Category: Nevin Manimala

EJNMMI Res. 2025 Oct 13;15(1):130. doi: 10.1186/s13550-025-01326-3.

ABSTRACT

BACKGROUND: Terbium-161 (¹⁶¹Tb) is a promising β⁻-emitter for theragnostics. However, its complex photon emission pattern-including intense X-rays and low-yield, high-energy γ-emissions-may complicate image-based quantification. This study aimed to assess the feasibility of accurate SPECT/CT-based ¹⁶¹Tb dosimetry through a series of phantom measurements using a GE Discovery NM/CT 670 Pro system. Three collimators were evaluated: extended low-energy general-purpose (ELEGP), low-energy high-resolution (LEHR), and medium-energy general-purpose (MEGP), using two separate energy windows: around the 75 keV γ-peak (± 10%), and around the 49 keV γ-peak and nearby X-rays (40.7-62.9 keV). A clinical OSEM reconstruction algorithm was employed.

RESULTS: On average, the SPECT calibration factors (CFs) were 2-fold higher with ELEGP compared to MEGP and LEHR, and 3-fold higher at 49 keV compared to 75 keV. For each collimator, derived CFs varied substantially depending on measurement and volume-of-interest geometry-more so at 49 keV, compared to 75 keV. Measurements of two 3D-printed kidney inserts revealed superior visual image quality with LEHR compared to ELEGP and MEGP. Across all collimators, the 75 keV window provided better spatial resolution and contrast than the 49 keV window. An anthropomorphic phantom study, including a LungSpine phantom with 8 spherical inserts and 3 different background activity levels, demonstrated a greater quantitative accuracy for MEGP compared to LEHR and ELEGP, with statistical significance for both energy windows (p ≤ 0.001). Errors were generally larger at 49 keV compared to 75 keV. For the low-energy collimators, considerable septal penetration (e.g., at 292 and 475 keV) was observed, along with systematic underestimation at high activity levels.

CONCLUSIONS: This study demonstrates that highly accurate SPECT/CT-based ¹⁶¹Tb quantification is feasible, further cementing ¹⁶¹Tb as a viable theragnostic alternative. A MEGP collimator, a 75 keV window, and a CF derived from a homogeneous cylinder measurement appears preferable. The 49 keV window could be useful at late imaging time points, given its high sensitivity, if further optimized. Degradation from penetration and subsequent downscatter may be mitigated with a more refined reconstruction. Further investigations into dead-time effects are encouraged.

PMID:41082018 | DOI:10.1186/s13550-025-01326-3

Biomech Model Mechanobiol. 2025 Oct 13. doi: 10.1007/s10237-025-02016-8. Online ahead of print.

ABSTRACT

Computed tomography (CT)-based finite element (FE) models can non-invasively assess bone mechanical properties, but their clinical application in paediatrics is limited due to fewer datasets and models. Statistical Shape-Density Model (SSDM)-based FE models using statistically inferred shape and density have application to predict bone stress and strains; however, their accuracy in children remains unexplored. This study assessed the accuracy of stress-strain distributions estimated from SSDM-based FE models of paediatric femora and tibiae. CT-based FE models used geometry and densities derived from 330 CT scans from children aged 4-18 years. Paediatric SSDMs of the femur and tibia were used to predict bone geometries and densities from participants’ demographics and linear bone measurements. Forces during single-leg standing were estimated and applied to each bone. Stress and strain distributions were compared between the SSDM-based FE models and CT-based FE models, which served as the gold standard. The average normalized root-mean-square error (NRMSE) for Von Mises stress was 6% for the femur and 8% for the tibia across all cases. Principal strains NRMSE ranged from 1.2% to 5.5%. High correlations between the SSDM-based and CT-based FE models were observed, with determination coefficients ranging from 0.80 to 0.96. These results illustrate the potential of SSDM-based FE models for paediatric application, such as personalized implant design and surgical planning.

PMID:41082014 | DOI:10.1007/s10237-025-02016-8

Bull Math Biol. 2025 Oct 13;87(11):158. doi: 10.1007/s11538-025-01541-y.

ABSTRACT

The coexistence of species in predator-prey systems is a critical ecological issue due to the intricate interactions among multiple influencing factors. In this study, we develop a predator-prey model that incorporates prey herd behavior, cooperative hunting strategies among predators, and the establishment of a reserved area for prey protection. We establish conditions for the positivity and boundedness of the system to ensure long-term biological feasibility. The existence and stability of equilibrium points, along with the conditions for Hopf and saddle-node bifurcations, are rigorously analyzed. Numerical simulations are performed to validate the analytical findings. Global sensitivity analysis reveals that key parameters, including the size of the reserved area, predator cooperation, and migration rates, significantly affect system dynamics and species coexistence. Our numerical results suggest that expanding the reserved area promotes prey recovery, with predator populations initially growing but eventually declining towards extinction. Increased hunting cooperation among predators initially boosts predator populations but ultimately accelerates prey depletion, leading to predator collapse due to overhunting.

PMID:41082013 | DOI:10.1007/s11538-025-01541-y

Eur J Clin Microbiol Infect Dis. 2025 Oct 13. doi: 10.1007/s10096-025-05317-z. Online ahead of print.

ABSTRACT

PURPOSE: Artificial Intelligence (AI) and Machine Learning (ML) are innovative technologies, gathering particular interest in all laboratory settings. The aim of this study was to assess the current state of AI and ML adoption in Italian laboratories of clinical microbiology.

METHODS: A structured 63-question survey was developed by the AI/ML in Microbiology Study Group and distributed to all members of the Italian Association of Clinical Microbiologists between December 2024 and March 2025. Responses were collected anonymously and analyzed using descriptive statistics analysis.

RESULTS: A total of 163 professionals completed the survey. While 25.4% reported current AI/ML usage-primarily in bacteriology and virology-the majority had limited experience with AI technologies. Only 13.6% of respondents had a good understanding of AI/ML concepts, and 2.5% reported having trained data scientists on staff. Major barriers included lack of trained personnel and insufficient infrastructure. Most participants (99.0%) expressed interest in targeted AI training, and 57.5% showed willingness to collaborate on AI-related initiatives. Large language models (LLMs) were seen as promising, especially for data interpretation, despite low adoption rates.

CONCLUSION: The survey might provide valuable insights to identify priority areas for intervention, guide future training initiatives and develop targeted strategies to promote the adoption of these technologies through a fruitful dialogue with companies and IT professionals.

PMID:41081991 | DOI:10.1007/s10096-025-05317-z

Eur J Clin Microbiol Infect Dis. 2025 Oct 13. doi: 10.1007/s10096-025-05278-3. Online ahead of print.

ABSTRACT

BACKGROUND: Recurrent Clostridioides difficile infection (CDI) is a persistent clinical challenge due to the high rate of relapse following treatment with standard antibiotics. Fecal microbiota transplantation (FMT) has emerged as a promising alternative, with comparable results. Aiming to restore intestinal microbial balance and reduce recurrence. Comparative evidence on the efficacy and safety of FMT versus antibiotics remains variable across studies, warranting a comprehensive synthesis to guide clinical decision-making.

AIM: This systematic review and meta-analysis aims to present an updated comparison of the effectiveness and safety of FMT versus Vancomycin/ fidaxomicin in patients with CDI.

METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to identify randomized controlled trials comparing FMT with standard antibiotic therapy for recurrent CDI. Primary outcomes included resolution of infection, recurrence, mortality, and adverse events. A random-effects model was used to calculate risk ratios with 95% confidence intervals. Statistical heterogeneity was assessed using the I-squared statistic. The quality of the included studies was evaluated using the Cochrane Risk of Bias version 2 and ROBINS-1 tools.

RESULTS: A total of 9 clinical trials involving 759 patients were included. FMT was significantly more effective in resolving CDI compared to antibiotic therapy, with a risk ratio (RR) of 1.51 (95% CI: 1.29 to 1.78). Recurrence rates were significantly lower in the FMT group, with a RR of 0.38 (95% CI: 0.29 to 0.50). Mortality did not differ significantly between groups (RR = 0.95). Adverse events (AEs) were comparable between FMT and antibiotics, and no serious AEs directly related to FMT were reported. In the subgroup analysis, the lower GI route adminstration showed significant results (p = 0.02) for both recurrence and resolution of CDI.

CONCLUSION: FMT is more effective than standard antibiotic therapy for achieving resolution and reducing recurrence in patients with recurrent CDI.

PMID:41081988 | DOI:10.1007/s10096-025-05278-3

Sleep Breath. 2025 Oct 13;29(6):317. doi: 10.1007/s11325-025-03490-1.

ABSTRACT

OBJECTIVE: The study aims to assess the effect of a continuous positive airway pressure (CPAP) trial before titration on acceptability, CPAP pressures and sleep efficiency, and to predict long-term adherence to CPAP titration. The study assesses the treatment response and determines the optimum pressures.

METHODS: Prospective, randomised, single-centre, Cohort Study conducted in a tertiary care hospital in India. Patients of Indian origin with moderate to severe OSA diagnosed by level 1 polysomnography in our hospital were included in the study. Patients with haemodynamic instability and psychiatric disorders, and those who refused to consent to the study, were excluded from the study. Patients randomised into two groups were assessed for acceptability to CPAP following the titration study, and other parameters like sleep efficiency and mean CPAP pressures were noted. Anxiety is assessed using the Beck Anxiety Inventory at baseline and at three months. Compliance with CPAP is evaluated at three months using a proforma with the data obtained from the CPAP apparatus.

RESULTS: The acceptability of CPAP was better in the interval group. The results showed a statistically significant negative correlation between acceptability and average use of CPAP (r=-0.382, p-value < 0.001) and with the number of nights CPAP was used last month for > 4 h (r=-0.514, p-value < 0.001). The sleep efficiency at titration was better in the interval group.

CONCLUSION: A trial of CPAP before a titration study could improve acceptability, lower the CPAP pressures and improve long-term adherence in patients with moderate to severe OSA.

PMID:41081982 | DOI:10.1007/s11325-025-03490-1

J Robot Surg. 2025 Oct 13;19(1):684. doi: 10.1007/s11701-025-02878-1.

ABSTRACT

Enhanced recovery after surgery (ERAS) protocols emphasize multimodal interventions to accelerate recovery. Minimally invasive elective robotic-assisted colorectal surgery is an ideal candidate for ERAS protocols. This study evaluates the role of intrathecal analgesia with diamorphine in optimizing postoperative outcomes, focusing on pain control, length of stay (LOS), and complications. A retrospective cohort study was conducted on 246 patients undergoing elective robotic-assisted colorectal surgeries between July 2021 and November 2024 at two hospitals in a single trust (Hospitals A and B). The patients were grouped based on analgesia type: intrathecal analgesia with diamorphine (IA) [Intervention] and non-intrathecal analgesia (nIA) [control] groups. The primary outcomes included LOS, postoperative pain scores, and opioid consumption. The secondary outcomes were postoperative ileus (POI) and time to first bowel movement. Intrathecal analgesia with diamorphine was used in 61.8% (Hospital A) and 0% (Hospital B) of cases. Patients receiving IA in Hospital A compared to nIA in Hospital A and Hospital B, respectively, had significantly shorter LOS (5.3 days vs. 6.1 days and 7.0 days, p < 0.001), reduced opioid requirements (88% reduction, p < 0.00001), and a lower incidence of POI (3.6% vs. 13.2% and 14.7%, p = 0.02). Time to bowel function recovery was also faster in the IA group (2.6 days vs. 3.0 days in other groups, p = 0.03). Intrathecal analgesia with diamorphine significantly enhances recovery in elective robotic-assisted colorectal surgery, aligning with ERAS objectives. Its integration into routine practice could optimize patient outcomes, reduce complications, and improve resource utilization. Further prospective studies are needed to confirm these findings.

PMID:41081975 | DOI:10.1007/s11701-025-02878-1

Lasers Med Sci. 2025 Oct 13;40(1):429. doi: 10.1007/s10103-025-04694-3.

ABSTRACT

The aim of this study was to evaluate the antibacterial efficacy of various irrigation activation methods and their effects on the push-out bond strength (PBS) of glass fiber posts (GFP) to radicular dentin in teeth with post spaces infected with E. faecalis. Sixty human mandibular premolar teeth were decoronized. All root canals were shaped using a similar protocol and sterilized in an autoclave. Sterilization was confirmed in 10 randomly selected samples. 50 root canals were obturated. Post spaces were prepared in all samples, and root canals were contaminated with E. faecalis and incubated for 4 weeks. Bacterial growth was confirmed in 10 randomly selected samples. Samples were randomly divided into four groups according to irrigation activation methods (n = 10): Standard needle irrigation (SNI), passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS). CFU levels were recorded before and after disinfection by taking samples from the root canals with paper points. GFPs were cemented with self-adhesive resin cement. 2 mm thick sections were taken from the apical, middle, and coronal parts of GFPs, and a push-out test was performed with a universal testing machine. Failure modes were examined under a stereomicroscope (40×). Data were analyzed statistically. None of the irrigation methods tested achieved complete bacterial elimination. However, PIPS and SWEEPS achieved significantly greater bacterial reduction than SNI (ΔCFU [S1-S2], mean: PIPS 0.097; SWEEPS 0.090; SNI 0.045; P < .05). No significant differences were observed in PBS among groups (P > .05); values were generally higher coronally than apically (e.g., SNI 79.1 ± 50.1 vs. 34.1 ± 26.7 MPa), regardless of irrigation method. Adhesive fractures were dominant in all sections in SWEEPS, cohesive fractures were dominant in SNI, and mixed fractures were dominant in PUI. PIPS and SWEEPS are more effective than SNI in reducing bacterial load in the post space; however, this superiority is not reflected in bond strength. Irrigation activation method may affect the dentin surface and fracture type but does not make a decisive difference on PBS.

PMID:41081972 | DOI:10.1007/s10103-025-04694-3

Clin Lab. 2025 Oct 1;71(10). doi: 10.7754/Clin.Lab.2025.250331.

ABSTRACT

BACKGROUND: Ethylenediaminetetraacetic acid-induced pseudothrombocytopenia (EDTA-PTCP) is a well-documented in vitro artifact characterized by platelet clumping, leading to spuriously low platelet counts despite normal platelet quantity and function. This phenomenon can result in inappropriate clinical management, including unnecessary platelet transfusions. To address this issue, we propose a post-analytical correction strategy that integrates kanamycin treatment with event-based analysis in the PLT-F channel of the Sysmex XN-20 automated hematology analyzer to improve platelet count accuracy.

METHODS: The platelet surface markers CD41a and CD61 were evaluated using flow cytometry to compare their expression on single platelets and platelet clumps. Forward and side scatter characteristics, along with dot plot distributions, were analyzed to determine the extent of overlap between large platelet clumps and the neutrophil gating region. Additionally, blood smears were examined before and after kanamycin treatment to evaluate the degree of platelet clump dissociation. A regression model utilizing Gating-4 event counts from the PLT-F scatter-gram was developed to estimate corrected platelet counts. The diagnostic performance of Gating-4 as a surrogate marker for platelet clumps was assessed using receiver operating characteristic (ROC) curve analysis.

RESULTS: Flow cytometry revealed moderate CD41a and CD61 expression on single platelets, while platelet clumps exhibited markedly increased expression of these markers. Larger platelet clumps demonstrated increased forward scatter intensities, overlapping with the neutrophil population in dot plots. Blood smear analysis confirmed complete platelet clump dissociation in 87 out of 96 samples following kanamycin treatment, whereas residual clumping persisted in 9 cases, leading to unreliable platelet counts. Regression analysis demonstrated that Gating-4 event counts were strong predictors of corrected platelet counts (R² = 0.705, p < 0.001), with high statistical significance (t = 12.377, p < 0.001). A Gating-4 event cutoff of 138.5 optimally distinguished clump presence, with an area under the ROC curve of 0.969 (p < 0.001).

CONCLUSIONS: This study introduces a regression model utilizing Gating-4 events from the PLT-F scattergram to improve platelet count estimation in clumped samples. The model demonstrated high accuracy in moderate clumping cases; however, additional correction was required for severe clumping. To enhance accuracy, we propose a stepwise approach that incorporates platelet clump size assessment and kanamycin intervention.

PMID:41078198 | DOI:10.7754/Clin.Lab.2025.250331

Clin Lab. 2025 Oct 1;71(10). doi: 10.7754/Clin.Lab.2025.250303.

ABSTRACT

BACKGROUND: Hypoalbuminemia is associated with poor outcomes in patients with infectious diseases. We aimed to determine the effect of hypoalbuminemia on treatment failure in adult patients with P. aeruginosa bloodstream infections.

METHODS: This retrospective cohort study included adults with microbiologically and clinically documented bloodstream infections caused by P. aeruginosa between January 2012 and December 2021. Hypoalbuminemia was de-fined as baseline serum albumin level < 35 g/L. The main clinical outcomes were treatment failure, 14-day and 30-day mortality, length of hospital stay, and intensive care unit admission.

RESULTS: Out of 207 patients included in the 10-year study period, 145 (70.0%) presented with hypoalbuminemia. Hypoalbuminemia patients were more likely to receive mechanical ventilation (20.0% vs. 4.8%, p = 0.006) and have a higher treatment failure rate (32.9% vs. 12.9%, p = 0.003) compared to normoalbuminemia patients. Multivariate analyses showed that hypoalbuminemia, glucocorticoid use, and Pitt score ≥ 2 are associated with treatment failure (p < 0.05).

CONCLUSIONS: Glucocorticoid use, hypoalbuminemia, and Pitt score ≥ 2 points were more frequent in patients with P. aeruginosa bloodstream infections and were associated with poor outcomes. Therefore, P. aeruginosa bloodstream infections patients may benefit from early replenish albumin molecules.

PMID:41078193 | DOI:10.7754/Clin.Lab.2025.250303