Nevin Manimala

J Voice. 2026 Apr 3:S0892-1997(26)00119-0. doi: 10.1016/j.jvoice.2026.03.002. Online ahead of print.

ABSTRACT

PURPOSE: Vocal folds (VF) are key structures for phonation, and their length varies between individuals depending on sex and anthropometric characteristics. The aim of this study was to measure VF length in healthy adults using videolaryngoscopy and to investigate its relationship with sex, age, height, and weight.

METHODS: This prospective study was approved by the Ethics Committee of Kayseri City Hospital (September 9, 2025, no: 563). A total of 215 patients (107 males, 108 females; aged 18-88 years) who underwent general anesthesia for various surgical procedures and had no history of laryngeal disease or dysphonia were included. After induction of anesthesia and neuromuscular blockade, videolaryngoscopic images of the glottis were obtained using a HugeMed-VL3R videolaryngoscope (image size 640 × 480 pixels). Calibration of pixel-to-millimeter conversion was performed on three cadaveric larynges by placing a ruler at the level of the VF; 10 mm corresponded to 118 pixels. Intraoperative images were analyzed in ImageJ. Right and left VF lengths were measured at the glottic level by three independent observers, each performing three repeated measurements (nine measurements per VF), and mean values were used for analysis. Statistical analyses were performed using IBM SPSS v23.

RESULTS: The mean age of the participants was 47.1 ± 16.1 years, mean height 167.8 ± 9.1 cm, and mean weight 74.2 ± 14.2 kg. The mean right VF length was 21.95 ± 3.89 mm (range: 10.7-31.5 mm) and the mean left VF length was 22.15 ± 3.92 mm (range: 11.3-31.3 mm). Both right and left VF lengths were significantly longer in males than in females (P < 0.001 for both). Height showed a strong positive correlation with right (r = 0.61, P < 0.001) and left (r = 0.63, P < 0.001) VF length, while weight showed a moderate positive correlation (r ≈ 0.32-0.34, P < 0.001). Age was not significantly correlated with VF length. Multiple regression analysis demonstrated that sex, height, weight, and age together explained 68% of the variance in right VF length and 66% in left VF length.

CONCLUSION: VF length is strongly associated with sex and height, and to a lesser degree with weight, whereas age has no significant effect on VF length in healthy adults. These findings may provide reference values for laryngeal assessment, preoperative planning, and voice-related clinical decision-making.

PMID:41935887 | DOI:10.1016/j.jvoice.2026.03.002

J Microbiol Immunol Infect. 2026 Mar 30:S1684-1182(26)00042-3. doi: 10.1016/j.jmii.2026.03.009. Online ahead of print.

ABSTRACT

BACKGROUND: Epidural analgesia (EA) is widely used during labor and frequently associated with maternal intrapartum fever, often prompting neonatal sepsis evaluations. Data from East Asia is scarce; we evaluated whether EA is associated with increased neonatal infection risk and related complications in a Taiwanese cohort.

METHODS: This retrospective cohort study included 2375 full-term, singleton vaginal deliveries at a tertiary medical center in Northern Taiwan from 2018 to 2021. Neonatal outcomes were compared between mothers who received EA and those who did not. Neonatal infection was operationalized as admission to the NICU for suspected infection, and prolonged antibiotic therapy (>48 h) was evaluated as a secondary outcome.

RESULTS: Neonates in the EA group had a slightly higher rate of NICU admission for suspected infection than non-EA infants (4.04% vs 2.81%; p = 0.157), but this difference was not statistically significant. Maternal intrapartum fever occurred significantly more often with EA (28.3% vs 11.4%; p < 0.001), whereas neonatal fever was rare and similar between groups (1.79% vs 1.58%), and only one infant had culture-confirmed infection. In the NICU subgroup (EA N = 63; non-EA N = 23), low Apgar scores and meconium aspiration occurred only in EA-exposed infants, but these rare events and neonatal fever were not independently associated with EA in exploratory Firth logistic regression. Stratified analyses instead suggested that maternal intrapartum fever, rather than EA exposure, was more closely linked to neonatal fever.

CONCLUSIONS: In this cohort, EA was associated with frequent precautionary neonatal sepsis evaluation without an increase in culture-confirmed infection. Potential residual confounding suggests that these findings should be interpreted as exploratory rather than causal. These findings highlight the need for cautious evaluation to prevent unnecessary antibiotic use in neonates.

PMID:41935873 | DOI:10.1016/j.jmii.2026.03.009

Acad Radiol. 2026 Apr 3:S1076-6332(26)00124-8. doi: 10.1016/j.acra.2026.02.033. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: This study aimed to comprehensively compare the diagnostic performance, technical efficacy, and safety profiles of four different approaches for core needle biopsy (CNB) of oropharyngeal and adjacent space lesions: transoral versus percutaneous approaches, each guided by either conventional ultrasound (US) or contrast-enhanced ultrasound (CEUS).

MATERIALS AND METHODS: This retrospective cohort study consecutively enrolled eligible adults who underwent imaging studies showing suspected oropharyngeal, parapharyngeal, retropharyngeal space, and adjacent space tumors from October 2015 to December 2024. From 388 eligible patients (initial cohort: 416), 240 patients were selected using a 1:1:1:1 matched design with percutaneous US-guided CNB as the reference group to form four balanced groups: transoral or percutaneous CNB guided by either conventional US or CEUS (60 patients per group). Matching by age and maximum tumor diameter was performed to balance baseline characteristics among groups. All procedures used 18-G automated cutting needles. The primary outcome was diagnostic concordance between US/CEUS-guided CNB histopathology and the reference standard. The secondary outcomes included imaging concordance (US/CEUS concordance with histopathological reference standard); procedure efficacy (first-puncture success; total number of needle punctures; and overall procedure duration); safety profile, including infection and hemorrhagic complications; and pain assessment. Statistical analyses accounted for the matched design by applying linear models, conditional logistic regression, and generalized estimating equations for continuous, binary, and repeated-measures outcomes, respectively.

RESULTS: Among 240 patients, transoral CEUS guidance demonstrated favorable perioperative outcomes across multiple domains. For procedural precision, first-attempt puncture success was significantly higher with transoral versus transcutaneous approaches (adjusted OR = 2.35, 95% CI: 1.18-4.68, P = 0.015). CEUS significantly reduced puncture attempts compared with conventional US (β = -0.69, 95% CI: -0.84 to -0.53, P < 0.001), with transoral CEUS achieving a notably greater reduction versus transcutaneous conventional US (β = -0.82, 95% CI: -1.04 to -0.60, P < 0.001). Intraoperative blood loss was statistically significantly lower with CEUS guidance overall (β = -0.30, 95% CI: -0.36 to -0.24, P < 0.001), with transoral CEUS showing a relatively greater effect (β = -0.34, 95% CI: -0.43 to -0.25, P < 0.001 vs transcutaneous conventional US). CEUS guidance was associated with a statistically significant prolongation of procedure time compared with US (β = 1.6 min; 95% CI: 1.3-1.9; P< 0.001). For transoral CEUS relative to percutaneous guidance, the prolongation was β = 1.7 min (95% CI: 1.4-2.0; P< 0.001). And transoral CEUS yielded a relatively more favorable pain profile, with significantly lower scores immediately postoperatively (β = -0.72, P < 0.001) and at 24 h (β = -0.40, P < 0.001). Diagnostic accuracy remained uniformly high across all groups (95.0-98.3%), with no significant differences by approach (P = 0.712) or guidance technique (P = 0.295). Complications were rare (1.25% overall: two hematomas, one infection), with no significant intergroup differences (P > 0.05); all resolved with conservative management.

CONCLUSIONS: CEUS-guided transoral biopsy achieved superior technical success with fewer puncture attempts and improved pain control for oropharyngeal lesions, despite modest procedural time extension. This approach demonstrates notable advantages over conventional methods and represents a valuable diagnostic technique for oropharyngeal space lesions.

PMID:41935848 | DOI:10.1016/j.acra.2026.02.033

J Nurs Scholarsh. 2026 May;58(3):e70087. doi: 10.1111/jnu.70087.

ABSTRACT

INTRODUCTION: In Taiwan, engagement in professional help-seeking among persons living with schizophrenia remains limited despite increasing demands on mental healthcare systems. Clarifying the factors that shape professional help-seeking attitudes is essential for promoting recovery-oriented care. This study examined the correlates of professional help-seeking attitudes in persons with schizophrenia in Taiwan.

DESIGN: A cross-sectional correlational study.

METHODS: A total of 144 persons receiving psychiatric rehabilitation care at three hospitals in Taiwan were recruited. Data were collected using structured self-report measures assessing sociodemographic and clinical characteristics, schizophrenia literacy, internalized stigma, and professional help-seeking attitudes. Descriptive statistics, bivariate analyses, and hierarchical multiple regression analyses were conducted.

RESULTS: Participants generally reported unfavorable attitudes toward professional help-seeking. More favorable attitudes were associated with higher educational attainment, shorter illness duration, greater schizophrenia literacy, and lower internalized stigma. Schizophrenia literacy and internalized stigma showed the most robust relationships with professional help-seeking attitudes.

CONCLUSION: Within Taiwanese mental healthcare settings, schizophrenia literacy and internalized stigma appear to be central to attitudes toward professional help-seeking among persons living with schizophrenia.

CLINICAL RELEVANCE: Routine assessment of schizophrenia literacy and internalized stigma, together with culturally sensitive and recovery-oriented nursing interventions, may enhance treatment engagement among persons living with schizophrenia. The findings may also inform mental health nursing practice in other cultural and healthcare contexts where limited schizophrenia literacy, stigma, and long-term inpatient care pose barriers to recovery-oriented care delivery.

PMID:41935843 | DOI:10.1111/jnu.70087

J Dent. 2026 Apr 2:106670. doi: 10.1016/j.jdent.2026.106670. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the impact of the COVID-19 pandemic on presentation, referrals, diagnoses, stage distribution, primary treatment, and survival for Head and Neck Cancer (HNC) patients in Northern Ireland (NI) by analysing population-based patient level data collected during 2016-2023.

METHODS: Individual-level data for all patients diagnosed with HNC available on the regional Cancer Patient Pathway System (CaPPs) during the period 2016-2023 was accessed to examine the number of cancers diagnosed, referrals, diagnosis, stage at diagnosis, and first treatment. Northern Ireland Cancer Registry (NICR) data up to 2021 was used to estimate the proportion of patients managed by the regional Multidisciplinary Team (MDT) and provide additional key characteristics and survival information. Data on activity in primary dental care (2016-2023) was accessed from the Northern Ireland Statistics and Research Agency (NISRA). Four time-periods were compared: pre-pandemic (PP: January 2016-March 2020), initial pandemic (IP: April 2020-March 2021), initial recovery (IR: April 2021-March 2022) and pandemic recovery (PR: April 2022-May 2023).

RESULTS: Adult dental examinations in primary care dental services decreased by 78%, from a yearly average of 965,000 during the PP period to 218,000 during the IP period. The number of HNC patients assessed at the MDT did not change significantly over the period 2016-2023 (P>0.05) from an annual average of 322 in the PP period; 302 in the IP period; 315 in the IR period and 342 in RP. Although there was an increased proportion of late-stage HNCs (III and IV) in the IP period, this was only significant for the oral cancer subsite (51.7% PP versus 67.1% IP), with recovery in the following periods. There was a decrease in the number of HNC patients receiving surgery as first treatment, and conversely an increase in radiotherapy, across the four time periods. The number of patients undergoing surgery as first treatment type decreased from PP (136) to IP periods (119) and failed to recover to pre-pandemic levels (117 in PR). Short-term (2-year) observed and net survival was not significantly different for HNC patients diagnosed pre-pandemic compared to periods thereafter (IP, IR, RP). The largest decrease in 2-year net survival was found for oral cancer, from 64.7% (PP) to 57.3% (IR), which approached significance (P=0.06).

CONCLUSION: The COVID-19 pandemic had wide-ranging impacts on HNC in Northern Ireland with substantially fewer examinations provided in primary dental care; reduced HNC incidence in the IP period; higher proportions of late-stage disease (statistically significant in oral cavity only); fewer surgical treatments and lower survival. These patterns approached statistical significance for oral cancers, the site most likely to be detected through dental screening.

CLINICAL SIGNIFICANCE: The COVID-19 pandemic severely impacted patient access to primary care dental services throughout NI, where clinical screening for HNC is undertaken by General Dental Practitioners (GDPs) as part of a dental check-up. This study demonstrates the importance of primary dental care services in the identification and early diagnosis of HNCs.

PMID:41935818 | DOI:10.1016/j.jdent.2026.106670

Environ Pollut. 2026 Apr 2:128058. doi: 10.1016/j.envpol.2026.128058. Online ahead of print.

ABSTRACT

Microplastics (MPs; 1-5000 μm) have been detected in various locations, and numerous surveys have been conducted in rivers to identify their sources and characterize the extent of MP pollution. However, standardized observation and analytical methods for small MPs have not yet been established, and the relationship between MP abundance and size-distribution characteristics remains poorly understood. This study aimed to characterize the size spectra of MP number and mass concentrations over a broad size range in river water and evaluate the applicability of a power-law model to these size spectra. To achieve this, we applied three different sampling methods to surface water in the Tsurumi River, Japan, yielding seven MP samples. The results demonstrated the statistical significance of the power-law approximation for the size spectra of the number and mass concentrations of MPs across all samples. The estimated power-law slopes were -3.27±0.19 and -1.05±0.20 for number and mass concentrations, respectively, which are close to the assumed values of -3 and -1, respectively. Additionally, MP mass concentrations were calculated from the measured values within a limited size range using the power-law model of the MP size spectrum. The results indicated that MP mass concentrations can be accurately estimated by extrapolating across unmeasured size ranges using a power-law relationship. This approach addresses a key limitation that has hindered inter-study comparisons owing to differences in the MP size ranges considered and provides an important step toward harmonizing MP datasets and improving the quantitative understanding of MP pollution in riverine environments.

PMID:41935770 | DOI:10.1016/j.envpol.2026.128058

Am J Cardiol. 2026 Apr 2:S0002-9149(26)00203-1. doi: 10.1016/j.amjcard.2026.03.060. Online ahead of print.

ABSTRACT

Traditional cardiovascular trials combine adverse events into composites, ignoring the clinical importance and weight of endpoints. The Win Ratio (“WR”) is a contemporary statistical technique overcoming these limitations. We aimed to evaluate outcomes of high-risk percutaneous coronary intervention supported with Impella® versus intra-aortic balloon pump (IABP), by pooling data from the PROTECT-II and PROTECT-III studies, using the win ratio. All patients from PROTECT-II RCT (“P-II”) and patients from PROTECT-III (“P-III”) who met P-II inclusion/exclusion criteria were pooled. The WR was based on independently adjudicated major adverse cardiac and cerebrovascular events (MACCE) at 90 days with following hierarchy: (1) Mortality; (2) Stroke; (3) Spontaneous Myocardial Infarction (sMI); 4) Re-Hospitalization; and (5) Peri-Procedural MI (pMI). All MACCE were analyzed as time-to-event outcomes, except pMI (binary endpoint). Sub-analyses included: 1) complex cases: patients with atherectomy or unprotected left main or chronic total occlusion, 2) all patients excluding firsts from P-II (“learning cases”); and 3) Impella P-II and P-III cohorts separately. Win statistics (WR, net benefit (NB), and win odds (WO)) were calculated. The primary analysis (719 Impella and 211 IABP-supported PCI) yielded a WR of 1.691 in favor of Impella (1.314-2.176, p<0.001), with NB of 0.166 (0.084-0.247, p<0.001) and WO of 1.398 (1.187-1.645, p<0.001). The WR, NB and WO for complex cases remained statistically significant in favor of Impella. Excluding first patients resulted in increased win statistics compared to primary analysis. In conclusion, pooled WR analyses from P-II and P-III studies demonstrated improved HRPCI outcomes up to 90 days with Impella compared to IABP.

PMID:41935767 | DOI:10.1016/j.amjcard.2026.03.060

J Arthroplasty. 2026 Apr 2:S0883-5403(26)00302-5. doi: 10.1016/j.arth.2026.03.078. Online ahead of print.

ABSTRACT

INTRODUCTION: Total knee arthroplasty (TKA) remains a highly successful and frequently performed procedure with variability in surgeon preferences regarding implant fixation and patellar resurfacing. This study aimed to characterize current practice patterns among members of The Knee Society and to identify key factors influencing implant fixation and patella resurfacing.

METHODS: A 23-question survey was distributed to 216 members of The Knee Society. The survey assessed demographic information, primary TKA volume, fixation technique preferences, patellar resurfacing practices, and the clinical rationale for these decisions. Responses were collected over a 4-week period in May 2025. Descriptive statistics were used to summarize the data.

RESULTS: The response rate was 48.1% (104 surgeons), with 52 (50.0%) being in practice greater than 25 years and 39 (37.9%) performing 201 to 300 primary TKAs annually. Cemented fixation was dominant, with an average use rate of 72.9%; 67.3% (70 surgeons) used both cemented and cementless implants, with an average cementless use of 35.8% of cases. Age (70.0%) and bone quality (82.9%) were the most cited indications for cementless use. Conversely, 35.6% (37 surgeons) reported using cemented fixation in all patients. Patellar resurfacing practices varied widely, with 34.7% (33 surgeons) reporting always resurfacing and individual rates ranging from 0 to 100%. 40.2% (41 surgeons) of respondents said their indications have changed in the past 5 years; resurfacing was most influenced by degree of arthritis (53.7%), patellar tracking (23.1%), and size/thickness (21.0 to 31.6%). Among surgeons performing cementless TKA, patellar resurfacing remained heterogeneous, and 40% (24 surgeons) still preferred cemented patellar components.

CONCLUSION: Cemented fixation in primary TKA remains the standard among expert TKA surgeons, though cementless techniques are increasingly used in select patients. Patellar resurfacing practices remain highly variable, reflecting individualized decision-making. These findings highlight evolving trends and underscore the need for continued research and consensus in primary TKA.

PMID:41935761 | DOI:10.1016/j.arth.2026.03.078

J Arthroplasty. 2026 Apr 2:S0883-5403(26)00272-X. doi: 10.1016/j.arth.2026.03.069. Online ahead of print.

ABSTRACT

BACKGROUND: The adoption of artificial intelligence (AI) scribes has grown rapidly in recent years, aiming to improve clinical workflow, increase efficiency, and reduce administrative burden by transcribing doctor-patient interactions. These systems capture in-office conversations and generate summaries using either standard or surgeon-specific templates. However, to date, no randomized controlled trials have rigorously assessed the proposed benefits of AI scribes. This randomized controlled trial focused on assessing AI scribe efficiency, error rate, accuracy, and patients’ perceptions in comparison to traditional clinical dictation-transcription methods.

METHODS: A randomized controlled trial was conducted involving 304 patients in a single-surgeon adult reconstruction practice. Patients were allocated into two groups: a conventional documentation group (using dictation transcribed by the office administrator or preconstructed templates: 140 patients) and an AI scribe group (139 patients). Timing data were recorded from when the surgeon entered a consultation room to when they began with the next patient. Additional data included administrative processing times, such as transcription and faxing of medical letters. All documentation was reviewed for medical errors by the surgeon in both groups. Grammar, spelling, and wrong wording were assessed by unblinded researchers. Letter quality was independently assessed using ChatGPT, focusing on grammar, clarity, and completeness.

RESULTS: Use of AI scribes resulted in a statistically significant reduction in both physician and administrative processing times (P < 0.0001). There was no significant difference in spelling or grammatical errors between groups. However, letters produced using AI scribes were rated as significantly more complete, professional, and clear. There were 19 medical errors in the AI scribe group compared to only nine errors in the conventional group. Patients were not negatively affected by using an AI scribe, and the vast majority found it helpful.

CONCLUSION: The use of AI scribes can effectively enhance clinical efficiency and reduce administrative workload without compromising documentation quality or patient safety. Their implementation offers meaningful benefits to both physicians and office staff, allowing more focus on patient care and other critical tasks.

PMID:41935758 | DOI:10.1016/j.arth.2026.03.069

J Affect Disord. 2026 Apr 2:121734. doi: 10.1016/j.jad.2026.121734. Online ahead of print.

ABSTRACT

BACKGROUND: Catatonia is a recurrent neuropsychiatric syndrome affecting approximately 9% of psychiatric inpatients, yet the impact of acute treatment strategies on long-term recurrence risk remains poorly understood. This study examined how treatments administered during acute catatonic episodes influence recurrence risk.

METHODS: We conducted a retrospective cohort study of 205 adults hospitalized with catatonia at a tertiary care center between 2001 and 2021. Catatonia diagnoses were confirmed by chart review using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The primary outcome was time to a new catatonic episode, with patients censored at last follow-up if no recurrence was observed. Treatment exposure was ascertained from the Latest Catatonia Episode (LaCE) for non-recurrent patients and from the Nearest Antecedent Catatonia Episode (NACE) for those with recurrence. Cox proportional hazards models estimated adjusted hazard ratios for benzodiazepines, antipsychotics, electroconvulsive therapy, and mood stabilizers, controlling for age and.

RESULTS: Overall, 31% of patients experienced recurrence over a median follow-up of 6.4 years. Benzodiazepines, used in 88% of patients, were consistently protective against recurrence (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p = 0.03). Antipsychotics demonstrated a biphasic effect: lower hazard of recurrence within 60 days (adjusted hazard ratio 0.36, 95% confidence interval 0.13-1.00, p = 0.05) but associated with increased hazard thereafter (adjusted hazard ratio 2.14, 95% confidence interval 1.08-4.254, p = 0.08).

CONCLUSIONS: Benzodiazepines use was associated with sustained protection against catatonia recurrence. The time-dependent antipsychotic effect warrants careful consideration in maintenance treatment planning. While our retrospective design limits causal inference, these findings emphasize the need for prospective studies to optimize maintenance strategies and prevent recurrence.

PMID:41935752 | DOI:10.1016/j.jad.2026.121734