Category: Nevin Manimala

Radiol Med. 2026 Jun 24. doi: 10.1007/s11547-026-02242-9. Online ahead of print.

ABSTRACT

INTRODUCTION: To evaluate the efficacy and safety of single-fraction LINAC-based radiosurgery (RS) for patients with drug-resistant trigeminal neuralgia (TN).

MATERIALS AND METHODS: We retrospectively reviewed 46 patients treated for TN between August 2008 and December 2024, 42 were evaluable. RS was delivered with a linear accelerator equipped with a micro-multileaf collimator. Diagnostic cisternography sequence MRI was co-registered with the CT plan to delineate the target volume and develop the treatment plan. The CTV was contoured on the retro-Gasserian ganglion. The dose was prescribed to the isocentre for all patients. The prognostic impact of parameters such as sex, side of TN, previous surgery, radiotherapy dose, clinical response probability, and response onset time was assessed. Statistical analysis was performed using the MedCalc software package and the Kaplan-Meier product limit method. Acute and late toxicities were graded according to the CTCAE v5.0 scale.

RESULTS: Patient characteristics For the 46 treated patients were as follows: 29 out of 46 females (63%) and 17 out of 46 males (37%), with a median age of 63 years (range, 32-88), and Karnofsky Performance Status (KPS) was 90 (range, 80-100). The median planning target volume (PTV) was < 0.1 cc. Dosimetric characteristics Median prescribed dose was 70 Gy (range, 40-75 Gy). Four patients were lost during follow-up, so overall 42 of the 46 patients were evaluable for RS response analysis. Clinical Outcomes After a very long median follow-up of 8.5 years (range, 0.6-13.5 years), the clinical response probability was 92% ± 4% at 1 year, 71% ± 7% at 2 years, and 53% ± 9% at 5 years. The median time to response onset was 3 months (range, 1-16 months), and the median clinical response probability was 62 months (range, 37-158 months). In the univariate analysis, there was a statistically significant difference in clinical response probability favouring the higher dose ≥ 70 Gy (p = 0.0036) with HR (CI 95%) of 3.5 (1.4-8.5). However, achieving an initial complete response did not significantly affect the duration of the response. Toxicity No acute toxicity was recorded. Chronic toxicity was rare, with two patients (4%) developing G2 hearing loss and one (2%) experiencing G1 tearing and paresthesia.

CONCLUSION: LINAC-based RS is a safe and effective non-invasive option for the treatment of medically refractory TN, particularly for patients without a neurovascular conflict but with significant comorbidities or contraindications to surgery. To obtain maximal and durable results, the prescribed dose must be at least 70 Gy and it is necessary to adhere to stringent dose constraints to maintain a low toxicity rate.

PMID:42340657 | DOI:10.1007/s11547-026-02242-9

Radiol Med. 2026 Jun 24. doi: 10.1007/s11547-026-02241-w. Online ahead of print.

ABSTRACT

Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are pancreatic cystic lesions originating from the pancreatic ducts, characterized by mucin production and progressive ductal dilation. They exhibit a wide spectrum of biological behavior, ranging from indolent lesions to entities with significant malignant potential. Although the 2024 Kyoto guidelines define worrisome features (WF) and high-risk stigmata (HRS) to support risk stratification and clinical management, predicting disease progression remains challenging. In this retrospective study, we investigated whether MRI-based radiomic analysis could identify, at the time of initial imaging, patients with BD-IPMNs who subsequently develop WF or HRS according to 2024 Kyoto guidelines. A total of 194 adult patients who underwent at least two MRI examinations between January 2011 and March 2025 were included, with a median follow-up of 53 months; progression was observed in 28.3% of patients, involving only some WF/HRS. Radiomic analysis included manual lesion segmentation, extraction of 107 features (shape, first- and second-order), and selection via LASSO within a weighted logistic regression framework to address class imbalance, using fivefold cross-validation; model performance was assessed with AUC and precision-recall metrics to account for skewed class distribution. After statistical analysis, nine shape-related features were found to be significant and a LASSO-based radiomic model, incorporating five features, was constructed. The model achieved an area under the curve (AUC) of 0.70 (95% CI 0.62-0.79). These results suggest that MRI-based radiomics may represent a valuable noninvasive tool for early risk stratification, predicting progression according to clinical-radiological criteria and potentially supporting personalized management of patients with BD-IPMNs. However, this study presents some limitations, including the retrospective design, the relatively small sample size and possible variability due to the use of multiple MRI scanners from different vendors. Prospective and multicentric studies with standardized imaging protocols are necessary to validate these findings and assess the added value of integrating radiomic data with clinical, histopathological and molecular information.

PMID:42340656 | DOI:10.1007/s11547-026-02241-w

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00955-5. Online ahead of print.

ABSTRACT

The sphenoid sinus (SS) exhibits significant anatomical variability that critically impacts the safety and efficacy of endoscopic transsphenoidal surgery. This systematic review and meta-analysis aims to establish global prevalence rates for SS pneumatization patterns, extensions, and the relationship with adjacent neurovascular structures to guide surgical planning. A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science until October 2025. Studies reporting SS pneumatization types, extensions, and neurovascular protrusions/dehiscences based on imaging or cadaveric dissection were included. Random-effect models were used for the meta-analysis. The sellar type was the predominant pneumatization pattern, with the complete sellar type accounting for 48.39%. Statistically significant results were identified based on nationality and study type. Extensions into the greater wing (34.17%) and pterygoid process (25.51%) were common. The Vidian nerve (VN) showed the highest rates of protrusion (32.61%) and dehiscence (14.60%), followed by the internal carotid artery (ICA) (protrusion: 29.77%; dehiscence: 9.47%) and optic nerve (ON) (protrusion: 23.46%; dehiscence: 10.92%). The imaging modality used did not affect the neurovascular structure variations. The SS is a highly variable structure with frequent extensions that expose vital neurovascular structures to surgical risk. Although the subgroup analyses did not depict statistically significant results, computed tomography scan with less than 1 mm slice thickness should be used for evaluation of SS anatomy. The high prevalence of VN and ICA dehiscence necessitates rigorous preoperative evaluation. These findings provide a crucial anatomical reference for optimizing surgical approaches and minimizing complications in skull base surgery.

PMID:42340651 | DOI:10.1007/s12565-026-00955-5

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00952-8. Online ahead of print.

ABSTRACT

Computed Tomography (CT) imaging has expanded possibilities for biological profile estimation in forensic contexts. This study examined whether two-dimensional (2D) morphometric measurements and Hounsfield Unit (HU) values derived from CT scans of dry proximal femora could reliably estimate sex, stature, and age, and whether machine learning (ML) could meaningfully improve on traditional methods. Three hundred left femora from Thai individuals were scanned, and mid-coronal sections were used to extract measurements from defined anatomical regions. For sex estimation, conventional estimation equations reached 93.2% accuracy, while Naïve Bayes classification achieved 96.5% as the best performance among the ML models tested. Stature estimation using sex-specific 2D parameters yielded a Standard Error of Estimate (SEE) of 4.43 cm, which dropped to 3.96 cm when Support Vector Machines (SVM) and Gaussian Process Regression (GPR) were applied. Age estimation relied on HU values, which showed a consistent negative relationship with age. The lowest SEE for age was 9.67 years from measurements at the Primary Tensile Line (PTL) and Ward’s Triangle in females. Models also performed better when applied to older age groups. Although sex-specific equations outperformed mixed-sex ones, the latter were kept in the analysis as a practical alternative when sex cannot be established prior to analysis. Overall, 2D morphometrics proved most useful for sex and stature estimation, while HU values emerged as a reliable, quantitative approach to age estimation. ML consistently improved model performance across all three estimation tasks, supporting its role in modern forensic anthropological practice.

PMID:42340647 | DOI:10.1007/s12565-026-00952-8

J Racial Ethn Health Disparities. 2026 Jun 24. doi: 10.1007/s40615-026-03065-0. Online ahead of print.

ABSTRACT

IMPORTANCE: Cutaneous melanoma accounts for 5% of new cancer diagnoses in the United States. Despite advancements in treatment of melanoma, marked racial, ethnic, and socioeconomic disparities persist.

OBJECTIVE: To determine if there are racial and ethnic disparities in melanoma survival and to highlight opportunities for interventions to improve melanoma patient outcomes.

DATA SOURCES: The databases PubMed/Medline, EMBASE, and Web of Science were searched from inception to February 9, 2021.

STUDY SELECTION: Original publications reporting mortality statistics by race/ethnicity for patients with cutaneous melanoma, vulvar melanoma, or melanoma metastases were selected. Only experimental studies, observational studies, and research letters, with a study population in the United States were included.

DATA EXTRACTION AND SYNTHESIS: This investigation was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Authors performed title and abstract screening, followed by full text review in duplicate.

MAIN OUTCOME(S) AND MEASURE(S): We hypothesized that racial and ethnic minority groups would have worse melanoma mortality outcomes when compared to White patients.

RESULTS: Five representative studies with dates ranging from 1992-2015 were selected. The overall hazard ratio (HR) for Black patients vs. White patients was 1.31 (95% confidence interval (CI): 1.09-1.57), indicating that Black patients had a 31% increase in the risk of death as compared to White patients. Asian/Pacific Islander patients also had a 31% increase in the risk of death as compared to White patients (HR 1.31, 95% CI: 1.17-1.46). Hispanic patients had a 9% increase in the risk of death as compared to Non-Hispanic White (HR 1.09, 95% CI: 1.03-1.16). There was no significant difference in risk between American Indian/Alaskan Native and White patients (HR 0.94, 95% CI: 0.57-1.55).

CONCLUSIONS AND RELEVANCE: Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by multiple studies. More current investigations of melanoma outcomes in racial and ethnic minorities are necessary to identify and implement measures to narrow the gap in health outcomes.

KEY POINTS: Question: Are there racial and ethnic disparities in melanoma mortality outcomes?

FINDING: The pooled meta-analysis revealed that there are significantly worse melanoma survival outcomes in racial and ethnic minority groups when compared to White patients. The overall HR for Black, Asian/Pacific Islander, and Hispanic patients compared to White patients were 1.31, 1.31, and 1.09, respectively. Meaning: Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by these meta-analyses.

PMID:42340645 | DOI:10.1007/s40615-026-03065-0

J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07403-3. Online ahead of print.

ABSTRACT

PURPOSE: To examine the impact of physical exercise on motor skills in children with autism spectrum disorders (ASD).

METHODS: This study followed PRISMA guidelines (PROSPERO: CRD42024600538). Six databases (Embase, Engineering Village, OVID, PubMed, Scopus, and Web of Science) were searched through October 30, 2025.

INCLUSION CRITERIA: children ≤ 12 years with ASD; randomized controlled trials (RCTs); physical exercise interventions; motor skills outcomes measured via standardized instruments (BOT-2, TGMD-2, PDMS-2, ADS-3, MABC). Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using Cochrane ROB 2.0; evidence quality via GRADE. Statistical analysis used R 4.4.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Random-effects models were applied when I² ≥ 50%.

RESULTS: Ten RCTs (256 children; mean age 6.91 ± 2.51 years) were included. Physical exercise significantly improved total motor skills (SMD = 1.58, 95%CI: 1.15-2.00, p < 0.0000), locomotion (SMD = 1.34, 95%CI: 0.98-1.70, p < 0.00001), object control (SMD = 1.37, 95%CI: 1.02-1.72, p < 0.00001), and balance (SMD = 1.73, 95%CI: 0.82-2.65, p = 0.0002). Publication bias was detected for total motor skills and balance. Meta-regression showed that intervention frequency positively correlated with balance improvement (p = 0.022), while duration negatively correlated (p = 0.002).

CONCLUSION: Physical exercise significantly improves motor skills in children with ASD. Meta-regression indicates that frequency is a positive moderator for balance gains, but prolonged duration shows diminishing returns due to adaptation plateaus. Age and session length did not affect the protocol, so it remained flexible.

PMID:42340634 | DOI:10.1007/s10803-026-07403-3

J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07402-4. Online ahead of print.

ABSTRACT

BACKGROUND: The Modified Checklist for Autism in Toddlers – Revised (M-CHAT-R) is widely used for screening children at age 2 for autism spectrum disorders (ASD), but it also identifies children at risk for broader developmental challenges. We aimed to examine whether M-CHAT-R risk status at age 2 is associated with cognitive, behavioral, adaptive, and school-related outcomes at ages 3 to 4.

METHODS: We used data from the French national birth Cohort ELFE, including children assessed with the M-CHAT-R at age 2. Children were classified as low or medium risk. Outcomes at ages 3-4 included general cognitive development (Child Development Inventory), non-verbal reasoning (Picture Similarities test), family and daily activities, school engagement and performance, attention regulation (teacher-rated ADHD symptoms), specific neurodevelopmental care and school-based assistance. Multivariate analyses used modified Poisson regression for binary outcomes and linear regression for continuous outcomes, adjusted for sociodemographic, child-related, and school-related factors.

FINDINGS: 9,223 children were classified as low-risk and 1,248 children as medium-risk. Medium-risk children were more often boys and from socioeconomically disadvantaged families. At 3.5 years, medium-risk children had increased likelihood of developmental delay (16.6% vs. 6.1%, RR 2.2 after adjustment) and lower cognitive and language scores (up to -0.4 SD). Despite these differences, most children attended school, and their school life was similar to that of low-risk peers.

INTERPRETATION: Children classified as medium-risk by the M-CHAT-R at age 2 have an increased likelihood of subtle but widespread developmental challenges at school entry. Strategies to improve access to neurodevelopmental care and school support could enhance outcomes for this group.

PMID:42340632 | DOI:10.1007/s10803-026-07402-4

Obes Surg. 2026 Jun 24. doi: 10.1007/s11695-026-08810-2. Online ahead of print.

ABSTRACT

BACKGROUND: Sleeve conversion to Gastric Bypass (SG-RYGB) surgery is the most common conversion surgery in the United States. However, chronic Immunosuppressive therapy (CIT) may be a relative contraindication prior to metabolic and bariatric surgery (MBS) due to the potential for a complicated postoperative course and recovery, particularly in patients undergoing complex, secondary MBS.

OBJECTIVE: This study assesses the impact of CIT on both short-term and long-term outcomes following SG-RYGB surgery.

METHOD: This retrospective review study compared outcomes of patients at a single academic center who underwent SG-RYGB conversion surgery from January 2012 to December 2024. Patients were divided into two groups based on perioperative CIT status: the CIT group included those with documented use of chronic systemic immunosuppressive medications for at least three months prior to surgery, while the non-CIT group had no history of such therapy. Data collected included patient demographics, Body Mass Index (BMI), underlying disease, immunosuppression regimen, and early and late complications, such as rehospitalization, reinterventions, and mortality.

RESULT: One hundred twenty-six patients had SG-RYGB surgery; the average age for patients was 52.5 ± 11.5 years, 87.3% female. Of these, 23 patients (18.3%) were classified as the CIT group, having received chronic systemic immunosuppression for at least three months before surgery. In the CIT group, organ transplantations (47.8%) and rheumatoid arthritis (26.3%) were most common. Among perioperative and postoperative outcomes, the only statistically significant difference observed was a longer length of stay for CIT patients (P = 0.046), likely reflecting closer postoperative monitoring. Otherwise, short- and long-term postoperative outcomes were comparable between the CIT and non-CIT groups, with no significant differences observed in this cohort.

CONCLUSION: Except for a slightly longer hospital stay, short- and long-term outcomes appeared comparable between patients with and without CIT undergoing complex conversion surgery. However, larger studies are needed to confirm these findings and to help define the precise effect of CIT on outcomes of complex conversion surgery.

PMID:42340628 | DOI:10.1007/s11695-026-08810-2

J Endocrinol Invest. 2026 Jun 24. doi: 10.1007/s40618-026-02947-8. Online ahead of print.

ABSTRACT

PURPOSE: Adrenocortical carcinoma (ACC) is a rare tumor with highly aggressive malignancy. Its two main pathological subtypes, conventional ACC (CAC) and oncocytic ACC (OAC), are hypothesized to differ in clinical behavior, but comparative studies are limited due to the rarity of OAC. This study aimed to compare the clinical characteristics, pathological features, and prognosis between CAC and OAC.

METHODS: A retrospective review was conducted on 128 ACC patients (105 CAC, 23 OAC) during the period of October 2015 and October 2025. Data on clinical presentation, hormonal status, pathological findings, and survival outcomes were collected and analyzed. Statistical comparisons were performed using t-tests, Mann-Whitney U tests, chi-square tests, Cox proportional hazards regression analysis, multivariable Cox proportional hazards regression analysis, and Kaplan-Meier survival analysis with log-rank test.

RESULTS: Compared with CAC, OAC patients had a significantly lower prevalence of Cushing’s syndrome (13.0% vs. 39.0%, P < 0.05) and hypertension (17.4% vs. 48.6%, P < 0.01). In contrast, adrenal-derived sexual characteristics abnormalities were more common in OAC (65.2% vs. 26.0%, P < 0.001). Pathologically, compared with CAC, the Ki-67 index was significantly lower in OAC (median: 14% vs. 20%, P < 0.05). Also, Kaplan-Meier survival analysis revealed a more favorable overall survival(OS) for OAC, with a 5-year OS rate of 70.4% compared to 48.4% for CAC (P < 0.05). After multivariate adjustment for ENSAT stage and Ki‑67, pathological subtype lost independent prognostic significance, while ENSAT stage and Ki‑67 remained independent predictors.

CONCLUSIONS: CAC was associated with a higher frequency of glucocorticoid excess symptom, a higher proliferative index (Ki-67). OAC was characterized by a higher prevalence of androgen excess symptoms. OAC demonstrated similar OS to CAC after adjustment for ENSAT stage and Ki‑67.

PMID:42340623 | DOI:10.1007/s40618-026-02947-8

J Endocrinol Invest. 2026 Jun 24. doi: 10.1007/s40618-026-02929-w. Online ahead of print.

ABSTRACT

PURPOSE: To define an age-continuous reference range for testosterone (T) in females.

METHODS: A large-scale retrospective analysis of anonymised serum T collected via capillary sampling from a private healthcare service. 5,323 female individuals (19-59 years) with no history of reproductive conditions, normal BMI and regular cycles were analysed to establish a robust, age-continuous reference range for T, including probability density distributions and specific quantiles. Competing models of log T values as a function of age were statistically assessed, and the best model selected. Additionally, a cohort with self-reported hirsutism was compared.

RESULTS: A weakly skew-Normal distribution describes the best-fit distribution of log T values at any specific age, such that the mean decreases and the variance increases linearly with age. Analysis of the hirsutism cohort showed significantly higher T levels compared to the reference cohort.

CONCLUSION: Establishing a reliable reference range for female T enables clinicians to differentiate between physiological and pathological states (e.g. hyperandrogenism). Here, we establish a robust, age-continuous reference range for T in a large female population under strict inclusion criteria. The findings underscore the importance of age-specific reference ranges and highlight a substantial decrease in T over adult life. This study provides a valuable tool for clinicians and researchers seeking to compare patient hormone levels to a reliable reference distribution of T levels in women.

PMID:42340622 | DOI:10.1007/s40618-026-02929-w