Category: Nevin Manimala

Radiol Med. 2025 Oct 1. doi: 10.1007/s11547-025-02111-x. Online ahead of print.

ABSTRACT

Thymomas are the most common primary tumors of the anterior mediastinum, frequently associated with paraneoplastic syndromes like myasthenia gravis. This preliminary study investigated the correlation between radiomic features extracted from venous-phase CT images, histological grading (WHO), and disease staging (Masaoka-Koga and TNM) in patients with thymomas. A total of 37 patients were analyzed, with 107 radiomic features extracted using PyRadiomics module. Statistical analysis revealed 11 significant radiomic features distinguishing early and advanced thymomas according to Masaoka-Koga/TNM staging (p < 0.05), with shape_Sphericity, shape_Maximum3DDiameter, and firstorder_Skewness being the most predictive. For WHO classification, 7 significant features differentiated low-risk and high-risk thymomas (p < 0.05), with shape_Sphericity, firstorder-Range, and firstorder_RootMeanSquared showing the highest performance. LASSO models demonstrated high accuracy, with an AUC of 0.9 for Masaoka-Koga/TNM staging and 0.82 for WHO classification. These findings suggest that radiomic features can effectively distinguish thymoma stages and risk levels, potentially aiding in treatment planning and prognosis. By enabling noninvasive tumor characterization, radiomic features could support more personalized treatment strategies and improve decision-making in clinical practice.

PMID:41032229 | DOI:10.1007/s11547-025-02111-x

Anat Rec (Hoboken). 2025 Oct 1. doi: 10.1002/ar.70062. Online ahead of print.

ABSTRACT

The human inner ear (IE) is a complex structure whose morphological variability underpins both normal function and the manifestation of otologic pathologies. Previous studies aiming to describe the structural variability of the IE have been limited by low-resolution imaging and small sample numbers. This study utilized the largest number of cadaveric high-resolution micro-computed tomography (CT) images to date to characterize the bony morphology of the healthy human IE. Fifty-four cadaveric temporal bone specimens underwent micro-CT imaging. Images were semi-automatically segmented and converted to three-dimensional surface mesh models for morphological measurement and analysis. Statistical shape models (SSMs) were created for the IE, cochlea, and vestibular system, as well as for sex- and side-based subgroups. Normative ranges for linear and volumetric dimensions of the IE were determined, and mean values were consistent with those previously reported. Significant sex-based differences and strong univariate linear relationships were identified for many dimensions and volumes. SSMs highlighted the semicircular canals, cochlear basal turn, and hook regions as key contributors to morphological variability across the total sample set. Sex-specific SSMs revealed distinct variation patterns: females exhibited greater vestibular variability, while males showed cochlear basal turn/hook region variability. Multivariate models were developed for the prediction of IE volumes from dimensions obtainable from clinical quality scans, with high accuracy. The morphological variability of the healthy IE was described in extensive detail and depicted in three dimensions. These findings may be used to inform the assessment of IE malformations, analysis of drug delivery strategies to the IE, and otologic implant design optimization.

PMID:41031437 | DOI:10.1002/ar.70062

Palliat Support Care. 2025 Oct 1;23:e178. doi: 10.1017/S1478951525100801.

ABSTRACT

OBJECTIVES: In the cultural context of China, it holds profound significance for nursing students to engage in discussions about hospice and palliative care with their families. This study aimed to explore nursing students’ willingness to discuss hospice and palliative care with their families and the factors associated with it.

METHODS: Nursing students from three schools in three Chinese provinces (n = 1,234) completed questionnaires on general information, hospice and palliative care awareness, attitude toward death, and willingness to discuss hospice and palliative care with their families. This cross-sectional analysis utilized logistic regression to investigate the predictors of participants’ willingness to discuss hospice and palliative care with their families.

RESULTS: The mean hospice and palliative care knowledge score was 6.68, and 19.1% were willing to discuss the topic with their families. Factors associated with nursing students’ willingness to discuss hospice and palliative care with their families included region, whether their family members considered talking about death a taboo, whether a family member was severely ill and at risk of death, their knowledge of World Hospice and Palliative Care Day, hospice and palliative care knowledge score, and death avoidance attitude. Participants with higher hospice and palliative care knowledge scores were more willing to discuss the topic with their families, while a higher death avoidance score was associated with unwillingness.

SIGNIFICANCE OF RESULTS: Nursing students significantly lack hospice and palliative care awareness, and their willingness to discuss the topic with their families needs improvement. Nursing schools should provide systematic and standardized hospice and palliative care education and communication skills training.

PMID:41031435 | DOI:10.1017/S1478951525100801

JMIR Med Educ. 2025 Sep 9. doi: 10.2196/71339. Online ahead of print.

ABSTRACT

BACKGROUND: Early exposure to research methodology is essential in medical education, yet many students show limited motivation to engage with non-clinical content. Gamified strategies such as educational escape rooms (EERs) may help improve engagement, but few studies have explored their feasibility at scale or evaluated their impact beyond student satisfaction.

OBJECTIVE: To assess the feasibility, engagement, and perceived educational value of a large-scale escape room specifically designed to introduce third-year medical students to the principles of diagnostic test evaluation.

METHODS: We developed a low-cost immersive escape room based on a fictional diagnostic accuracy study, with six puzzles mapped to five predefined learning objectives: (1) identifying key components of a diagnostic study protocol, (2) selecting an appropriate gold-standard test, (3) defining a relevant study population, (4) building and interpreting a contingency table, and (5) critically appraising diagnostic metrics in context. The intervention was deployed to an entire class of third-year medical students across 12 sessions between March and April 2023. Each session included 60 minutes of gameplay and a 45-minute debriefing. Students completed pre-/post-intervention questionnaires assessing their knowledge of diagnostic test evaluation and perceptions of research training. Descriptive statistics and paired t-tests were used to evaluate score changes; univariate linear regressions assessed associations with demographics. Free-text comments were analyzed using Reinert’s hierarchical classification.

RESULTS: Among 530 participants, 490 completed the full evaluation. Many participants had limited prior exposure to escape rooms (206/490, 42% had never participated), and most reported low initial confidence with critical appraisal of scientific articles. All student teams completed the scenario, with a mean completion time of 53 (±4) minutes. Mean overall knowledge scores increased from 62/100 (±1) before to 82/100 (±2) after the activity (+32%, p<0.001). Gains were observed across all learning objectives and were not influenced by age, sex, or prior experience. Students rated the EER as highly entertaining (9.1±1.1/10) and educational (8.2±1.5/10). Following the intervention, 87% (393/452) felt more comfortable with critical appraisal of diagnostic test studies, and 79% (357/452) considered the escape room format highly appropriate for an introductory session. Thematic analysis of open-ended feedback identified six clusters, including engagement, teamwork, and perceived usefulness of the pedagogical approach. Word clouds showed a marked shift from negative to positive attitudes toward research training.

CONCLUSIONS: This study demonstrates the feasibility and enthusiastic reception of a large-scale, reusable escape room aimed at teaching the fundamental principles of diagnostic test evaluation to undergraduate medical students. While not designed to cover the broader spectrum of research designs or methods, the intervention successfully addressed targeted objectives within a specific area of research appraisal. This approach may serve as a valuable entry point to engage students with evidence-based reasoning and pave the way for deeper exploration of medical research methodology.

PMID:41031434 | DOI:10.2196/71339

Eur J Prev Cardiol. 2025 Oct 1:zwaf597. doi: 10.1093/eurjpc/zwaf597. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammation contributes significantly to coronary artery disease (CAD). The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily available biomarker reflecting both inflammatory and immune cells’ activity, potentially enhancing risk stratification of patients with CAD. This study evaluates the clinical impact of baseline NLR in patients undergoing percutaneous coronary intervention (PCI) for both chronic coronary syndrome (CCS) and acute coronary syndrome (ACS).

METHODS: We conducted a retrospective analysis of patients undergoing PCI at Mount Sinai Hospital between 2012 and 2022. Patients were stratified into NLR quartiles and outcomes were analyzed using Cox regression models. The primary endpoint was major adverse cardiovascular events (MACE) at 1-year follow-up, including all-cause death, myocardial infarction (MI), and stroke.

RESULTS: A total of 7,287 patients were included in the study. Age, male sex, comorbidities, hsCRP and complexity of PCI tended to be higher in the highest NLR quartiles. At 1-year, MACE incidence increased across NLR quartiles, from 5.1% (1st quartile) to 9.3% (4th quartile) (P for trend = 0.004). Compared with the 1st quartile, the 4th NLR quartile (NLR >5.0) was associated with increased adjusted risks of MACE (adjHR 1.52, 95% CI 1.12-2.05), all-cause death (adjHR 1.71, 95% CI 1.10-2.65), MI (adjHR 1.53, 95% CI 1.00-2.35), and bleeding (adjHR 2.01, 95% CI 1.50-2.70). Ischemic risk associated with high NLR was more pronounced in patients presenting with ACS and chronic kidney disease (CKD).

CONCLUSIONS: Baseline NLR is associated with adverse cardiovascular outcomes in CAD patients undergoing PCI. Assessment of NLR could enhance risk stratification particularly in patients with ACS and CKD.

PMID:41031428 | DOI:10.1093/eurjpc/zwaf597

Eval Rev. 2025 Oct 1:193841X251380903. doi: 10.1177/0193841X251380903. Online ahead of print.

ABSTRACT

This study introduces a novel aligned technical index, derived from multiple technical indicators, that encompasses a broader spectrum of technical measurement strategies than those obtained from previous 3PRF (Three-Pass Regression Filter) research. Our empirical results demonstrate that this index exhibits significant predictive power for new energy price returns in both in-sample and out-of-sample tests. This index is extracted using the 3PRF method and yields significantly better results than those obtained with traditional methods. Considering that the market typically operates in two states, we incorporate a regime-switching model with time-varying transition probabilities into our forecasting framework. The findings indicate that the technical index influences the probability of regime transitions between states and that the inclusion of a regime-switching model further enhances predictive performance. The incorporation of the regime-switching mechanism further improves the predictive performance of the model. Moreover, from an asset allocation perspective, both the technical index and regime-switching models deliver considerable economic value to mean-variance investors.

PMID:41031418 | DOI:10.1177/0193841X251380903

Int J Chron Obstruct Pulmon Dis. 2025 Sep 24;20:3305-3315. doi: 10.2147/COPD.S524775. eCollection 2025.

ABSTRACT

OBJECTIVE: Neutrophilic inflammation, a key feature of chronic obstructive pulmonary disease (COPD), is associated with exacerbations and poor outcomes. Myeloperoxidase (MPO) is released from activated neutrophil granules. High or increasing MPO levels are associated with tissue damage, lung function decline and increased exacerbation risk in patients with COPD. We hypothesize that treatment with mitiperstat, a novel oral MPO inhibitor, may reduce lung oxidative stress, inflammation and exacerbations, thereby improving symptoms, lung function, and comorbidities in patients with COPD.

PATIENTS AND METHODS: CRESCENDO is a partially decentralized, Phase 2a, randomized, 24-week, double-blind study evaluating the efficacy and safety of mitiperstat versus placebo in patients (40-80 years, inclusive) with COPD at high risk of exacerbation (based on a documented history of ≥1 moderate or severe acute COPD exacerbation, frequent productive cough, or severe airflow limitation [forced expiratory volume in 1 second <50% predicted]). Patients recruited from approximately 100 sites across 14 countries, from primary or secondary care and community-based facilities, will be randomized 1:1 to receive mitiperstat 5 mg or placebo orally, once daily. The primary endpoint is the time to first CompEx event, a novel composite endpoint reflecting disease worsening, including changes in symptoms, reliever use, lung function, treatment for exacerbation, or study dropout. The study period is planned to take between 18 and 30 weeks for each patient.

CONCLUSION: CRESCENDO will assess efficacy and safety of mitiperstat using a novel, patient-centric trial design to enhance participant recruitment, partially via community-based facilities, helping to overcome restrictive trial designs and better reflect the real-world population with COPD, as well as reducing its environmental impact.

PMID:41031389 | PMC:PMC12477066 | DOI:10.2147/COPD.S524775

Front Nutr. 2025 Sep 15;12:1652718. doi: 10.3389/fnut.2025.1652718. eCollection 2025.

ABSTRACT

BACKGROUND AND AIM: Patients on maintenance hemodialysis (MHD) experience various complications, including malnutrition, reduced physical function, and psychological problems. Single-discipline medical approaches prove inadequate in addressing these complex situations. The multidisciplinary management model adopted by the nutritional support team has demonstrated effectiveness in managing such challenges. However, patient compliance remains suboptimal due to limited understanding of treatment regimens, fatigue from prolonged therapy, and insufficient psychological support. Consequently, establishing a patient-centered, transparent, and interactive communication platform is essential to improving treatment adherence through enhanced patient support.

METHODS: This prospective randomized controlled trial assigned patients to either an experimental group receiving community-based management or a control group receiving traditional management. Health status was evaluated through laboratory parameters, body composition analysis, anthropometric measurements, and standardized scale assessments.

RESULTS: A total of 28 patients with MHD were enrolled. Four patients died from primary disease (1 in the experimental group and 3 in the control group), leaving 24 who completed the trial. Statistical analysis was conducted on a dataset of 24 patients, including 13 in the experimental group and 11 in the control group. Seven outcomes demonstrated statistically significant differences. In terms of laboratory parameters, the experimental group achieved superior outcomes in serum albumin (12 patients, 92.3% versus 3 patients, 27.3%; p = 0.002), hemoglobin (11 patients, 84.6% versus 4 patients, 36.4%; p = 0.033), and blood phosphorus levels (10 patients, 76.9% versus 2 patients, 18.2%; p = 0.012), compared to control group. Body composition analysis indicated greater improvement in muscle mass (9 patients, 69.2% versus 3 patients, 27.3%; p = 0.038) and more favorable visceral fat distribution (11 patients, 84.6% versus 3 patients, 27.3%; p = 0.011) in the experimental group. Additionally, the experimental group scored higher on the Short Physical Performance Battery (SPPB; 10 patients, 76.9% versus 3 patients, 27.3%; p = 0.038) and exhibited better treatment compliance (10 patients, 76.9% versus 2 patients, 18.2%; p = 0.012). Notably, compliance mediated the effect of community-based management on SPPB scores (Proportion Mediated = 76.2%; p = 0.038).

CONCLUSION: Community-based management by the nutrition support team substantially improves patient compliance and enhances clinical outcomes.

CLINICAL TRIAL REGISTRATION: chictr.org.cn, identifier ChiCTR2500104523.

PMID:41031360 | PMC:PMC12477912 | DOI:10.3389/fnut.2025.1652718

Front Nutr. 2025 Sep 15;12:1624852. doi: 10.3389/fnut.2025.1624852. eCollection 2025.

ABSTRACT

BACKGROUND: Knee osteoarthritis (OA) is a disabling condition-characterized by pain, stiffness, and impaired quality of life-that affects more females than males. Chronic systemic inflammation is a key feature of knee OA and can be modulated by diet. We evaluated the sex-specific relationship between the inflammatory potential of diet and health-related quality of life (HRQOL), sleep quality, energy and fatigue levels, and psychological distress in individuals with knee OA.

METHODS: This cross-sectional study analyzed baseline data from 144 participants (64% female) aged 45-85 years with symptomatic knee OA enrolled in the FEAST (eFEct of an Anti-inflammatory diet for knee oSTeoarthritis) randomized controlled trial, which compared an anti-inflammatory dietary program to a standard low-fat dietary program. Dietary inflammatory potential was assessed using the dietary inflammatory index (DII^®) and energy-adjusted DII (E-DII™), calculated from 3-day food diaries. Higher scores reflect more proinflammatory diets. Outcomes were HRQOL (EQ-5D-5L utility score and 100 mm visual analogue scale [VAS]), self-reported sleep quality, energy and fatigue levels (100 mm VAS), and psychological distress (Kessler Scale). Linear regression with interaction terms assessed sex-specific associations between DII/E-DII and outcomes, adjusting for age and body mass index (BMI).

RESULTS: Male and female participants had a mean ± standard deviation BMI of 30.4 ± 3.8 and 30.2 ± 7.2 kg/m², respectively. Mean E-DII and DII were -0.35 ± 1.34 and 0.72 ± 1.49 (females), and -0.26 ± 1.52 and 0.33 ± 1.45 (males). Higher E-DII scores were associated with lower EQ-5D utility scores in females (unadjusted β = -0.03, 95% CI -0.05 to -0.001), but not after adjustment. Higher DII scores were associated with lower energy levels in males (unadjusted β = -4.34, 95% CI -8.44 to -0.23; adjusted β = -4.01, 95% CI -7.91 to -0.30). No associations were found between DII and HRQOL, sleep, fatigue, or psychological distress in either sex.

CONCLUSION: No associations were found between dietary inflammatory potential and sleep quality, fatigue, or psychological distress. A more proinflammatory diet was linked to lower energy levels in males with symptomatic knee OA. Findings from the FEAST trial will clarify whether reducing dietary inflammation improves these outcomes over time.

PMID:41031358 | PMC:PMC12476995 | DOI:10.3389/fnut.2025.1624852

Front Nutr. 2025 Sep 15;12:1617565. doi: 10.3389/fnut.2025.1617565. eCollection 2025.

ABSTRACT

BACKGROUND: Serum 25 (OH) D levels are associated with various diseases, including cancers, but inconsistencies exist for female-specific malignancies. This study is aimed to explore the real relationship between serum 25 (OH) D levels and incidence rates of female specific cancers in premenopausal women by a large-scale prospective cohort study.

STUDY DESIGN: We analyzed data from 51,286 UK Biobank participants using Cox regression models to explore associations. Subgroup analyses were based on vitamin D supplementation, alcohol, smoking, BMI, diabetes, sleep, and outdoor exposure. Categorical variables were described by frequencies and compared with chi-squared tests.

RESULTS: During a median follow-up of 13.8 years, all cancer incidence was 5.1% (n = 2,614), with ovarian cancer at 0.3% (n = 176), breast cancer at 4.4% (n = 2,232), and uterine body cancer at 0.5% (n = 235). Low serum 25 (OH) D (50 nmol/L) was linked to increased risks of ovarian (HR: 1.457, 95% CI: 1.047-2.027) and uterine body cancer (HR: 1.372, 95% CI: 1.023-1.841). Each 10 nmol/L increase in 25 (OH) D reduced ovarian cancer risk (HR: 0.904, 95% CI: 0.835-0.979). Alcohol use and sleep <6 h were risk factors for ovarian and uterine cancer in those with low 25 (OH) D levels.

CONCLUSION: Maintaining adequate serum 25 (OH) D levels is essential for overall health, reducing the risk of ovarian cancer, and potentially lowering susceptibility to uterine corpus cancer.

PMID:41031356 | PMC:PMC12477915 | DOI:10.3389/fnut.2025.1617565