Tag: nevin manimala

Rev Esc Enferm USP. 2026 Aug 10;60:e20250594. doi: 10.1590/1980-220X-REEUSP-2025-0594en. eCollection 2026.

ABSTRACT

OBJECTIVE: To analyze the association between the risk of developmental delay in children and mothers’ perceptions of urban infrastructure.

METHOD: A cross-sectional study was conducted in Salvador, Bahia, with mothers and children under 6 years of age registered at health units. Child development was assessed using the Survey of Well-being of Young Children, validated for the Brazilian population, and mothers’ perceptions of urban infrastructure were assessed using the Child-Friendly Neighborhood for Early Childhood scale (green/open, playful, safe, accessible, and inclusive). Descriptive statistical analyses and logistic regression models were used. All ethical aspects were respected.

RESULTS: A total of 503 mother-child dyads participated, and the risk of developmental delay was 11%. Regarding urban infrastructure, 41% of mothers considered their neighborhood green/open, 45% playful, 37% safe, 93% accessible, and 29% inclusive. Only mothers’ perception that the neighborhood was safe was associated with a lower likelihood of risk of developmental delay in children (OR = 0.33; 95%CI: 0.15-0.71; p < 0.001).

CONCLUSION: Maternal perception of neighborhood safety was associated with a lower likelihood of risk of developmental delay in children.

PMID:42599183 | DOI:10.1590/1980-220X-REEUSP-2025-0594en

Chaos. 2026 Aug 1;36(8):083128. doi: 10.1063/5.0345566.

ABSTRACT

Homophily, the tendency of individuals to interact with similar others, is key to understand social dynamics. This concept has traditionally been measured in a k-uniform hypergraph model that accounts group interactions involving exactly k individuals (k ≥ 2). However, real-world interactions do not always involve the same number of individuals. Thus, in this paper, we propose a new descriptive homophily measure for general social hypergraphs where group interactions involve arbitrary number of individuals. We establish constraints of monotonic and majority homophily for two-class labels, providing a framework for analyzing homophily patterns. Experiments on several datasets reveal systematic deviations in hyperedge composition associated with node class labels relative to a label-independent baseline, offering insights into homophily pattern in complex social networks. This work bridges the gap between theoretical measures and practical applications in non-uniform hypergraphs, advancing the understanding of social and structural dynamics.

PMID:42599155 | DOI:10.1063/5.0345566

Int J Lang Commun Disord. 2026 Sep-Oct;61(5):e70311. doi: 10.1111/1460-6984.70311.

ABSTRACT

BACKGROUND: The application of non-invasive brain stimulation in the rehabilitation of bilingual individuals with aphasia following a stroke is understudied. Recent studies show benefits of anodal cerebellar transcranial Direct Current Stimulation in bilinguals, while in monolinguals, repetitive Transcranial Magnetic Stimulation (rTMS) targeting the motor cortex of the lips seems to be effective in aphasia recovery.

OBJECTIVE: We aimed to investigate the effects of inhibitory continuous theta burst rTMS stimulation targeting the right motor cortex of the lips during picture naming task in the second language of a French-English post-stroke bilingual individual.

METHODS: We enrolled a single bilingual (PR) exhibiting chronic post-stroke aphasia in both her second language (L2), and first language (L1). In the present study PR engaged in naming tasks three times a week for six weeks, including 2-week baseline, 2-week intervention and 2-week follow-up.

RESULTS: The results demonstrated a statistically significant improvement in naming accuracy in the second language of the patient, as evidenced by visual analysis in both cognate and non-cognate words, as well as, overall language accuracy. Visual analysis revealed a positive improvement in all variables, with the greatest improvements observed in phonology, overall accuracy, and pathological language switching.

CONCLUSION: The stimulation of the motor cortex of the lips resulted in an improvement in naming accuracy in both the first and second language of the participant, despite the possible varying language recovery after stroke. This suggests the possible existence of shared representations of language in the brain, which is likely due to the similarities between the languages. Further studies are required to confirm the efficacy of non-invasive brain stimulation in bilingual individuals with aphasia for deeper understanding of the underlying mechanisms influencing these outcomes.

WHAT THIS PAPER ADDS: What is already known on this subject The application of non-invasive brain stimulation in bilinguals with post-stroke aphasia is understudied. Studies have indicated that the cortical organization of each language in bilingual individuals may exhibit overlap particularly in the case of similar languages, leading to a pathological language switching following cerebral lesions. A study by Coemans et al. (2023) demonstrated the efficacy of cerebellar transcranial direct current stimulation in bilingual individuals. The objective of this study is to investigate the effects of transcranial magnetic stimulation during a naming task on the second language of a post-stroke bilingual aphasia individual and to gain insight into the cortical organisation of each language. What this study adds to existing knowledge The present study demonstrates the potential of inhibitory repetitive transcranial magnetic stimulation (rTMS) targeting the right motor cortex of the lips to enhance picture naming accuracy in both languages and reduce pathological language switching in bilingual individuals with aphasia. The results demonstrate that rTMS not only facilitates recovery in each language but also has a beneficial impact on the cognitive control mechanisms involved in language switching, particularly for cognate words. That suggests that rTMS impacts both the targeted motor areas and broader cognitive networks, thereby providing insights into the bilingual language recovery process and highlighting the benefits of rTMS in bilingual aphasia. What are the clinical implications of this study? The clinical implications of this study indicate that rTMS may serve as a valuable tool for enhancing naming abilities and, consequently, language abilities in bilingual patients, particularly when the two languages exhibit similarities. The results suggest that rTMS targeting the motor cortex of the lip has the potential to simultaneously address linguistic and cognitive aspects of bilingual aphasia by targeting the phonological pathway and brain regions involved in cognitive control and language selection. These findings may assist clinicians in the development of personalized rehabilitation strategies for bilingual individuals with post-stroke aphasia.

PMID:42599151 | DOI:10.1111/1460-6984.70311

Blood Press. 2026 Aug 14:1-17. doi: 10.1080/08037051.2026.2719281. Online ahead of print.

ABSTRACT

BACKGROUND: Vasovagal syncope (VVS) without aura is characterized by a high fall risk and misdiagnosis rate. However, its hemodynamic characteristics remain unclear. In this study, we aimed to analyze the cardio-cerebral hemodynamic changes in patients with non-prodromal VVS, to generate a scientific basis for its management.

METHODS: A total of 221 participants were prospectively and consecutively enrolled, including 34 patients with non-prodromal VVS, 118 patients with prodromal VVS, and 69 non-syncope controls. All participants completed the head-up tilt test (HUTT) combined with transcranial Doppler (TCD). Blood pressure, heart rate, and cerebral hemodynamic parameters were monitored dynamically during the test. Data were statistically analyzed.

RESULTS: The non-prodromal VVS group consisted predominantly of males (70.59% vs. 37.29%), had a higher body mass index (median 24.14 vs. 21.26 kg/m²), and was older (median 47 vs. 37 years) (all P < 0.05). The baseline cerebral blood flow velocity (CBFV) in the non-prodromal VVS group was significantly lower than that in the prodromal VVS group (55 vs. 60 cm/s, P = 0.009), and the decrease of CBFV during the tilt test preceded the change of blood pressure. During the return to the supine position after HUTT, systolic blood pressure was significantly higher in the non-prodromal VVS group than in the prodromal VVS group (117.19 vs. 111.95 mmHg, P = 0.019), and the heart rate increment was greater during the drug-induced phase (11.35 vs. 8.38 beats per minute).

CONCLUSIONS: Non-prodromal VVS, with its unique hemodynamic profile involving early cerebral hypoperfusion and impaired central compensatory mechanisms, represents a high-risk subtype associated with higher fall risk. The identified hemodynamic differences may serve as objective biomarkers for its diagnosis. This study highlights the need for tailored management strategies, including comprehensive fall prevention measures and targeted interventions.

PMID:42599143 | DOI:10.1080/08037051.2026.2719281

Stat Med. 2026 Aug;45(18-19):e70705. doi: 10.1002/sim.70705.

ABSTRACT

The increasing prevalence of high-dimensional covariates presents a significant challenge to precision medicine. To overcome this, we propose a novel multi-stage optimal dynamic treatment regime method specifically designed for high-dimensional accelerated failure time models. Our approach, which aims to maximize individual survival time, employs backward induction with counterfactual survival times as the optimization objective at each stage. Parameter estimation leverages weighted counterfactual survival times to account for censoring, followed by the slope determination by analysis of residuals (SDAR) algorithm. Theoretical analysis guarantees exponential convergence with non-asymptotic error bounds under mild conditions. Simulation studies demonstrate a substantial improvement in survival time estimation, particularly under high censoring rates, compared to existing methods. We illustrate the practical utility of our method by applying it to a sepsis dataset, revealing clinically meaningful treatment recommendations.

PMID:42599126 | DOI:10.1002/sim.70705

Pharm Stat. 2026 Sep-Oct;25(5):e70111. doi: 10.1002/pst.70111.

ABSTRACT

In multiregional clinical trials (MRCTs), regional consistency probabilities (RCPs) must be evaluated at the trial design stage in addition to the power for the entire trial population. The Japanese Ministry of Health, Labour and Welfare guidance proposes two widely used criteria for this purpose, referred to as Method 1 and Method 2. While multiplicity adjustment for familywise error rate control is standard practice when multiple primary endpoints are employed, its implications for regional consistency evaluation in MRCTs have not been addressed in the existing literature. In this article, we demonstrate that applying unadjusted consistency thresholds under the Bonferroni procedure leads to monotone inflation of the null RCP with increasing number of endpoints for both Method 1 and Method 2, because the Bonferroni-adjusted critical value progressively selects more extreme overall treatment effect estimates, which in turn inflates the probability of satisfying the regional consistency criterion even when the true treatment effect is absent. To correct for this inflation, we propose adjusted consistency thresholds that restore the null RCP to its single-endpoint reference level, and show that these thresholds can be efficiently obtained via a standard root-finding algorithm. Through numerical studies, we demonstrate that the proposed adjusted thresholds result in only a modest reduction in RCP under the alternative hypothesis, and that thresholds derived under the Bonferroni procedure also prevent null RCP inflation when step-down procedures such as Holm, Hochberg, and Hommel are applied. The methodology is illustrated using a hypothetical MRCT with multiple primary endpoints, and an R package “rcpmcp” implementing all proposed methods is publicly available on GitHub.

PMID:42599125 | DOI:10.1002/pst.70111

Cancer Rep (Hoboken). 2026 Aug;9(8):e70649. doi: 10.1002/cnr2.70649.

ABSTRACT

BACKGROUND: Cholangiocarcinoma (CCA) is a highly heterogeneous malignancy with a poor prognosis. However, the molecular mechanisms underlying CCA and its treatment options remain unclear and limited.

AIMS: This study aims to identify novel prognostic biomarkers and potential therapeutic targets for CCA through transcriptomics and whole-exome sequencing analysis.

METHODS AND RESULTS: We analyzed the relationship between overall survival and various risk factors in 255 CCA samples from a published dataset and 36 samples from The Cancer Genome Atlas (TCGA) database. Transcriptomics analysis was used to identify genes whose expression plays a crucial role in CCA development and progression. Targeted drug databases were used to examine which gene expression signatures represent potential therapeutic targets for CCA. Mutated genes were analyzed to explore potential mechanisms. Standard statistical methods were applied to analyze associations between clinical data and candidate targets. A nomogram was constructed to predict the prognostic impact of the optimal candidate. Cell experiments were used to demonstrate the role of PKLR in CCA growth and metastasis. We identified FOLH1, PKLR, PTH1R, GPR114, KCNH2, LCN2, MMP10, PORCN, RIPK3, and SRPK3 as potential therapeutic targets for CCA, with PKLR being the most promising candidate based on the computational analyses. PKLR was lowly expressed in CCA tissues. PKLR expression was closely associated with ARID1A and KRAS mutations. PKLR mRNA levels were significantly correlated with tumor size (p = 0.024) and metastasis (p = 0.014). Low PKLR expression in CCA was positively associated with poor survival. A nomogram accurately predicted the prognosis of CCA patients based on PKLR expression levels. Silencing PKLR expression promotes growth and metastasis of CCA in vitro.

CONCLUSION: Our findings indicate that PKLR, an independent protective factor in CCA, is a potential prognostic biomarker and a candidate for further investigation as a therapeutic target. PKLR expression is significantly associated with ARID1A and KRAS mutations.

PMID:42599115 | DOI:10.1002/cnr2.70649

Microbiol Spectr. 2026 Aug 14:e0035426. doi: 10.1128/spectrum.00354-26. Online ahead of print.

ABSTRACT

Mycoplasma pneumoniae pneumonia (MPP) is the most common form of community-acquired pneumonia, which shows an epidemic interval of 3-7 years. This study was conducted to understand the changing trends in MPP in children hospitalized before and during the coronavirus disease 2019 pandemic and determine adverse outcomes and their influencing factors. This was a retrospective cohort study of children aged 28 days to 14 years hospitalized for MPP at our institution between January 2018 and December 2023. Clinical characteristics, adverse outcomes, and associated factors were analyzed using the chi-square test and multivariable logistic regression. A P < 0.05 was considered statistically significant. A total of 17,505 MPP cases were included, with the highest case number (4,619) in 2023. In 2023, the proportion of severe pneumonia was 44.1%, and bronchoscopy usage was 33.5%, both significantly higher than in 2018-2022. Older age, admission during July-December, co-infection with Epstein-Barr virus, chlamydia, or other bacteria, and complications, including pleural effusion, abnormal liver enzymes, acute respiratory distress syndrome, or atelectasis, were associated with bronchoscopy. Older age, admission during October-December, co-infection with respiratory syncytial virus, adenovirus, Epstein-Barr virus, chlamydia, or other bacteria, and complications, including cardiac failure, abnormal liver enzymes, myocardial damage, or anemia, were associated with severe pneumonia. Cases of MPP, severe pneumonia, and those requiring bronchoscopy increased in 2023 compared with the five previous years. Children with MPP were more susceptible to adverse clinical outcomes, which were associated with age, month of admission, co-infection, and complications.IMPORTANCEMycoplasma pneumoniae pneumonia (MPP) is a leading cause of community-acquired pneumonia in children. This study analyzed 17,505 hospitalized children in Northeast China from 2018 to 2023 to explore MPP trends before, during, and after the coronavirus disease 2019 pandemic. We found a sharp resurgence of MPP in 2023 with higher rates of severe pneumonia, complications, and bronchoscopy use. Key risk factors for adverse outcomes included older age, admission in October-December, viral/bacterial co-infection, and pulmonary or extrapulmonary complications. These findings improve understanding of post-pandemic MPP epidemiology, support early risk stratification, and help optimize clinical management and public health interventions for childhood MPP.

PMID:42599103 | DOI:10.1128/spectrum.00354-26

J Nephrol. 2026 Aug 14:aajag146. doi: 10.1093/joneph/aajag146. Online ahead of print.

ABSTRACT

BACKGROUND: Novel myosteatosis indices that measure intra- and inter-muscular fat content in abdominal muscles using computed tomography (CT) have been recently introduced. Therefore, we evaluated their usefulness in diagnosing low muscle strength in patients undergoing hemodialysis.

METHODS: This study included 114 patients on maintenance hemodialysis who underwent CT and handgrip strength assessments. Skeletal muscle density , total abdominal muscle area, normal-attenuation muscle area , low-attenuation muscle area, and intermuscular adipose tissue area at the third lumbar vertebral level were measured. Additionally, novel myosteatosis indices (normal-attenuation muscle area/total abdominal muscle area, low-attenuation muscle area/height2, and intermuscular adipose tissue area/total abdominal muscle area) were calculated. The relationship between myosteatosis indices and handgrip strength was examined.

RESULTS: Skeletal muscle density, normal-attenuation muscle area/total abdominal muscle area index, low-attenuation muscle area/height2, and intermuscular adipose tissue area/total abdominal muscle area index were 34.4 ± 9.0 Hounsfield Unit (HU), 58.2 ± 17.0%, 14.3 ± 5.7 cm2/m2, and 7.2 (3.9-12.8)%, respectively. The normal-attenuation muscle area/total abdominal muscle area index (r = 0.987), low-attenuation muscle area/height2 (r = 0.853), and log-transformed intermuscular adipose tissue area/total abdominal muscle area index (r = 0.843) were significantly correlated with skeletal muscle density (all P < .0001). Additionally, skeletal muscle density (β = 0.305), normal-attenuation muscle area/total abdominal muscle area index (β = 0.297), low-attenuation muscle area/height2 (β = -310), and intermuscular adipose tissue area/total abdominal muscle area index (β = -0.321) were independently linked to handgrip strength. The diagnostic value of the new myosteatosis index was similar to that of skeletal muscle density: age-sex-adjusted C-statistics (0.810): normal-attenuation muscle area/total abdominal muscle area index (0.809, P = .84), low-attenuation muscle area/height2 (0.810, P = .98), and intermuscular adipose tissue area/total abdominal muscle area index (0.810, P = .97). Increase in normal-attenuation muscle area/total abdominal muscle area index, but not in skeletal muscle density, was independently associated with reduced risk of low handgrip strength. Increase in intermuscular adipose tissue area/total abdominal muscle area index, but not low-attenuation muscle area/height2, was independently associated with greater risk of low handgrip strength.

CONCLUSIONS: Novel myosteatosis indices were independently associated with handgrip strength in patients undergoing hemodialysis and demonstrated diagnostic usefulness, were clinically acceptable, and comparable to that of skeletal muscle density.

PMID:42599101 | DOI:10.1093/joneph/aajag146

Microbiol Spectr. 2026 Aug 14:e0135726. doi: 10.1128/spectrum.01357-26. Online ahead of print.

ABSTRACT

Fluorescence microscopy and fungal culture are the primary diagnostic methods for superficial fungal infections, but they are limited by low sensitivity and long turnaround time, respectively. We determined the optimal cycle threshold (Ct) cutoff for a novel multiplex PCR assay (iFIND) using receiver operating characteristic analysis and evaluated whether a “microscopy + iFIND” combined strategy improves diagnostic performance. This prospective study enrolled 113 patients with suspected superficial mycoses. Specimens underwent fluorescence microscopy, fungal culture, and automated iFIND. Using a composite reference standard, we calculated positive percent agreement (PPA), negative percent agreement, and overall percent agreement. Cohen’s kappa and McNemar’s test assessed inter-method agreement. To mitigate verification bias, we performed a sensitivity analysis excluding cases diagnosed solely by clinical response. Internal bootstrap validation (1,000 resamples) was used to assess overfitting of the Ct cutoff. The optimal Ct cutoff for any fungal infection was 32.66 (area under the curve [AUC] = 0.746). Bootstrap validation confirmed robustness (optimism-corrected AUC = 0.7431, optimism = 0.00275, bias-corrected and accelerated 95% confidence interval for cutoff: 32.5-33.7). iFIND showed excellent discrimination for Epidermophyton (AUC = 0.824) and Trichophyton (AUC = 0.834). The combined approach achieved a PPA of 65.6%, superior to microscopy alone (50.0%, P < 0.001) and comparable to culture (75.0%, P = 0.701), while reducing turnaround time from weeks to <3 h. Sensitivity analysis excluding 15 clinically diagnosed cases yielded consistent results: iFIND alone PPA = 46.9% (23/49), combined strategy PPA = 69.4% (34/49). iFIND detected an additional 17.2% of infections missed by conventional methods. The iFIND assay is a rapid, accurate tool for superficial mycoses. The microscopy + iFIND strategy combines speed and sensitivity, offering culture-comparable utility with substantially faster results. However, positive results should be interpreted in a clinical context to avoid overtreatment.

IMPORTANCE: Fungal skin infections affect one in four people worldwide, but current diagnostic methods are either insensitive (microscopy) or painfully slow (culture, taking 2-4 weeks). This study validates a rapid PCR test that delivers results in under 3 h and, when combined with microscopy, matches the accuracy of culture. By establishing a data-driven cutoff value for test positivity and using rigorous statistical methods to confirm its reliability, we provide a practical framework that clinics can adopt immediately. The combined strategy reduces diagnostic delay, enabling same-day treatment decisions and reducing unnecessary antibiotic use. This is especially critical, given the global spread of antifungal-resistant strains, where rapid genus-level identification can guide appropriate therapy and curb resistance. Our approach offers an actionable, culture-comparable solution for routine clinical practice, directly addressing the urgent need for faster, more accurate fungal diagnostics worldwide.

PMID:42599092 | DOI:10.1128/spectrum.01357-26