Nevin Manimala

BMC Anesthesiol. 2026 Feb 14. doi: 10.1186/s12871-026-03694-2. Online ahead of print.

ABSTRACT

BACKGROUND: In this randomized controlled, double-blind study, we aimed to investigate the involvement of sympathetic nerve fibers in erector spinae plane block (ESPB) and to compare it with thoracic epidural analgesia (TEA) in patients scheduled for unilateral mastectomy. Additionally, we compared sympathetic blockade-related hemodynamic effects, sensory blockade distribution, and analgesic effects.

METHODS: Thirty-eight female patients aged 18-70 years, American Society of Anesthesiologists (ASA) classification I-III, were included in the study. The patients were divided into Group E (those who received general anesthesia after the ESPB) and Group T (those who received general anesthesia after TEA). The extent of sympathetic blockade (via the hot-cold test) and skin conductance (GSR) were recorded as the co-primary outcome measures. Secondary outcomes included skin temperature, perioperative hemodynamic data, sensory block extent, postoperative pain scores, and analgesic consumption.

RESULTS: Regarding the co-primary outcomes, there was no statistically significant difference between the groups in the hot-cold test or GSR values. In terms of secondary outcomes, although the rate of skin temperature change differed (p = 0.028), both groups showed significant warming. Hemodynamic data were comparable. However, ESPB produced a wider ipsilateral sensory block than TEA. The postoperative pain scores, patient-controlled analgesia (PCA) demand, and rescue analgesic consumption were not statistically significantly different between the two groups.

CONCLUSION: ESPB demonstrated similar sympathetic blockade efficacy to TEA. Additionally, it produced similar hemodynamic effects and postoperative analgesia in patients undergoing unilateral mastectomy due to malignancy.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04702061, Date of registration: 24/12/2020, https://clinicaltrials.gov/study/NCT04702061.

PMID:41691173 | DOI:10.1186/s12871-026-03694-2

BMC Infect Dis. 2026 Feb 14. doi: 10.1186/s12879-025-12507-9. Online ahead of print.

NO ABSTRACT

PMID:41691157 | DOI:10.1186/s12879-025-12507-9

BMC Infect Dis. 2026 Feb 14. doi: 10.1186/s12879-026-12837-2. Online ahead of print.

ABSTRACT

BACKGROUND: Central venous catheterization is a routine procedure in clinical practice, but it can result in severe and costly central line-associated bloodstream infections (CLABSIs), the risk of which may vary by insertion sites. This study sought to evaluate and compare the incidence of CLABSI in critically ill patients between internal jugular and subclavian sites, and to explore the correlation between insertion site and risk of CLABSI.

METHODS: This research encompassed critically ill patients with Central venous catheters (CVCs) placed in the internal jugular or subclavian site from ICUs of 22 public tertiary hospitals throughout China, from September 4, 2023, to February 29, 2024. The incidence of CLABSI was calculated and compared between the two groups using Poisson regression. The association between insertion site and CLABSI risk was assessed using univariable and multivariable Cox proportional hazards regression models, with additional adjustments for center-effects using a frailty model.

RESULTS: Among 2,379 patients analyzed, the internal jugular site was the predominant insertion site (68.3%, n = 1,626) compared to the subclavian site (31.7%, n = 753). Over 18,359 total CVC days, 19 CLABSIs were documented. The incidence rate was 0.66 and 1.22 per 1000 CVC days for the subclavian and internal jugular groups, respectively (Incidence rate ratio [IRR] = 1.86, 95% CI [0.67-6.62]; P = 0.27). In the primary analysis, no statistically significant association was found between insertion site and CLABSI risk, either in the unadjusted model (Hazard ratio [HR] = 1.83, 95% CI [0.61-5.53]) or after multivariable adjustment and accounting for between-center heterogeneity (adjusted HR = 2.07, 95% CI [0.65-6.62]).

CONCLUSIONS: In this large multicenter cohort from China, the overall CLABSI incidence was low. We observed no statistically significant difference in CLABSI risk between internal jugular and subclavian CVC insertion sites after adjustment for confounders and center effects. However, the findings were inconclusive due to the limited number of events and the potential for residual confounding inherent in the observational design. These results highlight the need for larger, sufficiently powered studies to provide definitive evidence on the comparative infection risk of CVC insertion sites.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41691144 | DOI:10.1186/s12879-026-12837-2

BMC Med Imaging. 2026 Feb 14. doi: 10.1186/s12880-026-02224-3. Online ahead of print.

ABSTRACT

BACKGROUND: HIV-associated neurocognitive disorders (HAND) are common complications in HIV-infected individuals, and working memory impairment is one of the core features. Although combination antiretroviral therapy (cART) has reduced the incidence of severe HAND, mild HAND remains prevalent. This study aims to explore the functional brain characteristics related to working memory in HIV-infected individuals with different cognitive states using resting-state and task-based functional magnetic resonance imaging (fMRI), and to identify candidate imaging markers for early diagnosis and inform future intervention targeting.

METHODS: Fifty-nine HIV-infected individuals (30 with cognitive integrity [CI], 29 with asymptomatic neurocognitive impairment [ANI]) and 37 healthy controls (HC) were enrolled. Resting-state and task-based fMRI were acquired. Task-fMRI was performed using a spatial working memory task to analyze brain activation, functional connectivity (FC), and reconfiguration efficiency of FC from rest to task. FC networks were constructed as ROI-ROI Pearson correlation matrices (Fisher z-transformed) and significant group differences were identified using network-based statistics. Pearson and Spearman correlation analyses were used to explore the relationships between reconfiguration efficiency and clinical/cognitive variables.

RESULTS: HC showed better task performance than both HIV groups, and ANI exhibited the poorest accuracy. Compared with CI, ANI had significantly lower neurocognitive domain T-scores in memory, attention/working memory, and abstraction/executive function. In task-fMRI analyses, ANI showed decreased activation in the bilateral orbital middle frontal gyri and the left middle temporal gyrus, alongside increased activation in the left cerebellum crus I relative to CI. Whole-brain analyses demonstrated widespread FC increases in both HIV groups at rest and during the task compared with HC. Reconfiguration efficiency differed across groups and showed stage-related associations with immune and cognitive measures.

CONCLUSIONS: Cognitive impairment in virally suppressed HIV is accompanied by altered working-memory network engagement, with greater cortico-cerebellar involvement in ANI. While static whole-brain FC showed widespread increases but limited CI-ANI separation under stringent correction, altered rest-to-task FC reconfiguration efficiency was associated with immune indices and neurocognitive/behavioral performance, suggesting that this cross-state metric may serve as a candidate marker for HAND phenotyping and risk stratification.

PMID:41691142 | DOI:10.1186/s12880-026-02224-3

Eur Radiol. 2026 Feb 14. doi: 10.1007/s00330-026-12372-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of a body mass index (BMI)-based sub-milliSievert low-dose CT (LDCT) protocol with multiple reconstruction algorithms for image quality and lung nodule assessment.

MATERIALS AND METHODS: This prospective study included 214 participants who underwent standard-dose CT (SDCT, 3.68 ± 1.53 mSv) reconstructed with 50% adaptive statistical iterative reconstruction (ASIR-V-50%) and LDCT. LDCT was randomly divided into a higher-dose group (LD-A, 0.57-1.15 mSv, n = 108) and a lower-dose group (LD-B, 0.33-0.63 mSv, n = 106). Each group was stratified into four BMI-based subgroups with individualized protocols reconstructed with deep learning image reconstruction (DLIR-H and DLIR-M), ASIR-V-50%, and filtered back projection (FBP). Image quality, nodule detection across BMI subgroups, and the performance of four algorithms in detection, size measurement accuracy, and Lung-RADS v2022 consistency were analyzed.

RESULTS: In LDCT, DLIR-H provided superior image quality (p < 0.001) and the highest overall nodule detection rate (99.04%), surpassing ASIR-V-50% (98.55%) and FBP (97.87%) (both p < 0.05). The advantage was most evident for nodules < 6 mm, while all nodules ≥ 6 mm were consistently detected across algorithms. Detection rates showed no significant variation among BMI subgroups (all p > 0.05). For measurement accuracy, FBP and ASIR-V-50% performed better in LD-A (all p < 0.05), whereas DLIR-M was superior in LD-B (p < 0.001). All algorithms demonstrated excellent Lung-RADS agreement (κ > 0.9, p < 0.001).

CONCLUSION: A BMI-based sub-milliSievert LDCT protocol significantly reduced radiation exposure while maintaining nodule detection across BMI subgroups, with DLIR offering superior image quality and diagnostic performance.

KEY POINTS: Question Evidence remains scarce on BMI-based sub-milliSievert low-dose CT using different reconstruction algorithms, regarding image quality and nodules detection (particularly < 6 mm). Findings BMI-based sub-milliSievert low-dose CT ensured balanced detectability across populations, while deep learning reconstruction improved image quality and achieved excellent sensitivity for lung nodule detection. Clinical relevance Deep learning reconstruction enhanced BMI-based sub-milliSievert low-dose CT, supporting its application in personalized sub-milliSievert low-dose lung cancer screening.

PMID:41691132 | DOI:10.1007/s00330-026-12372-3

Odontology. 2026 Feb 14. doi: 10.1007/s10266-026-01335-1. Online ahead of print.

ABSTRACT

Artificial intelligence (AI) chatbots are increasingly used by dental students for self-directed learning, yet their performance in specialty-level subjects like oral medicine remains underexplored. As oral medicine encompasses diagnostic and clinical reasoning across interdisciplinary domains, assessing AI competence in this field is necessary. This study aimed to evaluate and compare the performance of four advanced AI chatbots-ChatGPT-4, Microsoft Copilot, Google Gemini, and DeepSeek-in answering case-based oral medicine multiple choice questions (MCQs) across Bloom’s cognitive levels and key subtopics. A total of 114 high-quality, case-based MCQs were developed and validated based on authoritative references. Each question was classified according to Bloom’s taxonomy and mapped to one of six oral medicine subdomains. The chatbots’ responses were evaluated for accuracy, response time, and word count. Statistical comparisons were performed using Cochrane Q test, Friedman test, McNemar’s test, and Cohen’s kappa for inter-model agreement. All four chatbots demonstrated high overall accuracy (≥ 97.4%), with Microsoft Copilot showing numerically the highest score (99.1%) although no statistically significant differences were observed among the models. ChatGPT-4 generated the fastest response (mean: 7.0 s), while Copilot provided the most detailed explanations. Performance was consistent across cognitive levels, with near-perfect accuracy in the “Applying” and “Analyzing” domains. Accuracy across subtopics was also high although minor discrepancies were noted in infectious diseases and oral potentially malignant disorders. Inter-chatbot agreement ranged from moderate to perfect (kappa = 0.315-1.00). Advanced AI chatbots, including ChatGPT-4, Copilot, Gemini, and DeepSeek, demonstrated similarly high performance in answering case-based multiple choice questions in oral medicine.

PMID:41691106 | DOI:10.1007/s10266-026-01335-1

Sci Rep. 2026 Feb 14. doi: 10.1038/s41598-026-39929-y. Online ahead of print.

ABSTRACT

To evaluate postoperative pain following emergency pulpectomy in permanent teeth diagnosed with symptomatic irreversible pulpitis and to compare outcomes with or without adjunctive low-level laser therapy (LLLT). This parallel, randomized, single-blind clinical trial included 70 patients with permanent teeth diagnosed with symptomatic irreversible pulpitis. Patients were randomly assigned to two groups (n = 35 each): the experimental group received gallium-aluminum-arsenide laser therapy (808 nm, 100 mW), while the control group received no laser intervention. Postoperative pain was assessed using the Numerical Rating Scale (NRS-10) and the Visual Analogue Scale (VAS). Bite sensitivity was evaluated before and after emergency treatment. Demographic characteristics and analgesic intake were recorded. The primary outcome was postoperative spontaneous pain assessed at multiple time points. Secondary outcomes included bite sensitivity and analgesic intake. Time-dependent reductions in postoperative pain were observed in both groups. Inter-group comparisons showed statistically significant differences at isolated time points (12 and 24 h), with higher pain scores in the experimental group; however, these differences did not translate into a significant overall treatment effect. Longitudinal analysis accounting for repeated measures demonstrated a significant effect of time (p = 0.001), while treatment group was not a significant determinant of postoperative pain. Effect estimates are presented with 95% confidence intervals. Within the limitations of this pragmatic emergency-care study, adjunctive low-level laser therapy was not associated with a reduction in postoperative pain in permanent teeth with symptomatic irreversible pulpitis.

PMID:41691099 | DOI:10.1038/s41598-026-39929-y

J Racial Ethn Health Disparities. 2026 Feb 14. doi: 10.1007/s40615-025-02833-8. Online ahead of print.

ABSTRACT

This study evaluates the impact of the Housing First (HF) intervention on healthcare utilization among homeless adults with mental illness, comparing ethno-racial (ER) and non-ER groups with moderate mental health support needs. We linked data from the At Home/Chez-Soi (AH/CS) randomized controlled trial with health administrative data from Ontario, including the Ontario Health Insurance Plan and several healthcare databases (e.g., Discharge Abstract Database, Ontario Mental Health Reporting System). We analyzed outcomes such as primary care visits, hospitalizations, emergency department (ED) visits, and Ambulance arrival Incidents. Applying the intention-to-treat principle, we used generalized estimating equation models using the Poisson distribution which included the intervention (HF vs. TAU), the time period (0-7 years post-randomization vs 1-year pre-randomization) and their interaction. Incidence rate ratios (IRRs) were estimated to assess the differences in outcome rate changes between HF vs TAU comparing the 0 to 7 year follow-up period with the pre-randomization year for each stratified ethno-racial group. The results revealed a mitigated HF effect among non-ER participants, with increased utilization rates for both primary care and acute care services. [Primary care visits [IRR 2.17 95% (1.03-4.57)], acute care visits (Mental health hospitalization [IRR 2.68 95% CI (1.17-6.20)], Ambulance arrivals to ED [IRR 1.94 95% (1.05-3.56)] and number of Ambulance arrivals to ED [IRR 3.67 95% (1.05-13.02)]). However, no statistically significant effect was found among the ER participants in any of the healthcare services examined. The differential impact of HF on healthcare utilization suggests persistent systemic barriers to care, such as stigma and discrimination among ER participants.Trial Registration: The study is registered with the ISRCTN (#42520374).

PMID:41691097 | DOI:10.1007/s40615-025-02833-8

Bone Marrow Transplant. 2026 Feb 14. doi: 10.1038/s41409-026-02803-6. Online ahead of print.

ABSTRACT

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment landscape of relapsed/refractory (R/R) B-cell precursor acute lymphoblastic leukemia (B-ALL), with high remission rates across various CAR T-cell constructs. However, the durability of these responses remains a major challenge, with many patients experiencing relapse after an initial remission. This systematic review and meta-analysis aimed to compare the efficacy and safety of different CAR T-cell constructs across 40 clinical trials, including a total of 1540 R/R B-ALL patients. We assessed the impact of patient demographics, prior treatment exposure, and construct characteristics on treatment outcomes. The pooled complete remission rate (CRR) was 83.4% (I² = 49%), with a minimal residual disease-negative complete remission (MRDneg-CR/CRi) rate of 92.7% (I² = 48%). 4-1BB co-stimulatory domain constructs showed higher MRDneg-CR/CRi rates compared with CD28 (94.0% vs. 84.4%p = 0.048) and a lower incidence of immune effector cell-associated neurotoxicity syndrome. Additionally, CAR T-cell products targeting CD19 or CD19/CD22 patients presented higher MRDneg-CR/CRi rates than those targeting CD22 alone. In conclusion, our findings suggest that 4-1BB-based CAR T-cell therapy targeting CD19 offers the best efficacy and safety profile in R/R B-ALL.

PMID:41691095 | DOI:10.1038/s41409-026-02803-6

Arch Gynecol Obstet. 2026 Feb 14;313(1):95. doi: 10.1007/s00404-026-08322-5.

ABSTRACT

PURPOSE: This study assessed geographic variations in the supply, demand, and adequacy of the United States (US) obstetrics and gynecology physician (OGP) workforce.

METHODS: This was a cross-sectional analysis of OGPs using the Health Workforce Simulation Model. Supply and demand were defined as the numbers of full-time equivalent (FTE) OGPs working and needed, respectively. Adequacy was defined as the ratio of supply to demand. Comparisons were made using Chi-squared tests, and linear regression was used to analyze OGP workforce trends.

RESULTS: From 2025 to 2037, the demand for OGPs is projected to increase (52,620-54,020 FTEs, 2.7% increase, p < 0.001) while the supply of OGPs is projected to decrease (49,170-44,130 FTEs, 10.3% decrease, p < 0.001). As a result, OGP workforce adequacy is projected to decrease over the study period from 93.4% to 81.7% (P < 0.001). By 2037, the West had the lowest OGP workforce adequacy and the Northeast had the highest adequacy (74.4% vs 98.6%, P < 0.001). Non-metropolitan areas were projected to have lower OGP workforce adequacy than metropolitan areas (51.4% vs 85.1%, p < 0.001). The states with the lowest projected OGP workforce adequacy were Utah (49.3%), Idaho (51.5%), and Arizona (58.3%) in 2037.

CONCLUSION: OGP workforce supply is expected to fall short of anticipated demand, with uneven geographic distribution across the US. Addressing this imbalance will require strategic planning to expand the OGP workforce equitably, especially in non-metropolitan areas, the West, and certain identified states like Utah and Idaho.

PMID:41691088 | DOI:10.1007/s00404-026-08322-5