Nevin Manimala

JMIR Med Inform. 2026 Jun 22. doi: 10.2196/82855. Online ahead of print.

ABSTRACT

BACKGROUND: The growing need for and interest in geomatics in the medical sector, as well as the pandemic crisis, led us to create a France-wide geomatics project aimed at producing several atlases of all-cause mortality at the municipal and submunicipal district levels via uMap France, a free and open-source collaborative map-sharing platform. In 2020, we decided to circumvent the obstacle of accessing detailed COVID-19 data by adopting a mortality-based approach to map the consequences of the crisis.

OBJECTIVE: The aim of the uMap study was to provide a webmapping platform with original visualization and knowledge, as well as decision-making aids that complement existing information and are relevant to public and healthcare professionals. Our main hypotheses are as follows: 1- the medical sector could develop a private uMap platform dedicated to health; 2- interest in a municipal mortality atlas for France linked to the pandemic crisis will increase, even if it is produced after the pandemic; and 3- sharing the atlases with the uMap community will enhance their appeal and inspire the creation of similar atlases, owing to the new “experimental choropleth layer” recently developed by the uMap team.

METHODS: This approach focuses on three main parts-data management (data collection, cleansing and scheduling) and geomatic engineering-through a two-step geomatic action plan to create atlases of the first lockdown period in France, displayed on the uMap platform. A logarithmically transformed variable allows us to obtain an immediate statistical signal of excess mortality or submortality via the Traffic-Light Atlas.

RESULTS: The uMap Traffic-Light display provides instant statistical signals at a glance owing to the semantic interplay of colors. The atlas’s double legends make it easy to compare specific regions (northeast, northwest, southeast, and southwest) to all of France. The atlas revealed excess mortality in 42% of the municipalities (14,503) out of 34,833. Thirty-five percent are in the green class (close to average to twice the average), 5% are in the orange class (2-4 times the average), and 2% are in the red class (4-11 times higher than average).

CONCLUSIONS: We innovated, enriched, and reinforced the value of uMap for visual rendering by instantiating colored choropleth map atlases and double legends and showed its relevance to the healthcare sector. We focused on the Traffic-Light Atlas, which is the most relevant because of the instant message it conveys and its interpretability for all audiences. The uMap community can share our all-cause mortality atlases. A second version of the atlas encompassing four periods in 2020 and containing a minor error will be updated using either the “experimental choropleth layer” feature recently developed by the uMap team or, if this feature proves insufficient, the geomatic optimization process via the R-project.

CLINICALTRIAL: Not applicable.

PMID:42339616 | DOI:10.2196/82855

Cardiol Young. 2026 Jun 24:1-8. doi: 10.1017/S104795112611227X. Online ahead of print.

ABSTRACT

BACKGROUND: There has been a growing clinical application of ketamine for procedural sedation. This study aimed to determine its hemodynamic effects when utilized in patients in the pediatric cardiac intensive care unit.

METHODS: In this single-center, retrospective study, patients who were admitted to the pediatric cardiac intensive care unit and received a single dose of intravenous ketamine were studied. Patients were monitored utilizing high-fidelity physiologic data. Variables of interest for the study included: heart rate, arterial saturation, respiratory rate, mean arterial blood pressure, central venous pressure, and renal near infrared spectroscopy These variables of interest were obtained 30 min prior to the administration of ketamine, through 30 min after, serving as the comparison arm. Secondary aims included unexpected apnea, need for a fluid bolus, vasoactive bolus, or cardiopulmonary resuscitation.

RESULTS: A total of 45 administrations of intravenous ketamine were included. Average dose was 0.8 mg/kg per dose. Average age was 8.1 months. After administration of ketamine, there was a statistically significant increase in heart rate, arterial saturation, renal near infrared spectroscopy and central venous pressure and a statistically significant decrease in respiratory rate and mean arterial blood pressure. No cardiopulmonary resuscitation or bolus vasoactive was required after ketamine administration.

CONCLUSION: Intravenous ketamine dosed from 0.5 mg/kg to 1 mg/kg per dose in the pediatric cardiac intensive care unit appears safe and is associated with minimal hemodynamic change, apnea, or hemodynamic collapse. This represents the first data related to a single dose of ketamine’s effect captured with a 1-s temporal resolution.

PMID:42339600 | DOI:10.1017/S104795112611227X

Phys Occup Ther Pediatr. 2026 Jun 24:1-24. doi: 10.1080/01942638.2026.2691064. Online ahead of print.

ABSTRACT

AIM: To examine the effects of Action Observation Therapy (AOT) and Mirror Therapy (MT) on occupational performance, occupational satisfaction, goal-oriented activities, bilateral hand skills, and upper extremity functions in children with unilateral cerebral palsy (CP).

METHOD: This randomized controlled trial included 24 children with unilateral CP (12 AOT, 12 MT) aged 6-12 years. Both groups received 18 sessions over 6 wk (3 days/week), consisting of 30 min of Bilateral Activity Training (BAT) combined with 30 min of AOT or MT. Outcomes were assessed using the Canadian Occupational Performance Measure, Goal Attainment Scale, Shriners Hospital Upper Extremity Evaluation, and ABILHAND questionnaire at baseline, post-intervention, and 1-month follow-up.

RESULTS: Both groups showed significant improvements in occupational performance, satisfaction, goal attainment, bilateral hand skills, and upper extremity function after treatment (all p < 0.001) and at follow-up (AOT: p = 0.02-0.09; MT: p = 0.02-0.05). Although some variation in effect size estimates was observed across outcomes, between-group differences were not statistically significant (all p > 0.05).

INTERPRETATION: AOT and MT, when combined with BAT, appear to be effective complementary interventions for improving upper extremity-related outcomes in children with unilateral CP.

TRIAL REGISTRATION: This study was registered as a Clinical Trial Number with the code NCT05951829.

PMID:42339598 | DOI:10.1080/01942638.2026.2691064

Int Endod J. 2026 Jun 24. doi: 10.1111/iej.70198. Online ahead of print.

ABSTRACT

BACKGROUND: Dental pulp inflammation triggers immune responses involving macrophages and dental pulp stem cells (DPSCs), which interact to regulate angiogenesis essential for tissue repair. M1 pro-inflammatory macrophages predominate early in pulpitis, and clarifying their angiogenic role is vital in identifying inflammatory regenerative mechanisms.

METHODOLOGY: THP-1 cells and peripheral blood monocyte (PBM)-derived macrophages were polarized to M1 or M2 phenotypes, characterized by qRT-PCR, ELISA, and angiogenesis arrays. A vasculature-on-a-chip comprising DPSCs, human umbilical vein endothelial cells (HUVECs) and THP-1-derived macrophages was imaged, and the vascular segments/sprouts were quantified using ImageJ. Density effects used 5 × 10⁴ versus 7.5 × 10⁴ M1 macrophages/device, with propidium iodide staining for cytotoxicity. IL-8 effects on DPSC VEGF secretion were assessed by ELISA (with/without Reparaxin 1 μM), Matrigel tube formation assays, and exogenous IL-8 (0.5 ng/mL). Transwell co-cultures underwent RNA sequencing and bioinformatics analysis, which identified candidate hub genes and signalling pathways; the results were validated by Western blotting (p-ERK, HIF-1α; ERK inhibitor SCH772984, 25 nM). Statistical testing was performed using ANOVA with Tukey’s post hoc test (p < 0.05).

RESULTS: M1 macrophages at low density (5 × 10⁴ cells/device) significantly enhanced vascularization in the vasculature-on-a-chip, increasing vascular segments (p < 0.0001) and free sprouts (p < 0.05-0.01) compared to M0 or no-macrophage controls, with effects comparable to M2. High-density M1 seeding (7.5 × 10⁴ cells/device) reduced sprouts (p < 0.0001 day 4, p < 0.01 day 5) due to increased cytotoxicity (p < 0.0001). Both THP-1- and PBM-derived M1-conditioned media (CM) showed significantly elevated IL-8 levels. M1 CM (THP-1/PBM) induced DPSC VEGF secretion, blocked by Reparaxin (p < 0.01-0.0001), confirming IL-8 mediation via CXCR1/2. Exogenous IL-8 (0.5 ng/mL) upregulated DPSC VEGF protein/mRNA (p < 0.05) and Matrigel tube formation (segments/junctions p < 0.05). M1-DPSC CM enhanced vascular meshes/segments on Matrigel (p < 0.05), reduced by Reparaxin. RNA-seq of M1 co-cultured DPSCs identified 17 angiogenic genes (logFC > 1.2), with HIF-1α as a hub gene and an enriched MAPK/ERK pathway. Western blot analysis confirmed MAPK/ERK-HIF-1α as a contributory pathway in IL-8-induced upregulation of VEGF in DPSCs.

CONCLUSION: M1 macrophages promote angiogenesis via IL-8-induced DPSC VEGF secretion through CXCR1/2-MAPK/ERK-HIF-1α signalling density-dependently, suggesting that therapeutic modulation rather than total suppression of M1 activity could improve outcomes in vital pulp therapy.

PMID:42339579 | DOI:10.1111/iej.70198

Laryngoscope. 2026 Jun 24. doi: 10.1002/lary.70706. Online ahead of print.

ABSTRACT

OBJECTIVES: Petroclival and temporal bone meningiomas are rare neoplasms that mimic vestibular schwannomas in presentation. However, surgical approaches for their resection are often more complex, largely due to the necessity of resecting pathologic dura. Although several classification and staging systems for petroclival meningiomas have been proposed, they are rarely cited and none are reliably correlated with surgical outcomes. We present a descriptive framework and hypothesize that it is predictive of surgical outcomes.

METHODS: Medical records of patients seen at a tertiary referral center with a diagnosis of petroclival meningioma were reviewed. Patients were stratified into four tiers: tier 1, meningioma confined to internal auditory canal (IAC) only; tier 2, meningioma confined to cerebellopontine angle (CPA) only; tier 3, meningioma involving CPA and IAC; and tier 4, meningioma involving cavernous sinus, internal carotid artery or jugular bulb, or crossing midline. Tier 4 was subdivided into 4A (no carotid involvement) and 4B (carotid involvement). Outcomes of observation, radiation, and surgery were analyzed.

RESULTS: Of 64 qualified patients, tier 2 was most commonly encountered (41%); the remainder of patients were classified as tier 1, 3, and 4 (3%, 33%, 23%). Among patients indicated for resection, combined petrosal approach was utilized in 64% of cases. Simpson grade of resection, complication rate, and rate of residual/recurrent tumor were statistically significantly associated with tumor tier. Tier and postoperative House-Brackmann score showed no significant correlation.

CONCLUSION: The proposed framework demonstrates the potential clinical utility of an outcome-predictive staging system, helping to guide surgeon and patient expectations.

PMID:42339571 | DOI:10.1002/lary.70706

Int J Gynaecol Obstet. 2026 Jun 24. doi: 10.1002/ijgo.71189. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the association between gender-based violence (GBV) assessed in early pregnancy and adverse perinatal outcomes using relative and absolute effect measures in an urban low- and middle-income setting.

METHODS: We conducted a prospective cohort study including 3890 singleton pregnancies recruited from two public healthcare institutions in Mexico City between October 2020 and April 2023. GBV was assessed at first-trimester enrollment using a standardized screening procedure and analyzed as any reported violence versus none. The primary outcome was a composite of low birth weight, fetal growth restriction, or perinatal mortality. Associations were estimated using Poisson regression with robust variance to obtain adjusted risk ratios and risk differences. Secondary analyses examined fetal growth restriction, stillbirth, and neonatal mortality.

RESULTS: GBV was reported by 162 (4.16%) participants. After adjustment for sociodemographic factors, GBV was associated with higher risk of the composite adverse perinatal outcome (adjusted risk ratio [aRR] 1.23, 95% [confidence interval] CI: 1.06-1.44). The adjusted absolute risk difference was +0.099 (95% CI: 0.020-0.177), corresponding to approximately 99 additional adverse outcomes per 1000 births among women reporting GBV. GBV was not significantly associated with isolated fetal growth restriction but was associated with increased odds of stillbirth; no statistically significant association was observed with neonatal mortality.

CONCLUSION: In this urban cohort, GBV reported at first-trimester screening was associated with a clinically meaningful increase in adverse perinatal outcomes, largely driven by stillbirth.

PMID:42339561 | DOI:10.1002/ijgo.71189

J Int AIDS Soc. 2026 Jul;29(7):e70151. doi: 10.1002/jia2.70151.

ABSTRACT

INTRODUCTION: Multi-month dispensing (MMD), as a differentiated service delivery model, can reduce the frequency of clinic visits, waiting time and travel costs for clinically stable people living with HIV. This study aimed to evaluate the impact of 6-month MMD of antiretroviral therapy (ART) on retention and conduct a cost analysis in China.

METHODS: We conducted a randomized, non-blind, non-inferiority study from December 2022 to March 2023 at The First Hospital of China Medical University. Eligible participants were randomly assigned to a 3-month dispensing group (n = 789) or a 6-month dispensing group (n = 799) and followed up for 18 months. The proportion of patients continuing ART after 18 months, virological suppression rate (<50 copies/mL) and average treatment cost per patient were evaluated. Cox regression analysis was used to compare treatment retention rates and virological suppression rates between groups, while descriptive statistical analysis was applied to assess cost differences. Cost metrics comprised the average cost per clinic visit and the price of ART medications, among other factors. This trial is registered with ChiCTR2200066438.

RESULTS: A total of 1588 participants were included (median age 40.0 years, IQR 34.0-50.0; 94.8% male), with no significant between-group differences in demographic and clinical characteristics (all p>0.05). In the intention-to-treat analysis, treatment retention rates at 18 months were 94.9% (749/789) in the 3-month dispensing group and 94.2% (753/799) in the 6-month dispensing group. The risk difference (6-month minus 3-month) was -0.7% (95% CI -2.9% to 1.5%); non-inferiority was demonstrated as the lower bound of the 95% CI (-2.9%) exceeded the pre-specified margin of -5%. Viral suppression rates (<50 copies/mL) were similarly high in both groups in intent-to-treat analysis: 94.9% (3-month) versus 94.2% (6-month), with no statistically significant difference. Per-protocol analysis confirmed these findings (viral suppression 97.59% vs. 97.75%; χ² = 0.0421, p = 0.8375). In terms of cost, the 6-month dispensing group had two fewer annual outpatient visits (3 vs. 5), with total treatment costs reduced by 27.7% (¥931.82 vs. ¥1288.85) and work value loss decreased by 16.7% (¥174.20 vs. ¥209.04 yearly).

CONCLUSIONS: Six-month MMD of ART did not reduce treatment retention; instead, it decreased patients’ clinic visit costs, thereby meeting cost-effectiveness criteria.

CLINICAL TRIAL NUMBER: ChiCTR2200066438.

PMID:42339560 | DOI:10.1002/jia2.70151

Circ Arrhythm Electrophysiol. 2026 Jun 24:e014913. doi: 10.1161/CIRCEP.126.014913. Online ahead of print.

ABSTRACT

BACKGROUND: The origins of left ventricular outflow tract premature ventricular contractions (PVCs) differ in depth and may involve preferential pathways, potentially requiring complex ablation. However, a noninvasive method to preprocedurally estimate ablation complexity has not been established.

METHODS: Sixteen patients with idiopathic left ventricular outflow tract PVCs (V2 transition ratio ≥0.6) underwent 2-dimensional speckle-tracking echocardiography during monomorphic PVCs. Endocardial peak systolic strain timing in 18 left ventricular segments was displayed on a bull’s-eye map using 8 color-coded intervals (0-800 ms). Patients were classified as localized (n=6) when the earliest interval appeared in 1 segment and nonlocalized (n=10) when it involved ≥2 segments. Ablation outcomes were compared according to whether a simple ablation approach (PVC elimination within 30 s at a single site) was achieved.

RESULTS: Baseline electrocardiographic characteristics were comparable between the groups. Ablation-related parameters, including contact force, power output, and impedance drop at the initial ablation site, were also similar. However, the nonlocalized group required statistically significantly greater total radiofrequency energy to eliminate the targeted PVCs (median, 22 206 versus 10 409 J; P=0.031) and demonstrated a statistically significantly lower rate of successful simple ablation approach compared with the localized group (20.0% versus 83.3%; P=0.035). Nonlocalized patterns may reflect conduction from deeper origins with preferential pathways, thereby requiring more complex ablation strategies.

CONCLUSIONS: A localized earliest-strain pattern was associated with successful PVC elimination using a simple ablation approach, whereas a nonlocalized pattern indicated the need for more complex ablation. This simple, noninvasive metric may aid preprocedural planning for left ventricular outflow tract PVC ablation.

PMID:42339551 | DOI:10.1161/CIRCEP.126.014913

Ann Bot. 2026 Jun 24:mcag178. doi: 10.1093/aob/mcag178. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Xylopodia and woody rhizomes are highly lignified belowground bud-bearing organs (BBOs) reaching extensive depths in soil, persisting through a viable belowground bud bank over many years. In this context, maintaining hydraulic functionality and storing resources are essential secondary xylem functions for their survival in environments prone to disturbances such as fire and drought. Here, we examine how secondary xylem traits vary between roots and both BBOs (woody rhizomes and xylopodia) in resprouting woody species from Cerrado.

METHODS: We evaluated cross-sections of secondary xylem from two BBO types and their taproots of ten native woody species in a Cerrado area under regeneration after decades of pine cultivation. We applied linear mixed models (LMMs) to test whether secondary xylem traits differ between roots and BBOs.

KEY RESULTS: Xylopodium-type BBOs had narrower, dense vessels, a higher fiber fraction, and lower hydraulic potential conductivity than their roots. Woody rhizome-type BBOs had narrower vessel diameters and lower densities than their roots. Woody rhizome-type BBOs had narrower vessels and a higher density than xylopodia. Xylem fractions (vessels, rays, and axial parenchyma) were not statistically different between roots and BBOs.

CONCLUSIONS: BBOs share similar strategies regarding storage capacity and mechanical support. Storage is a key trait for belowground bud bank resourcing during unfavorable periods and supporting resprouting after fire and drought. Fibers are essential for the mechanical stability of new branches. In addition, high lignification could help prevent wood decay and herbivory in the soil, as BBOs remain buried throughout the species’ lifespan.

PMID:42339527 | DOI:10.1093/aob/mcag178

Front Oral Health. 2026 Jun 8;7:1789741. doi: 10.3389/froh.2026.1789741. eCollection 2026.

ABSTRACT

BACKGROUND: Molar Incisor Hypomineralization (MIH) is one of the most prevalent enamel development defects in contemporary dental practice. Understanding perceptions, knowledge, and attitudes of professionals towards this condition is key to optimizing clinical protocols and improving therapeutic results.

OBJECTIVE: To evaluate the perception, knowledge and attitudes of Ecuadorian dentists about diagnosis and management of patients with MIH.

METHODS: A cross-sectional observational study was carried out using a self-administered survey of registered dentists in Ecuador. A validated 19-question questionnaire was applied that explored demographic characteristics, knowledge of etiology and prevalence, attitudes towards clinical management, and therapeutic choices. In addition, two clinical cases with photographic support were included to evaluate treatment decisions. The statistical analysis incorporated descriptive statistics, chi-square or Fisher’s exact tests, and multivariate logistic regression models.

RESULTS: A total of 352 dentists participated, predominantly working in private practice (71.9%), particularly in general dentistry (61.1%). Most practitioners reported observing MIH monthly (45.7%) and perceived an increase in its occurrence (67.0%). Demarcated opacities were the most frequent clinical manifestation (93.2%), with antibiotics being the main reported etiological factor (31.8%). The frequency of observation varied significantly between specialties (p < 0.05). Management was considered difficult, with durability of restorations being the main concern. Glass ionomer (37.5-71.4%) was the primary therapeutic choice, followed by fluoride varnish (22.6-37.5%). In the multivariate logistic regression model, professionals with 6-10 years of experience showed significantly higher odds of adequate knowledge (adjusted OR = 2.23, 95% CI: 1.14-4.37, p = 0.019). No independent predictors of favorable attitude towards MIH management reached statistical significance after multivariate adjustment.

CONCLUSIONS: MIH is recognized as a growing and complex problem. It is frequently observed with demarcated opacities as the predominant sign and antibiotics as the main etiological factor. Its management is challenging, and professional experience appears to influence clinical knowledge. Continuing education and the development of standardized clinical protocols are needed to strengthen professional competence in MIH management.

PMID:42339505 | PMC:PMC13284098 | DOI:10.3389/froh.2026.1789741