Category: Nevin Manimala

J Anat. 2026 Apr 15. doi: 10.1111/joa.70153. Online ahead of print.

ABSTRACT

The domestic dog (Canis lupus familiaris), a species characterized by remarkable phenotypic diversity resulting from selective breeding, is among the several mammals that may exhibit an anatomical perforation of the humeral condyle, designated as the supratrochlear foramen (STF). The prevalence of the STF varies considerably across mammalian species and has been proposed to reflect functional adaptations linked to evolutionary and biomechanical factors, particularly in the human humerus. To the best of our knowledge, comprehensive studies on STF variation within present-day canine populations remain scarce. This study aimed to determine the prevalence and morphology of the STF in extant dogs, and to compare these findings with those from Roman Imperial Period dogs, and Iberian wolves (Canis lupus signatus), a subspecies considered representative of the dog’s wild ancestor, in order to explore evolutionary changes within Canis lupus subspecies. We analyzed 269 humeri (123 extant dogs, 76 ancient dogs, 70 Iberian wolves) using osteometric measurements and statistical analysis. Our results demonstrate that the STF was observed in 73.17% of extant dogs, compared to 82.89% in ancient dogs and 98.57% in Iberian wolves, suggesting a reduction in its prevalence over time in domestic lineages that may be linked to human-driven selection processes. In all studied groups, the STF was consistently located closer to the lateral humeral epicondyle, and its predominantly transversely elongated shape reveals a common morphological pattern across Canis lupus subspecies. Despite differences in humeral size among groups, STF dimensions showed a positive correlation with overall humeral measurements, with larger humeri exhibiting proportionally larger and more frequent STFs. Extant dogs displayed the smallest STF dimensions, followed by ancient dogs, with Iberian wolves having the largest. Considering the potential impact of the STF on the biomechanical properties of the distal humerus, this study provides new insights into its anatomical variability in dogs, emphasizing its clinical relevance for orthopedic diagnostic accuracy and surgical treatments in veterinary medicine.

PMID:41986904 | DOI:10.1111/joa.70153

Neurocrit Care. 2026 Apr 15. doi: 10.1007/s12028-026-02519-x. Online ahead of print.

ABSTRACT

BACKGROUND: A subset of patients with anterior circulation large-vessel occlusion (LVO) stroke progressed to malignant middle cerebral artery infarction (mMCAi) despite successful recanalization following endovascular treatment. This study investigated whether full medical support (FMS) could improve functional outcomes beyond reducing mortality in this population.

METHODS: In this retrospective cohort study, consecutive patients from hospital-based stroke registry (May 2015 to August 2021) with anterior LVO stroke who developed mMCAi despite successful recanalization were included. Patients were stratified into two groups on the basis of the intensity of postprocedural care: the FMS group (aggressive neurocritical care) and the non-FMS group (limited medical support or comfort care). The primary outcome was survival without severe disability, defined as a modified Rankin Scale (mRS) score of 0-4 at 90 days. Secondary outcomes included ordinal shift analysis of the mRS, rates of functional independence (mRS 0-2 and 0-3), and 90-day mortality.

RESULTS: Among 114 eligible patients, 65 were assigned to the FMS group and 49 to the non-FMS group. The FMS group demonstrated a significantly higher rate of the primary outcome (46.2% vs. 6.1%; P < 0.001) along with a markedly lower 90-day mortality (23.1% vs. 81.6%; P < 0.001) compared with the non-FMS group. After adjustment for age, gender, and confounders, FMS remained independently associated with increased odds of achieving mRS 0-4 [adjusted odds ratio (aOR), 5.88; 95% confidence interval (CI) 1.31-26.40; P = 0.021) and with reduced mortality (aOR, 0.14; 95% CI 0.05-0.42; P < 0.001), while no statistically significant difference was observed in the proportion of patients achieving an mRS of 0-2 or in those achieving an mRS of 0-3.

CONCLUSIONS: In patients who developed mMCAi after successful recanalization, FMS is associated with a greater likelihood of survival without severe disability (mRS 0-4). These findings suggest that withdrawal of aggressive medical care in this population should be approached with caution.

PMID:41986794 | DOI:10.1007/s12028-026-02519-x

Sci Rep. 2026 Apr 15. doi: 10.1038/s41598-026-48407-4. Online ahead of print.

ABSTRACT

Systemic sclerosis (SSc) is an autoimmune disorder marked by fibrosis of the skin and internal organs, with B cells increasingly recognized as key players in its pathogenesis. However, the characteristics of the B cell receptor (BCR) repertoire in SSc remain insufficiently defined. In this study, we performed high-throughput sequencing of immunoglobulin heavy chain genes in 15 female anti-centromere antibody (ACA)-positive SSc patients and five age-matched healthy female controls to explore disease-specific repertoire biases. A total of 2,597,460 in-frame sequence reads and 384,111 unique reads were obtained. While diversity metrics, including the Shannon, Simpson, and Pielou indices, tended to be higher in the SSc group, the differences were not statistically significant. Notably, the average complementarity-determining region 3 (CDR3) length was significantly shorter in SSc patients compared to controls (16.91 ± 3.727 vs. 17.44 ± 3.836, p < 0.0001). Gene usage analysis revealed no significant differences in IGHJ or IGHC segments; however, several IGHV and IGHD segments displayed statistically significant differences. IGHD5-5 (1.636% vs. 0.547%, p = 0.0001) and IGHD5-18 (1.607% vs. 0.547%, p = 0.0001) were significantly overrepresented in the SSc group, whereas IGHV1/OR15-2 was significantly underrepresented (0.062% vs. 0.130%, p = 0.0080). Further analysis demonstrated that IGHD5-5 clones with a 15-nucleotide CDR3 length were more conserved and exhibited distinctive sequence patterns compared to other lengths or genes. Specific nucleotide lengths, including 15, 23, and 24 for IGHD5-5, and 18 for IGHV1/OR15-2, showed significant frequency differences between groups (p < 0.05). Sequence logo plots confirmed reduced variability in these conserved clones, suggesting antigen-driven clonal selection. These findings identify unique BCR repertoire features in ACA-positive SSc patients and suggest their potential utility as disease biomarkers or therapeutic targets.

PMID:41986546 | DOI:10.1038/s41598-026-48407-4

J Voice. 2026 Apr 14:S0892-1997(26)00131-1. doi: 10.1016/j.jvoice.2026.03.019. Online ahead of print.

ABSTRACT

OBJECTIVE: Dysphonia in patients with Parkinson’s Disease (PD) negatively impacts quality of life. Treatment options are evolving and include both invasive and non-invasive interventions. The present study aims to assess current therapies and their effectiveness through a scoping review of the literature.

DATA SOURCES: PubMed, Ovid, and Embase.

REVIEW METHODS: Three databases were searched for articles through 2023 pertaining to treatment of PD-related dysphonia in accordance with PRISMA guidelines. Included studies were reviewed to extract demographic information, treatment techniques, and outcomes. Of 277 studies reviewed, 49 publications met inclusion criteria with a total of 1388 patients.

RESULTS: Treatments were categorized into groups: voice therapy, pharmacologic intervention, deep brain stimulation (DBS), vocal fold augmentation, neurosurgical intervention, and dietary modification. Measures reported to assess outcomes were heterogenous across studies. Voice therapy had the highest number of studies with statistically significant results, totaling 18 studies. Other treatments, including DBS, demonstrated improvement in systemic symptoms with worsening of voice symptoms.

CONCLUSION: The literature of current therapeutic options for PD patients with dysphonia is heterogenous; however, voice therapy remains standard of care. Further studies should emphasize standardization of voice metrics to permit head-to-head comparisons across treatment modalities. There is also an opportunity to leverage combining therapies for PD patients, but optimization of such regimens requires further investigation.

PMID:41986189 | DOI:10.1016/j.jvoice.2026.03.019

BMJ Open. 2026 Apr 15;16(4):e110853. doi: 10.1136/bmjopen-2025-110853.

ABSTRACT

OBJECTIVE: Ethnic communities provide an appropriate setting for examining patterns of pregnancy and childbirth. Policy-making aimed at improving maternal health will be rendered ineffective in the absence of knowledge and comprehension of the traditions and beliefs associated with childbirth. The objective of this study was to cross-ethnically compare childbirth experiences.

DESIGN: This research used a cross-sectional methodology and was conducted in 2023. The sampling in the cities of Tabriz (Azeri), Sanandaj (Kurdish), Babol (Mazani), Khorramabad (Lur), Ahvaz (Arab) and Tehran (Fars) was conducted using the cluster random approach. The data collection instruments included questionnaires of sociodemographic and obstetric characteristics and childbirth experience (Childbirth Experience Questionnaire 2.0). In bivariate analysis, a one-way analysis of variance test was employed. In contrast, a general linear model (GLM) was used in multivariate analysis to adjust for the influence of sociodemographic and obstetric characteristics. The data were analysed using SPSS V.24 software. The p value less than 0.05 was considered significant.

SETTING: Health centres in cities with different ethnic groups all over Iran.

PARTICIPANTS: For this purpose, 1331 women from six ethnic groups who were referred to health centres were selected 4 to 6 weeks after giving vaginal birth.

RESULTS: The following are the mean (SD) scores (scoring range: 1-4) for the childbirth experiences of the participating women: Azeri 2.31 (0.32), Kurdish 2.14 (0.31), Fars 2.26 (0.42), Mazani 1.93 (0.38), Lur 2.14 (0.4) and Arab 2.06 (0.18). Results from GLM multivariate analysis showed that while Azeri (B: 0.25; 95% CI 0.16 to 0.35; p<0.001), Kurdish (B: 0.10; 95% CI 0.03 to 0.18; p=0.007) and Fars (B: 0.18; 95% CI 0.03 to 0.27; p=0.014) women had significantly higher mean scores for childbirth experience than Arabs (the reference group), women of Mazani ethnicity had significantly lower scores (B: -0.10; 95% CI -0.18 to -0.04; p=0.002).

CONCLUSIONS: Women of different Iranian ethnicities have varying childbirth experiences. Women of Azeri and Fars ethnic groups report higher satisfaction with childbirth than those of others. Mazeni women had the lowest mean scores for having a positive birth experience. To offer compassionate and effective treatment for their patients, healthcare providers must have a deep understanding of cultural diversity.

PMID:41985963 | DOI:10.1136/bmjopen-2025-110853

BMJ Open. 2026 Apr 15;16(4):e113798. doi: 10.1136/bmjopen-2025-113798.

ABSTRACT

OBJECTIVES: To assess access to child-appropriate medicines in Albanian community pharmacies by applying a child-adapted version of sustainable development goal (SDG) indicator 3.b.3.

DESIGN: Cross-sectional survey.

SETTING: Community pharmacies providing primary care medicines in six urban areas in Albania.

PARTICIPANTS: Thirty community pharmacies were surveyed. Two predefined baskets of child-appropriate essential medicines were assessed: 24 medicines for children aged 1-59 months and 25 medicines for children aged 5-12 years. Medicines were selected from these child-adapted SDG 3.b.3 medicine baskets proposed at an international level and then matched to paediatric formulations registered nationally for application to Albania.

OUTCOMES: Individual facility scores by age group and medicine type (originator brands (OBs) vs lowest-priced generics (LPGs)), as well as sensitivity analyses using alternative affordability thresholds.

RESULTS: The SDG 3.b.3 indicator score was 0%, as no surveyed facility reached the 80% access threshold. Mean facility scores were 42.6% for medicines intended for children aged 1-59 months and 29.6% for those aged 5-12 years, indicating poorer access for older children. Scores for OBs were particularly low (11.8% and 13.6%, respectively), reflecting reliance on LPGs. In younger children, ibuprofen and hydroxycobalamin showed 0% availability, while in school-aged children, paracetamol, propranolol and budesonide were absent across surveyed facilities; benzylpenicillin was absent in both age groups, whereas ceftriaxone was consistently available in both. Although all surveyed medicines were affordable, limited availability remained the primary barrier to access.

CONCLUSIONS: Application of the child-adapted SDG indicator 3.b.3 in Albania highlights substantial gaps in access to essential paediatric medicines in private community pharmacies, driven primarily by poor availability rather than affordability. The findings underscore the need for targeted supply-side policies. This study demonstrates the complementary value of composite SDG indicators and medicine-specific availability measures in monitoring progress toward universal health coverage for children.

PMID:41985961 | DOI:10.1136/bmjopen-2025-113798

J Dent. 2026 Apr 13:106698. doi: 10.1016/j.jdent.2026.106698. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective study aimed to evaluate the impact of artificial intelligence (AI)-based automated segmentation (AS) on the accuracy of robotic computer-aided implant surgery (r-CAIS).

METHODS: Patients who underwent r-CAIS were enrolled. Preoperative CBCT images were segmented using either threshold-based SS approach (SS group) or the AI-based AS approach (AS group). Osteotomy preparation and implant placement were performed using a semi-active robot. Registration errors and deviations between planned and postoperatively placed implant positions were calculated. Intergroup comparisons were performed using Wilcoxon Mann-Whitney U tests, with P < 0.05 considered significant.

RESULTS: A total of 140 patients (79 females, 61 males) receiving 224 implants were included (SS group: 69 patients, 107 implants; AS group: 71 patients, 117 implants). The registration error in the AS group (0.10 ± 0.04 mm) was significantly lower than that in the SS group (0.12 ± 0.04 mm) (P < 0.05). The AS group demonstrated lower deviations at the platform (0.51 ± 0.16 vs.0.56 ± 0.18 mm), apex (0.60 ± 0.23 vs. 0.66 ± 0.23 mm), and angulation (1.13 ± 0.59° vs. 1.19 ± 0.53°), with a statistically significant difference observed in global platform deviation (P < 0.05).

CONCLUSIONS: r-CAIS demonstrated consistently high accuracy, which was further improved by AI-based AS. This improvement may be associated with enhanced registration precision achieved through AI-based AS.

CLINICAL SIGNIFICANCE: These findings support the potential clinical application of AI-based AS in r-CAIS.

PMID:41985737 | DOI:10.1016/j.jdent.2026.106698

J Oral Maxillofac Surg. 2026 Mar 31:S0278-2391(26)00257-0. doi: 10.1016/j.joms.2026.03.015. Online ahead of print.

ABSTRACT

BACKGROUND: There is a critical trade-off in ameloblastoma management: balancing the significant tissue-preserving benefits of decompression treatment against its potential for higher recurrence compared to radical resection.

PURPOSE: The study purpose was to evaluate the therapeutic effects of decompression treatment for managing ameloblastoma.

STUDY SELECTION: A systematic search was conducted across multiple databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of proportions was performed using a random-effects model in RStudio to pool data on size reduction and time to recurrence rates. Heterogeneity was assessed using I² and Tau statistics.

RESULTS: Nine studies met the inclusion criteria. The analysis included 555 ameloblastomas (381 unicystic ameloblastoma, 174 multicystic ameloblastoma). Decompression treatment yielded a significant mean size reduction of 55.3% (range: 7.5 to 93.02%). Recurrence outcomes were evaluated using time-to-event analysis where individual patient data were available (n = 287). The overall recurrence rate was 3.8 per 100 person-years (95% CI: 2.4 to 6.1). A stark difference was observed between histological subtypes: unicystic ameloblastoma demonstrated a recurrence rate of 2.1 per 100 person-years (95% CI: 1.1 to 4.0) compared to 8.9 per 100 person-years (95% CI: 5.4 to 14.6) for multicystic ameloblastoma (hazard ratio [HR] = 3.2; 95% CI: 1.8 to 5.7; P = .008). Longer decompression duration (>12 months) was associated with a significantly reduced recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012). Prolonged decompression (>12 months) was associated with a 48% reduction in recurrence hazard (HR = 0.52; 95% CI: 0.31 to 0.87; P = .012).

CONCLUSIONS AND RELEVANCE: Decompression treatment is effective for reducing ameloblastoma size, facilitating minimally invasive treatment. However, recurrence risk is significantly higher in multicystic and mural subtypes, with multicystic variants demonstrating a 3.2-fold increased hazard of recurrence compared to unicystic variants. These findings support a tailored surgical approach based on histology and clinical presentation, though they should be interpreted with caution due to the high heterogeneity among the included studies.

PMID:41985552 | DOI:10.1016/j.joms.2026.03.015

J Surg Educ. 2026 Apr 14;83(6):103958. doi: 10.1016/j.jsurg.2026.103958. Online ahead of print.

ABSTRACT

INTRODUCTION: Acquisition of technical skills in surgery requires both precise motor coordination and efficient cognitive control. While simulation platforms and benchtop dexterity tests have demonstrated utility in differentiating performance levels, their predictive validity remains variable. Concurrently, physiologic metrics of cognitive load have emerged as promising tools for quantifying mental effort during surgical tasks. Pupillometry, in particular, offers high temporal resolution, noninvasiveness, and task-synchronized measurement capabilities. However, few studies have integrated objective dexterity metrics with real-time physiologic workload assessment in a unified, scalable framework. To address this gap, we developed a benchtop testing protocol combining standardized fine-motor tasks with pupillometry to evaluate technical performance and cognitive load at different levels of surgical training.

METHODS: In a pilot cross-sectional observational study, 79 participants, including 49 medical students, 17 nonmedical controls, and 13 experts, completed 2 standardized dexterity tasks: the O’Connor Finger Dexterity and O’Connor Tweezer Dexterity Tests, followed by a knot-tying task. Performance metrics included completion time for each task. Cognitive load was indexed by baseline-corrected pupil diameter (Δ-BCPD), continuously captured and rescaled to normalized task time. Cognitive-load dynamics were compared across groups and performance tiers.

RESULTS: Finger dexterity scores differed significantly by role (p = 0.048) and correlated with knot-tying time (R² = 0.472), supporting their construct-specific validity. Tweezer-task scores showed no significant relationship with procedural performance (R² = 0.004). Pupillometry showed directionally consistent group-level gradients in Δ-BCPD, with experts exhibiting lower mean task-evoked dilation. High-performing participants demonstrated reduced cognitive load, particularly during the finger task, indicative of greater automation. Trends in Δ-BCPD were directionally consistent across groups but did not reach statistical significance.

CONCLUSIONS: Brief dexterity tasks paired with time-normalized pupillometry may provide complementary information about motor performance and cognitive workload. This exploratory, rater-independent framework showed promise for distinguishing performance differences and characterizing task demands, supporting further validation in larger cohorts.

PMID:41985317 | DOI:10.1016/j.jsurg.2026.103958

Nutrition. 2026 Mar 12;148:113202. doi: 10.1016/j.nut.2026.113202. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular disease (CVD) is a leading global cause of mortality, strongly influenced by diet. Research in this field has evolved from the analysis of nutrients to the evaluation of dietary patterns (DP), with the aim of more accurately reflecting real eating behaviors. A variety of statistical methods are employed to identify DP, leading to heterogeneous results. This variability highlights the need for methodological standardization to improve comparability and evidence synthesis.

OBJECTIVE: The aim of this study was to evaluate the statistical methodologies used to identify a posteriori DP and determine their relationship with CVD.

METHODS & PROCEDURES: A systematic search of the PubMed, Scopus and Web of Science databases was carried out, including observational studies conducted on adults aged 18 years and over. The review protocol was registered in PROSPERO (CRD4202525642904). The analysis of 18 studies that identified a posteriori DP related to CVD was conducted.

RESULTS: Across the included studies, DP were mainly derived using principal component analyses (PCA), although variability existed in component selection and factor loading thresholds. Most studies assessed sampling adequacy, applied Varimax orthogonal rotation, and selected components based on eigenvalue thresholds >1, although cut-offs varied. A small number of studies combined PCA with other multivariate approaches. Despite heterogeneity in identified patterns, Western, traditional, animal-based, and Mediterranean DP were most frequently reported. Western patterns were associated with increased CVD, whereas Mediterranean patterns showed a protective effect.

CONCLUSIONS: CVD-related DP are highly variable, depending on factors such as sex, culture and socio-economic status. This underlines the importance of standardizing dietary collection and assessment methods.

PMID:41985214 | DOI:10.1016/j.nut.2026.113202