Nevin Manimala

Hernia. 2026 May 27;30(1):233. doi: 10.1007/s10029-026-03732-5.

ABSTRACT

BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications.

METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE.

RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59).

CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience.

REGISTRATION/FUNDING: PROSPERO CRD420251272842.

PMID:42201585 | DOI:10.1007/s10029-026-03732-5

J Robot Surg. 2026 May 27;20(1):538. doi: 10.1007/s11701-026-03501-7.

ABSTRACT

During early adoption of robotic surgeries, evidence is primarily descriptive, and how such evidence emerges and accumulates over time remains poorly understood. This study introduces a framework for modeling the temporal dynamics of descriptive evidence on device-level utilities and operational issues accumulated during early adoption of the da Vinci system. We employed a three-step approach comprising systematic dataset acquisition, thematic coding of device utilities and operational issues, and quantitative temporal modeling. A PRISMA-guided search of PubMed and Web of Science identified early clinical studies of the da Vinci system from FDA clearance (July 2000) to the first published randomized controlled trial. Two reviewers independently coded descriptive themes, and cumulative occurrence proportions were modeled over time using exponential and logistic regression to characterize the emergence and saturation patterns. Nineteen studies met inclusion criteria, yielding 16 themes (7 utilities, 9 issues) with high inter-rater reliability (agreement rate 93.1%, Cohen’s κ = 0.85). Utilities, particularly instrument dexterity and stereoscopic depth perception, were reported early and reached saturation rapidly, whereas operational issues, including loss of haptic feedback and workflow-related constraints, emerged more gradually and required greater cumulative clinical experience. Time-series modeling demonstrated a clear saturating pattern, with utilities reaching 80% cumulative occurrence at 13.2 months versus 26.0 months for issues. This study presents a framework for modeling how descriptive evidence emerges and matures in early-stage medical device adoption. The observed asymmetry, rapid recognition of utilities versus delayed emergence of operational issues, highlights the importance of structured, continuous synthesis of early clinical evidence.

PMID:42201559 | DOI:10.1007/s11701-026-03501-7

Eur Spine J. 2026 May 27. doi: 10.1007/s00586-026-10038-8. Online ahead of print.

ABSTRACT

OBJECTIVES: Optimal bone quality is essential for spinal surgery, as it mitigates the risk of multiple serious complications. The purpose of this study was to establish a novel, straightforward, and clinically relevant scoring system to assess vertebral bone fragility and investigate its correlation with conventional dual-energy X-ray absorptiometry (DEXA) measurements.

METHODS: A retrospective analysis was conducted on patients who underwent lumbar spine MRI and DEXA scans at our institution for degenerative lumbar diseases between December 2023 and December 2024. Patients were categorized into normal group and osteopenia/osteoporosis group based on DEXA results. Demographic data were collected and imaging parameters, including vertebral bone quality (VBQ), disc signal intensity (DSI), and vertebral bone fragility (VBF), were calculated. Logistic regression analysis was employed to identify risk factors. Pearson correlation analysis was performed between VBF scores and DEXA T-scores. The diagnostic performance of the VBF score in identifying patients with reduced bone mineral density (BMD) was evaluated using receiver operating characteristic(ROC) curve.

RESULTS: Of the 109 patients included in the study, 73 were diagnosed with osteopenia/osteoporosis. Interobserver reliability for DSI and VBF scores was excellent. There were significant differences in age, sex, VBQ, and VBF scores between the two groups. Logistic regression analysis identified a high VBF score (OR 2.870, 95% CI 1.320-6.240) as a significant risk factor for osteopenia/osteoporosis. The area under the curve (AUC) of predicting osteopenia/osteoporosis was 0.829 (p < 0.001) for VBF score, and the best threshold was 3.51 (sensitivity, 64.4%; specificity, 91.7%). VBF score demonstrated a statistically significant correlation with DEXA T-scores (p < 0.001).

CONCLUSIONS: VBF score is a straightforward, reliable, and accurate method for assessing bone fragility in degenerative lumbar diseases, providing additional screening options for preoperative BMD evaluation.

PMID:42201553 | DOI:10.1007/s00586-026-10038-8

Am J Med Genet B Neuropsychiatr Genet. 2026 May 27. doi: 10.1002/ajmg.b.70024. Online ahead of print.

ABSTRACT

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the most prevalent late-onset neurodegenerative diseases worldwide. Both are influenced in part by genetic factors and are currently incurable. Tobacco and alcohol, the two most common substances used among the general adult population, are potential AD/PD risk factors and are also heritable. Although important progress has been made, most existing research on the genetics of AD and PD has been carried out in individuals of European genetic ancestry. Investigations in a broad range of groups are crucial to understand disease mechanisms. Given the current availability of ancestry-specific tobacco and alcohol use as well as AD and PD genome-wide association study summary statistics, we performed global and local genetic correlation analyses using East Asian datasets. Genes within the correlated genetic regions were subsequently used to identify potentially enriched biological pathways between substance use and neurodegenerative diseases. We identified a global genetic correlation between smoking cessation and PD, which we confirmed in complementary European genetic ancestry data. Gene set enrichment analyses highlighted potentially shared genetic mechanisms between breast cancer and AD, which warrants further exploration. This work aims to promote further analyses across genetic ancestry groups.

PMID:42200344 | DOI:10.1002/ajmg.b.70024

J Phys Chem Lett. 2026 May 27. doi: 10.1021/acs.jpclett.6c00398. Online ahead of print.

ABSTRACT

We present a multitask machine-learning strategy for improving the prediction of molecular dipole moments by simultaneously training on quantum dipole magnitudes and inexpensive Mulliken atomic charges. With dipole magnitudes as the primary target and assuming only scalar dipole values are available without vector components, we examine whether incorporating lower-quality labels that do not quantitatively reproduce the target property can still enhance model accuracy. Mulliken charges were chosen intentionally as an auxiliary task since they lack quantitative accuracy yet encode qualitative physical information about charge distribution. Our results show that including Mulliken charges with a small weight in the loss function yields up to a 30% improvement in the dipole prediction accuracy. This multitask approach enables the model to learn a more physically grounded representation of charge distributions, thereby improving both the accuracy and the consistency of dipole magnitude predictions. These findings highlight that even auxiliary data of limited quantitative reliability can provide valuable qualitative physical insights, ultimately strengthening the predictive power of machine-learning models for molecular properties.

PMID:42200332 | DOI:10.1021/acs.jpclett.6c00398

J Dent Res. 2026 May 27:220345261442125. doi: 10.1177/00220345261442125. Online ahead of print.

ABSTRACT

Preadhesion mineralization and in situ nano-deposition improving dentin bonding durability are currently explained by divergent paradigms: the former is attributed to collagen strengthening and protease fossilization, while the latter is known for the release of interface-confined water. This study challenges this dichotomy by hypothesizing that preadhesion mineralization fundamentally acts as a dehydration strategy. Two bonding strategies were formulated: a polyacrylic acid-stabilized amorphous calcium fluoride (PAA-ACF) preadhesion mineralization and in situ ACF nano-deposition. Cryo-transmission electron microscopy (TEM) revealed collagen binding by ACF nanoparticles within 30 s, whereas scanning electron microscopy, X-ray diffraction, and TEM showed that PAA‑ACF-mediated intrafibrillar mineralization on etched dentin began within 30 min and reached completion by 3 h. The PAA-ACF 3-h mineralization group showed approximately twice the surface roughness and elastic modulus of the phosphoric acid (PA) and ACF 30-s deposition groups, as measured by atomic force microscopy, whereas its gelatinase activity (assessed by zymography) was substantially lower, only about one-fifth and one-third of the levels in the PA and ACF 30-s groups, respectively. Fourier transform infrared spectroscopy, water absorption, and thermogravimetric analysis confirmed that both strategies effectively released the interface-confined water. Notably, both the nano-deposition and mineralization groups displayed similarly low proteolytic activity in resin-dentin interfaces. After 30,000 thermal cycles, the micro-tensile bond strength of the 3-h group was statistically comparable to that of the ACF 30-s group and exceeded that of conventional PA wet-bonding. Pearson correlation analyses revealed that bonding strength correlated not with mechanical properties or protease activity of preadhered dentin but with the extent of dehydration, which facilitated infiltration of the hydrophobic adhesive monomer (Bis-GMA), as validated by Nile red tracing and micro-Raman analysis. In summary, both strategies enhance adhesive infiltration by releasing the interface-confined water, forming a defect-low hybrid layer. This finding unifies the understanding of dentin bond durability improvement under a common dehydration-based mechanism.

PMID:42200302 | DOI:10.1177/00220345261442125

Stroke. 2026 May 27. doi: 10.1161/STROKEAHA.125.053752. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile stroke units (MSUs) aim to expedite acute stroke management when compared with conventional emergency medical services (EMS). Despite the growing body of evidence surrounding MSUs and acute ischemic stroke, experience with intracerebral hemorrhage (ICH) in MSUs has been lacking. We aimed to evaluate the impact of MSU transportation, compared with EMS, on times to diagnosis and goal-directed treatment in patients with ICH.

METHODS: Retrospective analysis of patients with acute ICH triaged by MSU or EMS from January 2018 to December 2022 was performed at 2 tertiary institutions, the Cleveland Clinic (OH) and Stony Brook University (NY). In the EMS cohort, only patients seen between 08:00 and 20:00, corresponding to the operating hours of MSU, were included. Primary outcomes included diagnosis by computed tomography, administration of antihypertensives, and time to goal systolic blood pressure (<160 mm Hg). Analyses included descriptive statistics and multivariable regression modeling of log-transformed time metrics, adjusting for important patient demographic and clinical characteristics.

RESULTS: Among 540 patients screened with ICH, after removing those with exclusion criteria, 218 MSU patients were compared with 192 EMS patients. Cohorts had similar baseline demographics, majority male (53.7% MSU versus 49.5% EMS), mean age 67±14 and 68±16, respectively. MSUs reduced time to diagnosis by 28% (β=0.72 [95% CI, 0.62-0.82]; P<0.001). Antihypertensives were administered to 78% of MSU patients, whereas not routinely given to EMS-transported patients until emergency department arrival. This facilitated a time reduction of 54% in the administration time of antihypertensive medications in MSU compared with EMS transported patients (β, 0.46 [95% CI, 0.36-0.59]; P<0.001). With 87% of MSU patients achieving blood pressure goal within 1 hour from last known well, compared with 60% in EMS (P<0.001).

CONCLUSIONS: MSUs provide faster diagnosis and medical treatment for patients with acute ICH than patients transported by conventional EMS.

PMID:42200292 | DOI:10.1161/STROKEAHA.125.053752

Stroke. 2026 May 27. doi: 10.1161/STROKEAHA.126.055253. Online ahead of print.

ABSTRACT

BACKGROUND: Intracranial aneurysm (IA) is a common neurovascular disorder; rupture causes aneurysmal subarachnoid hemorrhage with high mortality. Despite available interventions, effective preventative therapies are lacking. We aimed to identify novel genetic determinants of IA and aneurysmal subarachnoid hemorrhage to improve risk prediction and nominate hypothesis-generating therapeutic candidates for future evaluation.

METHODS: We conducted a multiancestry genome-wide association study and statistical fine-mapping study across European and East Asian cohorts and applied rigorous multiancestry and multitrait meta-analyses to identify IA-associated loci. Utilizing the Multi-Ancestry Sum of Single Effects model tool for fine mapping, we fine-mapped ancestry-specific and shared signals across loci. To derive a credible set of candidate genes, we integrated data from functional mapping and annotation, polygenic priority score, multivariate set-based association test (combined), transcriptome-wide association study, and summary data-based Mendelian randomization, focusing on genes identified by at least 4 methods. Machine learning algorithms developed diagnostic models, and a polygenic score model was evaluated using the UK Biobank data set.

RESULTS: We identified 3 novel IA-associated loci and observed significant genetic correlations between IA and systemic phenotypes. We prioritized a credible set of 40 candidate genes, including GPX1 and NPC1 among the top-ranked candidates, and an expression-based K-nearest neighbor classifier achieved an area under the curve of 0.89 for case-control discrimination between IA cases and controls. We evaluated an IA polygenic score in the UK Biobank evaluation sample, which yielded an area under the curve of 0.83 (95% CI, 0.81-0.84); this performance reflects discrimination in this evaluation setting and warrants further validation in additional independent cohorts before clinical implementation. We observed nominal evidence of interaction between polygenic score and smoking (P=1.09×10^-2), suggesting an interplay between genetic susceptibility and a modifiable lifestyle factor. Computational drug repurposing nominated 32 drug classes, including JAK inhibitors and dopamine receptor antagonists, as hypothesis-generating candidates for future experimental evaluation.

CONCLUSIONS: These findings refine IA/aneurysmal subarachnoid hemorrhage-associated loci, prioritize credible candidate genes for functional follow-up, and provide hypothesis-generating translational leads that may inform future studies, pending validation in independent cohorts and experimental models.

PMID:42200286 | DOI:10.1161/STROKEAHA.126.055253

J Int Med Res. 2026 May;54(5):3000605261431479. doi: 10.1177/03000605261431479. Epub 2026 May 27.

ABSTRACT

BackgroundIn this study we investigated the effect of adding dexmedetomidine to fascia iliaca compartment block on postoperative analgesia in patients undergoing femoral fracture surgery.MethodsIn this double-blind randomized clinical trial study, 70 patients aged 20-75 years, classified as American Society of Anesthesiologists physical status I and II who were scheduled to undergo femoral fracture surgery under spinal anesthesia were included. Patients were divided into intervention and control groups using the block randomization method (35 patients in each group). In the intervention group, fascia iliaca block was performed using 20 cc of 0.25% bupivacaine with 0.5 cc of 50 μg dexmedetomidine (fascia iliaca compartment block + dexmedetomidine group), and in the control group, the block was performed using 20 cc of 0.25% bupivacaine alone (fascia iliaca block group). The outcomes, including the average time to achieve sensory block, analgesia duration, number of times rescue analgesia was needed, time to first rescue analgesia, and pain severity assessed using the visual analog scale within 24 h postoperatively, were measured and compared between the two groups.ResultsThe demographic data and time to reach sensory block were not significantly different between the two groups (p > 0.05). The mean analgesia duration in the fascia iliaca compartment block + dexmedetomidine group was significantly longer than that in the fascia iliaca block group (11.42 ± 1.65 vs. 9.26 ± 1.39 h; p = 0.001). An analgesic was prescribed for 11.4% and 31.4% of the patients 2-6 h postoperatively and for 54.3% and 77.1% at 6-12 h postoperatively in the fascia iliaca compartment block + dexmedetomidine and fascia iliaca block groups, respectively, representing a statistically significant difference between the two groups (p = 0.03). The visual analogue scale scores while in recovery, at 2 h postoperatively, and at 12-24 h postoperatively did not show a statistically significant difference between the two groups (p > 0.05); however, patients in the fascia iliaca compartment block group had significantly higher pain scores than those in the fascia iliaca compartment block + dexmedetomidine group at 2-6 h and 6-12 h postoperatively (p < 0.05).ConclusionAddition of dexmedetomidine to bupivacaine in the fascia iliaca block in femoral fracture surgeries reduces the severity of postoperative pain and need for analgesics and increases the analgesia duration.

PMID:42200281 | DOI:10.1177/03000605261431479

Riv Psichiatr. 2026 Mar-Apr;61(2):78-82. doi: 10.1708/4685.47000.

ABSTRACT

INTRODUCTION: Patients with schizophrenia require long-term treatment, and poor medication compliance during therapy is a common issue. Poor compliance can lead to recurrent fluctuations in the patients’ disease course, exacerbate its progressive deterioration, severely impact patients’ social functioning and quality of life, and thus represents an increasingly serious public health problem. Long-acting injectable antipsychotics (LAIs) are generally considered one of the most effective treatments in psychiatry, which can reduce the substantial economic burden on patients and society, lowering readmission rates, improving patients’ quality of life, and decreasing healthcare costs. This study is a retrospective analysis based on follow-up data from patients with severe mental disorders.

OBJECTIVE: The study aims to explore the factors influencing medication compliance in schizophrenia patients treated with paliperidone palmitate injection, providing a basis for developing targeted compliance intervention strategies in clinical practice. The study included schizophrenia patients receiving paliperidone palmitate injection and systematically analyzed the impact of variables such as demographic characteristics, caregiver competence, social functioning, disease duration, and the presence of comorbid chronic conditions on medication compliance.

CONCLUSIONS: Medication compliance in patients with schizophrenia is influenced by the interaction of multiple factors. Among these, age ≥50 years is a core independent risk factor affecting medication compliance, while having a guardian with good caregiving ability serves as an independent protective factor. The impact of a disease duration ≥10 years on compliance approaches statistical significance (p=0.050). A comparison of social functioning across the dimensions of the SDSS revealed that differences in social functioning deficits between the two groups with different levels of medication compliance were only evident in the dimensions of social withdrawal and interest in and concern for the external environment. This suggests that deficits in these specific dimensions of social functioning are also important factors influencing medication compliance in patients.

PMID:42200256 | DOI:10.1708/4685.47000