Tag: nevin manimala

Eur Spine J. 2026 Jun 12. doi: 10.1007/s00586-026-10079-z. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative pain after lumbar microdiscectomy (MD) can be significant. While both the lumbar erector spinae plane block (L-ESPB) and the posterior quadratus lumborum block (P-QLB) are used for analgesia, they have not been directly compared. We hypothesized that L-ESPB and P-QLB would provide different levels of analgesia after MD.

METHODS: This single-center, prospective, randomized controlled trial included 60 adult patients (ASA I-II) undergoing unilateral single-level lumbar MD. Patients were randomized to receive a bilateral, postoperative L-ESPB (n = 30) or P-QLB (n = 30) with 30 mL of 0.25% bupivacaine per side. The primary outcome was the Numerical Rating Scale (NRS) pain score at 2 h postoperatively. Secondary outcomes included NRS pain scores over 24 h, rescue analgesia requirements, and adverse events.

RESULTS: Patients in the L-ESPB group had statistically lower static and dynamic NRS pain scores at all measured time points (1, 2, 4, 8, 16, and 24 h) compared to the P-QLB group (p = 0.001). The number of patients requiring rescue analgesia was lower in the L-ESPB group (1 vs. 9 patients, p = 0.012), and the total tramadol consumption was also lower (p = 0.005). The incidence of nausea and itching was significantly lower in the L-ESPB group. One patient in the L-ESPB group experienced a temporary motor block.

CONCLUSION: In patients undergoing lumbar MD, L-ESPB provided superior analgesia and resulted in lower opioid consumption and fewer opioid-related side effects compared to P-QLB over the first 24 postoperative hours.

PMID:42286352 | DOI:10.1007/s00586-026-10079-z

Am J Respir Crit Care Med. 2026 Jun 12:aamag276. doi: 10.1093/ajrccm/aamag276. Online ahead of print.

ABSTRACT

RATIONALE: Physician Orders for Life-Sustaining Treatment (POLST) and Advance Directives (AD) aim to honor patient autonomy. However, the impact of the signatory’s identity-whether the patient or a surrogate-on clinical trajectories in the intensive care unit (ICU) remains poorly characterized.

OBJECTIVES: To evaluate the association between signatory identity and terminal care intensity and hospitalization costs among adult patients in the ICU.

METHODS: This nationwide population-based cohort study utilized the South Korean National Health Insurance Service database, including 1,189,042 adult ICU admissions between 2020 and 2023. Statistical analyses employed high-dimensional fixed-effects models to account for institutional variability across 417 hospitals.

RESULTS: Among 1,189,042 patients, surrogate-determined POLST (SD-POLST) was more than three times as prevalent as patient-determined POLST (PD-POLST). Among 90-day decedents, PD-POLST was associated with significantly reduced odds of invasive terminal care (OR, 0.43; 95% CI, 0.43-0.54). Conversely, SD-POLST more than doubled the odds (OR, 2.16; 95% CI, 1.98-2.35). Notably, even patients with proactive ADs experienced increased care intensity once a surrogate signed the final order (OR, 1.69; 95% CI, 1.51-1.89), indicating a phenomenon of “AD erosion.” SD-POLST was also associated with significantly higher daily hospitalization costs (cost ratio, 1.04; 95% CI, 1.02-1.06) compared with no documentation.

CONCLUSION: The clinical efficacy of POLST in limiting non-beneficial care depends fundamentally on the signatory. Surrogate-led decisions were associated with paradoxically higher care intensity and costs, potentially overriding prior patient wishes. These findings highlight the critical importance of early, patient-led discussions to ensure goal-concordant end-of-life care in the ICU.

PMID:42286341 | DOI:10.1093/ajrccm/aamag276

Aesthetic Plast Surg. 2026 Jun 12. doi: 10.1007/s00266-026-06052-2. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to comprehensively evaluate the short-term changes in ocular surface parameters and meibomian gland function following Full-incision double-eyelid blepharoplast.

METHODS: In this observational self-controlled study, 50 patients (100 eyes) undergoing full-incision double-eyelid blepharoplasty were enrolled. Assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These included the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein tear film break-up time (FBUT), corneal fluorescein staining (CFS), Schirmer I test, meibum quality, meibomian gland expressibility, meibomian gland dropout (excluding 1-week), lipid layer thickness (LLT), and incomplete blinking rate (IBR). Statistical comparisons were performed using ANOVA with post-hoc analysis.

RESULTS: Compared to baseline, OSDI scores, meibum quality, meibomian gland expressibility, and IBR showed statistically significant deterioration at both 1 week and 1 month post-surgery (all p < 0.001). In contrast, no significant changes were observed in FBUT, CFS, Schirmer I test, LLT, or meibomian gland dropout at any time point. By the 3-month follow-up, all significantly altered parameters-OSDI, meibum quality, expressibility, and IBR-had recovered to levels that were not statistically different from preoperative baseline values.

CONCLUSIONS: Full-incision double-eyelid blepharoplasty induces a transient but significant dysfunction of the ocular surface and meibomian glands in the early postoperative period, which is closely associated with a sharp increase in incomplete blinking. These findings underscore the importance of proactive postoperative management, including dry eye counseling, artificial tears, and blink training, to enhance patient comfort during the recovery phase.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42286332 | DOI:10.1007/s00266-026-06052-2

Aesthetic Plast Surg. 2026 Jun 12. doi: 10.1007/s00266-026-06123-4. Online ahead of print.

ABSTRACT

This letter to the editor offers a constructive commentary on a recently published multivariate analysis of predictors of complications in abdominoplasty. The authors commend the original study for its rigorous surgical standardization, consecutive patient enrollment, and single‑surgeon design, and agree that high body mass index and active smoking are independent risk factors, while preservation of Scarpa’s fascia appears protective. However, three methodological limitations are identified. First, the sample size and number of events barely meet the minimum recommended events‑per‑variable ratio for multivariate regression. Second, treating seroma, necrosis, and dehiscence as independent outcomes ignores competing risks among these complications, which may bias risk estimates. Third, the single‑center, single‑surgeon design limits external validity, and the finding that diabetes is not a risk factor contradicts some existing literature. The letter suggests that future analyses adopt competing‑risk models and include multicenter external validation. It also notes that no new patient data are provided, so the proposed statistical refinements await empirical verification.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:42286329 | DOI:10.1007/s00266-026-06123-4

Surg Endosc. 2026 Jun 12. doi: 10.1007/s00464-026-12951-x. Online ahead of print.

ABSTRACT

BACKGROUND: Despite required simulation training and Fundamentals of Endoscopic Surgery certification, concerns remain about endoscopic competency among graduating general surgery residents. No prior study has directly evaluated resident endoscopic performance in clinical practice. Using the Society for Improving Medical Professional Learning (SIMPL) database, this study assesses general surgery resident competency and autonomy in colonoscopy, upper endoscopy, and sigmoidoscopy/proctoscopy.

METHODS: A retrospective analysis of the SIMPL database was conducted for general surgery residents completing endoscopic procedures between January 2015 and August 2025. Faculty-rated performance was dichotomized as competent (practice-ready/exceptional) versus not competent (unprepared/inexperienced/intermediate performance) and resident autonomy was dichotomized as meaningful (passive help/supervision only) versus not meaningful (show and tell/active help). Descriptive statistics on performance and autonomy were evaluated, including agreement between resident and faculty evaluations. Logistic regression was used to assess resident performance and autonomy according to training year, with case complexity as a covariate.

RESULTS: A total of 3,325 cases were evaluated, consisting of 2,696 colonoscopies, 364 upper endoscopies, and 265 sigmoidoscopies/proctoscopies. Faculty observed competent performance in 35.3% of colonoscopies, 50.0% of upper endoscopies, and 42.3% of sigmoidoscopies/proctoscopies. Faculty observed meaningful autonomy in 60.7% of colonoscopies, 68.9% of upper endoscopies, and 59.2% of sigmoidoscopies/proctoscopies. The likelihoods of achieving competency and meaningful autonomy in the most complex colonoscopies were 23.6% and 40.8%, respectively. At the chief resident level, faculty observed competency in 70.6% of colonoscopies, 89.5% of upper endoscopies, and 87.3% of sigmoidoscopies/proctoscopies.

CONCLUSIONS: Nearly one-third of colonoscopies performed by chief residents did not meet practice-ready competency standards, representing the most concerning finding of this study. Performance was even lower for complex cases, with fewer than one-quarter achieving competency and less than half demonstrating meaningful autonomy. Together, these findings highlight gaps in current training pathways and underscore the need to strengthen endoscopy education.

PMID:42286181 | DOI:10.1007/s00464-026-12951-x

Eur Radiol. 2026 Jun 12. doi: 10.1007/s00330-026-12652-y. Online ahead of print.

ABSTRACT

OBJECTIVE: Though subgroup performance reporting helps ensure the safety of artificial intelligence (AI) products, the extent of this reporting remains unclear. This scoping review identifies studies validating commercially available AI-based products and reports the trends in performance reporting across sex, age, and race/ethnicity demographic subgroups.

MATERIALS AND METHODS: Peer-reviewed validation studies of commercially available products published after 2010 were collected from the Health AI Register and PubMed on 29 November 2024. Study trends in the reporting of sex, age, and race/ethnicity were mapped with regression analysis. We apply the Wilson confidence interval equation to estimate which tuberculosis detection studies are underpowered for subgroup meta-analysis.

RESULTS: Three hundred ninety-two of 545 studies validating 252 products reported subgroup demographic data for any of the three groups. Only 77 of these presented subgroup performance results. Skeletal (20/88) and lung (30/139) studies, and those utilizing chest (24/79) or bone (19/63) radiographs, most often presented subgroup performance data. We found no evidence that more recent studies (OR: 1.039 [95% CI: 0.959-1.127]) or company sponsorship (OR: 1.010 [95% CI: 0.492-1.920]) led to increased subgroup reporting. We show that 14/21 tuberculosis datasets may be underpowered for post-hoc subgroup meta-analysis.

CONCLUSION: This scoping review quantifies how fragmented the commercial validation landscape is, showing that reporting for both the demographics and per-subgroup performance is inadequate for estimating subgroup bias. This systemic problem requires effort from all stakeholders, from researchers to regulatory agencies, encouraging thorough reporting and commercial product validation to support physician and patient trust in medical AI products.

KEY POINTS: Question The number of studies validating the performance of each commercially available radiology AI product for minority subgroup bias is unclear. Findings The currently available commercial AI validation studies often neglect to describe demographic subgroup data, and fewer provide performance results per subgroup, prohibiting algorithmic bias meta-analysis. Clinical relevance Physician and patient trust in the medical AI already used clinically must be built on peer-reviewed literature and meta-analysis. The current literature is insufficient for determining the safety and performance of these products for demographic minorities.

PMID:42286177 | DOI:10.1007/s00330-026-12652-y

Genomics Proteomics Bioinformatics. 2026 Jun 12:qzag046. doi: 10.1093/gpbjnl/qzag046. Online ahead of print.

ABSTRACT

Population admixture is a pivotal evolutionary process that has profoundly shaped genetic diversity and population structure in modern human populations. However, most existing methods for inferring admixture history rely on simplified assumptions, such as strictly sequential contributions from ancestral populations, thereby limiting their applicability to realistic scenarios. Here, we introduce HiMWA, a computational framework based on a hierarchical multiple-wave admixture model for reconstructing complex admixture histories involving multiple ancestral populations. HiMWA characterizes both hierarchical admixture, in which ancestral populations first admix to form intermediate populations, and subsequent multiple-wave admixture that shapes the final admixed population. The framework integrates model selection based on ancestry switch counts with parameter estimation using the length distribution of ancestral tracts. Extensive simulations demonstrate that HiMWA is accurate and robust across diverse admixture scenarios, including those affected by genetic drift and local ancestry inference errors. Applying HiMWA to Kazakhs and Uyghurs revealed a shared hierarchical admixture structure. In both populations, West European and South Asian ancestries first admixed to form a West Eurasian intermediate population, while East Asian and Siberian ancestries formed an East Eurasian intermediate population. These two intermediates subsequently contributed to present-day populations through multiple waves of admixture. Our results highlight the prevalence of hierarchical multiple-wave admixture in Central Asia and provide insights into the region’s complex demographic history. HiMWA offers a powerful and flexible framework for disentangling complex admixture histories and reconstructing realistic population genetic histories from genomic data. The HiMWA software, documentation, and example datasets are publicly available at https://github.com/Shuhua-Group/HiMWA and https://ngdc.cncb.ac.cn/biocode/tool/BT008069.

PMID:42286175 | DOI:10.1093/gpbjnl/qzag046

Commun Psychol. 2026 Jun 12;4(1):95. doi: 10.1038/s44271-026-00487-8.

ABSTRACT

As technology-based learning environments increasingly employ automated feedback, understanding how learners process feedback in real time is essential. This study examined how automated cognitive and metacognitive failure feedback delivered by a humanoid robot affected performance and how effects were moderated by feedback characteristics and learner characteristics. Ninety adults (18-59 years, M_age = 29.53, 61 female, 27 male, 2 diverse) completed a learning task in three conditions: (1) fixed guidance condition with fixed-frequency and content-generic feedback, (2) basic-adaptive condition with frequency-adaptive but content-generic feedback, or (3) personalized-adaptive condition with frequency-adaptive and content-personalized feedback adjusting content to learners specific errors and prior steps. A three-level generalized path model (trials nested within time blocks within learners) was estimated to investigate effects of failure feedback on immediate task performance and cross-level moderation effects. Results showed that cognitive and metacognitive failure feedback increased the likelihood of a correct subsequent response across conditions. Relative to fixed guidance (condition 1), the implemented form of frequency-adaptive feedback (condition 2) did not show statistically significant moderation to these effects. Content-personalized feedback (condition 3) reduced effectiveness of cognitive failure feedback on immediate performance but improved overall performance as compared to content-generic feedback (condition 2). Across conditions, learners with higher cognitive ability benefited less, while those reporting higher momentary on-task boredom benefited more from cognitive feedback. These findings highlight that the effectiveness of automated failure feedback depends on both its design and learners’ situational cognitive and emotional states, illustrating how a situational, temporally sensitive approach can help open the “black box” of feedback effectiveness.

PMID:42286158 | DOI:10.1038/s44271-026-00487-8

Sci Rep. 2026 Jun 12. doi: 10.1038/s41598-026-57254-2. Online ahead of print.

ABSTRACT

Rapid identification of methicillin-resistant Staphylococcus aureus (MRSA) is crucial for early optimization of antibiotic treatment, but current routine susceptibility testing typically requires 48-72 h. Attenuated total reflectance Fourier-transform infrared (ATR-FTIR) spectroscopy has emerged as a promising approach for bacterial identification and has recently been used to distinguish MRSA from methicillin-sensitive S. aureus (MSSA) after 60-120 min of β-lactam exposure. Here, we test whether ATR-FTIR can resolve MRSA versus MSSA within the first hour of antibiotic challenge. We exposed three MSSA (ATCC 6538, WKZ1, RN4220) and four MRSA (ATCC 43300, USA300-JE2, WKZ2, CA629) strains to sub-MIC ampicillin (0.5 μg/mL) and acquired spectra from 800 to 1800 cm^-1 at 0, 20, 30, and 60 min. We compared classification pipelines based on the full spectrum, PCA-reduced features, and LASSO-selected bands, coupled with linear discriminant analysis, partial least-squares discriminant analysis, and support vector machines. Models based on LASSO-selected features achieved the strongest early performance, with strain-aware classification accuracies of 0.91 at 20 min and 0.92 at 30 min. Leave-one-strain-out cross-validation (LOSO-CV) further showed that focusing on mechanistically relevant difference spectra enabled robust across-strain discrimination, with balanced accuracies of 0.91 at 20 min and 0.90 at 30 min. The most informative early bands mapped primarily to peptidoglycan and carbohydrate precursor regions, while later discrimination increasingly involved lipid-associated bands. Transmission electron microscopy and atomic force microscopy at 20 min independently confirmed antibiotic-induced cell-wall thickening and structural disruption in susceptible strains but not in resistant strains. Together, these results establish a proof of concept that early cell-wall stress signatures captured by ATR-FTIR, combined with lightweight and interpretable machine-learning models, can deliver rapid and accurate phenotypic discrimination between MRSA and MSSA.

PMID:42286152 | DOI:10.1038/s41598-026-57254-2

Sci Rep. 2026 Jun 12. doi: 10.1038/s41598-026-57707-8. Online ahead of print.

ABSTRACT

Emergency medical technicians (EMTs) frequently experience workplace violence in prehospital settings; however, evidence on the role of body-worn cameras (BWCs) in this context is limited. This study examined the factors associated with frequent workplace violence, the perceived need for BWCs, and actual BWC use among South Korean EMTs, incorporating individual- and regional-level indicators. A nationwide cross-sectional survey was conducted among EMTs employed by provincial fire departments in South Korea. Survey data on sociodemographic characteristics, work conditions, workplace violence over the past year, and BWC-related perceptions and behaviors were linked to province-level assault indicators from the National 119 emergency medical services (EMS) Statistical Yearbook (2020-2024). The main outcomes included frequent workplace violence, high perceived need for BWCs, and BWC use. Regional assault burden was modeled as tertiles of a five-year mean provincial assault index and as a continuous measure per 10-unit increase. All primary outcomes were self-reported within a knowledge-attitude-practice (KAP) survey design. Multivariable logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). To address within-province clustering, Generalized Estimating Equations (GEE) were additionally used as a sensitivity analysis. Of 3,595 EMTs included in the descriptive analyses, 2,555 provided complete violence data. Nearly all respondents (99.7%) reported some workplace violence in the past year, and 17.3% were classified as experiencing frequent workplace violence. Overall, 64.4% reported using a BWC, and 87.9% expressed a high perceived need. Frequent violence was associated with younger age, longer EMS career, higher daily call volume, and working as an EMT rather than an ambulance driver, but not with regional assault burden. High perceived need for BWCs was more common among female EMTs and varied by age, again without clear associations with regional assault indices. In contrast, actual BWC use was associated with job position, shorter EMS career, lower call volume, and high perceived need, and was inversely associated with higher regional assault burden. Workplace violence was highly prevalent among South Korean EMTs, and the perceived need for BWCs was widespread. Individual and work-related factors, rather than province-level assault burden, were the key determinants of frequent violence and BWC-related perceptions, whereas BWC use was less common in regions with higher recorded assault indices.

PMID:42286143 | DOI:10.1038/s41598-026-57707-8