Nevin Manimala

J Appl Clin Med Phys. 2026 Aug;27(8):e70714. doi: 10.1002/acm2.70714.

ABSTRACT

BACKGROUND: Radiotherapy for vulvar carcinoma often employs the “frog-leg” position to minimize skin toxicity, but this position is biomechanically unstable and prone to setup errors using conventional skin markings.

PURPOSE: To evaluate the clinical efficacy of Surface-Guided Radiotherapy (SGRT) for setup accuracy in vulvar cancer patients treated in the frog-leg position and to quantify the biomechanical correlation between Body Mass Index (BMI) and setup errors.

METHODS: A retrospective cohort study of 20 vulvar cancer patients treated in the frog-leg position was conducted. All patients were treated using a uRT-linac 506c accelerator with integrated helical Fan-Beam CT (FBCT). Daily image guidance was performed using a two-step registration protocol (bony anatomy followed by soft-tissue fine-tuning). Setup errors from 500 FBCT datasets were compared between the conventional laser group (n = 10) and SGRT group (n = 10). The correlation between BMI and setup errors was analyzed using Spearman’s rank correlation.

RESULTS: The SGRT group demonstrated significantly superior setup accuracy across multiple key dimensions (p < 0.001). Notably, the Pitch error was reduced from 1.21° ± 0.48° in the Conventional Group to 0.07° ± 0.32° in the SGRT Group (Cohen’s d = 2.79). Longitudinal (LNG) error decreased from 0.49 ± 0.26 cm to 0.04 ± 0.24 cm (d = 1.82), and vertical (VRT) errors were similarly reduced.

BMI CORRELATION: In the Conventional Group, BMI showed a strong significant correlation with Pitch and Yaw errors (ρ = -0.81, P = 0.005), indicating that obesity may exacerbate pelvic rotational instability. Conversely, in the SGRT Group, no statistically significant correlation was observed between BMI and setup errors in any dimension (p > 0.05), demonstrating the system’s robustness against body habitus variations.

CONCLUSION: The frog-leg position is characterized by significant biomechanical instability due to distinct anatomical factors. Traditional skin marking methods are susceptible to the “skin traction effect” and interference from BMI. SGRT, through real-time topographical matching, effectively corrects pelvic tilt and longitudinal sliding. Crucially, it eliminates the setup uncertainty associated with BMI, providing a solid evidence-based foundation for precision radiotherapy and individualized PTV margin reduction.

PMID:42503572 | DOI:10.1002/acm2.70714

J Nurs Scholarsh. 2026 Jul;58(4):e70118. doi: 10.1111/jnu.70118.

ABSTRACT

INTRODUCTION: Adults who grow up with a parent with severe mental illness are exposed to prolonged developmental adversity, yet little is known about how this experience shapes multidimensional outcomes in adulthood. In particular, the roles of personal adaptive resources, childhood trauma, parental bonding, and morbidity in influencing quality of life, social functioning, and healthcare utilization remain insufficiently understood. This study aimed to examine the relationships between personal adaptive resources (resilience and general self-efficacy), childhood experiences (trauma and parental bonding), and adult outcomes, including quality of life, social functioning, morbidity, and healthcare utilization, as well as to examine the moderating role of resilience.

DESIGN: A cross-sectional quantitative design was employed.

METHODS: A convenience sample of 300 adults who grew up with a parent with severe mental illness completed a self-report questionnaire which consisted of validated scales for study variables: Personal Wellbeing Index-Adult, Connor-Davidson Resilience Scale-10, New General Self-Efficacy Scale, Social Functioning Questionnaire, Parental Bonding Instrument, Childhood Trauma Questionnaire, and EUROHIS survey items for morbidity and healthcare utilization. Data were analyzed using Spearman correlations, hierarchical multiple linear regression, negative binomial regression, and moderation analysis using PROCESS.

RESULTS: Resilience and self-efficacy independently predicted higher quality of life. Childhood trauma and parental overprotection independently predicted poorer social functioning, while parental care did not contribute unique variance in multivariate models. Childhood trauma significantly predicted morbidity, and morbidity was associated with increased healthcare utilization. Resilience did not moderate the relationship between childhood trauma and either morbidity or social functioning, indicating independent rather than interactive effects.

CONCLUSION: Among adults who grew up with a parent with SMI, resilience and self-efficacy function as independent contributors to subjective wellbeing, while childhood adversity and morbidity shape long-term social and health outcomes. Resilience does not appear to buffer the long-term effects of trauma on health or functioning.

PMID:42503553 | DOI:10.1111/jnu.70118

Eur J Pediatr. 2026 Jul 27;185(8):612. doi: 10.1007/s00431-026-07273-y.

ABSTRACT

This study aimed to investigate the characteristics of febrile seizure (FS) associated with Kawasaki disease (KD) using nationwide population-based data. Children aged ≤ 5 years were analyzed using claims data from the Korean Health Insurance Review and Assessment Service between 2007 and 2022. FS and KD were identified using ICD-10 codes R56.0 and M30.3, respectively. Clinical characteristics were compared between FS associated with KD (KD-FS) and FS without KD (non-KD-FS). Of 1,230,434 children with FS, 1,683 (0.1%) had concomitant KD. Children with KD-FS were younger (1.66 vs. 1.81 years, p < 0.0001) and more likely to be male (58.8% vs. 55.9%, p = 0.0163) than those with non-KD-FS. During the coronavirus disease 2019 pandemic, the overall incidence of FS decreased markedly, whereas that of KD-FS increased. KD-FS occurred more frequently in winter and showed a distinct seasonal pattern, whereas the incidence of non-KD-FS peaked in summer. Children with KD-FS were more frequently treated in secondary or tertiary hospitals and had longer hospital stays. Chloral hydrate and acute/emergency anticonvulsants were more frequently administered in the KD-FS group; however, maintenance anticonvulsant use did not differ. Cerebrospinal fluid analysis and brain computed tomography were performed more frequently in the KD-FS group; brain magnetic resonance imaging and electroencephalography utilization and mortality rates were comparable.

CONCLUSION: KD-FS is rare and does not appear to be associated with a more severe neurological course than non-KD-FS.

WHAT IS KNOWN: • Kawasaki disease (KD) is a systemic vasculitis that can be accompanied by neurological manifestations, including febrile seizures (FS). • FS during acute KD is rare and remain insufficiently characterized in large population-based studies.

WHAT IS NEW: • In this nationwide study, FS associated with KD are rare but show distinct demographic and seasonal features, including younger age and winter predominance. • However, FS associated with KD are not associated with worse neurological outcomes or mortality compared with non-KD febrile seizures.

PMID:42503538 | DOI:10.1007/s00431-026-07273-y

J Robot Surg. 2026 Jul 27;20(1):759. doi: 10.1007/s11701-026-03697-8.

ABSTRACT

To systematically characterize global publication trends, collaboration patterns, intellectual foundations, research hotspots, and emerging frontiers in artificial intelligence (AI)-enhanced robotic and robot-assisted surgery in urology. Publications were retrieved from the Web of Science Core Collection (WoSCC) using a topic search strategy that included three keyword groups: robot-assisted surgery, urologic diseases or procedures, and AI-related technologies. English-language articles and reviews were included. Meeting abstracts, conference proceedings, editorials, letters, non-English publications, studies unrelated to urologic robotic surgery, and studies without substantive AI or intelligent algorithmic content were excluded. RStudio was used for descriptive statistics and annual publication trend visualization. VOSviewer was used for auxiliary bibliometric network construction and visualization. CiteSpace was used to construct collaboration networks, co-citation networks, keyword co-occurrence maps, cluster maps, timeline and time-zone maps, and citation burst maps. A total of 401 records were initially retrieved, and 253 publications were finally included after screening by document type, language, and topical relevance. These comprised 199 articles (78.66%) and 54 reviews (21.34%). Publications in this field began in 2004 and increased rapidly after 2018, reaching a peak of 53 publications in 2025. Because 2026 was an incomplete retrieval year, only 23 publications were recorded. Italy, the United States, the Netherlands, China, and Japan were the leading contributing countries. The University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, IRCCS Fondazione del Piemonte per l’Oncologia, the Netherlands Cancer Institute, and Leiden University Medical Center were the most productive institutions. Keyword clustering showed that the major research hotspots included renal cell carcinoma, augmented reality, image-guided surgery, indocyanine green, machine learning, registration, deep learning, and bladder cancer. AI-enhanced robotic surgery in urology has evolved from early research on registration, navigation, and image-guided surgery toward a surgical intelligence stage characterized by augmented reality, three-dimensional reconstruction, machine learning-based prediction, deep learning-based segmentation, surgical video understanding, and skill assessment. Future studies should prioritize multicenter standardized datasets, sharing of intraoperative video and robotic platform data, model interpretability, prospective validation, and integration into real-world clinical workflows.

PMID:42503526 | DOI:10.1007/s11701-026-03697-8

Orthop Surg. 2026 Jul 26. doi: 10.1111/os.70368. Online ahead of print.

ABSTRACT

PURPOSE: Cervical curvature loss is a frequent complication following 3-level anterior cervical discectomy and fusion (ACDF) using a Zero-Profile device. Consequently, the capacity of this device to maintain cervical sagittal alignment in 3-level ACDF remains highly controversial. This study aimed to identify potential predictors for postoperative curvature loss (PCL) and evaluate its impact on clinical outcomes.

METHODS: A total of 113 patients who underwent ACDF for 3-level cervical degenerative disc disease (CDDD) between January 2021 and December 2023 were retrospectively reviewed. Demographic data, radiological parameters, and clinical outcomes were analyzed. Radiographic measures included cervical curvature, T1 slope, C2-7 sagittal vertical axis, and titanium plate and endplate (TPE) distance. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Statistical analyses were performed using paired and independent t-tests, as well as Pearson correlation coefficients.

RESULTS: The average curvature loss was 6.82° from 1 week postoperatively to the final follow-up (p < 0.001). However, the final curvature (11.65°) was maintained, representing a 4.33° improvement compared to preoperative values. Significant correlations were observed between PCL and preoperative curvature (r = -0.368, p = 0.013), preoperative T1 slope (r = -0.546, p < 0.001), ∆T1 slope (r = 0.443, p = 0.002), and ∆TPE distance (r = 0.417, p = 0.004). PCL did not correlate with Japanese Orthopaedic Association (JOA) scores or arm VAS scores at the final follow-up. Nevertheless, patients with a PCL ≥ 6° exhibited significantly higher neck VAS (p = 0.028) and NDI scores (p = 0.041).

CONCLUSION: Although contiguous 3-level ACDF with a Zero-Profile device may result in PCL, it preserves an improved cervical lordosis compared to the preoperative baseline. Low preoperative curvature and a low preoperative T1 slope are potentially predictive factors for PCL. Postoperative changes in TPE distance and T1 slope are significantly associated with PCL, suggesting a potential biomechanical link that requires direct validation. Furthermore, PCL may lead to higher neck VAS and NDI scores. Consequently, the Zero-Profile device may require careful consideration in 3-level CDDD patients presenting with low preoperative curvature and a low T1 slope. Importantly, the 6° PCL threshold identified is preliminary and requires prospective validation before clinical application.

PMID:42503501 | DOI:10.1111/os.70368

Dementia (London). 2026 Jul 26:14713012261471592. doi: 10.1177/14713012261471592. Online ahead of print.

ABSTRACT

American Indian populations experience a disproportionately high prevalence of risk factors for Alzheimer’s disease and related dementias. This study assessed Alzheimer’s disease knowledge across seven domains and identified factors associated with overall and domain-specific Alzheimer’s disease knowledge among American Indian adults. Guided by the social determinants of health framework, we conducted a cross-sectional survey of American Indian adults residing in South Dakota. A total of 227 participants completed a self-administered survey questionnaire measuring Alzheimer’s disease knowledge across seven domains. Multivariable regression analyses were performed to examine factors associated with overall Alzheimer’s disease knowledge and each domain. Participants demonstrated 63.5% accuracy in overall Alzheimer’s disease knowledge (M = 18.7, SD = 4.1), indicating a moderate level of knowledge. Knowledge varied across domains: participants were most knowledgeable about the life impact of Alzheimer’s disease and least knowledgeable about risk factors and symptoms. Four domains were found to be statistically significant: disease course, treatment and management, risk factors, and caregiving. Higher educational attainment and employment status were significantly associated with greater overall Alzheimer’s disease knowledge. Education was the most consistent factor associated with greater knowledge across all four domains, whereas other social determinants of health variables (e.g., social support from significant others, lower depressive symptoms, health status, exercise) showed domain-specific associations. Findings highlight the need for educational outreach and culturally tailored interventions grounded in the social determinants of health and responsive to American Indian community contexts. Notable gaps in knowledge-particularly regarding risk factors and symptoms-suggest priority areas for Alzheimer’s disease prevention efforts. Health initiatives should address key social determinants, including education, employment, social support, health/mental health status, and health behaviors. Interventions must be developed in partnership with Indigenous leaders and health professionals to ensure culturally relevant, community-driven, and holistic approaches that improve Alzheimer’s disease knowledge and support Alzheimer’s disease prevention in American Indians.

PMID:42503498 | DOI:10.1177/14713012261471592

Am Surg. 2026 Jul 26:31348261471500. doi: 10.1177/00031348261471500. Online ahead of print.

ABSTRACT

BackgroundExcisional hemorrhoidectomy remains the standard for advanced disease, while the applicability of laser hemorrhoidoplasty remains uncertain. This study evaluates the tradeoff between short-term recovery and long-term durability to inform patient-centered decision-making.MethodsA systematic search of PubMed, Web of Science, Scopus, and CENTRAL was conducted through September 2025. Randomized controlled trials (RCTs) comparing diode laser hemorrhoidoplasty with conventional hemorrhoidectomy were included. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals were estimated using random-effects models. Heterogeneity was assessed with the I² statistic, and trial sequential analysis (TSA) was performed to explore the robustness of selected outcomes.ResultsFifteen RCTs involving 1099 patients were included. Laser hemorrhoidoplasty was associated with reduced postoperative pain on day 1 (MD -2.02; 95% CI -2.83 to -1.20) and day 7 (MD -2.13; 95% CI -3.06 to -1.20), shorter duration of analgesic use (MD -2.72 days), operative time (MD -12.49 min), intraoperative blood loss (MD -21.63 mL), hospital stay (MD -0.63 days), and earlier return to daily activities (MD -10.78 days). It was also associated with lower rates of postoperative bleeding (RR 0.35), urinary retention (RR 0.29), and anal stenosis (RR 0.12). TSA suggested that some short-term findings may be robust; however, several outcomes remained underpowered, and limited follow-up restricts the interpretation of long-term outcomes.ConclusionLaser hemorrhoidoplasty offers improved short-term recovery but with uncertain long-term durability. Given the low to very low certainty of the evidence and limited follow-up, these findings support a preference-sensitive approach rather than replacing excisional hemorrhoidectomy.

PMID:42503488 | DOI:10.1177/00031348261471500

Laryngoscope. 2026 Jul 26. doi: 10.1002/lary.70726. Online ahead of print.

ABSTRACT

OBJECTIVES: Composite cranioplasty reconstruction must protect underlying neural tissue, create a watertight dural barrier, and recreate the natural contour of the scalp/skull. Harvested as a fasciocutaneous, adipofascial, or fascial flap, the anterolateral thigh (ALT) free flap offers a versatile solution to multiple cranial defect types. This study compares utilization and outcomes of cranioplasty reconstruction utilizing three different ALT flap types at a single institution.

METHOD: A retrospective review was completed of patients undergoing ALT cranioplasty at a single institution between 01/01/2019 and 2/1/2025. Flaps were performed as fascia lata only, adipofascial, or fasciocutaneous depending on the nature of the defect. Trends in utilization, outcomes, and complications were collected.

RESULTS: A total of 72 patients underwent 79 ALT free tissue transfers categorized as fascia lata (n = 22), fasciocutaneous (n = 35), or adipofascial (n = 22). Defects most commonly involved the scalp/skull for all flap types. Although not reaching statistical significance, fasciocutaneous and adipofascial flaps tended to experience high overall complications (29% and 27%, respectively, vs. 5% for fascial alone). Most complications were due to infection or dehiscence. Similarly, flap failure rates did not differ significantly but tended to be higher for fasciocutaneous flap reconstruction (11%, vs. adipofascial 5% vs. fascial alone 0%).

CONCLUSION: The ALT free flap with perforator harvest and minimal access recipient vessel procurement technique offers an adaptable and effective reconstructive option for a wide variety of complex scalp and cranial vault defects.

PMID:42503446 | DOI:10.1002/lary.70726

J Matern Fetal Neonatal Med. 2026 Dec;39(1):2681372. doi: 10.1080/14767058.2026.2681372. Epub 2026 Jul 26.

ABSTRACT

OBJECTIVE: Early onset fetal growth restriction (FGR) shares pathophysiologic origins and may precede the development of Hypertensive Disorder of Pregnancy (HDP). The aim of this study was to evaluate risk factors associated with the development of HDP in individuals with early onset FGR.

METHODS: This retrospective cohort included all consecutive patients who presented to our tertiary, university-affiliated medical center between 2011 and 2024 for suspected early-onset FGR, defined as onset before 32 weeks of gestation. Maternal and pregnancy information retrieved from hospital records included maternal age, BMI, smoking history, parity, gestational age (GA) at diagnosis, chronic hypertension, maternal cardiac disease, pre- or gestational diabetes, thrombophilia, chronic renal disease, history of major pregnancy complications, mode of conception, number of fetuses, premature contractions (PMC), ultrasound (US) measured abdominal circumference (AC), US measured estimated fetal weight (EFW), umbilical artery Doppler PI (UAPI) and middle cerebral artery Doppler PI (MCAPI). AC and EFW were classified as <5% and <3% respectively based on local population growth charts. UAPI and MCAPI percentiles were calculated per specific GA. We present maternal and pregnancy characteristics stratified by the development of HDP and investigated the association of these variables with development of HDP using univariate and multivariable logistic regression. The analyses were performed using R statistical software, and statistical significance was defined as p < 0.05.

RESULTS: During the study period 774 pregnant individuals were presented for suspected early-onset FGR. Among them, 79 (10.2%) subsequently developed HDP later in pregnancy. Using multivariate analysis UAPI above the 95^th percentile (OR 3.35, CI 1.55-7.20, p < 0.01), GA 24-28 weeks at diagnosis (OR 2.54, CI 1.20-5.36, p = 0.01) and AC below the 5^th percentile (OR 2.31, CI 1.10-4.86, p = 0.02), were significantly associated with the subsequent development of HDP.

CONCLUSION: Among pregnancies with suspected early-onset FGR, an elevated UAPI (>95th percentile) was the strongest predictor of developing HDP. Additional risk factors included earlier gestational age at FGR diagnosis and an AC below the 5th percentile. Women with these risk factors warrant intensified maternal surveillance. Future studies integrating these clinical predictors with circulating angiogenic biomarkers may further refine risk stratification.

PMID:42503443 | DOI:10.1080/14767058.2026.2681372

JNCI Cancer Spectr. 2026 Jul 7;10(4):pkag062. doi: 10.1093/jncics/pkag062.

ABSTRACT

BACKGROUND: As tobacco use patterns shift toward non-combustible tobacco products such as electronic cigarettes (ECs) and nicotine pouches, dual use with combustible products may undermine potential public health benefits. Herein we describe adult trends in exclusive and dual use of combustible and non-combustible products in the United States between 2015 and 2023.

METHODS: We analyzed annual National Health and Interview Survey data including all adults with valid data on tobacco use, age, and sex. Joinpoint regression estimated annual percentage change (APC) and 95% CIs overall and by age group and sex. All tests were 2-tailed (P < .05).

RESULTS: Exclusive combustible use remained 2-3 times higher than exclusive non-combustible use or dual use across all years. From 2015 and 2023, combustible use declined in both sexes, with the steepest drops in younger adults after 2020. Exclusive non-combustible use increased in all age groups after 2017, especially among younger adults and females. The most common dual use pattern was cigarettes plus ECs, which was stable over time.

CONCLUSIONS: Exclusive use of combustible tobacco, primarily cigarettes, is declining but remains the most common pattern, especially in older adults. In contrast, exclusive EC use is displacing combustible use among younger adults. Dual use patterns were low overall and stable across the study period.

PMID:42503418 | DOI:10.1093/jncics/pkag062