Nevin Manimala

Am J Hum Biol. 2026 Mar;38(3):e70247. doi: 10.1002/ajhb.70247.

ABSTRACT

OBJECTIVES: Duration and quality of sleep are influenced by many factors, including hormonal changes. The aim of this study was to investigate the differences between the phases of the menstrual cycle in total sleep duration and sleep stage distribution, specifically the duration of rapid eye movement (REM) phase, light, and deep sleep states and compare sleep parameters between ovulatory and anovulatory cycles.

METHODS: The study involved 130 women aged 20-35 (mean = 26.2 years; SD = 4.14). Ovulation was detected using luteinizing hormone (LH) urine tests. Sleep data were collected using the Fitbit Alta HR trackers, which measured total sleep time and the duration of sleep stages. Sleep parameters were analyzed separately for each of the five phases: menstrual bleeding, follicular, periovulatory, luteal, and premenstrual using repeated measures ANOVA. Differences between ovulatory and anovulatory cycles were assessed using Student’s t-test.

RESULTS: Women with the ovulatory cycle slept longer and had longer REM phases compared to women without ovulation. No statistically significant differences were observed in total sleep duration or sleep stage distribution across five phases of the menstrual cycle among women with detected ovulation.

CONCLUSION: The findings suggest that ovulatory status might be associated with differences in total sleep time and REM sleep duration, whereas sleep duration and sleep stage distribution across menstrual cycle phases remain relatively constant. These results suggest that the presence of ovulation, rather than phase-specific changes during the cycle, may play a more important role in shaping sleep characteristics.

PMID:41876389 | DOI:10.1002/ajhb.70247

Cancer Med. 2026 Mar;15(3):e71748. doi: 10.1002/cam4.71748.

ABSTRACT

BACKGROUND: Although the impact of increased time to treatment initiation (TTI) on outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) has been well-studied, a deeper understanding of the mechanisms underlying delay in patients with human papillomavirus (HPV)-negative OPSCC is lacking in the current literature.

OBJECTIVE: To assess differences in sociodemographic factors and treatment timelines between patients with HPV-negative OPSCC with shorter versus. longer TTI.

METHODS: Patients treated for HPV-negative OPSCC at a single academic institution between 2013 and 2023 were retrospectively identified via chart review and dichotomized by the cohort median TTI (53.5 days; defined as the time from biopsy to first treatment initiation). Clinical timelines between delayed and nondelayed patients were compared using descriptive statistics and Mann-Whitney U testing. Independent predictors of delayed TTI (> 53.5 days) were evaluated using multivariate logistic regression modeling, with adjusted odds ratios (aORs) and 95% confidence intervals reported.

RESULTS: Seventy-six patients were identified. On multivariable analysis, male sex (aOR 3.28; 95% CI 1.02-10.49), unmarried status (aOR 5.96; 95% CI 1.36-26.07), primary chemoradiation versus surgery (aOR 0.25; 95% CI 0.07-0.85), and biopsy available before arrival (aOR 4.08; 95% CI 1.32-17.36) were independently and significantly (p< 0.05) associated with delayed treatment initiation. Treatment timeline analysis revealed that both the interval from biopsy to referral and the interval from PET scan to treatment initiation differed significantly between delayed and nondelayed patients (p< 0.05).

CONCLUSION: Primary nonsurgical treatment and lack of social support were found to be independently associated with treatment delay in patients with HPV-negative OPSCC. These findings highlight opportunities for improving the care of HPV-negative OPSCC at the specialty level.

PMID:41876381 | DOI:10.1002/cam4.71748

Hematology. 2026 Dec 31;31(1):2648344. doi: 10.1080/16078454.2026.2648344. Epub 2026 Mar 24.

ABSTRACT

INTRODUCTION: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare type of cutaneous lymphoma lacking standardized treatments. Consequently, patient outcomes vary significantly.

METHODS: This study explored the clinical characteristics and prognostic factors of 205 SPTCL patients from 2000 to 2021 in the Surveillance, Epidemiology, and End Results (SEER) database.

RESULTS: Overall survival (OS) at 1, 3, and 5 years were 78.3%, 75.7%, and 66.4%, respectively. Patients diagnosed after 2008 (possibly excluding the γ-δ subtype) (HR = 0.197, 95% CI = 0.106-0.364, p = 0.000) and Asian or Pacific Islanders (HR = 0.210, 95% CI = 0.049-0.902, p = 0.036) were independent predictors of favorable survival, whereas age 50-60 years (HR = 3.213, 95% CI = 1.357-7.607, p = 0.008) and age > 60 years (HR = 5.039, 95% CI = 2.327-10.911, p = 0.000) were independently associated with poor survival. Patients who received radiotherapy alone exhibited a significantly lower hazard risk compared to those receiving no chemotherapy or radiation (HR = 0.216, 95% CI = 0.048-0.983, p = 0.048). No statistically significant differences in prognosis were observed between patients who received no chemotherapy or radiation and those who received either chemotherapy alone (HR = 1.276, 95% CI = 0.644-2.529, p = 0.485) or radiochemotherapy (HR = 1.283, 95% CI = 0.463-3.558, p = 0.632). These associations persisted after IPTW adjustment, with age, race, year of diagnosis, and treatment remaining independent predictors of OS in SPTCL.

CONCLUSIONS: The Ann Arbor staging was not suitable for SPTCL. Radiotherapy represents an appropriate therapeutic option for patients with single or localized skin lesions. No statistically significant differences in prognosis were observed between patients who received no chemotherapy or radiation and those who received either chemotherapy alone or radiochemotherapy. This finding suggests that immunomodulatory agents may be preferable to cytotoxic therapy as initial treatment for SPTCL, an inflammatory lymphoma.

PMID:41876379 | DOI:10.1080/16078454.2026.2648344

Aging Male. 2026 Dec 31;29(1):2647019. doi: 10.1080/13685538.2026.2647019. Epub 2026 Mar 24.

ABSTRACT

OBJECTIVE: To compare the real-world safety profiles of α1-adrenoceptor antagonists (α1-blockers), 5α-reductase inhibitors (5ARIs), and phosphodiesterase type 5 inhibitor (PDE5I) used in the treatment of benign prostatic hyperplasia (BPH).

METHODS: This retrospective pharmacovigilance study analyzed FDA Adverse Event Reporting System (FAERS) from Q1 of 2004 to Q2 of 2025. Reports of adverse events (AEs) in male BPH patients receiving AUA guideline-recommended drugs including α-1 blockers (tamsulosin, silodosin, doxazosin, and alfuzosin), 5ARIs (finasteride and dutasteride), and tadalafil were extracted. Disproportionality analysis was performed to detect significant safety signals. AEs were classified using MedDRA terms.

RESULTS: Among 9,540 unique reports and 25,796 AEs entries, patients aged 65-80 years accounted for the majority of the reports. Most AEs occurred within 30 days of treatment initiation. Hospitalization was the most common serious outcome. Sixteen significant AEs were detected, including pollakiuria, gynecomastia, breast pain and so on, with distinct reporting patterns across drug classes.

CONCLUSIONS: This large-scale pharmacovigilance analysis identified distinct post-marketing safety signals among guideline-recommended pharmacotherapies for BPH, confirming known risks and suggesting potential novel adverse-event signals warranting further investigation.

PMID:41876378 | DOI:10.1080/13685538.2026.2647019

Eur J Intern Med. 2026 Mar 23:106813. doi: 10.1016/j.ejim.2026.106813. Online ahead of print.

ABSTRACT

BACKGROUND: Antibiotic treatment for asymptomatic bacteriuria (AB) is not recommended in the general population, and its significance in oncohematological patients remains unclear.

OBJECTIVES: This study aimed to determine the prevalence of AB in hematologic patients and assess the frequency of bacteremia caused by the same microorganism isolated in untreated baseline asymptomatic bacteriuria (Baseline-AB) during myelosuppression.

METHODS: A prospective, observational study was conducted from 2012-2017 in adult patients admitted for chemotherapy. Urine cultures (UCs) were performed, and no prophylactic antibiotics were administered. Blood and UC samples were collected during episodes of febrile neutropenia (FN) before antibiotic administration and compared with baseline UC results.

RESULTS: Among 121 patients, 167 FN episodes were recorded, with 19 (11.3%) having Baseline-AB. A urinary focus was found in 1/19 (5.2%) of the Baseline-AB episodes, compared to 9/148 (6%) of the non baseline-AB (No-Baseline-AB) episodes (OR: 0.86; 95% CI:0.10-7.17;p = 0.88). Bacteremia occurred in 4/19 (21%) of the Baseline-AB episodes and in 38/148 (25.6%) of the No-Baseline-AB episodes. Only 1/19 patients in the Baseline-AB group (5.2%) had bacteremia caused by the same microorganism identified in the baseline UC.

OUTCOME: FN resolved in all Baseline-ABs and in 96.6% of No-Baseline-ABs. Overall mortality occurred in 9/121 (7.4%) patients.

CONCLUSION: Baseline-ABs were present in more than 10% of episodes, but no correlation was found between Baseline-ABs and bacteremia during FN. Only one case showed the same pathogen in both the baseline UC and the blood culture, suggesting that routine antibiotic treatment for Baseline-AB may not be necessary in this population.

PMID:41876326 | DOI:10.1016/j.ejim.2026.106813

Cardiovasc Revasc Med. 2026 Mar 19:S1553-8389(26)00103-X. doi: 10.1016/j.carrev.2026.03.012. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary vulnerable plaque (VP) identification is crucial for preventing acute events. Intravascular ultrasound with near-infrared spectroscopy (IVUS-NIRS) is a reference technique to assess plaque vulnerability by quantifying lipid core burden index (LCBI) and plaque burden (PB). Murray’s flow ratio (μFR) and maximal radial wall strain (RWS_max) are new angiography-derived parameters that may stratify plaque risk profile. We aim to evaluate their ability to identify VP as defined by IVUS-NIRS.

METHODS: This retrospective study included 89 lesions who underwent IVUS-NIRS. VP was defined as maxLCBI_4mm ≥325 and PB ≥70%. μFR and RWS_max were calculated offline. Pearson/Spearman correlations assessed relationships with IVUS-NIRS parameters. Receiver operating characteristic (ROC) curve evaluated diagnostic performance for VP. Potential confounders were included in a multivariable model.

RESULTS: μFR was inversely correlated with maxLCBI_4mm (r = -0.452, p < 0.001) and PB (r = -0.276, p = 0.009). RWS_max was positively correlated with maxLCBI_4mm (r = 0.597, p < 0.001) and PB (r = 0.294, p < 0.001). ROC analysis revealed good accuracy for identifying VP for both μFR (AUC = 0.71) and RWS_max (AUC = 0.80). In multivariable analysis, RWS_max remained independently associated with VP, whereas μFR lost statistical significance.

CONCLUSIONS: μFR and RWS_max were correlated with PB and maxLCBI_4mm. RWS_max demonstrated independent predictive ability to identify VP.

PMID:41876322 | DOI:10.1016/j.carrev.2026.03.012

J Cardiothorac Vasc Anesth. 2026 Mar 3:S1053-0770(26)00202-8. doi: 10.1053/j.jvca.2026.03.004. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate paraspinal injectate spread following intertransverse process (ITP) block using 10 mL versus 20 mL in cadaveric models.

DESIGN: Prospective.

SETTING: An anatomy laboratory at an academic medical institution.

PARTICIPANTS: Adult cadavers (6 traditionally embalmed, 2 GreenMBalmed).

INTERVENTIONS: Under ultrasound guidance, 0.1% methylene blue dye was injected into the T3-4 or T7-8 ITP space using the mid-transverse process technique. A total of 12 injections were performed, with 6 injections per volume.

MEASUREMENTS AND MAIN RESULTS: In 8 adult cadavers, retropleural dissection and multilevel vertebral corpectomy assessed dye spread to the intercostal nerves, paravertebral space, and anterior/posterior epidural spaces. Paravertebral spread occurred in 11 of 12 injections. With 10 mL, the median spread was 2 levels in the paravertebral space and 1.5 levels in the intercostal space. With 20 mL, the median spread was 2 levels in both spaces. Epidural spread (anterior and/or posterior) occurred in 5 of 6 injections in each volume group. However, multilevel epidural spread (≥3 levels) occurred in 3 of 6 injections with 20 mL and 0 of 6 with 10 mL. With 20 mL, anterior epidural spread ranged 0 to 5 levels and posterior epidural spread ranged 0 to 7 levels, reflecting greater variability and occasional extensive spread. No statistically significant between-volume differences in median spread were detected.

CONCLUSION: These findings support anatomical continuity between the ITP and epidural spaces. Compared with 10 mL, 20 mL ITP injections showed greater variability and occasional extensive epidural spread, which may increase the risk of sympathectomy-related effects such as hypotension.

PMID:41876319 | DOI:10.1053/j.jvca.2026.03.004

J Formos Med Assoc. 2026 Mar 23:S0929-6646(26)00260-3. doi: 10.1016/j.jfma.2026.03.090. Online ahead of print.

ABSTRACT

BACKGROUND: White matter injury (WMI) is a major cause of neurodevelopmental impairment (NDI) in extremely preterm infants, with ventriculomegaly (VM) and impaired corpus callosum (CC) growth proposed as early indicators of diffuse WMI. This study evaluated whether early cranial ultrasound (cUS) markers are associated with later NDI.

METHODS: This retrospective study included infants born <28 weeks’ gestation and admitted to a tertiary NICU between 2019 and 2020 who completed serial cUS and neurodevelopmental assessments at 18-24 months of corrected age. Those with major brain lesions, severe intraventricular hemorrhage, or congenital anomalies were excluded. cUS measured CC thickness, length, and ventricular width from birth to term-equivalent age (TEA). Clinical characteristics and cUS findings were compared between infants with and without NDI.

RESULTS: Among 70 extremely preterm infants (mean GA 25.7 weeks; BW 827 g), 20 developed NDI. Perinatal factors or comorbidities were similar between groups. Isolated VM at TEA was more frequent in the NDI group (15% vs. 6%), though not statistically significant (p = 0.224). The NDI group had significantly thinner CC at TEA (1.6 mm vs. 1.8 mm, p = 0.026) and slower CC thickness growth rate before TEA (0.01 mm/week vs. 0.02 mm/week, p = 0.019), with no difference in CC length or its progression.

CONCLUSIONS: Serial cUS markers, particularly reduced CC thickness and slower CC growth velocity, were associated with later NDI. Higher but underpowered incidence of isolated VM was observed, supporting the role of serial cUS in early risk stratification over standalone prediction.

PMID:41876310 | DOI:10.1016/j.jfma.2026.03.090

J Prosthet Dent. 2026 Mar 23:S0022-3913(26)00162-9. doi: 10.1016/j.prosdent.2026.03.005. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Although cracked teeth have been a prevalent clinical concern, a consensus on appropriate treatment strategies-particularly for early-stage cracks without clinical symptoms-remains lacking. Current guidelines do not specify the critical crack dimensions, in terms of depth and width, at which tooth structural integrity becomes significantly compromised, leading to uncertainty in clinical decision-making between monitoring and restorative intervention.

PURPOSE: The purpose of this study was to investigate the effects of crack depth and width on the ultimate strength and stress distribution of human first premolars to guide clinical treatment decisions.

MATERIAL AND METHODS: Forty extracted, sound human first premolars were divided into 5 groups: a control group (no crack) and 4 groups with experimental mesio-occluso-distal cracks of varying depth (D:2 to 4 mm) and width (W:0.5 to 1 mm). Compression tests were conducted to assess ultimate strength, fracture origin, and propagation direction. Statistical analyses were performed using 1-way ANOVA and multiple linear regression (α=.05). Finite element analysis (FEA) was used to simulate stress distribution based on both principal stress and energy-based failure theories. The computational results were validated with experimental findings. Smaller cracks (D:1 to 3 mm; W:0.1 to 0.5 mm) were modeled via FEA to identify subclinical critical thresholds.

RESULTS: Crack depth dominated tooth ultimate strength reduction (β=-.803, P<.001), while width became insignificant at a depth of 4 mm (β=-.059, P=.480). Fractures in cracked teeth originated at crack tips (91% of cases), whereas fractures in sound teeth occurred at the palatal cusp. The von Mises stress criterion accurately predicted the behavior of cracked teeth, unlike the principal stress theory. Critical crack size thresholds were identified: a 15% strength reduction in the D1W0.5 and D2W0.1 cases and a 67% strength reduction (relative to sound teeth) when cracks extended to the pulp chamber in the D3W1 case.

CONCLUSIONS: Increasing crack size significantly weakens tooth strength, with depth being the dominant factor. The von Mises stress theory is recommended for analyzing cracked teeth. The identified critical crack sizes provide actionable thresholds for restorative intervention.

PMID:41876301 | DOI:10.1016/j.prosdent.2026.03.005

ISA Trans. 2026 Mar 20:S0019-0578(26)00154-0. doi: 10.1016/j.isatra.2026.03.033. Online ahead of print.

ABSTRACT

This paper proposes a reinforcement learning (RL)-based adaptive covariance scaling framework for robust INS/UWB integrated navigation in dynamic and NLOS-prone environments. By formulating covariance tuning as a Partially Observable Markov Decision Process (POMDP) and employing a recurrent PPO policy, the method enables anchor-wise adjustment of the UWB measurement noise to balance accuracy and statistical consistency. Simulation results show that the proposed approach achieves an RMSE of 0.258m, outperforming classical adaptive filters and existing RL baselines. Real-world quadrotor experiments further demonstrate centimeter-level accuracy (0.036m RMSE) and strong robustness under severe NLOS and anchor dropout conditions, highlighting its effectiveness for resilient intelligent navigation systems.

PMID:41876298 | DOI:10.1016/j.isatra.2026.03.033