Nevin Manimala

J Neurosurg Spine. 2026 Jul 10:1-15. doi: 10.3171/2026.2.SPINE251657. Online ahead of print.

ABSTRACT

OBJECTIVE: Preoperative risk-stratification tools, including frailty, nutritional, and surgical risk metrics, are used to predict complications after spine surgery. The relative performance of these tools across complication types and surgical subgroups is not well characterized. This study aimed to compare the predictive performance of 5 risk metrics, American College of Surgeons Surgical Risk Calculator (ACS SRC), serum albumin, Risk Analysis Index (RAI), modified 5-item frailty index (mFI-5), and Geriatric Nutritional Risk Index (GNRI), for perioperative complications.

METHODS: The authors analyzed 362,145 adult spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2017 to 2022. Adjusted odds ratios were estimated via multivariable logistic regression, controlling for age, sex, urgency, and procedure type (defined by Current Procedural Terminology [CPT] codes). Subgroup analyses were stratified by ICD-10 diagnosis category, including degenerative disease, tumor, trauma, infection, and spinal deformity. Discrimination for predicting complications was assessed using C-statistics and DeLong’s test.

RESULTS: Across all endpoints, ACS SRC had the best predictive accuracy: mortality C-statistic (95% CI) 0.908 (0.900-0.916), Clavien-Dindo grade IV (CD-IV) 0.823 (0.816-0.830), and major complications 0.749 (0.745-0.752). Serum albumin, despite being a single laboratory value, ranked second with mortality C-statistic (95% CI) 0.820 (0.807-0.833), CD-IV 0.734, and major complications 0.682 and showed strong discrimination for infectious complications (e.g., sepsis, septic shock, surgical site infection, and urinary tract infection), as well as for hospital length of stay and nonhome discharge. Compared to frailty-based metrics, albumin showed significantly better predictive value (p < 0.001 for pairwise comparisons) and maintained its advantages across all subgroups, including high-risk groups such as infection, trauma, and tumor cases. RAI provided moderate mortality prediction (C-statistic 0.807) and was most effective for predicting cardiovascular events, while both GNRI (0.753) and mFI-5 (0.647) were less consistent and demonstrated weaker associations with adverse outcomes. Multivariable regression confirmed that lower preoperative albumin and higher ACS SRC predictions were robust, independent predictors of increased risk for major complications, CD-IV events, and mortality. These performance patterns remained stable across surgical indications and in subgroup analyses.

CONCLUSIONS: ACS SRC remains among the comprehensive tools for risk stratification in spine surgery. Serum albumin offers strong, consistent predictive value, especially for infectious, respiratory, and life-threatening complications, and may be a valuable alternative when calculator inputs are incomplete.

PMID:42430800 | DOI:10.3171/2026.2.SPINE251657

Syst Biol. 2026 Jul 10:syag048. doi: 10.1093/sysbio/syag048. Online ahead of print.

ABSTRACT

Phylogenetic modeling of morphological shape in two or three dimensions is one of the most challenging statistical problems in evolutionary biology. As shape data are inherently correlated and non-linear, most naïve methods for phylogenetic analysis of morphological shape fail to capture the biological realities of evolving shapes. In this study we propose a novel framework for evolutionary analysis of morphological shape which facilitates stochastic character mapping on landmark shapes. Our framework is based on recent advances in mathematical shape analysis and models the evolution of shape as a diffusion process that accounts for the evolutionary correlation between nearby landmarks. The diffusion process we consider is parametrized in terms of meaningful parameters describing the evolutionary rate and the degree of spatial autocorrelation among landmarks. The framework we propose assumes that the phylogenetic tree is fixed and uses a Metropolis-Hastings Markov Chain Monte Carlo sampling scheme for inferring ancestral shapes and parameters of the model. We evaluate the new inference algorithm using simulations and show that the method leads to improved estimates of the shape at the root and well-calibrated credible sets of shapes at internal nodes. In addition, we also compare the diffusion parameter describing the degree of spatial autocorrelation to an existing metric of integration and find that they quantify integration in a shape in a similar way. To illustrate the method, we also apply it to a previously published data set of butterfly wing images.

PMID:42430784 | DOI:10.1093/sysbio/syag048

Comput Inform Nurs. 2026 Jul 10. doi: 10.1097/CIN.0000000000001601. Online ahead of print.

ABSTRACT

The aging population, particularly women, faces complex biopsychosocial health and social challenges, necessitating whole-person approaches and innovative research methods to better understand health and well-being to guide effective interventions. The objective of this pilot comparative cross-sectional study was to examine whole-person health and resilience of older adult women ages 65 and older in the United States and Türkiye. Data were collected from adult women in the United States (n=25) and Türkiye (n=25) between March and August 2024. Whole-person health was evaluated using the MyStrengths+MyHealth application, and resilience was measured using the 14-item Resilience Scale. Data were analyzed using descriptive and inferential statistics to examine between-group differences. The average age for the US participants was 78 (SD=6.2), and the average age for the Turkish participants was 68 (SD=2.8). There were significant differences in average self-reported strengths (P<0.001), challenges (P<.001), and needs (P<.001) between US and Turkish participants. US participants had a higher mean Resilience score [88.0 (SD=5.3)] versus Turkish participants [74.9 (SD=14.7)] (P<.001). The study revealed that both groups had above-average resilience and had both common strengths and differences in health challenges and needs. These findings highlight the importance of prioritizing a whole-person health approach when developing strengths-based interventions to address the complex and diverse needs of older women.

PMID:42430772 | DOI:10.1097/CIN.0000000000001601

J Am Acad Orthop Surg Glob Res Rev. 2026 Jul 1;10(7). doi: 10.5435/JAAOSGlobal-D-25-00375. eCollection 2026 Jul 1.

ABSTRACT

PURPOSE: Periarticular multimodal analgesia is a standard pain relief method for total knee arthroplasty (TKA) patients. Recent studies have demonstrated that intraosseous injections of pain relievers and antifibrinolytic agents provide statistically significant reductions in pain and blood loss. This study aimed to compare the outcomes of multimodal intraosseous femoral injections with those of tibial injections in patients undergoing bilateral TKA.

METHODS: A double-blind, randomized controlled trial was done in 40 individuals. Patients received multimodal intraosseous injections at either the femur or tibia for each TKA, with the site alternating between groups. Postoperative outcomes assessed included Visual Analog Scale (VAS) pain score, postoperative blood loss, amount of painkiller used after surgery, range of motion, adverse effects, and complications.

RESULTS: The primary outcomes were postoperative pain and blood loss. No significant differences were observed in VAS pain scores between groups at any time point; for example, at 12 hours, the mean difference was 0.06 (95% CI, -0.63 to 0.51, P = 0.149). However, the femoral site demonstrated significantly lower postoperative blood loss through drainage with a mean difference of -60.8 mL (95% CI, -98.54 to -23.06, P < 0.001) and lower total blood loss (mean difference -61.9 mL, 95% CI, -101.89 to -21.90, P < 0.001).

CONCLUSION: Multimodal intraosseous injection at the femoral site seemed to be as effective for pain management as at the tibial site, but it resulted in markedly reduced postoperative blood loss in patients undergoing TKA. Additional research is required to explore long-term benefits of this technique and confirm its safety profile.

PMID:42430771 | DOI:10.5435/JAAOSGlobal-D-25-00375

Arch Clin Neuropsychol. 2026 May 29;41(5):acag048. doi: 10.1093/arclin/acag048.

ABSTRACT

OBJECTIVE: Symptom overreporting is often considered to be moderated by external incentives, such as financial or legal advantages, although other factors may also play a role. Preliminary studies have suggested a connection between symptom overreporting and alexithymia, that is, trait-like difficulties in recognizing and describing internal sensations. This study aimed to further clarify the relationships among external gain expectations, alexithymia, and symptom overreporting. Specifically, we examined whether alexithymia is related to overreporting in patients without self-reported external gain expectations.

METHOD: Using a cross-sectional design, patients referred for psychological assessments in a hospital setting completed a questionnaire about external gain expectations (e.g., regarding work, housing, legal issues). We differentiated between those with self-reports of external gain expectations (n = 73) and those without (n = 84). Both subsamples were administered the Toronto Alexithymia Scale-20 (TAS-20), the Structured Inventory of Malingered Symptomatology (SIMS), and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF).

RESULTS: Across the full sample, alexithymia showed a positive and statistically significant association with symptom overreporting on the SIMS and the Infrequent somatic responses scale (Fs) of the MMPI-2-RF: r = 0.44 and r = 0.31, respectively. These positive associations were also evident in the subgroup without self-reported external gain expectations (i.e., r = 0.35, 95% CI [0.14, 0.52] and r = 0.35, 95% CI [0.15, 0.53], respectively). Regression analysis indicated that self-reported external gain expectations did not account for the relationship between symptom overreporting and alexithymia.

CONCLUSION: These findings suggest that alexithymia is associated with symptom overreporting independently of self-reported external gain expectations. More broadly, the results raise the possibility that alexithymic traits may compromise the accuracy of symptom reporting itself. If so, this has implications not only for the interpretation of symptom validity tests, but also for the broader use of self-report measures in clinical assessment.

PMID:42430770 | DOI:10.1093/arclin/acag048

JMIR Med Educ. 2026 Jul 10;12:e70400. doi: 10.2196/70400.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed a significant burden on health professionals (HPs). They face higher infection risks due to the nature of their work environment and patient care responsibilities. Their ability to access and apply reliable COVID-19 information affects their own preventive behavior and that of those around them. In this context, health literacy (HL) has become increasingly important. Despite extensive research, information to foster COVID-19-related HL in HPs remains limited.

OBJECTIVE: This systematic review aimed to identify, appraise, and synthesize intervention studies on the effectiveness of COVID-19-related HL interventions in HPs.

METHODS: Five electronic databases (eg, PubMed (MEDLINE), Embase), six clinical trials registries (eg, ISRCTN registry), one preprint server (MEDRXIV), published conference proceedings, and five gray literature databases (eg, opengrey.eu, ProQuest) were searched in May 2022 and updated in August 2025. Reference lists of included studies were screened manually. Two reviewers independently screened titles, abstracts, and full-texts according to eligibility criteria and extracted data; disagreements were resolved by discussion or consultation with a third reviewer. We included randomized controlled trials (RCTs), nonrandomized studies of interventions, and uncontrolled before-and-after studies evaluating the effectiveness of any COVID-19-related HL intervention. Primary outcomes include COVID-19-related HL, its four facets (access, understand, appraise, and apply COVID-19 information), and indicators (eg, COVID-19-related knowledge), assessed at postintervention and follow-up. When studies were sufficiently similar, random-effects meta-analyses were performed; otherwise, a narrative synthesis was provided. Risk of bias was assessed using validated tools based on study design, and the overall certainty of the evidence was evaluated by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

RESULTS: We included 15 RCTs (2034 participants), 4 nonrandomized studies of interventions (291 participants), 74 uncontrolled before-and-after studies (327,298 participants), 5 ongoing studies, and 1 study with awaiting classification. Interventions targeted a broad range of health occupational groups. Intervention type, delivery mode, methods, settings, and comparator varied widely. No outcome measure explicitly referred to an HL model. Most studies aimed to enhance COVID-19-related knowledge and skills, and had a high risk of bias. COVID-19-related interventions may increase knowledge of vaccines (standardized mean difference 1.00; 95% CI 0.33 to 1.67, I2=24%), and the infection prevention control skills, such as donning and doffing of personal protective equipment (standardized mean difference 1.95; 95% CI 1.82 to 3.09, I2=46%), but the evidence remains very uncertain.

CONCLUSIONS: COVID-19-related HL interventions may promote HP’s short-term competencies in infection control. However, the evidence remains uncertain, primarily due to the low quality of studies, characterized by a high risk of bias. Interventions specifically designed to enhance the full COVID-19 HL operationalized by its four facets are lacking. High-quality RCTs with sufficient statistical power, grounded in HL theoretical principles, are needed to achieve precise understanding.

PMID:42430764 | DOI:10.2196/70400

Plast Reconstr Surg. 2026 Jul 9. doi: 10.1097/PRS.0000000000013317. Online ahead of print.

ABSTRACT

BACKGROUND: Triple nerve transfer (TNT) combines cross-face nerve grafts, masseteric-to-facial nerve transfer, and hypoglossal-to-facial nerve transfer to restore facial function in long-standing facial paralysis. However, its efficacy in patients with severe soft tissue laxity or atrophy may be limited. This study evaluates whether adding autologous fascia lata suspension (TNTF) to TNT improves functional and psychosocial outcomes.

METHODS: A retrospective study compared 22 patients with chronic unilateral facial paralysis, treated with either TNT alone (n=14) or TNT plus fascia lata suspension (TNTF, n=8). All patients completed the Facial Clinimetric Evaluation (FaCE) Scale pre- and postoperatively (≥12 months). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U tests, ANCOVA, and repeated-measures ANOVA to adjust for baseline differences.

RESULTS: Both groups showed significant improvements in FaCE scores postoperatively (TNT: +18, p<0.001; TNTF: +24, p<0.01). The TNTF group had worse preoperative scores (median 25 vs. 37, p=0.006), but postoperatively, scores were comparable (49.1 vs. 55.1, p=0.095). The mean improvement was greater in TNTF (Cohen’s d ≈ 0.82, p=0.09), with significantly greater gains in oral function and social appearance (e.g., FaCE item Q15: +3 vs. +1, p=0.02). Correlation between EMG severity and baseline FaCE scores was significant (ρ ≈ 0.57, p<0.01).

CONCLUSION: TNT restores facial function, but adding fascia lata suspension improves static tone and symmetry in patients with severe soft tissue laxity, offering superior functional and psychosocial outcomes in complex cases.

PMID:42430759 | DOI:10.1097/PRS.0000000000013317

Kidney360. 2026 Jul 10. doi: 10.34067/KID.0000001265. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical trials in rare glomerular disease may establish short-term treatment efficacy but are limited by small sample sizes and short study duration. Observational data are needed to assess longer-term outcomes and can provide insights into real-world prescribing practices. This study applied modern statistical methods to real-world data from the Cure Glomerulonephropathy (CureGN) network to compare the effectiveness of rituximab and calcineurin inhibitors on long-term primary membranous nephropathy outcomes.

METHODS: CureGN participants with biopsy-confirmed primary membranous nephropathy who initiated either of the two treatments at least 6 months after any previous immunosuppressant exposure were eligible. Inverse-probability-of-treatment weighting balanced covariates at treatment initiation. Inverse-probability-of-censoring weights accounted for censoring individuals if another immunosuppressant was started during follow-up. Outcomes included time from treatment initiation to composite kidney disease progression (40% decline in eGFR, kidney replacement therapy, or eGFR <15), proteinuria remission, and relapse following remission. Hazard ratios and differences in restricted mean survival times were estimated.

RESULTS: 325 treatment initiations across 250 unique participants were eligible, with median follow-up 53 months (25th-75th percentile: 24-79). Participants on calcineurin inhibitors had significantly higher risks of disease progression (HR=2.81; 95% CI: 1.16, 6.80). Hazard ratios for proteinuria remission (HR=0.77; 95% CI: 0.50, 1.17) and relapse (HR=1.42, 95% CI: 0.69, 2.92) had wide confidence intervals.

CONCLUSIONS: Rituximab was associated with better kidney function preservation than calcineurin inhibitors over long follow-up. Proteinuria remission and relapse results favored rituximab but did not reach statistical significance. Long-term treatment comparative effectiveness in rare diseases can be evaluated with real-world data.

PMID:42430748 | DOI:10.34067/KID.0000001265

Dermatol Surg. 2026 Jul 7. doi: 10.1097/DSS.0000000000005260. Online ahead of print.

ABSTRACT

BACKGROUND: Procedures have traditionally been delayed 6 to 12 months after isotretinoin because of concerns about abnormal scarring; evidence for fractional ablative CO2 laser is limited in higher Fitzpatrick skin types.

OBJECTIVE: To assess the safety and effectiveness of ablative fractional CO2 laser (AFCL) for atrophic acne scars during and after oral isotretinoin.

METHODS: This was a single-center retrospective cohort of 106 patients (188 AFCL sessions) grouped as concurrent isotretinoin, ≤90 days since discontinuation, 91 to 180 days, or >180 days (control). Outcomes included abnormal scarring, delayed re-epithelialization (>14 days), postinflammatory hyperpigmentation (PIH) at 1 and 3 months, and scar-score change. Overall group comparisons and adjusted patient-level and session-level models were performed.

RESULTS: Abnormal scarring occurred in 3/106 patients (2.8%) with no significant between-group difference (p = .762). Delayed re-epithelialization >14 days occurred in 11/106 patients (10.4%) and was numerically highest in the concurrent isotretinoin group (6/31 [19.4%]); however, the overall four-group comparison was not significant (p = .243), and concurrent isotretinoin was not statistically significant in an adjusted session-level generalized estimating equation model (OR: 4.79, 95% confidence interval: 0.79-29.13; p = .089). PIH at 3 months was higher in the ≤90-day group versus controls (adjusted OR: 6.03, 95% confidence interval: 1.55-23.52; p = .010). Concurrent isotretinoin was not associated with increased PIH or abnormal scarring. Higher density predicted delayed re-epithelialization.

CONCLUSION: AFCL during low-dose isotretinoin or within 6 months after isotretinoin discontinuation was not associated with increased abnormal scarring. Because delayed re-epithelialization was numerically more frequent during concurrent isotretinoin and density was associated with slower healing, conservative density selection and careful counseling remain appropriate. PIH risk was elevated when treatment occurred within 90 days after discontinuation.

PMID:42430738 | DOI:10.1097/DSS.0000000000005260

J Med Internet Res. 2026 Jul 10;28:e101388. doi: 10.2196/101388.

ABSTRACT

BACKGROUND: Parenting interventions can improve parental and child outcomes across diverse settings. However, less is known about how family size, including the number of children, shapes baseline conditions, and how intervention effects unfold over time. Most studies also focus on average treatment effects, with limited attention to heterogeneity across family contexts and trajectories of change.

OBJECTIVE: This study examined whether the number of children was associated with baseline differences in parental and child outcomes, moderated immediate postintervention effects, and shaped postintervention trajectories over 6- and 12-month follow-up periods.

METHODS: We conducted secondary analysis of a pragmatic cluster randomized controlled trial evaluating a universal digital-human parenting intervention delivered through the preschool system in China (N=541). Families were categorized by the number of children (1, 2, 3, or more). We examined (1) baseline differences in parental and child outcomes, (2) moderation of intervention effectiveness at immediate postintervention, and (3) trajectories of change over 6- and 12-month follow-up periods using mixed-effects models.

RESULTS: Of the 541 enrolled families, 494 were included in the complete-case baseline analysis. Compared with 1-child families, 2-child families, and families with 3 or more children, reported lower levels of baseline early learning and stimulation and proactive parenting, as well as greater endorsement of corporal punishment and higher parenting stress. We found no statistically significant evidence that the number of children moderated immediate postintervention effects. In intervention-group trajectory analyses, 2-child families showed greater improvement in early learning and stimulation at the 6-month follow-up (b=3.966, 95% CI 1.468-6.463). Families with 3 or more children showed a similar pattern (b=5.749, 95% CI 0.536-10.962), although estimates for this subgroup were less precise because of the small sample size. This subgroup also showed larger but more variable reductions in selected child behavioral outcomes over follow-up.

CONCLUSIONS: Family size might not always be associated with short-term intervention effectiveness but was associated with divergence in longer-term trajectories. These findings suggest that caregiving demands are relevant for the sustainability of intervention effects. By integrating baseline differences, short-term effects, and longitudinal trajectories within a single framework, this study highlights the importance of moving beyond average treatment effects to more dynamic, context-sensitive evaluations. Designing parenting interventions, particularly scalable digital-human programs, that incorporate sustained and context-responsive support may be critical for addressing variation in family structure and enhancing long-term effectiveness.

PMID:42430727 | DOI:10.2196/101388