Category: Nevin Manimala

Lifetime Data Anal. 2025 Sep 22. doi: 10.1007/s10985-025-09670-1. Online ahead of print.

ABSTRACT

Bayesian inference for survival regression modeling offers numerous advantages, especially for decision-making and external data borrowing, but demands the specification of the baseline hazard function, which may be a challenging task. We propose an alternative approach that does not need the specification of this function. Our approach combines pseudo-observations to convert censored data into longitudinal data with the generalized method of moments (GMM) to estimate the parameters of interest from the survival function directly. GMM may be viewed as an extension of the generalized estimating equations (GEE) currently used for frequentist pseudo-observations analysis and can be extended to the Bayesian framework using a pseudo-likelihood function. We assessed the behavior of the frequentist and Bayesian GMM in the new context of analyzing pseudo-observations. We compared their performances to the Cox, GEE, and Bayesian piecewise exponential models through a simulation study of two-arm randomized clinical trials. Frequentist and Bayesian GMMs gave valid inferences with similar performances compared to the three benchmark methods, except for small sample sizes and high censoring rates. For illustration, three post-hoc efficacy analyses were performed on randomized clinical trials involving patients with Ewing Sarcoma, producing results similar to those of the benchmark methods. Through a simple application of estimating hazard ratios, these findings confirm the effectiveness of this new Bayesian approach based on pseudo-observations and the generalized method of moments. This offers new insights on using pseudo-observations for Bayesian survival analysis.

PMID:40976813 | DOI:10.1007/s10985-025-09670-1

Eur J Appl Physiol. 2025 Sep 22. doi: 10.1007/s00421-025-05993-x. Online ahead of print.

ABSTRACT

PURPOSE: The role of androgen levels in physiological characteristics of females is poorly understood, as previous research has mainly focused on testosterone and females not using hormonal contraceptives. Our aim was to investigate whether androgen levels are associated with body composition and physical performance in recreationally active and trained premenopausal females.

METHODS: The study examined two phases of the menstrual/combined oral contraceptive (COC) cycle of healthy eumenorrheic (EUM) and COC using females (age 19-35 years, n = 83). Total and free serum testosterone, dehydroepiandrosterone, androstenedione, dehydroepiandrosterone (DHEA), DHEA-sulfate, and sex hormone-binding globulin (SHBG) levels were analyzed. Linear mixed-effects models were used to examine the associations between androgen levels and fat-free mass (FFM), fat mass (FM), counter movement jump (CMJ), maximal isometric force production, and aerobic capacity ( $\dot{\text{V}}\text{O}$ _2peak).

RESULTS: None of the measured androgens were significantly associated with body composition or physical performance outcomes in the pooled sample. However, significant androgen-COC-use interactions indicated that the associations between DHEA and FFM (β = 0.23, p = 0.017), SHBG and FFM-FM-adjusted CMJ (β = 0.72, p = 0.041), and total testosterone and unadjusted $\dot{\text{V}}\text{O}$ _2peak (β = – 0.27, p = 0.016) differed according to COC-use. A significant association between SHBG and CMJ (β = – 0.66, p = 0.047) and total testosterone and $\dot{\text{V}}$ O_2peak (β = 0.15, p = 0.044) was found only in EUM; however, adjustment for FFM eliminated this statistical significance.

CONCLUSION: Serum androgen levels were not robustly associated with body composition or physical performance outcomes in healthy, recreationally active and trained premenopausal females. Hormonal contraceptive status may attenuate the associations between androgens and performance, driven potentially by FFM and individuals with high androgen levels.

PMID:40976810 | DOI:10.1007/s00421-025-05993-x

Updates Surg. 2025 Sep 21. doi: 10.1007/s13304-025-02402-y. Online ahead of print.

ABSTRACT

Flail chest is a severe thoracic injury associated with high morbidity, prolonged hospitalization, and an increased risk of chronic pain. Surgical stabilization of rib fractures (SSRF) has become an increasingly accepted treatment modality in selected patients. However, the optimal timing of intervention and the prognostic value of radiologic injury scoring systems remain areas of investigation. Our findings confirm prior evidence supporting the early use of SSRF in selected patients and further explore the predictive value of radiologic injury scores in postoperative outcomes. This retrospective study included 74 patients who underwent SSRF for flail chest between 2012 and 2023. Demographic data, radiologic injury scores (AIS Thorax, RibScore, BPC18), timing of surgery, and clinical outcomes were analyzed. Patients were grouped according to age (≤ 65 vs. > 65 years) and timing of surgery (≤ 2 days vs. ≥ 3 days post-admission). Primary endpoints included ICU and hospital length of stay, postoperative complications, mortality, return to normal activity, and incidence of chronic pain. The median number of fractured ribs was 7 (IQR: 3-10), with a median AIS Thorax score of 4.05, RibScore of 4.66, and BPC18 score of 2.66. Early surgery (≤ 48 h) was associated with a significantly shorter hospital stay (median 8 vs. 10 days, p = 0.037), although ICU stay, complication rates, and return to activity did not significantly differ between early and late surgery groups. No statistically significant differences in outcomes were observed between the age groups. AIS Thorax showed the strongest correlation with ICU stay (r = 0.513, p < 0.001), followed by BPC18 (r = 0.377, p = 0.001) and RibScore (r = 0.317, p = 0.003). All three scores were significantly correlated with total hospital stay duration as well. However, none were associated with chronic pain or time to return to normal activity. Chronic pain developed in 20.2% of the patients. Logistic regression analysis revealed no independent predictors of chronic pain, including age, sex, number of fractured ribs, injury severity scores, or surgical timing. SSRF is a safe and effective treatment for flail chest, including in elderly and severely injured patients. Early surgery supports faster recovery without added complications. While injury scores reflect acute outcomes, they do not predict chronic pain or long-term recovery.

PMID:40976804 | DOI:10.1007/s13304-025-02402-y

AIDS Behav. 2025 Sep 22. doi: 10.1007/s10461-025-04871-z. Online ahead of print.

ABSTRACT

This research evaluates the mediation and moderation of an efficacious physical activity (PA) intervention designed for African American men living with human immunodeficiency virus (HIV). Physical activity is a crucial element in managing the health of individuals with HIV, but African American men represent a population that is disproportionately affected by HIV and often faces barriers to engaging in regular PA. We analyzed data obtained from a randomized controlled trial (N = 302) that recruited African American men living with HIV who are 40 years or older and randomly assigned them to a PA intervention group or a health-awareness control group. We collected data at baseline, immediate post-intervention, and 3-, 6-, and 12-month post-intervention. We examined whether the intervention’s effect on adherence to PA guidelines was mediated through the Reasoned Action Approach and the Social Cognitive Theory constructs, including attitudes, social norms, self-efficacy, and intention. We explored whether individual characteristics, including Body Mass Index (BMI), Waist-Hip Ratio (WHR), age, education level, and marital status, influenced the intervention’s effect. We found that self-efficacy mediated the intervention’s effect (α × β × γ product = 0.125, 95% ACI [0.053, 0.229]) by influencing intentions. Statistical analyses did not identify significant moderations of the intervention effect by age, marital status, education level, BMI, or WHR. These findings suggest that interventions to enhance PA among African American men living with HIV should particularly focus on boosting self-efficacy to exercise. Future research should explore additional psychological mechanisms and potential moderators to further refine and tailor PA interventions for this population.

PMID:40976796 | DOI:10.1007/s10461-025-04871-z

Infect Dis Poverty. 2025 Sep 22;14(1):95. doi: 10.1186/s40249-025-01363-z.

ABSTRACT

BACKGROUND: Opisthorchiasis infected by Opisthorchis felineus has represented a significant but understudied public health issue for the population residing in Western Siberia and the Ural Region of the Russian Federation. This study aimed to produce high-resolution spatial-temporal disease risk maps for guiding prevention strategy in the above region.

METHODS: Data on prevalence and surveillance data reflecting reported annual incidence rate of O. felineus infection in the study region were collected through systematic review and the annual reports of the Ministry of Health of the Russian Federation. Environmental, socioeconomic and demographic data were downloaded from different open-access data sources. An advanced multivariate Bayesian geostatistical modeling approach was developed to estimate the O. felineus infection risk at high-resolution spatial-temporal by joint analysis of survey and surveillance data, incorporating potential influencing factors and spatial-temporal random effects. The annual spatial-temporal risk maps of O. felineus infection at a resolution of 5 × 5 km² were produced.

RESULTS: The final dataset included 76 locations of survey data and 303 locations of surveillance data on O. felineus infection. The infection risk was high (> 25%) in most part of central and eastern regions, and relatively low (< 25%) in most part of western region, while temporal variations were observed across the sub-regions in recent decades. Particularly, in the densely populated eastern region, there was an increased trend of infection risk from 30.46% (95% Bayesian credible intervals, BCI 10.78-53.45%) in 1980 to 53.39% (95% BCI 13.77-91.93%) in 2019 and gradually transformed into high-risk. In the study region (excluding the western region due to data sparsity), the population-adjusted estimated prevalence was 46.61% (95% BCI 15.09-76.50%) in 2019, corresponding to approximately 7.91 million (95% BCI 2.56-12.98 million) people infected.

CONCLUSIONS: The high-resolution risk maps of O. felineus in Western Siberia and the Ural Region of the Russian Federation have effectively captured the risk profiles, suggesting the infection risk remains high in recent years and providing substantial evidence for spatial-target control and preventive strategies.

PMID:40976794 | DOI:10.1186/s40249-025-01363-z

Cardiovasc Intervent Radiol. 2025 Sep 21. doi: 10.1007/s00270-025-04198-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to systematically evaluate the efficacy and safety of different bleomycin administration routes for treating GHHs, with a subgroup analysis comparing Transarterial chemoembolization (TACE) and percutaneous sclerotherapy (PS).

METHODS: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science from inception through May 6, 2025. Studies included reporting clinical and radiological outcomes after PS and TACE for GHHs (≥ 4 cm). Primary outcomes included technical success (complete and accurate application as predetermined in the study protocol), safety outcomes, clinical (symptom relief without additional intervention), and radiological success (≥ 50% size reduction and/or lack of enhancement on follow-up imaging). The outcomes were analyzed using a random-effects meta-analysis 106 1586.

RESULTS: A total of 17 studies, including 1692 patients (1586 treated with TACE and 106 with PS) and 1825 GHHs, were included. Among these, 13 studies assessed TACE, and four studies evaluated PS. The overall technical success rate was 100%, with pooled clinical and radiological success rates of 96.93% and 81.75%, respectively. In subgroup analyses, both TACE and PS achieved 100% technical success. TACE showed slightly higher clinical success, at 99.9%, compared to PS at 89.73%, although the difference was not statistically significant (p = 0.15). Radiological success was comparable (TACE: 81.9%, PS: 81.29%). Major complications were rare (0.27%, 95% CI: 0-0.55%). No significant differences were observed in major complication rates (TACE: 0.26%, PS: 0.85%, p = 0.67), total complications (p = 0.48), or procedure-related morbidity.

CONCLUSION: Both TACE and PS are effective treatments for GHHs, with PS showing a lower systemic complication rate.

PMID:40976792 | DOI:10.1007/s00270-025-04198-1

Br J Oral Maxillofac Surg. 2025 Aug 8:S0266-4356(25)00200-1. doi: 10.1016/j.bjoms.2025.07.012. Online ahead of print.

ABSTRACT

Assessing the health-related quality of life (HRQOL) in maxillofacial trauma patients is essential for understanding the holistic impact of injury. Whilst validated tools exist for oral cancer, trauma-specific HRQOL questionnaires are lacking. The University of Washington Quality of Life (UOW-QOL) questionnaire for oral cancer was adapted to evaluate maxillofacial patients as a pilot study. The aim was to capture functional and psychosocial challenges unique to trauma, thereby improving patient care. Thirty-five patients who sustained facial injuries then underwent surgery at the Royal London Hospital were recruited. They were routinely followed up in clinic one to six months postoperatively and completed the adapted QOL questionnaire, tailored for maxillofacial trauma. Version 28 IBM SPSS statistics software was used for data analysis. There was a statistically significant association between the dentoalveolar region and QOL (p < 0.001), indicating a lower QOL, potentially reflecting current NHS dental care deficiencies. The total severity of complications was significantly correlated with QOL (p < 0.047), meaning an increase in the number and severity of complications led to QOL deterioration. Among the complications, appearance and scarring were significant (p < 0.03 and p < 0.029, respectively), with a negative self-perception of appearance and more severe scarring contributing to a lower QOL. A validated QOL questionnaire is needed to assess maxillofacial patients postoperatively for more standardised comparisons of outcomes. The researchers found this tool effective in evaluating the QOL of these patients, and believe that if future studies adopt it, more consistent and comparable data can be generated.

PMID:40976755 | DOI:10.1016/j.bjoms.2025.07.012

Br J Oral Maxillofac Surg. 2025 Aug 22:S0266-4356(25)00211-6. doi: 10.1016/j.bjoms.2025.08.005. Online ahead of print.

ABSTRACT

Injuries to the face, mouth and jaws are common presentations to UK hospitals. Understanding the current volume of work and the recent changes can yield important lessons for the teams that deal with facial injuries. We examined the Hospital Episode Statistics (HES) covering England for the financial reporting years ending in 2015-2024 for relevant diagnoses and procedures undertaken during hospital admissions. A significant reduction in activity in many areas due to COIVD-19 was found. We report on the change between average volumes of activity in the years ending 2015-17, compared with the years ending 2022-24. For soft tissue trauma there was an 11.3% reduction in recorded repairs between these time periods. There were also reductions in orbital (-20.7%), nasoethmoidal (-22.2%), zygomatic complex (-32.4%), nasal (-52.9%), and mandibular (-18.5%) fracture repairs. In many areas this was found in contrast to increased diagnosis of these fracture types. In conclusion, for many types of facial trauma, there has been a reduction in clinically significant events over the last decade. Improved diagnosis and changes in coding behaviour may account for increased recognition of injuries with less clinical relevance.

PMID:40976754 | DOI:10.1016/j.bjoms.2025.08.005

Urol Oncol. 2025 Sep 20:S1078-1439(25)00343-6. doi: 10.1016/j.urolonc.2025.08.024. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Magnetic resonance imaging (MRI)-targeted biopsies for prostate cancer diagnosis can be performed as a transperineal biopsy (TP-Bx), yet its comparative performance with transrectal biopsy (TR-Bx) remains uncertain. We evaluated the detection of clinically significant prostate cancer (csPCa) by TP-Bx and TR-Bx according to lesion size and location using Prostate Imaging Reporting & Data System (PI-RADS) criteria.

METHODS: We retrospectively reviewed biopsy-naïve patients who underwent MRI-guided prostate biopsies at our institution. TR-Bx was performed using MRI-ultrasound fusion in the urology clinic, while TP-Bx utilized an MRI in-bore technique in the radiology department. Lesions were stratified by PI-RADS-defined score, location, and size.

RESULTS: Among 200 patients (100 TP-Bx, 100 TR-Bx), 276 PI-RADS score 3 to 5 lesions were biopsied (141 TP-Bx, 135 TR-Bx). Overall csPCa detection did not differ significantly between TP-Bx and TR-Bx (28% vs. 38%; OR = 1.5, CI = 0.9-2.6, P = 0.12). However, TR-Bx detected significantly more csPCa in non-apical peripheral zone (PZ) lesions compared to TP-Bx [45% (36/80) vs. 29% (21/73), adjusted OR = 4.6, 95% CI = 1.29-16.4, P = 0.019], particularly for small (diameter ≤1 cm) lesions (35% [16/46] vs. 12% [5/42], adjusted OR = 8.06, 95% CI = 1.45-44.7, P = 0.017). No significant difference was observed for larger lesions (diameter >1 cm).

CONCLUSIONS: Overall csPCa detection rates were comparable between TP-Bx and TR-Bx, with no statistically significant difference. However, TR-Bx demonstrated superior detection in small non-apical PZ lesions, suggesting an anatomic and size-dependent advantage. These exploratory findings support further prospective studies to refine MRI-targeted biopsy protocols using PI-RADS-defined lesion characteristics to inform personalized biopsy strategies.

PMID:40976748 | DOI:10.1016/j.urolonc.2025.08.024

J Prosthet Dent. 2025 Sep 20:S0022-3913(25)00695-X. doi: 10.1016/j.prosdent.2025.08.036. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Implant-supported crowns can be fabricated using additive (AM) or subtractive manufacturing (SM) with resin-based materials. However, their fracture strength on different implant abutments remains unclear.

PURPOSE: The purpose of this in vitro study was to evaluate the fracture strength (FS) and failure modes of AM interim crowns cemented on polyetheretherketone (PEEK) or titanium (Ti) abutments and compare them with SM crowns.

MATERIAL AND METHODS: Sixty-four implant-supported crowns were fabricated from 3 AM resins (Crowntec [AM_CT], FREEPRINT temp [AM_FP], Varseosmile Crown Plus [AM_VS]) and one SM resin (M-PM Disc [SM_MPM]) (N=16). The crowns were cemented on 1-piece PEEK or Ti abutments (n=8) using dual-polymerizing self-adhesive resin cement after standardized surface treatments. All specimens were subjected to thermomechanical aging (5000 thermal cycles, 250 000 cycles at 49 N, 1.7 Hz) followed by FS testing. Failures were classified as repairable crown crack or fracture, catastrophic crown fracture without abutment damage, abutment distortion without crown damage, or crown and abutment damage. One-way analysis of variance with Tukey test and chi-squared test were used for statistical analysis (α=.05).

RESULTS: All specimens survived cyclic loading. While Ti-supported crowns fractured consistently through catastrophic crown failure without abutment damage, most PEEK-supported crowns exhibited inconsistent failure patterns involving abutment distortion or combined crown-abutment damage. Only 6 crowns on PEEK abutments (4 AM_CT and 2 AM_FP) failed without abutment damage, making statistical comparison unreliable. Therefore, PEEK-supported crowns were excluded from statistical analysis. Among Ti groups, SM_MPM crowns demonstrated the highest FS, followed by AM_CT, while AM_FP and AM_VS showed significantly lower FS values (P≤.003). The distribution of failure modes differed significantly among crown materials, abutment types, and their combinations (P≤.014).

CONCLUSIONS: Crowns on Ti abutments fractured without abutment damage, with SM_MPM resulting in the highest FS, followed by AM_CT. In contrast, most PEEK-supported crowns exhibited abutment distortion without crown damage or simultaneous crown and abutment damage.

PMID:40976743 | DOI:10.1016/j.prosdent.2025.08.036