Nevin Manimala

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00955-5. Online ahead of print.

ABSTRACT

The sphenoid sinus (SS) exhibits significant anatomical variability that critically impacts the safety and efficacy of endoscopic transsphenoidal surgery. This systematic review and meta-analysis aims to establish global prevalence rates for SS pneumatization patterns, extensions, and the relationship with adjacent neurovascular structures to guide surgical planning. A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science until October 2025. Studies reporting SS pneumatization types, extensions, and neurovascular protrusions/dehiscences based on imaging or cadaveric dissection were included. Random-effect models were used for the meta-analysis. The sellar type was the predominant pneumatization pattern, with the complete sellar type accounting for 48.39%. Statistically significant results were identified based on nationality and study type. Extensions into the greater wing (34.17%) and pterygoid process (25.51%) were common. The Vidian nerve (VN) showed the highest rates of protrusion (32.61%) and dehiscence (14.60%), followed by the internal carotid artery (ICA) (protrusion: 29.77%; dehiscence: 9.47%) and optic nerve (ON) (protrusion: 23.46%; dehiscence: 10.92%). The imaging modality used did not affect the neurovascular structure variations. The SS is a highly variable structure with frequent extensions that expose vital neurovascular structures to surgical risk. Although the subgroup analyses did not depict statistically significant results, computed tomography scan with less than 1 mm slice thickness should be used for evaluation of SS anatomy. The high prevalence of VN and ICA dehiscence necessitates rigorous preoperative evaluation. These findings provide a crucial anatomical reference for optimizing surgical approaches and minimizing complications in skull base surgery.

PMID:42340651 | DOI:10.1007/s12565-026-00955-5

Anat Sci Int. 2026 Jun 24. doi: 10.1007/s12565-026-00952-8. Online ahead of print.

ABSTRACT

Computed Tomography (CT) imaging has expanded possibilities for biological profile estimation in forensic contexts. This study examined whether two-dimensional (2D) morphometric measurements and Hounsfield Unit (HU) values derived from CT scans of dry proximal femora could reliably estimate sex, stature, and age, and whether machine learning (ML) could meaningfully improve on traditional methods. Three hundred left femora from Thai individuals were scanned, and mid-coronal sections were used to extract measurements from defined anatomical regions. For sex estimation, conventional estimation equations reached 93.2% accuracy, while Naïve Bayes classification achieved 96.5% as the best performance among the ML models tested. Stature estimation using sex-specific 2D parameters yielded a Standard Error of Estimate (SEE) of 4.43 cm, which dropped to 3.96 cm when Support Vector Machines (SVM) and Gaussian Process Regression (GPR) were applied. Age estimation relied on HU values, which showed a consistent negative relationship with age. The lowest SEE for age was 9.67 years from measurements at the Primary Tensile Line (PTL) and Ward’s Triangle in females. Models also performed better when applied to older age groups. Although sex-specific equations outperformed mixed-sex ones, the latter were kept in the analysis as a practical alternative when sex cannot be established prior to analysis. Overall, 2D morphometrics proved most useful for sex and stature estimation, while HU values emerged as a reliable, quantitative approach to age estimation. ML consistently improved model performance across all three estimation tasks, supporting its role in modern forensic anthropological practice.

PMID:42340647 | DOI:10.1007/s12565-026-00952-8

J Racial Ethn Health Disparities. 2026 Jun 24. doi: 10.1007/s40615-026-03065-0. Online ahead of print.

ABSTRACT

IMPORTANCE: Cutaneous melanoma accounts for 5% of new cancer diagnoses in the United States. Despite advancements in treatment of melanoma, marked racial, ethnic, and socioeconomic disparities persist.

OBJECTIVE: To determine if there are racial and ethnic disparities in melanoma survival and to highlight opportunities for interventions to improve melanoma patient outcomes.

DATA SOURCES: The databases PubMed/Medline, EMBASE, and Web of Science were searched from inception to February 9, 2021.

STUDY SELECTION: Original publications reporting mortality statistics by race/ethnicity for patients with cutaneous melanoma, vulvar melanoma, or melanoma metastases were selected. Only experimental studies, observational studies, and research letters, with a study population in the United States were included.

DATA EXTRACTION AND SYNTHESIS: This investigation was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Authors performed title and abstract screening, followed by full text review in duplicate.

MAIN OUTCOME(S) AND MEASURE(S): We hypothesized that racial and ethnic minority groups would have worse melanoma mortality outcomes when compared to White patients.

RESULTS: Five representative studies with dates ranging from 1992-2015 were selected. The overall hazard ratio (HR) for Black patients vs. White patients was 1.31 (95% confidence interval (CI): 1.09-1.57), indicating that Black patients had a 31% increase in the risk of death as compared to White patients. Asian/Pacific Islander patients also had a 31% increase in the risk of death as compared to White patients (HR 1.31, 95% CI: 1.17-1.46). Hispanic patients had a 9% increase in the risk of death as compared to Non-Hispanic White (HR 1.09, 95% CI: 1.03-1.16). There was no significant difference in risk between American Indian/Alaskan Native and White patients (HR 0.94, 95% CI: 0.57-1.55).

CONCLUSIONS AND RELEVANCE: Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by multiple studies. More current investigations of melanoma outcomes in racial and ethnic minorities are necessary to identify and implement measures to narrow the gap in health outcomes.

KEY POINTS: Question: Are there racial and ethnic disparities in melanoma mortality outcomes?

FINDING: The pooled meta-analysis revealed that there are significantly worse melanoma survival outcomes in racial and ethnic minority groups when compared to White patients. The overall HR for Black, Asian/Pacific Islander, and Hispanic patients compared to White patients were 1.31, 1.31, and 1.09, respectively. Meaning: Worse melanoma survival outcomes in racial and ethnic minority groups are evidenced by these meta-analyses.

PMID:42340645 | DOI:10.1007/s40615-026-03065-0

J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07403-3. Online ahead of print.

ABSTRACT

PURPOSE: To examine the impact of physical exercise on motor skills in children with autism spectrum disorders (ASD).

METHODS: This study followed PRISMA guidelines (PROSPERO: CRD42024600538). Six databases (Embase, Engineering Village, OVID, PubMed, Scopus, and Web of Science) were searched through October 30, 2025.

INCLUSION CRITERIA: children ≤ 12 years with ASD; randomized controlled trials (RCTs); physical exercise interventions; motor skills outcomes measured via standardized instruments (BOT-2, TGMD-2, PDMS-2, ADS-3, MABC). Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using Cochrane ROB 2.0; evidence quality via GRADE. Statistical analysis used R 4.4.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Random-effects models were applied when I² ≥ 50%.

RESULTS: Ten RCTs (256 children; mean age 6.91 ± 2.51 years) were included. Physical exercise significantly improved total motor skills (SMD = 1.58, 95%CI: 1.15-2.00, p < 0.0000), locomotion (SMD = 1.34, 95%CI: 0.98-1.70, p < 0.00001), object control (SMD = 1.37, 95%CI: 1.02-1.72, p < 0.00001), and balance (SMD = 1.73, 95%CI: 0.82-2.65, p = 0.0002). Publication bias was detected for total motor skills and balance. Meta-regression showed that intervention frequency positively correlated with balance improvement (p = 0.022), while duration negatively correlated (p = 0.002).

CONCLUSION: Physical exercise significantly improves motor skills in children with ASD. Meta-regression indicates that frequency is a positive moderator for balance gains, but prolonged duration shows diminishing returns due to adaptation plateaus. Age and session length did not affect the protocol, so it remained flexible.

PMID:42340634 | DOI:10.1007/s10803-026-07403-3

J Autism Dev Disord. 2026 Jun 24. doi: 10.1007/s10803-026-07402-4. Online ahead of print.

ABSTRACT

BACKGROUND: The Modified Checklist for Autism in Toddlers – Revised (M-CHAT-R) is widely used for screening children at age 2 for autism spectrum disorders (ASD), but it also identifies children at risk for broader developmental challenges. We aimed to examine whether M-CHAT-R risk status at age 2 is associated with cognitive, behavioral, adaptive, and school-related outcomes at ages 3 to 4.

METHODS: We used data from the French national birth Cohort ELFE, including children assessed with the M-CHAT-R at age 2. Children were classified as low or medium risk. Outcomes at ages 3-4 included general cognitive development (Child Development Inventory), non-verbal reasoning (Picture Similarities test), family and daily activities, school engagement and performance, attention regulation (teacher-rated ADHD symptoms), specific neurodevelopmental care and school-based assistance. Multivariate analyses used modified Poisson regression for binary outcomes and linear regression for continuous outcomes, adjusted for sociodemographic, child-related, and school-related factors.

FINDINGS: 9,223 children were classified as low-risk and 1,248 children as medium-risk. Medium-risk children were more often boys and from socioeconomically disadvantaged families. At 3.5 years, medium-risk children had increased likelihood of developmental delay (16.6% vs. 6.1%, RR 2.2 after adjustment) and lower cognitive and language scores (up to -0.4 SD). Despite these differences, most children attended school, and their school life was similar to that of low-risk peers.

INTERPRETATION: Children classified as medium-risk by the M-CHAT-R at age 2 have an increased likelihood of subtle but widespread developmental challenges at school entry. Strategies to improve access to neurodevelopmental care and school support could enhance outcomes for this group.

PMID:42340632 | DOI:10.1007/s10803-026-07402-4

Obes Surg. 2026 Jun 24. doi: 10.1007/s11695-026-08810-2. Online ahead of print.

ABSTRACT

BACKGROUND: Sleeve conversion to Gastric Bypass (SG-RYGB) surgery is the most common conversion surgery in the United States. However, chronic Immunosuppressive therapy (CIT) may be a relative contraindication prior to metabolic and bariatric surgery (MBS) due to the potential for a complicated postoperative course and recovery, particularly in patients undergoing complex, secondary MBS.

OBJECTIVE: This study assesses the impact of CIT on both short-term and long-term outcomes following SG-RYGB surgery.

METHOD: This retrospective review study compared outcomes of patients at a single academic center who underwent SG-RYGB conversion surgery from January 2012 to December 2024. Patients were divided into two groups based on perioperative CIT status: the CIT group included those with documented use of chronic systemic immunosuppressive medications for at least three months prior to surgery, while the non-CIT group had no history of such therapy. Data collected included patient demographics, Body Mass Index (BMI), underlying disease, immunosuppression regimen, and early and late complications, such as rehospitalization, reinterventions, and mortality.

RESULT: One hundred twenty-six patients had SG-RYGB surgery; the average age for patients was 52.5 ± 11.5 years, 87.3% female. Of these, 23 patients (18.3%) were classified as the CIT group, having received chronic systemic immunosuppression for at least three months before surgery. In the CIT group, organ transplantations (47.8%) and rheumatoid arthritis (26.3%) were most common. Among perioperative and postoperative outcomes, the only statistically significant difference observed was a longer length of stay for CIT patients (P = 0.046), likely reflecting closer postoperative monitoring. Otherwise, short- and long-term postoperative outcomes were comparable between the CIT and non-CIT groups, with no significant differences observed in this cohort.

CONCLUSION: Except for a slightly longer hospital stay, short- and long-term outcomes appeared comparable between patients with and without CIT undergoing complex conversion surgery. However, larger studies are needed to confirm these findings and to help define the precise effect of CIT on outcomes of complex conversion surgery.

PMID:42340628 | DOI:10.1007/s11695-026-08810-2

J Endocrinol Invest. 2026 Jun 24. doi: 10.1007/s40618-026-02947-8. Online ahead of print.

ABSTRACT

PURPOSE: Adrenocortical carcinoma (ACC) is a rare tumor with highly aggressive malignancy. Its two main pathological subtypes, conventional ACC (CAC) and oncocytic ACC (OAC), are hypothesized to differ in clinical behavior, but comparative studies are limited due to the rarity of OAC. This study aimed to compare the clinical characteristics, pathological features, and prognosis between CAC and OAC.

METHODS: A retrospective review was conducted on 128 ACC patients (105 CAC, 23 OAC) during the period of October 2015 and October 2025. Data on clinical presentation, hormonal status, pathological findings, and survival outcomes were collected and analyzed. Statistical comparisons were performed using t-tests, Mann-Whitney U tests, chi-square tests, Cox proportional hazards regression analysis, multivariable Cox proportional hazards regression analysis, and Kaplan-Meier survival analysis with log-rank test.

RESULTS: Compared with CAC, OAC patients had a significantly lower prevalence of Cushing’s syndrome (13.0% vs. 39.0%, P < 0.05) and hypertension (17.4% vs. 48.6%, P < 0.01). In contrast, adrenal-derived sexual characteristics abnormalities were more common in OAC (65.2% vs. 26.0%, P < 0.001). Pathologically, compared with CAC, the Ki-67 index was significantly lower in OAC (median: 14% vs. 20%, P < 0.05). Also, Kaplan-Meier survival analysis revealed a more favorable overall survival(OS) for OAC, with a 5-year OS rate of 70.4% compared to 48.4% for CAC (P < 0.05). After multivariate adjustment for ENSAT stage and Ki‑67, pathological subtype lost independent prognostic significance, while ENSAT stage and Ki‑67 remained independent predictors.

CONCLUSIONS: CAC was associated with a higher frequency of glucocorticoid excess symptom, a higher proliferative index (Ki-67). OAC was characterized by a higher prevalence of androgen excess symptoms. OAC demonstrated similar OS to CAC after adjustment for ENSAT stage and Ki‑67.

PMID:42340623 | DOI:10.1007/s40618-026-02947-8

J Endocrinol Invest. 2026 Jun 24. doi: 10.1007/s40618-026-02929-w. Online ahead of print.

ABSTRACT

PURPOSE: To define an age-continuous reference range for testosterone (T) in females.

METHODS: A large-scale retrospective analysis of anonymised serum T collected via capillary sampling from a private healthcare service. 5,323 female individuals (19-59 years) with no history of reproductive conditions, normal BMI and regular cycles were analysed to establish a robust, age-continuous reference range for T, including probability density distributions and specific quantiles. Competing models of log T values as a function of age were statistically assessed, and the best model selected. Additionally, a cohort with self-reported hirsutism was compared.

RESULTS: A weakly skew-Normal distribution describes the best-fit distribution of log T values at any specific age, such that the mean decreases and the variance increases linearly with age. Analysis of the hirsutism cohort showed significantly higher T levels compared to the reference cohort.

CONCLUSION: Establishing a reliable reference range for female T enables clinicians to differentiate between physiological and pathological states (e.g. hyperandrogenism). Here, we establish a robust, age-continuous reference range for T in a large female population under strict inclusion criteria. The findings underscore the importance of age-specific reference ranges and highlight a substantial decrease in T over adult life. This study provides a valuable tool for clinicians and researchers seeking to compare patient hormone levels to a reliable reference distribution of T levels in women.

PMID:42340622 | DOI:10.1007/s40618-026-02929-w

Discov Nano. 2026 Jun 24;21(1):284. doi: 10.1186/s11671-026-04711-6.

ABSTRACT

The present study investigates transient nanofluid flow in a vertical porous channel with buoyancy effects and Navier slip at the walls, with particular emphasis on thermodynamic irreversibility, entropy generation, and mixed convection. The study formulates dimensionless, coupled nonlinear governing equations for velocity, temperature, and entropy generation. These equations are solved numerically using a finite-difference scheme (FDS) that is second-order accurate in space and first-order accurate in time, capturing both transient and steady-state behaviors. Parametric analyses are conducted for permeability (Darcy number), buoyancy (Grashof number), pressure gradient, Biot number, Prandtl number, Brinkman number, and distinct Navier slip coefficients at the heated and cooled walls. Increasing permeability and buoyancy accelerate the flow and enhance convective heat transfer, but intensify entropy generation near the walls where velocity and temperature gradients are highest. Stronger pressure forcing sharpens the centerline velocity and increases near-wall irreversibility. Higher Biot and Prandtl numbers reduce velocity and temperature levels across the channel, while potentially increasing entropy generation due to steeper thermal gradients. Increased viscous dissipation raises temperatures near the heated wall and amplifies entropy generation near both plates.

PMID:42340619 | DOI:10.1186/s11671-026-04711-6

Knee Surg Sports Traumatol Arthrosc. 2026 Jun 24. doi: 10.1002/ksa.70499. Online ahead of print.

ABSTRACT

PURPOSE: To compare clinical and functional outcomes after primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon (QT) autografts versus bone-patellar tendon-bone (BPTB) and, separately, QT versus hamstring tendon (HT) autografts, to inform evidence-based graft selection.

METHODS: We performed a Cochrane-guided systematic review and meta-analysis. Searches of PubMed, Scopus, Cochrane Library, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and major trial registries through November 2025 identified randomized controlled trials (RCTs) comparing QT with HT or BPTB in adults undergoing primary ACLR. Random-effects models (REML) were used to pool mean differences/standardized mean differences and risk ratios. Heterogeneity was quantified using I² and Q statistics. Sensitivity analyses (leave-one-out) and the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach were applied. When pooling was infeasible, a structured narrative synthesis was provided.

RESULTS: Fifteen RCTs (2014-2025) were included. Objective anterior stability (KT-1000) showed no significant difference between QT and HT at 12 or 24 months and no significant difference between QT and BPTB at 12 months. Patient-reported outcomes (International Knee Documentation Committee, Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], Tegner) were largely equivalent at 12-24 months. After resolving inconsistencies due to non-exchangeable constructs/comparators, a small 12-month KOOS signal favoured QT, while 24-month effects remained null. Graft failure rates were comparable for QT versus HT and QT versus BPTB. Donor-site morbidity was substantially lower with QT versus BPTB; QT versus HT showed no significant difference. Pivot-shift favoured QT, but not significantly; postoperative stiffness did not differ. Overall certainty was mostly moderate (downgrades for imprecision and occasional indirectness); donor-site morbidity versus BPTB reached high certainty.

CONCLUSION: Across randomized evidence up to 24 months, QT provides stability and patient-reported outcomes comparable to HT and BPTB, with clearly lower donor-site morbidity compared to BPTB and no excess failure compared to HT. QT is an evidence-supported alternative for primary ACLR; longer, adequately powered, construct-specific RCTs are needed for guideline-level certainty.

LEVEL OF EVIDENCE: Level I, systematic review of Level I randomized controlled studies.

PMID:42340609 | DOI:10.1002/ksa.70499