Nevin Manimala

Clin Transl Oncol. 2026 Jun 7. doi: 10.1007/s12094-026-04391-9. Online ahead of print.

ABSTRACT

PURPOSE: In patients with endometrial cancer (EC) with metastases at diagnosis, palliative treatment is the only therapy considered and to our knowledge there is no literature on the evolution of these patients following external-beam-irradiation (EBRT) and image-guided brachytherapy (IGBT). We present the clinical outcomes of 11 FIGO 2009 stage-IVB EC patients treated with IGBT ± EBRT.

METHODS/PATIENTS: From July 2009 to February 2018, 11 stage IVB patients were treated with IGBT ± EBRT in 4 European centres. The treatments and the outcomes of these patients were analysed.

STATISTICS: Kaplan-Meier and descriptive analysis were used for analysing overall survival (OS).

RESULTS: The median age was 63 years (46-79) and the median follow-up was 39 months (8-128). The sites of metastases were reported in 8/11 patients: the lung in 4 patients, peritoneal and liver metastasis in one, pleural metastasis in one, bone in one and inguinal lymph nodes in one. Seven patients underwent chemotherapy (5 achieving complete response (CR)). Two patients received IGBT alone and 9 EBRT + IGBT. Three developed uterine relapse, 3 lymph node relapse and all died. Four had distant metastases and only one was alive after treatment. The OS was 69.3% at 2 and 3 years and 41.6% at 5 and 10 years.

CONCLUSION: In this series, patients with stage IVB EC with CR after chemotherapy and treated with IGBT ± EBRT achieved an OS of 41.6% at 5 and 10 years. Local treatment with EBRT ± IGBT should be considered mainly in good responders to chemotherapy and should be validated in prospective trials including biological markers.

PMID:42251630 | DOI:10.1007/s12094-026-04391-9

Intern Emerg Med. 2026 Jun 7. doi: 10.1007/s11739-026-04424-9. Online ahead of print.

ABSTRACT

Existence of linguistic, gender and ethno-racial differences in patients with sepsis remains relatively unknown, especially in the public health domain. Retrospective analysis of data reported by a hospital in South Brooklyn to a New York State sepsis registry was undertaken over a 24-month period. Inclusion criteria were age over 18, available linguistic, gender and ethno-racial data, and registration in the New York State sepsis registry. Patients with missing data fields were excluded from the study. Primary outcome was the correlation of gender, race, ethnic & language-based differences with overall sepsis-based mortality. Secondary outcomes were the correlation of the same demographic variables with rates of mechanical ventilation, vasopressor use, intensive care unit (ICU) admission rates & overall incidence of sepsis and septic shock. Results: 677 patients were included in the final analysis in this single center retrospective observational cohort study and multiple statistically significant primary and secondary outcomes were found. Non-English-speaking patients had a higher incidence rate of sepsis-based mortality when compared to their English-speaking cohorts. The incidence rate difference is -0.36 (95% CI -0.49 to -0.22), with a P-value < 0.0001. A higher rate of vasopressor use was noted among non-English speaking patients when compared to their English speaking counterparts. The difference in incidence rates was -0.35, (95% CI -0.46 to -0.25) with a P-value of < 0.0001. Non-English-speaking patients had a higher incidence of receiving mechanical ventilation when compared to English-speaking cohorts. The incidence rate difference is -0.35 (95% CI -0.48 to -0.22), with a P-value < 0.0001. Non-English-speaking patients had a higher ICU admission rate with an incidence rate difference of -0.30, at a P value < 0.0001. Non-English-speaking patients had a higher sepsis incidence rate (0.70, 95% CI 0.63 to 0.78) compared to English-speaking patients (0.30, 95% CI 0.25 to 0.36), with a P-value of < 0.0001. Non-English-speaking patients experienced a higher incidence of septic shock (0.70, 95% CI 0.63 to 0.78) compared to English-speaking patients (0.30, 95% CI 0.25 to 0.36), with a P-value of < 0.0001. Caucasians showed statistically significant and higher rates across all primary and secondary outcomes albeit with greater statistical fragility. No significant differences were noted with regards to the impact of gender on all outcomes. Conclusion: Significant and multiple linguistic and ethno-racial differences were noted in this single center study with regards to sepsis-based morbidity and mortality outcomes. These differences need to be validated in larger, multi-center trials and could inform future efforts focused on identifying higher risk subsets in patients presenting with sepsis and septic shock in a public health setting.

PMID:42251623 | DOI:10.1007/s11739-026-04424-9

Int J Implant Dent. 2026 Jun 7. doi: 10.1186/s40729-026-00694-2. Online ahead of print.

ABSTRACT

PURPOSE: Accurate assessment of the distance between dental implants and the mandibular canal is essential for preventing nerve injury. Although cone-beam computed tomography (CBCT) is widely used for implant planning, its accuracy in resolving submillimeter distances remains uncertain. This study evaluated the measurement accuracy of CBCT for assessing distances below 1.0 mm.

METHODS: A custom phantom enabling 0.0-1.0 mm implant-canal distances in 0.1-mm increments was developed. CBCT images were acquired at varying distances, positional shifts (X, Y, Z), and tube voltages. Five dentists involved in implant treatment measured the implant-canal distances using medical-grade and general-purpose monitors. Measurement error and contributing imaging factors were statistically analyzed.

RESULTS: CBCT did not reliably distinguish distances ≤ 0.4 mm, with the greatest instability observed at 0.3 mm (interquartile range = 0.121). Although a linear trend was observed from 0.1 to 0.4 mm, variability exceeded clinically acceptable limits. For distances ≥ 0.5 mm, reproducibility was high, but CBCT consistently underestimated the true gap by 0.2-0.3 mm. The central field of view produced the most stable measurements, whereas accuracy decreased with off-center positioning. Tube voltage and monitor type had minimal influence on measurement accuracy.

CONCLUSIONS: CBCT cannot accurately identify implant-canal distances ≤ 0.4 mm, which may directly affect clinical risk assessment. Even for distances ≥ 0.5 mm, CBCT underestimates the true distance by 0.2-0.3 mm. These findings provide practical guidance for setting safe margins in implant planning and postoperative evaluation.

PMID:42251614 | DOI:10.1186/s40729-026-00694-2

Arch Gynecol Obstet. 2026 Jun 7;313(1):200. doi: 10.1007/s00404-026-08479-z.

ABSTRACT

PURPOSE: The aim of this study was to evaluate sexual function in the long term after total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LASH) in patients with benign indications.

METHODS: As part of a longitudinal follow-up, 74 patients who had originally participated in a prospective study on sexual function after TLH or LASH were surveyed again (TLH: n = 45; LASH: n = 29). The median follow-up period was 92 months (TLH) and 98 months (LASH). Sexual function was assessed using the validated Female Sexual Function Index (FSFI). Statistical analyses were performed using a 2 sample t test, Chi² test and Fisher’s exact test.

RESULTS: Over the long term, there was no significant difference in the FSFI total score between TLH and LASH (22.51 vs. 22.25, p-value: 0.261). Within the TLH group, sexual function remained stable compared to baseline data (p = 0.20). In contrast, the LASH group showed a significant deterioration in the total score (p = 0.028), particularly in the lubrication (p = 0.007) over time.

CONCLUSION: Both surgical methods ensure comparable sexual function. While TLH shows stable results over the years, LASH shows a significant decrease in some areas of sexual function, particularly with regard to lubrication. However, these differences do not result in a significantly worse overall outcome compared to TLH.

PMID:42251612 | DOI:10.1007/s00404-026-08479-z

Sports Med Open. 2026 Jun 7;12(1):64. doi: 10.1186/s40798-026-01014-z.

ABSTRACT

BACKGROUND: To our knowledge, no previous systematic review and meta-analysis of doping prevalence in sport from indirect estimation models (IEM) exists.

OBJECTIVE: To conduct a systematic review and meta-analysis of empirical IEM-based studies of admitted doping prevalence in sport.

METHODS: We conducted electronic database and ad hoc searches up to March 2025, and estimated lifetime and past year prevalence rates through a cross-classified model including prevalence (lifetime vs. past year), sample (competitive vs. recreational) and sports (multi-sport vs. single-sport) types.

RESULTS: Forty-six records (K) were included in the review (k [subset records included in the meta-analysis] = 30, n [independent studies from the records] = 34). The World Anti-Doping Agency’s definition of doping use was applied for data collection in most studies (k = 18), and doping prevalence was mostly assessed as past year/season (k = 20). Studies included in the meta-analysis were mostly conducted in Europe (k = 22) and applied the Unrelated Question (k = 8) and Forced Response with Cheater Detection (k = 6) models. Study participants were mostly multi-sport (k = 20) and competed at diverse levels, and most data (k = 28) was collected outside sport events. The corpus included articles that re-analysed existing data (k = 4). Lifetime prevalence was highest for multi-sport competitive athletes (22.6%) and lowest for single-sport competitive athletes (12.7%), whereas past year prevalence was highest for single-sport recreational sportspersons (15.5%) and lowest for multi-sport recreational sportspersons (8.7%).

CONCLUSIONS: Under IEM, about one of five multi-sport competitive athletes admitted to ever doping whereas about one of six of single-sport recreational sportspersons admitted to doping in the past year. Furthermore, multi-sport (vs. single-sport) competitive athletes show relatively higher doping prevalences, whereas single-sport (vs. multi-sport) recreational sportspersons report relatively higher doping prevalences. Secondary (re-)analysis presents a novel methodological challenge for meta-analyses. Registration PROSPERO: CRD42022373691.

PMID:42251609 | DOI:10.1186/s40798-026-01014-z

Am J Hosp Palliat Care. 2026 Jun 7:10499091261457550. doi: 10.1177/10499091261457550. Online ahead of print.

ABSTRACT

BackgroundMany studies exist outlining poor outcomes related to cardiopulmonary resuscitation (CPR) administered to patients who are elderly and/or have comorbid medical conditions with sudden cardiac arrest. Patients with asystole or pulseless electrical activity have worse outcomes. Studies show only 10% of patients with out-of-hospital cardiac arrest and initial asystole survive until they reach the hospital. Less than 5% survive until hospital discharge with good neurologic function.Research QuestionGiven these poor outcomes, the question arises: what are the impacts on the healthcare personnel providing this type of aggressive intervention?Study Design and MethodsThe study design was a cross-sectional, mixed-methods anonymous online survey of hospital personnel in one large academic setting. The survey included demographic questions and 6 questions regarding feelings around the use of CPR. Descriptive statistics were used to report on respondents and their responses. Thematic qualitative analysis of free-text responses was completed.ResultsOne-hundred fifty-four people of 780 (20%) responded to an anonymous survey sent to hospital personnel. Ninety-four percent of respondents were involved in a hospital code experience; 87% surveyed had performed CPR on an individual knowing there was a low likelihood of survival. Eight themes with subthemes were identified in the data. Participants primarily had challenging emotions associated with taking part in CPR including sadness and frustration.ConclusionsA large majority of healthcare workers surveyed in a single hospital system reported performing CPR on patients knowing there was a low likelihood of survival. Many respondents reported emotional effects.

PMID:42251604 | DOI:10.1177/10499091261457550

Phys Rev Lett. 2026 May 22;136(20):200401. doi: 10.1103/36fj-lsw7.

ABSTRACT

We theoretically investigate the role of spatial dimension and driving frequency in a nonequilibrium phase transition of a driven-dissipative interacting bosonic system. In this setting, spatial dimension is dictated by the shape of the external driving field. We consider both homogeneous driving configurations, which correspond to standard integer-dimensional systems, and fractal driving patterns, which give rise to a noninteger Hausdorff dimension for the spatial density. The onset of criticality is characterized by critical slowing down in the excited density dynamics as the system asymptotically approaches the steady state. By analyzing the system-size dependence of the asymptotic decay rate using numerical simulations of the full multimode dynamics, complemented by an analytical statistical mean-field treatment, we determine the lower critical dimension of the nonequilibrium phase transition. We show that this dimension can be noninteger and fractal in nature, and that it can be tuned continuously via the frequency detuning of the driving field.

PMID:42251579 | DOI:10.1103/36fj-lsw7

Phys Rev Lett. 2026 May 22;136(20):206101. doi: 10.1103/6n5m-rxc1.

ABSTRACT

Plastic deformation in amorphous solids is carried by localized shear transformations that self-organize into avalanches. In amorphous carbon modeled with a machine-learned interatomic potential, we find that the energetics and organization of these avalanches can be resolved by systematically following the underlying energy landscape. With a pseudoarclength numerical continuation framework, we decompose avalanches into constituent shear transformations and determine their strain-dependent energetics. Our analysis shows that, prior to onset, avalanches have a latent structure that consists of well-separated local minima. We further demonstrate that arclength continuation yields an event driven framework for following avalanche dynamics, eliminating time-step effects on statistical avalanche properties such as distributions of stress drops.

PMID:42251541 | DOI:10.1103/6n5m-rxc1

Urol J. 2026 May 24. doi: 10.22037/uj.v23i00.8445. Online ahead of print.

ABSTRACT

PURPOSE: To study the effect of Body mass index (BMI) on 24-h urine quantitative analysis in pediatric urolithiasis, and to explore whether obesity and overweight promote the formation of urinary calculi in children.

MATERIALS AND METHODS: A comprehensive search of EMBASE, Pubmed and the Cochrane Library, Web of Science, and Scopus were conducted in March 2024 and updated in October 2025 to find all related studies. BMI was used to specify the body size. And then, a predetermined inclusion and exclusion criteria was used to screen each article. Data from appropriate studies was extracted, a meta-analysis was performed using Stata14.0 software.

RESULTS: Eight studies, including 1033 children with urolithiasis who underwent 24-hour urine collection for chemical analysis, were included in this meta-analysis. The BMI ≥85th percentile group exhibited significantly higher uric acid excretion (SMD = 0.756, 95% CI = 0.092-1.420, P = .026). No statistically significant differences were found in calcium (SMD = -0.320, 95% CI = -0.600 to -0.050, P = .519), 24-h urine volume (SMD = -0.310, 95% CI = -0.790 to 0.160, P = .555), magnesium (SMD = -0.470, 95% CI = -0.820 to -0.120, P = .471), phosphate (SMD = -0.360, 95% CI = -0.610 to -0.110, P = .805), oxalate (SMD = -0.110, 95% CI = -0.390 to 0.170, P = .315), citrate (SMD = -0.190, 95% CI = -0.680 to 0.290, P = .057), or sodium (SMD = 0.200, 95% CI = -0.390 to 0.800, P = .050) excretion between the two groups. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSION: While overweight/obese children with urolithiasis demonstrate higher urinary uric acid excretion, the absence of significant differences in other key urinary risk factors suggests that BMI alone should not be considered a separate and definitive risk factor for pediatric urolithiasis.

PMID:42251510 | DOI:10.22037/uj.v23i00.8445

Urol J. 2026 May 24. doi: 10.22037/uj.v23i00.8514. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury is a common disease in hospitalized patients, which can have a significant impact on outcomes, including an increase in overall complications and mortality rates, criteria such as serum creatinine level, urinary output, And scoring systems such as KDIGO in acute conditions do not have acceptable specificity and sensitivity to evaluate the kidney function of people; Therefore, this study was conducted with the aim of determining the relationship between plasma uric acid level and mortality rate in patients with sepsis and acute kidney failure.

METHODS: In this descriptive-analytical (cross-sectional) study included 52 children , with the age range of one month to 15 years with sepsis (based on qSOFA criteria) and acute kidney failure (based on serum creatinine level) PICU of Ali Bin Abi Taleb Hospital from October 1401 to October 1402 were admitted and hospitalized, they were studied by census method. Within 48 hours after the admission of patients to the ICU, blood samples should be collected to check serum uric acid levels, electrolytes, albumin, complete blood count (CBC), kidney function tests, arterial blood gases, and chest x-rays. All patients were followed up until discharge or death due to progression of kidney failure. Finally, the findings of the research were analyzed using SPSS version 26 statistical software.

RESULTS: The mean age of patients was 3.66±4.92.The expired number in the hyperuricemia group was significantly higher than in the normal uric acid group (p-value = 0.03), an odds ratio of 3.45 indicates that a high level of uric acid is a risk factor for death. In this study, the duration of hospitalization was longer in those who survived (p-value = 0.02). A particularly strong predictor in our analysis was the QSOFA score (p < 0.001), highlighting its critical role in outcome alive or dead. Serum uric acid level and QSOFA scale showed no significant difference, in totally (p-value = 0.76), subgroup analysis from alive and death patients between uric acid and the QSOFA scale presented the same result (p-value = 0.203, p-value = 0.29, respectively) Conclusion: Finally, it can be stated that the level of uric acid can be considered as a laboratory variable to predict the prognosis of patients.

PMID:42251509 | DOI:10.22037/uj.v23i00.8514