Category: Nevin Manimala

Pediatr Res. 2025 Jul 1. doi: 10.1038/s41390-025-04214-7. Online ahead of print.

ABSTRACT

BACKGROUND: Community-acquired pneumonia (CAP) is a common infectious disease with a mortality rate of 2-14%. Respiratory syncytial virus (RSV) frequently causes CAP in children. This study aimed to investigate RSV genetic diversity in children under 15 years of age with CAP, evaluate nucleotide substitution rates, and examine associations with clinical characteristics and outcomes.

METHODS: A retrospective observational study was conducted using nasal swab samples collected from children under 15 years of age diagnosed with CAP. RSV identification involved cell culture and immunofluorescence microscopy, followed by molecular analyses using qPCR, nested PCR, and Sanger sequencing. Bioinformatics tools were applied to assess phylogenetics, evolutionary trends, genetic distance, and nucleotide substitution rates. Statistical analysis of clinical and laboratory data was performed to identify correlations between RSV features and patient characteristics.

RESULTS: Among 346 CAP cases, RSV was detected in 26.88%, with the highest prevalence in children aged 1-2 years. Subtype A exhibited higher nucleotide substitution rates than subtype B. Shortness of breath and high fever were significantly associated with increased nucleotide diversity. RSV infections peaked in winter, particularly in 2018 and 2019. Elevated substitution rates were linked to longer hospital stays, greater risk of complications such as secondary bacterial infections, and increased RSV-related morbidity.

CONCLUSION: RSV higher nucleotide substitution rates, especially in children under 3 years of age, were associated with more severe clinical outcomes and prolonged hospitalization. Phylogenetic analysis indicated distinct evolutionary patterns, with subtype B exhibiting a more rapid evolutionary rate than subtype A.

IMPACT: This study highlights the high prevalence of respiratory viruses, particularly respiratory syncytial virus (RSV), in children with community-acquired pneumonia in Guangzhou. It provides detailed molecular epidemiological data on RSV, including genetic variation patterns and evolutionary rates. The findings contribute regional data essential for epidemiological research and public health planning in similar geographic areas. These results support clinical decision-making and inform public health strategies, particularly those focused on RSV vaccination and infection control.

PMID:40593188 | DOI:10.1038/s41390-025-04214-7

Sci Rep. 2025 Jul 1;15(1):21239. doi: 10.1038/s41598-025-06116-4.

ABSTRACT

The zero-inflated negative binomial regression (ZINBR) model is used for modeling count data that exhibit both overdispersion and zero-inflated counts. However, a persistent challenge in the efficient estimation of parameters within ZINBR models is the issue of multicollinearity, where high correlations between predictor variables can compromise the stability and reliability of the maximum likelihood estimator (MLE). We propose a new two-parameter hybrid estimator, designed for the ZINBR model, to address this problem. This estimator aims to mitigate the effects of multicollinearity by incorporating a combination of existing biased estimators. To test the effectiveness of the proposed estimator, we conduct a comprehensive theoretical comparison with conventional biased estimators, including the Ridge and Liu, the Kibria-Lukman, and the modified Ridge estimators. An extended Monte Carlo simulation study complements the theoretical results, evaluating the estimator’s performance under various multicollinearity conditions. The simulation results, evaluated by metrics such as mean squared error (MSE) and mean absolute error (MAE), show that the proposed hybrid estimator consistently outperforms conventional methods, especially in high multicollinearity. Furthermore, we apply it to two real-world datasets. The experimental application demonstrates the superior performance of the estimator in producing stable and accurate parameter estimates. The simulation study and experimental application results strongly suggest that the new two-parameter hybrid estimator offers significant progress in parameter estimation in ZINBR models, especially in complex scenarios due to multicollinearity.

PMID:40593177 | DOI:10.1038/s41598-025-06116-4

Sci Rep. 2025 Jul 1;15(1):20567. doi: 10.1038/s41598-025-06046-1.

ABSTRACT

To observe the efficacy and safety of Ripertamab in the treatment of Idiopathic Membranous Nephropathy (IMN). Clinical data from patients with IMN treated with Ripertamab or Rituximab were retrospectively collected from six tertiary hospitals in Jilin Province between January and December 2023. Patients were grouped based on treatment regimen into the Ripertamab and Rituximab groups and matched 1:1 by age and gender. Follow-ups were conducted over six months to assess baseline characteristics, laboratory parameters, and adverse reactions related to anti-CD20 monoclonal antibody therapy. A total of 112 patients with IMN were identified, including 52 treated with Ripertamab and 60 with Rituximab. After matching, 40 patients were included in each group. Baseline clinical characteristics were comparable between the groups (P > 0.05). There was no statistically significant difference in efficacy between the two groups (P > 0.05). At 6 months, the overall effectiveness rate of Ripertamab in the treatment of IMN was 65.0%, of which the partial and complete remission rates were 50.0% and 15.0%, respectively. The overall effectiveness rate of Rituximab was 60.0%, of which the partial and complete remission rates were 47.5% and 12.5%, respectively. Similarly, there were no significant differences in the incidence of infusion reactions, pulmonary infections, interstitial lung disease, HBV reactivation, neutropenia, or thrombocytopenia (P > 0.05). Ripertamab demonstrates a therapeutic efficacy comparable to Rituximab for IMN, with a similar incidence of infusion-related adverse reactions and complications.

PMID:40593173 | DOI:10.1038/s41598-025-06046-1

Eur Radiol. 2025 Jul 2. doi: 10.1007/s00330-025-11754-3. Online ahead of print.

ABSTRACT

OBJECTIVES: Coronary computed tomography angiography (CCTA) is highly effective for detecting coronary artery disease (CAD) but cannot assess its hemodynamic significance, often requiring additional tests. This study evaluates the clinical performance and cost-effectiveness of integrating dynamic myocardial CT perfusion (DynCTP) into the assessment of symptomatic patients with suspected CAD or prior chronic coronary syndrome (CCS).

MATERIALS AND METHODS: We conducted a single center, retrospective study comparing two matched cohorts. In the first cohort patients underwent CCTA followed by non-CT-based functional tests, while in the second cohort DynCTP was included for cases of potential functionally significant CAD. The study analyzed the number of additional tests, diagnostic process duration, and the incidence of major adverse cardiovascular events. A probabilistic cost analysis was performed to evaluate the economic impact.

RESULTS: A total of 205 patients were included, 71% of whom were male, with a mean age of 72.5 ± 10 years. Over a follow-up of 30 months, the CCTA+DynCTP cohort showed a 56% reduction in additional tests and 45% in time to clinical decision-making, with a higher proportion of patients requiring only the initial study. No significant differences were observed in the number of invasive coronary angiograms or major adverse clinical events, although an increase in overall healthcare costs was documented.

CONCLUSION: Integrating DynCTP into the evaluation of symptomatic patients with suspected CAD or prior CCS streamlines the diagnostic process compared to a strategy based on CCTA and other functional tests, reducing time and additional testing without increasing adverse outcomes, although it is associated with slightly higher healthcare costs.

KEY POINTS: Question Evaluating the hemodynamic significance of coronary artery stenosis identified by coronary CT angiography is important to determine the best treatment strategy, but requires complementary tests. Findings DynCTP reduced the time to clinical decision-making and the need for additional testing without increasing major adverse cardiovascular events. Clinical relevance The integration of DynCTP safely streamlines the diagnostic process of CAD compared to a strategy based on CCTA and additional functional tests.

PMID:40593171 | DOI:10.1007/s00330-025-11754-3

Eur Radiol. 2025 Jul 1. doi: 10.1007/s00330-025-11648-4. Online ahead of print.

ABSTRACT

Early detection of lung cancer through low-dose CT lung cancer screening in a high-risk population has proven to reduce lung cancer-specific mortality. Nodule management plays a pivotal role in early detection and further diagnostic approaches. The European Society of Thoracic Imaging (ESTI) has established a nodule management recommendation to improve the handling of pulmonary nodules detected during screening. For solid nodules, the primary method for assessing the likelihood of malignancy is to monitor nodule growth using volumetry software. For subsolid nodules, the aggressiveness is determined by measuring the solid part. The ESTI-recommendation enhances existing protocols but puts a stronger focus on lesion aggressiveness. The main goals are to minimise the overall number of follow-up examinations while preventing the risk of a major stage shift and reducing the risk of overtreatment. KEY POINTS: Question Assessment of nodule growth and management according to guidelines is essential in lung cancer screening. Findings Assessment of nodule aggressiveness defines follow-up in lung cancer screening. Clinical relevance The ESTI nodule management recommendation aims to reduce follow-up examinations while preventing major stage shift and overtreatment.

PMID:40593170 | DOI:10.1007/s00330-025-11648-4

Eur Radiol. 2025 Jul 1. doi: 10.1007/s00330-025-11647-5. Online ahead of print.

ABSTRACT

The European Society of Thoracic Imaging (ESTI) nodule management recommendation for lung cancer screening with low-dose CT builds on existing nodule management guidelines but puts a stronger focus on lesion aggressiveness and measurement error. Key objectives included finding a compromise between the overall number of follow-up examinations, avoiding a major stage shift, and reducing the risk for overtreatment. Nodule management categories at baseline are chosen depending on the size of a solid nodule or the solid component of a subsolid or cystic nodule, with suspicious morphology upgrading risk to the next higher category. Higher risk categories mandate shorter follow-up times or diagnostic workup. Volume is the preferred size measure, with diameter measurements as a fallback if segmentation for volumetry is inaccurate at visual control. Nodule aggressiveness at follow-up is estimated from growth rate, calculated as volume doubling time (VDT), or yearly diameter change. Calculation of growth rate, however, is strongly affected by measurement variability, with large error margins for short follow-up and slower growing lesions. Growth thresholds were therefore set so that rapidly growing lesions can be identified while still small, while unnecessary workups for benign or slow-growing lesions could be kept low. New lesions that are retrospectively visible on earlier scans are managed according to their growth rate. New nodules not visible on earlier scans are followed after 3 months if they have a volume of ≥ 30 mm³. KEY POINTS: Question This work strives to reduce follow-up examinations while preventing major stage shift and overtreatment. It provides nodule management based on estimated nodule aggressiveness. Findings Calculation of the growth rate of pulmonary nodules is strongly affected by measurement variability, with large error margins for short follow-up and slower growing lesions. Clinical relevance Growth thresholds that trigger management are adjusted to the follow-up time so that rapidly growing lesions can be identified while still being small while unnecessary workups for benign or slow-growing lesions can be reduced.

PMID:40593169 | DOI:10.1007/s00330-025-11647-5

Eur Radiol. 2025 Jul 1. doi: 10.1007/s00330-025-11787-8. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of preoperative contrast-enhanced cone-beam breast CT (CE-CBBCT) and identify significant predictors of nipple-areolar complex (NAC) involvement in early-stage breast cancer patients.

MATERIALS AND METHODS: This retrospective study included 641 breast cancer cases from 631 patients at Sun Yat-sen University Cancer Center (2019.3-2021.3). From these, 182 cases were selected after one-by-one matching with the NAC involvement group using the propensity score matching method. Two radiologists independently assessed CE-CBBCT imaging factors in 182 cases. Diagnostic performance indices were analyzed, and predictors of NAC involvement in breast cancer were identified using logistic regression analyses.

RESULTS: The 182 matched cases were females with a median age of 50 (interquartile range, 44-55; range, 25-81 years). Interobserver agreement regarding CBBCT prediction by two radiologists was relatively substantial (κ = 0.730). The accuracy of radiologists in predicting NAC involvement in CE-CBBCT was 83.52% (152/182), with a sensitivity of 96.70% (88/91), specificity of 70.33% (64/91), negative predictive value of 95.52% (64/67), and positive predictive value (PPV) of 76.52% (88/115). On CE-CBBCT, asymmetric NAC enhancement (odds ratio, 5.279; p = 0.001) and TNE (tumor-nipple enhancement) within 2 cm of the NAC (odds ratio, 4.184; p = 0.02) were significant predictors of NAC involvement. When asymmetric NAC enhancement and TNE extending to the NAC were present, the PPV was 82.35% (56/68).

CONCLUSIONS: CE-CBBCT is a safe and non-invasive modality with comparably high accuracy for the preoperative diagnosis of NAC involvement. Asymmetric NAC enhancement and TNE within 2 cm of the NAC performed well in predicting NAC involvement.

KEY POINTS: Question Several imaging modalities have been studied to preoperatively evaluate NAC involvement, but CE-CBBCT’s performance was unknown. Findings CE-CBBCT showed high accuracy in diagnosing NAC involvement. Asymmetric NAC enhancement and tumor-nipple enhancement within 2 cm of the NAC were independent predictors of NAC involvement. Clinical relevance CE-CBBCT can serve as a safe, non-invasive modality to diagnose NAC involvement preoperatively and help to identify candidates for nipple-sparing mastectomy.

PMID:40593168 | DOI:10.1007/s00330-025-11787-8

Sci Rep. 2025 Jul 1;15(1):21656. doi: 10.1038/s41598-025-98985-y.

ABSTRACT

There is no consensus on which diet best for improving male reproductive health and published studies on the effect of diet on sexual function and semen quality are limited. The aim of this study was to investigate the effect of intervention based diet, namely Persian Medicine Diet (PMD) and Mediterranean Diet (MD), on sexual function and semen quality parameters. In this single blind, randomized controlled clinical trial, 159 male patients with oligoasthenospermia aged between 18 and 45 years were enrolled and divided into three groups of 53 people each. The patients were randomly assigned to either PMD or MD intervention and control groups for two months between July 2022 and February 2023 in Shiraz, Iran. To evaluate the outcomes, we used the International Index of Erectile Function (IIEF-15) questionnaires that included five subscales and semen quality parameters. The mean age of the participants was 30.87 ± 6.55. Our analysis showed that total score of IIEF was higher in the PMD intervention (P ≤ 0.001). In addition, the PMD intervention showed a higher average difference in erectile function and intercourse satisfaction subscales, respectively (P ≤ 0.001, P ≤ 0.003). However, MD intervention showed a higher average difference in orgasm function subscale (P = 0.053). Additionally, in semen analysis, the study showed that MD intervention improved statistically. Also, semen count, sperm motility, and morphology difference improved significantly (all P ≤ 0.001). To improve infertility, PMD and MD interventions could positively impact male sexual function and semen quality parameters in infertile mess. Further studies with larger sample sizes and longer durations are needed for conclusive results.

PMID:40593139 | DOI:10.1038/s41598-025-98985-y

Sci Rep. 2025 Jul 1;15(1):21467. doi: 10.1038/s41598-025-06428-5.

ABSTRACT

The optimal timing for initiating anticoagulation following an ischemic stroke remains a debated issue. While several professional societies offer guidelines derived from observational studies and randomized clinical trials in patients with atrial fibrillation, these studies often exclude patients with high-risk embolic sources and hemorrhagic transformation. To address this gap, we conducted a nationwide survey to determine current practice patterns among vascular neurologists. We used the REDCap platform at the University of Chicago to distribute a survey to board-certified vascular neurologists identified through the American Board of Psychiatry and Neurology and the American Academy of Neurology databases. Statistical analyses, including t-tests, chi-squared tests, Mann-Whitney-Wilcoxon tests, and Kruskal-Wallis tests, were performed to evaluate continuous and categorical variables as applicable. Out of 1,556 invited participants, 201 (approximately 13%) responded, with 62% identifying as academic neurologists. Early anticoagulation is defined as within 24 h for ischemic stroke < 1.5 cm, 5 days for one third of MCA territory with hemorrhagic transformation type 1, and 7 days with parenchymal hemorrhage type 2. When compared to atrial fibrillation, vascular neurologists are more likely to initiate early anticoagulation in ischemic stroke with hemorrhagic transformation type 1 when it is caused by LV thrombus (69% vs. 21%, p < 0.001), antiphospholipid syndrome (87% v 21%, p < 0.001), and non-occlusive thrombus (83% vs. 21%, p < 0.001). A similar trend of early anticoagulation was noted in cases of ischemic stroke with parenchymal hemorrhage type 2 caused by LV thrombus (63% vs. 13%, p < 0.001), antiphospholipid syndrome (73% vs. 13%, p < 0.001), and non-occlusive thrombus (71% vs. 13%, p < 0.001) when compared to atrial fibrillation as the underlying cause. This study suggests that vascular neurologists prefer early anticoagulation in high-risk stroke mechanisms as compared to atrial fibrillation.

PMID:40593128 | DOI:10.1038/s41598-025-06428-5

Sci Rep. 2025 Jul 1;15(1):22398. doi: 10.1038/s41598-025-07630-1.

ABSTRACT

Sleep staging plays a crucial role in the diagnosis and treatment of sleep disorders. Traditional sleep staging requires manual classification by professional technicians based on the characteristic features of each sleep stage. This process is time-consuming, and the accuracy of staging is heavily influenced by subjective factors. Currently, research on automatic sleep staging models based on deep learning has made significant progress. However, the automatic sleep staging models proposed by researchers seldom distinguish between age groups. With increasing age, changes in sleep architecture occur, and older adults experience a reduction in deep sleep duration. This age-related alteration makes older adults more susceptible to sleep disorders. Consequently, the automatic sleep staging problem for older adults is more challenging and warrants greater attention. This study first established a three-dimensional time‒frequency feature fusion map dataset based on continuous wavelet transform and determined the optimal channel signals from the Sleep-EDF expanded dataset. We subsequently proposed an automatic sleep model tailored for older adults, named RICM-SleepNet. This model employs Inception modules to extract features at multiple scales, uses the CBAM attention mechanism to further identify efficient features at different scales, and finally employs the multiscale connection structure to concatenate features from different stages, enhancing the model’s feature utilization capability. RICM-SleepNet was subject to a performance evaluation on the three-dimensional time‒frequency feature fusion map dataset, yielding a sleep staging accuracy and κ value of 87.66% and 0.8492, respectively. Compared with the baseline models GoogLeNet, MobileNetV2, ShuffleNetV2, DenseNet121, RegNet, and ResNet50, RICM-SleepNet exhibited the highest recognition accuracy. To further validate the superiority of the RICM-SleepNet model, this study compared it with recent research methods that have demonstrated good performance in sleep staging. The results indicate that the proposed RICM-SleepNet model is superior to the other models in terms of performance. The Kruskal‒Willis test yielded a p value of 0.0014, indicating statistical significance. RICM-SleepNet attained the highest mean rank, underscoring its superior performance. In summary, the proposed multichannel automatic sleep staging model, RICM-SleepNet, shows promise in enhancing the accuracy and effectiveness of sleep staging, especially for older adults. Further validation and refinement of the model are warranted for its application in clinical settings and broader use in addressing sleep-related issues in the ageing population.

PMID:40593120 | DOI:10.1038/s41598-025-07630-1