Nevin Manimala

Eur J Med Res. 2026 Feb 14. doi: 10.1186/s40001-026-04037-0. Online ahead of print.

ABSTRACT

INTRODUCTION: Cardiovascular-Kidney-Metabolic (CKM) syndrome reflects the convergence of cardiovascular, renal, and metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD), as the hepatic phenotype of metabolic impairment, provides a critical link within this continuum. However, the association between CKM syndrome staging, MASLD prevalence, and liver fibrosis severity remains unclear.

METHODS: This study included 3084 individuals with CKM stages 1-4 from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Hepatic steatosis and fibrosis were assessed through vibration-controlled transient elastography, providing both controlled attenuation and stiffness indices. To explore the links between CKM staging, MASLD prevalence, and fibrosis severity, weighted multivariable logistic regression was performed. Furthermore, predictive machine learning models were constructed, and SHapley Additive exPlanations (SHAP) were applied to clarify the relative impact of CKM components on MASLD prevalence.

RESULTS: Advancing CKM stages were associated with higher prevalence of MASLD, advanced fibrosis, and cirrhosis, whereas no significant association was observed with significant fibrosis. Among machine learning models, the random forest model showed the best predictive performance (AUC = 0.809). SHAP analysis identified waist circumference, HbA1c, metabolic syndrome, triglycerides, diabetes, HDL-C, and age as key predictors.

CONCLUSION: CKM stage was significantly associated with MASLD prevalence, advanced liver fibrosis, and cirrhosis. Machine learning interpretation highlighted adiposity, glycemic control, and lipid metabolism as the principal contributors, suggesting that these CKM-related metabolic domains may contribute to MASLD and fibrotic burden.

PMID:41691268 | DOI:10.1186/s40001-026-04037-0

BMC Oral Health. 2026 Feb 14. doi: 10.1186/s12903-026-07871-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the feasibility and effectiveness of mixed reality combined with surgical navigation for resection of oral and maxillofacial tumors.

METHODS: Patients with maxillary or mandibular tumors in the oral and maxillofacial region who underwent surgical treatment at Peking University School and Hospital of Stomatology between January 2020 and June 2023 were enrolled in this study. During the preoperative phase, patients in the mixed reality-surgical navigation group (MRSN group) underwent additional image data processing using mixed reality-surgical navigation technology, which enabled intraoperative tumor localization and resection under navigation guidance. The control group underwent conventional virtual surgical planning (VSP) incorporating computer-aided design (CAD) and computer-aided manufacturing (CAM). Tumor resection in the control group was also performed under surgical navigation guidance. Baseline patient characteristics were recorded for both groups. Using a normal vector-based selection method, osteotomy planes were extracted from the preoperative virtual surgical plan and from postoperative computed tomography reconstruction models using digital software for chromatographic analysis. Deviations between planned and actual osteotomy planes were compared between the two groups. All analyses were performed using SPSS 26.0 software (IBM Corp, Armonk, NY, USA), with statistical significance set at P < 0.05.

RESULTS: A total of 38 patients were included, with 19 patients in each group. The mean osteotomy deviation was significantly smaller in the MRSN group than in the control group (1.84 mm vs. 3.07 mm, P < 0.001). Chromatographic analysis showed that 74.84% of osteotomy points in the MRSN group deviated by less than 3 mm, compared with 64.81% in the control group. Subgroup analyses by tumor location (maxillary vs. mandibular) and pathology (benign vs. malignant) demonstrated consistently smaller deviations in the MRSN group. No significant differences in osteotomy accuracy were observed between maxillary and mandibular tumors or between benign and malignant tumors within either group (P > 0.05). During a mean follow-up of 27 months in the MRSN group, five patients experienced complications, including facial paralysis, skin numbness, and titanium mesh exposure; no tumor recurrence or distant metastasis was observed. In the control group, with a mean follow-up of 18.8 months, two patients developed complications (infection and titanium mesh exposure), and three patients experienced tumor recurrence.

CONCLUSION: The clinical application of mixed reality combined with surgical navigation is feasible for the resection of oral and maxillofacial tumors. Compared with conventional navigation systems, this approach allows more precise localization of osteotomy planes and improves the accuracy of tumor resection.

PMID:41691248 | DOI:10.1186/s12903-026-07871-0

BMC Psychiatry. 2026 Feb 14. doi: 10.1186/s12888-026-07884-7. Online ahead of print.

ABSTRACT

BACKGROUND: Suicide represents a major public health challenge globally, with depression, anxiety, and stress constituting well-established risk factors. Spiritual health has emerged as a potentially protective factor against psychological distress, yet its relationship with mental health outcomes in suicide attempters remains inadequately characterized, particularly in Middle Eastern populations where spiritual and religious frameworks play central roles in cultural identity.

OBJECTIVE: This study aimed to investigate the relationship between spiritual health and depression, anxiety, and stress among individuals who attempted suicide in Yasuj, Southwest Iran.

METHODS: This cross-sectional study was conducted on 136 individuals who attempted suicide and were admitted to Imam Sajjad Hospital in Yasuj, Iran, during 2023-2024. Participants were selected using convenience sampling. Data were collected through face-to-face interviews using a demographic questionnaire, the Depression Anxiety Stress Scale-21 (DASS-21), and the Paloutzian and Ellison Spiritual Health Questionnaire. Data analysis was performed using SPSS version 26, employing descriptive statistics and Spearman correlation coefficients to examine relationships between spiritual health and psychological distress variables across urban and rural subgroups.

RESULTS: The sample consisted predominantly of young adults aged 16-30 years (70.6%), females (55.9%), single individuals (64.0%), and urban residents (76.5%). Drug ingestion was the most common suicide method (94.9%), and 34.5% reported prior suicide attempts. Severe to extremely severe depression was present in 80.9% of participants, with 81.6% experiencing severe to extremely severe stress, and 38.9% reporting severe to extremely severe anxiety. Spiritual health demonstrated significant negative correlations with depression (urban: r = -0.591, p < 0.01; rural: r = -0.544, p = 0.001) and stress (urban: r = -0.602, p < 0.01; rural: r = -0.499, p = 0.004). However, correlations between spiritual health and anxiety were weak and non-significant in both urban (r = -0.186, p = 0.059) and rural areas (r = -0.100, p = 0.585). Strong positive intercorrelations were observed among depression, anxiety, and stress (r = 0.430-0.663, all p < 0.01).

CONCLUSION: Spiritual health is significantly and inversely associated with depression and stress, but not with anxiety, among suicide attempters in Southwest Iran. These findings suggest that spiritual health may serve as a protective factor against specific dimensions of psychological distress in this high-risk population. The integration of spiritual health assessment and spiritually-informed interventions into comprehensive suicide prevention and post-attempt care protocols may enhance treatment outcomes, particularly for individuals whose cultural and personal identities incorporate spiritual dimensions. Future longitudinal research is needed to establish causal relationships and evaluate the efficacy of spiritually-integrated therapeutic interventions for reducing psychological distress and preventing suicide reattempts.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41691222 | DOI:10.1186/s12888-026-07884-7

BMC Pregnancy Childbirth. 2026 Feb 14. doi: 10.1186/s12884-026-08824-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The management of symptomatic hydronephrosis during pregnancy requires balancing maternal and fetal health. This exploratory retrospective study evaluated outcomes of conservative versus invasive intervention approaches in pregnant patients with symptomatic hydronephrosis.

METHODS: We conducted a retrospective analysis of pregnant patients with symptomatic hydronephrosis who underwent conservative management or invasive interventions. Groups were compared regarding demographics, gestational age at diagnosis, fetal birth weight, maternal renal function, and pregnancy-related complications.

RESULTS: The conservative (n = 52) and invasive intervention (n = 29) groups had comparable baseline characteristics, including maternal age (25.8 ± 4.7 vs. 27.0 ± 4.9 years, p = 0.290) and gestational age at diagnosis (24.1 ± 5.9 vs. 24.8 ± 5.8 weeks, p = 0.610). Birth weight was significantly higher with conservative management (3,289 ± 531 g vs. 3,045 ± 337 g, p = 0.029). Multivariable regression analysis adjusting for maternal age, gestational week, and gravidity showed no significant independent association with birth weight (β = 167.5 g, 95% CI: -55.5-390.5 g, p = 0.139), with the most significant difference observed in Grade 3 hydronephrosis (654 g, p = 0.055). Serum BUN levels were lower with invasive intervention (6.9 ± 1.0 vs. 7.5 ± 1.1 mg/dL, p = 0.020), though serum creatinine, a more specific renal function marker, showed no significant difference (p = 0.836). Rates of gestational hypertension and preeclampsia were comparable between groups.

CONCLUSION: Both conservative and invasive management strategies appear feasible and clinically acceptable for symptomatic hydronephrosis during pregnancy, with no clinically significant differences in maternal or neonatal outcomes. Although a statistically significant difference in birth weight was observed, neonatal outcomes, including Apgar scores, were comparable between groups, and birth weights did not fall into categories of small for gestational age or fetal growth restriction. Invasive procedures may be necessary in severe cases with refractory symptoms, infection, or deteriorating renal function. Treatment selection should be individualized based on clinical severity rather than expected outcome differences.

PMID:41691207 | DOI:10.1186/s12884-026-08824-9

BMC Gastroenterol. 2026 Feb 14. doi: 10.1186/s12876-026-04687-8. Online ahead of print.

ABSTRACT

BACKGROUND: The variability of pancreatic vasculature, especially the dorsal pancreatic artery (DPA), increase surgical difficulty and may elevate the risk of intra- and postoperative bleeding. This study aimed to establish a precise preoperative vascular assessment protocol for pancreatic surgery, summarize DPA variant patterns, and evaluate their impact on pancreatic surgery-related bleeding.

METHODS: In this prospective study, 206 patients undergoing pancreatic surgery were included and evaluated preoperatively using computed tomography (CT) imaging and Preoperative Accurate Assessment Form for Pancreatic Vascular Variations (PAAF-PVV). 50 historical controls who underwent pancreatic surgery without PAAF-PVV were retrospectively included. DPA variants were systematically classified. The impact of PAAF-PVV-based vascular assessment and DPA variants on bleeding outcomes was analyzed.

RESULTS: Among patients who underwent precise preoperative vascular assessment for the pancreas (n = 148) versus those who did not (n = 32), no significant differences were observed in intraoperative blood loss, PPH incidence and postoperative hemoglobin decline (ΔHb). However, in the distal pancreatectomy group, the hemoglobin decline on POD2 differed significantly (ΔHb_POD2-POD1, -5.11 vs. -10.69 g/L, 95% CI 1.45-9.71, P = 0.010). Then, DPA origins were classified into five types and no significant association was found with intraoperative blood loss or PPH incidence. However, type IIB DPA may increase the risk of early postoperative hemoglobin decline, whereas type IC DPA appeared to be associated with a lower risk, as reflected by ΔHb_POD2-POD1 values (-12.45 ± 11.605 vs. -1.15 ± 6.902 g/L, P = 0.046). DPA branching patterns were also documented. Patients with DPA head-side branch (HB) showed more postoperative hemoglobin decline than those without HB in distal pancreatic surgery, as reflected by ΔHb_POD3-POD1 values (-11.65 ± 6.434 vs. -7.45 ± 8.667 g/L, P = 0.049). Interestingly, we also found that centro-inferior pancreatic vein (CIPV) drainage type was associated with ΔHb_POD3-POD1, with inferior mesenteric vein (IMV) drainage type linked to greater hemoglobin decline (-12.52±11.422 vs. -7.27±9.508 g/L, P=0.009). Besides, the minimally invasive surgical approach, distal pancreatic resection, and benign pancreatic disease appeared to be associated with fewer intra-operative blood loss.

CONCLUSION: Variations in the pancreatic vasculature, including both arterial and venous systems, may influence surgery-related bleeding. Robust statistical evidence for bleeding reduction is not established in the overall study. Although the clinical outcome related measures presented in this study are merely associative and exploratory findings, a precise preoperative vascular assessment could help enhance anatomical understanding and optimize preoperative procedural planning, which is particularly valuable for surgeons during their learning phase.

PMID:41691178 | DOI:10.1186/s12876-026-04687-8

BMC Anesthesiol. 2026 Feb 14. doi: 10.1186/s12871-026-03694-2. Online ahead of print.

ABSTRACT

BACKGROUND: In this randomized controlled, double-blind study, we aimed to investigate the involvement of sympathetic nerve fibers in erector spinae plane block (ESPB) and to compare it with thoracic epidural analgesia (TEA) in patients scheduled for unilateral mastectomy. Additionally, we compared sympathetic blockade-related hemodynamic effects, sensory blockade distribution, and analgesic effects.

METHODS: Thirty-eight female patients aged 18-70 years, American Society of Anesthesiologists (ASA) classification I-III, were included in the study. The patients were divided into Group E (those who received general anesthesia after the ESPB) and Group T (those who received general anesthesia after TEA). The extent of sympathetic blockade (via the hot-cold test) and skin conductance (GSR) were recorded as the co-primary outcome measures. Secondary outcomes included skin temperature, perioperative hemodynamic data, sensory block extent, postoperative pain scores, and analgesic consumption.

RESULTS: Regarding the co-primary outcomes, there was no statistically significant difference between the groups in the hot-cold test or GSR values. In terms of secondary outcomes, although the rate of skin temperature change differed (p = 0.028), both groups showed significant warming. Hemodynamic data were comparable. However, ESPB produced a wider ipsilateral sensory block than TEA. The postoperative pain scores, patient-controlled analgesia (PCA) demand, and rescue analgesic consumption were not statistically significantly different between the two groups.

CONCLUSION: ESPB demonstrated similar sympathetic blockade efficacy to TEA. Additionally, it produced similar hemodynamic effects and postoperative analgesia in patients undergoing unilateral mastectomy due to malignancy.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04702061, Date of registration: 24/12/2020, https://clinicaltrials.gov/study/NCT04702061.

PMID:41691173 | DOI:10.1186/s12871-026-03694-2

BMC Infect Dis. 2026 Feb 14. doi: 10.1186/s12879-025-12507-9. Online ahead of print.

NO ABSTRACT

PMID:41691157 | DOI:10.1186/s12879-025-12507-9

BMC Infect Dis. 2026 Feb 14. doi: 10.1186/s12879-026-12837-2. Online ahead of print.

ABSTRACT

BACKGROUND: Central venous catheterization is a routine procedure in clinical practice, but it can result in severe and costly central line-associated bloodstream infections (CLABSIs), the risk of which may vary by insertion sites. This study sought to evaluate and compare the incidence of CLABSI in critically ill patients between internal jugular and subclavian sites, and to explore the correlation between insertion site and risk of CLABSI.

METHODS: This research encompassed critically ill patients with Central venous catheters (CVCs) placed in the internal jugular or subclavian site from ICUs of 22 public tertiary hospitals throughout China, from September 4, 2023, to February 29, 2024. The incidence of CLABSI was calculated and compared between the two groups using Poisson regression. The association between insertion site and CLABSI risk was assessed using univariable and multivariable Cox proportional hazards regression models, with additional adjustments for center-effects using a frailty model.

RESULTS: Among 2,379 patients analyzed, the internal jugular site was the predominant insertion site (68.3%, n = 1,626) compared to the subclavian site (31.7%, n = 753). Over 18,359 total CVC days, 19 CLABSIs were documented. The incidence rate was 0.66 and 1.22 per 1000 CVC days for the subclavian and internal jugular groups, respectively (Incidence rate ratio [IRR] = 1.86, 95% CI [0.67-6.62]; P = 0.27). In the primary analysis, no statistically significant association was found between insertion site and CLABSI risk, either in the unadjusted model (Hazard ratio [HR] = 1.83, 95% CI [0.61-5.53]) or after multivariable adjustment and accounting for between-center heterogeneity (adjusted HR = 2.07, 95% CI [0.65-6.62]).

CONCLUSIONS: In this large multicenter cohort from China, the overall CLABSI incidence was low. We observed no statistically significant difference in CLABSI risk between internal jugular and subclavian CVC insertion sites after adjustment for confounders and center effects. However, the findings were inconclusive due to the limited number of events and the potential for residual confounding inherent in the observational design. These results highlight the need for larger, sufficiently powered studies to provide definitive evidence on the comparative infection risk of CVC insertion sites.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41691144 | DOI:10.1186/s12879-026-12837-2

BMC Med Imaging. 2026 Feb 14. doi: 10.1186/s12880-026-02224-3. Online ahead of print.

ABSTRACT

BACKGROUND: HIV-associated neurocognitive disorders (HAND) are common complications in HIV-infected individuals, and working memory impairment is one of the core features. Although combination antiretroviral therapy (cART) has reduced the incidence of severe HAND, mild HAND remains prevalent. This study aims to explore the functional brain characteristics related to working memory in HIV-infected individuals with different cognitive states using resting-state and task-based functional magnetic resonance imaging (fMRI), and to identify candidate imaging markers for early diagnosis and inform future intervention targeting.

METHODS: Fifty-nine HIV-infected individuals (30 with cognitive integrity [CI], 29 with asymptomatic neurocognitive impairment [ANI]) and 37 healthy controls (HC) were enrolled. Resting-state and task-based fMRI were acquired. Task-fMRI was performed using a spatial working memory task to analyze brain activation, functional connectivity (FC), and reconfiguration efficiency of FC from rest to task. FC networks were constructed as ROI-ROI Pearson correlation matrices (Fisher z-transformed) and significant group differences were identified using network-based statistics. Pearson and Spearman correlation analyses were used to explore the relationships between reconfiguration efficiency and clinical/cognitive variables.

RESULTS: HC showed better task performance than both HIV groups, and ANI exhibited the poorest accuracy. Compared with CI, ANI had significantly lower neurocognitive domain T-scores in memory, attention/working memory, and abstraction/executive function. In task-fMRI analyses, ANI showed decreased activation in the bilateral orbital middle frontal gyri and the left middle temporal gyrus, alongside increased activation in the left cerebellum crus I relative to CI. Whole-brain analyses demonstrated widespread FC increases in both HIV groups at rest and during the task compared with HC. Reconfiguration efficiency differed across groups and showed stage-related associations with immune and cognitive measures.

CONCLUSIONS: Cognitive impairment in virally suppressed HIV is accompanied by altered working-memory network engagement, with greater cortico-cerebellar involvement in ANI. While static whole-brain FC showed widespread increases but limited CI-ANI separation under stringent correction, altered rest-to-task FC reconfiguration efficiency was associated with immune indices and neurocognitive/behavioral performance, suggesting that this cross-state metric may serve as a candidate marker for HAND phenotyping and risk stratification.

PMID:41691142 | DOI:10.1186/s12880-026-02224-3

Eur Radiol. 2026 Feb 14. doi: 10.1007/s00330-026-12372-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of a body mass index (BMI)-based sub-milliSievert low-dose CT (LDCT) protocol with multiple reconstruction algorithms for image quality and lung nodule assessment.

MATERIALS AND METHODS: This prospective study included 214 participants who underwent standard-dose CT (SDCT, 3.68 ± 1.53 mSv) reconstructed with 50% adaptive statistical iterative reconstruction (ASIR-V-50%) and LDCT. LDCT was randomly divided into a higher-dose group (LD-A, 0.57-1.15 mSv, n = 108) and a lower-dose group (LD-B, 0.33-0.63 mSv, n = 106). Each group was stratified into four BMI-based subgroups with individualized protocols reconstructed with deep learning image reconstruction (DLIR-H and DLIR-M), ASIR-V-50%, and filtered back projection (FBP). Image quality, nodule detection across BMI subgroups, and the performance of four algorithms in detection, size measurement accuracy, and Lung-RADS v2022 consistency were analyzed.

RESULTS: In LDCT, DLIR-H provided superior image quality (p < 0.001) and the highest overall nodule detection rate (99.04%), surpassing ASIR-V-50% (98.55%) and FBP (97.87%) (both p < 0.05). The advantage was most evident for nodules < 6 mm, while all nodules ≥ 6 mm were consistently detected across algorithms. Detection rates showed no significant variation among BMI subgroups (all p > 0.05). For measurement accuracy, FBP and ASIR-V-50% performed better in LD-A (all p < 0.05), whereas DLIR-M was superior in LD-B (p < 0.001). All algorithms demonstrated excellent Lung-RADS agreement (κ > 0.9, p < 0.001).

CONCLUSION: A BMI-based sub-milliSievert LDCT protocol significantly reduced radiation exposure while maintaining nodule detection across BMI subgroups, with DLIR offering superior image quality and diagnostic performance.

KEY POINTS: Question Evidence remains scarce on BMI-based sub-milliSievert low-dose CT using different reconstruction algorithms, regarding image quality and nodules detection (particularly < 6 mm). Findings BMI-based sub-milliSievert low-dose CT ensured balanced detectability across populations, while deep learning reconstruction improved image quality and achieved excellent sensitivity for lung nodule detection. Clinical relevance Deep learning reconstruction enhanced BMI-based sub-milliSievert low-dose CT, supporting its application in personalized sub-milliSievert low-dose lung cancer screening.

PMID:41691132 | DOI:10.1007/s00330-026-12372-3