Category: Nevin Manimala

Ann Biomed Eng. 2026 Apr 20. doi: 10.1007/s10439-026-04120-x. Online ahead of print.

ABSTRACT

PURPOSE: Postsurgical adhesion remains a significant clinical challenge. Seprafilm^® is widely used as a barrier to reduce adhesion formation, however its efficacy may be inconsistent. Recombinant human proteoglycan-4 (rhPRG4), a surface-active, anti-inflammatory glycoprotein found in synovial fluid inhibits cell and protein adhesion. This study investigated whether coating Seprafilm with rhPRG4 could enhance its anti-adhesive potential.

METHODS: Macrophages (J774), human fibroblast-like synoviocytes (HFLS), and melanoma (A375) cells were cultured on tissue culture wells treated with rhPRG4 or bovine submaxillary mucin (BSM) to determine optimal seeding density. Seprafilm sheets were coated with rhPRG4 or BSM (0.78-200 µg/mL). Cell adhesion was quantified using CellTiter-Glo^® while non-adherent macrophages were assessed for viability and re-adhesion. Migration was tested with the Oris^™ Universal Cell Migration assay and oxidative stress with MitoSOX^™ Red staining. ANOVA with multiple comparisons was used for statistical analysis.

RESULTS: Seprafilm alone promoted HFLS and macrophage adhesion, whereas application of rhPRG4 significantly reduced adherence compared to both control and BSM coated surfaces. The combination of rhPRG4 with Seprafilm showed the greatest reduction in adhesion without compromising viability or re-adherence. Seprafilm alone increased macrophage migration and ROS production, while rhPRG4 coated surfaces alone or in combination with Seprafilm suppressed both.

CONCLUSION: Coating Seprafilm with rhPRG4 enhances its anti-adhesive properties by reducing adhesion, migration, and oxidative stress in vitro. These findings suggest rhPRG4 may improve the biological performance of adhesion barriers by suppressing early cellular infiltration and inflammatory activation. Anti-adhesive bioactive surface modifications may advance postsurgical adhesion prevention and wound healing.

PMID:42010021 | DOI:10.1007/s10439-026-04120-x

Neurocrit Care. 2026 Apr 20. doi: 10.1007/s12028-026-02527-x. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal management of small-to-moderate volume (≤ 50 mL) basal ganglia spontaneous intracerebral hemorrhage (ICH) is controversial. This meta-analysis aimed to compare the efficacy and safety of stereotactic drainage treatment (SDT) with conservative medical treatment (CMT) in this patient population.

METHODS: We queried major databases up to October 2025 for studies comparing SDT versus CMT for basal ganglia ICH ≤ 50 mL. The primary endpoint was good functional recovery (modified Rankin Scale score 0-2). Subgroup analyses were performed on the basis of cohort-mean hematoma volume (< 25 mL vs. 25-50 mL) and follow-up duration.

RESULTS: Eleven studies involving 1634 participants were analyzed. Compared with CMT, SDT was associated with a higher proportion of favorable functional outcome up to 12 months (P < 0.001). Subgroup analysis showed consistent functional benefits across both volume strata (< 25 mL and 25-50 mL), with significant superiority emerging from 3 months onwards (all P < 0.001). Mortality did not differ significantly between groups (P = 0.05). SDT also accelerated hematoma resolution and reduced hospital stay (all P < 0.05) without increasing infection (P = 0.17) or rebleeding risks (P = 0.19).

CONCLUSIONS: SDT was associated with improved long-term functional recovery compared with CMT in cohorts with small-to-moderate basal ganglia ICH. Safety outcomes showed no statistically significant differences between groups. Large, multicenter randomized trials with standardized protocols are needed to confirm SDT’s efficacy and safety and to refine patient selection.

PMID:42010003 | DOI:10.1007/s12028-026-02527-x

Mol Psychiatry. 2026 Apr 20. doi: 10.1038/s41380-026-03563-x. Online ahead of print.

ABSTRACT

Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 2% of the global population. Beyond core symptoms such as social communication deficits and repetitive behaviors, individuals with ASD are at increased risk of cardiometabolic comorbidities, including obesity, diabetes, and cardiovascular disease. Here, we investigate the shared genetic architecture between ASD and cardiometabolic traits using large genome-wide association studies datasets and advanced statistical approaches: the bivariate causal mixture (MiXeR) model and pleiotropy-informed conditional false discovery rate (pleioFDR). Our results show significant polygenic overlap between ASD and several cardiometabolic phenotypes, despite almost negligible genetic correlation between the traits. Specifically, we observed positive genetic correlations within the shared component for ASD and metabolic traits, such as body mass index (rg=0.03), type 2 diabetes (rg=0.23), and total cholesterol (rg=0.78). In contrast, negative correlations emerged between ASD and cardiovascular traits, including diastolic and systolic blood pressure (rg = -0,22, for both), pulse pressure (rg = -0.25), and coronary artery disease (rg = -0.90). Finally, we identified 100 shared loci between ASD and cardiometabolic traits, mapping to 124 genes and suggesting shared biological mechanisms underlying these phenotypes and pointing to potential therapeutic targets. Shared loci between ASD and metabolic traits predominantly showed concordant effects, whereas those overlapping with cardiovascular traits-particularly blood pressure-related traits-tended to exhibit discordant effects. Together, these findings deepen our understanding of the biological connections between ASD and cardiometabolic comorbidities and may help inform more personalized strategies for managing ASD and its associated long-term health risks.

PMID:42009985 | DOI:10.1038/s41380-026-03563-x

Aesthetic Plast Surg. 2026 Apr 20. doi: 10.1007/s00266-026-05675-9. Online ahead of print.

ABSTRACT

BACKGROUND: Prepectoral breast reconstruction using acellular dermal matrices (ADMs) or micro-polyurethane foam-covered breast implants have emerged as commonly used surgical techniques. Although the use of both ADMs and micro-polyurethane foam-covered implants in prepectoral breast reconstruction are widely described in literature, comparative data remains limited.

OBJECTIVES: Our goal was to compare the short-term and medium-term clinical outcomes as well as the patient-reported outcomes in patients undergoing direct-to-implant (DTI) prepectoral breast reconstruction using ADM versus micro-polyurethane foam-covered implants.

METHODS: A retrospective matched cohort study was conducted on 64 patients (32 ADM-wrapped and 32 micro-polyurethane foam-covered breast implants). Patients were matched based on prior surgery, adjuvant radiotherapy, and implant volume. Demographic and oncological characteristics, surgical variables, short- and medium-term outcomes, and patient-reported outcomes were compared between the two groups.

RESULTS: The micro-polyurethane group had significantly older patients (median age 53 vs. 47 years; p = 0.036). Periprosthetic fluid collection (31% vs. 3%; p = 0.006) and need for percutaneous fluid aspiration (38% vs. 9%; p = 0.016) occurred significantly more often in the ADM group. The indication for further surgery was also higher with ADM (47% vs. 19%; p = 0.031). Patient satisfaction showed a non-significant trend favoring micro-polyurethane implants in satisfaction with outcome domain (mean: 89 vs. 82; p = 0.060).

CONCLUSIONS: Both ADM-assisted reconstructions and micro-polyurethane implants demonstrated high performance in the short and medium term, and they were associated to high patient satisfaction with reconstruction. However, micro-polyurethane implants were associated with fewer periprosthetic fluid collections and a lower need for percutaneous fluid aspirations compared to the ADM group. These findings suggest a potential advantage in terms of reduced postoperative complications.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42009925 | DOI:10.1007/s00266-026-05675-9

J Hum Lact. 2026 Apr 20:8903344261432421. doi: 10.1177/08903344261432421. Online ahead of print.

ABSTRACT

BACKGROUND: Neonatal hypernatremic dehydration (NHD) is a dangerous disease that can lead to hospitalization of the infant, serious complications, and death. Despite the significant advantages of breast milk for both the mother and the baby, some neonates who are exclusively breastfed experience malnutrition in the first few days.

RESEARCH AIM: This study aims to evaluate the clinical presentations, maternal and neonatal risk factors, and preventive strategies for hypernatremic dehydration in term and late-preterm infants who were exclusively breastfed.

METHODS: In this study, neonates who were hospitalised with the diagnosis of hypernatremic dehydration in the Neonatal Intensive Care Unit of Mardin Training and Research Hospital between 2019 and 2023, who were exclusively breastfed after birth, whose gestational age was 35 weeks and above, and whose serum sodium concentration was measured ≥150 mEq/L were retrospectively evaluated. Statistical analyses were performed using SPSS 25.0 software.

RESULTS: A total of 141 newborns diagnosed with hypernatremic dehydration were included in the study. The mean age at presentation was 4 (1-20) days, and 53% of the patients were male. The mean birth weight was 3248.16±491.05 g, while the mean admission weight was 2885.67±477.61 g, indicating a significant weight loss of 11.33±7.46%. The mean maternal age was 28.95±6.22 years, and 41% of deliveries were by caesarean section. Transcranial ultrasonography was normal in 97.2% of the patients, while 2.8% had signs of haemorrhage or oedema. The most common presenting complaint was malnutrition (46.8%), followed by jaundice (41.1%).

CONCLUSION: Awareness of NHD among both mothers and healthcare personnel is the most important factor. Calling babies for early postnatal check-ups, close monitoring of neonatal weight loss, and encouraging successful breastfeeding techniques may reduce hospitalization rates.

PMID:42007909 | DOI:10.1177/08903344261432421

Oper Neurosurg. 2026 Apr 20. doi: 10.1227/ons.0000000000002019. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Lateral interbody fusion represents a minimally-invasive approach to achieve indirect decompression via disc height restoration and alignment correction in patients with degenerative lumbar spondylolisthesis. If the surgeon opts for an anterior-to-psoas (“oblique”) corridor, the patient must be positioned in the lateral decubitus position to facilitate interbody placement, which may then be followed by posterior percutaneous pedicle screw placement in either the same lateral decubitus position or by repositioning to prone. It is presently unclear whether operative position significantly affects postoperative spondylolisthesis correction and alignment. We sought to determine the impact of patient positioning on radiographic outcomes and perioperative complications following single-position lateral vs dual-position lateral-then-prone oblique lumbar interbody fusion (OLIF).

METHODS: This is a retrospective cohort study at a tertiary academic center. All adult patients undergoing single-level OLIF for degenerative spondylolisthesis were identified and reviewed. Same-level revision cases, patients undergoing additional unrelated procedures, standalone interbody cases, or patients undergoing interbody placement in the prone position were excluded. The primary outcome measures were the percentage reduction in spondylolisthesis and changes in sagittal alignment; secondary outcomes included operative time, radiographic pedicle screw placement accuracy, and complications.

RESULTS: We identified 71 cases meeting criteria for the analysis, including 29 (40.9%) single-position and 42 (59.1%) dual-position procedures. Single-position lateral cases lasted on average 29.4 minutes shorter than dual-position cases (95% CI: 11.3-47.6 minutes). There were no statistically significant differences between cohorts in spondylolisthesis reduction, segmental/regional lordosis, or pedicle screw accuracy.

CONCLUSION: In this retrospective single-center analysis, single-position lateral OLIF was associated with shorter operative duration compared with dual-position lateral-then-prone OLIF with no significant impact on pedicle screw accuracy or spondylolisthesis reduction. In cases without need for posterior procedures beyond percutaneous instrumentation, surgeons may opt for either approach at their own discretion without clinically significant impact on postoperative alignment or complication rates.

PMID:42007755 | DOI:10.1227/ons.0000000000002019

Pediatr Emerg Care. 2026 Apr 17. doi: 10.1097/PEC.0000000000003609. Online ahead of print.

ABSTRACT

PURPOSE: Point-of-care ultrasound-guided fascia iliaca nerve block (POCUS-FINB) is an effective method for pain control in children with femur fractures. Many pediatric emergency medicine (PEM) providers have not been trained in this technique, and there is no standard curriculum. While other studies have evaluated in-person POCUS-FINB didactics, assessment of online educational interventions is lacking. We created and implemented a novel online POCUS-FINB module and evaluated its efficacy in knowledge, confidence, and technical skill acquisition among PEM physicians.

METHODS: This was a prospective presurvey and postsurvey study of PEM attendings and fellows. The curriculum was developed using the Kern 6-step framework and included an online module and a brief hands-on session. Confidence, knowledge, and technical skills were assessed using a Likert scale, multiple-choice tests, and an observation checklist, respectively. In addition, we reviewed the proportion of eligible patients who received POCUS-FINB at our institution precurriculum and postcurriculum implementation.

RESULTS: Twenty-seven PEM physicians in 2 pediatric emergency departments participated in the study. Twenty-two completed all assessments from January 2022 to July 2023. Physicians demonstrated improved confidence with POCUS-FINB methods after completion of the online curriculum, with 4% reporting being confident or very confident before and 71% after the module (P<0.001). On the knowledge test, there was a statistically significant improvement, with mean scores from 77% premodule to 95% postmodule (P<0.001). Immediately after the module, participants scored well in technical skills with a mean score of 92%. There was a significant increase in the proportion of eligible patients with femur fractures who received blocks over the study period, 19% during the premodule period and 38% during the postmodule period (P=0.046).

CONCLUSION: After completing a web-based curriculum for POCUS-FINB, PEM physicians showed improvement in confidence and knowledge and performed well in their technical skills.

PMID:42007732 | DOI:10.1097/PEC.0000000000003609

Acta Radiol. 2026 Apr 20:2841851261438071. doi: 10.1177/02841851261438071. Online ahead of print.

ABSTRACT

BackgroundT2* mapping provides objective data on chondromalacia. However, its reliability in evaluating both patellar and trochlear cartilages has not yet been established.PurposeTo evaluate the repeatability and reproducibility of T2* mapping of patellar and trochlear cartilage in patients with patellofemoral maltracking, and to compare the reliability of axial and sagittal imaging planes for early detection of chondromalacia.Material and MethodsThis retrospective study included 106 knees from patients aged 18-40 years presenting with anterior knee pain and MRI evidence of patellofemoral malalignment between January 2023 and August 2025. T2* mapping was performed on a 3 T MRI scanner using standardized protocols. Patellar and trochlear cartilage were manually divided into 12 compartments in axial and sagittal planes. Regions of interest were placed manually, and T2* relaxation times were measured independently by a musculoskeletal radiologist and an orthopedic surgeon. Intra- and inter-observer reliability were assessed using intraclass correlation coefficients (ICCs).ResultsMost compartments demonstrated good-to-excellent intra- and inter-observer agreement (ICC ≥0.75), particularly in the upper and mid patellar cartilage zones. Axial-plane measurements consistently showed higher ICC values than sagittal-plane measurements. The lowest reliability was observed in lower cartilage zones and in sagittal-plane measurements. All results were statistically significant (P <0.001).ConclusionT2* mapping of the patellofemoral joint provides reliable measurements, with superior performance in the axial plane and in mid-upper zones. Routine use of axial-plane T2* mapping may facilitate early detection of chondromalacia in young adults with anterior knee pain, potentially improving clinical decision-making and preventing irreversible cartilage damage.

PMID:42007709 | DOI:10.1177/02841851261438071

mSphere. 2026 Apr 20:e0008626. doi: 10.1128/msphere.00086-26. Online ahead of print.

ABSTRACT

Built environment surveillance is a proven approach for tracking disease burden of some viruses within hospitals and long-term care facilities. However, studies in clinical settings are lacking for simultaneously surveying targets in a built environment using targeted metatranscriptomics. We swabbed six discrete floor locations within an acute care center’s emergency department (ED) in Ottawa, Canada, and sequenced cDNA using a 132 viral taxa panel, identifying viral burden across sampling locations and time. The determined SARS-CoV-2 variant profile across time was matched to provincial variant prevalence. The correlation between metatranscriptomic read abundances and reported cases of influenza A, SARS-CoV-2, and RSV was assessed. We quantified these via qPCR and assessed the correlation of Cq versus metatranscriptomic reads for these viruses. We sequenced a median of 1,302,882 reads per sample from 38 floor swabs collected during peak respiratory viral season (November 2022-February 2023). Diversity of viral communities varied significantly across locations in the ED. SARS-CoV-2 variant abundance shifts matched the changing infection landscape concurrently reported in Ontario. Relationships between targeted metatranscriptomic read ratios and clinical burden were not statistically significant, although we found modest correspondence between qPCR signal and read depth for RSV and SARS-CoV-2. This approach characterized the viral communities and the within-species diversity within an ED. Correlating sequencing-derived data with disease burden for three key respiratory viruses was inconsistent, with the exception of significant correlation between metatranscriptomic reads and Cq data for SARS-CoV-2. We were able to recover the distribution of clinically reported SARS-CoV-2 variants from the floor swab data.

IMPORTANCE: Environmental surveillance is useful for estimating the disease burden for certain viruses. qPCR is commonly used for surveillance of wastewater and built environments, including during the COVID-19 pandemic, but single, multiplexed reaction targets are limited. Targeted metagenomic or metatranscriptomic approaches can accurately quantify microbial populations of interest in an environment, reduce off-target sequencing, and evaluate a broader number of targets than qPCR assays. Here, we assessed the capacity of a targeted viral metatranscriptomic panel to correlate viral abundance in the hospital built environment with key pathogens of interest, including influenza A, RSV, and SARS-CoV-2. Our results suggest that targeted metatranscriptomics may identify viral communities in healthcare facilities, including strain-level detection capability. However, this approach must be validated for its effectiveness in viral surveillance that accurately reflects disease burden. This work contributes to a growing toolkit for pathogen surveillance, a critical endeavor to safeguard against outbreaks of known and emerging pathogens.

PMID:42007699 | DOI:10.1128/msphere.00086-26

J Acoust Soc Am. 2026 Apr 1;159(4):3448-3463. doi: 10.1121/10.0042760.

ABSTRACT

Humans perceive non-linguistic sounds (NLSs) by associating auditory events with corresponding physical sources in a complex acoustic environment. However, previous studies have shown that cochlear implant (CI) users, vs normal hearing (NH) listeners, can face more severe challenges in identifying and tracking NLS. For CI listeners, this leads to limited autonomy, environmental awareness, safety, contextual navigation and daily engagement with individuals, society, and environmental situations. In earlier work, we studied NLS classification among CI and NH listeners and proposed a NLS enhancement solution to benefit CI/NH listeners. Building on this foundation, we propose here an experimental framework to investigate competing environmental sounds or NLS perception among CI and NH listeners. We introduce a two-source mixture model featuring “target” and “interference” source characteristics and develop an experimental setup for listener evaluation in three conditions: (i) mixed-baseline, (ii) source separation (SS) using the SUccessive DOwnsampling and Resampling of Multi-Resolution Features network, and (iii) source separation with non-linguistic sound enhancement (SSE) achieved by cascading SS output with our previously developed NLS enhancement technique. CI and NH listener evaluations were based on subjective ratings and forced-choice preference test based on perceptual measures: (i) interference, (ii) audio quality, and (iii) distortion. Our study shows a statistically significant improvement in interference reduction, with CI listeners demonstrating reduction for “nature” sounds with “category-matched” interference [F(2,21) = 4.935, p = 0.0175], and NH listeners exhibiting reductions across all NLS categories, with F-values ranging from [F(2,135) = 8.481, p = 0.000 339] to [F(2,135) = 32.37, p = 3.29 × 10-12]. Pairwise forced-choice test revealed preferences for SSE-processed nature and “domestic noises” among both CI and NH listeners. Our proposed experimental framework addresses key challenges in competing environmental sound perception among CI and NH listeners: (1) evaluation of SS for interference-characterized NLS mixture, (2) evaluation of environmental sound or NLS enhancement framework to improve perceptual outcomes with speech-targeted CI processing, and (3) perceptual measures to characterize NH and CI listener experience.

PMID:42007671 | DOI:10.1121/10.0042760