Category: Nevin Manimala

Breast Cancer. 2026 May 20. doi: 10.1007/s12282-026-01858-z. Online ahead of print.

ABSTRACT

BACKGROUND: Large language models (LLMs), a form of generative artificial intelligence (AI), are increasingly explored for clinical applications due to their ability to synthesize medical information. In breast cancer care, where therapeutic decision-making is complex because of expanding treatment options, AI-based decision support tools may improve efficiency and consistency. However, their clinical validity and safety remain insufficiently evaluated in real-world settings. The present study aimed to compare the characteristics of treatment recommendations generated by a large language model with those proposed by breast cancer specialists using identical clinical information.

METHODS: This retrospective observational study included 100 patients with advanced or recurrent breast cancer. Clinical information was provided to ChatGPT using a standardized prompt to generate treatment recommendations. Six board-certified breast cancer specialists independently proposed treatment strategies for the same cases. Recommendations were evaluated using five predefined criteria: 1. Comprehensiveness and appropriateness of literature selection, 2. Accuracy of interpretation of key evidence, 3. Clinical appropriateness and diversity of treatment options, 4. Accuracy of adverse event information, 5. Time required to generate recommendations. Group comparisons were performed using linear mixed-effects models with case and evaluator as random effects.

RESULTS: ChatGPT achieved higher scores than specialists across all five evaluation criteria, with the largest difference observed for accuracy of key evidence interpretation. The mean total score was 93.7 for ChatGPT and 44.1 for specialists, and linear mixed-effects model analysis confirmed a significantly higher total score for ChatGPT (p < 0.001). These findings suggest that AI-generated responses tended to provide more comprehensive and structured summaries of available evidence within the predefined evaluation framework.

CONCLUSIONS: LLMs were able to generate comprehensive and structured treatment recommendations based on the provided clinical information. However, these findings primarily reflect differences in information synthesis under predefined evaluation criteria rather than superiority in real-world clinical decision-making. Given the potential risk of hallucinations, AI should be positioned as an assistive tool to support specialist-led decision-making in breast cancer care.

PMID:42159946 | DOI:10.1007/s12282-026-01858-z

Clin Exp Nephrol. 2026 May 20. doi: 10.1007/s10157-026-02886-x. Online ahead of print.

ABSTRACT

BACKGROUND: Platelet indices, including platelet distribution width (PDW) and mean platelet volume (MPV), reflect platelet activation and have been associated with kidney disease progression in various populations. However, whether these indices are associated with incident chronic kidney disease (CKD) in high-risk individuals remains unclear.

METHODS: We retrospectively examined the associations of PDW and MPV with incident CKD using longitudinal data from 1,281 individuals without CKD but with one or more established CKD risk factors (hypertension, diabetes mellitus, dyslipidemia, or a history of cardiovascular disease) in the Fukushima Cohort Study. Participants were categorized into quartiles according to baseline PDW or MPV. The primary outcome was incident CKD.

RESULTS: During a median follow-up of 5.2 years, 384 participants developed incident CKD. Higher quartiles of PDW and MPV were associated with increased cumulative incidence of CKD in Kaplan-Meier analyses. Compared with the second PDW quartile, the highest quartile was associated with a significantly higher risk of incident CKD (adjusted hazard ratio 1.51, 95% confidence interval 1.11-2.06). A similar association was observed for MPV. However, when PDW and MPV were simultaneously included in the multivariable model, only PDW remained significantly associated with incident CKD, whereas the association of MPV was no longer statistically significant. In addition, analyses treating these indices as continuous variables did not show statistically significant associations.

CONCLUSION: PDW and MPV showed associations with incident CKD in high-risk individuals; however, these findings were not consistent across all analyses. Therefore, the results should be interpreted as hypothesis-generating and require further confirmation.

PMID:42159944 | DOI:10.1007/s10157-026-02886-x

Discov Ment Health. 2026 May 20;6(1):90. doi: 10.1007/s44192-026-00475-8.

ABSTRACT

BACKGROUND: About 3-6% of individuals infected with SARS-CoV-2 develop post-COVID-19 condition (post-COVID), also known as multisystem disease, which comprises somatic and psychological symptoms. Nevertheless, there is an absence of research findings that differentiate patients with post-COVID from those with psychosomatic problems, for instance with regard to the presence of mental disorders. In addition, a comprehensive understanding of the factors that influence the manifestation of psychological symptoms in these patients is crucial for the development of multimodal interventions and lead to a destigmatization of post-COVID.

METHODS: A cross-sectional study was conducted at a Clinic for Psychotherapy and Psychosomatics (Dresden University Hospital) to compare the self-reported sociodemographic, clinical, and psychopathological characteristics of post-COVID patients (n = 357), attending a psychosomatic post-COVID outpatient clinic, with those of a group of patients with different psychosomatic disorders, attending a general psychosomatic outpatient clinic (n = 991). Clinical diagnoses were assessed by clinical experts according to the International Classification of Diseases (ICD-10), somatic symptom severity, depressive symptoms and anxiety, using the Patient Health Questionnaire (PHQ-D) (primary outcomes). In addition, in the post-COVID group, the influence of sociodemographic, clinical, and psychopathological variables on primary outcomes and incapacity to work were analyzed. The statistical methods encompassed linear and logistic regression analyses, generalized linear models, Mann-Whitney U-tests and chi-squared tests.

RESULTS: Post-COVID patients demonstrated a greater degree of PHQ-15 somatic symptom severity (B = 1.37, p < .001) and higher levels of somatic and psychological multimorbidity (OR = 1.14, p = .005). At the level of specific disorders, post-COVID patients demonstrated an elevated risk of somatoform disorders (OR = 3.25, p < .001), while the risk of anxiety disorders (OR = .40, p < .001), affective disorders (OR = .52, p < .001) and personality disorders (OR = .11, p < .001) was reduced. In post-COVID, female gender (p = .003), somatic and psychological multimorbidity (p ≤ .025), experience of psychotherapy (p ≤ .031), and stress (p < .001) were associated with increased psychological symptom burden.

CONCLUSIONS: Post-COVID patients can be regarded as a specific group, distinguishable from psychosomatic patients and presumably with prevailing somatoform processing mechanisms. In accordance with the recommendations of the German post-COVID guideline, mental disorders should be accorded serious consideration in the treatment of post-COVID, with the objective of averting the risk of chronicity through early intervention.

TRIAL REGISTRATION: The present study does not report results of a health care intervention on human participants. Therefore no registration was necessary.

PMID:42159938 | DOI:10.1007/s44192-026-00475-8

Discov Nano. 2026 May 20;21(1):206. doi: 10.1186/s11671-026-04625-3.

ABSTRACT

The present study examines the magnetohydrodynamics (MHD) flow of a ternary hybrid nanofluid, comprised of titanium oxide, zinc oxide, and gold nanoparticles dispersed in a water-based fluid, over a curvilinear catalytic surface within a porous medium. The model integrates volumetric and surface nonthermal plasma heating with species generation. The Joseph slip conditions are implemented to characterize the tangential partial slip behavior. The governing partial differential equations are reduced to a system of nonlinear, coupled ordinary differential equations for analysis. Subsequently, the Galerkin weighted residual method is employed to solve the resulting system of equations. The friction coefficients compared to the existing literature demonstrate an agreement. The skin friction coefficient, Nusselt number, and Sherwood number converge to 0.202419, -1.48261, and -1.00, respectively, for different trial numbers. Volumetric and surface nonthermal plasma heating have been observed to enhance the Nusselt number, whereas the species generation parameter correspondingly increases the Sherwood number. The magnetic parameter diminishes fluid velocity and enhances energy and species concentrations, while the isotherm contours exhibit a pronounced elliptic configuration, thereby illustrating the fluid’s thermal maximum. These findings indicate that the magnetic parameter can be employed to guide the fluid, thereby facilitating the localization and subsequent removal of charged impurities within the system. Furthermore, the nonthermal plasma parameters not only elevate the fluid’s temperature but also exhibit a propensity to enhance heat and mass transfer between the fluid and the curved catalytic surface.

PMID:42159935 | DOI:10.1186/s11671-026-04625-3

CVIR Endovasc. 2026 May 20;9(1):58. doi: 10.1186/s42155-026-00699-3.

ABSTRACT

OBJECTIVE: Determine the outcome of patients treated with catheter-directed interventions as per published recommendations for management escalation by the Pulmonary Embolism Response Team (PERT) Consortium.

DESIGN: Retrospective, observational cohort study.

MATERIALS AND METHODS: Retrospective review of patient records managed with catheter-directed intervention between April 2012 and March 2022. Risk stratification was performed as per European Society of Cardiology (ESC) guidelines. Patient demographics, clinical status, and imaging on presentation, procedural details, and outcomes with a minimum follow-up period of 1 year were analysed.

RESULTS: Seventy-nine cases were performed in 76 patients (n = 76; mean age 52 years, range 7-86; male:female = 37:39). Fifty-four patients were high-risk, 16 intermediate-high and 7 intermediate-low risk (n = 77 cases). 39% of high-risk and 22% of intermediate-risk cases had an absolute or relative contraindication to thrombolytic therapy. Seventeen percent of high-risk and 4% of intermediate-risk cases had a failed trial of systemic thrombolysis. 54% of high-risk and 78% of intermediate-risk cases had a failed trial of anticoagulation. There was a statistically significant reduction in the RV:LV ratio (p = 0.05) and clot burden (p < 0.0001) following catheter intervention. Available echocardiographic data demonstrated a trend towards improving right heart strain. Bleeding events occurred in 18% of cases, with 79% being high-risk. There was a significant improvement in functional outcomes as per WHO functional status (p < 0.001).

CONCLUSION: Catheter-directed thrombolysis under the guidance of a PERT is a safe and effective therapy and provides a valuable management option for patients who have a contraindication to systemic thrombolysis or have failed a trial of systemic therapy.

PMID:42159923 | DOI:10.1186/s42155-026-00699-3

BMC Sports Sci Med Rehabil. 2026 May 19. doi: 10.1186/s13102-026-01759-w. Online ahead of print.

ABSTRACT

PURPOSE: Chronic ankle instability (CAI) is a prevalent consequence of ankle sprains among athletes and is often linked to compromised dynamic balance. This meta-analysis aims to evaluate the effects of balance training (BT) on dynamic balance in athletes with CAI, while also exploring whether the pooled effects differ based on participant characteristics, types of comparators, intervention modalities, and assessment tools.

METHODS: A systematic search was conducted in PubMed, Web of Science, PsycINFO, and the Cochrane Library until April 7, 2025. Thirteen randomized controlled trials (RCTs) involving 468 athletes diagnosed with CAI were included in this review. A multilevel (three-level) random-effects meta-analysis was performed to synthesize both composite and direction-specific dynamic balance outcomes. Additionally, exploratory subgroup analyses, Egger’s regression test, trim-and-fill analysis, CR2-adjusted cluster-robust sensitivity analyses, and GRADE certainty assessments were conducted to evaluate the robustness of the findings.

RESULTS: BT statistically significantly improved dynamic balance across all pooled outcomes, including the composite score (SMD = 1.32, 95% CI: 0.08 to 2.55), anterior direction (SMD = 0.67, 95% CI: 0.29 to 1.06), posteromedial direction (SMD = 0.59, 95% CI: 0.16 to 1.02), and posterolateral direction (SMD = 0.74, 95% CI: 0.12 to 1.36). Substantial between-study heterogeneity was observed (I² = 76.6%-94.1%), and the approximate prediction intervals for all four outcomes crossed the null value, indicating uncertainty in the robustness of the findings. Exploratory subgroup analyses suggested possible variation across regions, participant types, comparator types, intervention modalities, and assessment tools, although these findings were inconsistent and based on small subgroup sample sizes. CR2-adjusted sensitivity analyses showed that the anterior, posteromedial, and posterolateral effects remained statistically significant, whereas the composite effect was attenuated and no longer statistically significant.

CONCLUSION: BT may improve direction-specific dynamic balance outcomes in athletes with CAI, particularly in the anterior, posteromedial, and posterolateral directions. Although the composite outcome was statistically significant in the primary three-level meta-analysis, it exhibited less robustness in the CR2-adjusted sensitivity analysis. Given the substantial heterogeneity, wide prediction intervals, and limited evidence base, the pooled effects should be interpreted with caution, and subgroup findings should be considered exploratory.

PMID:42157072 | DOI:10.1186/s13102-026-01759-w

BMC Psychol. 2026 May 19. doi: 10.1186/s40359-026-04776-z. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between teacher support and students’ mathematics achievement has been extensively studied. However, its underlying mechanism remains unclear.

METHODS: This study aimed to examine the associations between teacher support and mathematics achievement among high school students, and to test the potential mediating roles of mathematics anxiety and learning engagement in these associations. Participants included 1,340 high school students (M_age = 16.71 years), and all participants completed questionnaires measuring teacher support, math anxiety and learning engagement, as well as three standardized mathematics achievement tests. The data analysis in this study was performed using the structural equation model (SEM) in SPSS 25.0 and Mplus 8.3.

RESULTS: The results revealed that: (1)teacher support was positively correlated with mathematics achievement; (2)mathematics anxiety mediated the relationship between teacher support and mathematics achievement; (3)learning engagement mediated the relationship between teacher support and mathematics achievement; (4)mathematics anxiety and learning engagement jointly played a chain mediating role in the relationship between teacher support and mathematics achievement.

CONCLUSION: These findings highlight the significant associations between perceived teacher support and mathematics achievement among high school students, mediated through cognitive and behavioral mechanisms, thus providing preliminary correlational evidence that may inform future longitudinal and experimental research on educational practices.

PMID:42157062 | DOI:10.1186/s40359-026-04776-z

BMC Pregnancy Childbirth. 2026 May 19. doi: 10.1186/s12884-026-09268-x. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to identify the most diagnostically valuable features among the 11 MRI features of Placenta accreta spectrum (PAS) described in the joint consensus statement by the Society of Abdominal Radiology (SAR) and the European Society of Urogenital Radiology (ESUR), and to evaluate the diagnostic efficacy of MRI, risk factors, and ultrasound (US) used alone or in combination for prenatal PAS diagnosis.

METHODS: This retrospective study included 199 pregnant women who delivered at Zhengzhou Central Hospital from November 2018 to December 2022. Standardized evaluations of Risk Factors, US, and MRI features were conducted, and subjects were divided into PAS (89 cases) and non-PAS groups (110 cases). Chi-square tests, logistic regression, and the Bootstrap method were used to identify MRI features with intergroup differences. Diagnostic scheme efficacy was compared using the area under the curve (AUC), and improvements were assessed using the net reclassification improvement index (NRI) and integrated discrimination improvement index (IDI). The final diagnosis of PAS was based on surgical and/or pathological findings according to the International Federation of Gynecology and Obstetrics (FIGO) criteria.

RESULTS: Three Risk Factors (caesarean delivery (CD) history, placenta previa, advanced maternal age) and three MRI features (T2-dark intraplacental bands, Loss of retroplacental T2-hypointense line, and Asymmetric shape/thickening of the placenta) showed statistical differences. The AUC for Risk Factors, US, and MRI alone was > 0.8. Combined schemes (MRI + US and MRI + US + Risk Factors) had higher efficacy, with MRI + US + Risk Factors demonstrating the highest efficacy.

CONCLUSION: This study identifies three key standardized MRI features and three key risk factors to simplify clinical application. For high-risk pregnant women, a multimodal approach combining risk assessment, ultrasound, and standardized MRI features produced the highest diagnostic performance, but prospective external validation is required before broader clinical implementation.

PMID:42157046 | DOI:10.1186/s12884-026-09268-x

Diabetol Metab Syndr. 2026 May 19. doi: 10.1186/s13098-026-02182-4. Online ahead of print.

ABSTRACT

BACKGROUND: Insulin resistance (IR) is linked to overactive bladder (OAB), with chronic inflammation serving as a common pathophysiological mechanism in both conditions. As a robust marker of IR, estimated glucose disposal rate (eGDR) was selected as the exposure variable to examine its relationship with OAB, with a specific focus on the mediating role of inflammation.

METHODS: We conducted a cross-sectional study using data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). We utilized weighted logistic regression to assess the association of eGDR with OAB, while restricted cubic splines (RCS) helped characterize potential nonlinear patterns in this relationship. Subgroup analyses and interaction tests were performed to assess heterogeneity in the eGDR-OAB association across different subgroups. Mediation analysis was used to explore whether systemic inflammatory biomarkers statistically explain part of the eGDR-OAB association, while acknowledging that causal inference is limited by the cross-sectional design.

RESULTS: 31,351 participants were included in this study, of whom 6,356 (20.27%) were diagnosed with OAB. In the fully adjusted Model, each one-unit increment in eGDR was associated with a 11% reduction in OAB risk (OR = 0.89; 95% CI: 0.87-0.91; P < 0.001) and a 48% decreased risk of OAB for the highest eGDR quartile (Q4) compared to the lowest quartile (Q1) (OR = 0.52; 95% CI: 0.42-0.64; P < 0.001). RCS analysis showed a significant nonlinear inverse association between eGDR and OAB, and this association was consistently observed across nearly all subgroups. Mediation analyses revealed that systemic inflammatory biomarkers statistically mediated the relationship between eGDR and OAB, explaining approximately 0.64-3.15% of the total effect, suggesting that inflammation accounts for only a small fraction of the eGDR-OAB association, while other mechanisms (e.g., autonomic dysfunction, microvascular damage, urothelial changes) likely contribute more substantially.

CONCLUSIONS: Our research confirmed the correlation between eGDR, inflammation and OAB. The potential mediating effect of inflammation between eGDR and OAB provides a meaningful direction for future research and targeted interventions.

PMID:42157045 | DOI:10.1186/s13098-026-02182-4

BMC Oral Health. 2026 May 20. doi: 10.1186/s12903-026-08464-7. Online ahead of print.

ABSTRACT

BACKGROUND: Orthodontic malocclusion may affect both functional and psychosocial aspects of health; however, its relationship with global self-esteem in young adults remains unclear. This study aimed to compare self-esteem levels according to orthodontic treatment need as assessed by the Index of Complexity, Outcome, and Need (ICON) and Angle classification among university students.

METHODS: A cross-sectional study was conducted between April and December 2024 among university students. A total of 290 participants were initially recruited, and 269 were included in the final analysis (198 females, 92 males; mean age: 21.8 ± 2.3 years). Participants were recruited from different faculties through voluntary participation. Self-esteem was assessed using the validated Turkish version of the Rosenberg Self-Esteem Scale (RSES; 10 items, 4-point Likert scale). Orthodontic status was evaluated through intraoral examination by a single calibrated orthodontist using the ICON (treatment-need cutoff ≥ 43) and Angle classification (Class I, II/1, II/2, III). Intra-examiner reliability was high for both ICON and Angle assessments (κ = 0.91 and 0.89, respectively). Data were anonymized and analyzed using non-parametric statistical tests (Mann-Whitney U and Kruskal-Wallis H tests).

RESULTS: A total of 269 valid responses were analyzed, yielding a mean ± SD RSES score of 32.04 ± 5.13. No statistically significant difference in self-esteem was observed between ICON-defined treatment-need groups (U = 7168.00, r = 0.048, p = 0.446). However, a small but statistically significant difference was observed among Angle classifications (H = 13.10, η² = 0.038, p = 0.004). The RSES demonstrated high internal consistency (Cronbach’s α = 0.869).

CONCLUSIONS: Self-esteem was not significantly associated with orthodontic treatment need as defined by ICON, while only minimal differences were observed across Angle classifications. These findings suggest that objective measures of malocclusion may have a limited influence on global self-esteem among university students. Future studies incorporating broader sociodemographic variables may provide a more comprehensive understanding of the psychosocial impact of malocclusion.

PMID:42157033 | DOI:10.1186/s12903-026-08464-7