Category: Nevin Manimala

Neurol Sci. 2025 Oct 1. doi: 10.1007/s10072-025-08525-9. Online ahead of print.

ABSTRACT

BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder potentially influenced by immune system dysregulation, with the human leukocyte antigen (HLA) system implicated in its pathogenesis. This study aims to evaluate HLA variants’ association with PD risk and clinical attributes.

METHODS: A systematic review and meta-analysis, registered with PROSPERO (CRD420250650550) and adhering to PRISMA Guidelines, was conducted. PubMed, Web of Science, and Scopus were searched from February 2005 to February 2025 for determined keywords. Eligible studies included human-based primary research reporting HLA associations with PD risk or clinical features. Data was extracted on study characteristics, HLA alleles/genotypes, and clinical outcomes. Meta-analysis used fixed-effect models to pool odds ratios (ORs) with 95% confidence intervals (CIs), assessing heterogeneity via I² and Cochran’s Q statistics. Publication bias was evaluated using the trim-and-fill method.

RESULTS: Sixteen studies analyzing 42 HLA markers were included. Pooled ORs indicated increased PD risk with insignificant heterogeneity for HLA-B*07, HLA-C*07:02, HLA-DQA1*01:02, HLA-DQA1*05:05, HLA-DRB1*03:01, and HLA-DRB1*15:01, with protective effects for HLA-DQB1*03:02 and HLA-DQB1*04:01. The analysis for HLA genotypes showed substantial heterogeneity across the studies. The publication bias effect was limited using trim-and-fill method, affecting all the homogenous analyses. HLA-DR expression correlated with motor-cognitive function, and HLA-DQB1*06:02 was linked to daytime sleepiness.

CONCLUSION: Specific HLA alleles influence PD susceptibility and clinical presentation, highlighting the immune system’s role in PD pathogenesis. Future research may explore the influence of HLA haplotypes on PD to ascertain whether there is a direct impact or if the associations are merely a consequence of linkage disequilibrium.

PMID:41032234 | DOI:10.1007/s10072-025-08525-9

Eur Arch Paediatr Dent. 2025 Oct 1. doi: 10.1007/s40368-025-01115-5. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effectiveness of the “Marzhan Tis” mobile application in improving oral hygiene practices among children with autism spectrum disorder (ASD) and to examine its usability and correlation with learning success.

METHODS: A prospective, non-randomized cohort study was conducted with 90 children aged 3-18 years diagnosed with Level 1 ASD from rehabilitation centers in Almaty, Kazakhstan. Participants were divided into an intervention group (IG), which used the app for 1 month, and a control group (CG), which received standard oral hygiene instructions. Oral hygiene was assessed using the Simplified Oral Hygiene Index (OHI-S), approximal plaque index (API), and papillary-marginal-alveolar index (PMA). Adherence was measured using the modified Oral Hygiene Assessment Scale (OHAS-10), and a structured 15-item caregiver questionnaire evaluated behavioral changes and app usability. Statistical analysis included the Shapiro-Wilk test for normality, Mann-Whitney U and Wilcoxon signed-rank tests for between and within-group comparisons, Chi-square tests for categorical variables, and Pearson correlation for usability-learning associations.

RESULTS: Significant improvements were observed in the IG for all oral hygiene indices (OHI-S reduction: 28-52%; API and PMA improvement > 50%, p < 0.05). Oral hygiene adherence increased by 18.8% (p = 0.001). Independence in brushing improved in 85% of IG children (χ² = 28.7, p = 0.001). A strong correlation was found between app usability and learning outcomes (r = 0.65, p = 0.01).

CONCLUSION: The “Marzhan Tis” mobile app effectively improved oral hygiene skills and independence in children with ASD Level 1. Its usability and gamified features support its integration into pediatric oral health interventions.

PMID:41032232 | DOI:10.1007/s40368-025-01115-5

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