Nevin Manimala

Vet Ophthalmol. 2026 Sep;29(5):e70208. doi: 10.1111/vop.70208.

ABSTRACT

OBJECTIVE: Cohen’s kappa is widely used to measure rater agreement on binary outcomes and performs well when outcome prevalence is relatively balanced. This paper aims to explain the challenges encountered with Cohen’s kappa, and to provide guidance to veterinary ophthalmologists on the usage and interpretation of kappa values.

ANIMALS STUDIED: Article based on an existing dataset in which two examiners graded iridocorneal angle abnormalities in 60 client-owned dogs during pre-breeding examinations.

PROCEDURE: Following the 2022 ECVO-HED (European College of Veterinary Ophthalmology-Hereditary Eye Diseases) gonioscopy grading scheme and its general recommendations, eyes were classified into two categories-“breeding-YES” (not affected, mildly or moderately affected) or “breeding-NO” (severely affected). Inter-examiner agreement was separately assessed for real (60 left and 58 right eyes) and simulated data (manually balanced left eye dataset with unchanged agreement between examiners).

RESULTS: While the two examiners classified 52/60 left and 51/58 right eyes into the “breeding-YES” category, they disagreed on 7/60 left and 1/58 right eyes, with resulting kappa values of 0.18 and 0.91 for the left and right eyes, respectively. After balancing the data, with both examiners classifying 27/60 left eyes into the “breeding-yes” category, but still disagreeing on 7/60 eyes, the kappa value increased to 0.77.

CONCLUSIONS: Readers should be cautious when comparing kappa values across studies with different underlying prevalence and bias. Under non-ideal data distribution, additional statistical indices like prevalence- and bias index, prevalence-and-bias-adjusted kappa (PABAK), and maxKappa, do not replace Cohen’s kappa, but assist in interpreting it.

PMID:42473033 | DOI:10.1111/vop.70208

J Cachexia Sarcopenia Muscle. 2026 Aug;17(4):e70345. doi: 10.1002/jcsm.70345.

ABSTRACT

BACKGROUND: Electroacupuncture (EA) treatment has been utilized for recovery from neuromuscular-related diseases and may play a significant role in the treatment of sarcopenia. This interventional, randomized controlled clinical study aims to explore the efficacy of EA treatment in maintenance haemodialysis (MHD) patients with sarcopenia.

METHODS: Thirty-six participants with sarcopenia undergoing MHD were randomly divided into the control group and the EA group. The participants in the EA group received a total of 24 treatments, each lasting 30 min, and were administered three times per week. Participants in the control group were instructed to continue their current lifestyle and treatment plans. The assessments were conducted at baseline and after 8 weeks. Statistical analysis was performed using two-way analysis of covariance (ANCOVA) adjusted according to gender and baseline values. Repeated measures analysis of variance (ANOVA) was used to assess EA effects, reporting main effects and the time × group interaction with partial eta squared (η²p) effect sizes. The primary outcome was 6-m gait speed; the secondary outcomes were skeletal muscle mass index (SMI) and handgrip strength. Fasting blood samples were collected, and serum metabolomics using the liquid chromatography-mass spectrometry method was employed to reveal metabolic changes.

RESULTS: One participant from the EA group dropped out, and 35 participants were included in the analysis, aged (59.06 ± 11.69) years, including 22 men and 13 women. After intervention, the 6-m gait speed of the EA group increased (Δ = 0.10 ± 0.08; p < 0.001), whereas that of the control group decreased (Δ = -0.06 ± 0.09; p = 0.018). The handgrip strength of the EA group increased (Δ = 0.68 ± 0.98; p = 0.011), whereas that of the control group decreased (Δ = -0.76 ± 1.19; p = 0.015). The SMI in the EA group increased (Δ = 0.19 ± 0.22; p = 0.003), although there was no significant difference in the control group. No serious adverse events were observed during the EA treatment. The results of serum metabolomics indicated that a total of 127 differentially expressed metabolites were identified (p < 0.05, VIP > 1), including 35 up-regulated metabolites and 92 down-regulated metabolites. KEGG pathway enrichment analysis showed that glycerophospholipid metabolism, linoleic acid metabolism and other pathways related to lipid metabolism were significantly changed.

CONCLUSIONS: EA treatment was an effective therapy for sarcopenia in patients undergoing MHD. Its therapeutic effect may be related to the positive regulation of systemic metabolism (including amino acid and lipid profiles).

PMID:42473028 | DOI:10.1002/jcsm.70345

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-63040-x. Online ahead of print.

ABSTRACT

The association between sleep duration and physical, psychological and cognitive multimorbidity (PPC-MM) remains unclear. This study explores whether frailty accounts for part of this association using both cross-sectional and longitudinal analyses. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2018, involving 7,193 participants for cross-sectional and 5,380 for longitudinal analysis. Multivariate logistic regression and Cox proportional hazards models evaluated the association between sleep duration, frailty, and PPC-MM risk. Nonlinear dose-response relationships were assessed with restricted cubic spline (RCS) analysis, and subgroup analyses examined demographic differences. Bootstrap resampling with 1,000 iterations was used to estimate the indirect pathways. In the cross-sectional path analysis, logistic regression analysis showed that sleep duration was negatively associated with PPC-MM (OR = 0.84, 95% CI: 0.80-0.89, P < 0.001). Frailty showed a positive association with PPC-MM (OR = 4.80, 95%CI: 3.92-5.88, P < 0.001). Frailty accounted for 31.61% of the statistical association between sleep duration and PPC-MM. In the longitudinal exploratory mediation analysis, Cox models showed that longer sleep duration was associated with a lower risk of incident PPC-MM (HR = 0.85, 95% CI: 0.80-0.89, P < 0.001). Frailty was positively associated with PPC-MM risk (HR = 5.89, 95% CI: 4.81-7.21, P < 0.001). Exploratory mediation analysis further indicated that the indirect pathway via frailty accounted for 26.99% of the total prospective association between sleep duration and incident PPC-MM. Sleep duration was negatively associated with PPC-MM, while frailty was positively associated with PPC-MM. Exploratory analyses suggested that frailty may serve as a partial intermediary in this association.

PMID:42473003 | DOI:10.1038/s41598-026-63040-x

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-60777-3. Online ahead of print.

ABSTRACT

In-service heavy-haul railway bridges often operate under damaged conditions, requiring continuous health monitoring to ensure operational safety and facilitate intelligent maintenance. However, conventional assessment methods based on ground monitoring, limited by sparse sensor deployment, cannot fully capture the global bridge state and its evolution, and neglect stochastic track irregularities that induce significant response variability, thereby decreasing assessment reliability. To address these issues, a distribution-driven probabilistic bridge state assessment framework is proposed based on vehicle-bridge collaborative monitoring. The extreme-value distributions of vibration responses from the bogie, wheelset, and key span sections under stochastic track irregularities and varying bridge damage conditions are characterized using the probability density evolution method, revealing a mapping between damage-induced variations in bridge states and the corresponding distribution shifts. Based on this mapping, baseline thresholds for extreme responses are statistically determined under undamaged conditions to define six distinct bridge health levels. The probability for each level is estimated via a weight-adaptive hierarchical probabilistic evaluation model, which fuses probabilities derived from the extreme-value distributions of multi-source vibration response indicators, with weights allocated according to indicator sensitivity to damage. The bridge state is assessed as the one with the highest probability among the six levels. Case studies on scenarios with different damage locations and severities demonstrate that the proposed framework effectively distinguishes the effects of damage on bridge states and traces state evolution as damage progresses, providing reliable and interpretable assessments for bridge maintenance decision-making.

PMID:42472990 | DOI:10.1038/s41598-026-60777-3

Sci Rep. 2026 Jul 19. doi: 10.1038/s41598-026-63141-7. Online ahead of print.

ABSTRACT

The prevalence of metabolic syndrome has increased significantly, and visceral obesity is closely associated with non-alcoholic fatty liver disease. This study aimed to investigate the association between inflammatory indices derived from blood cell counts and to investigate the association between inflammatory indices, metabolic syndrome, and NAFLD in Sabzevar, Iran, in 2025. This case-control study used data from a large adult cohort. A total of 1500 participants with metabolic syndrome were selected as the case group, and for each case, one control without metabolic syndrome was randomly selected from the same cohort. All participants were subsequently evaluated for the presence or absence of non-alcoholic fatty liver disease and, additionally, for liver fibrosis using the Fibrosis-4 (FIB-4) index. Data were analyzed using SPSS version 16, and a p-value < 0.05 was considered statistically significant. In this study, the mean age was 51.01 ± 8.3 years in the metabolic syndrome group and 46.9 ± 8.2 years in the healthy group. In the metabolic syndrome group, 621 participants were male and 879 were female. Overall, no significant associations were observed between metabolic syndrome and inflammatory indices, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index, hemoglobin level, or liver fibrosis classification based on the Fibrosis-4 (FIB-4) index. In contrast, metabolic syndrome was significantly associated with demographic factors, anthropometric measures, metabolic parameters, non-alcoholic fatty liver disease, and the monocyte-to-high-density lipoprotein cholesterol ratio. Non-alcoholic fatty liver disease showed no significant association with the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, hemoglobin level, or systemic inflammatory response index. Still, it was significantly associated with demographic characteristics, anthropometric indices, metabolic factors, the platelet-to-lymphocyte ratio, systemic immune-inflammation index. Liver fibrosis classification based on the FIB-4 index was not significantly associated with several metabolic and inflammatory variables; however, it showed significant associations with age, sex, anthropometric measures, selected inflammatory indices, and hemoglobin level. Given that imaging methods are costly and not readily accessible for all patients, the findings of this study may provide a basis for identifying more cost-effective and easily accessible approaches for the diagnosis of this disease.

PMID:42472984 | DOI:10.1038/s41598-026-63141-7

Neurosurg Rev. 2026 Jul 20;49(1):484. doi: 10.1007/s10143-026-04405-8.

ABSTRACT

Chronic subdural hematoma (CSDH) is increasingly common in older adults and in patients receiving antithrombotic therapy. Although burr-hole drainage is generally safe and effective, perioperative mortality remains a concern, and reliable preoperative predictors are incompletely defined. We aimed to identify independent preoperative predictors of in-hospital mortality after burr-hole drainage for CSDH, with explicit characterization of causes of death, comorbidity burden, and the discriminative performance of candidate predictors. This single-center retrospective cohort study included 121 consecutive adult patients surgically treated for CSDH between January 2015 and December 2024. Preoperative variables included demographics, Glasgow Coma Scale (GCS) score, hematoma thickness, midline shift (MLS), cerebral edema on CT, antithrombotic use, and a comprehensive set of comorbidities (chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, diabetes mellitus, dementia, malignancy). Intensive care unit admission and postoperative complications were also recorded. The primary outcome was in-hospital mortality. Causes of death were systematically categorized. Associations were evaluated using Firth penalized logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis with bootstrap confidence intervals. A prespecified exploratory interaction analysis between cerebral edema and significant midline shift was performed. In-hospital mortality was 12.4% (15/121). The principal cause of death was cerebral herniation (9/15, 60.0%); extracranial complications (respiratory, septic, cardiac) accounted for 6/15 (40.0%). In the original multivariable Firth model, GCS ≤ 13 (adjusted OR 11.71, 95% CI 2.82-48.61, p < 0.001) and cerebral edema (adjusted OR 8.90, 95% CI 1.93-40.98, p = 0.005) were independently associated with mortality. In an extended model incorporating comorbidities, chronic kidney disease (OR 23.78, p = 0.025) and congestive heart failure (OR 42.39, p = 0.043) emerged as additional independent predictors, while cerebral edema (OR 61.89, p = 0.008) and GCS ≤ 13 (OR 5.80, p = 0.032) retained their associations. Combined model discrimination was excellent (Model 1: AUC 0.920; Model 2 with comorbidities: AUC 0.958). Subgroup analysis demonstrated a marked mortality gradient: 0% in patients with neither cerebral edema nor significant midline shift (n = 59), versus 72.2% in patients with both findings (n = 18). The exploratory interaction term (cerebral edema × midline shift ≥ 5 mm) was directionally consistent with synergy but did not reach statistical significance (OR 39.19, 95% CI 0.26-∞, p = 0.152), reflecting limited statistical power. Preoperative neurological impairment and cerebral edema are independently associated with in-hospital mortality after burr-hole drainage for CSDH. The coexistence of cerebral edema and significant midline shift identifies a clinically recognizable high-risk phenotype that may warrant heightened perioperative attention. Renal and cardiac comorbidities further contribute to mortality risk. These findings are hypothesis-generating and require validation in larger, prospective cohorts before incorporation into clinical risk stratification.Clinical trial number: not applicable.

PMID:42472980 | DOI:10.1007/s10143-026-04405-8

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10458-8. Online ahead of print.

ABSTRACT

OBJECTIVE: It is known that both adenoid hypertrophy (AH) and allergic rhinitis (AR) can cause obstructive sleep apnea (OSA), but their relative importance, especially when tonsil size is considered, remains unclear. This study aimed to compare the independent contributions of AR, AH, and tonsil hypertrophy to OSA severity and to determine the primary contributing factor.

METHOD: A total of 177 children aged 3 to 6 were included in the study. They were divided into four groups based on adenoid size (nasal endoscopic obstruction ≥ 75%) and AR (serum total IgE, inhalant-specific IgE, or clinical diagnosis): Group A (AH alone, n = 39), Group B (mixed factors, n = 63), Group C (AR alone, n = 53), and Group D (control, n = 22). OSA severity was assessed using the apnea-hypopnea index (AHI) measured by polysomnography. Intergroup comparisons were performed using the Kruskal-Wallis test. Spearman’s correlation analysis was used to evaluate the correlation between total IgE and AHI. A multivariate linear regression model was employed to identify independent predictors of ln_AHI.

RESULT: The AHI in Group B was significantly higher than that in Groups A, C, and D (P < 0.05). Total IgE showed a weak but significant positive correlation with AHI (r_s = 0.15, P = 0.042). AR was the strongest independent predictor of ln_AHI (standardized β = 0.258, 95% CI: 0.095-0.311, P < 0.0001), followed by tonsil size, BMI, adenoid size and gender, while age was not statistically significant.

CONCLUSION: Among preschool children, AR is the strongest independent predictor of OSA severity, followed by the size of the adenoid and tonsil. Clinically, for preschool children with OSA, assessing allergic status should be prioritized alongside evaluation of adenotonsillar anatomy, and anti‑allergic therapy should be considered as a key component of OSA management, either as a stand‑alone treatment in mild cases or as an adjunct to adenotonsillectomy in more severe cases.

PMID:42472964 | DOI:10.1007/s00405-026-10458-8

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10442-2. Online ahead of print.

ABSTRACT

INTRODUCTION: In adult cochlear implant users, conventional frequency (CF) mapping is standard practice. Tonotopic fitting (TF) refers to a programming strategy in which the frequency allocation of the speech processor is matched as closely as possible to the natural tonotopic organization of the cochlea. Whether TF mapping improves outcomes over CF remains uncertain.

METHODS: We searched PubMed, Embase, and Cochrane for randomized controlled trials comparing tonotopic versus conventional mapping in adult cochlear implant users. Random-effects meta-analysis was performed using RevMan 5.4. Continuous outcomes were analyzed using standardized mean difference (SMD) with 95% confidence intervals (CIs), and heterogeneity was assessed with I². A two-tailed P-value < 0.05 was considered statistically significant. We created an effect-direction plot for selected outcomes to provide a visual summary of the direction and consistency of effects across studies.

RESULTS: A total of five publications were included, representing four trials (n = 109). There was no significant difference between TF and CF mapping in speech understanding in quiet (SMD = -0.07; 95% CI -0.82, 0.68; P = 0.86; I² = 79%) and in noise (SMD = 0.51; 95% CI -0.44,1.46; P = 0.30; I² = 93%). The sensitivity analysis for speech understanding in noise favored TF. Also music perception favored TF on the effect direction plot, while sound quality showed variable outcomes.

CONCLUSION: TF mapping may have potential benefits over CF mapping for speech understanding in noise and music perception. Larger randomized trials are needed to establish the clinical significance of TF mapping.

PMID:42472950 | DOI:10.1007/s00405-026-10442-2

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10396-5. Online ahead of print.

ABSTRACT

PURPOSE: This systematic review and meta-analysis aim to evaluate the efficacy and safety of Ciprofloxacin compared to alternative treatments for managing PTTO.

METHODS: A comprehensive search was carried out in PubMed, MEDLINE, Springer, and Embase. Randomized controlled trials and interventional studies were included if they assessed Ciprofloxacin in children (0-18 years) with PTTO following tympanostomy tube insertion. The primary outcomes analyzed were clinical resolution of otorrhea, time to resolution, recurrence rates, and adverse effects. For the meta-analysis, only studies comparing Ciprofloxacin to placebo were included to minimize heterogeneity, and outcomes were analyzed using a random effects model with risk ratios and 95% confidence intervals via RevMan 5.4 software.

RESULTS: Out of 704 identified records, four randomized controlled trials met the inclusion criteria, comprising a total of 1,025 pediatric patients aged 6 months to 14 years. These studies evaluated Ciprofloxacin, either as topical drops or sustained-release intratympanic injections, against a placebo for the prevention or treatment of PTTO. All studies reported that Ciprofloxacin significantly reduced the incidence of otorrhea compared to placebo, with relative risk reductions ranging from approximately 46% to 66%. The pooled meta-analysis of 892 participants demonstrated a statistically significant reduction in otorrhea with Ciprofloxacin treatment (risk ratio 0.53; 95% confidence interval 0.35 to 0.79; p = 0.002), with no observed heterogeneity (I² = 0%).

CONCLUSION: This systematic review and meta-analysis demonstrated that ciprofloxacin, whether administered as topical drops or sustained-release formulations, reduces post-tympanostomy tube otorrhea in children without significant safety concerns.

PMID:42472949 | DOI:10.1007/s00405-026-10396-5

Eur Arch Otorhinolaryngol. 2026 Jul 19. doi: 10.1007/s00405-026-10447-x. Online ahead of print.

ABSTRACT

PURPOSE: Presence of toxic heavy metals such as lead (Pb) and chromium (Cr) and also low or high levels of essential heavy metals such as zinc (Zn) and copper (Cu) have detrimental health effects. However, malignant salivary gland tumours (MSGTs) have not been considered in this context. The etiopathogenesis of MSGTs and toxicity of heavy metals involve common mechanisms such as oxidative damage and chronic inflammation. The aim of this study was to investigate the possible relationship between MSGTs and heavy metals.

METHODS: A total of 60 participants (30 patients with MSGTs and 30 matched healthy controls) were investigated. Data including both serum and saliva heavy metal levels of patients and healthy controls were statistically compared. Standard solutions of the elements to be analysed (Fe, Zn, Cu, Mn, Cr, Pb) were prepared using increasing concentrations of 2% nitric acid solution. An inductively coupled plasma mass spectrometer was used for analysis.

RESULTS: In both serum and saliva, Fe levels were not different between patients and controls (p > 0.05), but significantly lower Zn (p < 0.001) and Cu (p ≤ 0.011) and higher Pb (p < 0.001) levels were found in patients compared to controls. Also, in saliva, significantly higher Mn (p < 0.001) and Cr (p < 0.001) levels were found in the patients compared to the controls.

CONCLUSIONS: This study revealed that patients with MSGTs are associated with lower levels of Zn and Cu, but higher levels of Pb in both serum and saliva. Furthermore, these cancers are associated with higher levels of Mn and Cr in saliva.

PMID:42472942 | DOI:10.1007/s00405-026-10447-x