Category: Nevin Manimala

Spine Deform. 2026 Jan 14. doi: 10.1007/s43390-026-01278-1. Online ahead of print.

ABSTRACT

PURPOSE: Osteogenesis Imperfecta (OI) is a rare connective tissue disorder often associated with severe, brace-resistant scoliosis. Posterior spinal fusion (PSF) with pedicle screws can achieve up to 60% coronal correction, while preoperative halo-gravity traction (HGT) may provide additional benefits but carries potential risks. This study evaluated whether HGT offers perioperative or radiographic advantages compared with PSF alone in pediatric OI patients.

METHODS: Thirty-six patients treated between 2002 and 2020 with ≥ 2 years’ follow-up were retrospectively analyzed. Patients were divided into HGT + PSF (N = 19) and PSF-only (N = 17) groups, comparable in baseline characteristics. The primary outcome was coronal correction rate (CR); secondary outcomes included operative time, blood loss, length of stay (LOS), complications (Modified Clavien-Dindo-Sink Classification, MCDS), and loss of correction at follow-up. Statistical comparisons used Mann-Whitney U and Chi-Squared tests (p < 0.05).

RESULTS: Postoperative major and minor curve CR were 60.2% and 66.5% in the HGT + PSF group vs. 55.1% and 37.7% in PSF (p = 0.337 and p = 0.003). At last follow-up, CR was 51.1% and 38.8% for HGT + PSF vs. 44.9% and 25.2% for PSF (p = 0.298 and p = 0.238). Mean blood loss (1235 vs. 1368 mL, p = 0.972), operative time (443 vs. 410 min, p = 0.490), and LOS (12.6 vs. 9.5 days, p = 0.186) were not significantly different. Complications occurred in 57.9% of HGT + PSF vs. 29.4% of PSF patients (p = 0.367), with more major complications in the HGT + PSF group.

CONCLUSIONS: In this cohort, HGT provided only modest additional coronal correction without clear perioperative advantages compared with PSF alone. Given these limited and partly transient effects, its routine use should be considered cautiously and in the context of individual patient characteristics. Larger prospective multicenter studies are needed to clarify the specific clinical scenarios in which preoperative HGT may offer meaningful benefit in the surgical management of OI-related scoliosis.

PMID:41533302 | DOI:10.1007/s43390-026-01278-1

Qual Life Res. 2026 Jan 14;35(2):43. doi: 10.1007/s11136-025-04157-w.

ABSTRACT

PURPOSE: To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR).

METHODS: In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains.

RESULTS: In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 (P < 0.001), and for physical (P < 0.001) and emotional (P < 0.001) disease-related symptoms, as well as treatment side effects (P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 (P < 0.001) and the FKSI-19 (P < 0.001).

CONCLUSIONS: HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

PMID:41533299 | DOI:10.1007/s11136-025-04157-w

Clin Transl Oncol. 2026 Jan 14. doi: 10.1007/s12094-025-04198-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate how the implementation of intensity-modulated/image-guided RT (IMRT/IGRT) with intraprostatic seeds can impact the risk of late gastrointestinal (LGI) and genitourinary (LGU) toxicity in prostate cancer (PCa) patients treated with dose-escalation RT.

MATERIALS /METHODS: Retrospective analysis of a prospective cohort of 1,010 men treated within a risk-adapted, intensification program with a minimum follow-up (FU) of 5 years. The median radiation dose to prostate was 79.5 Gy (IQR: 75.0, 80.3). Short-term ADT (STADT, n = 165) and long-term ADT (LTADT, n = 385) were administered to intermediate- and high-risk patients, respectively. Late toxicities were assessed using the EORTC/RTOG criteria. Kaplan-Meier analysis: to calculate the cumulative incidence of late toxicities; Cox proportional regression model: to estimate hazard ratios (HRs).

RESULTS: Median FU was 116 months (IQR: 88-133). The median RT dose for IMRT/IGRT was 80.0 Gy (IQR 79.1, 81.2) and 78.0 Gy (IQR 73.1, 79.6), (p = 0.001) for those treated with 3DCRT. The 10-year Kaplan-Meier grade ≥ 2 LGI and LGU toxicities were 10% (95% confidence interval [CI] 8-12) and 16% (95% CI 14-18), respectively. The multivariate analysis (MVA) showed that the use of IMRT/IGRT with intraprostatic seeds was a significant protective factor for grade ≥ 2 LGI toxicity (HR: 0.66, 95%CI: 0.46-0.95, p = 0.021), despite the higher radiation dose in the IMRT/IGRT group. However, its impact on decreasing grade ≥ 2 LGU toxicity did not achieve statistically significance (13% vs 18%; p = 0.053, HR 0.88). A prior transurethral resection of the prostate (TURP) (HR 1.98, 95% CI: 1.30-2.59, p = 0.002) and the presence of acute grade ≥ 2 GU complications (HR:1.76, 95% CI: 1.20-2.9, p = 0.003) were associated with a higher incidence of grade ≥ 2 LGU toxicity, while LTADT was significantly associated with a lower risk of GU complications (HR:0.66, 95% CI: 0.46-0.95, p = 0.021).

CONCLUSION: The study confirms that IMRT/IGRT with intraprostatic fiducial markers significantly reduces grade ≥ 2 late GI toxicity, and appears to prevent an increase in GU toxicity rates despite dose escalation.

PMID:41533295 | DOI:10.1007/s12094-025-04198-0

Int J Comput Assist Radiol Surg. 2026 Jan 14. doi: 10.1007/s11548-025-03564-1. Online ahead of print.

ABSTRACT

Purpose Surgical gestures are fundamental components of surgical procedures, encompassing actions such as cutting, suturing, and knot-tying. Gesture recognition plays a pivotal role in the automatic analysis of surgical data. Although recent advancements have improved surgical gesture recognition, much of the existing research relies on simulations or minimally invasive surgery data, failing to capture the complexities of open surgery. In this study, we introduce and employ a new open surgery dataset focused on closing incisions after saphenous vein harvesting. Methods Our goal is to improve gesture recognition accuracy by incorporating tool pose estimation and 3D hand pose predictions of surgeons. We employ MS-TCN++ and LTContext for gesture recognition, and further enhance performance through an ensemble of models using different modalities-video, tool pose, and hand pose data.Results The results reveal that using an ensemble model combining all three modalities provides a substantial improvement over video-only approaches, leading to statistically significant gains across multiple evaluation metrics. We further demonstrate that the model can rely solely on hand and tool poses, completely discarding the video input, while still achieving comparable performance. Additionally, we show that an ensemble model using only hand and tool poses produces results that are either: statistically significantly better than using video alone, or not statistically significantly different.Conclusion This study highlights the effectiveness of integrating multimodal data for surgical gesture recognition. By combining video, hand pose, and tool pose information, our approach achieves higher accuracy and robustness compared to video-only methods. Moreover, the comparable performance of pose-only models suggests a promising, privacy-preserving alternative for surgical data analysis.

PMID:41533294 | DOI:10.1007/s11548-025-03564-1

Clin Transplant. 2026 Jan;40(1):e70441. doi: 10.1111/ctr.70441.

ABSTRACT

BACKGROUND: Efforts to identify barriers and improve access to kidney transplantation in the United States are limited by a lack of population-level data on early steps in the transplant evaluation process.

METHODS: We used a rule-based natural language processing (NLP) approach with clinical notes in the US Veterans Affairs Healthcare System (VA) electronic health record (EHR) and linkage with the United States Renal Data System registry to characterize sequential steps in the kidney transplant evaluation process. Adults with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73m²) from 1/1/2012-12/31/2019 who were receiving care within the VA were followed through 12/31/2021.

RESULTS: Among 45,174 cohort members, the median age was 71 (IQR 64, 80) years, and 97.2% were men. There was documentation of kidney transplant being mentioned as a treatment option for 46.3% of cohort members, 28.2% engaged in some type of evaluation for transplant, and 8.4% were referred to and 5.4% evaluated at a VA kidney transplant center. 6.9% of cohort members were added to the national deceased donor waitlist and 3.1% received a kidney transplant. Compared with events identified through EHR chart search and manual review by two clinicians, NLP identified events within 90 days with a precision of 0.82-0.94 and recall of 0.56-0.89.

CONCLUSION: These results illuminate the substantial proportion of patients who engage in early steps in the kidney transplant evaluation process. The work also demonstrates that NLP can accurately identify these key steps in the process as documented in patients’ EHRs.

PMID:41533291 | DOI:10.1111/ctr.70441

Int Urol Nephrol. 2026 Jan 14. doi: 10.1007/s11255-026-05015-5. Online ahead of print.

ABSTRACT

BACKGROUND: Vascular complications following percutaneous nephrolithotomy (PCNL), although uncommon, may result in significant morbidity. This systematic review and meta-analysis evaluated the incidence, distribution, and management outcomes of vascular complications after PCNL in contemporary practice.

METHODS: A systematic search of PubMed/MEDLINE, EMBASE, BIOSIS, Google Scholar, and the Cochrane Library identified observational studies reporting vascular complications after PCNL published between 2015 and 2025. Pooled proportions were calculated using a DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed using the I² statistic, and methodological quality was evaluated using the Newcastle-Ottawa Scale. This review was not prospectively registered.

RESULTS: Ten studies met the inclusion criteria. Four studies reporting denominator-level data (10,440 PCNL procedures) were included in the pooled incidence analysis, yielding a vascular complication incidence of 3% (95% CI 2-4%). Among 625 reported vascular complications, pseudoaneurysms were the most frequent lesion (57%), followed by arteriovenous fistulas (29%), arterial lacerations (25%), and arteriocaliceal fistulas (11%); lesion categories were not mutually exclusive. Nine studies reported outcomes following angioembolization (703 cases) and two studies reported conservative management outcomes (204 cases). The pooled success rate was 92% (95% CI 84-98%) for angioembolization and 67% (95% CI 52-80%) for conservative management (p = 0.0013). No procedure-related mortality was reported.

CONCLUSIONS: Vascular complications after PCNL remain infrequent in contemporary practice but may be clinically significant when they occur. Pseudoaneurysm is the most reported lesion. Angioembolization is associated with high success rates in appropriately selected patients, while conservative management remains effective in selected cases. Interpretation of these findings should consider the observational nature of the evidence and substantial heterogeneity across studies.

PMID:41533282 | DOI:10.1007/s11255-026-05015-5

Environ Monit Assess. 2026 Jan 14;198(2):126. doi: 10.1007/s10661-025-14888-5.

ABSTRACT

Wrack, composed of organic debris like seagrass and the brown macroalga, Sargassum, accumulates on beaches and when present in overwhelming quantities can impact ecosystem function and public health through microbial contamination, trace element accumulation, and toxic gas emissions. Although studies have started to evaluate the impacts to the microbial quality from different types of wrack, few evaluate the impacts of trace elements. This study assessed enterococci and arsenic levels in beach environments across five South Florida beaches with varying wrack types (Sargassum vs. seagrass) and management practices. Enterococci levels did not significantly differ between wrack types (p = 0.30), with a maximum of 9,600 CFU/g. However, Sargassum exhibited significantly higher arsenic concentrations (up to 64.3 mg/kg) compared to seagrass (2.18 mg/kg) (p < 0.001). In sand, arsenic levels were statistically higher (4.92 mg/kg) when Sargassum was managed through integration. These findings emphasize the need to consider wrack composition when assessing arsenic impacts and can inform beach management strategies to minimize environmental and public health risks associated with excessively large Sargassum strandings.

PMID:41533276 | DOI:10.1007/s10661-025-14888-5

Jpn J Ophthalmol. 2026 Jan 14. doi: 10.1007/s10384-025-01325-w. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the incidence and clinical characteristics of malignant glaucoma (MG) following Preserflo MicroShunt (PMS) implantation.

STUDY DESIGN: Retrospective multicenter cohort study METHODS: We investigated 957 consecutive eyes that underwent PMS implantation between August 2022 and May 2025. In all eyes, patient age, sex, glaucoma subtype, preoperative intraocular pressure (IOP), medication score, axial length (AL), and use of intraluminal suture stenting (ISS) were examined. We identified cases in which MG developed postoperatively and compared age, preoperative IOP, medication score, and AL between the MG and non-MG groups. The timing of MG onset and treatment outcomes were also evaluated. After Bonferroni correction, the adjusted significance level was set at P<0.0125 (0.05/4).

RESULTS: MG occurred in 4 eyes (0.42%) of 2 men and 2 women, with a median age of 85.5 years (interquartile range [IQR], 84-90 years). All eyes were diagnosed with exfoliation glaucoma (XFG). Patients in whom MG developed were significantly older (P=0.006) and had a significantly higher preoperative IOP (P=0.006) than those without MG. No significant differences in AL or medication score were observed between the groups. MG developed on postoperative days 2, 3, and 4 in 3 eyes without ISS. In 1 case with ISS, MG occurred 3 days after ISS removal, but not during ISS placement. All MG cases were successfully treated with irido-zonulo-hyaloido-vitrectomy, with or without pars plana vitrectomy.

CONCLUSIONS: Although rare, MG can occur in the early postoperative period after PMS implantation, particularly in older patients with a high preoperative IOP.

PMID:41533256 | DOI:10.1007/s10384-025-01325-w

Maxillofac Plast Reconstr Surg. 2026 Jan 14. doi: 10.1186/s40902-026-00500-4. Online ahead of print.

ABSTRACT

BACKGROUND: Lingual nerve injury following dental procedures, such as lower third molar extractions, can cause significant sensory deficits. For patients with persistent severe symptoms, surgical reconstruction using a nerve conduit is often considered. However, the degree of recovery varies, and the optimal timing of intervention and the significance of the nerve gap distance remain subjects of clinical debate.

OBJECTIVES: Using the Medical Research Council Scale (MRCS) as a standardized measure of sensory function, this study aims to determine the independent effects of the timing of surgery, nerve gap length, and other potential prognostic factors on nerve functional recovery, specifically defining success as MRCS S3+ or higher.

METHODS: This study retrospectively analyzed a cohort of 49 patients who underwent lingual nerve repair surgery. The success of nerve recovery was evaluated using two established criteria: the standard Functional Sensory Recovery (FSR), MRCS S3 or higher, and the strict MRCS S3+ or higher criteria based on American Society of Plastic Surgeons (ASPS) criteria. The MRCS S3+ or higher criteria was designated as the primary outcome for all multivariate analyses. The time to surgery variable was logarithmically transformed, Log (Time to Surgery, months), to account for the highly skewed distribution. Statistical analysis used univariate and multivariate logistic regression to assess the association between each predictor and postoperative MRCS score. A secondary analysis examined predictors for allodynia resolution.

RESULTS: The logarithmically transformed time to surgery, Log (Time to Surgery, months), was the sole statistically significant independent predictor for achieving MRCS S3+ (Odds Ratio OR = 0.236, 95% CI: 0.063-0.887, P = 0.032). This indicates that earlier intervention significantly increases the odds of functional recovery. Nerve gap length was not a significant predictor (OR = 0.941, P = 0.518). Furthermore, no variable was found to be a significant predictor for allodynia resolution (P > 0.05).

CONCLUSION: Earlier surgical intervention, quantified by Log (Time to Surgery), is an independent and critical factor for achieving MRCS S3+ functional sensory recovery after lingual nerve repair. The distance of the nerve gap did not show an independent predictive effect on the final sensory outcome.

PMID:41533252 | DOI:10.1186/s40902-026-00500-4

Cerebellum. 2026 Jan 14;25(1):11. doi: 10.1007/s12311-025-01952-6.

ABSTRACT

Neurodegenerative ataxias represent a heterogeneous group of disorders lacking effective treatments. This double-blind, sham-controlled study investigated the therapeutic potential of cerebellar transcranial Direct Current Stimulation (tDCS) in degenerative ataxia. Sixteen patients were randomized to receive either real or sham tDCS (10 sessions). Clinical evaluation, quantitative assessment of gait and upper limb function (through the “hand-to-mouth” task) and EEG were performed before and after treatment. Clinical outcome tools included the Modified International Cooperative Ataxia Rating Scale (MICARS), the Scale for the Assessment and Rating of Ataxia (SARA) and the Robertson dysarthria profile to rate ataxic and dysarthric symptoms. Quantitative kinematic assessment of upper and lower limb motor function was carried out by means of optical motion capture system. At last, resting state electroencephalography (EEG) enabled evaluation of cortical oscillatory changes. The primary outcomes were change from baseline in SARA and MICARS total scores; secondary outcomes included changes in Robertson dysarthria profile score, spatiotemporal gait and hand‑to‑mouth kinematics and cortical beta/gamma power on resting state EEG. Both real and sham tDCS groups showed improvements in ataxic and dysarthric symptoms, but real tDCS induced greater benefits in posture, gait (MICARS), and upper-limb coordination (SARA) subscales. Although statistical significance was not reached for main gait parameters, a higher proportion of patients receiving real tDCS demonstrated clinically meaningful gains in gait speed and step width. In contrast, hand-to-mouth parameters remained unchanged. EEG showed increases in central/parietal beta and low‑gamma power after active but not sham stimulation, supporting neuromodulatory effects on the cerebello-thalamo-cortical network. Overall, these data support a therapeutic potential of cerebellar tDCS in improving symptoms in degenerative ataxia of different aetiology and contribute to elucidate the mechanisms underlying these effects. ClinicalTrials.gov registration: NCT07250321 (registered 2025-11-18).

PMID:41533249 | DOI:10.1007/s12311-025-01952-6