Category: Nevin Manimala

Phys Med. 2026 May 7;146:105812. doi: 10.1016/j.ejmp.2026.105812. Online ahead of print.

ABSTRACT

PURPOSE: To develop an automated class-solution treatment-planning workflow for biologically guided dose-painting based on combined FDG- and FMISO-PET in head and neck cancer (HNC), and to compare its performance with manual planning.

MATERIAL AND METHODS: The workflow incorporating image-processing and treatment planning via a class-solution template was implemented in RayStation-10B-R and applied to patients imaged with FDG- and FMISO-PET/CT. The workflow converted FMISO- and FDG-PET uptake into oxygen partial pressure and clonogenic cell-density distributions, respectively. Accordingly, simultaneous integrated boost plans aiming at 95% tumour control probability (TCP) and using a dose-painting-by-contours approach for TV1, TV2, the GTV, and the hypoxic target volume (HTV), were created. For nine patients, automated and manual plans were compared using equivalent dose in 2-Gy fractions (EQD2)-based target metrics, organ-at-risk (OAR) doses, plan-complexity parameters, planning time, TCP and normal tissue complication probability (NTCP).

RESULTS: The automated workflow generated plans achieving target coverage; however not all plans met mandatory OAR constraints. In the nine-patient comparison, no statistically significant differences were found in OAR metrics or TCP/NTCP, except for the right parotid EQD2_mean, which favoured manual plans. Target results were mixed: template plans performed better for inner volumes, whereas manual plans showed higher EQD2_mean in the TV1-TV2 and HTV. Manual planning required ∼ 1 h, whereas automated planning required ∼ 5 h with no user interaction.

CONCLUSIONS: A scripting-based, biologically guided class-solution for dose-painting in HNC is feasible and achieves plan quality and radiobiological outcomes comparable to manual planning, providing a platform for standardised and adaptive radiotherapy workflows.

PMID:42102428 | DOI:10.1016/j.ejmp.2026.105812

Cortex. 2026 Apr 23;201:10-39. doi: 10.1016/j.cortex.2026.04.006. Online ahead of print.

ABSTRACT

The contralateral delay activity (CDA) is a widely used electrophysiological marker of visual working memory (VWM), yet recent work has questioned whether typical sample sizes in CDA studies are sufficient to robustly detect set size effects and brain-behavior correlations. As part of the #EEGManyLabs initiative, the present multi-site replication study aimed to rigorously test replicability of the key findings of Vogel and Machizawa (2004)using a large sample of 304 participants across 10 laboratories and a preregistered analysis plan. We replicated the expected contralateral-ipsilateral asymmetry and observed increases in CDA amplitude from set size 2 to 4 and from set size 2 to 6. In contrast, the hypothesized positive correlation between the CDA increase from set size 2 to 4 and individual VWM capacity was not replicated in the preregistered meta-analytic correlation. Across different pipelines and statistical analyses, the meta-analytic correlation estimate was small (r = .15) and substantially attenuated relative to the original effect size in Vogel and Machizawa (2004)study (r = .78). To contextualize these findings, we applied a funnel-plot diagnostic combining published effects with the #EEGManyLabs data, indicating small-study inflation and publication bias. Taken together, our results indicate that reports of strong correlations between CDA amplitude and VWM capacity may have been overestimated, in part because statistically significant findings were selectively reported. Our results highlight the importance of open science practices, including well-powered, preregistered studies with transparent data and analysis pipelines, in order to characterize the magnitude and robustness of individual-difference associations in psychophysiology.

PMID:42102425 | DOI:10.1016/j.cortex.2026.04.006

J Neurosurg Spine. 2026 May 8:1-8. doi: 10.3171/2025.10.SPINE241562. Online ahead of print.

ABSTRACT

OBJECTIVE: Interventional pain management physicians (IPMPs) and spine surgeons are allies in treating spinal disorders. In addition to medical management, IPMPs can perform procedures such as epidural injections, rhizotomies, or kyphoplasties to bring relief to patients. However, some IPMPs perform procedures traditionally performed by spine surgeons, such as minimally invasive spine surgery, neural decompression, and spinal fusion. The line between spine procedures performed by spine surgeons and interventional pain management procedures performed by IPMPs has blurred. This study aimed to determine the incidence of IPMPs performing interventional spinal procedures traditionally performed by spine surgeons.

METHODS: IPMPs were identified through the American Society of Interventional Pain Physicians (ASIPP) DoctorFinder database. Each physician’s Scopus profile was evaluated to determine academic productivity. Personal physician websites were queried to determine whether they offered minimally invasive or open spinal procedures. Potential associations and differences among IPMPs performing interventional spinal procedures were analyzed using descriptive statistics, independent-sample t-tests, and chi-square analyses.

RESULTS: After neurosurgeons and orthopedic surgeons were removed from the initial list of 325 registered healthcare providers, 269 providers were included in the analysis (mean [SD] age, 56.3 [9.6] years). Physician degrees included MD (n = 237) and DO (n = 32). Some physicians held an additional degree (MS [n = 4], PhD [n = 4], and unspecified [n = 38]). Of the 269 healthcare providers, 130 had Scopus research profiles (mean publications, 24.2; mean h-index, 6.0; mean citations, 925.6). Seventy-four physicians (27.5%) performed interventional spinal procedures: 35 (13.0%) performed minimally invasive lumbar decompression (mild procedure), 33 (12.3%) performed Superion or Vertiflex interspinous spacer insertion, 18 (6.7%) performed spinal arthrodesis or fusion, 26 (9.7%) performed discectomies, 11 (4.1%) performed Minuteman interspinous-interlaminar fusion, 1 (0.4%) performed disc replacement, and 14 (5.2%) performed other unspecified decompressive spinal procedures. There were no significant differences in age (p = 0.62), publication number (p = 0.19), h-index (p = 0.53), citation count (p = 0.44), and fellowship incidence (p = 0.19) between IPMPs who performed interventional spine procedures and those who did not. No significant associations were found between sex (p = 0.19), medical degree (MD: p = 0.07, DO: p = 0.11), or number of publications (p = 0.38) and whether interventional spinal procedures were performed.

CONCLUSIONS: The incidence of invasive spine procedures performed by IPMPs is high. Future studies must analyze patient-reported outcomes, and differences in the training for traditional spine surgery interventions performed by surgeons and interventional pain spinal procedures performed by IPMPs must be better defined.

PMID:42102410 | DOI:10.3171/2025.10.SPINE241562

J Neurosurg Spine. 2026 May 8:1-10. doi: 10.3171/2025.12.SPINE25166. Online ahead of print.

ABSTRACT

OBJECTIVE: Traumatic central cord syndrome (TCCS) is the most common incomplete spinal cord injury, yet the optimal management strategy remains controversial, particularly for older adults who often present with worse outcomes. The authors aimed to determine whether surgical intervention confers different benefits across age groups, focusing on 1-year functional and neurological recovery.

METHODS: The authors retrospectively analyzed 890 patients with TCCS from the multi-institutional Spinal Cord Injury Model Systems (SCIMS) Database between 2006 and 2021. TCCS was defined as an American Spinal Injury Association (ASIA) Impairment Scale grade C or D cervical injury and at least a 5-point discrepancy favoring lower extremity motor score over upper extremity motor score. Missing admission ASIA data were addressed via validated random forest imputation. The authors compared surgical versus nonsurgical groups using full optimal matching to reduce confounding, achieving balanced cohorts (698 patients in the surgical group vs 179 in the nonsurgical group). The authors then applied a causal forest algorithm to detect heterogeneous treatment effects and used segmented regression to identify age-related inflection points. The primary outcome was the Physical Function Composite Score (PFCS) (range 0-300), which captures physical independence, mobility, and occupational function. Sensitivity analyses further evaluated neurological recovery on the basis of ASIA motor scores and stricter criteria for TCCS identification after the exclusion of imputed data.

RESULTS: Across the matched cohort, surgery was associated with mean PFCS improvement of 6.6 points (95% CI -4.5 to 17.8), which did not reach statistical significance. However, subgroup analysis revealed that age was the strongest effect modifier of surgical benefit (relative importance 42.8%, p < 0.001). Segmented regression identified an inflection at approximately 64 years of age. Patients older than 64 years demonstrated a significant improvement of 34.7 points (95% CI 12.2-57.2), whereas younger individuals showed no statistically significant surgical benefit (-4.1 points, 95% CI -16.8 to 8.6). All sensitivity analyses were consistent with the results of our primary findings.

CONCLUSIONS: The authors’ findings suggest that the effectiveness of surgical intervention for TCCS may be influenced by age, with adults older than 64 years experiencing differentially greater functional and neurological benefit. These results may inform patient-specific treatment decisions and clinical guidelines. Prospective research is needed to validate these observations, elucidate underlying mechanisms, and guide evidence-based TCCS management.

PMID:42102409 | DOI:10.3171/2025.12.SPINE25166

J Neurosurg Pediatr. 2026 May 8:1-14. doi: 10.3171/2025.12.PEDS25331. Online ahead of print.

ABSTRACT

OBJECTIVE: Tethered cord syndrome (TCS) is heterogeneous, and a filum with lipomatous tissue can present in multiple patterns. The aim of this study was to determine whether filum characteristics are associated with particular symptomatology.

METHODS: A descriptive cross-sectional retrospective study was conducted over 2 years (2023-2025) at a single institution. Patients with TCS and filum with lipomatous tissue were evaluated using 24 TCS-related variables and 10 filum-related variables. Statistical methods included using the chi-square test and ANOVA for frequency differences, multivariable logistic regression with odds ratios, and statistical weight analysis.

RESULTS: Sixty-eight patients (35 male, mean age 9.01 years) were included in the analysis. A significantly younger age at diagnosis was seen in patients with proximal lipomatous tissue (mean 4.67 ± 3.90 years), lipomatous tissue > 3 cm (mean 7.07 ± 3.17 years), conus medullaris below L2 (mean 6.43 ± 3.74 years), and syrinx (mean 5.42 ± 3.03 years). Vesicourethral dyssynergia was more frequent in patients with filar lipoma versus lipomatous filum (58.3% vs 26.8%), those with complete conus versus caudal regression (63.6% vs 26.3%), and those with vertebral dysraphism versus without (44.4% vs 18.8%). In the multivariate analysis, smaller total lipomatous tissue was associated with less overactive bladder (OR 0.04 and 0.044). Conus medullaris below L2 (OR 31.5) and proximal lipomatous tissue (OR 18.1) were related to underactive bladder. Proximal lipomatous tissue (OR 26.2) and low-lying conus (OR 9.8) were associated with high-risk neurogenic bladder. Lipomatous filum < 1 cm was associated with idiopathic scoliosis (OR 3.25). Distal lipomatous tissue interactions such as filum ≤ roots with distal lipomatous tissue (OR 121.20), dural adhesion with distal lipomatous tissue (OR 43.90), and yin-yang signal pattern with distal lipomatous tissue (OR 19.40) were associated with foot deformities. The yin-yang signal intensity pattern on MRI and vertebral dysraphism (OR 5.8) increased the likelihood of moderate-to-severe sciatic pain.

CONCLUSIONS: Filum patterns were associated with features of TCS, supporting classification of the filum based on lipomatous tissue.

PMID:42102406 | DOI:10.3171/2025.12.PEDS25331

J Neurophysiol. 2026 May 8. doi: 10.1152/jn.00572.2025. Online ahead of print.

ABSTRACT

An exercise-induced increase in cerebral blood flow (CBF) serves as a candidate mechanism underlying a postexercise executive function (EF) benefit. Here, healthy young adults completed four 20-min interventions of active and passive (via mechanical flywheel) cycle ergometry at pedal cadences of 55 and 85 revolutions per minute (rpm). Active and passive exercise were used because each modality increases CBF – albeit via distinct mechanisms – and different pedal cadences were used because an increase in passive exercise cadence is thought to increase CBF. Hence, we sought to determine whether the magnitude of a passive exercise increase in CBF influences the magnitude of a postexercise EF benefit. Transcranial Doppler ultrasound measured middle cerebral artery velocity (MCAv) to estimate CBF and the antisaccade task completed at pre- and post-intervention was used to assess changes in EF. Results showed that active exercise produced a larger baseline to steady state increase in MCAv than passive exercise, and both modalities showed an increase in MCAv with increasing pedal cadence. Moreover, both modalities produced a post-intervention reduction in antisaccade reaction times (RTs); however, frequentist and Bayesian statistics indicated the RT benefit did not vary with exercise modality nor pedal cadence, and the RT reduction was not correlated with active or passive exercise-mediated changes in CBF changes. Accordingly, active and passive exercise provide a comparable immediate postexercise EF benefit, and an exercise-mediated change in CBF does not provide a unitary account for the benefit.

PMID:42102395 | DOI:10.1152/jn.00572.2025

Phlebology. 2026 May 8:2683555261451570. doi: 10.1177/02683555261451570. Online ahead of print.

ABSTRACT

BackgroundLipedema is a chronic, progressive adipose tissue disorder affecting mainly women, characterized by bilateral, disproportionate fat accumulation in the lower extremities. The condition is often associated with pain, heaviness, and functional limitations. While the adipose tissue changes in lipedema are well-described, its impact on muscle mass, strength, and functional performance remains underexplored. This study aimed to evaluate the prevalence of sarcopenia and its relationship with lipedema severity.Materials and methodsA cross-sectional observational study was conducted on 48 women with clinically diagnosed lower-extremity lipedema. Diagnosis followed the International Lipoedema Association and German S2k guidelines. Sarcopenia was assessed using a multidimensional approach, including ultrasonographic rectus femoris thickness, handgrip strength, the Five Times Sit-to-Stand Test, and four-m walking speed. The lipedema stage was determined using morphological criteria. Statistical analyses evaluated the relationships between sarcopenia, functional parameters, and lipedema stage.ResultsParticipants had a mean age of 47.2 ± 8.4 years and a BMI of 33.0 ± 4.3 kg/m². Sarcopenia was identified in 33.3% of participants, with 14.6% classified as severe. Those with sarcopenia exhibited lower rectus femoris thickness and slower walking speed (p < .05). Advancing lipedema stage correlated with reduced muscle thickness, weaker handgrip strength, slower gait, and prolonged Five Times Sit-to-Stand Test duration (p < .05). Stage 3 patients demonstrated the highest prevalence of sarcopenia, indicating progressive impairment in muscle mass and functional performance with disease severity (p < .05). No significant associations were found between age or BMI and muscle parameters (p > .05).ConclusionsSarcopenia is prevalent in women with lower-extremity lipedema and increases with disease stage. Comprehensive musculoskeletal assessment should be integrated into lipedema management to address functional impairment and optimize patient care.

PMID:42102393 | DOI:10.1177/02683555261451570

Medwave. 2026 May 8;26(4):e3176. doi: 10.5867/medwave.2026.04.3176.

ABSTRACT

INTRODUCTION: Depression is currently one of the most impactful mental health conditions worldwide, with more than 280 million reported cases. However, there is a critical lack of data on Indigenous populations due to language barriers and the absence of culturally adapted assessment tools, limiting timely diagnosis and appropriate care. The aim of this work is to culturally and linguistically adapt the Patient Health Questionnaire-9 (PHQ-9) into the Shawi language and to evaluate its psychometric properties among Indigenous adults in Alto Amazonas, Peru.

METHODS: A rigorous cultural adaptation process was carried out, including translation by bilingual experts and back-translation. Validation involved expert technical review and a pilot phase conducted within the participating community. Content validity was assessed using Aiken’s V coefficient as a statistical indicator. The internal structure was evaluated using confirmatory factor analysis and structural equation modeling.

RESULTS: The sample consisted of 432 members of the Shawi community. The instrument showed excellent content validity (V = 0.90 to 1.00). Confirmatory factor analysis supported a unidimensional model with good fit (comparative fit index: 0.98; root mean square error of approximation: 0.06) and adequate internal consistency (α = 0.80; ω = 0.81). In addition, invariance of the PHQ-9 was demonstrated across age, sex, educational level, and marital status, supporting its applicability across different population subgroups.

CONCLUSIONS: The Shawi version of the Patient Health Questionnaire-9 has proven to be a reliable and valid tool for detecting depressive symptoms in this Indigenous population. This advancement represents a significant contribution to reducing mental health disparities by facilitating culturally appropriate diagnoses and improving care in historically underserved Amazonian communities.

PMID:42102351 | DOI:10.5867/medwave.2026.04.3176

Anesthesiology. 2026 May 8. doi: 10.1097/ALN.0000000000006133. Online ahead of print.

ABSTRACT

BACKGROUND: Deep brain stimulation for Parkinson’s disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation.

METHODS: In this prospective, noninferiority randomized controlled trial, patients with Parkinson’s disease (UK Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square, nRMS >2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates.

RESULTS: Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high nRMS proportion (89.4% vs. 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 minutes; 95% CI, -13.99 to -4.14; P<0.001). At 6 months, changes in Unified Parkinson’s Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P=0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P=0.128) and the complication rates (general anesthesia: 10.9% vs. conscious sedation: 8.9%; p=0.655) were comparable between the groups.

CONCLUSION: General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.

PMID:42102350 | DOI:10.1097/ALN.0000000000006133

J Pediatr Orthop. 2026 May 8. doi: 10.1097/BPO.0000000000003321. Online ahead of print.

ABSTRACT

BACKGROUND: Elastic stable intramedullary nailing (ESIN) is an established treatment for unstable pediatric forearm fractures. Although routine radiographic follow-up at 4 weeks is widely performed, its clinical benefit is unclear. This study aimed to evaluate the relevance of routine 4-week radiographs and to develop a risk-adapted follow-up protocol.

METHODS: We retrospectively analyzed all patients aged 0 to 18 years treated with ESIN for diaphyseal forearm fractures at a level I trauma center between 2014 and 2024. Clinical and radiologic findings at the scheduled 4-week follow-up visit were assessed retrospectively. Radiologic abnormalities were defined as secondary displacement, implant-related problems, or signs of infection. Therapeutic consequences were recorded. Statistical analyses included χ2 or Fisher exact tests, Mann-Whitney U tests, and logistic regression.

RESULTS: Of 610 patients screened, 553 were included (mean age: 8.0±3.5 y, 61.1% male). At the 4-week follow-up, 65.5% (362/553) were asymptomatic. Radiologic abnormalities were rare (1.3%, n=7). Importantly, none of the 362 asymptomatic patients showed relevant radiologic findings. Radiologic abnormalities were more frequent in children with clinical abnormalities (2.6% vs. 1.1%). In multivariable analysis, radiologic abnormalities remained the only independent predictor of therapeutic consequences (aOR: 11.9, 95% CI: 2.3-62.3; P=0.003).

CONCLUSION: Routine 4-week radiographs after ESIN osteosynthesis in pediatric forearm fractures do not lead to therapeutic consequences in asymptomatic patients. An algorithm for risk-adapted x-ray is proposed, although further prospective evaluation is needed.

LEVELS OF EVIDENCE: Level III-retrospective cohort study.

PMID:42102347 | DOI:10.1097/BPO.0000000000003321