Nevin Manimala

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

Am J Ophthalmol. 2026 Jul 26:S0002-9394(26)00413-7. doi: 10.1016/j.ajo.2026.07.034. Online ahead of print.

ABSTRACT

OBJECTIVE: To longitudinally compare changes in ocular surface signs and symptoms over two to three years in patients with isolated KCS (KCS-only) and those with concomitant SjD (KCS+SjD).

DESIGN: Prospective cohort study using data from the Sjögren’s International Collaborative Clinical Alliance (SICCA) registry. Participants were enrolled from 2003-2012 and invited for 2- to 3-year follow-up.

PARTICIPANTS: Participants with KCS (defined as ocular staining score [OSS] ≥ 5) who presented at both baseline and follow-up visits were included.

METHODS: Participants underwent standardized ocular surface testing, including OSS, Schirmer I, tear break-up time (TBUT), and Ocular Surface Disease Index-6 (OSDI-6), at baseline and follow-up visits. Multivariable linear regression models evaluated differences in longitudinal change in ocular metrics between KCS-only and KCS+SjD participants.

MAIN OUTCOME MEASURES: Changes in ocular metrics, including OSS, Schirmer I, TBUT, and OSDI-6, from baseline to follow-up.

RESULTS: This analysis included data from 427 participants (mean age: 54.4±12.8 years, 94.8% female), including 305 with KCS+SjD and 122 with KCS-only. Participants with KCS+SjD exhibited significantly more severe dry eye signs than those with KCS-only at both time points. After adjusting for covariates, the change score for OSS was 1.51 points higher (95% confidence interval [CI], 0.99-2.04; P <.001) in the KCS+SjD groups compared to the KCS-only group. Similarly, participants with KCS+SjD demonstrated greater longitudinal decline in TBUT (-1.10 sec, 95% CI: -1.56 to -0.65; P <.001) and in Schirmer I (-2.16 mm, 95% CI: -3.31 to -1.01; P <.001). The difference in OSDI-6 scores was not statistically significant (0.36, 95% CI, -0.60 to 1.33; P = .46).

CONCLUSIONS: Participants with KCS+SjD exhibited more severe baseline signs and greater longitudinal worsening of objective ocular findings compared to KCS-only participants. These findings support the hypothesis that KCS associated with SjD and isolated KCS may represent distinct clinical forms of dry eye disease and may help differentiate these dry eye subtypes.

PMID:42503399 | DOI:10.1016/j.ajo.2026.07.034

Exp Gerontol. 2026 Jul 27:113252. doi: 10.1016/j.exger.2026.113252. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Medication nonadherence among older adults with type 2 diabetes is common and contributes to preventable complications, especially in African American communities. MediTeddi is a new cognitive prosthetic in the form of a friendly talking electronic bear that delivers scheduled medication prompts, collects simple confirmations, and provides rolling statistical feedback based on Self-Determination Theory. This study evaluated its pilot efficacy and explored support for a cognitive prosthetic framework.

RESEARCH DESIGN AND METHODS: Two pilot studies were conducted with African American adults with poorly controlled type 2 diabetes. Study 1 was a 24-week randomized controlled trial (N = 16) comparing MediTeddi plus biweekly calls with calls alone. Study 2 was a 26-week repeated-measures trial (N = 50; n = 35 completers) examining within-person change with MediTeddi and biweekly calls. The primary behavioral outcome was medication adherence (MMAS-4), and the primary clinical outcome was hemoglobin A1c (HbA1c); secondary outcomes were depressive symptoms and diabetes-related distress.

RESULTS: In Study 1, the intervention group showed a greater reduction in HbA1c (mean decrease 0.88) than the control group (0.32), with a trend toward significance (p < .10). MMAS-4 adherence also improved more in the intervention group (mean increase 0.67 vs. 0.00). In Study 2, participants demonstrated large and statistically significant gains in adherence (MMAS-4 increase from 1.61 to 3.14), along with a 1.71-point reduction in HbA1c and significant reductions in depressive symptoms and diabetes distress.

DISCUSSION: These pilot trials suggest that a simple, socially engaging cognitive prosthetic can meaningfully improve adherence, glycemic control, and psychosocial outcomes in older African American adults with diabetes and warrant larger, theory-driven trials with objective adherence measures. (272 words).

PMID:42503366 | DOI:10.1016/j.exger.2026.113252

Am J Prev Med. 2026 Jul 26:108526. doi: 10.1016/j.amepre.2026.108526. Online ahead of print.

ABSTRACT

INTRODUCTION: British Columbia, Canada implemented a three-year pilot that decriminalized the personal possession of select illegal drugs beginning January 31, 2023. The policy was amended to prohibit drug possession in all public spaces starting May 7, 2024. The impacts of decriminalization and the subsequent decriminalization amendment on police-reported drug possession seizures were examined, which were identified on the basis of incidents in which drug possession offences were recorded as the most serious offence.

METHODS: Monthly, population-based crude rates of police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams were analyzed in an interrupted time series design using generalized additive models (January 2019-July 2025; Data collected and analyzed in 2026). The models tested level changes in the outcomes associated with the initial decriminalization policy and the subsequent decriminalization policy amendment relative to pre-decriminalization.

RESULTS: Decriminalization relative to pre-decriminalization was associated with a 68% decrease in police-reported drug possession seizures of any quantity (β [95% CI]: -1.1 [-1.4, -0.9]). However, police-reported drug possession seizures of any quantity increased after the decriminalization amendment, such that they were statistically indistinguishable from pre-decriminalization (β [95% CI]: -0.2 [-0.6, 0.1]). A similar pattern of findings was observed for police-reported drug possession seizures involving up to 2.5 grams: decriminalization relative to pre-decriminalization was associated with an 87% decrease (β [95% CI]: -2.0 [-2.5, -1.6]), while the decriminalization amendment relative to pre-decriminalization was not associated with significant changes (0.4 [-0.2, 1.0]).

CONCLUSIONS: Decriminalization was associated with decreases in police-reported drug possession seizures of any quantity and police-reported drug possession seizures involving up to 2.5 grams. The subsequent decriminalization amendment reversed this trend, as both types of police-reported drug possession seizures returned to comparable levels observed pre-decriminalization.

PMID:42503363 | DOI:10.1016/j.amepre.2026.108526