Tag: nevin manimala

Int J Med Inform. 2026 Jun 19;219:106549. doi: 10.1016/j.ijmedinf.2026.106549. Online ahead of print.

ABSTRACT

OBJECTIVE: While manual coding or rule-based software are approaches used by most countries for cause of death classification, the application of advanced deep learning tools is likely to enhance the efficiency and accuracy of national mortality statistics. To systematically review the current implementation of automated coding or categorising tools for cause of death classification, summarising the methodologies applied, performance achieved, and the progress and obstacles for application.

METHODS: PubMed and Scopus were systematically searched from 2018 to 2024 to identify studies that used automated tools to code or categorise the causes of death. Two researchers independently selected the papers with disagreement adjudicated by a third supervisor. For each study, the general profile, detailed methodology, and performance of the tools were extracted with progress and potential obstacles for implementation assessed qualitatively. An adapted version of QUADAS-2 was used to assess the risk of bias.

RESULTS: Among the 46 included studies, the training sample size ranged from 165 to 10,519,268 people. The most popular approaches used were deep learning (n = 22, of which 7 were recurrent neural network and 6 were transformer) and rule-based (n = 15) automation. Large disparities existed in the performance, with recall (sensitivity) ranging from 0.253 to 1.000 and precision (positive predictive value) ranging from 0.396 to 1.000. Precision was often higher than recall and could vary substantially for different settings within the same study. Quality of text was the major obstacle to implementation of older automated tools, while for deep learning models, target task and materials were required for pre-training. The performance of deep learning was unsatisfactory for infrequent causes of death and head-to-head comparisons of performance with rule-based tools were limited.

CONCLUSION: Despite deep learning applications gaining popularity over rule-based tools, their performance is inconsistent and evidence of head-to-head comparisons is insufficient. All approaches are influenced by the quality of the training data.

PMID:42320083 | DOI:10.1016/j.ijmedinf.2026.106549

J Surg Res. 2026 Jun 18;325:96-101. doi: 10.1016/j.jss.2026.05.033. Online ahead of print.

ABSTRACT

INTRODUCTION: Hydrocephalus treatment via shunting to the peritoneum, atrium, or pleural space may be contraindicated in pediatric patients with complex surgical history or small size. We aim to describe experience and outcomes of ventriculogallbladder shunt (VGBS) placement.

METHODS: A retrospective review was performed of all patients (<18 y) who underwent VGBS placement at a single quaternary children’s hospital (January 1, 2014-October 31, 2025). Patients were identified by Current Procedural Terminology code and operative records. Demographics, past medical history, prior shunt history, indication for VGBS, subsequent revisions, and duration were collected. Descriptive statistics were utilized.

RESULTS: Five male patients were identified with a median age at VGBS placement of 6.9 mo (interquartile range [IQR] 5.9, 9.0). Four patients developed hydrocephalus secondary to neonatal intraventricular hemorrhage and one from obstructive intracranial malignancy. All patients had intra-abdominal pathology: three necrotizing enterocolitis, one omphalocele and intestinal atresia, and one dysfunctional peritoneum. One patient had a ventriculoperitoneal shunt, ventriculoatrial shunt, and ventriculopleural shunt prior to VGBS, three patients had prior ventriculoperitoneal shunt, and one patient had no prior shunts. Of the four patients with prior shunt placement, the median age at first drainage procedure was 4.1 mo (IQR 3.0, 4.8) with a median of 4.5 revisions (IQR 3.5, 7.5) prior to VGBS. Three of the five VGBS remain functional after 2.4, 4.8, and 7.2 y with two patients undergoing conversion to ventriculopleural shunts (1.4 and 6.8 y postplacement).

CONCLUSIONS: The gallbladder is a feasible and vital consideration for distal ventricular shunt placement in children of small size and/or intra-abdominal pathology which prohibit traditional locations.

PMID:42320073 | DOI:10.1016/j.jss.2026.05.033

J Neurosurg Spine. 2026 Jun 19:1-6. doi: 10.3171/2026.1.SPINE251110. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to determine whether patient-specific precontoured rod (PCR) instrumentation is associated with lower rates of proximal junctional kyphosis (PJK) compared with manually contoured conventional rods (CRs) in adult spinal deformity (ASD) surgery.

METHODS: The data of ASD patients (age ≥ 18 years) undergoing posterior spinal instrumentation and fusion of a minimum of 5 levels were consecutively reviewed from 2016 to 2021. A propensity score-matching algorithm was used to match patients undergoing instrumentation with PCRs (n = 80) to those treated with CRs (n = 210). The primary outcome was the rate of radiographic PJK at a minimum follow-up of 1 year. PJK was defined by two criteria: a postoperative proximal junctional sagittal angle (PJA) 1) ≥ 10° and 2) at least 10° greater than the preoperative measurement.

RESULTS: Following propensity score matching, 160 patients were included in the study (80 per group). Patients demonstrated similar preoperative baseline characteristics and preoperative radiographic alignment. Preoperatively, the mean PJAs measured 9.24° ± 6.8° and 8.8° ± 7.3° for the PCR and CR groups, respectively (p = 0.751). At the most recent follow-up, the PCR and CR groups demonstrated mean PJAs of 11.6° ± 9.1° and 10.8° ± 8.3°, respectively (p = 0.545). Ten (12.5%) patients experienced PJK in the PCR group compared to 16 (20%) patients in the CR group (p = 0.199). In patients with upper instrumented vertebrae in the lower thoracic region, 5 (11.1%) patients in the PCR group experienced PJK versus 12 (26.7%) patients in the CR group (p = 0.059). Furthermore, 7 (10.9%) patients in the PCR group experienced PJK compared to 14 (21.5%) patients in the CR group after including patients with fusion to the sacrum/pelvis (p = 0.103).

CONCLUSIONS: Lower rates of PJK were observed in the PCR group when compared to the CR cohort. However, this relationship was not statistically significant. Future studies with longer-term follow-up and larger sample sizes are warranted to investigate the relationship between PCR instrumentation and PJK prophylaxis. While PCR technology alone is likely not a definitive solution for preventing PJK, its strength lies in enabling rigorous preoperative planning and thoughtful deformity correction strategies. When integrated into a comprehensive approach to patient optimization, alignment, and junctional control, PCRs may serve as a useful adjunct in mitigating PJK risk.

PMID:42320061 | DOI:10.3171/2026.1.SPINE251110

J Neurosurg Pediatr. 2026 Jun 19:1-10. doi: 10.3171/2026.1.PEDS25486. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the clinical features and surgical complication rates of preterm infants with posthemorrhagic ventricular dilatation (PHVD) who underwent CSF diversion, comparing early intervention (EI) and late intervention (LI).

METHODS: This was a retrospective international multicenter study of infants born at ≤ 34 weeks’ gestational age (GA) and treated between 2018 and 2022 for grade III or IV germinal matrix hemorrhage and intraventricular hemorrhage, who required intervention for PHVD. The primary outcome of interest was the rate of postoperative surgical complications. Secondary outcomes were rate of temporizing neurosurgical procedures (TNPs) after initial lumbar puncture (LP) if performed, rate of conversion from TNP to a ventriculoperitoneal shunt (VPS), and overall rate of VPS insertion. Summary statistics and univariable and multivariable logistic regression were performed to determine variables predictive of complications.

RESULTS: One hundred seventy infants from 6 centers in the United States, Canada, and the Netherlands were included. Infants at LI centers were more premature (GA 26.7 ± 2.8 vs 29.3 ± 2.4 weeks, p < 0.001) with lower birth weights (BWs; 1004 ± 448 vs 1438 ± 462 g, p < 0.001) compared to those at EI centers. The first neurosurgical intervention occurred at a median day of life after birth (DOL) of 31.5 (IQR 24-45) days at LI centers versus 18 (IQR 13-21) days at EI centers (p < 0.001). Ventricular index (> 97th percentile) at the first neurosurgical intervention (TNP and/or VPS placement) was lower at EI centers (5.05 ± 2.32 vs 12.88 ± 5.70 mm, p < 0.001). Infant weight at the first neurosurgical intervention did not differ between site types (p = 0.466). EI centers had a larger proportion of patients who underwent LP (97% vs 58%, p < 0.001) and smaller proportion who required a VPS after TNP (42% vs 70%, p = 0.002). The overall VPS insertion rate was higher at LI centers (62% vs 30%, p < 0.001). There was no statistical difference in the complication rate between EI and LI centers (11% vs 24%, respectively, OR 0.42, 95% CI 0.12-1.24, p = 0.115). On univariable analysis, lower GA (p = 0.002), lower BW (p = 0.003), later DOL at first neurosurgical intervention (p = 0.035), diagnosis of meningitis before neurosurgical intervention (p = 0.047), and of necrotizing enterocolitis (p = 0.017) during the neonatal intensive care unit admission were predictive of complications. However, only lower GA (p = 0.029) and BW (p = 0.031) remained significant on multivariable analysis.

CONCLUSIONS: The neurosurgical complication rate did not differ between EI and LI centers. On multivariable analysis, neurosurgical complications were associated with younger GA and lower BW but not with variables regarding the timing of intervention. These observations support cautious early CSF diversion in more preterm infants with lower BWs.

PMID:42320053 | DOI:10.3171/2026.1.PEDS25486

Am J Clin Pathol. 2026 Jun 4;165(6):aqag040. doi: 10.1093/ajcp/aqag040.

ABSTRACT

OBJECTIVES: Rhino-sino-orbital mucormycosis (RSOM) is a life-threatening, emergent medical and surgical condition with high mortality. Although direct intraorbital delivery methods of amphotericin B have been explored, clear guidelines for its administration and dosing are lacking. We conducted this prospective study to determine the role of intraorbital amphotericin B (IOAB) in the management of advanced RSOM and assessed histologic changes in response to IOAB administration.

METHODS: Patients with advanced orbital disease were offered treatment with IOAB before exenteration. Individuals who refused IOAB and underwent orbital exenteration made up a control group. Hematoxylin-eosin-stained slides of orbital exenterations were reviewed and representative whole slide images were captured. Areas of necrosis, inflammatory cell infiltrate, and fibrosis were annotated as indicators of tissue inflammatory response, quantified and estimated as a percentage of the total area of the tissue. A semiquantitative assessment of fungal load was conducted.

RESULTS: The control group (n = 9) showed statistically significantly greater mean area (P = .004) and percentage area (P = .002) of tissue destruction, angioinvasion (P = .02), and optic nerve invasion (57% vs 33%; P = .31) compared with the intervention group (n = 9). Fungal load was low in test cases but high in most of the control group (P = .15). Inflammation of ocular structures was absent in 5 test cases but present in all control group cases (P = .008).

CONCLUSIONS: The considerably lower tissue destruction, fungal load, angioinvasion, and invasion of the optic nerve in orbital exenteration specimens following administration of IOAB indicates a promising role in the treatment of patients with RSOM and advanced involvement of the orbit.

PMID:42320051 | DOI:10.1093/ajcp/aqag040

J Econ Entomol. 2026 Jun 19:toag154. doi: 10.1093/jee/toag154. Online ahead of print.

ABSTRACT

Diaphorina citri Kuwayama (Hemiptera: Liviidae) vector bacteria (Candidatus Liberibacter asiaticus) that cause huanglongbing, an economically devastating disease of citrus. Management of D. citri infestations is primarily through insecticides, but alternative control methods remain under consideration including the co-opting and disruption of D. citri mating-duet vibrational communication signals. This study applies generative adversarial network and convolutional neural network methods to distinguish among female and male duetting signals when the sex of the signaler is not visually verifiable or when multiple male-female pairs are duetting. Up to 99% accuracy was achieved in identifying D. citri female and male signalers in experiments where standard statistical analyses fail to distinguish them at P < 0.05 statistical significance. Such knowledge has potential to increase mating disruption effectiveness by identifying signals to which females have greater preference. Although these studies were conducted only with D. citri, there is future opportunity to consider interference from communication signals produced when vibrational signals of multiple pest species are present and, combined with Internet of Things (IoT) technological capabilities, to further improve the capability for early detection and management of insect pests.

PMID:42320042 | DOI:10.1093/jee/toag154

Plast Reconstr Surg. 2026 Jun 19. doi: 10.1097/PRS.0000000000013135. Online ahead of print.

ABSTRACT

BACKGROUND: Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes.

PURPOSE: This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures.

METHODS: All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups.

RESULTS: We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 ± 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p ≥ 0.06).

CONCLUSION: The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.

PMID:42320038 | DOI:10.1097/PRS.0000000000013135

JMIR Res Protoc. 2026 Jun 19;15:e86787. doi: 10.2196/86787.

ABSTRACT

BACKGROUND: Language barriers in mental health care can hinder diagnostic accuracy, communication quality, and therapeutic rapport. Multilingual mental health care providers (MHCPs) or qualified interpreters are not always available, prompting interest in mobile translation apps as alternative tools. The usability of such tools in mental health consultations remains underexplored.

OBJECTIVE: This pilot study aims to assess whether a mobile machine translation app can support MHCPs in conducting accurate mental health assessments with patients who speak a different language. Secondary objectives include assessing usability, communication quality, translation accuracy, and nonverbal interaction in a simulated mental health care setting. The feasibility objectives are to examine recruitment, retention, data completeness, time adherence, acceptability, scenario realism, and resource requirements to inform the design of a larger future trial.

METHODS: This is a single-arm, simulation-based, mixed methods pilot study involving 12 German-speaking MHCPs and 2 Turkish-speaking standardized service users. In this study, MHCPs include both fully trained professionals and individuals in advanced training involved in mental health care delivery. Each health care provider will participate in a simulated mental health consultation lasting up to 30 minutes, using the mobile translation app Mabel, which provides real-time translation during multilingual clinical interactions. Data will be collected via video and audio recordings, app use metrics, postsimulation questionnaires, and optional qualitative interviews. Data will be analyzed using descriptive statistics, thematic analysis, and mixed methods triangulation.

RESULTS: As of March 2026, no participants have been enrolled. The pilot study is being conducted within an ongoing Volkswagen Foundation-funded research project. Preparatory work, including scenario development, scoring rubrics, and data collection materials, is at an advanced stage. Recruitment is scheduled to begin in May 2026, with data collection completion anticipated in July 2026. Results will be reported in a future publication.

CONCLUSIONS: This pilot study will provide initial evidence on the usability and feasibility of mobile translation apps in mental health care and inform the design of a larger implementation study.

TRIAL REGISTRATION: OSF Registries osf.io/7r2hn; https://osf.io/7r2hn.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/86787.

PMID:42320032 | DOI:10.2196/86787

JMIR Cardio. 2026 Jun 19;10:e76932. doi: 10.2196/76932.

ABSTRACT

BACKGROUND: Rapid activation of the cardiac catheterization laboratory (CCL) for ST-segment elevation myocardial infarction (STEMI) is essential to minimize time to reperfusion. However, system-wide efforts to reduce treatment delays have been accompanied by increased false activations, defined as activations that do not result in emergent coronary intervention. False activations contribute to unnecessary team mobilization (UTM), staff fatigue, workflow disruption, and inefficient resource use.

OBJECTIVE: This study aimed to evaluate whether the implementation of a cloud-based care coordination platform (Stenoa) was associated with reductions in false activations and UTMs at a high-volume tertiary cardiac center.

METHODS: In September 2021, the McGill University Health Centre implemented Stenoa, a mobile, cloud-based STEMI coordination platform enabling systematic case validation using electrocardiographic and clinical data. A retrospective cohort study was conducted, including all CCL activations between September 2020 and December 2022. Activations were grouped as preimplementation (group 0: September 2020 to September 2021) and postimplementation (group 1: September 2021 to December 2022) periods. A false activation was defined as a CCL activation followed by case cancellation before any procedure was performed. The primary outcome was the rate of UTM.

RESULTS: In total, 632 activations were analyzed (group 0: n=288; group 1: n=344). UTM decreased from 8.7% (23/265) to 4.4% (14/316) following platform implementation (P=.04). False activation frequency decreased from 10.2% (27/265) to 6.9% (22/316), although this difference did not reach statistical significance (P=.16). Among false activations, the proportion resulting in UTM declined from 85% to 63% (P=.08).

CONCLUSIONS: The implementation of a cloud-based STEMI coordination platform was associated with a significant reduction in unnecessary catheterization laboratory team mobilization. Structured digital communication may improve workflow efficiency and resource use in STEMI systems of care. Further multicenter evaluation is warranted.

PMID:42320015 | DOI:10.2196/76932

Anal Chem. 2026 Jun 19. doi: 10.1021/acs.analchem.6c01147. Online ahead of print.

ABSTRACT

Histone post-translational modifications (PTMs) alter chromatin dynamics and contribute to the regulation of gene expression in health and disease, yet mass spectrometry-based histone PTM analysis remains constrained by inefficient sample preparation workflows. Here, we develop RIPUP (Rapid Identification of histone PTMs in Underivatized Peptides), a streamlined multiprotease workflow that reduces sample preparation to hours while improving PTM coverage and quantitative accuracy. Systematic evaluation of Arg-C Ultra and a recombinant (r)-Chymotrypsin protease under varied conditions, including standard derivatization with propionic anhydride and tandem mass tag (TMT) labeling, demonstrated that Arg-C Ultra with TMT labeling achieves a detection of total PTM that exceeds Trypsin-based approaches. Using the HiP-Frag computational framework for unrestrictive PTM identification, we discovered that TMT’s tertiary amine provides charge compensation that rescues the ionization of negatively charged acylations revealing 58 succinylation and 31 glutarylation sites─a “dark epigenome” largely undetected by propionylation-based methods. Complementary digestion with Arg-C Ultra and r-Chymotrypsin provides orthogonal sequence coverage, enabling the detection of PTMs in H2A variants, linker histones, and regions poorly represented by arginine-specific cleavage alone. In HEK293T cells treated with the pan-sirtuin inhibitor nicotinamide, RIPUP quantified 112 statistically significant peptidoforms (adj p < 0.05), predominantly increasing with the NAM dose (88 up, 24 down). Application of RIPUP to frozen-thawed rat hippocampal sections within a 3 h workflow identified >200 PTMs including H3 K27/K36/K37 methylation, H4 N-terminal acetylation patterns, and H2A K118/K119 ubiquitination. This rapid, high-efficiency platform enables timely discovery of epigenetic mechanisms and accelerates the path from PTM identification to therapeutic target validation.

PMID:42319981 | DOI:10.1021/acs.analchem.6c01147