Nevin Manimala

Surg Endosc. 2026 Aug 20. doi: 10.1007/s00464-026-13241-2. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate identification of anatomical landmarks such as loose connective tissue, nerves, the vas deferens, and microvessels is essential for transabdominal preperitoneal inguinal hernia repair (TAPP). However, this skill largely depends on the surgeon’s experience. EUREKAα (Anaut Inc., Tokyo, Japan), an artificial intelligence (AI)-based surgical support system, was approved in Japan in April 2024 to provide real-time intraoperative recognition and visualization of loose connective tissue.

METHODS: Of the 508 TAPP procedures performed between February 2020 and December 2025, 54 were carried out using real-time AI navigation (RAIN), whereas 454 were performed using conventional techniques. Patient characteristics, surgical outcomes, and postoperative complications were statistically analyzed to evaluate the effectiveness and safety of RAIN. Propensity score matching (PSM) was conducted.

RESULTS: The RAIN group showed significantly shorter operative times (48.6 vs. 38.6 min) compared with the conventional group, with no significant differences in postoperative complications. After PSM, 53 matched pairs of patients for each group. Mean operative time (49.2 vs. 38.5 min) was significantly shorter in the RAIN group compared to the conventional group.

CONCLUSIONS: Real-time intraoperative AI surgical support in TAPP was associated with shorter operative time without increasing postoperative complications. As the clinical use of EUREKAα is still in its early stages, its full value will be more clearly defined through future studies.

PMID:42622652 | DOI:10.1007/s00464-026-13241-2

Int J Legal Med. 2026 Aug 20. doi: 10.1007/s00414-026-03968-x. Online ahead of print.

ABSTRACT

Beyond its clinical applications, Dual-Energy X-ray Absorptiometry (DXA) offers potential for forensic biological profiling, particularly in cases involving fragmented remains. This study establishes proof of concept for the use of DXA-derived variables, including Area, Bone Mineral Density (BMD), and Bone Mineral Content (BMC) across proximal femoral regions for the estimation of sex, age, and stature. Predictive performance was evaluated by directly comparing traditional baseline methods (Discriminant Function Analysis and stepwise regression) against various algorithmic approaches, including classical statistical models and modern Machine Learning (ML) algorithms. Feature importance analysis revealed that Area and BMC were the primary predictors for sex and stature, while BMD was critical for age estimation, consistent with age-related bone loss. For sex estimation, classical Logistic Regression (LR) outperformed the traditional Discriminant Function Analysis (DFA) baseline, increasing accuracy from 90.7% to 93.4% while demonstrating minimal class-specific bias. In stature estimation, Gaussian Process Regression (GPR) improved upon traditional stepwise regression, reducing the estimation error from 4.53 cm to 4.06 cm in the mixed-sex sample. When the sex-specific models were applied, stature estimation errors were 4.28 cm for males and 3.25 cm for females. For age estimation, traditional regression and GPR demonstrated comparable performance in the mixed-sex group (errors of 9.32 and 9.60 years). However, the models exhibited systematic bias at chronological extremes due to regression to the mean. To mitigate this, sex-specific modeling was employed to enhance prediction precision. This study affirms the proximal femur’s potential as an effective “three-in-one” estimator when analyzed using DXA and demonstrates that the integration of optimized algorithms enhances overall predictive accuracy. These findings demonstrate the utility of DXA- and ML-based methods for future large-scale, population-specific forensic applications.

PMID:42622651 | DOI:10.1007/s00414-026-03968-x

Int J Speech Lang Pathol. 2026 Aug 20:1-15. doi: 10.1080/17549507.2026.2718365. Online ahead of print.

ABSTRACT

PURPOSE: This study explored the self-perceived competence of speech-language pathologists working in Australia to manage stuttering across the lifespan, factors influencing provision of evidence-based practice, and support needs to develop confidence in this area.

METHOD: A national online survey was completed by 147 practising speech-language pathologists. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using content analysis.

RESULT: Perceived competence was highest and above the competence threshold for assessment of stuttering across the lifespan and for working with pre-school children. Participants rated themselves below the competence threshold in one-third of measured areas, including troubleshooting therapy and discharging clients for school-age, adolescents, and adults who stutter. Adolescent stuttering received the most ratings below the competence threshold, specifically in selecting appropriate therapy, collaborating with teachers, and evaluating outcomes. Barriers to evidence-based practice included affordability, long waitlists, and session frequency. Factors affecting treatment success included systemic constraints, limited experience, and challenges applying research to diverse presentations. Speech-language pathologists emphasised the need for practical learning, observation, supervision, and accessible professional development.

CONCLUSION: Findings highlight self-reported gaps in competence and systemic barriers to managing stuttering. Support needs identified by speech-language pathologists provide evidence to inform future professional development and advocacy to improve services.

PMID:42622633 | DOI:10.1080/17549507.2026.2718365

J Obstet Gynaecol. 2026 Dec;46(1):2693660. doi: 10.1080/01443615.2026.2693660. Epub 2026 Aug 20.

ABSTRACT

BACKGROUND: To evaluate reproductive outcomes after hysteroscopic myoma resection and septal surgery in women with primary or secondary infertility.

METHODS: This monocentric retrospective cohort study included women with infertility who underwent hysteroscopic myoma resection or septal surgery between 2014 and 2021. Patients with uterine septa were divided into three groups, depending on the extent of the septa (mild, moderate and sub-/total). All procedures were performed by a single experienced surgeon. Pregnancy rates and live birth rates before and after surgery were compared.

RESULTS: Of 85 women who underwent hysteroscopic surgery, 65 were available for follow-up. After surgery, 55.4% achieved pregnancy and 44.6% had a live birth (p = .001). Live birth rates increased after both septal surgery (14.7 vs. 50%; p = .002; n = 34) and myoma resection (16.1 vs. 38.7%; p = .092; n = 31). In women with uterine septa, live birth rates improved significantly after surgery, independent of septum extent (mild: 16.67% vs. 50%; moderate: 13.64% vs. 50%; sub-/total: 16.67% vs. 50%). Postoperative reproductive treatment increased pregnancy rates (44.44% vs. 63.16%) but did not affect live birth rates (44.44% vs. 44.74%).

CONCLUSION: Hysteroscopic treatment of uterine septa and submucosal fibroids was associated with improved live birth outcomes in women with infertility. These findings suggest that, in suitable cases of infertility, hysteroscopic surgery should be considered.

PMID:42622621 | DOI:10.1080/01443615.2026.2693660

J Prim Care Community Health. 2026 Jan-Dec;17:21501319261481324. doi: 10.1177/21501319261481324. Epub 2026 Aug 20.

ABSTRACT

BackgroundAntenatal anxiety affects a substantial proportion of pregnant women worldwide, particularly in low- and middle-income countries. Despite associations with preterm birth and low birth weight, antenatal anxiety receives less screening attention than depression, even in Jordan.ObjectiveTo determine the prevalence of antenatal anxiety and associated sociodemographic and obstetric factors among pregnant women in Jordanian maternal and child health centers.MethodsThis cross-sectional, multicentre study included 182 pregnant women recruited from seven maternal and child health centers between June and August 2025 in Amman, Jordan. Pregnant women aged ≥18 years in their second or third trimester who were nulliparous or primiparous and had no pre-existing psychiatric disorders or high-risk pregnancies were included. Antenatal anxiety was assessed using the validated Arabic version of the Stirling Antenatal Anxiety Scale (SAAS). Sociodemographic and obstetric characteristics were collected using a structured questionnaire. Univariate analyses were performed using t-tests and one-way ANOVA, followed by multivariable linear regression to examine factors associated with antenatal anxiety.ResultsAmong 182 participants, 78.0% screened positive for elevated antenatal anxiety (SAAS ≥12). The highest-scoring SAAS item reflected concerns about fetal health, whereas concerns regarding maternal self-worth had the lowest scores. In univariate analysis, women with a history of abortion had significantly higher SAAS scores than those without such a history (22.11 vs. 19.06; p = 0.040). Within the multivariable regression model, abortion history was the only variable that showed a statistically significant independent association with higher SAAS scores after adjustment for the included covariates (B = 4.625, p = 0.007). However, the overall model demonstrated limited explanatory performance. No significant associations were observed for age, education, residence, income, delivery facility, gestational age, parity, stillbirth history, or infertility history.ConclusionAntenatal anxiety was highly prevalent among pregnant women attending Jordanian MCH centers. A history of abortion was the only factor showing an independent statistical association with higher antenatal anxiety scores, suggesting that women with a history of abortion may benefit from closer psychological assessment and support during antenatal care. Longitudinal studies are warranted to clarify its progression and assess culturally tailored interventions.

PMID:42622612 | DOI:10.1177/21501319261481324

Ther Adv Respir Dis. 2026 Jan-Dec;20:17534666261480225. doi: 10.1177/17534666261480225. Epub 2026 Aug 20.

ABSTRACT

BackgroundAcute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a lethal condition with mortality exceeding 50% at 3 months, driven by hyperinflammation. Elevated interleukin-6 (IL-6) is associated with poor outcomes. Tocilizumab (TCZ), an IL-6 receptor antagonist, may modulate this harmful inflammation.ObjectivesTo evaluate the efficacy and safety of tocilizumab combined with corticosteroids in AE-IPF.DesignRetrospective, propensity score-matched, case-control study.MethodsThirty-nine AE-IPF patients from a registry (NCT03666234) were included. Thirteen received tocilizumab (8 mg/kg) plus methylprednisolone, matched 1:2 to 26 receiving conventional therapy. The primary outcome was 3-month all-cause mortality or lung transplantation. Secondary outcomes included changes in ground-glass opacity (GGO) scores and inflammatory biomarkers.ResultsBaseline characteristics were balanced. A GGO score ≥18 predicted higher mortality (HR 5.01, 95% CI 1.47-17.14; p=0.01). In univariable analysis, TCZ was associated with a lower but non-significant risk of the 90-day composite endpoint compared with conventional therapy (unadjusted HR 0.39, 95% CI 0.13-1.18; p=0.095). In an exploratory multivariable Cox model adjusting for baseline GGO score and inflammatory markers, TCZ was associated with a significant risk reduction (adjusted HR 0.20, 95% CI 0.05-0.72; p=0.014). In exploratory subgroup analyses, TCZ was associated with marked risk reductions in high-risk subgroups: GGO score ≥18 (HR 0.07, 95% CI 0.01-0.36; p=0.002), moderate oxygenation impairment (HR 0.12, 95% CI 0.02-1.00; p=0.05), and elevated inflammatory markers (HR 0.26, 95% CI 0.08-0.82; p=0.021). Tocilizumab also reduced GGO scores (p=0.009). Severe infections occurred in 23.1% (3/13) of the tocilizumab group between post-treatment days 12 and 30.ConclusionIn this small, propensity-matched cohort, while the primary unadjusted analysis did not reach statistical significance, multivariable adjustment revealed a significant survival benefit signal associated with TCZ, particularly in patients with extensive ground-glass opacities or hyperinflammation. These findings suggest that TCZ may offer clinical advantages for specific high-risk AE-IPF subgroups, warranting validation in larger prospective trials.

PMID:42622607 | DOI:10.1177/17534666261480225

J ECT. 2026 Aug 20. doi: 10.1097/YCT.0000000000001311. Online ahead of print.

ABSTRACT

OBJECTIVES: Establishing intravenous access before each electroconvulsive therapy (ECT) session can be challenging, contributing to delays, sedation-related interventions, and treatment discontinuation. Implantable ports may reduce these barriers, yet factors associated with port placement are not well understood. This study examined correlates of port placement among patients receiving ECT.

METHODS: We conducted a retrospective cohort study of patients who received ECT at a single academic center between 2017 and 2025. The primary outcome was receipt of an implantable port for facilitation of ECT. Variables examined included age, sex, race, number of ECT sessions, history of catatonia, and history of autism spectrum disorder, using univariate statistical tests.

RESULTS: A total of 1057 patients were included; 27 (2.6%) received a port. Higher ECT session count was associated with port placement (P<0.001). The number of ECT sessions before port placement ranged from 0 to 135, with a median value of 11. The history of autism was more common among port recipients (6.6% in nonport patients vs. 22.2% with port, P=0.002). Female sex was associated with port placement (56.4% vs. 77.8%, P=0.027).

CONCLUSIONS: Higher treatment burden, history of autism, and female sex were associated with increased likelihood of port placement among patients receiving ECT. Recognition of these factors may support earlier consideration of port placement in patients anticipated to require prolonged or complex ECT courses.

PMID:42622601 | DOI:10.1097/YCT.0000000000001311

J Pediatr Health Care. 2026 Aug 19:S0891-5245(26)00225-7. doi: 10.1016/j.pedhc.2026.07.003. Online ahead of print.

ABSTRACT

BACKGROUND: Asthma is the most common childhood chronic disease in the United States and imposes a significant health care burden. Spirometry is a lung function test recommended routinely at well-child checks to assess asthma control.

PROBLEM: Despite national guidelines recommending routine spirometry, it remains underutilized in primary care.

METHODS: A quality improvement initiative integrated a spirometry eligibility protocol and provided education to APRNs and staff on spirometry administration and interpretation to improve its appropriate use among children with asthma.

RESULTS: Spirometry utilization among eligible patients increased from 0% to 25.9% (χ² [1, 100] = 12.78, p < .001), protocol adherence rate was 12.1%, and APRN perspective survey results increased by 14.8% (median = 20.25 [n = 4] vs. median = 23.25 [n = 4]; Z = -0.730, p = .465).

CONCLUSIONS: Spirometry education and protocol integration increased spirometry utilization in primary care and improved APRNs’ understanding of its role in pediatric asthma management.

PMID:42622579 | DOI:10.1016/j.pedhc.2026.07.003

J Hand Surg Am. 2026 Aug 19:S0363-5023(26)00524-1. doi: 10.1016/j.jhsa.2026.07.009. Online ahead of print.

ABSTRACT

PURPOSE: Suture button suspensionplasty (SBS) has gained popularity for the treatment of thumb carpometacarpal joint osteoarthritis; however, fractures of the index metacarpal (MC) at the site of fixation have been reported. The biomechanical effect of SBS on index MC integrity and the influence of K-wire drill hole trajectory remain incompletely understood. This cadaveric study evaluates the mechanical strength of the index MC following SBS using three commonly employed K-wire trajectories compared with native controls.

METHODS: Forty-three fresh-frozen cadaveric hands were randomized into four groups with differing K-wire hole trajectories: native control (n = 10); single central bicortical pass (BC; n = 11); dorsal unicortical followed by bicortical pass (DUC; n = 11); and volar unicortical followed by bicortical pass (VUC; n = 11). SBS was performed using a Mini TightRope. Index MCs were subjected to a custom cantilever bend test using a servo-hydraulic testing system until failure. Maximum load to failure and peak stress were calculated. Group comparisons were performed using heteroscedastic analysis of variance with post hoc testing, Welch t tests, and Bayesian analyses.

RESULTS: All index MCs failed via fracture at the K-wire hole fixation site. While a notable overall difference in maximum load among groups was observed, post hoc testing did not identify a single drill trajectory that conferred a statistically significant biomechanical advantage. When aggregated, SBS specimens demonstrated a 33% reduction in force-to-failure compared with native controls, with a large effect size and moderate to strong Bayesian evidence supporting reduced index MC strength after SBS. No statistically significant differences in peak stress were identified. Bayesian analysis of peak stress demonstrated weak evidence favoring VUC.

CONCLUSIONS: Suture button suspensionplasty considerably reduces the load-bearing capacity of the index metacarpal, independent of drill hole trajectory. The VUC construct demonstrated more favorable stress characteristics than DUC. These findings provide biomechanical context for reported index metacarpal fractures following SBS and may inform surgical technique and patient counseling.

TYPE OF STUDY/LEVEL OF EVIDENCE: Bench Research V.

PMID:42622577 | DOI:10.1016/j.jhsa.2026.07.009

JMIR Nurs. 2026 Aug 19;9:e96912. doi: 10.2196/96912.

ABSTRACT

BACKGROUND: Shift work disorder and insufficient sleep are prevalent among nurses, leading to fatigue, reduced well-being, and potential safety concerns. The increasing use of wearable sleep-tracking devices presents an opportunity to evaluate nurses’ sleep quality objectively.

OBJECTIVE: The primary objective was to evaluate the feasibility of wearable-based sleep monitoring and to obtain preliminary evidence of agreement with validated actigraphy among nurses. The secondary objective was to describe nurses’ sleep characteristics and to examine exploratory associations between sociodemographic characteristics, shift patterns, sleep hygiene, and sleep parameters.

METHODS: A 2-phase feasibility observational cohort study was conducted in a tertiary hospital in Singapore. In phase 1, 5 nurses concurrently wore a consumer-grade, wrist-worn Apple Watch Series 10 and a validated actigraph (GENEActiv; ActivInsights Ltd) for 2 weeks. Preliminary agreement between the Apple Watch and GENEActiv was examined using intraclass correlation coefficients. Feasibility was determined through wear-time compliance and data completeness. In phase 2, 50 nurses working rotating or single shifts completed demographic and work-related questionnaires and the Sleep Hygiene Index. Multiple linear regression analyses were performed to examine exploratory associations between selected covariates and sleep parameters, with adjustment for age, sex, BMI, parental status, workplace, total length of service, and sleep hygiene.

RESULTS: The Apple Watch showed preliminary evidence of agreement with GENEActiv for total sleep time, in-bed wake time, and sleep efficiency (intraclass correlation coefficients of 0.95, 0.72, and 0.69, respectively), with high wear compliance and minimal missing data, supporting its feasibility for sleep monitoring. Mean total sleep time was 381 (SD 55) minutes, and mean sleep efficiency was 94.77% (SD 4.11%). Shift nurses reported poorer sleep hygiene than nonshift nurses; however, shift work status was not independently associated with sleep outcomes after adjustment. Higher BMI was associated with shorter total sleep time (unstandardized coefficient B=-3.76 min/kg/m²; P=.01), reduced rapid eye movement sleep (unstandardized coefficient B=-1.18 min; P=.03), shorter core sleep (unstandardized coefficient B=-2.72 min; P=.02), and reduced time in bed (unstandardized coefficient B=-4.05 min; P<.01=.008). Age was negatively associated with deep sleep duration, with older age associated with less deep sleep (unstandardized coefficient B=-1.00 min/y; P=.003).

CONCLUSIONS: Apple Watch-based monitoring was feasible and showed preliminary agreement with actigraphy. Nurses slept less than recommended, and BMI and age were associated with sleep outcomes in exploratory analyses. These findings support larger studies and workplace strategies to improve sleep opportunity and healthy sleep behaviors.

PMID:42622562 | DOI:10.2196/96912