Nevin Manimala

Precis Radiat Oncol. 2025 Jun 28;9(3):167-176. doi: 10.1002/pro6.70022. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: When validating intracranial multi-lesion CyberKnife M6/S7 plans with SRSmapcheck, setting the array to a fixed 0° measures only one target dose distribution, leaving the other lesions unmeasured. Moreover, the CyberKnife treatment planning system does not support roll verification tools, and testing confirms that X-sight fiducial marker guidance is incompatible with free array roll. A novel method and workflow are required to validate multi-lesion plans with random positions.

METHODS: A geometric model was established based on the relationship between SRSmapcheck and the tumor location. For two tumors spaced 77 mm apart (each 20 mm in diameter, or one 40 mm apart and the other infinitesimally small), the corresponding array roll angle interval was approximately 15.05°. The SRSmapcheck and StereoPHAN computed tomography (CT) images were acquired at 15° intervals, starting at 0°, and preprocessed into phantom plans for verification. A total of 101 intracranial multi-lesion plans were verified using the fixed 0° and pre-set roll angle methods to optimize the dose distribution, particularly in high-dose and rapidly varying areas. A two-sample test compared the results of the 0° versus pre-set roll angle verification and assessed the performance under different criteria to determine suitable criteria for pre-set roll angle verification.

RESULTS: The equivalent diameter of the 296 tumors ranged from 5 to 45 mm (average: 21.86 mm). Each plan had an average of 2.97 lesions. Using the pre-set roll angle method, 2.34 targets were assessed on average (89.83% of lesions had diameters ranging from 10 to 40 mm), compared to 1.32 targets on average in 0° plans. Statistically significant differences occurred at 2 mm/1% and 2 mm/2% in the γ analysis, showing that plan pass rates were stable between the fixed 0° and pre-set roll angle methods. Relaxing either the distance to agreement or dose deviation significantly increased the pass rates during pre-set roll angle verification, whereas cross-transforming criteria had minimal impact. For pre-set roll angle methods, it is recommended to use 1 mm/1% (action limit: 86.0% ± 13.3%) and 1 mm/2% (action limits: 91.6% ± 7.9%) for γ analysis.

CONCLUSION: SRSmapcheck with the pre-set roll angle method can verify intracranial multi-lesion CyberKnife plans by measuring multiple targets in a single validation and comparing the 1 mm/1% and 1 mm/2% γ analysis criteria.

PMID:41164809 | PMC:PMC12559907 | DOI:10.1002/pro6.70022

Precis Radiat Oncol. 2025 Aug 23;9(3):177-184. doi: 10.1002/pro6.70025. eCollection 2025 Sep.

ABSTRACT

OBJECTIVE: Radiation recall pneumonitis (RRP) is a localized inflammatory reaction occurring in previously irradiated lung regions, typically triggered by certain anticancer agents. In clinical settings, we have observed that COVID-19 infection may also act as a precipitating factor for RRP. However, its true incidence and possible risk factors remain poorly defined.

METHODS: Lung cancer patients who received radiotherapy and were diagnosed with COVID-19 between November 2022 and February 2023 were included. RRP was defined as pulmonary changes limited to the previously irradiated regions, occurring at least 6 months after radiotherapy. Patients medical records and radiation dose distribution data were analyzed to identify potential contributing factors to RRP.

RESULTS: The study included 140 patients who underwent thoracic radiotherapy with a minimum six-month interval before COVID-19 diagnosis. Among these, 62 patients (44.2%) developed RRP, and 45% of these experienced grade ≥ 2 pneumonitis. No radiotherapy dose-related factors were significantly associated with RRP. However, statistical analysis showed that RRP incidence was significantly associated with baseline T-stage (P = 0.034) and the time interval from radiotherapy completion to COVID-19 infection (P < 0.001).

CONCLUSIONS: A 44.2% incidence of COVID-19-related RRP was identified, which is notably higher than previously reported. While radiotherapy dosimetry did not correlate with RRP risk, baseline T-stage and timing of COVID-19 infection after radiotherapy were significantly associated with its occurrence.

PMID:41164806 | PMC:PMC12559899 | DOI:10.1002/pro6.70025

Clin Ophthalmol. 2025 Oct 24;19:3933-3939. doi: 10.2147/OPTH.S545977. eCollection 2025.

ABSTRACT

PURPOSE: To evaluate the visual performance, refractive stability, and glistening-free clarity of the Clareon^® monofocal intraocular lens (IOL) implanted using the AutonoMe^® automated delivery system in a real-world North American setting.

PATIENTS AND METHODS: A prospective, single-arm study was conducted at a single Canadian site involving 46 patients, or 85 eyes, undergoing cataract surgery with Clareon^® IOL implantation. Eligible participants were ≥22 years old with best-corrected distance visual acuity (BCDVA) of 0.3 logMAR or worse, targeted for emmetropia, and had <1.0 D of preoperative astigmatism. Exclusion criteria included retinal disease, glaucoma, amblyopia, corneal pathology, and prior intraocular or corneal surgery. Manifest refraction, uncorrected (UDVA), best-corrected (BCDVA), and low-contrast visual acuity (LCVA) were assessed at 1, 3, and 12 months postoperatively. Glistenings were graded using the Miyata scale at 3 and 12 months.

RESULTS: No statistically significant changes were observed in manifest refraction, UDVA, or BCDVA between 1 and 3 months (p > 0.05). At 3 months, the mean spherical equivalent was +0.09 D, with low residual astigmatism (-0.33 D). Mean logMAR UDVA and BCDVA were 0.13 and 0.02, respectively. LCVA was 0.04 logMAR. No glistenings were observed at either 3 or 12 months in any patient. Refractive and visual outcomes remained stable over time, with no device-related complications reported.

CONCLUSION: The Clareon^® IOL demonstrated excellent refractive accuracy, stable visual performance, and sustained optical clarity with no glistenings up to one year postoperatively. Its compatibility with the AutonoMe^® delivery system supports its utility as a reliable option for cataract surgery.

PMID:41164804 | PMC:PMC12560656 | DOI:10.2147/OPTH.S545977

Vasc Health Risk Manag. 2025 Oct 24;21:889-894. doi: 10.2147/VHRM.S559706. eCollection 2025.

ABSTRACT

INTRODUCTION: A greater association of systemic arterial hypertension with worse prognosis in patients hospitalized with COVID-19 was described. Early in the pandemic, concerns were raised that the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) could lead to unfavorable outcomes.

OBJECTIVE: To evaluate whether there is an association between the use of the ACEi and ARB medications with unfavorable outcomes in hypertensive patients hospitalized with COVID-19.

METHODS: This is a descriptive and retrospective study, collecting data through electronic medical records of patients with COVID-19 admitted to a University Hospital in 2020. Demographic data, use of ACEi or ARB medications, comorbidities, and outcomes, defined by the use of invasive ventilatory support (IVS), renal failure with progression to renal replacement therapy, and death were evaluated.

RESULTS: 700 medical records were analyzed, 374 were of hypertensive individuals. The mean age of the patients was 66 ± 14 years, 51% were male, and 89% were white. There was a significantly higher prevalence of hospital discharge among patients who received ACEi/ARB compared to those who did not take these medications, (p-value = 0.027). There was no statistically significant difference in the use of ACEi/ARB for IVS (p-value = 0.062) and for renal replacement therapy (p-value = 0.587).

CONCLUSION: The use of ACEi/ARB drugs is not associated with worse outcomes in individuals with COVID-19. The present study demonstrated lower mortality rate associated with the use of these classes of drugs, similar to recent studies.

PMID:41164788 | PMC:PMC12560647 | DOI:10.2147/VHRM.S559706

Open Forum Infect Dis. 2025 Oct 8;12(10):ofaf634. doi: 10.1093/ofid/ofaf634. eCollection 2025 Oct.

ABSTRACT

BACKGROUND: Long COVID is a heterogeneous post-infectious condition. Although patient-reported outcome (PRO) measures for diagnosis or therapeutic monitoring have been adapted from related complex chronic illnesses, no PRO has been validated specifically in Long COVID. The STOP-PASC randomized, placebo-controlled trial of nirmatrelvir/ritonavir (NMV/r) in adults with Long COVID showed no overall treatment effect. This exploratory analysis aimed to identify distinct symptom trajectories and clinical characteristics associated with improvement or worsening over time.

METHODS: We performed latent class trajectory modeling (LCTM) on PRO measures-including the Patient Global Impression of Severity (PGIS), Patient Global Impression of Change (PGIC), PROMIS domains, and core symptoms-among 155 randomized participants. Participants were followed for 15 weeks with serial symptom assessments. Trajectory groups were identified using Bayesian Information Criteria and characterized using descriptive statistics and absolute standardized differences.

RESULTS: LCTM revealed heterogeneity in symptom trajectories. Two groups emerged for PGIS (improving n = 17, persistent/severe n = 136) and PGIC (improving n = 130; worsening n = 22). PROMIS-Physical Function modeling identified four groups (improving, normal/mild, moderate, and severe), fatigue core symptom modeling identified three (improving; moderate; severe). Worsening groups had higher proportions of NMV/r-treated participants and greater prevalence of cardiovascular symptoms and low-dose naltrexone use. Improving groups had shorter time since infection and higher baseline physical function. No subgroup showed a clear benefit from NMV/r.

CONCLUSIONS: Distinct PRO trajectories reflect the clinical heterogeneity of Long COVID. NMV/r showed no clear benefit across subgroups. These findings emphasize the need for validated, Long COVID-specific PRO instruments and targeted therapeutic trials tailored to Long COVID subtypes.

PMID:41164784 | PMC:PMC12560753 | DOI:10.1093/ofid/ofaf634

Brain Commun. 2025 Oct 28;7(5):fcaf356. doi: 10.1093/braincomms/fcaf356. eCollection 2025.

ABSTRACT

Duchenne muscular dystrophy is a monogenic X-linked genetic disorder that is caused due to the absence of dystrophin. In addition to the skeletal and cardiac manifestations, challenges in executive function are pervasive and persistent, affecting a majority of young individuals with Duchenne muscular dystrophy. Executive function-related disability is linked to chronic stress, academic under-achievement and poor vocational attainment. Of the executive function domains, inhibitory control and working memory are disproportionately affected, and linked to academic under-achievement in Duchenne muscular dystrophy. Despite its consequential importance to the quality-of-life in affected individuals, the neural substrates underpinning working memory challenges are poorly understood in this disease. The dynamic interactions of bilateral dorsolateral prefrontal cortex as part of the frontoparietal network is critical for working memory. Atypical neural connectivity within the frontoparietal network may underlie the neural basis of working memory challenges in Duchenne muscular dystrophy. Effective (directional) connectivity analysis of brain functional MRI is an advanced analytical approach that quantitates the directionality and the nature (facilitatory or inhibitory) causal interactions between brain regions. The strength of effective connectivity in Hertz-stronger (facilitatory) versus weaker (inhibitory)-within the frontoparietal network was analysed using dynamic causal modelling in 11 right-handed male participants with Duchenne muscular dystrophy and 9 right-handed male neurotypicals while they completed an n-back working memory task. Participants also completed standardized neurocognitive assessments out-of-scanner. Age-corrected working memory scores were comparable in Duchenne muscular dystrophy (mean 100.0, standard deviation 16.0) and neurotypicals (mean 109.0, standard deviation 8.0) (P = 0.15). Task-based hypoactivation of frontoparietal-occipital regions was observed in Duchenne muscular dystrophy. The group difference in mean frontoparietal effective connectivity during the in-scanner n-back working memory tasks was statistically lower by Bayes factor of 3 in Duchenne muscular dystrophy, compared to neurotypicals. The right posterior parietal → dorsolateral prefrontal connectivity correlated negatively to out-of-scanner working memory performance in Duchenne muscular dystrophy. Median reaction times during the 0-back and 2-back working memory tasks were longer in Duchenne muscular dystrophy compared to neurotypicals, but the difference did not reach statistical significance (P = 0.2). Median reaction time during the 0-back fearful facial condition was longer in Duchenne muscular dystrophy compared to neurotypicals (P = 0.01). Our work implicates atypical task-based effective connectivity within the frontoparietal network and impaired perceptual processing in Duchenne muscular dystrophy. Dynamic neural network signatures can serve as mechanistic targets for pharmacological and non-pharmacological interventions to mitigate executive function impairment in Duchenne muscular dystrophy.

PMID:41164778 | PMC:PMC12560160 | DOI:10.1093/braincomms/fcaf356

Front Pharmacol. 2025 Oct 14;16:1681113. doi: 10.3389/fphar.2025.1681113. eCollection 2025.

NO ABSTRACT

PMID:41164767 | PMC:PMC12558836 | DOI:10.3389/fphar.2025.1681113

Front Psychol. 2025 Oct 14;16:1666403. doi: 10.3389/fpsyg.2025.1666403. eCollection 2025.

ABSTRACT

This study investigates the prevalence and predictors of anxiety among Emirati university students in the post-pandemic period, focusing on the influence of socio-demographic variables, mental health comorbidities, and lifestyle behaviors. A cross-sectional online survey was conducted across 16 UAE public university campuses from November 2022 to February 2023, yielding 7,244 complete responses from students aged 18 and above. The survey assessed anxiety using the Generalized Anxiety Disorder 7-item (GAD-7) scale and included items on demographics, physical and mental health, support systems, and behavior patterns such as substance use and internet engagement. Multivariable logistic regression models examined associations between anxiety and key explanatory variables. Results revealed that 8% of respondents experienced severe anxiety, with significant associations observed between anxiety and gender, age, income, disability status, and physical health conditions. Females, younger individuals, those with household incomes below AED 10,000, and students with chronic illnesses or disabilities were at higher risk. Mental health comorbidities such as depression, panic attacks, eating disorders, OCD, and ADHD showed strong associations with anxiety severity. Furthermore, behavioral correlations including excessive internet use, gaming, alcohol consumption, and prescribed medication use were linked to elevated anxiety levels, although not all were statistically significant. Despite efforts to increase mental health awareness in the UAE, stigma and cultural norms remain barriers to help-seeking. The study underscores the need for culturally tailored mental health interventions that address stigma, promote early screening, and consider the role of maladaptive coping behaviors. Universities should implement accessible support systems that incorporate Arabic-language resources, peer mentoring, and family or religious engagement. These findings contribute to the global understanding of anxiety in higher education and highlight the importance of localized mental health strategies in post-pandemic recovery.

PMID:41164735 | PMC:PMC12558803 | DOI:10.3389/fpsyg.2025.1666403

Front Psychol. 2025 Oct 14;16:1678675. doi: 10.3389/fpsyg.2025.1678675. eCollection 2025.

ABSTRACT

BACKGROUND: The relationship between social media use and subjective well-being is an important research topic. Nevertheless, limited research has specifically explored the role of social media use for information acquisition on life satisfaction. This study investigated how the use of social media for information acquisition influenced life satisfaction by examining a proposed theoretical model.

METHODS: Data were collected online through a survey company. A total of 1,651 individuals responded to the survey invitation via email and participated in the study. Data cleaning was conducted, resulting in a final valid sample of 1,513 cases. In this study, SPSS 22.0 was used to perform descriptive statistics and correlation analysis on the data. The mediation model was tested using the SPSS macro PROCESS (Model 6), with the significance of indirect effects assessed through the bootstrap method.

RESULTS: The results indicated that social media use for information acquisition exerted both a direct positive effect on life satisfaction and an indirect effect through the sequential mediation of health knowledge and self-efficacy. Notably, only perceived knowledge demonstrated a significant mediating effect, whereas actual knowledge did not. Additionally, self-efficacy significantly mediated the relationship in conjunction with both types of knowledge.

CONCLUSION: By differentiating the roles of perceived and actual knowledge within digital environments, this study extends of the knowledge, beliefs, and practices theory and provides practical implications for health-related interventions.

PMID:41164734 | PMC:PMC12558970 | DOI:10.3389/fpsyg.2025.1678675

Front Psychol. 2025 Oct 14;16:1631504. doi: 10.3389/fpsyg.2025.1631504. eCollection 2025.

ABSTRACT

INTRODUCTION: A high discrepancy between a generally positive attitude and consent to donation has been observed in Italy, as in 2021 only 68.2% of registered individuals had provided consent. Understanding which variables may play a role in this decision-making process, considering the experiences of different groups, is essential to support the development and implementation of targeted policies. The aim of this study was to investigate the demographic and psychosocial variables associated with the decision to register consent for post-mortem organ donation in Italy, and to compare the experiences of different population groups to support the development of targeted policies.

METHODS: A quantitative study was conducted in 2021 in collaboration with the National Centre for Transplantation. A total of 353 participants-including healthcare professionals, citizens, opinion leaders and registry office employees-completed an ad-hoc questionnaire before and after participating in a focus group on organ donation. Descriptive statistics and regression analyses were conducted.

RESULTS: Of the 353 participants, 93.8% reported a positive attitude toward post-mortem organ donation (score > 5 on a 7-point Likert scale). In the pre-focus group questionnaire, the mean attitude was 6.45 (SD = 1.05), which increased significantly to 6.56 (SD = 0.99) after the focus groups (Z = -4.06, p < 0.001). Regarding actual behavior, 50.4% had already registered their consent to donation. Significant associations emerged between positive attitude and gender (women reporting higher scores; U = 13,129, p = 0.045), level of education (r = 0.156, p = 0.004), familiarity with donation (e.g., knowing a donor or someone who registered consent; p < 0.001), and being registered with donation-related associations (p < 0.001). Intention to register was strongly predicted by attitude (p < 0.001), and actual consent registration was more likely among participants with higher education and those familiar with donation practices.

CONCLUSION: Findings highlight the role of demographic factors, familiarity, and personal values in shaping donation behavior, supporting the use of multivariable models to better explain consent registration. These insights underline the need to implement targeted awareness campaigns and policies aimed at promoting informed choices about organ donation.

PMID:41164729 | PMC:PMC12558963 | DOI:10.3389/fpsyg.2025.1631504