Category: Nevin Manimala

Lasers Med Sci. 2025 Dec 13;40(1):523. doi: 10.1007/s10103-025-04774-4.

ABSTRACT

Onychomycosis is a persistent nail infection often caused by dermatophytes or yeasts, with conventional treatments limited by long durations, poor compliance, and resistance. The long-pulsed Nd: YAG 1064 nm laser (NDYL) has emerged as a potential adjunct; however, its effects in combination with antifungals against yeast-related cases are unclear. This study examined the in vitro synergistic effect of NDYL with four antifungal agents-Ketoconazole (KET), Itraconazole (ITK), Voriconazole (VRC), and Terbinafine(TRB)-on clinical yeasts isolates from patients with onychomycosis. Yeast isolates were identified through ITS PCR sequencing. Susceptibility testing was conducted using the CLSI disk diffusion method (document M44-A2). Two experimental series-vital nail scrapings and cultured colonies-were exposed to standardized NDYL laser parameters. Antifungal activity was assessed by measuring inhibition zone diameters, and statistical comparisons were performed using paired t-tests. NDYL significantly enhanced antifungal activity, with the most pronounced effects observed for KET and ITC (p < 0.05). KET achieved up to 100% sensitivity improvement in nail scraping samples. VRC and TRB demonstrated moderate but consistent enhancements. Recorded irradiation temperatures remained below 42 °C, suggesting primarily non-thermal mechanisms. The relative frequencies of increased inhibition zone diameters in nail scrapings, yeast colonies, and combined datasets were: ITC (83.3%, 50.0%, 66.7%), VRC (66.7%, 50.0%, 58.3%), TRB (33.3%, 16.7%, 25.0%), and KET (100%, 66.7%, 83.3%). These findings support NDYL as a potential adjunctive tool for enhancing antifungal efficacy in yeast-associated onychomycosis. Further in vivo research is warranted to confirm clinical applicability and refine treatment protocols.

PMID:41389091 | DOI:10.1007/s10103-025-04774-4

Eur Radiol. 2025 Dec 13. doi: 10.1007/s00330-025-12165-0. Online ahead of print.

ABSTRACT

Gadolinium-based contrast agents (GBCAs) have been fundamental to head and neck cancer (HNC) imaging, enabling effective detection, characterization, treatment response assessment, and disease progression monitoring of lesions. Additionally, perfusion-weighted imaging (PWI) utilizing dynamic contrast enhancement (DCE) has been evaluated for its ability to provide insights into microvascular parameters concerning blood flow within tumor tissue. Nevertheless, increasing worries regarding gadolinium accumulation within the central nervous system and its effects on the environment have led to a reconsideration of its application. This narrative review explores the current role of GBCAs in HNC imaging, the primary sequences used after GBCA administration, their interpretation, and potential alternative imaging approaches. Currently, GBCA administration is a cornerstone of multiparametric MRI for the diagnosis, staging, and monitoring of HNCs, commonly involving a 3D T1-weighted sequence with fat saturation during the equilibrium phase. While PWI shows potential for clinical application in HNCs, its broader clinical adoption requires further standardization. Notably, DCE can visually aid in detecting subtle tumors, and its application in the differential diagnosis of solid parotid lesions is yielding promising results. Arterial spin labeling is emerging as a compelling alternative for PWI, eliminating the need for GBCA administration. Other promising strategies for reducing or even avoiding GBCA use include hybrid PET/MRI examinations, the development of novel contrast agents (including high-relaxivity GBCAs and gadolinium-free contrast agents), and the implementation of artificial intelligence tools. KEY POINTS: Question When should GBCAs be administered to patients undergoing MRI for HNCs? Findings GBCA injection is a cornerstone of multiparametric MRI for the diagnosis, staging, and monitoring of HNCs. Clinical relevance GBCAs are recommended for HNC MRIs, with a possible exception for patients with no clinical or radiological evidence of recurrence after 27 months of follow-up. DCE is useful for identifying small carcinomas and characterizing parotid lesions.

PMID:41389084 | DOI:10.1007/s00330-025-12165-0

Eur Radiol. 2025 Dec 13. doi: 10.1007/s00330-025-12200-0. Online ahead of print.

ABSTRACT

OBJECTIVES: Coronary artery calcium (CAC) scoring is a well-established marker of atherosclerotic burden in the general population. Limited research has examined CAC progression and clinical implications in heart transplant (HT) recipients. We evaluated CAC progression in HT patients during long-term follow-up.

MATERIALS AND METHODS: We included adult HT recipients (≥ 5 years post-HT) from a retrospective single-center cohort undergoing annual cardiac CT with ≥ 4 years of follow-up. CAC scores were assessed using non-contrast CT. Patients were classified into two groups: no CAC progression (CAC = 0 across all CT scans) or any increase in CAC during follow-up. Generalized linear mixed models evaluated temporal changes in CAC; logistic regression identified variables associated with CAC progression.

RESULTS: Among 116 patients (median age at baseline CT: 52 [38-63] years, 62% male), 65 showed CAC progression. From baseline to final CT, the proportion of patients with cardiac allograft vasculopathy (CAV) score 0 declined (90-83%), while CAV 1 and 3 increased (3-6%; 8-11%). CAC scores showed an annual increase in Ln(CAC + 1) of 0.4 (95% CI: 0.4-0.5; p < 0.001), corresponding to a 55% relative yearly increase. Significant interactions were found with recipient age at baseline CT (p = 0.008), donor heart age (p < 0.001), sex (p = 0.024), and recipient ischemic cardiomyopathy (p < 0.001). Only donor heart age was independently associated with CAC progression (p < 0.001).

CONCLUSION: CAC progression is common post-HT, with donor heart age showing the strongest association. Younger recipient and donor heart age, male sex, and ischemic cardiomyopathy were associated with faster CAC progression, suggesting the need for closer surveillance and more aggressive cardiovascular management.

KEY POINTS: Question Longitudinal changes in CAC score were assessed in HT recipients to provide insights into cardiovascular risk and disease progression. Findings Over half of HT recipients showed CAC progression, which was significantly associated with donor age. Recipient age, sex, and primary diagnosis influenced progression rate. Clinical relevance Routine CAC monitoring may help identify patients at higher risk of cardiovascular events after heart transplantation, allowing for closer surveillance and more aggressive cardiovascular management, which in turn might improve long-term outcomes.

PMID:41389083 | DOI:10.1007/s00330-025-12200-0

JACC Heart Fail. 2025 Dec 11:102841. doi: 10.1016/j.jchf.2025.102841. Online ahead of print.

ABSTRACT

BACKGROUND: The preCARDIA device is a novel intervention designed to mechanically reduce cardiac filling pressures in patients with acute decompensated heart failure (ADHF) by regulating flow through the superior vena cava.

OBJECTIVES: The VENUS-HF Early Feasibility Study (SVC Occlusion in Subjects With Acute Decompensated Heart Failure; NCT03836079) tested the safety and feasibility of the next-generation preCARDIA system, which includes updates to the sheath, catheter, and console.

METHODS: In a multicenter, prospective, single-arm safety and feasibility study, 60 subjects with ADHF received preCARDIA support for up to 24 hours. Primary and secondary endpoints testing the safety and technical feasibility of the device were analyzed.

RESULTS: Freedom from device- or procedure-related major adverse events was observed in 98.3% (n = 59/60), and successful device deployment and removal in all subjects (n = 60/60). No statistically significant difference in major adverse events was observed between recipients of the original (0%, n = 0/30) and newest (3.3%, n = 1/30) generation preCARDIA devices. In subjects with 24 ± 3 hours of preCARDIA duration (n = 52), paired right atrial and pulmonary capillary wedge pressures decreased by 23% (18 ± 6 vs 11 ± 6 mm Hg, P < 0.0001) and 18% (30 ± 8 vs 24 ± 9 mm Hg, P < 0.0001), respectively, from baseline to end of device use. Compared with 24 hours before device initiation, net urine output increased during the 24-hour period during device use (-1.5 ± 0.9 vs -3.4 ± 2.4 L, P < 0.001).

CONCLUSIONS: Use of the preCARDIA system in patients with ADHF was feasible and well tolerated, with early exploratory signals of significantly reduced cardiac filling pressures and increased urine output. These findings provide a foundation for larger, prospective studies, such as the upcoming COR-ADHF (Cardiovascular UnlOading with preCARDIA in Acute Decompensated Heart Failure) trial, to determine clinical efficacy.

PMID:41389079 | DOI:10.1016/j.jchf.2025.102841

J Emerg Nurs. 2025 Dec 12:S0099-1767(25)00471-4. doi: 10.1016/j.jen.2025.11.016. Online ahead of print.

ABSTRACT

Pediatric emergency nurses play a central role in mass casualty incident response, yet persistent gaps in readiness remain. This quality improvement project evaluated baseline mass casualty incident readiness among registered nurses in a large pediatric emergency department and assessed the impact of an educational intervention combining didactic review and simulation-based functional exercises. Using a pre-/postintervention design, nurses completed a readiness survey and participated in timed functional tasks to assess knowledge, confidence, and efficiency. The intervention comprised a didactic review of institutional protocols, a practical review of supply locations, and 30-minute functional simulation drills focused on zone leader responsibilities. A total of 63 nurses completed preassessments, and 64 completed postassessments. After the intervention, 92% accurately identified supply locations, 98% described zone leader roles, and 100% reported feeling at least neutral in preparedness. Knowledge gains in this project were statistically significant (P < .001). The results indicate that structured education combined with simulation improved pediatric emergency nurses’ readiness for mass casualty incidents within this setting. The intervention’s effectiveness was further demonstrated when it was applied successfully during an actual mass casualty incident. Incorporating pediatric-focused mass casualty incident training into ongoing ED education may continue to enhance nurse competence, support team performance, and strengthen institutional disaster preparedness.

PMID:41389075 | DOI:10.1016/j.jen.2025.11.016

Clin Neuropsychol. 2025 Dec 13:1-12. doi: 10.1080/13854046.2025.2601744. Online ahead of print.

ABSTRACT

Objective: Teleneuropsychology (TeleNP) shows promise as an alternative visit type for patients in which face-to-face (FTF) neuropsychological evaluation is not a viable option. Undergoing FTF presurgical deep brain stimulation (DBS) neuropsychological evaluations may represent a hardship for some patients with movement disorders, yet comparison of performance for TeleNP and FTF for the commonly used Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not been studied in this population. The current study aimed to examine RBANS performance of FTF and TeleNP administration in a cohort of movement disorders patients in a clinical setting, hypothesizing similar performance regardless of modality. Method: Four hundred six patients with Parkinson’s disease or essential tremor completed the RBANS between two medical centers between 2020 and 2024 as part of standard clinical care within their presurgical assessment for candidacy for DBS or High-Intensity Focused Ultrasound thalamotomy. Results: The TeleNP sample was significantly older than the FTF sample (p = .02). There were no statistical differences in gender (p = .18) or education (p = .66) between the samples. After controlling for age and motor diagnosis differences between the two groups, 9 of the 11 RBANS subtests were comparable, with the TeleNP group performing significantly better on the Picture Naming subtest and the FTF group performing significantly better on the Figure Recall subtest. The effect size of these differences were small, indicating relatively low clinical meaningfulness. Conclusions: The findings of the current study suggest the two methods of administration were associated with broadly comparable performances in this movement disorder population, suggesting TeleNP may be a viable option for presurgical evaluation.

PMID:41389068 | DOI:10.1080/13854046.2025.2601744

Med Phys. 2025 Dec;52(12):e70191. doi: 10.1002/mp.70191.

ABSTRACT

BACKGROUND: Four-dimensional computed tomography (4DCT) imaging is a crucial component to lung cancer radiotherapy planning and enables CT-ventilation-based functional avoidance planning to mitigate radiation toxicity. However, 4DCT scans are frequently impaired by acquisition artifacts that corrupt downstream analyses that depend on lung segmentation and deformable image registration, such as CT-ventilation and dose accumulation.

PURPOSE: This study develops 3D deep learning models to identify phase-binning artifacts at the voxel level and a heuristic, rule-based method to identify interpolation slices within 4DCT images.

METHODS: We introduce a generator that systematically inserts synthetic phase-binning and interpolation artifacts into any artifact-free breathing phase obtained from nine different clinical 4DCT datasets to produce ground-truth data for (1) training modified nnUNet and SwinUNETR models to detect phase-binning artifacts, and (2) to determine thresholds in the rule-based detection method for interpolation artifacts. The use of multiple datasets incorporates robustness across artifact severities, lung geometries, and cancer progressions.

RESULTS: After training on generated synthetic data and several configurations (region-based learning masks, left-right lung separation), the nnUNet and SwinUNETR models demonstrated state-of-the-art artifact detection accuracy, averaging 0.957 $\pm$ 0.024 (95% CI: [0.956, 0.958]), with an nnUNet configuration achieving the highest averaged accuracy of 0.965, sensitivity of 0.805, and specificity of 0.998 when inferring artifact-affected axial slices from voxel-level predictions. By interpolating and comparing groups of slices, the accuracy, sensitivity, and specificity of the proposed interpolation detection method is 0.97, 0.97, and 0.97 on manually labeled true artifact cases. We propose a localized artifact correction method that simply replaces the predicted artifact-affected voxels with the average surrounding lung intensity value, resulting in 65% of lung segmentation masks with Dice scores greater than 0.95 (opposed to 11% of cases before correction) when applying an automatic segmentation tool and within a tight artifact-bound region. When applied to 1989 cases with true artifacts, SwinUNETR configurations tend to be more generalizable despite marginally lower performance on synthetic artifacts. We quantify this performance without ground-truth artifact masks by statistically comparing artifact properties of detected synthetic and true cases.

CONCLUSIONS: We demonstrate state-of-the-art artifact detection accuracy using 3D deep learning models trained on synthetic data and a rule-based approach configured on true data, providing interpretability by highlighting which voxel locations indicate a slice is artifact-affected. The SwinUNETR model accuracy and fast run-time have the potential to enable more targeted artifact correction methods or signal an imaging technologist when to re-scan a patient in real-time.

PMID:41389065 | DOI:10.1002/mp.70191

Neuromodulation. 2025 Dec 13:S1094-7159(25)01150-X. doi: 10.1016/j.neurom.2025.11.006. Online ahead of print.

ABSTRACT

OBJECTIVES: Deep brain stimulation (DBS) is increasingly being used to treat a variety of neuropsychiatric conditions, many of which exhibit idiosyncratic symptom presentations and neural correlates across individuals. Thus, we have used inpatient stereoelectroencephalography (sEEG) to identify personalized therapeutic stimulation sites for long-term implantation of DBS. Informed by our experience, we have developed a statistics-driven framework for stimulation testing to identify therapeutic targets.

MATERIALS AND METHODS: Fourteen participants (major depressive disorder = 6, chronic pain = 6, obsessive-compulsive disorder = 2) underwent inpatient testing using sEEG and symptom monitoring to identify personalized stimulation targets for subsequent DBS implantation. We present a structured approach to this sEEG testing, integrating a Stimulation Testing Decision Tree with power analysis and effect size considerations to inform adequately powered results to detect therapeutic stimulation sites with statistical rigor.

RESULTS: Effect sizes (Hedges’ g) of stimulation-induced symptom score changes ranged from -1.5 to +2.39. The SD of sham trial responses was a strong predictor of stimulation response variability, as confirmed by a leave-one-out cross-validated linear regression (R² = 0.67, permutation p < 0.001). Thus, early sham trial data could be used to estimate the variability of stimulation responses for power analysis calculations. We show that approximately ten sham trials were needed to robustly estimate sham variability. Power analysis (using a paired t-test) showed that for effect sizes ≥1.1, approximately ten trials should be used per stimulation site for sufficiently powered results.

CONCLUSIONS: The presented workflow is adaptable to multiple indications and is specifically designed to overcome key challenges experienced during stimulation site testing. Through incorporating sham trials, effect size calculations, and tolerability testing, the described approach can be used to identify personalized and clinically efficacious stimulation sites.

PMID:41389045 | DOI:10.1016/j.neurom.2025.11.006

J Hosp Med. 2025 Dec 13. doi: 10.1002/jhm.70245. Online ahead of print.

ABSTRACT

BACKGROUND: Left atrial enlargement (LAE) is predictive of cardiovascular morbidity and mortality. Prior studies of point-of-care ultrasound (POCUS) interpretation methods for identifying LAE utilized older echocardiographic reference ranges.

OBJECTIVES: Compare the test characteristics of hospitalist-performed POCUS techniques for identifying LAE as compared to contemporary echocardiographic reference ranges.

METHODS: Fully paired, comparative diagnostic accuracy study of two index tests applied to archived echocardiogram images: visual assessment of the left atrium to aorta diameter (LAE sign) and left atrial (LA) anteroposterior diameter >4 cm in the parasternal long axis view. The reference test was moderate to severe LAE by echocardiography-derived left atrial volumetric index.

RESULTS: After exclusion criteria, 239 of 321 (74.5%) exams were included. The LAE sign had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 67.5%, 71.4%, 32.1%, and 91.6%. LA diameter of >4 cm had a sensitivity, specificity, PPV, and NPV of 87.5%, 75.9%, 42.2%, and 96.8%. The difference in sensitivity (p = .005) and specificity (p = .049) between the index tests was statistically significant. The diameter measurement had better positive and negative likelihood ratios (LR + 3.63, LR-0.16) than the LAE sign (LR + 2.36, LR- 0.46).

CONCLUSIONS: Both POCUS techniques for diagnosing LAE performed reasonably well compared to current echocardiographic reference ranges, with LA diameter >4 cm having better sensitivity and specificity than visual estimation of the LAE sign. These tests can help identify patients at risk for cardiovascular disease who may benefit from echocardiogram referral.

PMID:41389028 | DOI:10.1002/jhm.70245

J Med Internet Res. 2025 Dec 12. doi: 10.2196/84393. Online ahead of print.

ABSTRACT

BACKGROUND: Cisgender lesbian, bisexual, and queer (LBQ+) women of color (WOC) experience barriers to accessing sexual and reproductive health (SRH) services in the United States (US). Barriers, including limited provider access and poor patient-provider communication, contribute to underutilization of SRH services and poorer outcomes compared to heterosexual counterparts. Digital health modalities, including telemedicine, mobile health, and artificial intelligence (AI)-enabled chatbots, offer potential to expand access to SRH information and services among LBQ+ WOC.

OBJECTIVE: This study investigated current use, influencing factors, acceptability, and concerns regarding digital health modalities (video calls, SMS text messaging, mobile apps) and AI-enabled chatbots to support SRH information and service access among LBQ+ WOC in the US. It also assessed awareness and knowledge of HPV and cervical cancer prevention, and attitudes toward HIV prevention medication.

METHODS: A self-administered online survey was conducted from November 2020 to March 2021 with 285 LBQ+ WOC (aged ≥18 years) residing in the US. The 88-item survey assessed digital health use, SRH knowledge and awareness, and acceptability of and concerns about digital health use for SRH information and services. Data were analyzed using descriptive statistics, Fisher’s exact tests, multivariable logistic regression, and thematic analysis.

RESULTS: Most respondents were comfortable using video calls (81.8%) to communicate with a healthcare provider for SRH support. Respondents with a bachelor’s degree or higher (95% CI 0.00-0.24, P < .001), with health insurance (95% CI 56.1-1025.7, P < .001), and without a usual place of care (95% CI 0.07-0.43, P < .001) were significantly more likely to agree with using video calls. Respondents with a bachelor’s degree or higher (95% CI 0.23-0.74, P < .001), aged <45 years (95% CI 0.07-0.25, P < .001), and with health insurance (95% CI 3.23-12.45, P < .001) were significantly more likely to agree with using a mobile app. Respondents ≥45 years (95% CI 0.14-0.53, P < .001), without health insurance (95% CI 0.01-0.06, P < .001), and with an income < $49,000 (95% CI 1.32-3.93, P < .001) were significantly more likely to agree with the use of SMS text messaging. High acceptance was reported for using chatbots to self-assess risk for sexually transmitted infections (80.3%), but lower acceptance for self-assessing cervical cancer risk (47.8%). Key concerns included data privacy and confidentiality, lack of affective communication, and technology connectivity and digital literacy issues. Respondents also demonstrated low knowledge of HPV and cervical cancer prevention.

CONCLUSIONS: Digital health was highly acceptable for supporting access to SRH information and services among LBQ+ WOC. Culturally tailored, digital tools and interventions could improve awareness, knowledge, and attitudes toward SRH services. Addressing varying levels of digital literacy, concerns about data privacy, technology access, and affective communication when developing digital health solutions may help to advance SRH equity among LBQ+ WOC.

PMID:41388972 | DOI:10.2196/84393