Nevin Manimala

J Craniofac Surg. 2026 Mar 23. doi: 10.1097/SCS.0000000000012548. Online ahead of print.

ABSTRACT

PURPOSE: To microscopically examine the central thickness of the superior tarsal plate and determine whether it exhibits uneven thickness or contour.

METHODS: Central sagittal sections of 22 upper eyelids (12 right and 10 left) from 15 East Asian cadavers (8 male and 7 female), aged 38 to 88 years old (mean age: 70.5 y), were histologically analyzed. Specimens were fixed in 10% formalin and stained with Masson’s trichrome. The thickest and thinnest regions of each tarsal plate were measured, and statistical analysis was performed to compare these measurements.

RESULTS: A statistically significant difference was found between the thickest and thinnest regions of the tarsal plate (P<0.001). The thickest areas were located around the superior one-third of the tarsal height, while the thinnest areas were found near the inferior one-fourth, close to the marginal artery or slightly below the insertion of the levator aponeurosis. No statistically significant differences were observed based on age (thickest: P=0.632 and thinnest: P=0.785), sex (thickest: P=0.844 and thinnest: P=0.237), or laterality (thickest: P=1.000 and thinnest: P=0.404).

CONCLUSION: The superior tarsal plate demonstrates an uneven crescent-shaped central contour, with a prominent thickening in the superior region. The thickest portion is located around the superior one-third of the tarsal height, while the thinnest portion lies near the inferior one-fourth, adjacent to the marginal artery or slightly below the levator aponeurosis insertion. No significant differences were found based on age, sex, or laterality.

PMID:41871289 | DOI:10.1097/SCS.0000000000012548

Clin Exp Dent Res. 2026 Apr;12(2):e70315. doi: 10.1002/cre2.70315.

ABSTRACT

OBJECTIVES: The main aim of this systematic review and meta-analysis was to report the prevalences of orofacial and dental injuries among rugby players and to discuss the prevention of these injuries through mouthguard use.

METHODS: A literature search of the PubMed, Scopus, EMBASE, Cochrane Library and Dentistry & Oral Science Sources (DOSS) databases was performed to identify eligible studies from 1998 to 31^st March 2025. This review was conducted on studies reporting the prevalence or incidence of orofacial or dental injuries among rugby players.

RESULTS: In total, 268 records were screened for eligibility, and 16 studies met the inclusion criteria. The overall prevalence of orofacial injuries was 40.4% (95% CI: 38.5-42.2) with the higher prevalence (70.2%) in a study of 2010 among male rugby players of 17-18 years. The most common orofacial injuries involve the soft tissues. The overall prevalence of dental injuries was 19.6% (95% CI: 18.1-21.3). A fractured tooth was the most common dental injury. Mouthguards were mainly worn during competition, less during training. The certainty in cumulative evidence was considered to be very low.

CONCLUSION: This review highlights a high rate of orofacial and dental injuries in rugby. It is necessary to increase awareness and the use of protective mouthguards to enhance prevention.

PMID:41871283 | DOI:10.1002/cre2.70315

Proc Natl Acad Sci U S A. 2026 Mar 31;123(13):e2527755123. doi: 10.1073/pnas.2527755123. Epub 2026 Mar 23.

ABSTRACT

In early 2025, the NIH unexpectedly terminated 2,291 active research grants, withdrawing $2.45 billion and disrupting thousands of projects. While the economic magnitude of these cuts is known, less is understood about how they differed across researchers’ demographic groups. Using an original dataset of publicly available records, we documented how cancelations varied by gender and career stage. Although cuts occurred across all regions and institution types, statistical patterns show that early-career investigators-assistant professors, postdoctoral scholars, trainees, and graduate students-were disproportionately affected, as were women. Women’s projects were smaller on average, had a larger share of unspent funds at cancelation, and were more concentrated in training and transition awards. Although available data cannot determine downstream causal effects, NIH economic multipliers suggest a potentially large unrealized loss to the US research enterprise. These patterns highlight the vulnerability of early-career researchers and women to abrupt funding instability and underscore the need for sustained investment to protect the future scientific workforce.

PMID:41871241 | DOI:10.1073/pnas.2527755123

Proc Natl Acad Sci U S A. 2026 Mar 31;123(13):e2523152123. doi: 10.1073/pnas.2523152123. Epub 2026 Mar 23.

ABSTRACT

Why do girls outperform boys in education? One contributing factor might be that girls read more than boys, which fosters competencies relevant in education. Moreover, boys might rely more heavily on schools to support and encourage reading, meaning that unplanned and planned school closures disproportionally affect boys. We map the gender gap in reading in the period 2020 to 2022 using two large-scale datasets from Denmark, one measuring students’ weekly reading in school via a popular reading app and the other measuring students’ borrowing of library books. Our data document a clear gender gap in reading that increased during unplanned school closures due to the COVID-19 pandemic and planned closures due to vacations. Our findings underscore the role of schools in mitigating gender differences in reading.

PMID:41871238 | DOI:10.1073/pnas.2523152123

J Clin Psychiatry. 2026 Mar 18;87(2):26f16375. doi: 10.4088/JCP.26f16375.

ABSTRACT

Persons with mental health disorders are at increased risk of dental disease, including lost teeth. Dental implants are the preferred option for most persons who have lost teeth. Recent studies suggest that antidepressant drugs, especially the selective serotonin reuptake inhibitors, are associated with an increased risk of dental implant failure. This article provides a background about the epidemiology of loss of teeth, the causes of tooth loss, the need to replace lost teeth, and the use of dental implants to replace lost teeth. Two meta-analyses of retrospective cohort studies of the association between antidepressant use and implant failure are examined in detail. One meta-analysis included 6 studies and the other, 10 studies. An additional retrospective cohort study, published after the meta-analyses, is also examined. In summary, there is consistent evidence for a higher risk of implant failure in patients taking antidepressants, and for a higher number of implants failing in patients taking antidepressants, relative to patients not taking antidepressants. Broad findings were that, at the patient level, implant failure occurred in 6%-23% of antidepressant users vs 2%-8% of nonusers, and at the implant level, implant failure occurred in 6%-22% of antidepressant users vs 2%-9% of nonusers. Because unadjusted risks were more than doubled in antidepressant users, it implies that, in the real world, antidepressant use is a clinically important marker for risk of implant failure; it is hard to draw cause and effect inferences from the studies reviewed because of inadequacies in study designs and statistical methods. Action points are that antidepressant users should be educated about the risk of implant failure, and vigorous efforts should be made to identify and negate, to the extent possible, other risk factors for implant failure in these patients. Suggestions are offered for future research in the field.

PMID:41871232 | DOI:10.4088/JCP.26f16375

Urol Int. 2026 Mar 23:1-13. doi: 10.1159/000551610. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the performance of five advanced reasoning models on urology-related clinical multiple-choice questions from the MedQA dataset, and to benchmark AI performance against medical students and experienced urologists in terms of accuracy, response efficiency, and agreement patterns.

METHODS: We extracted 434 urology-relevant items and evaluated five models-DeepSeek-R1, ChatGPT O4-mini, Gemini 2.5 Pro, Claude 3.7 Sonnet, and Grok 3-using a standardized prompt. Accuracy was computed against reference answers; API response times and connection failures were recorded. In addition, 20 senior medical students and 20 experienced urologists answered subsets of the same item bank using a balanced block design; group-level majority-vote answers were used as human baselines. Statistical analyses included Cochran’s Q and McNemar tests (AI-only accuracy), a logistic generalized linear mixed-effects model (GLMM) with urologists as the reference (model-adjusted accuracy), Fleiss’ κ and Cohen’s κ (agreement), and Friedman and Wilcoxon signed-rank tests (response time).

RESULTS: Across the AI-only comparison, all models achieved high accuracy (86.9-93.3%), with DeepSeek-R1, ChatGPT O4-mini, and Gemini 2.5 Pro outperforming Claude 3.7 Sonnet and Grok 3. In the model-adjusted analysis, all five AI models showed significantly higher odds of correct answers than experienced urologists (all p < 0.001, Dunnett-adjusted), while medical students did not differ significantly from urologists. ChatGPT O4-mini had the shortest median API response time (5.03 s), whereas group-level median task completion times were 15.87 s for students and 17.57 s for urologists; Grok 3 was slowest among AI models (27.62 s). Connection failure rates were 0% for ChatGPT O4-mini, Gemini 2.5 Pro, and Claude 3.7 Sonnet; 1.6% for DeepSeek-R1; and 2.8% for Grok 3. Agreement across the five AI models and the two human majority-vote baselines was moderate-to-substantial (Fleiss’ κ = 0.685, p < 0.001).

CONCLUSION: Modern reasoning models achieve strong accuracy and efficiency on urology-focused benchmark questions, supporting their potential role as useful clinical assistants when implemented with appropriate human oversight. ChatGPT O4-mini’s rapid latency further underscores its suitability for time-sensitive workflows, while model-adjusted analyses indicate its consistently superior accuracy relative to experienced urologists within this standardized assessment format.

PMID:41871224 | DOI:10.1159/000551610

Postgrad Med J. 2026 Mar 23:qgag030. doi: 10.1093/postmj/qgag030. Online ahead of print.

ABSTRACT

Physicians rely on clinical judgment and patients look for it. However, clinical judgment is infrequently discussed in the literature, and is often perceived as an intuitive art, that is likely to be replaced by technology and artificial intelligence. This review offers a reconceptualization of the role of clinical judgment in current medical practice and research, informed by the extensive knowledge that has accumulated in psychosomatic medicine. Clinical judgment consists of three phases: collecting clinical information; interpretation and clinical reasoning; decision making. Interviewing is the primary method for gathering data. Clinical reasoning involves bringing together relevant information and formulating hypotheses, which result in decisions and therapeutic acts. Clinimetrics, the science of clinical measurements, facilitates physician’s reasoning and organization of data. Improving the features of clinical judgment is likely to yield a highly effective precision medicine.

PMID:41871207 | DOI:10.1093/postmj/qgag030

Trends Hear. 2026 Jan-Dec;30:23312165261434604. doi: 10.1177/23312165261434604. Epub 2026 Mar 23.

ABSTRACT

Implicit learning is thought to play an important role in speech recognition under challenging conditions. However, auditory deprivation has been proposed to influence implicit learning, including in the visual modality, although evidence in adults with post-lingual deafness is limited. Therefore, we investigated implicit visual learning and its associations with speech recognition in adults with post-lingual deafness who use cochlear implants (CIs). Thus, this study focuses on the effects of late auditory deprivation rather than on the effects of early deprivation associated with congenital deafness. Adult CI users (n = 30) and a group of individuals with normal hearing (NH, n = 36) completed two implicit visual learning tasks (statistical and perceptual), a battery of challenging speech recognition tests and cognitive measures (vocabulary, working memory, attention, and verbal processing speed). NH listeners demonstrated significant visual statistical learning, whereas CI users showed a similar but nonsignificant pattern. In the visual perceptual learning task, both groups exhibited comparable learning effects. In CI users, visual statistical learning contributed to the recognition of speech in noise (words and sentences). Visual perceptual learning only contributed to the recognition of words in noise. The current findings are inconsistent with the idea that auditory deprivation beyond the sensitive period interferes with visual learning. Rather, in CI users, visual implicit learning contributes to the recognition of challenging speech. Therefore, future work might investigate whether visual learning in CI candidates is predictive of postimplantation milestones.

PMID:41870495 | DOI:10.1177/23312165261434604

Inhal Toxicol. 2026 Mar 23:1-14. doi: 10.1080/08958378.2026.2644247. Online ahead of print.

ABSTRACT

BACKGROUND: Six years since the revised Test Guidelines 412 and 413 (TG412 and TG413) were issued, there are sufficient data to evaluate the relationship between bronchoalveolar lavage (BAL) cytology and biomarkers with histopathology.

OBJECTIVE: This retrospective study evaluates the correlation between mandatory endpoints in the BAL fluid (LDH activity, concentration of total protein, inflammatory cell counts) and histopathological changes in the lungs following sub-chronic inhalation exposure in rats.

MATERIALS AND METHODS: Twenty-eight studies conducted across two Test Facilities from 2018 to 2023 were reviewed to identify trends.

RESULTS: At baseline, there were no strain differences in BAL fluid total protein, but LDH activity was statistically different between sexes and ages. LDH activity and total protein in BALF at the lowest observed adverse effect concentration showed no pathological pattern following inhalation exposure to the tested chemicals, while immune cell counts shifted in Wistar Han rats. Specifically in studies with adverse lung histopathology, total protein and LDH activity were generally elevated, along with a shift in immune cells toward neutrophils and eosinophils, without correlation to the severity score of adverse microscopic findings.

CONCLUSION: These results suggest that BALF parameters are insufficient to independently characterize adversity but may be used in other ways to progress new approach methods.

PMID:41870483 | DOI:10.1080/08958378.2026.2644247

JAMA Intern Med. 2026 Mar 23. doi: 10.1001/jamainternmed.2026.0102. Online ahead of print.

ABSTRACT

IMPORTANCE: Cardiopulmonary resuscitation (CPR) guidelines recommend chest compressions at the lower half of the sternum. This may lead to aortic valve compression, which is associated with poor outcomes, while compressions over the left ventricle are seldom achieved.

OBJECTIVE: To test the hypothesis that transesophageal echocardiography (TEE) guidance during CPR to avoid aortic valve compression and target the left ventricle would improve outcomes in patients with nontraumatic out-of-hospital cardiac arrest compared with conventional CPR.

DESIGN, SETTING, AND PARTICIPANTS: This cluster-randomized clinical trial (the EXECT-CPR study) was conducted from June 26 to November 19, 2023, at 1 tertiary medical center in Taiwan. Participants were adults who consecutively presented to the emergency department (ED) with nontraumatic out-of-hospital cardiac arrest. Exclusion criteria were prehospital return of spontaneous circulation, extracorporeal CPR, contraindications to TEE, prior do-not-resuscitate orders, and obvious signs of death. Complete blinding was not feasible; the allocation schedule was disclosed only to the principal investigator.

INTERVENTION: Post-ED arrival CPR at TEE-guided (avoid aortic-valve compression and target the left ventricle) or guideline-recommended (the lower half of the sternum) site.

MAIN OUTCOMES AND MEASURES: The primary outcome was a sustained return of spontaneous circulation (≥20 minutes). Secondary outcomes were any return of spontaneous circulation, survival to intensive care unit admission, survival to hospital discharge, cerebral performance category of 2 or lower at discharge, and intra-CPR end-tidal carbon dioxide levels.

RESULTS: A total of 132 patients underwent randomization (66 in each group; median [IQR] age, 68 [55-74] years; 87 [66%] male). The primary outcome was similar between groups (TEE-guided group, 29 [44%]; conventional group, 26 [39%]; cluster-adjusted odds ratio, 1.21; 95% CI, 0.64-2.29). The secondary outcomes also did not significantly differ, except for higher intra-CPR end-tidal carbon dioxide levels in the TEE-guided group during the 11th to 20th minutes after arrival. Adverse event rates related to TEE and CPR were comparable.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among adults transported to the emergency department with ongoing CPR for nontraumatic out-of-hospital cardiac arrest, TEE-guided CPR with an adjusted compression site after arrival did not significantly improve clinical outcomes compared with conventional CPR, although it produced potential hemodynamic benefits without increasing adverse events. Given that the trial was underpowered due to optimistic effect size assumptions, these neutral findings should be interpreted with caution.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05907460.

PMID:41870444 | DOI:10.1001/jamainternmed.2026.0102