Nevin Manimala

Drug Saf. 2026 Jun 11. doi: 10.1007/s40264-026-01686-2. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Concerns about modafinil and armodafinil use in pregnancy emerged from animal reproductive toxicity and limited human data, including a US registry suggesting increased risk of major congenital malformations (MCMs). Subsequent studies have reported conflicting findings. This study aimed to evaluate the risk of MCMs and other adverse pregnancy outcomes following prenatal modafinil exposure in the French population.

METHODS: This retrospective cohort study identified pregnancies during 2012-2019 using the French national health database (SNDS). Pregnancies exposed and unexposed to modafinil were identified and propensity score matched (1:4 ratio). Outcomes assessed included MCMs, spontaneous abortion, stillbirth, elective termination, preterm birth, low birth weight, and growth restriction. Prevalence and prevalence ratios (PRs) were calculated and adjusted risk ratios (RR) were estimated using Poisson regression models.

RESULTS: A total of 786 modafinil-exposed pregnancies were matched to 3144 unexposed pregnancies. The prevalence of MCMs among first-trimester modafinil-exposed pregnancies was 4.2%, compared with 3.3% in unexposed pregnancies (PR 1.26; 95% CI 0.77-2.04). After adjustment for potential confounding factors, no statistically significant increase in MCM risk was observed (RR 1.32, 95% CI 0.81-2.15). Most other pregnancy and birth outcomes showed no significant differences. However, elective terminations were 32% more frequent in the exposed group (PR 1.32; 95% CI 1.14-1.51).

DISCUSSION: This large, population-based study found no increased risk of MCMs or most adverse pregnancy outcomes following modafinil exposure. The elevated rate of elective terminations may reflect clinical decisions influenced by underlying maternal conditions such as narcolepsy. While these findings do not indicate an increased risk of MCM, caution remains warranted regarding modafinil use during pregnancy.

PMID:42274903 | DOI:10.1007/s40264-026-01686-2

Head Neck Pathol. 2026 Jun 11;20(1):65. doi: 10.1007/s12105-026-01929-9.

ABSTRACT

PURPOSE: To benchmark the diagnostic accuracy and inter-model agreement of contemporary large language models (LLMs) on text-only histopathologic narrative descriptions in oral and maxillofacial pathology (OMFP), and to assess how performance varies by diagnostic dependency and diagnostic category.

METHODS: In this retrospective diagnostic accuracy study, 171 de-identified OMFP cases were screened, and 155 cases were included after predefined selection. Each case comprised an edited histopathologic narrative and a single expert-verified reference diagnosis. Three general-purpose LLMs (ChatGPT-5.0, Gemini-2.5-Pro, Claude-Opus-4.1) were queried once per case using an identical zero-shot prompt requesting a single definitive diagnosis. Primary outcome was case-level accuracy; paired comparisons used McNemar’s test, and inter-model agreement was assessed with Cohen’s κ. Performance was stratified by histology-sufficient (HS) versus correlation-dependent (CD) lesions and by OMFP diagnostic category.

RESULTS: Overall accuracies were 83.2% (ChatGPT-5.0), 77.4% (Gemini-2.5-Pro), and 72.3% (Claude-Opus-4.1). ChatGPT-5.0 significantly outperformed Claude-Opus-4.1, whereas the differences between ChatGPT-5.0 and Gemini-2.5-Pro and between Gemini-2.5-Pro and Claude-Opus-4.1 were not statistically significant. Agreement was highest between Gemini-2.5-Pro and Claude-Opus-4.1 (κ = 0.73). All models showed higher accuracy for HS than CD lesions, with best performance in malignant, hematolymphoid, and immune-mediated categories.

CONCLUSION: Contemporary LLMs can interpret OMFP histopathologic narratives with moderate overall diagnostic accuracy, particularly for lesions with distinctive microscopic features. Performance declined for CD entities, indicating persistent reliance on clinicoradiologic context. Although not suitable as stand-alone diagnosticians, these findings provide a controlled benchmark of text-based diagnostic performance and suggest potential supportive value in OMFP education and exploratory pathology informatics applications under expert supervision.

PMID:42274902 | DOI:10.1007/s12105-026-01929-9

Ir J Med Sci. 2026 Jun 11. doi: 10.1007/s11845-026-04439-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effects of psychosocial interventions on sexual function, quality of life, and stress levels in women with gynecologic cancer.

METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Web of Science, EBSCOhost, Google Scholar, and the YÖK Thesis Center were searched between June and July 2024 without year restriction. Randomized controlled and quasi-experimental studies evaluating psychosocial interventions were included. Data were synthesized using meta-analysis and narrative synthesis. Outcomes were synthesized separately for sexual function, quality of life, and stress.

RESULTS: Seven studies were included in the analysis. Psychosocial interventions significantly improved sexual function (SMD: 0.868; 95% CI: 0.021 to 1.715; Z = 2.008; p = 0.045; I² = 89.97%) and quality of life (SMD: 0.709; 95% CI: 0.060 to 1.358; Z = 2.142; p = 0.032; I² = 88.61%) in women with gynecologic cancer. However, psychosocial interventions did not demonstrate a significant effect on stress levels (SMD: – 1.126; 95% CI: – 2.649 to 0.397; Z = – 1.449; p = 0.147; I² = 95.65%).

CONCLUSION: This systematic review and meta-analysis indicates that psychosocial interventions are associated with improvements in sexual function and quality of life among women with gynecologic cancer, whereas no statistically significant reduction in stress was observed. Although substantial between-study heterogeneity was present, the overall evidence supports the integration of psychosocial approaches into supportive oncology nursing care.

PMID:42274896 | DOI:10.1007/s11845-026-04439-3

Cerebellum. 2026 Jun 11;25(4):92. doi: 10.1007/s12311-026-02033-y.

ABSTRACT

Upper limb postural tremor is common in both Spinocerebellar Ataxia type 12 (SCA12) and Essential Tremor (ET). In the early stages, their clinical presentation can be similar, leading to potential misdiagnosis. This study aimed to develop and evaluate a low-cost device and methods to quantify 2D reaching kinematics objectively, with the goal of improving differentiation between ET and SCA12 using machine learning (ML) models. We recruited 48 participants, including 16 SCA12 patients, 16 ET patients, and 16 healthy controls (HC). Clinical severity was scored using TETRAS and SARA scales. A Raspberry Pi-based device was used to record upper limb reaching during a button-press task. The videos were processed with DeepLabCut and six 2D kinematic parameters were extracted via MATLAB scripts. We expanded the dataset using Generative Adversarial Networks (GAN). Classification was performed using multiple ML algorithms, with and without GAN-based data augmentation. Both patient cohorts showed significant alterations in kinematic features compared to HC, with SCA12 demonstrating more pronounced abnormality. Kinematic parameters including maximum reaching speed, endpoint precision, and time fraction to peak speed emerged as potential markers for differentiating ET and SCA12. The ML models demonstrated high classification performance in distinguishing HC from patients (CA 88.9%) and SCA12 from ET (CA 83.3%) using original data. The device-guided reaching kinematics provide objective markers of motor impairment. Combined with ML, this approach could enhance diagnostic accuracy; it also has potential for remote monitoring and as an outcome measure in clinical trials.

PMID:42274882 | DOI:10.1007/s12311-026-02033-y

Curr Med Imaging. 2026;22:e15734056495507. doi: 10.2174/0115734056495507260515193943.

ABSTRACT

INTRODUCTION: Soft tissue metastases are rare lesions seen in the course of systemic malignancies and pose diagnostic challenges. Radiological findings are heterogeneous, and standardized criteria are needed for reliable differentiation from benign lesions. While the diagnostic importance of perilesional changes is emphasized in the current literature, comprehensive analyses considering the clustered data structure are lacking. In this study, we aimed to determine effective radiological parameters for distinguishing soft tissue metastases from benign soft tissue lesions and to reveal the independent predictive value of perilesional findings.

METHODS: Soft tissue lesions detected by computed tomography (CT) and magnetic resonance imaging (MRI) between January 2015 and December 2023 were retrospectively evaluated in this single-center study. The study included 57 benign lesions (55 patients) and 139 metastatic lesions (65 patients). Lesion size, contour characteristics, morphological shape, anatomical localization, perilesional edema, and perilesional vascularity were evaluated. Due to the clustered data structure, the Generalized Estimating Equations (GEE) methodology was used. Model performance was evaluated using ROC curve analysis, precision-recall curve, and Brier score. Statistical analyses were performed using Jamovi v2.6.44, JASP v0.19.3, and R v4.5.1 software.

RESULTS: Metastatic lesions were significantly smaller than benign lesions (median 17.0 mm vs. 33.3 mm; p<0.001). In the GEE analysis, the presence of perilesional edema increased the likelihood of metastasis by 35 times (OR=35.25; 95% CI: 7.58-164.00; p<0.001), and perilesional vascularity increased the likelihood of metastasis by 45 times (OR=44.54; 95% CI: 1.86-1066.00; p = 0.016). Abdominal-pelvic localization showed a 133- fold (OR=133.00; 95% CI: 10.90-1622.00; p<0.001) higher likelihood of metastasis compared to the extremities, while thoracic-anterior chest wall localization showed a 35-fold (OR=35.22; 95% CI: 2.41-514.00; p = 0.007). Each unit increase in standardized size reduced the likelihood of metastasis by 90% (OR=0.10; 95% CI: 0.02-0.42; p = 0.001). The model demonstrated excellent discrimination (AUC-ROC=0.947) and calibration (Brier score=0.075) performance.

DISCUSSION: Our results show that perilesional edema and perilesional vascularity are key diagnostic signs of metastatic lesions. The combined assessment of perilesional findings and anatomical localization can significantly enhance diagnostic accuracy in daily practice. Furthermore, the relationship between lesion size and the metastatic process emphasizes the need for more careful evaluation of smaller lesions.

CONCLUSION: Perilesional edema, perilesional vascularity, and trunk region localization were associated with soft tissue metastasis. These findings may be helpful in the radiological differentiation of metastasis and benign soft tissue lesions.

PMID:42273870 | DOI:10.2174/0115734056495507260515193943

Dan Med J. 2026 May 20;73(6):A11250903. doi: 10.61409/A11250903.

ABSTRACT

INTRODUCTION: Rectal prolapse significantly impairs the quality of life, particularly in elderly women. Minimally invasive ventral mesh rectopexy (VMR) has emerged as a preferred surgery, offering anatomical correction and improved post-operative outcomes. This study evaluated operative details, complications and recurrence rates following laparoscopic VMR (LVMR) and robotic VMR (RVMR) at a single tertiary care centre over a five-year period.

METHODS: A retrospective analysis of patients undergoing LVMR or RVMR between 2019 and 2024 was conducted. The two groups were compared with respect to demographics, intraoperative details, post-operative complications, recurrence and long-term functional outcomes.

RESULTS: A total of 88 patients had undergone VMR, of whom 69 underwent RVMR; 19 underwent LVMR. All patients were female with a median age of 74 years. External prolapse was observed in 97.7% of the patients, whereas only 2.3% had internal prolapse. No statistically significant difference was observed between LVMR and RVMR with regard to length of stay or mean operative time. The conversion rate was 0%. Post-operative complications were classified according to Clavien-Dindo (CD); six patients had a CD IIIb, requiring return to surgical theatres. A single patient from the RVMR group had a recurrence after one year.

CONCLUSIONS: Minimally invasive VMR is a long-term, effective and safe surgical method for rectal prolapse, with a low recurrence rate, a relatively low complication rate and a significant improvement in functional outcomes.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.

PMID:42273863 | DOI:10.61409/A11250903

Cancer Med. 2026 Jun;15(6):e71963. doi: 10.1002/cam4.71963.

ABSTRACT

AIM: We examine the impact of interferon (IFN)-based and IFN-free treatment on the prognosis of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) sustained virological response (SVR).

METHODS: Clinical information was collected on 311 cases of HCC after HCV-SVR from 16 facilities affiliated with the Kyushu Liver Surgery Study Group. Clinical factors and the tumor microenvironment of HCC after SVR treatment with IFN-based and IFN-free treatments were analyzed.

RESULTS: No statistically significant differences were observed in the recurrence rate and overall survival (OS) between the two groups. Propensity score-matched analysis similarly showed no statistically significant differences in recurrence and OS. In the IFN-based treatment group, OS time was significantly shorter for the programmed death-ligand 1(PD-L1)-positive HCC than the PD-L1-negative HCC group (p = 0.0183). No significant difference was observed in the recurrence rate between PD-L1-positive and PD-L1-negative HCC groups. In the IFN-based treatment group, the recurrence rate in the cluster of differentiation (CD) 8-positive group was significantly lower than in the CD8-negative group (p = 0.0292). There was no difference in OS time between the CD8-positive and CD8-negative groups. In the IFN-free treatment group, PD-L1 and CD8 were not associated with recurrence rate or OS.

CONCLUSIONS: No statistically significant differences were observed in recurrence or OS rate after HCC resection in the IFN-free treatment group compared with the IFN-based treatment group. In the IFN-based treatment group, PD-L1 and CD8 expression on cancer cells might be prognostic factors.

PMID:42273857 | DOI:10.1002/cam4.71963

Inquiry. 2026 Jan-Dec;63:469580261444668. doi: 10.1177/00469580261444668. Epub 2026 Jun 11.

ABSTRACT

Relative deprivation has been associated with adverse health outcomes, yet the psychological pathways linking perceived socioeconomic disadvantage to health remain insufficiently understood, particularly in the Chinese context. This study therefore examines whether subjective well-being mediates the relationship between relative deprivation and health among Chinese adults. This cross-sectional study analyzed 5604 adults aged ≥ 18 using data from the 2023 Chinese General Social Survey (CGSS) conducted in China. After computing descriptive statistics and correlations, stepwise regression models tested whether subjective well-being mediated the relationship between relative deprivation and health. Indirect effects were estimated using bias-corrected bootstrap procedures (5000 replications). Urban-rural stratification examined geographic heterogeneity in mediation pathways, while robustness checks included ordered logit models and a sensitivity analysis that dichotomized subjective well-being into low and high categories. STATA 18.0 was used throughout. The results indicated that relative deprivation demonstrated a significant negative association with Chinese adults’ health. Furthermore, subjective well-being was independently associated with better health outcomes. Mediation analysis revealed that subjective well-being significantly mediated 20.5% of the total effect between relative deprivation and health. Regional stratification showed that the indirect pathway through subjective well-being did not differ significantly between urban and rural residents, whereas the direct effect of relative deprivation on health was significantly stronger among rural residents. These findings highlight the potential role of subjective well-being as a psychological mechanism linking perceived relative deprivation to health. While this pathway appears comparable across urban and rural contexts, the association between relative deprivation and health is stronger among rural residents. Addressing health disparities therefore requires attention to both psychosocial processes and the broader structural conditions that shape socioeconomic inequality.

PMID:42273849 | DOI:10.1177/00469580261444668

J Chem Inf Model. 2026 Jun 11. doi: 10.1021/acs.jcim.6c00675. Online ahead of print.

ABSTRACT

Two-dimensional (2D) inorganic crystals are a class of materials that are gaining significant attention for use in electronic and optoelectronic devices. Among many other exciting applications, 2D materials offer a range of beneficial properties to such devices owing to charge carrier confinement, high carrier mobility, tunable band gaps, strong light-matter interactions, and atomically thin geometries that enable excellent electrostatic control and mechanical flexibility. In parallel, data-driven approaches to predictions of inorganic material properties have gained considerable attention as computationally lightweight surrogate models for properties of interest. This is particularly important when screening candidate materials for particular sets of structure-property relationships. Many of these approaches have targeted three-dimensional bulk crystalline materials. In this work, we develop a set of data-driven models for predicting the properties of 2D layered, van der Waals, and ultrathin film materials, namely, thermodynamic stability, metallicity, and electronic band gap. We train the models on materials sourced from open-source computational databases of 2D materials (Alexandria_2D, C2DB, MC2D, and 2DMatpedia) and use chemically relevant elemental, physical, and compositional features as input. The large feature space is reduced to a subset of critical features by a statistical and gradient-boosted feature selection strategy. The models are fully interpretable with feature relevance scores and SHapley Additive exPlanations analysis assessing the global and local influence of feature values. The classifiers for thermodynamic stability and metallicity achieve F₁-scores of 0.832 and 0.870 and accuracies of 89.7% and 89.7%, respectively. The regressor model for the band gap achieves an R² of 0.883, a mean-absolute error (MAE) of 0.317 eV, and a root-mean-squared error (RMSE) of 0.485 eV on the in-distribution test set. We assess the band gap predictor regressor against a 2D material band gap data set (N ∈ 177) manually extracted from the academic literature to quantify the model’s ability to predict outside of the training distribution, achieving an R² of 0.334, an MAE of 0.675 eV, and an RMSE of 0.961 eV. These results demonstrate the efficacy of feature selection in producing fully explainable machine learning surrogate models for high-throughput property prediction for 2D materials.

PMID:42273839 | DOI:10.1021/acs.jcim.6c00675

Afr J Reprod Health. 2026 Jun 11;(11):20-27. doi: 10.29063/ajrh2026/v30i11.2.

ABSTRACT

Contraceptive failure remains a global public health challenge among HIV positive women. Therefore, this study aimed to propose a contraceptive failure prediction framework based on the findings from HIV-positive women of reproductive age in South Africa and the perception of their healthcare providers. A mixed-methods approach was utilized, with participants purposively selected based on their knowledge and experiences. Qualitative data gathered from two focus group discussions (FGDs) involving seven (n = 7) healthcare workers (HCWs) and in-depth interviews involving ten (n = 10) HIV-positive women as well as quantitative data comprising a cohort of one hundred and seventy-three (n = 173) HIV-positive women who participated in the South African National HIV Prevalence, Incidence, Behavior Survey (SABSSM) were used to identify contraceptive failure determinants. Participant demographic information was analyzed using descriptive statistics, while inferential analysis was done using multiple regression statistics. The qualitative data were thematically analyzed. Healthcare workers’ (HCWs’) support, knowledge of contraceptive use, access to preferred contraceptives, and income collectively predicted contraceptive failure. These findings facilitated the development of a Contraceptive Failure Prediction Framework (CFPF), interpreted here as a determinants framework.

PMID:42273838 | DOI:10.29063/ajrh2026/v30i11.2