Category: Nevin Manimala

Clin Oral Investig. 2026 May 7;30(6):219. doi: 10.1007/s00784-026-06897-6.

ABSTRACT

OBJECTIVES: To evaluate the efficacy of artificial intelligence (AI)-driven three-dimensional (3D) anatomical models as an adjunct to cone-beam computed tomography (CBCT) for root canal assessment regarding diagnostic accuracy, observer confidence, and time efficiency among undergraduate and postgraduate students.

MATERIALS AND METHODS: In this observational diagnostic study, 26 observers (13 undergraduates and 13 postgraduates) evaluated 22 tooth roots with complex anatomy from nine CBCT scans under two conditions: CBCT alone and CBCT supplemented with AI-generated 3D anatomical models. Observers assessed the number of roots, root canals, and apical foramina, while confidence (5-point Likert scale) and assessment time were recorded. Each observer performed 132 assessments, totaling 3,432 evaluations. A reference standard was established by consensus between two specialists. A significance level was set at 5% (α = 0.05) for all statistical analyses.

RESULTS: Augmenting CBCT with AI-generated 3D models significantly improved diagnostic accuracy for all parameters (p < 0.001). Root detection accuracy reached 100% in both groups. Root canal detection increased from 83% to 94% among undergraduates and from 88% to 99% among postgraduates, while apical foramina detection increased to 99% in both groups. Observer confidence significantly increased (p < 0.001), reaching a median score of 5 (IQR: 5-5). Workflow efficiency also improved (p < 0.001), with median assessment time decreasing from 102 s to 39 s for undergraduates and from 97 s to 24 s for postgraduates.

CONCLUSION: AI-driven 3D anatomical models used with CBCT enhance diagnostic accuracy, observer confidence, and evaluation efficiency in endodontic assessment. However, multi-centre studies with larger, more diverse samples, particularly including cases with pronounced artefacts, would further support generalisability.

CLINICAL RELEVANCE: AI-generated 3D anatomical models derived from CBCT scans may serve as a valuable adjunct for the interpretation of complex root canal anatomy, improving diagnostic accuracy, increasing observer confidence, and reducing assessment time. These findings support their potential role not only in clinical decision-making but also as an effective educational tool for training dental students and clinicians.

PMID:42096111 | DOI:10.1007/s00784-026-06897-6

Eur J Pediatr. 2026 May 7;185(6):358. doi: 10.1007/s00431-026-07003-4.

ABSTRACT

The purpose of this study is to evaluate whether piperacillin-tazobactam therapy, compared with cefepime monotherapy, results in significant difference in treatment success, mortality, and duration outcomes in pediatric patients with febrile neutropenia (FN). A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched up to February 3. No starting limits for dates were used. We only included studies of pediatric patients with FN comparing piperacillin-tazobactam to cefepime monotherapy. Risk of bias was assessed using Cochrane RoB 2 tool. Meta-analysis was performed using random-effects model to calculate risk ratios (RR) and mean differences (MD). Five RCTs involving 470 episodes were included. The pooled analysis for treatment success showed no statistically significant difference between groups (RR = 1.02; 95% CI [0.89; 1.18]; P = 0.76) with low heterogeneity (I² = 0.0%). No significant differences for mortality (RR = 2.09; 95% CI [0.62; 7.03]; P = 0.23; I² = 0.0%). Duration of treatment was 0.9 day shorter for cefepime group (MD = 0.9 day; 95% CI [0.2; 1.6]; P < 0.1; I² = 0%).

CONCLUSION: No statistically significant difference was found in treatment success or mortality between the groups. Patients receiving cefepime had a treatment duration 0.9 days shorter than those receiving piperacillin-tazobactam, although this finding should be interpreted with caution. The available evidence remains limited. Further RCTs are needed to elucidate potential differences in treatment success, mortality, and duration between the drugs.

REGISTRATION: PROSPERO (CRD420261296621).

WHAT IS KNOWN: • Cefepime and piperacillin-tazobactam are widely utilized as empirical monotherapy for febrile neutropenia, but evidence regarding their comparative clinical efficacy and safety in children remains inconclusive.

WHAT IS NEW: • This meta-analysis quantifies differences in treatment success, mortality and duration of treatment outcomes in pediatric patients with febrile neutropenia.

PMID:42096109 | DOI:10.1007/s00431-026-07003-4

Hernia. 2026 May 7;30(1):197. doi: 10.1007/s10029-026-03694-8.

ABSTRACT

BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; however, their implementation and effectiveness remain variable. This systematic review evaluates current evidence on the role of preoperative optimization in patients undergoing VHR.

MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were searched for studies comparing preoperative interventions versus standard care in patients undergoing VHR. The primary outcome was characterization of rehabilitation strategies. Secondary outcomes included surgical utilization, emergent repair, readmission, surgical site infection (SSI), surgical site occurrence (SSO), recurrence, reoperation, and mortality.

RESULTS: Six studies were included, comprising a total of 3,556 patients, of whom 1,805 (50.7%) underwent preoperative optimization. Preoperative optimization interventions were highly heterogeneous and primarily consisted of multidisciplinary programs focused on exercise, weight loss, and lifestyle modification. Control groups varied widely, precluding formal meta-analysis. Studies requiring predefined optimization targets reported unsuccessful rehabilitation rates of 5.1%-45%. Emergent repair occurred in 6.8% of intervention patients in one study. SSI rates seemed lower and ranged from 4.2% to 11.8% in intervention groups versus 11.0%-16.7% in controls, SSO and reoperation rates were generally lower in optimization groups.

CONCLUSION: Structured preoperative optimization pathways may be associated with improved short-term outcomes in select patients undergoing VHR. However, the current literature is heterogeneous, and standardized protocols and prospective studies are needed to better define optimal implementation strategies and long-term effectiveness.

PMID:42096105 | DOI:10.1007/s10029-026-03694-8

Inflamm Res. 2026 May 7;75(1):111. doi: 10.1007/s00011-026-02257-y.

ABSTRACT

BACKGROUND: Over 25% of patients with ulcerative colitis (UC) develop extraintestinal manifestations (EIMs), resulting in significant systemic morbidity. We define the shared genetic foundation of these manifestations as the UC-associated Multisystem Inflammatory Genetic Architecture (UC-MIGA). This study aims to identify shared genomic drivers and actionable immunosenescence therapeutic targets across the UC-EIM spectrum.

METHODS: We applied genomic structural equation modeling (SEM) to seven European-ancestry GWAS datasets (UC, deep vein thrombosis, ankylosing spondylitis, primary sclerosing cholangitis, pyoderma gangrenosum, interstitial lung disease, and erythema nodosum) to identify a shared latent genetic factor (F1). Post-SEM analyses included FUMA mapping, SuSIE/FINEMAP fine-mapping, FUSION/FOCUS transcriptome-wide studies, MAGMA enrichment, CELLECT deconvolution, LDSC partitioned heritability, and single-cell eQTL Mendelian randomization (MR). UC exhibited the highest standardized factor loading (0.9801) on F1, justifying its use as a representative proxy for UC-MIGA in downstream analyses. UC-telomere relationships were assessed via tissue-specific eQTL/sQTL enrichment across 49 GTEx tissues, spatial transcriptomics (gsMap), single-cell profiling (GSE214695, GSE163974), hdWGCNA, and colocalization analyses (eCAVIAR, fastENLOC).

RESULTS: SEM identified substantial genetic overlap (CFI = 1.0, SRMR = 0.17). Within the UC-MIGA framework, we identified 17,005 SNPs (P ≤ 1 × 10⁻2⁰⁰), 2,622 risk loci, and 152 high-confidence effector genes. Pathways implicated Th17/Treg imbalance and inflammasome signaling. Super-enhancer regions showed exceptional heritability enrichment (80.16%, fold = 4.79, p = 0.0007). MR identified 35 causal immune cell-gene associations. UC-telomere analyses revealed convergence in colon-specific DNA repair-mitochondrial energetics-telomere maintenance pathways, with B cells prioritized as the core cell type. Colocalization identified NKX2-3 and LINC01475 as high-confidence shared candidates. Embryonic intestinal enrichment supported the developmental origins of this systemic axis.

CONCLUSION: UC-MIGA represents a genetically coherent architecture driven by super-enhancer-mediated epigenetic dysregulation, Th17/Treg imbalance, and immunosenescence features, including telomere dysfunction and B-cell exhaustion. The ‘developmental vulnerability-environmental trigger’ model explains the gut-origin inflammatory cascade underlying extraintestinal manifestations, with UC-telomere analysis providing a genomic foundation for systemic therapeutic strategies targeting the inflammation-aging nexus.

PMID:42096094 | DOI:10.1007/s00011-026-02257-y

Orthopadie (Heidelb). 2026 May 7. doi: 10.1007/s00132-026-04841-w. Online ahead of print.

ABSTRACT

BACKGROUND: Different minimally invasive approaches have been established in the management of elective hip arthroplasty. However, there is almost no data on the endoprosthetic treatment of femoral neck fractures in obese patients.

MATERIALS AND METHODS: The monocentric case-control study is based on the retrospective evaluation of a database. Included were patients with a body mass index (BMI) of > 30 kg/m² who received endoprosthetic treatment due to a femoral neck fracture. The cohort was dichotomized based on the surgical approach: direct lateral (DL) and minimally invasive anterolateral (MIV AL). Demographic and perioperative variables were collected. The primary study objective was the comparison of general and specific complications. The secondary study objective was the comparison of survival rate and mobility according to the Parker score.

RESULTS: A total of 155 surgeries conducted between 2011 and 2024 were included, of which 52 procedures were performed using a DL approach and 103 procedures using an MIV AL approach. The mean age of the overall cohort was 77.9 ± 9.4 years, and the mean BMI was 33.4 ± 3.2 kg/m². The demographic variables showed a homogeneous distribution. The overall revision rate was noticeably higher for the MIV AL approach, but not statistically significant (p = 0.18). Dislocations (n = 7) and infections (n = 3) occurred exclusively in the MIV AL group. There was no significant difference in mortality or survival rates. The 30-day and 1‑year mortality rates were 0% and 9.0%, respectively (p = 0.776). The mean survival rate according to Kaplan-Meier was 7.1 years (95% confidence interval, 6.12-8.03) without significant differences regarding the surgical approaches (log rank = 0.656). Mobility according to Parker (n = 78) at the time of follow-up was also comparable (p = 0.60).

CONCLUSION: The MIV AL approach to endoprosthetic treatment of femoral neck fractures in obese patients showed a higher, but not significant, dislocation and infection rate compared to the DL approach. For the overall cohort, mortality rates were low. Recording the surgical approaches and BMI in registry data would be useful to generate larger case numbers.

LEVEL OF EVIDENCE: III; retrospective case-control study.

PMID:42096082 | DOI:10.1007/s00132-026-04841-w

Hernia. 2026 May 7;30(1):198. doi: 10.1007/s10029-026-03703-w.

ABSTRACT

BACKGROUND: Recurrence of hiatal hernia after primary repair is a major concern, particularly early recurrence related to technical factors. Reliable preoperative predictors are essential for optimal surgical strategies. Because the hernial sac area can also affect operative complexity, this study aimed to evaluate early recurrence-associated factors and their relationship with operative time using quantitative computed tomography (CT).

METHODS: We retrospectively analyzed 48 patients who underwent laparoscopic hiatal hernia repair between July 2012 and July 2025. Preoperative CT was used to measure the maximum diameter and area of the hernial sac in the axial and coronal planes. We examined the association between these parameters and surgical outcomes including recurrence.

RESULTS: Early recurrence was observed in four patients (8.3%), all of whom required reoperation within 3 days. Patients with early recurrence had longer operative times and larger axial hernial sac areas (p < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the axial maximum diameter provided the highest predictive performance for early recurrence (area under the curve [AUC] = 0.89), with an optimal cutoff value of 117.6 mm. Other parameters, including axial area, coronal area, coronal diameter, and hiatal width, showed moderate predictive ability but none exceeded axial diameter accuracy.

CONCLUSION: Axial hernial sac measurements are associated with early recurrence. Preoperative CT-based quantitative assessments may provide valuable information for predicting surgical complexity and recurrence, thereby supporting preoperative risk stratification and surgical planning. Therefore, prospective validation using a larger cohort is warranted.

PMID:42096069 | DOI:10.1007/s10029-026-03703-w

Int Urogynecol J. 2026 May 7. doi: 10.1007/s00192-026-06536-4. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disorder of unclear etiology that impairs quality of life; physically, emotionally, and sexually. Up till now, no standard effective therapy has existed. Phosphodiesterase-5 inhibitors are vasodilatory and anti-inflammatory. We studied the efficacy and safety of tadalafil, amitriptyline, and their combination in female IC/BPS patients.

METHODS: In this study, 132 female patients were randomized into three groups. Assessments were performed at baseline and at 4, 8, and 12 weeks using voiding diary, uroflowmetry, the visual analog scale (VAS), the Interstitial Cystitis Symptom Index (ICSI), and the Interstitial Cystitis Problem Index (ICPI). Global Response Assessment (GRA) and correlations between VAS and voided volume were analyzed at the end. Statistical analysis was performed using the Kruskal-Wallis test.

RESULTS: Tadalafil and combination improved daytime voids more than amitriptyline (tadalafil vs amitriptyline p = 0.0005, amitriptyline vs combination p < 0.0001, tadalafil vs combination p = 0.0009). Night-time voids improved notably in tadalafil and combination vs amitriptyline (p < 0.0001). Maximum urinary flow rate (Qmax) increased in combination and tadalafil vs amitriptyline (p = 0.0004) and (p = 0.0294) respectively. Voided volume was higher in combination vs amitriptyline (p = 0.0041). ICSI, ICPI, and VAS scores decreased in all groups (p < 0.0001). Ninety-two patients achieved a GRA score of 7. VAS correlated with voided volume in the tadalafil group (r = -0.60). Amenorrhea was the most bothering adverse event among the patients in the tadalafil group.

CONCLUSIONS: Tadalafil, alone or combined with low-dose amitriptyline, is a safe and effective treatment for female IC/BPS. The combination had comparable or superior efficacy to tadalafil using a lower amitriptyline dose while reducing adverse events.

PMID:42096062 | DOI:10.1007/s00192-026-06536-4

Int Urogynecol J. 2026 May 7. doi: 10.1007/s00192-026-06656-x. Online ahead of print.

ABSTRACT

INTRODUCTION: The efficacy of pelvic floor muscle training (PFMT) in preventing and treating postpartum urinary incontinence remains inconclusive. This systematic review aims to evaluate the efficacy of pelvic floor muscle training (PFMT) in treating postpartum urinary incontinence (PPUI).

METHOD: We systematically searched Embase, PubMed, and Cochrane Library for randomized controlled trials (RCT) investigating PFMT for PPUI. Studies published before October 2024 were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Cochrane Risk of Bias Tool (ROB 2.0). Meta-analyses were performed using random-effects models, with effect sizes reported as risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CI).

RESULTS: A total of 19 RCTs were included in the analysis. Statistically significant improvements were observed in pelvic floor muscle strength (SMD 0.61, 95% CI [0.10, 1.12], P = 0.02) and endurance (SMD 0.68, 95% CI [0.06, 1.30], P = 0.03). However, no significant differences were found in quality of life (SMD -0.46, 95% CI [-1.18, 0.27], P = 0.22) or urinary incontinence incidence (RR 0.87, 95% CI [0.73, 1.04], P = 0.12). The subgroup analysis demonstrated that supervised PFMT interventions lasting more than 8 weeks were the most effective approach for improving pelvic floor muscle strength.

CONCLUSION: Pelvic floor muscle training (PFMT) demonstrates significant efficacy in improving pelvic floor muscle function (strength and endurance) in postpartum women with urinary incontinence (UI), supporting its physiological mechanism of action. However, owing to limitations in the available data and substantial heterogeneity across studies, the direct impact of PFMT on symptom resolution-specifically UI incidence and quality of life-remains less certain and should be interpreted with caution.

PMID:42096061 | DOI:10.1007/s00192-026-06656-x

Clin Oral Investig. 2026 May 7;30(6):220. doi: 10.1007/s00784-026-06899-4.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the clinical outcomes of gingival recession Type 1 (RT1) treatment using a coronally advanced flap (CAF) alone and in combination with L-PRF at 6 months.

MATERIALS AND METHODS: A total of 70 RT1 from 19 patients were included. Participants were randomly assigned to the test group (TG, CAF + L-PRF, n = 42) and the control group (CG) (CAF alone, n = 28). Clinical parameters were assessed at baseline and at 6 months: the primary outcomes were percentage of root coverage (%RC) and complete root coverage (CRC); and the secondary outcomes included mean root coverage (MRC), changes in gingival thickness (GT) and volumetric tissue gain, recession area reduction, analgesic consumption, healing quality (the Inflammatory Proliferative Remodeling [IPR] score), and patient-reported outcome measures (PROMs). Statistical analyses were performed to determine differences between groups; a random-intercept mixed-effects model was used for all site-level outcomes.

RESULTS: At six months, %RC was 89.30% ± 20.33% (TG) and 81.60% ± 27.93% (CG) (p > 0.05). For the TG and CG, respectively, %CRC was 73.81% and 57.14%; the mean GT gain was 0.16 ± 0.10 mm and 0.11 ± 0.10 mm (p = 0.08); the mean volume gain was 1.13 ± 1.25 mm³ and 0.86 ± 0.84 mm³ (p = 0.32); the mean number of pills taken was 1.67 ± 0.98 and 2.25 ± 1.02 (p = 0.04); the esthetic satisfaction was 95% ± 5% and 90% ± 7% (p = 0.31); willingness to undergo the procedure again: 93% ± 4% and 88% ± 6% (p = 0.22); sensitivity reduction: 85% ± 6% and 80% ± 8% (p = 0.19). There was no statistically significant difference in healing quality and PROMs.

CONCLUSION: Both CAF alone and CAF combined with L-PRF yielded comparable clinical and volumetric outcomes in RT1 treatments. No statistically significant advantages were observed with the adjunctive use of L-PRF.

CLINICAL RELEVANCE: Because CAF alone achieves high predictability for RT1 defects, the routine adjunctive use of L-PRF provides limited additional clinical benefits.

PMID:42096052 | DOI:10.1007/s00784-026-06899-4

Anat Sci Int. 2026 May 7. doi: 10.1007/s12565-026-00934-w. Online ahead of print.

ABSTRACT

Sex determination from skeletal remains presents significant challenges, particularly when bones are damaged or incomplete. In such cases, histomorphological analysis of fragmented bone pieces becomes essential. The medial clavicle is recognized as a valuable anatomical marker in forensic and anthropological research due to its pronounced sex-related morphological variations. This study aimed to develop a deep learning-based method for sex determination using histological images of the medial clavicle in Thai population, and to evaluate its performance with both validation and blind test sets utilizing the GoogLeNet convolutional neural network architecture. A total of 100 pairs of clavicles were included, with 70 cases (35 males,35 females) assigned to the training group and 30 (15 males,15 females) to the test group. Histological images underwent pre-processing and were standardized in size before being input into the training model. Validation accuracy was assessed using MATLAB, while descriptive statistics for the test set were calculated with SPSS software. GoogLeNet demonstrated superior performance, achieving a validation accuracy of 96.43% and a blind test accuracy of 90%. These results highlight the potential of a deep learning approach using 2D histological images of the medial clavicle as a straightforward and effective tool for sex determination in forensic anthropology, offering a high degree of accuracy. This method paves the way for rapid, objective, and accessible sex identification, even from fragmented human remains, and demonstrates promise for broader applications in the forensic and anthropological sciences.

PMID:42096030 | DOI:10.1007/s12565-026-00934-w