Tag: nevin manimala

Zhen Ci Yan Jiu. 2025 Nov 11;51(3):310-322. doi: 10.13702/j.1000-0607.20241347.

ABSTRACT

OBJECTIVES: To observe the effects of acupuncture on the KAT3B/ACSL4 pathway in the cerebral cortex of cerebral ischemia-reperfusion injury (CIRI) rats, and to explore the mechanisms by which acupuncture mitigates ferroptosis and ferritinophagy in CIRI.

METHODS: Forty male SD rats were randomly divided into sham operation, model, acupuncture, and western medicine groups, with 10 rats in each group. The CIRI rat model was established by middle cerebral artery occlusion. The rats in the acupuncture group received acupuncture at “Baihui” (GV20), “Sishencong” (EX-HN1), and “Shuigou” (GV26) acupoints, with the needles retained for 30 min once daily for 7 consecutive days. The rats in the western medicine group received intraperitoneal injections of 0.29 mL·100 g^-1·d^-1 edaravone dexborneol for 7 consecutive days. Neurological deficit was assessed using the neurological deficit score. Infarct volume was measured by 2, 3, 5-triphenyltetrazolium chloride (TTC) staining. Blood-brain barrier permeability was assessed by Evans blue assay. Hematoxylin-eosin (HE) staining and Nissl staining were applied to assess histopathological alterations in the ischemic cerebral cortex. TUNEL staining was used for apoptosis detection in the ischemic cerebral cortex. Immunofluorescence staining was performed to detect the expression levels of neuronal nuclei (NeuN), nuclear receptor coactivator 4 (NCOA4), and autophagy-related protein light chain 3B (LC3B) in the ischemic cerebral cortex. Dihydroethidium (DHE) fluorescence probe was used to measure reactive oxygen species (ROS) levels in the ischemic cerebral tissue. Colorimetric assay was used to quantify the contents of ferrous iron (Fe²⁺), lipid peroxidation (LPO), malondialdehyde (MDA), and glutathione (GSH), along with superoxide dismutase (SOD) activity in the ischemic cerebral tissue. Transmission electron microscopy was used to assess mitochondrial damage in neurons of the ischemic cerebral cortex. Western blot was performed to evaluate the protein expression levels of KAT3B, ACSL4, glutathione peroxidase 4 (GPX4), solute carrier family 7 member 11 (SLC7A11), NCOA4, transferrin receptor 1 (TfR1), ferritin heavy chain 1 (FTH1), and ferroportin-1 (FPN-1) in the ischemic cerebral tissue.

RESULTS: Compared with the sham operation group, the model group showed significant increases in neurological deficit score, cerebral infarction volume, and Evans blue permeability (P<0.01);neuronal structure damage, with cell necrosis, nuclear shrinkage, loss of cytoplasm, and a decrease in Nissl bodies (P<0.01). TUNEL-positive cells were increased (P<0.01). Mitochondrial integrity was lost, mitochondria enlarged with cristae rupture and vacuolization. Expression of NeuN was decreased, while NCOA4 and LC3B expressions were increased (P<0.01). In the ischemic cerebral tissue, contents of ROS, Fe²⁺, LPO, and MDA were increased, as well as the protein expression levels of KAT3B, ACSL4, NCOA4, and TfR1 were elevated (P<0.01). By contrast, GSH content, SOD activity, and the expressions of GPX4, SLC7A11, FTH1, and FPN-1 were reduced (P<0.01). Compared with the model group, the acupuncture and western medicine groups demonstrated reversal of these indicators (P<0.05). There was no statistically significant difference between the acupuncture and western medicine groups.

CONCLUSIONS: Acupuncture can improve cerebral injury in CIRI rats and reduce ferroptosis and ferritinophagy, potentially through inactivation of the KAT3B/ACSL4 pathway.

PMID:41839581 | DOI:10.13702/j.1000-0607.20241347

Int J Spine Surg. 2026 Mar 16:8860. doi: 10.14444/8860. Online ahead of print.

ABSTRACT

BACKGROUND: Investigational device exemption (IDE) studies for spine technologies have evolved significantly since the early 2000s, when traditional randomized controlled trials (RCTs) established a specific regulatory framework for lumbar total disc replacement. Modern clinical trial designs are pragmatic and can address escalating costs (lumbar fusion costs increased 177% between 2004 and 2015), patient enrollment challenges, and evolving regulatory acceptance of alternative evidence standards. Following the 21st Century Cures Act, the US Food and Drug Administration has increasingly accepted real-world evidence (RWE) in regulatory decision-making, fundamentally reshaping the landscape for medical device development. This perspective examines how modern IDE trials integrate RWE to address economic and practical barriers while maintaining scientific validity.

METHODS: We reviewed the evolution of clinical trial designs for lumbar motion preservation technologies from 2000 to 2025 and analyzed the methodological framework of the MOTUS lumbar total joint replacement IDE study. This modern trial design employs prospective dual-arm enrollment with an investigational lumbar total joint replacement arm and an independent RWE control arm documenting transforaminal/posterior lumbar interbody fusion outcomes under standard-of-care conditions. Prespecified design elements included identical sites and surgeons enrolling in identical overlapping intervals, standardized outcome measures, propensity score adjustment for potential confounding, and adaptive sample size allowing for mid-study adjustment.

RESULTS: Modern trial designs incorporating RWE demonstrate substantial advantages over traditional RCTs for spine device evaluation. The MOTUS IDE substantially completed enrollment in 3.5 years vs 4 to 5 years for historical lumbar total disc replacement RCTs. Insurance coverage of standard-of-care procedures in the RWE arm reduced sponsor costs 5- to 10-fold compared with sponsor-funded control arms in traditional RCTs. The design foregoes inherent limitations of spine device RCTs, including the inability to blind participants and patient reluctance to accept randomization to nonmotion preservation techniques (eg, implantation of fusion hardware), while preserving comparative validity through propensity score methodology validated across multiple regulatory submissions.

CONCLUSIONS: Incorporating RWE in a clinical trial approach enables resource-constrained innovators to advance novel technologies through the Premarket Approval pathway, addressing a critical gap in medical technology innovation, as large manufacturers have withdrawn from lumbar motion preservation development.

CLINICAL RELEVANCE: This perspective provides insight into the challenges of clinical trials for novel motion-preserving spine technologies.

PMID:41839575 | DOI:10.14444/8860

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Mar 15;40(3):430-437. doi: 10.7507/1002-1892.202601049.

ABSTRACT

OBJECTIVE: To analyze the changing trends in the burden of gout disease attributable to high body mass index (BMI) and impaired kidney function in China from 1990 to 2023, and predict the burden of gout disease attributable to high BMI and impaired kidney function in China from 2024 to 2035, to provide a scientific basis for gout prevention and control.

METHODS: Based on the 2023 Global Burden of Disease (GBD) study data, this study analysed the characteristics of the burden of gout attributable to high BMI and impaired kidney function by gender and age group. It employed the Joinpoint regression model to examine trends in the age-standardized disability-adjusted life years (DALYs) rate and utilized the autoregressive integrated moving average (ARIMA) model to predict the disease burden trend from 2024 to 2035.

RESULTS: From 1990 to 2023, the age-standardized DALYs rate for gout attributable to high BMI in China increased (1990: 3.79 per 100 000, 95% UI: 2.15 per 100 000-6.24 per 100 000; 2023: 7.34 per 100 000, 95% UI: 4.22 per 100 000-11.39 per 100 000). Joinpoint analysis results showed that from 1990 to 2023, the age-standardized DALYs rate for gout attributable to high BMI in China exhibited an overall upward trend [average annual percent change (AAPC) for males=2.12%, 95% CI: 2.02%-2.22%; AAPC for females=1.92%, 95% CI: 1.79%-2.04%, both P<0.05]. For gout attributable to impaired kidney function, the age-standardized DALYs rate showed a slow overall increase in males, while the change in females was not significant (AAPC for males=0.36%, 95% CI: 0.27%-0.45%, P<0.05; AAPC for females=0.11%, 95% CI: -0.11%-0.33%). According to the ARIMA model predictions, by 2035, the age-standardized DALYs rates of gout attributable to high BMI in males and females and attributable to impaired kidney function in females were projected to stabilize at 10.85 per 100 000, 3.48 per 100 000, and 1.75 per 100 000, respectively. In contrast, the age-standardized DALYs rate of gout attributable to impaired kidney function in males was predicted to continue rising until 2035, reaching an estimated 5.98 per 100 000.

CONCLUSION: The disease burden of gout associated with high BMI and impaired kidney function continues to worsen in China. The age-standardized DALYs rate for gout attributable to impaired kidney function in males is projected to continue rising until 2035. Therefore, there is an urgent need to improve population-wide BMI management strategies and enhance medical support for patients with kidney diseases, with targeted interventions prioritized among specific groups such as middle-aged obese individuals and middle-aged and elderly patients with kidney diseases.

PMID:41839557 | DOI:10.7507/1002-1892.202601049

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Mar 15;40(3):422-429. doi: 10.7507/1002-1892.202601010.

ABSTRACT

OBJECTIVE: To investigate the epidemiological features and changing trends of disease burden of spinal cord injury (SCI) in China from 1990 to 2023, conduct decomposition analysis of disease burden changes, and provide evidence for SCI prevention and control.

METHODS: Based on the 2023 Global Burden of Disease (GBD) study data, indicators including incidence and years lived with disability (YLDs) were used to analyze the status and changing trends of SCI disease burden in China from 1990 to 2023. The Gupta decomposition framework was applied to quantify the contributions of population growth, population aging, age-specific incidence rate changes, and disease severity changes to YLDs growth.

RESULTS: In 2023, the number of SCI incidence cases in China was 232 700 cases, representing a 43.6% increase compared to 1990. From 1990 to 2023, the age-standardized YLDs rate of SCI decreased, while the age-standardized incidence rate showed an overall upward trend: it increased year by year from 1990 to 2015, declined briefly after 2015, and rose again from 2020. The disease burden of SCI in males was higher than in females. The age distribution of disease burden showed a shift toward older age groups, with incidence rates increasing with age among middle-aged and elderly populations. Falls were the main cause of SCI in China. Compared with 1990, YLDs in males and females increased by 48.58% and 41.72% respectively in 2023. The proportions of male growth attributed to population growth, population aging, age-specific incidence rate changes, and disease severity changes were 22.79%, 22.69%, 34.99%, and -31.88%, while those for females were 23.82%, 26.30%, 21.99%, and -30.40%.

CONCLUSION: From 1990 to 2023, population aging made a substantial contribution to the growth of SCI disease burden in China. The primary factor driving the growth of SCI disease burden differed by gender. Clinical interventions that mitigate disease severity represent a key strategy for addressing the rapid growth of SCI disease burden.

PMID:41839556 | DOI:10.7507/1002-1892.202601010

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Mar 15;40(3):414-421. doi: 10.7507/1002-1892.202601044.

ABSTRACT

OBJECTIVE: To analyze the changing trends and attributable risk factors of low back pain disease burden in Chinese population from 1990 to 2023, and to predict the related disease burden of low back pain in 2030.

METHODS: Based on the 2023 Global Burden of Disease (GBD) study database, the incidence, prevalence, years lived with disability (YLDs), and characteristics and trends of risk factors among Chinese individuals with low back pain from 1990 to 2023 were analyzed, the age and gender differences in disease burden were assessed, and the disease burden in 2030 was jointly predicted by autoregressive integrated moving average model and age-period-cohort model.

RESULTS: From 1990 to 2023, the number of incident cases, the number of prevalent cases, and YLDs in Chinese low back pain population showed an upward trend, from 29.989 1 million cases, 68.636 3 million cases, and 7.732 4 million person-years to 41.383 6 million cases, 95.324 0 million cases, and 10.635 9 million person-years, respectively. The incidence rate, prevalence rate, and YLDs rate increased from 2 543.31 per 100 000, 5 820.89 per 100 000, and 655.77 per 100 000 to 2 892.65 per 100 000, 6 663.01 per 100 000, and 743.43 per 100 000 respectively. However, the age-standardized incidence rate, age-standardized prevalence rate, and age-standardized YLDs rate showed a downward trend, from 2 859.73 per 100 000, 6 636.60 per 100 000, and 740.83 per 100 000 to 2 164.80 per 100 000, 4 929.78 per 100 000, and 551.92 per 100 000, respectively. The burden of low back pain in women was significantly higher than that in men and increased with age (peak at 50 to 59 years old). Attribution analysis showed that smoking, occupational factors, and high body mass index (BMI) were the main factors leading to the increase of YLDs, and there was a gender difference. The tow model showed that the age-standardized incidence rate, the age-standardized prevalence rate, and the age-standardized YLDs rate for low back pain would decrease year by year from 2023 to 2030.

CONCLUSION: The disease burden of low back pain in China shows that from 1990 to 2023, the burden of low back pain in the Chinese population has been increasing year by year. Smoking, occupational factors, and high BMI are the main risk factors. Interventions targeting these controllable risk factors are crucial for reducing the disease burden. It is expected that by 2030, the disease burden of low back pain is expected to decrease, although the absolute burden will remain high. Greater attention should be paid to the middle-aged and elderly population, especially the female population, who bear a heavier disease burden. Targeted interventions, such as weight control and smoking cessation management, should be actively implemented against these controllable risk factors.

PMID:41839555 | DOI:10.7507/1002-1892.202601044

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Mar 15;40(3):405-413. doi: 10.7507/1002-1892.202601124.

ABSTRACT

OBJECTIVE: Based on the data from the 2023 Global Burden of Disease (GBD) study, the changing trends of the disease burden of neck pain and its demographic characteristics in China from 1990 to 2023 was systematically evaluated, in order to provide evidence for the formulation of neck pain prevention and control strategies.

METHODS: Data on the incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates of neck pain in China were extracted from the GBD 2023 database. A descriptive analysis was conducted by stratifying data by gender and age. The Joinpoint regression model was used to analyze the temporal trends of age-standardized incidence, prevalence, and YLDs rates, and the average annual percentage change (AAPC) was calculated.

RESULTS: From 1990 to 2023, the number of incident cases, prevalent cases, and YLDs of neck pain in China increased by 66.08%, 83.06%, and 80.49%, respectively, while the age-standardized rates showed relatively small fluctuations overall (rate of change<1.2%). The incidence, prevalence, and YLDs rates in females were higher than those in males, and the age-standardized YLDs rate in females showed a continuous upward trend (AAPC=0.067%, P<0.05). The disease burden of neck pain gradually increased with age, being most concentrated in middle-aged, elderly, and advanced-age populations. Joinpoint regression analysis revealed that the age-standardized incidence, prevalence, and YLDs rates exhibited multi-stage changes, with a common upward phase from 2005 to 2009 and a slight decline after 2021.

CONCLUSION: The increase in the absolute burden of neck pain in China is mainly driven by population aging. Priority should be given to focusing on female, middle-aged, and elderly populations, and early intervention should be strengthened to reduce long-term disability burden.

PMID:41839554 | DOI:10.7507/1002-1892.202601124

Acta Med Philipp. 2026 Jan 30;60(2):66-72. doi: 10.47895/amp.vi0.11821. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVE: Humans need constant interaction for a better well-being. It is advisable to actively participate socially to acquire psychological support and elicit satisfaction. In fact, social participation is a key driver of life satisfaction among the elderly. This study aims to describe social participation and life satisfaction among employees of a premier university in Manila, Philippines and infer their relationship through activity theory.

METHODS: Seventy-one participants ages fifty years and older as of June 30, 2020 representing various employee categories participated in the online survey: a) faculty; b) research extension and professional staff; and c) administrative staff. Ten key informant interviews (KIIs) were likewise conducted to determine their opinions and perceptions on social participation in campus.

RESULTS: Social media usage and “malling” ranked the highest, contributing to 76% and 48% of the activities for indoor and outdoor activities, respectively. In terms of membership, professional organizations comprised 69%. On the other hand, 68% of organization members were elected officers. The relationship between social participation and life satisfaction were observable as indicated by the high rate of social participation and low percentage of participants who reported life dissatisfaction (4%).

CONCLUSIONS: High levels of social participation in terms of indoor and outdoor activities; membership including activeness in organizations; as well as positions held in organizations may indicate high levels of life satisfaction. Further research on a large sample size may explore statistical analysis on the longitudinal effects of social participation and life satisfaction.

PMID:41835905 | PMC:PMC12982903 | DOI:10.47895/amp.vi0.11821

Acta Med Philipp. 2026 Jan 30;60(2):22-32. doi: 10.47895/amp.vi0.11548. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVES: Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS: This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS: Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid-stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION: Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

PMID:41835902 | PMC:PMC12982906 | DOI:10.47895/amp.vi0.11548

Acta Med Philipp. 2026 Jan 30;60(2):59-65. doi: 10.47895/amp.vi0.10060. eCollection 2026.

ABSTRACT

BACKGROUND AND OBJECTIVE: Severe Acute Respiratory Syndrome – Coronavirus-2 (SARS-CoV-2) was initially known to affect the respiratory system and has been reported to also involve the cardiovascular system leading to myocardial damage. Remdesivir is one of the approved treatments for COVID-19, wherein viral replication is inhibited by terminating the RNA transcription prematurely. According to studies, the primary electrocardiographic effect of remdesivir in COVID-19 patients are sinus bradycardia and QT prolongation. The use of electrocardiogram (ECG) is an essential diagnostic tool in assessing the electrical conditions of the heart. The objective of this study is to describe the electrocardiographic profile of adult patients with COVID-19 who were given remdesivir and admitted in the University of the Philippines-Philippine General Hospital (UP-PGH). To this date, this is the only study done locally identifying the electrocardiographic profiles of adult patients with COVID-19 who were given remdesivir.

METHODS: This was a retrospective descriptive study involving adult patients with COVID-19 who were given remdesivir and admitted in UP-PGH from June 2021 to June 2022. Demographic profiles and 12-lead ECG done during the hospital admission were gathered. Descriptive statistics was used to summarize the clinical characteristics and the electrocardiographic findings of the patients.

RESULTS: There were 412 confirmed COVID-19 patients who were given remdesivir (mean age 56 years old; female 52%) included in this study. The most common comorbidities were hypertension, diabetes mellitus, and stroke. Majority of the patients had severe (58%) to critical (22%) COVID-19 infection. Most of the patients had sinus rhythm (94%), normal rate (72%), and normal axis (93%). The most common baseline ECG findings were non-specific ST-T wave changes (42%). Some patients had atrioventricular blocks (3.4%), bundle branch blocks (3.6%), prolonged QT interval (1.9%). Among those with repeat 12-L ECG (136 patients) during admission, ECG changes observed were sinus bradycardia (6%), prolonged QT interval (4%), and both (1.5%).

CONCLUSION: Based on this retrospective review, which to our knowledge is the only study done locally investigating the effects of remdesivir on ECG of adult Filipino patients with COVID-19 infection, majority of the patients had sinus rhythm, normal rate, and axis. The most common ECG finding was non-specific ST-T wave changes. This study demonstrated a low incidence of adverse ECG changes that would preclude the administration of remdesivir when indicated. These include sinus bradycardia and QT interval prolongation which did not require further interventions. ECG remains to be useful, low-cost noninvasive tool that can help monitor electrophysiologic adverse events of remdesivir.

PMID:41835901 | PMC:PMC12982897 | DOI:10.47895/amp.vi0.10060

Front Psychol. 2026 Feb 26;17:1791041. doi: 10.3389/fpsyg.2026.1791041. eCollection 2026.

ABSTRACT

BACKGROUND: Earthquakes are frequently associated with elevated levels of psychological trauma, particularly among vulnerable groups. In this context, understanding the conceptual pathways and relational processes through which individuals cope becomes an important focus for research.

OBJECTIVE: This study investigates the serial mediation role of life engagement and coping humor in the link between psychological resilience and trauma among physical education and sport teachers affected by the earthquake, aiming to clarify how individual and psychosocial resources contribute to post-trauma adaptation.

METHODS: The study was conducted with 689 physical education and sport teachers affected by the earthquake. Data were collected using the Brief Resilience Scale (BRS), the Life Engagement Scale (LES), the Coping Humor Scale (CHS), and the Post Earthquake Trauma Level Determination Scale (PETLDS). Statistical analyses were performed with SPSS v22. The relationships among the variables were examined using Pearson correlation and regression analyses, and serial mediation associations were tested using the PROCESS Macro v3.5 (Model 6) with 5,000 bootstrap samples.

RESULTS: Psychological resilience was negatively associated with post-earthquake trauma in the serial mediation model (β = -0.736, p = 0.030). Life engagement and coping humor were associated with this relationship through statistically significant indirect pathways, as indicated by bootstrap confidence intervals that did not include zero [a1b1 = -0.110, 95% CI (-0.231, -0.018); a2b2 = -0.077, 95% CI (-0.183, -0.004); a1d1b2 = -0.033, 95% CI (-0.082, -0.003)]. These findings indicate that resilience, life engagement, and coping humor are related through theoretically consistent indirect associations within the proposed serial mediation framework.

CONCLUSION: Psychological resilience, life engagement, and coping humor were associated with individuals’ trauma experiences following the earthquake. The findings indicate that these factors constitute relevant psychosocial resources in post-disaster contexts; however, their potential implications should be interpreted cautiously, given the study’s cross-sectional design.

PMID:41835898 | PMC:PMC12979233 | DOI:10.3389/fpsyg.2026.1791041