Nevin Manimala

Laryngoscope. 2025 Sep 18. doi: 10.1002/lary.70149. Online ahead of print.

ABSTRACT

OBJECTIVE: Intralesional steroid injections for vocal fold (VF) scarring are rapidly cleared, limiting their effectiveness. This study evaluates the efficacy of a light-activatable dexamethasone implant compared to a single steroid injection for VF scar healing.

METHODS: Ten rabbits underwent endoscopic VF injury and were treated with either a dexamethasone injection or a light-activatable implant; injured-only and no-injury VFs served as controls. On days 0 and 21, VF implants were irradiated with a near-infrared pulsed laser for 1 min. Larynges were harvested after 42 days. High-speed video (> 10 kHz) of excised larynges captured VF vibrations for kymographic analysis. Normal force, structural stiffness, and displacement were measured. Data were analyzed with appropriate statistical tests.

RESULTS: Compared to injury-only VFs, implant-treated VFs demonstrated significantly reduced normal force and stiffness (5.28 ± 0.77 mN vs. 2.34 ± 0.66 mN, p < 0.0001; 17.74 ± 2.45 mN/mm vs. 6.80 ± 1.32 mN/mm, p < 0.0001), and increased displacement at 1.96 mN (0.14 ± 0.02 mm vs. 0.29 ± 0.05 mm, p < 0.0001) along the injury zone. Implant-treated VFs exhibited larger amplitude ratios and improved tissue architecture than untreated scars. No differences in quantitative measures were observed between implant-treated and injection-treated groups.

CONCLUSION: A light-activatable dexamethasone implant improved VF biomechanics, vibratory behavior, and histological outcomes in a rabbit injury model comparable to a single steroid injection. This novel approach shows promise for delivering controlled, repeatable therapy to VF scars.

PMID:40964826 | DOI:10.1002/lary.70149

Hand (N Y). 2025 Sep 18:15589447251371089. doi: 10.1177/15589447251371089. Online ahead of print.

ABSTRACT

BACKGROUND: The use of large language models (LLMs) such as ChatGPT and Gemini in clinical settings has surged, presenting potential benefits in reducing administrative workload and enhancing patient communication. However, concerns about the clinical accuracy of these tools persist. This study evaluated the concordance of ChatGPT and Gemini’s recommendations with American Academy of Orthopedic Surgeons (AAOS) clinical practice guidelines (CPGs) for carpal tunnel syndrome, distal radius fractures, and glenohumeral joint osteoarthritis.

METHODS: ChatGPT (version 4o) and Gemini (version 1.5 Flash) were queried using structured text-based prompts aligned with AAOS CPGs. The LLMs’ outputs were analyzed by blinded reviewers to determine concordance with the guidelines. Concordance rates were compared across models, topics, and guideline strength using descriptive statistics and McNemar’s test. The transparency of responses, including source citation, was also assessed.

RESULTS: A total of 174 recommendations were generated, with an overall concordance rate of 62.1%. When comparing concordance rates between LLMs, there was no statistically significant difference between ChatGPT and Gemini (66.7% vs 57.5%, P = .131). Concordance varied by topic and guideline strength, with ChatGPT performing best for moderately supported guidelines. Both models demonstrated low citation transparency. Gemini provided sources for 39.1% of recommendations, significantly more than ChatGPT’s 3.5% (P < .0001).

CONCLUSIONS: Despite modest concordance rates, both models exhibited significant limitations, including variability across topics and guideline strengths, as well as insufficient citation transparency. These findings highlight the challenges in integrating LLMs into clinical practice and emphasize the need for further refinement and evaluation before adoption in hand surgery.

PMID:40964819 | DOI:10.1177/15589447251371089

J Biol Dyn. 2025 Dec;19(1):2548493. doi: 10.1080/17513758.2025.2548493. Epub 2025 Sep 18.

ABSTRACT

Chemical control is crucial in pest management, but delayed responses to pesticide application can significantly affect its success. This study develops a type of novel mathematical models combining delayed impulse differential equations with pulse pesticide spraying to evaluate these delayed effects. The uniform stability of the pest eradication solution is analysed, and key parameters influencing pest control success are explored. Considering delays in both pest population growth reaching environmental capacity and pesticide response, a double delayed impulse differential equation is formulated. The asymptotic stability and exponential stability of the system are studied, and threshold conditions for pest extinction are identified. The findings help optimize pest control strategies under delayed pesticide responses.

PMID:40964803 | DOI:10.1080/17513758.2025.2548493

J Am Chem Soc. 2025 Sep 18. doi: 10.1021/jacs.5c10140. Online ahead of print.

ABSTRACT

The chemical stability of charged molecules in all-organic redox flow batteries (RFBs) is required for the prolonged operation of these devices. Molecular engineering and electrolyte optimization are used to mitigate parasitic reactions and extend the lifetimes of the charge carriers. However, how much can structural variation extend the lifetime? To probe this query, we designed a high-throughput kinetic study of the radical cation of N-methylphenothiazinium, guided by statistical sampling and learning algorithms. Using Argonne’s autonomous discovery facility, we conducted over 6,000 kinetic experiments with robotic sample preparation, parallel kinetic measurements, and machine learning inputs, testing 188 solvent molecules selected from a space of over 540 candidates from 11 chemical classes. Algorithmic selections guided us to stable solvent candidates, which were further tested in high concentration with and without supporting electrolyte. Our findings reveal the inherent difficulty of exceeding the current state of the art through solvent variation. The desired stability is statistically rare and poorly predictable. Among the many tested, only three solvents significantly outperformed our baseline, acetonitrile─and none by more than a factor of 3─suggesting a general challenge in achieving the necessary techno-economic targets. We suggest that self-discharge through solvent homolysis is the cause of the observed limitations. Several structural motifs contribute to >1,000 h half-life stability including molecular simplicity, symmetry, oxidation complement, and strategic fluorination. Importantly, this workflow establishes effective assays for diagnosing and predicting oxidative stress for highly stable liquid electrolytes in all batteries.

PMID:40964797 | DOI:10.1021/jacs.5c10140

Monaldi Arch Chest Dis. 2025 Sep 17. doi: 10.4081/monaldi.2025.3363. Online ahead of print.

ABSTRACT

Tuberculosis is a global healthcare concern, being the leading infectious cause of mortality by a single infectious agent. India bears the highest burden of tuberculosis. Disease outcome is an important indicator for the successful implementation of the National Program. Risk factors associated with unsuccessful outcomes must be identified, and differential care must be provided to those with risk factors. The study included all pulmonary tuberculosis patients registered from 1st October 2022 to 30th September 2023 at the Directly Observed Therapy Short Course Center, Dr. BR Ambedkar State Institute of Medical Sciences, Mohali, who received treatment. Data was collected from the Nikshay portal retrospectively. Out of 1103, 575 (52.13%) patients were declared cured, whereas 452 (40.97%) were declared treatment completed. A total of 19 (1.72%) pulmonary tuberculosis patients died during treatment, and 57 (5.16%) were declared failures. Advanced age [adjusted odds ratio (AOR) 4.028, 95% confidence interval (CI): 1.368-4.610, p=0.003], people living with HIV (AOR 0.185, 95% CI 0.031-1.082, p=0.05) and male gender (crude OR 1.611, 95% CI: 0.371-1.006, p=0.050) were associated with poor outcomes. Diabetes, retreatment, microbiological confirmation, and low body mass index were not statistically significant in the study. Age above 45 years, male sex, and HIV co-infection are determinants for unsuccessful treatment outcomes in patients with pulmonary tuberculosis.

PMID:40964790 | DOI:10.4081/monaldi.2025.3363

Int J Clin Pharmacol Ther. 2025 Sep 18. doi: 10.5414/CP204790. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the colonization rate of group B Streptococcus (GBS) during the second trimester of pregnancy, the correlation between GBS infection and miscarriage as well as the impact of intervention on pregnancy outcomes.

MATERIALS AND METHODS: 228 GBS-positive pregnant women at 14 – 28 weeks of gestation were divided into 3 groups according to their preferences to receive medical intervention: group A (antibiotic group, n = 54) received oral antibiotic, group B (probiotic group, n = 96) received oral probiotic, and group C (non-intervention group, n = 78) received no drug treatment. 300 GBS-negative pregnant women were selected voluntarily and randomly as the control group (group D). The incidence of miscarriage-related conditions, negative conversion rate of GBS were compared between the 4 groups. Perinatal outcomes were compared between the GBS persistent positive and negative groups.

RESULTS: GBS colonization rate was 14.7%. The incidence of threatened miscarriage and miscarriage in group A were 1.85 and 1.85%, both of which were lower than those in group B at 21.9 and 6.3%, and group C at 33.3 and 7.7%, with all differences being statistically significant (p < 0.05). The incidence of threatened miscarriage and miscarriage in group B and group C were significantly higher than those in group D at 3.3 and 2.7% (p < 0.05). The negative conversion rate of GBS in group A was significantly higher than that in group C (14.8 vs. 2.7%, p < 0.05). There was a difference in the incidence of fetal distress, premature delivery, premature rupture of the fetal membrane, chorioamnionitis, and neonatal infection between the continuously positive and negative pregnant women (p < 0.05).

CONCLUSION: GBS colonization rate was 14.7% in the second trimester of pregnancy. GBS infection can increase the risk of threatened miscarriage and miscarriage as well as the risk of adverse pregnancy outcomes. Early intervention with antibiotics can increase the negative conversion rate of GBS, reduce the incidence of threatened miscarriage and miscarriage, and ameliorate the adverse outcome of pregnancy. The effect of probiotic intervention on the negative conversion of GBS was insignificant.

PMID:40964782 | DOI:10.5414/CP204790

Clin Nephrol. 2025 Sep 18. doi: 10.5414/CN111796. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to evaluate the anxiety and depression domains of patients with primary glomerulopathies from the patients’ perspective via patient-reported outcome measurements and to identify the factors associated with worse scores.

MATERIALS AND METHODS: This was a cross-sectional study involving 46 patients in which a patient-reported outcome measurement instrument was applied to evaluate the domains of anxiety and depression in patients with primary glomerulopathies. Exploratory univariate statistical analyses were performed, followed by multiple linear regression analyses.

RESULTS: 46 patients participated in the study. The mean age was 38.5 ± 16.4 years. The anxiety T score was 58.6%, and the depression T score was 54.7%. Female patients had worse anxiety scores (p = 0.044) and depression scores (p = 0.040). Patients under 60 years of age had worse anxiety scores (p = 0.041). A lower educational level was related to a worse depression score (p = 0.010). The concomitant presence of diabetes mellitus and a diagnosis time ≥ 9 months were associated with worse anxiety scores (p = 0.015 and p = 0.014) and depression (p = 0.012 and p = 0.007).

CONCLUSION: Patients with primary glomerulopathies have more anxiety and depression, and the variables associated with worse scores are female sex, age under 60 years, lower educational level, time since diagnosis, and diabetes mellitus.

PMID:40964780 | DOI:10.5414/CN111796

Histopathology. 2025 Sep 18. doi: 10.1111/his.15561. Online ahead of print.

ABSTRACT

AIMS: Vulvar squamous cell carcinoma (VSCC) is classified into human papillomavirus (HPV)-associated and HPV-independent types, primarily using p16 immunohistochemistry, with p53 staining playing a complementary role since a subset of HPV-independent VSCC is driven by TP53 mutations. We aimed to assess the robustness of the six-pattern p53 classification by evaluating interobserver agreement and mapping pattern distribution in relation to p16 status.

METHODS: We performed p53 immunohistochemistry on 1293 VSCC cases, comprising 832 p16-negative and 461 p16-positive cases. Eight pathologists independently evaluated p53, with each case assessed by two pathologists. Expression was classified as wild-type (scattered or mid-epithelial) or mutated (basal overexpression, parabasal/diffuse overexpression, absent or cytoplasmic). Interobserver agreement was measured using kappa statistics.

RESULTS: Overall concordance across the six p53 patterns was 66.7%, increasing to 86.9% when dichotomized as wild-type versus mutated. In the p16-negative cases, concordance was 68.8% across all six patterns and 82.6% when dichotomized. Corresponding rates in the p16-positive cases were 62.9% and 94.6%. Kappa values for pairwise assessments ranged from 0.44 to 0.73 (six-pattern) and from 0.60 to 0.88 (dichotomized). After resolving discordant cases, 79.9% of p16-negative cases showed a mutated pattern, and 20.1% were wild type (scattered). Among the p16-positive cases, 93.1% exhibited a wild-type pattern.

CONCLUSIONS: Findings support the clinical robustness of the six-pattern p53 framework, as interobserver agreement was high and most discrepancies were unlikely to impact tumour classification. While p16 proved helpful in p53 interpretation, certain cases remained challenging due to p53 heterogeneity or ambiguous p16/p53 combinations indicating a need for additional molecular testing in such instances.

PMID:40964778 | DOI:10.1111/his.15561

Histopathology. 2025 Sep 18. doi: 10.1111/his.15554. Online ahead of print.

ABSTRACT

AIMS: Endoscopic mucosal resection (EMR) is widely used for treating Barrett’s-related oesophageal dysplasia and low-stage carcinoma. Disease can recur after this procedure. We analysed a large cohort of EMR specimens to assess clinical and histopathologic factors and their relationship to recurrence.

METHODS AND RESULTS: We conducted a retrospective study of 129 patients who had in total 290 oesophageal EMRs for glandular neoplasia. Patient age, patient sex, specimen fragmentation, intestinal metaplasia, highest-grade lesion, margin status and clearance, cancer invasion depth, lymphovascular invasion, tumour budding (using published guidelines for colorectal carcinoma), post-procedure cryoablation/radiofrequency ablation and disease recurrence were recorded. Statistical analyses were performed on 227 eligible cases to determine the significance of these factors in local disease recurrence. Adenocarcinoma was the highest-grade lesion in 42% of the 290 specimens, high-grade dysplasia in 36% and low-grade dysplasia in 22%. Mean age at first EMR was 66 years. Among the 227 statistically analysed cases, post-procedure ablation was performed for 111 (49%) and recurrence of same or worse disease was documented in 104 (46%). Tumour depth and budding did not affect recurrence risk. On multivariate analysis, lack of post-procedure ablation was associated with increased recurrence risk for high-grade dysplasia and carcinoma. Additionally, poor differentiation and margin status were associated with increased recurrence risk for specimens with carcinoma. These relationships mostly held true for recurrence of same/worse neoplasia or recurrence of any neoplasia.

CONCLUSIONS: Differentiation, margin status and post-EMR ablation influence the risk of local disease recurrence for Barrett’s-related adenocarcinoma, while other factors such as tumour budding and lesional depth do not.

PMID:40964766 | DOI:10.1111/his.15554

Indian J Public Health. 2025 Sep 17. doi: 10.4103/ijph.ijph_240_24. Online ahead of print.

ABSTRACT

INTRODUCTION: The first case of measles outbreak in Pune was reported on November 14, 2022; since then, there were a total of 266 cases from Pune Municipal Corporation (PMC).

OBJECTIVE: The objective is to find out risk factors associated with measles during an outbreak in Pune city.

METHODS: This was a 1:1 unmatched case-control study conducted from February 2023 to September 2023 in PMC. Cases were immunoglobulin M-positive laboratory-confirmed measles cases and a control was any child who did not have any rash in the study period and not living in the same household with a case. Face-to-face interview of cases and controls were carried out by visiting houses to obtain information on sociodemographic characteristics and immunization history, including Vitamin A supplementation. The sample size was 200.

RESULTS: There was a statistically significant difference among the mean age of cases (53.18 ± 18.08) and controls (30.08 ± 18.08). Father’s and mother’s education, immunization, and Vitamin A supplementation were also significant. Those who had not received any dose of measles-rubella (MR) vaccine had a higher chance of having infection with an odds ratio of 3.093 (95% confidence interval [CI]: 2.37-4.037) and those who were partially immunized with 1 dose of MR showed odds ratio of 2.027 (95% CI: 1.328-3.096) for having measles infection. COVID-19 lockdown was the reason given by majority (29.3%) for unimmunized of the measles vaccine.

CONCLUSIONS: In this study, the main cause of this measles outbreak was under immunization. It is important to maintain high levels of under 5 immunization even during emergencies to prevent future measles outbreaks.

PMID:40964759 | DOI:10.4103/ijph.ijph_240_24