Nevin Manimala

Insights Imaging. 2025 Dec 8;16(1):274. doi: 10.1186/s13244-025-02135-x.

ABSTRACT

INTRODUCTION: RADUCATION – a digital platform for radiological postgraduate training by the German Young Radiology Forum – provides learning content structured according to the German Training Curriculum, including original board exam questions. This is the first study to evaluate user statistics, experience, and preferences.

MATERIALS AND METHODS: Data were collected through webpage analytics and surveys. User statistics were analyzed for four periods: initial usage (05/2022-05/2023), post-introduction of theoretical board exam questions (05-11/2023), post-introduction of image-based board exam questions (12/2023-05/2024), and ongoing usage (03-12/2024). User perception surveys were conducted before (05/2023-01/2024) and after (06-08/2024) implementation of image-based board exam questions. Analyses included descriptive statistics and multivariable logistic regressions.

RESULTS: User numbers increased steadily, with board exam questions becoming the most accessed feature. Mean monthly active user numbers increased from 372 between 05/2022-05/2023 (total users 4468), to 613 between 03/2024-12/2024 (total 15,828). Survey respondents (n = 243) consistently rated RADUCATION as valuable for board exam preparation (88.6%), for night/weekend shifts (75.6%), and for clinical routine (73.4%). Board exam preparation was more beneficial for 4th/5th-year residents (odds ratio (OR) 1.35 (95% confidence interval (95% CI): 1.15-1.59)), while shift preparation was less critical for senior than for junior residents (OR 0.77 (95% CI: 0.59-0.99)). Video- and image-based learning content were preferred, with users rating the platform highly user-friendly (86.0%) and clearly structured (88.0%).

CONCLUSIONS: RADUCATION is a valuable, widely used digital learning tool for radiology residents. Board exam questions substantially increased engagement. Its structured, peer-developed design offers a scalable model for digital postgraduate medical education across specialties and countries.

CRITICAL RELEVANCE STATEMENT: This is the first comprehensive evaluation of RADUCATION, a peer-developed, competency-based digital learning platform for the radiology residency. Integrating original board exam questions significantly increases engagement and perceived educational value, offering a scalable model for modern postgraduate medical education.

KEY POINTS: RADUCATION, a peer-developed, competency-based learning platform for radiology residents, is a highly valued, scalable model for postgraduate medical training. Users prefer video- and image-based content, while engagement and perceived educational value increase when integrating original board exam questions. RADUCATION is perceived as user-friendly and well-structured, and is considered particularly valuable for exam preparation by senior residents.

PMID:41359302 | DOI:10.1186/s13244-025-02135-x

Gen Thorac Cardiovasc Surg. 2025 Dec 8. doi: 10.1007/s11748-025-02236-w. Online ahead of print.

ABSTRACT

OBJECTIVES: Few physiological assessments are available for patients who undergo mitral valve repair for severe mitral regurgitation (symptomatic or asymptomatic). The aim of the study was to evaluate change in exercise tolerance as a means of physiological assessment following mitral valve repair.

METHODS: We studied 41 consecutive patients who received elective isolated mitral valve repair for severe mitral regurgitation in a minimally invasive manner via a completely endoscopic platform and who underwent cardiopulmonary exercise testing in our institution between February 2018 and August 2019. There were 21 asymptomatic (group A) and 20 symptomatic (group S) patients. Physiological assessment was performed by cycle ergometer cardiopulmonary exercise testing pre-operatively and at approximately 6 months post-operatively.

RESULTS: Mean age was 59 ± 11.6 years and 24 patients were male (58.5%). Overall, there was no significant change in peak oxygen consumption or anaerobic threshold after surgical repair. There were no intergroup differences in terms of peak oxygen consumption, anaerobic threshold, ventilation/carbon dioxide production, or gas exchange ratio. There were no intergroup differences in any transthoracic echocardiographic variable except for post-operative left atrial dimension (group A: 35.2 ± 5.9 vs. group S: 39.8 ± 6.2, p = 0.01).

CONCLUSIONS: There was no statistically discernible change in functional capacity at 6-12 months after endoscopic mitral valve repair. The physiological assessment found no improvements in cardiopulmonary exercise testing values post-operatively despite improvement of the symptoms.

PMID:41359257 | DOI:10.1007/s11748-025-02236-w

J Clin Monit Comput. 2025 Dec 8. doi: 10.1007/s10877-025-01392-x. Online ahead of print.

ABSTRACT

The Mean flow index (Mxa) is widely used to assess dynamic cerebral autoregulation in different clinical populations. This calculation is based on defined characteristics, including blocks, overlap periods, and epochs of the whole recordings. This study aimed to investigate the reproducibility of different Mxa calculations, using variable blocks, overlap periods, and epochs. We retrospectively analyzed 50 transcranial Doppler recordings from septic shock patients, acquired within 48 h of ICU admission. Mxa was computed using eight signal-processing strategies that varied by block duration (5-10 s), overlap percentage (20%, 50%, 80%), and epoch length (3-5 min), as well as a continuous approach without epochs. Each configuration was labeled using the format epoch-block-overlap. Mxa values were compared using repeated measures analyses, intraclass correlation coefficients (ICC), Bland-Altman plots, and polychoric correlation heatmaps. Median Mxa values ranged from 0.36 to 0.45 across configurations, with no statistically significant differences in within-patient comparisons (p > 0.05). ICCs demonstrated excellent agreement (ICC > 0.90) between approaches using the same epoch duration. Agreement declined modestly when comparing configurations with different epoch lengths (e.g., ICC = 0.782 between 3-10-50 and 5-10-50). Fixed-effects analysis did not identify any individual segmentation parameter as a significant source of variability. Mxa values calculated using different combinations of block, overlap, and epoch duration were consistent within patients, particularly when epoch length was maintained. These findings support the reproducibility of Mxa and suggest flexibility in processing strategies, provided methodological consistency is maintained. Further validation is warranted.

PMID:41359245 | DOI:10.1007/s10877-025-01392-x

J Interv Card Electrophysiol. 2025 Dec 8. doi: 10.1007/s10840-025-02206-5. Online ahead of print.

ABSTRACT

BACKGROUND: Pulsed-field ablation (PFA) has emerged as a potentially safer alternative to radiofrequency ablation (RFA). However, recent studies have raised concerns that PFA may induce hemolysis, which could contribute to the development of acute kidney injury (AKI).

METHODS: The PubMed, Embase, Scopus, and Cochrane databases were searched for randomized clinical trials (RCTs) and non-RCTs that reported AKI incidence and hemolysis biomarkers after PFA. Random-effects models were used to calculate pooled odds ratio (OR) and mean differences (MDs) with 95% confidence intervals (CIs). Substantial heterogeneity was defined as I² > 25%.

RESULTS: Ten studies, including one RCT, comprising a total of 3,843 patients, were included, with 1,859 in the PFA group and 1,994 in the RFA group. In the primary endpoint analysis related to AKI and renal function, no significant differences were found between the PFA and RFA groups, with PFA having a total prevalence of 2.1% (95% CI [0.90; 4.84]). The leave-one-out analysis, specifically the exclusion of one outlier study, led to the comparative results having statistical significance statistical significance (OR 3.70, 95% CI [2.49; 5.51], p = 0.0019; I² = 0%), indicating no heterogeneity, and with the total prevalence increasing to 2.4% (95% CI [0.96; 5.93]). Regarding hemolysis, all evaluated biomarkers were significantly elevated in the PFA group, although with high heterogeneity.

CONCLUSION: PFA appears to be associated with a slightly higher risk of AKI than RFA. Renal injury is mostly mild-degree and transient. PFA is associated with significant peri-procedural hemolysis.

PMID:41359232 | DOI:10.1007/s10840-025-02206-5

J Assist Reprod Genet. 2025 Dec 8. doi: 10.1007/s10815-025-03770-5. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate how the timing of oocyte denudation (DN) and intracytoplasmic sperm injection (ICSI) affects embryological and clinical outcomes in highly standardized oocyte donation cycles.

METHODS: This retrospective cohort study included 1538 donor stimulation cycles from a single IVF center between January 2019 and July 2023. Timing intervals between human chorionic gonadotropin (hCG) administration, oocyte pick-up (OPU), DN, and ICSI were recorded. Outcomes included oocyte maturation (MII rate), fertilization, embryo quality, and clinical results. Statistical analyses included linear and logistic regression models, and chi-square tests, adjusting for donor and recipient age and BMI.

RESULTS: Longer hCG-DN intervals (> 39 h) were significantly associated with increased MII rates and decreased proportions of MI and discarded oocytes (P < 0.05). However, hCG-DN timing had no effect on fertilization rates, embryo quality, or pregnancy outcomes. Shorter DN-ICSI intervals (< 90 min) were associated with a higher proportion of top-quality blastocysts and fewer medium-quality embryos (P < 0.05). DN-ICSI timing did not influence clinical outcomes. Recipient BMI was the strongest predictor of pregnancy, clinical pregnancy, and live birth (P < 0.001).

CONCLUSIONS: Extended incubation prior to denudation improves oocyte maturation but does not affect fertilization or pregnancy. Short DN-ICSI intervals favor top-quality blastocyst formation without altering clinical results. Recipient BMI significantly impacts reproductive success. These findings support timing optimization in ART and highlight the influence of patient-specific factors.

PMID:41359227 | DOI:10.1007/s10815-025-03770-5

Eur Arch Paediatr Dent. 2025 Dec 8. doi: 10.1007/s40368-025-01147-x. Online ahead of print.

ABSTRACT

PURPOSE: To assess the prevalence and experience of dental caries among 6-year-old children in Ajman, United Arab Emirates (UAE), and examine associations with sociodemographic, behavioural, and service-related factors.

METHODS: A cross-sectional survey was conducted among 285 Grade One children in government schools. Parent questionnaires captured background, diet, oral hygiene, fluoride exposure, and dental visits. Clinical dental examinations were conducted using the International Caries Detection and Assessment System (ICDAS II), with d(4-6)mft as the main criterion, and incipient lesions (d(1-2)) were also systematically recorded, providing novel insight into the early stages of caries lesions amongst local children.

RESULTS: The findings revealed a high prevalence of dental caries, with children experiencing both advanced and early-stage lesions. The prevalence of dental caries was 85.6%, with a mean d(4-6)mft score of 5.8 ± 4.4, whilst incipient caries (d(1-2)t) affected 47.6% of the children. Caries experience was higher amongst children who frequently consumed sugar-sweetened beverages (ARR [Adjusted Rate Ration] = 2.4, 95% CI 0.9-7.5), whilst regular brushing with fluoride toothpaste was associated with lower caries experience (ARR = 0.5, 95% CI 0.3-0.9). In contrast, symptom-driven dental visits were statistically significantly associated with greater caries experience (ARR = 2.0, 95% CI 1.0-4.1).

CONCLUSIONS: The present study identified a high prevalence of dental caries amongst 6-year-old children in Ajman and represents the first report in the UAE to include both incipient and cavitated lesions based on ICDAS-II. These findings highlight the need to strengthen national oral health strategies through school-based caries preventive programmes and integration into child health policies. They support implementing school-based fluoride and dietary interventions to reduce caries experience and advance child oral health in the UAE.

PMID:41359223 | DOI:10.1007/s40368-025-01147-x

Dermatol Ther (Heidelb). 2025 Dec 8. doi: 10.1007/s13555-025-01595-9. Online ahead of print.

ABSTRACT

INTRODUCTION: While bimekizumab has demonstrated rapid, superior clinical efficacy versus adalimumab and ustekinumab, with sustained responses through 4 years, its comparative and long-term impact on patient-reported outcomes (PROs) remains underexplored. Here, we report PROs with bimekizumab versus adalimumab/ustekinumab/placebo in phase 3 controlled trials, and over 4 years with bimekizumab.

METHODS: Data were analyzed from BE SURE, BE VIVID, BE READY (52/56 weeks), and their open-label extension (OLE), BE BRIGHT (144 weeks; 4 years’ total treatment). Patients were randomized to bimekizumab/adalimumab/ustekinumab/placebo during comparator-controlled periods; all received bimekizumab during BE BRIGHT. Proportions of patients reporting Psoriasis Symptoms and Impacts Measure (P‑SIM) = 0 and Dermatology Life Quality Index (DLQI) = 0 (both at item-level) were assessed during comparator‑controlled periods using non-responder imputation (NRI). Over 4 years, PROs were analyzed using modified NRI in patients who received continuous bimekizumab from baseline into the OLE.

RESULTS: BE SURE included 478 patients (bimekizumab, 319; adalimumab, 159); BE VIVID included 567 (bimekizumab, 321; ustekinumab, 163; placebo, 83); BE READY included 435 (bimekizumab, 349; placebo, 86). In total, 771 patients received continuous bimekizumab into the OLE. A larger proportion of bimekizumab-treated patients achieved P-SIM = 0 across key items versus adalimumab (week 24; itching, 30.7% vs. 18.9%; skin pain, 43.9% vs. 30.2%; scaling, 39.2% vs. 19.5%), ustekinumab (week 16; itching, 31.2% vs. 17.8%; skin pain, 51.7% vs. 27.6%; scaling, 43.6% vs. 17.2%), and placebo. Similar trends were seen for other P-SIM items and in proportions of bimekizumab-treated patients reporting DLQI = 0 across items versus comparators. The patient-reported benefits of bimekizumab were demonstrated throughout the OLE, with 65.5-94.8% of patients reporting DLQI = 0 across items at 4 years.

CONCLUSIONS: Bimekizumab provided greater improvements in PROs versus comparators, with durable effects over 4 years. These findings reinforce bimekizumab’s role in effective psoriasis management, linking clinical efficacy with sustained patient-reported benefits.

TRIAL REGISTRATION: NCT03412747, NCT03370133, NCT03410992, NCT03598790. A Graphical Abstract is available for this article.

PMID:41359217 | DOI:10.1007/s13555-025-01595-9

J Prev (2022). 2025 Dec 8. doi: 10.1007/s10935-025-00888-1. Online ahead of print.

ABSTRACT

Youth violence, including gender-based violence, is a major public health issue in the UK, yet evidence on effective interventions in the UK remains limited. Becoming a Man (BAM) is a two-year school-based positive youth development programme for adolescent boys, developed in Chicago, US, where two RCTs found reduced violent crime arrests and improved academic engagement. This study evaluated BAM’s potential in the UK using a theory-driven design (no comparison group). 97 boys aged 12-14 years (66% Black/Black British) in three London schools enrolled in BAM. Data sources included: implementation records (recruitment, attendance, adherence, quality, youth socio-demographics); school data (attendance, exclusions, attainment); 36 qualitative interviews (11 scholars, 14 parents, 3 school staff, 3 BAM counsellors (2 interviews each), 1 each from delivery organisation and intervention developer); and a counsellor focus group. Interviews focused on implementation, outcomes and BAM contribution to outcomes. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using framework analysis. Case studies of 11 scholars explored what worked, for whom, under what circumstances and why. Implementation outcomes were mixed. Attendance targets were met but those for group size, reach and curriculum progression were not. Case study scholars who engaged deeply with BAM’s values demonstrated improved self-control and decision-making, although external influences also affected their development. Concerns about negative labelling were mitigated through balanced recruitment. Limited adverse effects on academic attainment were reported. BAM has potential in the UK but requires further adaptation, implementation support and evaluation (including impact on gender norms).

PMID:41359212 | DOI:10.1007/s10935-025-00888-1

Infection. 2025 Dec 8. doi: 10.1007/s15010-025-02685-8. Online ahead of print.

ABSTRACT

PURPOSE: Sepsis is a leading cause of morbidity and mortality, yet its documentation and coding in administrative health data remain unreliable. Accurate coding is essential for epidemiological surveillance, quality assurance, and reimbursement. This study aims to identify patient characteristics associated with under-diagnosis and under-coding of sepsis in German inpatient administrative health data (IAHD).

METHODS: This secondary analysis of the multicenter OPTIMISE study included 10,334 hospital cases from ten German hospitals (2015-2017). Sepsis cases were identified via structured chart review and compared to ICD-coded diagnoses. Logistic regression and classification tree analyses were used to determine predictors of under-diagnosis and under-coding, including ICU admission, organ dysfunction, and infection source.

RESULTS: Among 1,310 cases fulfilling severe sepsis-1 criteria, only 30.7% were correctly coded. The strongest predictor for coding accuracy was explicit mention of sepsis in the medical chart (OR 19.58). ICU treatment, organ dysfunction severity, and mechanical ventilation were also associated with higher coding rates, while pneumonia as the infection source was linked to a lower probability of sepsis being named and coded.

CONCLUSION: Sepsis coding in administrative data is frequently inaccurate. Explicit naming of sepsis and severity markers strongly influence correct coding. As Germany introduces mandatory sepsis quality assurance in 2026, targeted interventions – including enhanced clinician documentation and electronic coding support – are essential to improve coding reliability and patient care.

PMID:41359203 | DOI:10.1007/s15010-025-02685-8

Carbon Balance Manag. 2025 Dec 8. doi: 10.1186/s13021-025-00370-9. Online ahead of print.

ABSTRACT

Consolidated airborne laser scanning (ALS) programs, satellite imagery and spaceborne structural measurements have enabled major advances in canopy height mapping that translate towards the forest carbon biomass arena. However, we must carefully evaluate the cost of using fine-grained canopy height products to predict biomass under calibration models scoped at the scale of inventory plots. In this study, we estimated biomass using field plots and ALS metrics before predicting biomass over a jurisdiction of ~ 15,500 km² in Spain using 10 m, 25 m, 44 m, and 100 m as prediction scales. We altered the scale of ALS-based biomass predictors in 10 sub-jurisdictions intensively surveyed by the Spanish National Forest Inventory (NFI) before estimating mean and total biomass using three options: (i) traditional NFI design-based (DB) estimation, (ii) a model-based (MB) approach using scale-varying canopy height metrics from ALS and NFI plots, and (iii) an small-area estimation (SAE) implemntation designed for sub-jurisdictional domains. Higher uncertainties – relative standard errors (SE) – were found for DB, particularly at sub-jurisdictional and stratum levels. We observed a consistent increase in uncertainty for MB estimation from the finest 10 m scale up to 100 m. In MB estimation, the maximum relative bias reached 11% for 10-m predictions compared to the baseline estimate at the NFI sampling native resolution. The bias associated with the prediction scale ranged from + 5% (25 m) to -8% (100 m). The mean biomass estimates for SAE generally ranged between DB and MB but at lower uncertainty to the former, especially as the NFI sampling becomes scarcer and not enough for solid inference of biomass mean. The SEA statistics helped to disentangle biomass comparisons between ALS-based inference and the traditional NFI estimation that do not incorporate remote sensing data.

PMID:41359202 | DOI:10.1186/s13021-025-00370-9