Nevin Manimala

Medicine (Baltimore). 2026 Jun 26;105(26):e49486. doi: 10.1097/MD.0000000000049486.

ABSTRACT

It has been proved that lipids have an effect on endometriosis, and the plasma atherosclerosis index (AIP), as a new lipid index, has not been proved to be correlative to endometriosis. The National Health and Nutrition Examination Survey from 1999 to 2006 covered 2405 female. AIP (log10 (triglyceride/high-density lipoprotein cholesterol)) was employed to evaluate the danger of hyperlipidemia. Moreover, the connection between AIP and endometriosis can be further studied by using multivariate logistic regression, restricted cubic spline and subgroup analysis. Totally 2405 female were covered, of whom 182 (7.57%) had endometriosis and 2223 (92.43%) did not have endometriosis (named control). The AIP level in the endometriosis group (0.37) was visibly exceed that in the non-endometriosis group (0.26), and the imparity was statistically meaningful(P < .0001), even when sensitivity analysis was performed, the imparity retained the same. Overall, there was a significant active connection between the AIP and endometriosis (per 1-unit increment in the AIP: OR = 2.624; 95% CI 1.479, 4.657). The consequences of subgroup analysis demonstrated that there was no meaningful interaction between AIP and concrete subgroups (all interaction P < .05). Restricted cubic spline analysisprovide evidence of statistically significant linearity between AIP and endometriosis prevalence. AIP is actively connection with endometriosis in US female. Therefore, by using AIP as a new lipid market indicator, we are expected to offer new ideas and insights into the prevention and treatment of endometriosis.” To further confirm our works, we need larger cohort researches to support the consequences of this research.

PMID:42363550 | DOI:10.1097/MD.0000000000049486

Medicine (Baltimore). 2026 Jun 26;105(26):e49477. doi: 10.1097/MD.0000000000049477.

ABSTRACT

We performed a 2-step Mendelian randomization (MR) study to investigate the associations of Fms-related tyrosine kinase 3 ligand (FLT3L) and phosphate levels with the risk of hypertrophic cardiomyopathy (HCM). Genetic instruments for 75 circulating inflammatory factors were obtained from the NHGRI-EBI GWAS Catalog, while summary statistics for circulating phosphate and HCM were derived from the UK Biobank and FinnGen, respectively. Univariable MR analysis using the inverse-variance weighted method indicated that genetically predicted higher phosphate levels were associated with an increased risk of HCM (OR = 1.36, P = 4.82 × 10-2). Among the inflammatory markers, FLT3L emerged as a significant candidate and showed inverse associations with phosphate levels (β = -0.05, P = 1.70 × 10-9) and HCM (OR = 0.79, P = 4.10 × 10-2). Bidirectional MR analyses did not support a causal effect of phosphate on FLT3L. Mediation analysis suggested that phosphate levels accounted for an estimated 12.05% of the total effect of FLT3L on HCM. Genetic liability to lower FLT3L levels is associated with a higher risk of HCM, and this relationship may be partially mediated through circulating phosphate levels.

PMID:42363547 | DOI:10.1097/MD.0000000000049477

Medicine (Baltimore). 2026 Jun 26;105(26):e49518. doi: 10.1097/MD.0000000000049518.

ABSTRACT

The routine placement of a double-J (DJ) stent before ureteroscopic lithotripsy (URS) remains controversial. This study aims to compare the stone clearance rates between preoperative DJ stent placement and non-placement and to analyze the risk factors associated with residual stones, providing more clinical evidence for preoperative management. A retrospective analysis was conducted on 163 patients who underwent URS for kidney and ureteral stones between April 2023 and October 2024, among which 135 patients met the inclusion criteria. General clinical and perioperative data were collected. The stone clearance rates were compared between the group with preoperative DJ stent placement and the group without DJ stent placement. Univariate and multivariate logistic regression analyses were used to identify risk factors for residual stones after URS. The overall stone clearance rate in patients undergoing URS was 85.19% (115/135). The stone clearance rate in the non-DJ group was 75.51% (37/49), while it was 90.70% (78/86) in the DJ group, showing a statistically significant difference between the 2 groups (P = .017). Univariate regression analysis found that the preoperative DJ stent placement (P = .021) and surgery duration (P = .047) were risk factors for residual stones after URS. Multivariate regression analysis also identified the preoperative DJ stent placement (P = .019) and surgery duration (P = .039) as independent risk factors for residual stones after URS. Preoperative DJ stent placement resulted in a higher stone clearance rate compared to non-placement during URS. The preoperative DJ stent placement and surgery duration were independent risk factors for residual stones after URS.

PMID:42363538 | DOI:10.1097/MD.0000000000049518

Medicine (Baltimore). 2026 Jun 26;105(26):e49526. doi: 10.1097/MD.0000000000049526.

ABSTRACT

The association between early magnesium sulfate administration and outcomes in sepsis remains incompletely understood, particularly in relation to differences in systemic immune-inflammatory status. In this retrospective cohort study using Medical Information Mart for Intensive Care IV (version 3.1), adult critically ill patients with sepsis were included. Systemic immune-inflammation index (SII) was calculated from platelet, neutrophil, and lymphocyte counts obtained within a peri-intensive care unit window (6 hours before to 24 hours after intensive care unit admission). Early magnesium administration was defined as intravenous magnesium sulfate initiated within the same window. The primary outcome was 30-day all-cause mortality. Propensity score matching was performed to balance baseline characteristics. Associations were examined overall and across SII quartiles using stratified multivariable Cox proportional hazards models, with nonlinear relationships explored using restricted cubic splines. Among 12,087 patients, 6039 received early intravenous magnesium. After propensity score matching, 3396 matched pairs were analyzed. Early magnesium administration was associated with lower 30-day mortality overall (15.8% vs 18.3%, P = .007). In stratified analyses, adjusted hazard ratios were 0.66 (95% confidence interval: 0.51-0.87), 0.65 (0.49-0.85), 0.75 (0.59-0.94), and 0.85 (0.70-1.04) across quartiles 1 to 4. Restricted cubic spline analyses showed descriptive attenuation at higher SII values (P for interaction = .208), without evidence of a statistically definitive interaction. Early magnesium administration was associated with lower 30-day mortality in critically ill patients with sepsis. Although formal interaction testing did not reach statistical significance, adjusted hazard ratios showed a descriptive gradient of attenuation across increasing SII quartiles, directionally consistent across sensitivity analyses. These findings are hypothesis-generating and require prospective validation.

PMID:42363536 | DOI:10.1097/MD.0000000000049526

BMC Pharmacol Toxicol. 2026 Jun 26. doi: 10.1186/s40360-026-01177-1. Online ahead of print.

ABSTRACT

BACKGROUND: Methylphenidate is widely prescribed for attention-deficit/hyperactivity disorder, and its use has increased substantially in recent years. Although generally considered safe within therapeutic ranges, supratherapeutic ingestion may result in various systemic adverse effects. This study aimed to evaluate the demographic and clinical characteristics of children presenting with overdose ingestion and to identify potential factors associated with symptom development.

METHODS: We conducted a retrospective review of patients younger than 18 years who presented to a tertiary pediatric emergency department between January 1, 2020, and December 31, 2024, due to overdose ingestion. Demographic characteristics, psychiatric history, ingested dose, mode of exposure, clinical findings, emergency department course, and factors potentially associated with adverse effects were analyzed.

RESULTS: Thirty-two patients were included; 72% were female, and ingestion was intentional in 84%. The mean ingested dose was 5.7 mg/kg. Clinical symptoms developed in 41% of patients. The most frequent findings were tachycardia (38%), mild hypertension (34%), agitation (22%), and seizures (16%). Although most cases were mild and resolved within 12 h of observation, one toddler developed neuropsychiatric manifestations requiring close monitoring with full recovery within 48 h. No statistically significant association was observed between age, sex, gastrointestinal decontamination status, or reported ingested dose and the development of clinical symptoms (p > 0.05).

CONCLUSIONS: Pediatric methylphenidate intoxication is generally mild, but severe neuropsychiatric and cardiovascular effects may occur. Careful clinical monitoring remains essential.

TRIAL REGISTRATION: Not applicable.

PMID:42363304 | DOI:10.1186/s40360-026-01177-1

J Neuroeng Rehabil. 2026 Jun 26. doi: 10.1186/s12984-026-02060-0. Online ahead of print.

ABSTRACT

BACKGROUND: Functional constipation (FCon) involves central nervous system dysregulation, particularly in brain regions responsible for visceral sensation, emotional processing, and autonomic control. Using functional near-infrared spectroscopy (fNIRS), we examined brain activity alterations in FCon patients to elucidate brain-gut interactions.

METHOD: Patients with constipation meeting Rome IV criteria were recruited from Sir Run Run Shaw Hospital, while healthy controls were enrolled from the local community. The cortical regions of interest (ROIs) included the prefrontal cortex (PFC), dorsolateral prefrontal cortex (DLPFC), broca’s area, primary motor cortex (M1), supplementary motor area (SMA)/premotor cortex (PMC), and primary somatosensory cortex (S1). Participants were monitored during resting state and three defecation-related tasks: imagined defecation, simulated defecation and anal sphincter contraction. Functional connectivity (FC) strength and regional brain activation (HbO concentration changes) were compared between groups and across tasks.

RESULT: 64 patients and 64 healthy controls (50% females each) were included. There was no significant difference in average FC between groups (P = 0.757). In both groups, simulated defecation and anal sphincter contraction activated most ROIs more strongly than imagined defecation (P < 0.05). In healthy controls, anal sphincter contraction elicited significantly lower HbO than simulated defecation in the left Broca’s area (P < 0.05); no significant differences between these two tasks were found in the FCon group. No significant between-group differences in HbO were found during any task. During imagined defecation, FCon patients showed a trend toward lower HbO across most ROIs, most notably in the right M1, with comparable levels in the right PFC. During simulated defecation, a similar trend of lower HbO in sensorimotor ROIs was observed alongside numerically higher HbO in the right PFC/DLPFC. During anal sphincter contraction, they showed numerically higher HbO across all ROIs. Progression curves further revealed a linear increasing pattern in FCon patients across tasks, contrasting with task-appropriate modulation in healthy controls.

CONCLUSION: This first fNIRS study reveals task-specific cortical dysregulation in FCon. Although between-group differences were not statistically significant, these trends and dynamic patterns identify sensorimotor and prefrontal cortical targets for future neuromodulation therapies. Trial registration ChiCTR2500104882.

PMID:42363274 | DOI:10.1186/s12984-026-02060-0

Health Qual Life Outcomes. 2026 Jun 26. doi: 10.1186/s12955-026-02573-1. Online ahead of print.

ABSTRACT

PURPOSE: Quality of life (QOL) research in diabetes has long been a concern with many specific instruments being developed, but no scale for diabetes has been developed based on the modular approach. This study aimed to develop and validate the Diabetes Mellitus Scale of the System of Quality of Life Instruments for Chronic Diseases QLICD-DM (V2.0) by a modular approach and mixed methods.

METHODS: The Scale was developed based on procedural decision-making methods and by combining the general module and the specific module. The instrument was used to assess the quality of life of 242 diabetic patients both before and after treatments. Under Classical Test Theory (CTT), the psychometric properties of the scale were assessed with regard to validity, reliability and responsiveness by correlation analyses, structural equation modeling, as well as t-tests. In addition, G-study and D-study in Generalizability Theory (GT) were used to validate the scale further.

RESULTS: The QLICD-DM (V2.0) was developed with a 14-item specific module and a 28-item general module in the final scale. For all domains, Cronbach’s α values were greater than 0.70 with the exception of physical function (0.68), the test-retest reliability correlations r and ICCs were greater than 0.80 with the exception of physical and social function (0.65,0.64). The theoretical construct was supported by correlation analyses and confirmatory factor analysis using structural equation modeling, which demonstrated good construct validity. There were significant differences (P < 0.05) in the domains of physical function, specific module and the total scale before and after treatments. The standardized response means (SRMs) of the physical, psychological, social, and the specific module were 0.36, 0.14, 0.11 and 0.28 respectively. All G-coefficients were all greater than 0.70 with the exception of the physical domain (0.683), further confirming the reliability of the scale further. The overall error was found to be small in the G-study and in the D-study, indicating a high level of accuracy.

CONCLUSION: The QLICD-DM (V2.0) not only integrated characteristics of generic and disease-specific instruments but also demonstrated good reliability, validity, and moderate responsiveness, and it could serve as a quality of life assessment tool for diabetes patients.

PMID:42363272 | DOI:10.1186/s12955-026-02573-1

Thyroid Res. 2026 Jun 26. doi: 10.1186/s13044-026-00308-4. Online ahead of print.

ABSTRACT

AIM AND OBJECTIVES: Tumour stroma is acknowledged as a fundamental constituent of the tumour microenvironment, which drives cancer progression. Cancer-associated fibroblasts are an integral part of the cancer stroma. However, their role in thyroid cancer is not fully elucidated. The aim of this study is to determine the relationship between the expression of stromal cancer-associated fibroblasts’ immunohistochemical biomarkers in thyroid cancer and clinicopathological features of the disease.

METHODS: Eighty-five formalin-fixed paraffin-embedded tissue sections of different thyroid cancer cases were stained with Masson’s trichrome, α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP) and scored based on the extent of the stained area and staining intensity. Statistical analysis was performed to assess any correlation with clinicopathological features.

RESULTS: α-SMA showed a positive correlation with male gender (p = 0.02), tumour size greater than 1 cm (p = 0.0014) and histopathologic features of aggressiveness (p = 0.023). FAP was positively correlated with extent of desmoplasia (p = 0.024). Additionally, stromal desmoplasia was negatively correlated with tumour size greater than 1 cm (p = 0.0082).

CONCLUSION: Cancer-associated fibroblasts are associated with increased tumour progression and desmoplasia in thyroid cancer.

PMID:42363240 | DOI:10.1186/s13044-026-00308-4

BMC Oral Health. 2026 Jun 26. doi: 10.1186/s12903-026-08893-4. Online ahead of print.

ABSTRACT

OBJECTIVE: Obesity has become one of the leading health concerns in the world. There has been limited data on the effect of obesity on oral health in children and no research has specifically examined the impact of obesity on halitosis in this population. The aim of this study was to evaluate the potential effects of obesity on oral health parameters including dental caries, periodontal health, and halitosis in children.

MATERIALS AND METHODS: A total of 295 children aged 10-13 years were included in the study. Height, body weight, and waist circumference were measured, and body mass index (BMI), z-scores, and percentile values were calculated using the WHO AnthroPlus 2007 program. Participants were classified into obese and non-obese groups. The obese group consisted of overweight/obese children, whereas the non-obese group comprised underweight/normal weight children. Oral health status, including the presence of halitosis, was assessed. In addition, a questionnaire was administered to the parents. The collected data were statistically analyzed using the chi-square test, Fisher’s exact test, Mann-Whitney U test, and multivariable logistic regression analysis (p < 0.05).

RESULTS: The obese group consisted of 111 children (37.6%), whereas the non-obese group comprised 184 children (62.4%). No statistically significant differences were observed between the obese and non-obese groups regarding DMFT/DMFS, dmft/dmfs, ICDAS II, plaque index, or gingival index scores. However, a statistically significant difference was found in the prevalence of halitosis between the groups. The frequency of halitosis was significantly higher in the obese group (24.3%) than in the non-obese group (14.7%) (p = 0.038). Furthermore, the association between tongue coating and halitosis was statistically significant in the non-obese group (p = 0.049), but not in the obese group (p = 0.790). Multivariable logistic regression analysis also identified overweight and obesity as potential risk factors for halitosis (OR = 1.847, 95% CI: 1.006-3.389).

CONCLUSIONS: In addition to the well-known causes of halitosis, overweight and obesity may also be considered potential risk factors in children. Parents should be informed that overweight and obesity may be associated with bad breath, which can lead to embarrassment and anxiety in children.

PMID:42363236 | DOI:10.1186/s12903-026-08893-4

AIDS Res Ther. 2026 Jun 26. doi: 10.1186/s12981-026-00902-4. Online ahead of print.

ABSTRACT

PURPOSE: Caribbean countries are among the most heavily burdened by both human immunodeficiency virus (HIV) and cancer, with prevalent stigmatization of both illnesses. This novel pilot study responds to the need to examine and understand both cancer- and HIV-related stigma among cancer survivors living with HIV (CSLWH).

METHODS: Data were collected via quantitative surveys and administered in person in Trinidad and Tobago. The survey used in this pilot study included an HIV stigma scale and a cancer stigma scale. Descriptive analyses were conducted using IBM SPSS Statistics 29.0.0.

RESULTS: For most stigma items, HIV stigma is higher than cancer stigma, especially for personal and relational self-stigma: 95% vs 28% of participants reported that they feel telling someone is risky for their HIV status and cancer status, respectively. HIV-related societal/community stigma is also higher than cancer-related stigma: 87% of participants reported that they feel most people believe a person who has HIV is dirty, vs 18% reported the same stigma for cancer. Most CSLWH believed HIV is more stigmatized than cancer by the community/society (90.6% vs 9.4%) and family/friends (93.8% vs 6.3%). However, cancer-related stigma exists in health outcome beliefs: 57% of CSLWH believed that once having cancer, a person will never be ‘normal’ again, while 45% of CSLWH felt the same for HIV.

CONCLUSIONS: Our preliminary findings suggest greater HIV-related personal and relational self-stigma and societal/community stigma compared to cancer-related stigma among CSLWH. However, more cancer-related health outcome beliefs are stigmatizing compared to HIV-related stigma among CSLWH.

PMID:42363228 | DOI:10.1186/s12981-026-00902-4