Category: Nevin Manimala

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70140. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate tumor staging and treatment response evaluation (TRE) are critical for nasopharyngeal carcinoma (NPC) clinical decisions. Conventional methods relying on manual imaging analysis are expertise-dependent, time-consuming, and prone to inter-observer variability and errors.

PURPOSE: To assess the performance of two large language models (LLMs): ChatGPT-4o-latest and DeepSeek-V3-0324 in automating T, N staging and TRE for NPC patients.

STUDY TYPE: Retrospective.

POPULATION: Three hundred seven NPC patients from three centers (mean age: 45.5 ± 11.3 years; 216 men, 91 women).

FIELD STRENGTH/SEQUENCE: All imaging was conducted using 3.0T or 1.5T scanners. The imaging sequence included axial T1-weighted fast spin-echo, T2-weighted fast spin-echo, T2-weighted fat-suppressed spin-echo, and Contrast-Enhanced T1-weighted fast spin-echo.

ASSESSMENT: Two radiologists established the reference standards for TN staging at baseline and for TRE at two time points: post-induction chemotherapy (TRE-1) and post-concurrent chemoradiotherapy (TRE-2), based on the 9th version of AJCC/UICC guidelines and the RECIST1.1 criteria. LLMs were via few-shot chain-of-thought prompting and tested on 277 patients with 831 reports. Additionally, four radiologists independently assessed 68 cases both with and without the assistance of LLMs and compared the performance and efficiency in both conditions.

STATISTICAL TESTS: McNemar-Bowker test, Wilcoxon signed-rank test. p < 0.05 was considered statistically significant.

RESULTS: DeepSeek-V3-0324 significantly outperformed GPT-4o-latest in TRE-1 staging (96.5% vs. 82.9%, p < 0.001). For T staging (95.3% vs. 93.5%, p = 0.24), N staging (93.8% vs. 89.6%, p = 0.265), and TRE-2 (94.9% vs. 93.2%, p = 0.556), the accuracy between DeepSeek-V3-0324 and ChatGPT-4o-latest showed no significant difference. DeepSeek-V3-0324 also showed stronger agreement with expert annotation (κ = 0.85-0.90), compared to ChatGPT-4o-latest (κ = 0.49-0.86). Significant improvements in time efficiency were observed across all radiologists with LLM assistance (p < 0.001).

DATA CONCLUSION: LLMs, particularly DeepSeek-V3-0324, can automate NPC TN staging and TRE with high accuracy, enhancing clinical efficiency. LLMs integration may improve diagnostic consistency, especially for junior clinicians.

TECHNICAL EFFICACY: Stage 4.

PMID:41045017 | DOI:10.1002/jmri.70140

Pediatr Int. 2025 Jan-Dec;67(1):e70224. doi: 10.1111/ped.70224.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to significant epidemiological shifts in various diseases due to reduced interpersonal contact. This study examined changes in pediatric intestinal intussusception incidence, a disease with unclear etiology, during the pandemic.

METHODS: Weekly intussusception cases in children ≤10 years old in Seoul (2009-2022) were collected from the Health Insurance Review and Assessment Service (HIRA). Trends were analyzed using spline functions, and breakpoints were identified via student methods. Bayesian Structural Time Series (BSTS) models assessed incidence changes relative to predicted values. Cases were stratified by surgical intervention, and the complicated-to-uncomplicated case ratio was evaluated.

RESULTS: A sharp decline in intussusception incidence was observed around 2020, with breakpoints aligning with the first reported COVID-19 case. Post-breakpoint, total cases decreased by 58.8% (95% CrI: -79.0%, 7.8%), with reductions of 62.4% (95% CrI: -78.9%, -20.2%) for uncomplicated cases and 51.1% (95% CrI: -62.6%, -33.8%) for complicated cases. The complicated-to-uncomplicated ratio increased by 43.3% (95% CrI: 13.0%, 87.1%). When analyzing only the post-COVID-19 period, total and uncomplicated cases increased by 23.1% (95% CrI: 5.7%, 45.5%) from May 2022, but the change in ratio was not statistically significant.

CONCLUSION: Pediatric intussusception incidence significantly declined following COVID-19 onset, supporting a link between disease occurrence and contact or infectious exposure.

PMID:41045014 | DOI:10.1111/ped.70224

Pediatr Int. 2025 Jan-Dec;67(1):e70214. doi: 10.1111/ped.70214.

ABSTRACT

BACKGROUND: Postural stability is a prerequisite for the performance of daily gross motor functions. It is usually impaired in children with cerebral palsy. The aim of this study was to compare the effect of robotic-assisted gait training and body weight supported treadmill training on postural stability in ambulatory children with cerebral palsy.

METHODS: A randomized clinical trial involved 40 ambulatory children with cerebral palsy (5-14 years old). They were randomly allocated to one of two locomotor treadmill-training groups: (1) robotic-assisted gait training (RAGT) and (2) body weight supported treadmill training (BWSTT). All participants completed 24 training sessions within 8 weeks. Postural stability was measured by a computer dynamic posturography (NeuroCom EquiTest®) before and after the intervention.

RESULTS: A two-way repeated measures ANOVA revealed that there was a statistically significant interaction between group and time [F(15, 24) = 3.02, p = 0.008]. The study found that RAGT is more effective than BWSTT on some variables of static and dynamic postural stability. RAGT showed more improvement in weight symmetry at 60° knee flexion, limit of stability, velocity composite (front/back), and directional control composite for both left/right and front/back (p < 0.05).

CLINICALTRIALS: gov (identifier: NCT06719271).

CONCLUSION: Ambulatory children with CP can improve their postural stability after intensive RAGT.

PMID:41045011 | DOI:10.1111/ped.70214

Glob Chang Biol. 2025 Oct;31(10):e70533. doi: 10.1111/gcb.70533.

ABSTRACT

In large river basins, migratory fish populations are threatened by the combination of hydropower and climate change. With river temperatures rising and hydropower development increasing globally, the longstanding monitoring programs for threatened Pacific salmon populations in the Columbia River Basin present an opportunity to study these impacts over extended time scales. We fit a statistical model to 20 years of PIT-tagging data to jointly model the effects of temperature and dam operations (spill management) on the movement of Steelhead (anadromous Oncorhynchus mykiss) during their adult pre-spawn migration. We modeled the relationship between these factors and behaviors that pose mortality risks, including natal tributary overshoot (ascending a dam upstream of a natal tributary) and non-natal tributary use. We then used the posterior distributions of model-estimated parameters to predict the homing success of fish to natal tributaries under different climate and hydropower scenarios. Across the populations in our study, movement decisions were consistently thermally influenced, with temperature having a negative relationship with natal homing and a positive relationship with both natal tributary overshoot and non-natal tributary use. Another consistent finding across the populations in our study was that higher overshoot rates were associated with lower homing rates. Despite data limitations associated with the PIT-tag array network, we found evidence for population-specific benefits of winter spill on natal homing success, which is currently being implemented to assist the downstream migration of overshooting Steelhead. We demonstrate how integrating the effects of climate and hydropower management actions with movement ecology provides powerful insights into how species may respond to future scenarios. In our case study, we found that pre-spawn mortality of Steelhead is likely to increase with future climate change due to temperature-driven interactions with the hydrosystem, but there is potential for hydropower managers to partially offset these impacts.

PMID:41045009 | DOI:10.1111/gcb.70533

J Oral Rehabil. 2025 Oct 4. doi: 10.1111/joor.70068. Online ahead of print.

ABSTRACT

AIM: Systematically evaluate the previous literature on the association between insomnia and sleep bruxism (SB) in adults.

METHODS: Advanced searches were performed in different databases (PubMed, Embase, LILACS, Scopus and Web of Science) and grey literature until March 2025. Two trained reviewers independently conducted all stages of the review to identify observational studies evaluating the association between insomnia and SB in adults. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). A narrative synthesis summarised the main characteristics of the included studies. Meta-analyses were performed to obtain pooled estimates separately for self-reported and polysomnography (PSG)-based SB. Available data on insomnia and SB were converted into odds ratio (OR) with corresponding 95% confidence intervals (CIs).

RESULTS: Of the 1135 records initially identified, 931 were screened by title and abstract, and 23 were assessed in full text. Eight studies met the inclusion criteria for the systematic review, and six were eligible for meta-analysis, comprising a total sample of approximately 6990 adults. The meta-analysis of four studies investigating the association between insomnia and self-reported SB found no statistically significant association under the random-effects model (OR 1.17; 95% CI 0.79-1.72). Likewise, the pooled analysis of studies assessing PSG-based SB also showed no significant association with insomnia (OR 0.91; 95% CI 0.43-1.95).

CONCLUSION: Our findings indicate a lack of consistent evidence for a significant association between insomnia and SB. This conclusion is further limited by the small number of included studies, the moderate risk of bias in some studies, and the observed heterogeneity.

PMID:41044999 | DOI:10.1111/joor.70068

Pediatr Int. 2025 Jan-Dec;67(1):e70209. doi: 10.1111/ped.70209.

ABSTRACT

BACKGROUND: Epilepsy often begins in childhood or adolescence, a period marked by significant hormonal changes. Antiepileptic drugs (AEDs) like valproic acid (VPA) and levetiracetam (LEV) are commonly used, but VPA is associated with notable endocrine side effects, particularly in adolescent girls. This raises concerns about drug choice during puberty.

OBJECTIVE: To compare the effects of VPA and LEV monotherapy on pubertal hormone profiles, menstrual characteristics, physical development, and gynecologic ultrasound findings in adolescent girls with primary epilepsy.

METHODS: This prospective, cross-sectional study included 61 adolescent girls (16 on VPA, 15 on LEV, 30 controls) at a tertiary hospital from January 2018 to January 2019. Participants underwent anthropometric measurements, hormonal evaluations (FSH, LH, estradiol, testosterone, SHBG, TSH, 17-OH progesterone, DHEASO₄), menstrual assessments, and pelvic ultrasound. Statistical analysis was performed with a significance level of p < 0.05.

RESULTS: VPA users had significantly higher TSH levels than LEV users and controls (p = 0.036), suggesting possible subclinical thyroid dysfunction. They also had lower 17-OH progesterone and DHEASO₄ levels (p = 0.008 and p = 0.022, respectively). No significant differences were observed between groups in weight, height, BMI, pubertal hormone levels, menstrual cycle characteristics, or ultrasound findings. Treatment duration did not significantly affect hormone levels.

CONCLUSION: VPA appears to negatively impact thyroid and adrenal hormones in adolescent girls, whereas LEV has a safer endocrine profile. Given the hormonal sensitivity during puberty, LEV may be a safer alternative for adolescent girls with epilepsy to reduce potential endocrine disturbances.

PMID:41044995 | DOI:10.1111/ped.70209

Orthod Craniofac Res. 2025 Oct 3. doi: 10.1111/ocr.70038. Online ahead of print.

ABSTRACT

OBJECTIVE: Temporomandibular disorders (TMDs) are heterogeneous conditions of unclear aetiology involving the temporomandibular joint, masticatory muscles and neural tissues. Limited understanding of their pathogenesis hampers accurate diagnosis and targeted treatment. Therefore, this study aimed to identify salivary microRNA (miRNA) signatures associated with TMDs to support future diagnostic, therapeutic and prognostic applications.

MATERIALS AND METHODS: Unstimulated cell-free saliva (5 mL) was collected from 9 adult female TMD subjects (using Diagnostic Criteria/TMD) and eight healthy female controls of similar ages. Total RNA was extracted, small RNA libraries were prepared, and sequencing was performed using Illumina NovaSeq 6000. Reads were aligned to the human genome (GRCh38) via STAR. Differential expression analysis was conducted using DESeq2, followed by functional enrichment via miEAA 2.1.

RESULTS: A total of 187 salivary miRNAs were significantly differentially expressed between TMD and control groups (adjusted p < 0.05; log2-fold change > +1 or < -1), with 125 upregulated and 62 downregulated in TMD subjects. Several differentially expressed miRNAs were linked to the negative regulation of cadherin-mediated cell-cell adhesion, neurogenesis and chemokine production. Some overlapped with miRNAs implicated in rheumatoid arthritis and osteoarthritis, suggesting shared mechanisms. While no clear association was found between miRNA and TMD phenotypes, 5 miRNAs were strongly (R = 0.67-0.77) and significantly (p < 0.05) correlated with pain intensity and chronic pain grade.

CONCLUSIONS: Salivary miRNA profiling offers promise as a non-invasive diagnostic tool for TMDs, with the potential to uncover molecular endotypes and disease mechanisms not evident through clinical evaluation. Future studies with larger, more diverse cohorts are needed to validate these findings and assess their clinical utility.

PMID:41044994 | DOI:10.1111/ocr.70038

J Orthop Res. 2025 Oct 3. doi: 10.1002/jor.70077. Online ahead of print.

ABSTRACT

Unicompartmental knee arthroplasty (UKA) may enable improved functional outcomes compared to total knee arthroplasty (TKA). This randomized controlled trial assessed pre- and postoperative patient reported outcome measures (PROMs) and knee joint gait biomechanics for UKA and TKA patients. Patients were allocated to UKA (Oxford Partial Knee, Biomet, USA) and TKA (Persona CR Knee System, Zimmer, USA) study arms. Patients completed the Oxford Knee Score (OKS) and Western Ontario & McMaster University Arthritis Index (WOMAC), as well as instrumented gait analysis before and 1-year after surgery. Measures of interest: OKS scores; WOMAC sub-scores; Patient-specific correlations and root mean squared errors (RMSE) of stance phase sagittal and coronal knee angles. Statistical analysis included linear mixed-effects models (PROMs; α = 0.0125) and multivariate analysis of variance (gait biomechanics; α = 0.05). A total of 38 patients were recruited (UKA n = 17; TKA n = 21). All PROMs improved significantly following surgery (n = 37, p < 0.001), regardless of surgical technique. A significant effect of surgical technique on gait biomechanics was observed (n = 30, F_4,25, p = 0.010), where UKA patients displayed greater sagittal plane correlations [median(Q1,Q3) UKA 0.985 (0.967, 0.991), TKA 0.955 (0.942, 0.973)]; p = 0.018] and lower coronal plane RMSEs [UKA 3.6 (2.4,5.0)°, TKA 8.6 (5.1, 11.5)°; p = 0.002]. Although patient-reported outcomes improved similarly following UKA and TKA, UKA more closely preserved native knee kinematics as indicated by the greater similarity of sagittal gait patterns shapes and lower magnitude of coronal angle changes. CLINICAL SIGNIFICANCE: Greater preservation of patient-specific knee kinematics with UKA supports its use in appropriately selected patients and informs the design of targeted, functionally oriented rehabilitation protocols.

PMID:41044992 | DOI:10.1002/jor.70077

J Appl Toxicol. 2025 Oct 4. doi: 10.1002/jat.4952. Online ahead of print.

ABSTRACT

This study investigates the in vitro effects of florasulam, a widely used herbicide with known environmental impact, on bull epididymal sperm and primary testicular cells. Epididymal spermatozoa were collected from the cauda epididymis attached to one testis of a paired set obtained from a local abattoir and diluted to a concentration of 1 × 10⁸ spermatozoa/mL. The other testis was used to isolate testicular cells, which were then seeded onto 12-well and 96-well plates at the concentration of 5 × 10⁵ and 5 × 10⁴ cells per well, respectively. Sperm samples were exposed to various concentrations of florasulam (0-1000 μg/mL) for 2 h and evaluated for motility (M), plasma membrane integrity (PMI), acrosome integrity (AI), and mitochondrial membrane potential (MMP). Likewise, testicular cells were treated with different concentrations of florasulam for 48 h and assessed for cytotoxicity, apoptosis, steroidogenesis, and MMP. Statistical analyses were performed using ANOVA followed by Duncan’s multiple range test. The results showed that florasulam exposure significantly reduced sperm motility and MMP at concentrations of 100-1000 μg/mL. Additionally, 10 μg/mL florasulam stimulated cell proliferation, whereas 10, 100, and 500 μg/mL inhibited steroid secretion in testicular cells. Apoptosis was significantly increased at 500 and 1000 μg/mL, and MMP was negatively affected at 1000 μg/mL (p ≤ 0.05). These findings provide the first evidence that florasulam, even at sub-toxic concentrations, can impair male reproductive function by reducing sperm motility and mitochondrial activity, and by inducing apoptosis and hormonal disruption in testicular cells. This highlights its potential risk to cattle fertility and broader environmental reproductive health.

PMID:41044991 | DOI:10.1002/jat.4952

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251380623. doi: 10.1177/21501319251380623. Epub 2025 Oct 3.

ABSTRACT

BACKGROUND: Previous publications have demonstrated the benefits of pharmacist involvement in hypertension management, including in rural health care settings. Unlike many of the previous studies that evaluated pharmacist interventions occurring in collaboration with physicians, this study uniquely assessed the impact of pharmacist-led interventions under a collaborative practice agreement (CPA) on hypertension outcomes in a rural, medically underserved federally qualified health center (FQHC) in the southeastern U.S.

OBJECTIVES: To evaluate the effectiveness of direct pharmacist intervention under a CPA compared to physician-only standard care in achieving blood pressure (BP) control. Secondary outcomes included all-cause hospitalization rates and adherence to antihypertensive medications.

METHODS: This retrospective, single-center observational study included adult patients with hypertension seen by either a clinical pharmacist or a primary care provider over a 3-month period. Primary outcomes were the proportion of patients reaching target systolic and/or diastolic BP and the median time in days to control. Secondary outcomes included all-cause hospitalizations and changes in antihypertensive medication adherence, measured by proportion of days covered (PDC).

RESULTS: Among 159 patients, those managed by pharmacists achieved significantly faster BP control (SBP: 49 days vs 182 days, P < .0001; DBP: 146 days vs 160 days, P = .0061). Combined SBP/DBP control was also achieved more quickly (160 days, P < .0001), despite higher initial BP levels. Notably, 0% of patients in the pharmacist group were hospitalized, compared to 10% in the physician-only group (P = .0065). Medication adherence improved, with average PDC rising from 72.5% to 80.2%, and 70.4% of patients reaching ≥80% adherence by study end.

CONCLUSIONS: Pharmacist-led hypertension management under a CPA significantly improves BP control, time to goal, medication adherence, and reduces hospitalizations compared to physician-only care in a rural, underserved FQHC setting.

PMID:41044881 | DOI:10.1177/21501319251380623