Nevin Manimala

Phys Rev Lett. 2026 Mar 6;136(9):091201. doi: 10.1103/fp1v-xrr5.

ABSTRACT

The amplification of magnetic fields is crucial for understanding the observed magnetization of stars and galaxies. Turbulent dynamo is the primary mechanism responsible for that but the understanding of its action in a collapsing environment is still rudimentary and relies on limited numerical experiments. We develop an analytical framework and perform numerical simulations to investigate the behavior of small-scale and large-scale dynamos in a collapsing turbulent cloud. This approach is also applicable to expanding environments and facilitates the application of standard dynamo theory to evolving systems. Using a supercomoving formulation of the magnetohydrodynamic equations, we demonstrate that dynamo action in a collapsing background leads to a superexponential growth of magnetic fields in time, significantly faster than the exponential growth seen in stationary turbulence. The enhancement is mainly due to the increasing eddy turnover rate during the collapse, which boosts the instantaneous growth rate of the dynamo. We also show that the scaling of final saturated magnetic field strength with density robustly exceeds the expectation from considerations of pure flux-freezing. Apart from establishing a formal framework for studying magnetic field evolution in collapsing (or expanding) turbulent plasmas, these findings suggest that during star and galaxy formation magnetic fields can become dynamically relevant much earlier than previously thought.

PMID:41861294 | DOI:10.1103/fp1v-xrr5

JCO Oncol Pract. 2026 Mar 20:OP2501121. doi: 10.1200/OP-25-01121. Online ahead of print.

ABSTRACT

PURPOSE: Patients overestimate their likelihood of benefit from early phase clinical trials (EPCT). Concerns about taking away hope from patients represent a purported barrier to prognostic discussions. In this study, we aimed to assess prognostic perceptions and hope among patients with advanced cancer at the time of enrollment in an EPCT.

METHODS: We enrolled patients at the time of EPCT enrollment at an academic medical center. Participants completed questionnaires assessing prognostic perceptions (Prognosis and Treatment Perceptions Questionnaire), hope (Herth Hope Index; range, 12-48, higher scores indicate higher hope), and symptoms (Edmonton Symptom Assessment System-Revised). We used descriptive statistics and regression models to explore associations of prognostic perceptions and hope.

RESULTS: Among 189 study participants (mean age = 62.5 years, 56.6% female, 93.1% White), 27.4% reported that the goal of their cancer treatment was to cure their cancer and 62.2% reported having conversations with their oncologist about prognosis. The majority (92.4%) reported that knowing about prognosis was extremely/very helpful. Patients’ mean hope score was 39.1 (standard deviation, 5.1). We found no association between hope and perceptions of the intent of cancer therapy (B = -0.59, P = .486) or hope and patient-reported frequency of conversations with their oncologist about prognosis (B = -1.25, P = .125).

CONCLUSION: At the time of enrollment in an EPCT, we found no association between patients’ hope and perception of the intent of cancer therapy or report of having discussed their prognosis with their oncologist. These findings suggest that patients can have hope despite acknowledging the noncurative intent of their therapy and prognostic discussions.

PMID:41861273 | DOI:10.1200/OP-25-01121

Medicine (Baltimore). 2026 Mar 20;105(12):e48005. doi: 10.1097/MD.0000000000048005.

ABSTRACT

This study aims to investigate the mediating role of the systemic immune-inflammation index (SII) in the relationship between obesity-related glycolipid indices and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in women with polycystic ovary syndrome (PCOS). A total of 598 women diagnosed with PCOS according to the Rotterdam criteria and undergoing their first IVF/ICSI cycle at the Reproduction Medicine Center, Taizhou People’s Hospital Affiliated with Nanjing Medical University, Jiangsu, China between January 2021 and December 2023 were included. Key exposures included obesity-related metabolic indices (e.g., triglyceride to high-density lipoprotein ratio [TG/HDL], homeostasis model assessment of insulin resistance [HOMA-IR]) and the SII. The primary outcome was the live birth rate per initiated cycle. Associations were evaluated using multivariate generalized linear models, and causal mediation analysis was performed to quantify the proportion of the effect mediated by the SII. Higher TG/HDL, total cholesterol to HDL ratio (TC/HDL), low-density lipoprotein to HDL ratio (LDL/HDL), and HOMA-IR levels showed dose-dependent negative correlations with oocyte yield, fertilization rate, embryo quality, and live birth rate (all P < .05). An elevated SII was an independent predictor of a reduced live birth rate (β = -0.08, P = .008) and mediated 8.8% to 10.7% of the adverse effects of dyslipidemia (via TC/HDL and LDL/HDL) on live birth. This study shows that the SII is statistically linked to and potentially mediates the connection between metabolic dysfunction and poor IVF/ICSI outcomes in PCOS. Integrated strategies targeting both metabolism and inflammation may optimize fertility success in this population.

PMID:41861236 | DOI:10.1097/MD.0000000000048005

Medicine (Baltimore). 2026 Mar 20;105(12):e47960. doi: 10.1097/MD.0000000000047960.

ABSTRACT

There are three types of diabetes-related stigma (DRS): perceived, experienced, and internalized, all of which negatively impact individuals with diabetes. Over the past 2 decades, research in Japan has grown, highlighting the significant clinical effects of DRS. In this study, we focused on the least-studied form, experienced stigma investigating its prevalence, clinical correlates, and the awareness of DRS and advocacy activities among Japanese people with diabetes. We conducted a single-center, cross-sectional study from April 3 to 28, 2023, at the Ohta Nishinouchi Hospital Diabetes Center in Japan, involving 114 adults with type 1 or type 2 diabetes. Participants with severe mental or physical conditions were excluded. Each participant completed a questionnaire assessing experienced stigma, the impact of diabetes on their social life, and their familiarity with the terms “diabetes stigma” and “advocacy activities.” Associations between reported stigma and demographic or clinical factors were analyzed statistically. Our findings showed that only 19.3% of participants reported a significant impact of DRS on their social life, with younger individuals and those on multiple diabetes medications more likely to report experiencing stigma. Additionally, awareness of “diabetes stigma” and “advocacy activities” was notably low among participants. In conclusion, compared to international studies, the prevalence of experienced stigma among Japanese individuals with diabetes appears lower, based on this single-center face-to-face study of outpatients. However, age and polypharmacy were identified as significant factors associated with increased reports of stigma. Despite the limitations of a single-center design, small sample size, and use of non-validated survey tools, the observed low awareness of “diabetes stigma” and “advocacy activities” underscored the need for enhanced educational initiatives by healthcare professionals and diabetes-related organizations in Japan.

PMID:41861231 | DOI:10.1097/MD.0000000000047960

Medicine (Baltimore). 2026 Mar 20;105(12):e47899. doi: 10.1097/MD.0000000000047899.

ABSTRACT

The value of applying enhanced recovery after surgery (ERAS) pathways in the perioperative management of lung cancer requires further high-level evidence. This study aimed to evaluate the impact of the ERAS nursing pathway on the recovery and prognosis of patients undergoing radical surgery for lung cancer. A retrospective cohort study design was adopted, including patients who underwent radical lung cancer surgery between January 2022 and January 2024. Based on the nursing model, patients were divided into an ERAS group (n = 121) and a conventional care control group (n = 170). Propensity score matching was used to control for confounding factors, resulting in 104 well-matched patients (52 in each group) for analysis. The ERAS group received multidisciplinary, standardized perioperative interventions. Hospital stay, recovery indicators, complications, quality of life (QoL), and patient experience were compared between the 2 groups. After matching, the postoperative hospital stay and total hospital stay in the ERAS group were significantly shorter than those in the control group (median: 5.0 days vs 8.0 days, P < .001; 9.0 days vs 13.0 days, P < .001). The ERAS group showed significantly earlier times to first ambulation, flatus, oral intake, and chest tube removal (all P < .001). Furthermore, the ERAS group had significantly lower overall complication rates (15.4% vs 36.5%, P = .012) and pulmonary complication rates (9.6% vs 25.0%, P = .035). Additionally, the ERAS group exhibited significantly lower postoperative pain scores, lower incidence of nausea and vomiting, while patient satisfaction and early postoperative QoL scores were significantly higher (all P < .05). Subgroup and sensitivity analyses yielded consistent results, confirming the robustness of the conclusions. For lung cancer patients undergoing radical surgery, implementing the ERAS nursing pathway can safely and effectively accelerate postoperative recovery, significantly shorten hospital stay, reduce the risk of complications, and improve patients’ symptom experience and QoL, demonstrating significant clinical value for widespread promotion.

PMID:41861229 | DOI:10.1097/MD.0000000000047899

Medicine (Baltimore). 2026 Mar 20;105(12):e47988. doi: 10.1097/MD.0000000000047988.

ABSTRACT

The role of endothelial injury in worsening congestive heart failure (CHF) remains unquantified. This study evaluates the Endothelial Activation and Stress Index (EASIX) for predicting short-term mortality in patients with critical CHF. This was a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (2008-2022). Adults with CHF admitted to the intensive care unit were stratified by ln(EASIX) quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable Cox regression, restricted cubic splines, and subgroup analyses were performed. Among 4556 patients (median age 72.1 years, 42.8% female), the highest EASIX quartile (Q4) had a 44.2% 30-day mortality rate versus 19.2% in Q1 (adjusted hazard ratio [HR] = 1.6, 95% confidence interval [CI]: 1.27-2.02, P < .001). A nonlinear association was observed (nonlinearity P = .008) with an inflection point at ln(EASIX) = 0.05. Beyond this threshold, each unit increase in ln(EASIX) conferred a 14.2% higher mortality risk (HR = 1.142, 95% CI: 1.062-1.227). Ln(EASIX) remained predictive after full adjustment for severity scores and treatments, with the highest quartile (Q4) exhibiting a 60% increased mortality risk (adjusted HR = 1.60, 95% CI: 1.27-2.02). EASIX is a robust predictor of short-term mortality in patients with critical CHF, particularly valuable in nonsepsis populations. Its simple calculation (lactate dehydrogenase/creatinine/platelets) that refines risk stratification beyond conventional severity scores.

PMID:41861227 | DOI:10.1097/MD.0000000000047988

Medicine (Baltimore). 2026 Mar 20;105(12):e47945. doi: 10.1097/MD.0000000000047945.

ABSTRACT

This study aims to investigate the positional relationship between the pars interarticularis and the pedicle in lumbar spinal stenosis patients and clarify its guiding significance for individualized decompression strategies in unilateral biportal endoscopy (UBE). All patients received standardized UBE. DLM, laminar abduction angle [LAA], laminar width (LW), and facet joint angle (FJA) differed significantly among groups (all P < .001), with smaller DLM associated with narrower LW, smaller LAA, and higher FJA sagittalization. The small DLM group had lower inferior articular process reservation (24.84 ± 16.71%) and higher grade 2 to 3 destruction (75.0%, P < .001), accompanied by worse postoperative back visual analogue scale (VAS), Oswestry Disability Index, longer hospital stay, and greater drainage volume (all P < .05). No significant differences were found in dural sac area improvement or leg VAS among groups (all P > .05). DLM is closely associated with UBE clinical outcomes and an important anatomical reference. Smaller DLM may increase intraoperative facet joint injury risk, potentially due to compact spinal anatomy, which may worsen postoperative recovery. Preoperative DLM evaluation may help identify high-risk patients and guide individualized strategies, balancing decompression efficacy and spinal stability. A retrospective cohort study included patients with L3-S1 lumbar spinal stenosis who underwent UBE decompression between January 2020 and December 2024. Inclusion criteria: confirmed imaging diagnosis, typical symptoms consistent with imaging, ineffective conservative treatment for ≥3 months, limited surgical segments, complete clinical/imaging data, follow-up ≥3 months. Exclusion criteria: lumbar spondylolisthesis (Meyerding grade ≥ II), prior same-segment spinal surgery, pathological stenosis, severe systemic/mental illnesses, blurred imaging data. Patients were grouped by the distance from the lateral margin of pars interarticularis to medial margin of pedicle (DLM). Evaluated indicators: preoperative imaging parameters (LAA, LW, FJA), surgical indicators, clinical outcomes (preoperative/postoperative VAS, preoperative/3-month postoperative Oswestry Disability Index, 3-month postoperative Macnab score), and postoperative imaging parameters (inferior articular process reserved amount, destruction grade, dural sac area). Statistical analyses used SPSS 26.0: ANOVA/Kruskal-Wallis H test, χ2 test/Fisher’s exact test, Spearman correlation, Jonckheere-Terpstra test, and ICC for consistency; P < .05 was significant.

PMID:41861225 | DOI:10.1097/MD.0000000000047945

Medicine (Baltimore). 2026 Mar 20;105(12):e47572. doi: 10.1097/MD.0000000000047572.

ABSTRACT

This study aims to evaluate the survival rate and short-term clinical outcomes of hybrid unicompartmental knee arthroplasty (UKA). We retrospectively analyzed 155 Oxford phase-3 hybrid UKAs in 155 patients who were followed for more than 3 years. Kaplan-Meier survival curves were generated using revision as an endpoint. Oxford knee score (OKS) and range of motion (ROM) were evaluated for clinical assessment, and radiographs were used to assess implant-related complications. At an average follow-up of 3.6 years (range, 3-6 years), 2 knees required revision. The reasons for revision were bearing dislocation and unexplained pain. The overall survival rate was 98.7% at the 6-year follow-up. The mean OKS decreased from 40.94 ± 4.86 to 14.84 ± 1.39 at the last follow-up (P < .001). The mean OKS showed a significant improvement during the first 2 years. The mean ROM improved from 104.81 ± 10.03° to 114.93 ± 7.51° at the last follow-up (P < .001). The mean ROM increased during the first 3 years. Radiolucent lines were observed in 6 cases at 6 years postoperatively, affecting 4 knees. At 6 years postoperatively, the following complication rates were observed: overall revision rate: 1.33% (2/150); deep vein thrombosis rate: 3.33% (5/150); chronic soft tissue pain rate: 1.33% (2/150); stiffness rate: 0.67% (1/150); prosthesis dislocation rate: 0.67% (1/150); lateral meniscus injury rate: 0.67% (1/150); lateral arthritis progression rate: 2.67% (4/150). Oxford phase-3 hybrid UKA provides good survival rates and clinical outcomes in the short-term follow-up.

PMID:41861224 | DOI:10.1097/MD.0000000000047572

J Am Acad Orthop Surg. 2026 Apr 1;34(7):e970-e984. doi: 10.5435/JAAOS-D-25-00057. Epub 2025 Sep 8.

ABSTRACT

INTRODUCTION: Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based on their sex and region.

METHODS: Faculty lists from the 45 Pediatric Orthopaedic Society of North America fellowship programs were accessed in February 2024. Data on sex, training history, fellowship director status, institution, publication counts, and H-indices were collected from program websites and Scopus. The attending publication rate was calculated by dividing the total number of publications completed as an attending by the number of years in practice. Results were displayed using (mean ± SD). Categorical variables were analyzed using Pearson chi square. Mann-Whitney U and one-way analysis of variance were used for nonparametric and parametric data, respectively. Analyses were done using GraphPad Prism 10, with significance set at P < 0.05.

RESULTS: Four hundred one pediatric orthopaedic surgeons (302 male, 99 female) from 45 fellowship programs were analyzed. Female surgeons had fewer publications, lower H-indices, and lower publication rates than male surgeons. In the Northeast, male attendings had higher publication counts, rates, and H-indices. Men also had higher H-indices than women in the Midwest and Southwest. Among male pediatric orthopaedic attendings, those in the Northeast exhibited the highest publication counts, rates, and H-indices. However, no regional differences were observed among female pediatric orthopaedic surgeons.

CONCLUSION: Notable gender disparities persist among pediatric orthopaedic surgeons in the United States, reflecting systemic barriers that limit women’s research opportunities. Male faculty outnumber female faculty across fellowship programs and have higher publication counts, rates, and H-indices. Regional differences were most notable in the Northeast, where male attendings had markedly higher publication counts, rates, and H-indices. H-index disparities were also present in the Midwest and Southwest. Targeted strategies are needed to improve research access and support for women trainees and faculty.

PMID:41860572 | DOI:10.5435/JAAOS-D-25-00057

JAMA Netw Open. 2026 Mar 2;9(3):e262645. doi: 10.1001/jamanetworkopen.2026.2645.

ABSTRACT

IMPORTANCE: Health care systems can help protect patients from the increasing threat of extreme heat-driven morbidity and mortality. Electronic health records (EHRs) provide insight into trends and local variation in thresholds above which extreme heat is associated with emergency department (ED) use among at-risk patient populations.

OBJECTIVE: To examine associations between extreme heat exposure and all-cause ED visits among patients aged 65 years and older.

DESIGN, SETTING, AND PARTICIPANTS: This matched case-control study of patients seeking emergency care at an urban health care system during the summer (May 1 to September 30) from 2022 to 2024. Two New York City (NYC) EDs were included: (1) ED-1, predominantly serving Medicaid-enrolled patients from minoritized racial and ethnic groups, and (2) ED-2, predominantly serving White, privately insured patients. Included patients were aged 65 years or older and presented to ED-1 and ED-2 during the study period. Data were analyzed from April to August 2025.

EXPOSURES: Daily maximum heat index (HImax) values during the summer were calculated from the National Centers for Environmental Information monitor-derived recordings.

MAIN OUTCOMES AND MEASURES: Daily all-cause ED use counts were derived from EHRs, and extreme heat exposure-outcome curves were calculated. Daily HImax anomalies were calculated based on a 30-year baseline average. The cumulative odds ratio (OR) and 95% CIs were calculated.

RESULTS: This study included 55 200 ED encounters and represented 15 092 unique patients at ED-1 and 19 559 at ED-2 with a mean (SD) age of 74.9 (8.92) years at ED-1 and 74.9 (8.72) years at ED-2. Compared with ED-2, more ED-1 patients were female (8589 [56.9%] vs 10 767 [55.0%]), Hispanic (3544 [23.5%] vs 2576 [13.2%]), and Medicaid-enrolled (1321 [8.8%] vs 824 [4.2%]). At ED-1, daily HImax associations increased after 66 °F (OR, 1.10 [95% CI, 1.01-1.21]), peaking at 101 °F (OR, 1.24 [95% CI, 1.11-1.39]), and were higher on days with HImax anomalies between 15 °F (OR, 1.07 [95% CI, 1.01-1.13]) and 18 °F (OR, 1.10 [95% CI, 1.01-1.20]) warmer than average. At ED-2, daily HImax ED use associations were not significant and were significantly negative for days with HImax anomalies above 16 °F, nadiring at 21 °F (0.84, 95% CI [0.73, 0.95]) warmer than average.

CONCLUSIONS AND RELEVANCE: In this case-control study of the association between heat exposure and ED use in adults aged 65 years and older, positive associations were only observed at ED-1, which served a predominantly lower-income population from minoritized racial and ethnic groups. These association thresholds were not fully captured by NYC heat advisories, which were triggered by 2 days above HImax 95 °F or any time above 100 °F, highlighting an opportunity for future research to develop targeted, risk-informed health care system-based heat warning strategies.

PMID:41860548 | DOI:10.1001/jamanetworkopen.2026.2645