Nevin Manimala

Chin J Integr Med. 2026 Jan 5. doi: 10.1007/s11655-025-3932-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effect and safety of Andrographolide Sulfonate (AS) Injection for adjunctive treatment of non-severe community-acquired pneumonia (CAP) in adults.

METHODS: This is a multicenter, randomized, double-blind, and placebo-controlled trial. Adult patients with non-severe CAP were randomly assigned in a 1:1 ratio to the AS or control group using a stratified block randomization method. Patients received either intravenous AS Injection (500 mg once per day) or placebo for 5 d. Both groups were treated with guideline-based standard therapy simultaneously. The primary outcome was time to clinical stability. Secondary outcomes were initial treatment failure rate, time to fever recovery, length of hospital stay, duration of intravenous antibiotic treatment, and cost of hospitalization. Safety outcomes included adverse events (AEs) and serious AEs.

RESULTS: From September 2016 to April 2019, 482 patients were randomized into AS or control group (241 cases per group), and all were included in the intention-to-treat (ITT) analysis. The median time to clinical stability was 1 h shorter in the AS group than that in the control group [hazard ratio (HR) 1.440; 95% confidence interval (CI) 1.194, 1.736; log rank P<0.01]. AS group had 5 h shorter median time to fever recovery than the control group (HR 1.461; 95% CI 1.150, 1.857; log rank P<0.01). The initial treatment failure rate was significantly lower in the AS group than that in the control group (6.3% vs. 16.0%, P<0.01). There was no statistically significant difference in the length of hospital stay, duration of intravenous antibiotics treatment, and cost of hospitalization between groups (P>0.05). The proportion of patients with at least 1 AE was 41.5% in the AS group and 40.6% in the control group.

CONCLUSIONS: Adjunctive AS Injection probably accelerates the clinical stability and lowers the initial treatment failure rate in adult hospitalized patients with non-severe CAP, but the absolute clinical benefits are marginal. Its use should take into account efficacy, safety, cost, and Chinese medicine syndrome classification. (Trial registration No. NCT02913118).

PMID:41489779 | DOI:10.1007/s11655-025-3932-8

Mol Cell Biochem. 2026 Jan 5. doi: 10.1007/s11010-025-05426-5. Online ahead of print.

NO ABSTRACT

PMID:41489769 | DOI:10.1007/s11010-025-05426-5

Surg Endosc. 2026 Jan 5. doi: 10.1007/s00464-025-12433-6. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the clinical outcomes of pancreaticoduodenectomy combined with longitudinal pancreatojejunostomy (PD-L) for chronic pancreatitis with a suspicious pancreatic head mass. We evaluated these derived surgical procedures with a focus on pain relief, functional preservation, and oncologic vigilance.

METHODS: This retrospective single-center cohort study analyzed clinical data from 20 consecutive patients diagnosed with chronic pancreatitis who underwent PD-L at the Hepatobiliary Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University between December 2021 and December 2024. We systematically analyzed perioperative parameters, morbidity profiles, and histopathological characteristics. Post-discharge monitoring focused on quantitative pain assessment, pancreatic exocrine and endocrine functional status, and surveillance.

RESULTS: The patients’ cohort comprised 20 male patients (mean age 52.3 ± 10.1 years, range 32-70) who underwent PD-L procedures: open (n = 15), laparoscopic (n = 3), and robotic-assisted (n = 2) approaches. The mean operative time was (387.7 ± 75.1) minutes, with an average intraoperative blood loss of (286 ± 141.0) mL. The mean total length of hospital stay was (18.9 ± 4.6) days. Postoperative complications occurred in 2 patients: one case of abdominal hemorrhage requiring angiographic embolization and one case of delayed gastric emptying managed through endoscopic drainage. Notably, no pancreatic fistula were observed in any case. Pathology revealed chronic pancreatitis in 9 patients, PanIN in 9 (6 PanIN-1, 3 PanIN-2), and pancreatic cancer in 2. Preoperative comparisons between the CP group (n = 9) and the PanIN/malignant group (n = 11) showed no significant differences. Although considerable differences in the smoking index were observed between the two groups, they did not reach statistical significance (p = 0.081). During a median follow-up of 14.5 months, 78.9% (15/19) achieved sustained pain relief without the need for analgesics. Improvements in BMI and enhancements in glycemic regulation were observed in 6 and 5 patients, respectively.

CONCLUSION: PD-L is a safe and effective surgical option for selected CP patients those with a space-occupying lesion in the pancreatic head that may raise suspicion of malignancy, concurrent with calculi-associated dilatation of the main pancreatic duct in the distal pancreatic body and tail segments.

PMID:41489749 | DOI:10.1007/s00464-025-12433-6

Clin J Sport Med. 2026 Jan 5. doi: 10.1097/JSM.0000000000001401. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this cross-sectional study was to evaluate associations among injury, quality of life (QOL), and mental health among elite youth soccer athletes.

DESIGN: Study materials were sent to Elite Clubs National League (ECNL) clubs through an online survey link.

SETTING: Soccer athletes were invited to participate in May and June of 2024 by their respective clubs.

PARTICIPANTS: Six hundred sixty-eight ECNL soccer athletes (ages 13-19 years) completed the study.

ASSESSMENT OF RISK FACTORS: Injury history and risk factors were assessed using a demographic survey.

MAIN OUTCOME MEASURES: Outcomes including QOL (Pediatric Quality of Life Inventory), anxiety (General Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) were compared between athletes by injury status (uninjured, recovered, injured) using Tukey-adjusted pairwise comparisons of estimated marginal means.

RESULTS: Two hundred ninety-five (44.2%) respondents reported an injury in the prior 6 months, of whom 224 (33.5%) had recovered, and 71 (10.6%) were currently injured. Uninjured athletes reported significantly lower symptoms of anxiety (5.0, 95% CI [4.5-5.5]) than currently injured (6.6 [5.5-7.7], P = 0.008) and recovered athletes (6.0 [5.3-6.6], P < 0.001). Currently injured athletes reported higher levels of depression (6.9 [5.8-8.1]) than recovered (5.2 [4.5-5.8], P = 0.01) and uninjured athletes (4.6 [4.0-5.1], P < 0.001), while the difference between recovered and uninjured athletes was not statistically significant (P = 0.19). Uninjured athletes also demonstrated significantly higher total QOL (81 [80-82]) than recovered (79 [77-80], P = 0.021) and currently injured (73 [70-76], P < 0.001) athletes.

CONCLUSIONS: Injured youth soccer athletes report worse mental health and QOL than uninjured athletes, even after return to play. Stakeholders in youth sports should consider that negative psychosocial impacts of injury may persist beyond physical impacts.

PMID:41489726 | DOI:10.1097/JSM.0000000000001401

Curr Obes Rep. 2026 Jan 5;15(1):3. doi: 10.1007/s13679-025-00679-z.

ABSTRACT

PURPOSE OF REVIEW: We aimed to summarise recent evidence on age- and sex-specific reference curves for metabolic syndrome (MetS) indicators in paediatric populations.

RECENT FINDINGS: There is a lack of consensus regarding diagnostic thresholds for MetS in children and adolescents, leading to challenges in its early identification and intervention. A systematic search was performed in PubMed/Medline, Web of Science and Scopus, covering the period between January 2018 and February 2025. Three researchers evaluated 8,529 studies according to the inclusion criteria. Finally, 46 articles that reported reference values for at least one metabolic indicator: waist circumference, fasting glucose, glycated haemoglobin, homeostatic model assessment for insulin resistance, high-density lipoprotein cholesterol, triglycerides, systolic or diastolic blood pressure, in children aged 0 to 18 years were included in the review and data synthesis. The age-specific trends in each MetS indicator were assessed by calculating the median reference curves along with the lower and upper percentile bounds. Overall, there has been a substantial heterogeneity in the reported reference values for waist circumference and glucose metabolism biomarkers. Comparatively smaller variations were observed for blood pressure and lipid parameters. Limited data were available for young age groups (0-4 years) and there have been substantial differences in study methodologies including study design, assays and statistical approaches used to derive reference curves. This systematic review highlighted the substantial inconsistencies in the reported reference curves for MetS indicators in children and adolescents. There is a pressing need for deriving harmonized reference curves for paediatric MetS from diverse populations.

PMID:41489719 | DOI:10.1007/s13679-025-00679-z

Res Health Serv Reg. 2026 Jan 5;5(1):1. doi: 10.1007/s43999-025-00084-y.

ABSTRACT

PURPOSE: The purpose of this study is to analyse geographic variation in rates of patients and service utilisation for persons with substance use disorders (SUD) across Norwegian hospital catchment areas from 2017 to 2021, considering both outpatient and Inpatient care across substance use diagnosis.

METHOD AND MATERIAL: This registry-based study used data from the Norwegian Patient Registry and Statistics Norway, covering 58,889 unique patients and 121,495 patient-years. Adjusted for age and sex this material yields a national SUD treatment rate of 14.0 per 1,000 over five years, on average 5.8 per year with a declining annual rate from 6.1-5.5. Analyses included diagnoses related to alcohol, opioids, cannabis, and other substances, excluding tobacco and opioid maintenance treatment. Three variation measures-Extreme Quotient (EQ), Coefficient of Variation (CV), and Systematic Component of Variation (SCV)-were used to assess disparities.

RESULTS: Geographic variation in SUD treatment rates ranged from 3.6 to 11.5 per 1,000 inhabitants reaching a threefold difference between areas (EQ = 3.1). We found that SCV values (8.7-23.5) and SCV _5-95 (5.7-14.5) for diagnose groups and service type consistently exceeded the threshold of high and extremely high variation. Procurement of private services increased capacity significantly but did not markedly reduce variation. Variation remained extremely high even when the highest and lowest rates were excluded (SCV 13.8, SCV_5-95 11.3).

CONCLUSION: Patient rates in SUD treatment fell every year between 2017-2021 and the geographic variation was high to extremely high. Treatment of substance use disorders in Norway may require stronger regional governance to reduce unwarranted variation and ensure equitable access to treatment. Substantial reductions in variation can be achieved by i) redistributing capacity among catchment areas, ii) purchasing fewer and shorter Inpatient stays and iii) increasing outpatient treatment. In addition, such means could dramatically increase patient rates. There is a need for more consistent clinical practices and adjusted capacity for treating specific substance diagnoses.

PMID:41489708 | DOI:10.1007/s43999-025-00084-y

Bull Math Biol. 2026 Jan 5;88(2):14. doi: 10.1007/s11538-025-01581-4.

ABSTRACT

Gene expression is inherently stochastic, and transcription initiation is a key source of variability across cells. While classical promoter models often assume linear state transitions, emerging evidence suggests more flexible promoter architectures. Here we introduce a generalized cyclic promoter model and compare it with the standard linear model using exact analytical solutions for initiation-time and nascent RNA distributions. Our results reveal that linear promoters produce only monotonic initiation-time statistics and a limited set of RNA expression patterns, whereas cyclic promoters generate non-monotonic initiation-time distributions and richer RNA profiles, including multimodal cases not achievable with linear architectures. We further show that cyclic promoters consistently buffer variability in initiation timing and RNA output, providing tighter control over transcriptional noise. Within the cyclic model, the number of exit pathways serves as a tunable parameter that shifts distributions from bimodal to unimodal and reduces noise, offering a potential mechanism for balancing robustness with flexibility in gene regulation. This framework highlights promoter topology as a critical determinant of transcriptional heterogeneity, bridges initiation dynamics with RNA-level variability, and generates testable predictions that can guide single-cell experiments probing promoter structure.

PMID:41489699 | DOI:10.1007/s11538-025-01581-4

Pediatr Surg Int. 2026 Jan 5;42(1):61. doi: 10.1007/s00383-025-06290-6.

ABSTRACT

PURPOSE: The aim of this study was to compare the clinical efficacy, diagnostic concordance, and recurrence rates of open high ligation versus laparoscopic percutaneous internal ring suturing (PIRS) in adolescent inguinal hernia repair.

METHODS: A retrospective review was conducted of 87 adolescent patients who underwent inguinal hernia repair via open high ligation (n = 44) or laparoscopic PIRS (n = 43) between 2012 and 2024 at a single tertiary care center. Demographic data, postoperative complications, recurrence, diagnostic concordance (kappa), and follow-up duration were analyzed.

RESULTS: The median age in both groups was 12 years (range 10-17). Intraoperative diagnostic laparoscopy was performed in 44 patients in the open surgery group to evaluate the contralateral inguinal region, and contralateral hernia was detected and repaired simultaneously in one patient. Diagnostic concordance was perfect in the open group (κ = 0.945) and near-perfect in the PIRS group (κ = 0.885), both statistically significant (p < 0.001). No recurrences were observed in the open group, whereas recurrence occurred in one patient in the laparoscopic group (p = 0.99). The mean follow-up duration was 103.8 months (range 11-150) and 31.7 months (range 4-137) in the open and laparoscopic group, respectively.

CONCLUSION: Laparoscopic PIRS repair in adolescents demonstrated outcomes comparable to open high ligation in terms of recurrence and complication rates.

PMID:41489688 | DOI:10.1007/s00383-025-06290-6

Eur J Pediatr. 2026 Jan 5;185(1):53. doi: 10.1007/s00431-025-06675-8.

ABSTRACT

Acute kidney injury (AKI) in preterm neonates is a serious pathology linked to the neonatal mortality rate. Since there is no comprehensive systematic review and meta-analysis in this regard, this study aimed to investigate the global prevalence of AKI in preterm neonates. A comprehensive literature search was conducted using MeSH-based keywords across multiple databases (by August 22, 2025). Eligibility criteria were considered via the PRISMA guideline, and quality assessment was applied using the STROBE checklist. Following data extraction, meta-analysis was applied using CMA (v.3) software. Heterogeneity was assessed using the I² test, publication bias was evaluated via the Egger test and funnel plots, and subgrouping and sensitivity analyses were considered to ensure result robustness. Data were presented as 95% CI, and p < 0.05 was considered a significant level. Following the assessment of 1032 records, 26 eligible investigations with a total number of 1,328,711 preterm neonates admitted to NICU were selected. 21,568 cases were diagnosed with AKI; thus, the global prevalence of AKI in preterm neonates admitted to NICU was 17.8% (95% CI: 8.6%-33.2%, I² = 99.8%, p < 0.001). Subgroup analyses demonstrated regional variations in prevalence, including 18.3% in Africa, 18.5% in America, 15.2% in Asia, and 20.1% in Europe. Meta-regression found no significant temporal trend in AKI prevalence over the study years.

CONCLUSION: According to the findings, it is essential to monitor the renal health status in preterm infants admitted to the NICU. Failure to undergo preterm screening can lead to long-term kidney issues in adulthood.

WHAT IS KNOWN: • AKI is a major complication among preterm neonates and contributes to neonatal morbidity and mortality. • Diagnosis of AKI in neonates is challenging due to varying definitions and inconsistent use of biomarkers.

WHAT IS NEW: • This study included over 1.3 million preterm neonates, establishing a pooled AKI prevalence of 17.8%. • Africa (15.2%) and Europe (20.1%) comprise the lowest and the highest rates of AKI, respectively.

PMID:41489685 | DOI:10.1007/s00431-025-06675-8

Odontology. 2026 Jan 5. doi: 10.1007/s10266-025-01293-0. Online ahead of print.

ABSTRACT

This study investigated the effects of air abrasion with different abrasive particles on the surface roughness and bond strength of resin-based luting agents to enamel and dentin, including dentin surfaces treated with immediate dentin sealing (IDS). Bovine teeth were used, and four types of substrates were prepared: enamel, untreated dentin, dentin treated with IDS using an adhesive, and dentin treated with IDS using a resin composite. Air abrasion was performed using aluminum oxide (29 µm, 53 µm) or bioactive glass at 0.3 MPa for 10 s from a 10-mm distance prior to the bonding procedure. Acid-etched enamel specimens were included for comparison. A 2.4 mm cylindrical mold was set on the surface and filled with resin-based luting agents, followed by light curing. Surface roughness (Ra) after the surface pretreatments, and the shear bond strength were evaluated. The number of repetitions was set to 15. Statistical analyses were conducted using one-way ANOVA and Tukey’s post hoc test (α = 0.05). Acid etching produced the highest bond strength on enamel, although air abrasion with 29-µm alumina resulted in comparable values. In contrast, air abrasion increased surface roughness but did not enhance bond strength on either untreated dentin or IDS-treated dentin, regardless of whether an adhesive or resin composite was used. These findings suggest that while 29-µm alumina abrasion is a viable alternative to acid etching on enamel when acid use is contraindicated, its effectiveness appears to be substrate-dependent and may not facilitate improved bonding to dentin or IDS-treated dentin despite increased roughness.

PMID:41489675 | DOI:10.1007/s10266-025-01293-0