Nevin Manimala

Am J Speech Lang Pathol. 2026 Jun 24:1-15. doi: 10.1044/2026_AJSLP-25-00087. Online ahead of print.

ABSTRACT

PURPOSE: Dysarthria, drooling, and swallowing disorders are common motor problems in people with Parkinson’s disease (PwP), leading to significant physical, emotional, and functional impairments that compromise quality of life. However, evidence on the progression of these disorders and their relationship with other features of Parkinson’s disease (PD) remains scarce. This study aimed to investigate the progression of dysarthria, drooling, and swallowing disorders in PwP and identify predictors of progression.

METHOD: A 1-year prospective cohort study was conducted with 73 PwP. Dysarthria was assessed using the Frenchay Dysarthria Assessment-Second Edition (FDA-2), drooling with Item 2.2 (Saliva and drooling) of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), and swallowing with the Swallowing Clinical Assessment Score in Parkinson’s Disease (SCAS-PD). The FDA-2 and SCAS-PD rely on clinician assessment, whereas MDS-UPDRS Item 2.2 (Saliva and drooling) assesses patient-reported problems with saliva control. The Wilcoxon signed-ranks test for paired samples was used to compare baseline and 1-year follow-up scores, and linear regression was used to identify predictors of progression.

RESULTS: Dysarthria worsened significantly (p < .001) after 1 year and was predicted by poorer cognitive (β = -.02; SE = 0.01; p = .02) and motor performance (β = .48; SE = 0.21; p = .03). Drooling and swallowing showed a trend toward deterioration, although these changes were not statistically significant (p > .05).

CONCLUSIONS: After 1 year, dysarthria worsened significantly, while drooling and swallowing showed a tendency to decline, but did not reach statistical significance. Assessments based on clinician and patient reports may have limited sensitivity to subtle changes. Dysarthria progression reflected overall PD severity, with poorer cognitive and motor performance emerging as key predictors. These findings highlight the importance of routine clinical monitoring of these domains and support future studies using instrumental assessments (e.g., acoustic analysis and videofluoroscopic swallow studies) to better capture progression in dysarthria, drooling, and swallowing disorders.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32764596.

PMID:42340753 | DOI:10.1044/2026_AJSLP-25-00087

JAMA Netw Open. 2026 Jun 1;9(6):e2621632. doi: 10.1001/jamanetworkopen.2026.21632.

ABSTRACT

IMPORTANCE: Suicide is a leading cause of death among US adolescents, and restrictive abortion policies may influence suicide risk by increasing uncertainty and reducing perceived control over life trajectories, particularly among female adolescents who face disproportionate barriers to abortion access. Following the 2022 US Supreme Court decision in Dobbs v Jackson Women’s Health Organization, multiple states implemented total abortion bans. Their association with adolescent suicidality has not been quantitatively assessed.

OBJECTIVE: To evaluate whether implementation of total abortion bans was associated with suicidal ideation and suicide attempts among female high school students.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used difference-in-differences and event-study analyses of data from the Centers for Disease Control and Prevention Youth Risk Behavior Surveys (2017, 2019, 2021, and 2023) conducted among female and male students in grades 9 to 12 at public high schools in 15 participating states. Analyses were conducted between January 2025 and February 2026 and stratified by sex.

EXPOSURE: State-level implementation of a total abortion ban during the 12 months preceding survey administration.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were self-reported suicidal ideation (serious consideration or planning) and suicide attempts (≥1) in the past 12 months, measured using Youth Risk Behavior Survey items.

RESULTS: The analytic sample included 338 324 students (median [IQR] age, 16 [15-17] years), of whom 169 967 (50%) were female. Among female students, increases in suicidal ideation were greater in states that implemented abortion bans than in states that did not (adjusted difference-in-differences estimate, 4.3 [95% CI, 1.6 to 6.5] percentage points). For suicide attempts, the corresponding estimate was similar but less precise and did not reach statistical significance (adjusted difference-in-differences estimate, 3.2 [95% CI, -0.4 to 6.1] percentage points). Among male students, estimates were smaller and not statistically significant (adjusted difference-in-differences estimate: ideation, 1.1 [95% CI, -0.9 to 4.4] percentage points; attempts, -0.3 [95% CI, -3.2 to 6.6] percentage points). For both sexes, event-study estimates reinforced the difference-in-differences findings and showed no evidence of differential prepolicy trends.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of high school students, implementation of total abortion bans was associated with increased suicidal ideation among female students, with similar but less precise estimates observed for suicide attempts. These findings suggest that the policies in these states may adversely influence female adolescents’ mental health and underscore the importance of accessible suicide prevention and mental health services in affected states.

PMID:42340717 | DOI:10.1001/jamanetworkopen.2026.21632

JAMA Psychiatry. 2026 Jun 24. doi: 10.1001/jamapsychiatry.2026.1438. Online ahead of print.

ABSTRACT

IMPORTANCE: Surveys have indicated that patients and clinicians can overestimate the efficacy and safety of drugs approved by the US Food and Drug Administration (FDA). In recent years, only approximately half of new drug approvals have been based on 2 or more adequate and well-controlled trials; furthermore, regulations do not limit how many trials can be conducted or provide clear guidance on how the FDA should consider a drug with conflicting evidence of benefit from multiple trials.

OBJECTIVE: To understand how the FDA evaluated a single investigational drug with positive and negative preapproval trials.

FINDINGS: The case of gepirone extended release (ER), approved for major depressive disorder, was reviewed. The FDA based its efficacy evaluation of gepirone ER on 13 trials: 12 acute treatment trials and 1 maintenance or relapse prevention trial. The FDA judged 2 acute treatment trials as positive. In the others, gepirone ER did not demonstrate superiority to placebo; and for 3, the FDA found evidence of statistical inferiority to an active comparator. Concerned that the positive trials might have occurred by chance and the amount of countervailing evidence, the FDA rejected the New Drug Application from the sponsor 4 times (Organon in 1999, 2002, and 2004, and Fabre-Kramer Pharmaceuticals, Inc in 2007). In 2014, the sponsor filed a dispute resolution request, leading to intervention by senior FDA leaders. In 2015, an FDA Advisory Committee voted that drug efficacy had not been demonstrated. Nevertheless, FDA leaders came to agree with the sponsor’s arguments that the 2 positive trials had not occurred by chance and that the drug satisfied the FDA statutory standard for efficacy, and the drug was approved.

CONCLUSIONS AND RELEVANCE: The case of gepirone shows how the FDA evaluated an investigational drug with conflicting evidence. The FDA sometimes exercises “regulatory flexibility” and focuses on statistical (as opposed to clinical) significance in a few trials, allowing the approval of drugs with scant benefits. Product labeling should transparently report on all adequate and well-controlled trials relating to an FDA-approved indication, not just those with positive outcomes, so that clinicians can make better-informed prescribing decisions.

PMID:42340691 | DOI:10.1001/jamapsychiatry.2026.1438

Cutan Ocul Toxicol. 2026 Jun 24:1-10. doi: 10.1080/15569527.2026.2692370. Online ahead of print.

ABSTRACT

BACKGROUND: Multimodal Large Language Models (LLMs) are increasingly positioned as diagnostic assistants in dermatology. However, current research often relies on clear-cut cases, leaving their performance in clinically ambiguous, gray zone scenarios insufficiently explored. Specifically, whether integrating visual data helps LLMs correct initial human misdiagnoses or reinforces cognitive biases remains unknown.

OBJECTIVES: To evaluate the diagnostic accuracy of three recent multimodal large language models all queried through their default web interfaces on 5 February 2026, using standardized single-turn prompts in biopsy-confirmed dermatologic cases initially misdiagnosed by clinicians, and to assess the impact of visual integration on human error replication rates.

METHODS: A cross-sectional analysis was conducted on 30 diagnostic dilemmas confirmed by histopathology. Models were queried using a two-stage protocol: (1) Text-Only and (2) Multimodal. Primary outcomes were Top-1 accuracy, visual gain, and the rate of replicating the clinician’s initial error.

RESULTS: Gemini 3 achieved the highest multimodal Top-1 accuracy (60.0% (18/30), followed by ChatGPT-5.2 at 56.7% (17/30) and Claude 4.5 Sonnet at 33.3% (10/30). In the inflammatory subgroup, Gemini 3 accuracy increased from 45.5% (5/11) in text-only to 72.7% (8/11) in multimodal mode; this difference was not statistically significant (McNemar’s test, p = 0.248). All models showed limited accuracy for malignant lesions using macro-images.

CONCLUSIONS: While Gemini 3 shows promise as a de-biasing tool in complex inflammatory dermatoses, multimodal LLMs currently lack the granular precision required for malignancy detection without dermoscopic data. These findings underscore the need for cautious integration of AI in high-stakes diagnostic scenarios.

PMID:42340682 | DOI:10.1080/15569527.2026.2692370

Interdiscip Cardiovasc Thorac Surg. 2026 Jun 24:ivag173. doi: 10.1093/icvts/ivag173. Online ahead of print.

ABSTRACT

OBJECTIVES: We examined whether cardiopulmonary exercise testing (CPET) variables predict 30‑day postoperative complications in patients undergoing anatomical resection for non‑small cell lung cancer (NSCLC).

METHODS: Consecutive patients who underwent segmentectomy or greater between January 2023 and March 2025 at a single tertiary center were reviewed. All patients underwent CPET within 30 days preoperatively. Data on demographics, comorbidities, pulmonary function, operative factors, and outcomes were collected. Associations were assessed using univariable and multivariable logistic regression; discrimination was evaluated with receiver operating characteristic curve (ROC). Results with two‑sided α = 0.05 were considered significant. Statistical analyses were conducted with R 4.4.2 (stats).

RESULTS: Among 353 patients (mean age 68.4 ± 8.4 years; 58.1% male individuals), 33 (9.4%) experienced complications. Patients were older (71.8 vs 68.0 years) and more often male individuals (81.8% vs 55.6%) than controls; they had lower BMI (23.1 vs 24.4 kg/m2) and lower FEV1/FVC (69.5% vs 72.7%). In the univariable analysis, age (OR 1.07), female sex (OR 0.28 vs male), BMI (OR 0.88 per kg/m2), FEV1/FVC (OR 0.96 per %), VE/VCO2 slope (OR 1.06 per unit), attained stage (OR 0.66 per stage), and operation time (OR 1.58 per hour) were associated with complications. In the multivariable analysis, BMI (OR 0.86, 95% CI 0.75-1.00), FEV1/FVC (OR 0.94, 95% CI 0.90-0.99), and VE/VCO2 slope (OR 1.06, 95% CI 1.00-1.11) remained independent predictors. ROC curves showed poor discrimination: VO2peak AUC, 0.52; AT, 0.59; VE/VCO2 slope, 0.40; and AT time 0.43. Dichotomized cut‑offs were generally non‑informative.

CONCLUSIONS: Individual CPET variables had limited discriminative accuracy (AUC < 0.6). CPET should complement clinical and spirometric predictors rather than serve as a stand‑alone gatekeeper.

PMID:42340681 | DOI:10.1093/icvts/ivag173

Bioinformatics. 2026 Jun 24:btag371. doi: 10.1093/bioinformatics/btag371. Online ahead of print.

ABSTRACT

MOTIVATION: Identifying robust microbial biomarkers is crucial for disease diagnosis and prediction, elucidation of biological mechanisms, and development of targeted therapies. Machine learning-based approaches, particularly the random forest model, have been widely used for biomarker identification during sample stratification. However, those biomarkers often vary considerably for the same disease, limiting their practical applicability. A robust framework for reliable biomarker identification in microbiome research is needed. To address this gap, we proposed a prevalence-aware feature selection framework (ParSlet) that incorporates a universal scaling relationship between taxon prevalence and selection frequency.

RESULTS: We first identified a universal exponential scaling law linking the probability of a taxon being consistently recognized as a biomarker versus its prevalence. Then, we integrated this scaling law with taxa prevalence into the biomarker identification using random forest. We systematically evaluated this approach in both simulated microbiome datasets and real-world microbiome datasets and compared it with existing methods, finding that our integrated approach generally improved feature stability and reproducibility of biomarker identification. In colorectal cancer (CRC) datasets, our method robustly identified well-established microbial biomarkers such as Ruminococcus, Clostridium_XVIII, and Faecalibacterium. Integrating a prevalence-based scaling adjustment into feature importance enhances the stability of microbiome biomarker identification. This approach holds promise for enabling more reliable disease diagnostics, uncovering generalizable microbial signatures across cohorts, and guiding the development of targeted microbiome-based interventions.

AVAILABILITY: ParSlet is available at https://github.com/KelabatOSU/Feature_selection.

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:42340677 | DOI:10.1093/bioinformatics/btag371

Radiol Med. 2026 Jun 24. doi: 10.1007/s11547-026-02242-9. Online ahead of print.

ABSTRACT

INTRODUCTION: To evaluate the efficacy and safety of single-fraction LINAC-based radiosurgery (RS) for patients with drug-resistant trigeminal neuralgia (TN).

MATERIALS AND METHODS: We retrospectively reviewed 46 patients treated for TN between August 2008 and December 2024, 42 were evaluable. RS was delivered with a linear accelerator equipped with a micro-multileaf collimator. Diagnostic cisternography sequence MRI was co-registered with the CT plan to delineate the target volume and develop the treatment plan. The CTV was contoured on the retro-Gasserian ganglion. The dose was prescribed to the isocentre for all patients. The prognostic impact of parameters such as sex, side of TN, previous surgery, radiotherapy dose, clinical response probability, and response onset time was assessed. Statistical analysis was performed using the MedCalc software package and the Kaplan-Meier product limit method. Acute and late toxicities were graded according to the CTCAE v5.0 scale.

RESULTS: Patient characteristics For the 46 treated patients were as follows: 29 out of 46 females (63%) and 17 out of 46 males (37%), with a median age of 63 years (range, 32-88), and Karnofsky Performance Status (KPS) was 90 (range, 80-100). The median planning target volume (PTV) was < 0.1 cc. Dosimetric characteristics Median prescribed dose was 70 Gy (range, 40-75 Gy). Four patients were lost during follow-up, so overall 42 of the 46 patients were evaluable for RS response analysis. Clinical Outcomes After a very long median follow-up of 8.5 years (range, 0.6-13.5 years), the clinical response probability was 92% ± 4% at 1 year, 71% ± 7% at 2 years, and 53% ± 9% at 5 years. The median time to response onset was 3 months (range, 1-16 months), and the median clinical response probability was 62 months (range, 37-158 months). In the univariate analysis, there was a statistically significant difference in clinical response probability favouring the higher dose ≥ 70 Gy (p = 0.0036) with HR (CI 95%) of 3.5 (1.4-8.5). However, achieving an initial complete response did not significantly affect the duration of the response. Toxicity No acute toxicity was recorded. Chronic toxicity was rare, with two patients (4%) developing G2 hearing loss and one (2%) experiencing G1 tearing and paresthesia.

CONCLUSION: LINAC-based RS is a safe and effective non-invasive option for the treatment of medically refractory TN, particularly for patients without a neurovascular conflict but with significant comorbidities or contraindications to surgery. To obtain maximal and durable results, the prescribed dose must be at least 70 Gy and it is necessary to adhere to stringent dose constraints to maintain a low toxicity rate.

PMID:42340657 | DOI:10.1007/s11547-026-02242-9

Radiol Med. 2026 Jun 24. doi: 10.1007/s11547-026-02241-w. Online ahead of print.

ABSTRACT

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are pancreatic cystic lesions originating from the pancreatic ducts, characterized by mucin production and progressive ductal dilation. They exhibit a wide spectrum of biological behavior, ranging from indolent lesions to entities with significant malignant potential. Although the 2024 Kyoto guidelines define worrisome features (WF) and high-risk stigmata (HRS) to support risk stratification and clinical management, predicting disease progression remains challenging. In this retrospective study, we investigated whether MRI-based radiomic analysis could identify, at the time of initial imaging, patients with BD-IPMNs who subsequently develop WF or HRS according to 2024 Kyoto guidelines. A total of 194 adult patients who underwent at least two MRI examinations between January 2011 and March 2025 were included, with a median follow-up of 53 months; progression was observed in 28.3% of patients, involving only some WF/HRS. Radiomic analysis included manual lesion segmentation, extraction of 107 features (shape, first- and second-order), and selection via LASSO within a weighted logistic regression framework to address class imbalance, using fivefold cross-validation; model performance was assessed with AUC and precision-recall metrics to account for skewed class distribution. After statistical analysis, nine shape-related features were found to be significant and a LASSO-based radiomic model, incorporating five features, was constructed. The model achieved an area under the curve (AUC) of 0.70 (95% CI 0.62-0.79). These results suggest that MRI-based radiomics may represent a valuable noninvasive tool for early risk stratification, predicting progression according to clinical-radiological criteria and potentially supporting personalized management of patients with BD-IPMNs. However, this study presents some limitations, including the retrospective design, the relatively small sample size and possible variability due to the use of multiple MRI scanners from different vendors. Prospective and multicentric studies with standardized imaging protocols are necessary to validate these findings and assess the added value of integrating radiomic data with clinical, histopathological and molecular information.

PMID:42340656 | DOI:10.1007/s11547-026-02241-w

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00955-5. Online ahead of print.

ABSTRACT

The sphenoid sinus (SS) exhibits significant anatomical variability that critically impacts the safety and efficacy of endoscopic transsphenoidal surgery. This systematic review and meta-analysis aims to establish global prevalence rates for SS pneumatization patterns, extensions, and the relationship with adjacent neurovascular structures to guide surgical planning. A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science until October 2025. Studies reporting SS pneumatization types, extensions, and neurovascular protrusions/dehiscences based on imaging or cadaveric dissection were included. Random-effect models were used for the meta-analysis. The sellar type was the predominant pneumatization pattern, with the complete sellar type accounting for 48.39%. Statistically significant results were identified based on nationality and study type. Extensions into the greater wing (34.17%) and pterygoid process (25.51%) were common. The Vidian nerve (VN) showed the highest rates of protrusion (32.61%) and dehiscence (14.60%), followed by the internal carotid artery (ICA) (protrusion: 29.77%; dehiscence: 9.47%) and optic nerve (ON) (protrusion: 23.46%; dehiscence: 10.92%). The imaging modality used did not affect the neurovascular structure variations. The SS is a highly variable structure with frequent extensions that expose vital neurovascular structures to surgical risk. Although the subgroup analyses did not depict statistically significant results, computed tomography scan with less than 1 mm slice thickness should be used for evaluation of SS anatomy. The high prevalence of VN and ICA dehiscence necessitates rigorous preoperative evaluation. These findings provide a crucial anatomical reference for optimizing surgical approaches and minimizing complications in skull base surgery.

PMID:42340651 | DOI:10.1007/s12565-026-00955-5

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00952-8. Online ahead of print.

ABSTRACT

Computed Tomography (CT) imaging has expanded possibilities for biological profile estimation in forensic contexts. This study examined whether two-dimensional (2D) morphometric measurements and Hounsfield Unit (HU) values derived from CT scans of dry proximal femora could reliably estimate sex, stature, and age, and whether machine learning (ML) could meaningfully improve on traditional methods. Three hundred left femora from Thai individuals were scanned, and mid-coronal sections were used to extract measurements from defined anatomical regions. For sex estimation, conventional estimation equations reached 93.2% accuracy, while Naïve Bayes classification achieved 96.5% as the best performance among the ML models tested. Stature estimation using sex-specific 2D parameters yielded a Standard Error of Estimate (SEE) of 4.43 cm, which dropped to 3.96 cm when Support Vector Machines (SVM) and Gaussian Process Regression (GPR) were applied. Age estimation relied on HU values, which showed a consistent negative relationship with age. The lowest SEE for age was 9.67 years from measurements at the Primary Tensile Line (PTL) and Ward’s Triangle in females. Models also performed better when applied to older age groups. Although sex-specific equations outperformed mixed-sex ones, the latter were kept in the analysis as a practical alternative when sex cannot be established prior to analysis. Overall, 2D morphometrics proved most useful for sex and stature estimation, while HU values emerged as a reliable, quantitative approach to age estimation. ML consistently improved model performance across all three estimation tasks, supporting its role in modern forensic anthropological practice.

PMID:42340647 | DOI:10.1007/s12565-026-00952-8