience. Recently, various novel computer-guided techniques have been introduced for mandibular fracture repair, hiring surgical guides of diverse designs and strategies. These techniques served as a substitute for the conventional treatment modalities, offering improved precision, speed and reproducibility. Therefore, this randomized controlled trial (RCT) compares the overall precision of this distinct complete computer-guided virtual surgical planning (VSP) protocol as a whole, employing screw-holes locator and custom-made plates versus the conventional workflow for parasymphyseal mandibular fracture repair.

METHODS: Twenty-six cases presented with uncomminuted parasymphyseal mandibular fracture were enrolled and randomized into two groups. The interventional group underwent ORIF utilizing a screw-hole locator and custom-made plates, while the control group utilized ready-made mini-plates for ORIF. In both groups, virtual surgical planning of the fractured mandible was accomplished, creating a virtual reduced model by Mimics software aided by preoperative computer tomography (CT) scan. Then, three-dimensional model derived from the postoperative CT scan was superimposed onto the VSP reduced model. Linear deviations between predefined dental and bony landmarks to established anatomical planes were measured and underwent statistical analysis.

RESULTS: The actual postoperative mandibular model in the computer-guided group demonstrated negligible deviation from the VSP model. While the conventional group revealed considerably greater deviation. The average deviation of the bony landmarks was 0.044 ± 0.14 mm for the intervention group versus 0.69 ± 0.5 mm for the control group (p < 0.001). The average deviation of the dental landmarks was 0.04 ± 0.13 mm for the intervention group versus 0.47 ± 0.33 mm for the control group (p < 0.001). The average surgical time of the intervention group was 1.46 ± 0.18 h versus 1.80 ± 0.34 h for the control group (p = 0.004), with the intergroup difference being statistically significant.

CONCLUSIONS: The integration of screw-holes locator and patient-specific implants (PSI) have improved anatomical reduction precision, facilitated reestablishment of the patient’s native occlusion and ensured more standardized reproducible outcomes, especially beneficial for less experienced surgeons.

TRIAL REGISTRATION: The study is a randomized control trial, registered at ClinicalTrials.gov Protocol Registration and Results System Receipt, NCT05647460, Data: 2022-12-05.

PMID:42498926 | DOI:10.1186/s12903-026-09303-5

Behav Res Methods. 2026 Jul 24;58(9):248. doi: 10.3758/s13428-026-03119-5.

ABSTRACT

A novel dataset of 556 street art images is presented, accompanied by affective evaluations from 1,239 Portuguese and Brazilian participants. Artworks were selected to reflect themes associated with the United Nations Sustainable Development Goals. Using a stimulus-sampling design, each participant completed an online survey in which 10 randomly selected artworks were presented and reported their responses in terms of valence, arousal, and specific emotion labels (being moved, awe, inspiration, hope, sadness, fear, anger, emotional connection, reflection, awareness, and interest), as well as their interest in street art and sustainability consciousness. Multilevel analyses showed that higher interest in street art and greater sustainability consciousness were consistent predictors of more positive emotional responses to the artworks. In contrast, the effects of gender and age were negligible, and national differences emerged only for feeling moved and awe. Network analyses revealed a highly interconnected emotional structure, with three clusters: self-transcendent, epistemic, and negative emotions. Feeling moved and emotional connection occupied central bridging positions, showing both direct and indirect links across positive and negative emotion clusters. Overall, these findings indicate that street art evokes a broad range of interconnected self-transcendent, cognitive-epistemic, and negative emotions, highlighting the complexity of viewers’ responses to the artworks. The dataset provides a valuable resource for research on emotional responses to street art and can support broader investigations into visual perception, aesthetic processing, and the communication of sustainability-related themes.

PMID:42498908 | DOI:10.3758/s13428-026-03119-5

Behav Res Methods. 2026 Jul 24;58(9):247. doi: 10.3758/s13428-026-03128-4.

ABSTRACT

Cognition is not a static process but is subject to substantial and meaningful variation within individuals over time. This has led to an increase in studies that aim to describe cognition in daily life by sampling participants repeatedly and remotely. Such studies, which we call high-frequency cognitive assessment or “HFCA”, tend to use a limited number of brief cognitive tests. This focus on a small number of tests leaves open questions concerning the psychometric characteristics of a wide array of cognitive tasks useful for HFCA that can guide researchers on appropriate task selection. We developed the Cognitive Variability Battery (CVB), a series of nine cognitive tests clustered into three distinct cognitive domains: attentional control, processing speed, and episodic memory. CVB was administered to participants three times per day for 3 weeks. Cognitive tests were rotated to reduce the length of any single testing session. Each test was administered up to 60 times. We provide detailed descriptions of the performance of each task, including variability, skew, and reliability statistics, using intraclass correlations. We examine the sensitivity of each test to several contextual factors including stress, affect, and social interactions. Finally, we provide power analyses on each cognitive test to determine how many assessments and participants are needed to detect effects of interest. These analyses will be essential to anyone seeking to implement HFCA testing in their own research programs, by providing guidance on which cognitive tests to select and how many participants and observations may be needed.

PMID:42498901 | DOI:10.3758/s13428-026-03128-4

Funct Integr Genomics. 2026 Jul 25;26(1):203. doi: 10.1007/s10142-026-01979-w.

ABSTRACT

We examined clinical, genetic, and molecular links between sleep disorders and endometriosis. Women aged 20-54 years in NHANES 2005-2006 were analyzed with survey-weighted logistic regression. Bidirectional two-sample Mendelian randomization (MR) was used to assess genetic directionality. Endometriosis-related genes were obtained from the Endometriosis eQTL analysis, whereas sleep disorder-related proteins were obtained from the sleep disorder pQTL analysis and mapped to their encoding genes. The two candidate lists were intersected by gene symbol, and shared candidates were evaluated by pathway enrichment, transcriptomic validation, machine-learning prioritization, single-cell localization, drug-gene annotation, and exploratory docking. Among 1,460 women, clinician-diagnosed sleep disorder was more common in those with endometriosis than in those without endometriosis (weighted prevalence, 13.4% vs 5.1%). In the core adjusted model, endometriosis was associated with higher odds of clinician-diagnosed sleep disorder (OR 2.64, 95% CI 1.03-6.76; P = 0.044). Forward MR suggested a modest association between genetic liability to sleep disorders and endometriosis risk (IVW OR 1.11, 95% CI 1.00-1.22; P = 0.040), whereas reverse MR provided no clear evidence for the opposite direction. Intersecting endometriosis-related eQTL genes with sleep disorder-related pQTL protein-coding genes yielded 37 shared xQTL-prioritized gene/protein candidates. Downstream analyses highlighted glucose metabolism, MAPK signaling, inflammatory pathways, and stromal-cell expression of SPARC and YEATS4. Sleep disorders and endometriosis showed convergent epidemiologic, genetic, and expression-based signals. The core clinical association remained positive after adjustment for major demographic and lifestyle covariates. The genetic and molecular findings should be interpreted as hypothesis-generating pending prospective and experimental validation.

PMID:42498900 | DOI:10.1007/s10142-026-01979-w

Neurocrit Care. 2026 Jul 24. doi: 10.1007/s12028-026-02605-0. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate early prognostication in patients with acute brain injury remains a major challenge in neurocritical care. Conventional bedside assessments provide limited insight into long-term outcomes and may not fully capture preserved brain function that supports recovery. Functional neuroimaging can detect brain activity not evident at the bedside, but its use in intensive care remains constrained by cost, logistics, and the need for stronger evidence supporting its value. Functional near-infrared spectroscopy (fNIRS) offers a scalable, bedside-compatible approach for assessing brain function in critically ill patients, but its value for early prognostication has yet to be established.

METHODS: In this prospective observational cohort study, 33 patients with acute brain injury in the intensive care unit (ICU) underwent fNIRS recording while listening to two audio-only movie clips. Functional connectivity features were used to train a machine learning model to classify 6-month functional outcome, defined by the Glasgow Outcome Scale-Extended (favorable ≥ 4, unfavorable < 4). Model performance was assessed using balanced accuracy and statistically evaluated using permutation testing. Performance was compared with validated behavioral assessments and clinical variables. Secondary analyses evaluated prediction of behavioral responsiveness (observable command-following after testing) and covert awareness (neural command-following).

RESULTS: A total of 26 patients had an unfavorable outcome and 7 had a favorable outcome. The fNIRS-based model predicted 6-month outcome with a balanced accuracy of 81.3% (sensitivity = 85.7%, specificity = 76.9%; p = 0.006), outperforming clinical models (balanced accuracy = 67.6%; p = 0.018). The fNIRS-based model also predicted recovery of behavioral responsiveness (balanced accuracy 78.5%; p = 0.008) but not covert awareness (70.4%; p = 0.109).

CONCLUSIONS: Bedside fNIRS provides objective neural measures associated with later functional recovery and behavioral responsiveness in patients with acute brain injury. These findings suggest that fNIRS may capture clinically relevant brain function not detected by conventional assessments. With further validation in larger, multicenter cohorts, such approaches may complement existing methods for early prognostication.

PMID:42498895 | DOI:10.1007/s12028-026-02605-0

Behav Res Methods. 2026 Jul 24;58(9):250. doi: 10.3758/s13428-026-03079-w.

ABSTRACT

This paper introduces an open-source Python package for simplified, customizable computerized adaptive testing (CAT) using Bayesian methods for ability estimation. It addresses the lack of sophisticated packages for CAT in the Python programming language. Moreover, it bridges the gap between the construction and simulation of adaptive tests and their practical application by providing a dedicated API for integration with experiment software. Thereby, it eliminates the need for major code rewrites when transitioning from simulated to real-world adaptive testing. By leveraging Python’s object-oriented programming approach, such as abstract classes, protocols, and inheritance, the package allows for easy extension and customization of its functionality. For example, Bayesian estimators can be modified to incorporate custom priors. This paper outlines the relevance and practical use of the adaptivetesting package through a walkthrough example. The package is fully documented, and its source code is published on GitHub. It is also available on the Python Package Index (PyPi) and conda-forge thus it can easily be installed using Python’s package manager pip or conda. Leveraging R’s reticulate package, adaptivetesting can also be accessed from within RStudio.

PMID:42498892 | DOI:10.3758/s13428-026-03079-w

Int Urol Nephrol. 2026 Jul 24. doi: 10.1007/s11255-026-05307-w. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the efficacy of telitacicept in patients with biopsy-proven lupus nephritis.

METHODS: Twenty-one patients diagnosed with lupus nephritis by taking the renal biopsy were enrolled in this study and received telitacicept treatment for at least 6 months. The laboratory test and renal remission rate were assessed during the follow-up period.

RESULTS: All patients were followed for at least 12 months. At the 12-month follow-up, patients with Class II, III, or V LN all had achieved complete or at least partial remission, whereas some patients with Class III + V, IV, or IV + V LN had not achieved remission. However, with extended follow-up (median of 24 months), all patients ultimately achieved complete or partial remission by the end of the study. Significant improvements were observed at 3 months, including a decrease in the urinary protein to creatinine ratio (UPCR) and increases in serum albumin (ALB) and hemoglobin (Hb) levels. C3, C4 complement concentrations, and platelet (PLT) were markedly elevated at 1 month, while immunoglobulins (IgG, IgA, and IgM) decreased significantly and remained at low levels over the following 12 months. No severe adverse events were reported during the observation period. Compared with the noninitial-treatment group, patients initially treated with telitacicept had significantly lower baseline albumin, C3, and C4 levels, but subsequent follow-up revealed no statistically significant differences between the groups.

CONCLUSIONS: Telitacicept is a promising treatment option for patients with LN. The study demonstrated favorable efficacy and safety in LN patients, regardless of whether they were undergoing initial therapy, had failed previous treatments, or had experienced disease relapse. Further randomized controlled trials are warranted to confirm this conclusion.

PMID:42498888 | DOI:10.1007/s11255-026-05307-w