Category: Nevin Manimala

Nat Commun. 2026 Aug 8;17(1):8014. doi: 10.1038/s41467-026-76312-x.

ABSTRACT

Established determinants of health in the elderly help guide routines for indicated vaccine administration, while unmeasured frailty may limit vaccine access. We evaluate the performance of the 2024-2025 COVID-19 vaccine adapted to the Omicron JN.1 lineage in a Swedish population aged ≥65 years (N = 245 696). Vaccine effectiveness (VE) on COVID-19-related hospitalization and a negative control outcome (NCO; all-cause mortality) are assessed in various cohorts between October 1, 2024 to March 31, 2025. The VE was 75% (95% CI 70%-79%) overall, and 84% (95% CI 80%-87%) and 65% (95% CI 34%-82%) in individuals with and without vaccination with the prior updated COVID-19 vaccine in 2023-2024, respectively. The NCO in individuals exposed to the study vaccine in 2024-2025 was half of that seen in those not exposed to the vaccine (HR 0.43 [95% CI 0.40-0.45]). Removing individuals hospitalized with COVID-19 from this population did not change the difference in NCO (HR 0.43 [95% CI 0.41-0.46]). These findings suggest the presence of selection effects arising from under-provision of health services to elderly individuals with frailty. The healthy vaccinee effect should be considered in observational studies of the effectiveness of updated COVID-19 vaccines in elderly populations.

PMID:42570961 | DOI:10.1038/s41467-026-76312-x

Evid Based Dent. 2026 Aug 8. doi: 10.1038/s41432-026-01238-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the accuracy and reliability of three AI platforms ChatGPT, Perplexity, and Google Gemini in assessing the methodological quality of systematic reviews using the AMSTAR 2 checklist, compared with expert manual evaluation in dental research.

METHODS: A cross-sectional comparative study was conducted to assess the performance of three AI platforms ChatGPT, Perplexity, and Google Gemini in evaluating the methodological quality of 35 systematic reviews using the AMSTAR 2 checklist. Manual assessments by a domain expert served as the reference standard. Each AI system was prompted with a standardized AMSTAR 2 query, and item-level outputs were collected for direct comparison. Key metrics included percentage agreement, error proportions, and inter-rater reliability measured by Cohen’s kappa. Error proportions represent the proportion of discordant assessments out of total valid pairwise comparisons across 16 AMSTAR-2 items. Differences between LLM-generated and reference AMSTAR-2 ratings were summarized using effect estimates with corresponding 95% confidence intervals. Comparative performance across platforms was assessed based on confidence-interval overlap rather than hypothesis testing. Results are presented as effect estimates with corresponding 95% confidence intervals, without hypothesis testing or statistical dichotomization. This approach provided a robust and reproducible framework to benchmark AI-assisted quality appraisal in dental evidence synthesis.

RESULTS: Among 35 systematic reviews assessed, Perplexity demonstrated the highest agreement with expert AMSTAR-2 ratings (error proportion: 19.0%; weighted κ_w: 0.78, 95% CI 0.71-0.85), followed by ChatGPT (error proportion: 22.9%; weighted κ_w: 0.62, 95% CI 0.54-0.70) and Google Gemini (error proportion: 43.9%; weighted κ_w: 0.41, 95% CI 0.33-0.49). Perplexity also achieved the best sensitivity (81.3%, 95% CI 76.5-85.4%) and specificity (82.7%, 95% CI 78.1-86.5%) for correctly identifying high-quality reviews. Non-overlapping 95% confidence intervals suggest meaningful differences in performances among platforms, with Perplexity showing superior agreement across all metrics. Across all platforms, agreement was generally higher for non-critical AMSTAR-2 domains involving clear and structured reporting, whereas performance was weaker for critical domains requiring interpretation of complex methodological details, risk-of-bias considerations, and evidence synthesis procedures.

CONCLUSIONS: Perplexity demonstrated the highest accuracy and agreement with expert assessments of the methodological quality of systematic reviews, suggesting its potential as a supportive AI tool for AMSTAR-2-based appraisal in dental evidence synthesis. In contrast, systematic biases observed in ChatGPT and Google Gemini underscore the continued need for human oversight to ensure the validity of methodological assessments. Differences in agreement and error proportions were observed across all models when compared with expert AMSTAR-2 evaluations, indicating meaningful variability in methodological appraisal performance, reinforcing that AI-assisted appraisal of systematic review methodology should complement rather than replace expert human judgment in dental research.

PMID:42570960 | DOI:10.1038/s41432-026-01238-8

Sci Rep. 2026 Aug 8;16(1):24551. doi: 10.1038/s41598-026-62965-7.

ABSTRACT

During the COVID-19 pandemic, inter-hospital transfer of critically ill patients between intensive care units was widely used to manage capacity shortages. While several individual studies have compared outcomes of transferred and non-transferred patients, no systematic synthesis of this evidence exists. This systematic review aims to determine whether inter-hospital ICU-to-ICU transfer of adult COVID-19 patients is associated with increased mortality or other adverse clinical outcomes. We systematically searched PubMed, Web of Science, and Scopus for observational studies comparing clinical outcomes of adult COVID-19 patients who underwent inter-hospital ICU-to-ICU transfer with non-transferred ICU patients. Two reviewers screened, selected, and extracted data independently and in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale and ROBINS-I, and certainty of evidence using GRADE. Exploratory random-effects meta-analyses were performed separately for each effect measure, with Hartung-Knapp and crude-effect sensitivity analyses. Nine observational studies from seven countries were included (approximately 6,100 transferred and 29,200 non-transferred ICU patients). None of the adjusted effect estimates showed a statistically significant mortality disadvantage for transferred patients. Pooled adjusted subgroup estimates were an odds ratio of 1.29 (95% CI 0.84 to 1.98; k = 3) and a hazard ratio of 0.71 (95% CI 0.34 to 1.46; k = 2). Length of stay was longer in transferred patients in most studies. The available observational evidence did not show a clear increase in mortality among transferred compared with non-transferred COVID-19 ICU patients. These findings support the use of inter-hospital transfer as a safe strategy for managing ICU surge capacity. PROSPERO CRD420261356915.

PMID:42570952 | DOI:10.1038/s41598-026-62965-7

Ultrasound Med Biol. 2026 Aug 8:S0301-5629(26)00287-5. doi: 10.1016/j.ultrasmedbio.2026.07.013. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the value of Microvascular Flow (MV-Flow) vascular pattern and quantitative parameter vascular index (VI) in differentiating benign from malignant lymph nodes.

METHODS: A total of ninety-five patients who underwent ultrasound-guided lymph node aspiration biopsy at the First Hospital of Sun Yat-sen University between February 2023 and September 2023 were prospectively enrolled. Conventional ultrasound and MV-Flow examinations were performed, and the diagnostic efficacy was analyzed. The influencing factors of the VI were investigated.

RESULTS: Among grayscale features, lymph node hilum, shape, liquefaction, and calcification differed significantly between benign and malignant nodes (p < 0.05). In the vascular pattern of Color Doppler Flow Imaging (CDFI) and MV-Flow, benign nodes mainly showed hilar flow, while malignant nodes mainly showed mixed flow (p < 0.05 for both). MV-Flow and CDFI demonstrated comparable overall diagnostic performance (AUC: 0.682 vs. 0.646), with no statistically significant difference (p > 0.05). MV-Flow vascular pattern classification showed good interobserver agreement (κ = 0.801), and the vascular index (VI) demonstrated high reliability (ICC = 0.811). A moderate negative correlation was observed between lymph node depth and VI across all four sections.

CONCLUSIONS: MV-Flow provided superior qualitative visualization of microvascular flow compared to CDFI, but this did not translate into a statistically significant improvement in quantitative diagnostic performance for differentiating benign from malignant lymph nodes. Therefore, it should serve as a secondary diagnostic adjunct for lymph nodes with indeterminate CDFI findings, particularly to microvascular architecture that traditional Doppler fails to detect.

PMID:42570926 | DOI:10.1016/j.ultrasmedbio.2026.07.013

Acad Radiol. 2026 Aug 8:S1076-6332(26)00557-X. doi: 10.1016/j.acra.2026.07.049. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To compare an integrated “Plaque-Vessel” high-resolution vessel wall imaging (HR-VWI) radiomics model against a “Plaque-only” model for predicting 1-year adverse clinical events in symptomatic intracranial atherosclerotic stenosis (ICAS).

MATERIALS AND METHODS: This retrospective study enrolled 272 symptomatic ICAS patients. A temporal split was applied: patients from 2022 (n = 133) constituted the training and validation cohorts, while those from 2023 (n = 139) served as an independent temporal test cohort. Radiomic features were extracted from T1-weighted and contrast-enhanced T1-weighted HR-VWI. Two signatures were constructed: a “Plaque” model (plaque ROI only) and a “Plaque-Vessel” model (incorporating plaque, vessel wall, and lumen). The primary endpoint was a composite of 1-year adverse clinical events. Performance was assessed using the area under the curve (AUC) and decision curve analysis (DCA), comparing against a qualitative imaging model (comprising intraplaque hemorrhage, plaque enhancement, and positive remodeling), the Essen Stroke Risk Score (ESRS), and NIHSS.

RESULTS: The Plaque-Vessel model yielded the highest predictive performance, achieving an AUC of 0.800 (95% CI: 0.724-0.863) in the temporal test set. This performance showed a trend toward improvement compared to the Plaque-only model (AUC = 0.721, P = .27) and significantly outperformed the qualitative plaque features model (AUC = 0.631, P = .03), ESRS (AUC = 0.554, P < .01), and NIHSS (AUC = 0.543, P < .01). Calibration curves showed good agreement. DCA demonstrated that the Plaque-Vessel signature provided greater net clinical benefit than the Plaque-only model or clinical scores across the majority of threshold probabilities.

CONCLUSION: The integrated Plaque-Vessel radiomics model significantly outperforms conventional clinical scores and routine visual plaque assessment for predicting 1-year adverse events. However, given the inconclusive statistical difference between the integrated and plaque-only models, these findings remain exploratory. The model requires further large-scale validation before it can be considered ready to guide routine clinical decisions.

PMID:42570909 | DOI:10.1016/j.acra.2026.07.049

Acad Radiol. 2026 Aug 8:S1076-6332(26)00572-6. doi: 10.1016/j.acra.2026.07.067. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: Crohn’s disease (CD) is often associated with sleep disturbances through poorly understood mechanisms. The glymphatic-related perivascular clearance system may provide a potential link via the gut-brain axis. This study investigated noninvasive diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) in patients with CD and its correlations with intestinal inflammation and sleep quality. MATERIALS AND METHODS: This study enrolled 90 patients with CD (45 active, 45 in remission) and 50 healthy controls (HC). All subjects underwent comprehensive clinical screening, sleep evaluation using the Pittsburgh Sleep Quality Index, and 3T magnetic resonance imaging with DTI for ALPS index quantification. Patients with CD additionally provided stool samples for fecal calprotectin to assess levels of intestinal inflammation.

RESULTS: Patients with CD demonstrated significantly reduced ALPS index compared to HC (P < 0.001), particularly in the active disease state. The ALPS index exhibited moderate diagnostic utility in distinguishing active from remitted CD (area under the curve = 0.785, 95% confidence interval: 0.688-0.883). Partial correlation analysis revealed a significantly negative correlation between the ALPS index and both inflammatory markers and poor sleep quality. Mediation analysis revealed that reduced ALPS statistically accounted for 25.22% of the association between intestinal inflammation and sleep disturbances.

CONCLUSION: Reduced periventricular diffusivity assessed by DTI-ALPS is associated with both intestinal inflammation and sleep disturbances in CD, statistically accounting for a modest proportion of their association. These cross-sectional findings suggest a potential gut-brain perivascular pathway connection that requires prospective validation.

PMID:42570907 | DOI:10.1016/j.acra.2026.07.067

J Prosthet Dent. 2026 Aug 8:S0022-3913(26)00518-4. doi: 10.1016/j.prosdent.2026.07.015. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Three-dimensional (3D) facial scanning has been increasingly integrated into digital dental workflows. Smartphone-based 3D facial scanning applications offer an accessible alternative to professional extraoral scanners; however, their metric validity for clinically relevant facial measurements remains unclear.

PURPOSE: The purpose of this retrospective clinical study was to determine whether linear facial measurements obtained from smartphone-based 3D facial scanning applications were statistically equivalent to those obtained from professional extraoral facial scanners.

MATERIAL AND METHODS: Facial scans from 23 participants, obtained via repeated scanning with smartphone-based scanners (Qlone, Magiscan, 3D App Scanner, on iPhone 13 Pro; Apple Inc) and professional scanners (Artec Spider; Artec, EinStar; Shining 3D), were retrospectively analyzed. Four facial distances (trichion-nasion, nasion-pronasion, pronasion-pogonion, and right zygomatic-left zygomatic) were measured on all scans. The equivalence of these distances between smartphone-based scanners and each professional scanner was assessed using the two 1-sided t tests (TOST) procedure with a predefined equivalence margin of ±1 mm and Bonferroni-adjusted significance levels.

RESULTS: Across all distances, smartphone-based and professional scanners were statistically equivalent, with absolute mean differences below 0.12 mm (90% confidence interval: -0.03 to 0.26; P<.001 for all comparisons).

CONCLUSIONS: Smartphone-based 3D facial scanning applications provided linear facial measurements that were statistically equivalent to those obtained from professional extraoral scanners for selected distances. These applications may be considered valid for targeted clinical applications in dentistry and as complementary tools within digital workflows.

PMID:42570899 | DOI:10.1016/j.prosdent.2026.07.015

Eur Urol Oncol. 2026 Aug 8:S2588-9311(26)00215-4. doi: 10.1016/j.euo.2026.07.015. Online ahead of print.

ABSTRACT

BACKGROUND: Erectile dysfunction remains a major morbidity after radical prostatectomy. The SAFE technique uses real-time, micro-ultrasound-guided low-pressure hydrodissection to enable atraumatic nerve sparing.

OBJECTIVE: We compared functional and oncologic outcomes of SAFE versus standard robotic-assisted radical prostatectomy (RARP).

DESIGN, SETTING, AND PARTICIPANTS: In this randomized trial, patients were assigned 1:1 to micro-ultrasound-guided SAFE-RARP or standard RARP. Surgeons were unblinded; patients and outcome assessors were blinded.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was erectile function recovery at 6 mo (SHIM ≥17), with secondary functional and oncologic outcomes. The primary endpoint was assessed at the prespecified interim analysis using a one-sided pooled z-test within a group-sequential O’Brien-Fleming α-spending framework (interim efficacy boundary, one-sided p < 0.002).

RESULTS AND LIMITATIONS: A total of 107 patients were analyzed (SAFE, n = 54; control, n = 53). At 6 mo, erectile function recovery was higher with SAFE than with standard RARP (52% vs 43%; absolute difference 8.5%, 95% CI -10% to 27%; one-sided p = 0.22), without crossing the prespecified interim efficacy boundary. At 6 weeks, early recovery rates were higher with SAFE (37% vs 21%; one-sided p = 0.032), with a smaller difference at 3 mo. Linear mixed-effects modeling showed earlier improvement in SHIM with SAFE, with convergence by 6 mo. Continence, oncologic outcomes, and complication rates were similar between groups. Limitations include the prespecified interim nature of the analysis, the relatively small sample size, and the need for longer follow-up to determine the durability and clinical significance of functional differences.

CONCLUSIONS: In this prespecified interim analysis, the primary endpoint of 6-mo recovery was not met. Exploratory analyses suggested earlier postoperative recovery with SAFE, without evidence of compromised safety or oncologic outcomes; these findings are hypothesis-generating.

PMID:42570880 | DOI:10.1016/j.euo.2026.07.015

Am J Clin Nutr. 2026 Aug 8:101462. doi: 10.1016/j.ajcnut.2026.101462. Online ahead of print.

ABSTRACT

BACKGROUND: The potential cardiac toxicity of glutamate is debated and has been suggested by some epidemiological and experimental studies. To our knowledge, none investigated the links between both naturally occurring and food additive glutamate and cardiovascular disease (CVD) risk.

OBJECTIVE: Our objective was to assess the associations between intakes of total, food additive and naturally occurring glutamate, and the risk of CVD, including cerebrovascular (CVA) and coronary heart (CHD) diseases, in a large population-based study.

METHODS: Participants (n= 108,932, NutriNet-Santé prospective cohort, 2009-2023, France, mean age=42.4y (SD=14.5), 79.3% females) completed repeated 24h-dietary records (mean = 21 (SD=18), up to 84), including brands of industrial food consumed. Exposure to food additive glutamate was evaluated through multiple composition databases and ad-hoc laboratory assays in food matrices. Associations between time-dependent continuous exposures to total, naturally occurring and food additive glutamate and risk of CVD, CVA, and CHD were investigated using multivariable Cox models.

RESULTS: During follow-up (median=7.92y), 2397 CVD, 1113 CVA, and 1284 CHD cases were diagnosed. Higher intakes of food additive glutamate (Hazard Ratio_{per 200mg/d}=1.05, 95%Confidence Interval (1.01, 1.09), p-value=0.02), naturally occurring glutamic acid (HR_3000mg/d=1.13(1.03, 1.25), p-value=0.009), and total glutamate (HR_3000mg/d=1.15(1.05, 1.26), p-value=0.004) were associated with higher risks of CHD. For CVD, corresponding HRs were 1.03(1.00, 1.06; p-value=0.07), 1.09(1.01, 1.18; p-value=0.02) and 1.10(1.02, 1.18; p-value=0.01). No association was detected for CVA (all p-values≥0.5). Residual confounding cannot be entirely ruled out, and causality cannot be established based on this single observational study.

CONCLUSIONS: This large prospective study showed positive linear associations between higher glutamate intakes and increased risks of CVD. In particular, food additive glutamate, naturally occurring glutamic acid, and total glutamate intakes were all associated with higher CHD risk. This adds to previous experimental data showing a role of glutamate in regulating heart functioning at physiological doses, while also suggesting heart rate dysfunction at higher exposures.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03335644.

PMID:42570865 | DOI:10.1016/j.ajcnut.2026.101462

Orthop Traumatol Surg Res. 2026 Aug 8:104856. doi: 10.1016/j.otsr.2026.104856. Online ahead of print.

ABSTRACT

BACKGROUND: Transtibial pull-out repair is widely used for the treatment of medial meniscus posterior root tears (MMRTs). However, the optimal suture material remains unclear despite differences in biomechanical and biological properties between absorbable and non-absorbable sutures. This study aimed to evaluate whether suture material influences clinical and radiological outcomes after transtibial pull-out repair for MMRTs through a systematic review and meta-analysis.

METHODS: This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Eligible studies reporting clinical or radiological outcomes after transtibial pull-out repair for MMRTs were included. Extracted data included patient-reported outcomes, magnetic resonance imaging (MRI)-based meniscal healing, meniscal extrusion, Kellgren-Lawrence (KL) grade progression, and conversion to total knee arthroplasty (TKA). Random-effects meta-analyses and subgroup analyses were performed according to suture absorbability, and meta-regression was used to explore potential sources of heterogeneity.

RESULTS: Sixteen studies encompassing 647 patients were included; these comprised one Level II study, seven Level III studies, and eight Level IV studies. No significant subgroup differences according to suture absorbability were identified for changes in International Knee Documentation Committee score (P = 0.07), Lysholm score (P = 0.43), meniscal extrusion (P = 0.19), MRI-based meniscal healing (P = 0.77), KL grade progression (P = 0.75), or conversion to TKA (P = 0.06). The pooled healing proportions were 0.60 (95% CI, 0.33-0.82) for non-absorbable sutures and 0.68 (95% CI, 0.00-1.00) for absorbable sutures. The corresponding pooled proportions of conversion to TKA were 0.05 (95% CI, 0.00-1.00) and 0.22 (95% CI, 0.10-0.38), respectively.

CONCLUSION: The available evidence did not identify statistically significant differences in clinical or radiological outcomes between absorbable and non-absorbable sutures after transtibial pull-out repair for MMRTs. However, because these findings were derived primarily from indirect comparisons across heterogeneous studies, they should not be interpreted as evidence of equivalence, and the current evidence remains insufficient to determine whether suture absorbability independently influences postoperative outcomes.

LEVEL OF EVIDENCE: IV; systematic review and meta-analysis of Level II-IV studies.

PMID:42570862 | DOI:10.1016/j.otsr.2026.104856