Nevin Manimala

Eur Radiol Exp. 2025 May 4;9(1):49. doi: 10.1186/s41747-025-00586-x.

ABSTRACT

BACKGROUND: Gunshot deaths due to homicide or military encounters are a major health concern. Noninvasive bullet characterization is of major importance for patients with lodged bullets or in mass disasters with multiple cadavers, which must be prioritized for autopsy. Therefore, the aim of this study was to investigate whether brass and lead bullets can be differentiated using photon-counting CT (PCCT).

METHODS: Nine different lead (n = 6) or brass (n = 3) bullets were investigated on a state-of-the-art PCCT using a clinically unavailable research mode. Here, four image sets were reconstructed for different energy thresholds (20, 55, 72, 90 keV). Three circular regions of interest were placed on the 20-keV threshold images by two readers and automatically copied to the three other threshold images. Based on measured HU mean and max values, dual-energy indices (DEI) were calculated for the low/high energy threshold pairs of 20/90, 55/90, and 72/90 keV.

RESULTS: Significant differences of DEIs between lead and brass projectiles were observed for the 20/90 keV DEI for HU mean ± standard deviation values (Qr40 kernel, lead: -0.085 ± 0.021, brass: 0.024 ± 0.048) and HU max values (Qr40 kernel, lead: -0.093 ± 0.011, brass: 0.023 ± 0.057) (p < 0.001 for both). Differences decreased for the 55/90 and 72/90 keV DEIs between the two projectile materials but remained statistically significant.

CONCLUSION: In this PCCT phantom study, significant differences were observed between lead and brass bullets in the different energy threshold images.

RELEVANCE STATEMENT: Photon-counting CT could be a promising tool for bullet identification as significant differences were found in the different energy threshold images for lead and brass bullets, with application in clinical and forensic radiology.

KEY POINTS: In emergency settings, noninvasive bullet characterization is of importance for law enforcement. Bullet material characterization can be performed using photon-counting CT. These characteristics can be quantified in the four different energy threshold images.

PMID:40319414 | DOI:10.1186/s41747-025-00586-x

Neurorehabil Neural Repair. 2025 May 4:15459683251331586. doi: 10.1177/15459683251331586. Online ahead of print.

ABSTRACT

BackgroundCognitive rehabilitation and exercise training are promising approaches for improving cognition in persons with progressive multiple sclerosis (MS). Identifying heterogeneity of change and factors that influence the effects of cognitive rehabilitation and/or exercise training on cognitive outcomes at the individual level have direct relevance for developing tailored and optimized rehabilitation interventions for improving cognition in progressive MS.ObjectiveThis study involved a secondary data analysis from the CogEx trial in progressive MS. This study first described heterogeneity of change in cognitive processing speed (CPS) across the intervention conditions and then identified possible adherence/compliance, baseline performance, and demographic/clinical variables as correlates of rehabilitation-related CPS changes.MethodsA total of 311 persons with progressive MS who were pre-screened for impaired CPS completed 12 weeks of combined cognitive rehabilitation (or sham) and exercise training (or sham). CPS was measured before and after the 12-week period. As potential correlates of CPS changes, we measured adherence/compliance (ie, treatment exposure), performance outcomes at baseline, as well as demographic and clinical characteristics at baseline.ResultsThere was heterogeneity of change in CPS across the 4 intervention conditions. We further identified baseline learning and memory impairment and premorbid intelligence quotient (IQ), but not adherence/compliance, other baseline performance outcomes, or demographic/clinical characteristics as significant correlates of CPS changes across the 4 intervention conditions.ConclusionsThe overall pattern of results suggests that future trials in this area might account for impaired learning and memory and/or premorbid IQ as potential covariates, or more carefully consider the role of reserve within rehabilitation interventions in progressive MS.

PMID:40319368 | DOI:10.1177/15459683251331586

J Anim Sci. 2025 May 4:skaf136. doi: 10.1093/jas/skaf136. Online ahead of print.

ABSTRACT

This study addresses the challenge of limited data availability in animal science, particularly in modeling complex biological processes such as methane emissions from ruminants. We propose a novel rank-based method for generating synthetic databases with correlated non-normal multivariate distributions aimed at enhancing the accuracy and reliability of predictive modeling tools. Our rank-based approach involves a four-step process: (1) fitting distributions to variables using normal or best-fit non-normal distributions, (2) generating synthetic databases, (3) preserving relationships among variables using Spearman correlations, and (4) cleaning datasets to ensure biological plausibility. We compare this method with copula-based approaches to maintain a pre-established correlation structure. The rank-based method demonstrated superior performance in preserving original distribution moments (mean, variance, skewness, kurtosis) and correlation structures compared to copula-based methods. We generated two synthetic databases (normal and non-normal distributions) and applied random forest (RF) and multiple linear model (LM) regression analyses. RF regression outperformed LM in predicting methane emissions, showing higher R² values (0.927 vs. 0.622) and lower standard errors. However, cross-testing revealed that RF regressions exhibit high specificity to distribution types, underperforming when applied to data with differing distributions. In contrast, LM regressions showed robustness across different distribution types. Our findings highlight the importance of understanding distributional assumptions in regression techniques when generating synthetic databases. The study also underscores the potential of synthetic data in augmenting limited samples, addressing class imbalances, and simulating rare scenarios. While our method effectively preserves descriptive statistical properties, we acknowledge the possibility of introducing artificial (unknown) relationships within subsets of the synthetic database. This research uncovered a practical solution for creating realistic, statistically sound datasets when original data is scarce or sensitive. Its application in predicting methane emissions demonstrates the potential to enhance modeling accuracy in animal science. Future research directions include integrating this approach with deep learning, exploring real-world applications, and developing adaptive machine-learning models for diverse data distributions.

PMID:40319357 | DOI:10.1093/jas/skaf136

Disabil Rehabil Assist Technol. 2025 May 3:1-9. doi: 10.1080/17483107.2025.2492369. Online ahead of print.

ABSTRACT

PURPOSE: Athletes with hand function impairment are eligible to compete in handcycling using assistive technology designed to compensate for their reduced grip strength. However, there is no evidence suggesting that these athletes perform similarly to their peers without such impairments. This study examined the impact of three simulated hand function impairments on handcycling performance in non-disabled novices.

MATERIALS AND METHODS: Fourteen non-disabled individuals voluntarily participated in four measurement sessions using a standard handbike. Different hand function levels were simulated in the four sessions (no impairment and three simulated conditions: asymmetry, finger, and wrist impairments) using strapping and gloves to enable cyclic motion. Each session included two 4-minute submaximal handcycling tests (at 30 W and 45 W) and one 20-second isokinetic sprint. Repeated measures ANOVA was used to analyze differences among the hand function conditions in oxygen uptake (VO₂sub) during submaximal tests and peak and mean power output (PO (W)) during the sprints.

RESULTS: No significant differences in VO₂sub were observed across the four conditions. During the sprint, participants achieved higher peak PO without impairments compared to the simulated impairments, with values 14-17% higher (p < 0.01). However, no significant differences were found in mean PO, which was 5-9% higher without impairments but did not reach statistical significance (p ≥ 0.05).

CONCLUSION: The results suggest that individuals without hand function impairments may have an advantage over their peers with impairments during maximal efforts but not during submaximal efforts. However, these findings need to be validated in handcycling athletes.

PMID:40319336 | DOI:10.1080/17483107.2025.2492369

BMC Med Educ. 2025 May 3;25(1):647. doi: 10.1186/s12909-025-07252-1.

ABSTRACT

BACKGROUND: Burnout is a pervasive issue among medical students, with implications for their mental health, academic performance, and future careers in healthcare. Medical students face unique stressors, including heavy academic workload, emotional demands and insufficient support, which may contribute to burnout. In Nigeria, where medical students also grapple with socioeconomic challenges, the prevalence and causes of burnout remain underexplored. This study aims to investigate the prevalence of burnout, its contributing factors, and the role of support systems among medical students at the University of Ibadan, Nigeria.

METHOD: A mixed-methods approach was employed, combining both quantitative and qualitative data. The study involved 355 medical students from the University of Ibadan, spanning second to sixth years, who completed a self-administered online survey. The quantitative component assessed burnout using the Oldenburg Burnout Inventory for Students (OLBI-S) and social support using the Multidimensional Scale of Perceived Social Support (MSPSS). The qualitative component consisted of a focus group discussion (FGD) with 11 participants, exploring their perceptions of burnout, coping mechanisms, institutional support and factors contributing to burnout. Data from both components were triangulated for comprehensive analysis.

RESULTS: The survey found that 81.1% of participants were classified as experiencing burnout, with high academic workload and lack of breaks as the primary contributing factors. Female students (91.7%, p < 0.001) and those in advanced years (600 level, p = 0.004) reported significantly higher levels of burnout. While 59.2% of students reported strong social support, particularly from family, only 3.9% had ever utilised the College’s counselling services, highlighting a gap in institutional support. The FGD revealed that students rely heavily on peer support, family, social events and religious gatherings to cope with burnout. However, dissatisfaction with the College’s counselling services was prevalent, as they were seen as ineffective and underutilised.

CONCLUSION: The high prevalence of burnout among medical students at the University of Ibadan underscores the need for systemic reforms in medical education. Key recommendations include more frequent academic breaks, improved infrastructure and enhanced institutional support services. Efforts to address burnout should focus on fostering a more supportive academic environment. These findings are crucial for developing interventions aimed at improving the mental health and well-being of medical students in Nigeria and similar contexts.

PMID:40319327 | DOI:10.1186/s12909-025-07252-1

Syst Rev. 2025 May 3;14(1):99. doi: 10.1186/s13643-025-02827-x.

ABSTRACT

BACKGROUND: Long-acting reversible contraceptives (LARCs), including implants and intrauterine contraceptive devices (IUCDs), are essential in preventing unintended pregnancies and empowering women by providing long-term, reliable contraception that supports informed decision-making about family planning and reproductive health. However, their uptake and acceptability remain low in Ethiopia due to various individual, social, and systemic barriers. This study systematically reviews the factors influencing LARC acceptability and utilization among Ethiopian women, adolescents, and healthcare providers, using the Capability, Opportunity, Motivation, and Behaviour (COM-B) framework.

METHODS: A systematic search of PubMed, Embase, Scopus, African Journals OnLine, and EBSCOhost (CINAHL) was conducted, along with gray literature sources, to identify studies published between January 2021 and June 2024. Inclusion criteria encompassed studies conducted in Ethiopia that examined the acceptability and utilization of LARCs, focusing on implants and IUCDs. The types of studies considered included quantitative, qualitative, and mixed-method designs, focusing on postpartum, post-abortion, and nonpostpartum women, adolescents, and healthcare providers. Data on barriers, facilitators, and associated factors of acceptability and utilization were extracted, and the findings were mapped to the COM-B framework. Atlas.ti v.9 software was used in the analysis process.

RESULTS: A total of 58 cross-sectional, qualitative, and mixed-method studies were included, encompassing diverse Ethiopian populations and geographies. Among immediate and extended postpartum women, barriers included limited awareness and fear of insertion pain for IUCDs, low awareness, and limited access to LARCs, while postpartum counselling emerged as a facilitator. For adolescents, social stigma, male partner disapproval, and misconceptions about LARC side effects were prominent barriers; school-based education and youth-friendly services supported acceptability. Healthcare providers noted inadequate training on family planning methods as a barrier, while targeted training improved their confidence in recommending LARCs. Nonpostpartum women frequently cited partner opposition and cultural beliefs as barriers, but family planning programs with partner engagement facilitated greater acceptance.

CONCLUSIONS: The findings highlight an urgent need to expand community-based education programs to dispel myths and misconceptions about LARCs, particularly in rural and pastoral regions. Prioritizing provider training to improve counselling and service delivery, alongside engaging male partners in family planning discussions, is essential for enhancing LARC utilization and meeting reproductive health needs in Ethiopia.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024594288.

PMID:40319326 | DOI:10.1186/s13643-025-02827-x

Cardiovasc Diabetol. 2025 May 3;24(1):192. doi: 10.1186/s12933-025-02720-w.

ABSTRACT

BACKGROUND AND PURPOSE: Epicardial adipose tissue (EAT) comprises three distinct lipid components, each exerting differential effects on cardiovascular diseases. During disease progression, dynamic alterations in lipid composition and spatial distribution contribute to the inherent heterogeneity of EAT. The excessive activation of inflammatory cells may contribute to chronic inflammation, promoting atherosclerosis and cardiac diseases. However, the role of EAT in patients with myocardial infarction (MI) who develop heart failure with preserved ejection fraction (HFpEF) remains unclear. This study aims to quantify the overall and perivascular volumes of EAT using cardiac magnetic resonance (CMR) imaging and assess its heterogeneity, exploring the predictive value of EAT heterogeneity and different EAT volumes combined with inflammatory cells for the occurrence of HFpEF in MI patients with normal left ventricular ejection fraction (LVEF).

METHODS: This retrospective cohort study enrolled patients diagnosed with MI with preserved LVEF via clinical assessment and CMR at the Second Affiliated Hospital of Kunming Medical University between January 2015 and July 2023. Patients who did not undergo percutaneous coronary intervention (PCI) were followed, with the incidence of HFpEF serving as the primary endpoint. The cohort was stratified into two groups: those without HFpEF and those who developed HFpEF.Cardiac structure, function, EAT volume, and infarct volume parameters were obtained using the CMR post-processing software CVI-42, while EAT heterogeneity parameters entropy were derived using Python software. Independent sample t-tests, non-parametric tests, and chi-square tests were employed to analyze the differences in clinical baseline data and CMR metrics between the two groups. Spearman’s rank correlation was utilized to analyze the associations between EAT parameters and inflammatory cells, inflammatory markers, and diastolic dysfunction indicators. Furthermore, we conducted univariate and multivariate Cox regression analyses to determine the predictive value of each parameter for the development of HFpEF in MI patients. Time-dependent ROC curves were generated to evaluate the efficacy of each parameter in predicting HFpEF, the AIC values of each parameter and the final model were calculated to evaluate the predictive performance. The optimal cut-off values were identified using time-dependent ROC curves in R software, and Kaplan-Meier event-survival curves were plotted to illustrate the event-free rates based on these optimal thresholds.The median follow-up time was calculated using the reverse Kaplan-Meier method.

RESULTS: A total of 203 MI patients with normal LVEF were included, with 74 in the HFpEF group and 129 in the non-HFpEF group. No significant differences were observed between the two groups regarding age, sex, and infarct volume; however, significant statistical differences were noted in BMI, diabetes, renal failure, leukocytes, neutrophils, monocytes, total EAT, EAT entropy, left ventricular EAT (LV EAT), left atrial end-systolic volume (LAESV), triglycerides, NHR, MHR and LACI(Left atrioventricular coupling index) (P < 0.05). Both overall and local EAT volumes showed a positive correlation with leukocytes and monocytes,as well as with the inflammatory markers MHR and SIRI. Furthermore, EAT volume exhibited a positive correlation with the LACI, a marker of diastolic dysfunction. Univariate and multivariate Cox regression analyses indicated that BMI, diabetes, monocyte, LV EAT, and EAT entropy are independent risk factors for HFpEF. And the AIC value of the multivariate regression model was the smallest.Further time-dependent ROC analysis revealed that the maximum AUC for BMI was 0.67, while the AUC for LV EAT was 0.63, and EAT entropy was 0.60, the maximum AUC for monocyte was 0.70, and the combined prediction of LV EAT and EAT entropy had a maximum AUC of 0.70. After a median follow-up of 34 months, Kaplan-Meier survival curves demonstrated that LV EAT greater than 21.23 mL was associated with the occurrence of HFpEF, whereas EAT entropy was not.

CONCLUSIONS: In patients with chronic MI, normal LVEF, and no prior PCI, the occurrence of HFpEF is not correlated with infarct volume; however, BMI, diabetes, monocyte, LV EAT, and EAT entropy are independent risk factors for HFpEF with significant predictive value, with the highest predictive efficacy observed monocyte and when combining EAT entropy and LV EAT. Additionally, both overall and local EAT volumes exhibit a moderate positive correlation with leukocytes,monocytes and inflammatory markers, and were also positively correlated with diastolic dysfunction. This suggests that, in clinical practice, beyond traditional indicators, there should be an increased focus on EAT heterogeneity and perivascular EAT in MI patients with normal LVEF who have not undergone PCI to to reduce the incidence of HFpEF.

PMID:40319313 | DOI:10.1186/s12933-025-02720-w

BMC Public Health. 2025 May 3;25(1):1642. doi: 10.1186/s12889-025-22779-0.

ABSTRACT

BACKGROUND: Dry Eye Disease (DED) is a multifactorial ocular condition characterized by the disturbance of the tear film and interpalpebral ocular surface. It is characterized by ocular itchiness, grittiness, burning, and visual disturbances. Many risk factors were linked to DED, including occupational-related risk factors. This study aimed to investigate the prevalence and impact of DED on work productivity among outdoor and indoor workers in the West Bank of Palestine and the impact of DED on daily activities performance.

METHODS: A population-based descriptive cross-sectional study was conducted on male and female Palestinian workers aged 18 years or older, carried out between July to October 2024. Structured interview questionnaires using the Arabic version of the Ocular Surface Disease Index questionnaire (Arab-OSDI) and the Work Productivity and Activity Impairment questionnaire (WPAI) for participants who scored 13 or higher on OSDI.

RESULTS: A total of 464 participants were included, ages 18 or older. Males were 81.3% of the study population. 50% of the sample were indoor workers and 50% were outdoor workers. The prevalence of DED in Palestinian workers was 61.4%, which was higher among outdoor workers (64.7%) than indoor workers (58.2%), but this difference was not statistically significant (p = 0.15). The impact of DED on work productivity was reported in all severity levels (p < 0.001); participants with severe DED had a mean of 5.93 h, which is higher than the mean for moderate and mild DED patients (4.71 and 3.42 h), respectively. Similarly, the impact on the ability to perform daily activities was significant (p < 0.001), greatest among respondents with severe disease (5.86 h).

CONCLUSIONS: Outdoor workers have been associated with DED more than in-office workers in the West Bank. Meanwhile, workers with DED report lower productivity and struggle with everyday tasks regardless of the severity level. This underlines the detrimental effects of the workplace on the ocular surface, which present a significant risk for the onset and exacerbation of dry eye symptoms.

PMID:40319299 | DOI:10.1186/s12889-025-22779-0

Acta Neuropathol Commun. 2025 May 3;13(1):90. doi: 10.1186/s40478-025-01998-x.

ABSTRACT

Traumatic brain injury (TBI) occurs in 2-3 million Americans each year and is a leading cause of death and disability. Among the many physiological consequences of TBI, the hypothalamic pituitary axis (HPA) is particularly vulnerable, including a reduction in growth hormone (GH) and insulin-like growth factor (IGF-1). Clinical and preclinical supplementation of IGF-1 after TBI has exhibited beneficial effects. IGF-1 receptors are prominently observed in many tissues, including in the brain and in the gastrointestinal (GI) system. In addition to causing damage in the brain, TBI also induces GI system damage, including inflammation and alterations to intestinal permeability and the gut microbiome. The goal of this study was to assess the effects of systemic IGF-1 treatment in a rat model of TBI on GI outcomes. Because GI dysfunction has been linked to hippocampal dysfunction, we also examined proliferation and immature granule cells in the hippocampal dentate gyrus. 10-week-old male rats were treated with an intraperitoneal (i.p.) dose of IGF-1 at 4 and 24 h after lateral fluid percussion injury (FPI). At 3- and 35-days post-injury (DPI), gut permeability, gut dysmorphia, the fecal microbiome, and the hippocampus were assessed. FPI-induced permeability of the blood-gut-barrier, as measured by elevated gut metabolites in the blood, and this was prevented by the IGF-1 treatment. Gut dysmorphia and alterations to the microbiome were also observed after FPI and these effects were ameliorated by IGF-1, as was the increase in immature granule cells in the hippocampus. These findings suggest that IGF-1 can target gut dysfunction and damage after TBI, in addition to its role in influencing adult hippocampal neurogenesis.

PMID:40319295 | DOI:10.1186/s40478-025-01998-x

J Orthop Surg Res. 2025 May 3;20(1):442. doi: 10.1186/s13018-025-05858-1.

ABSTRACT

BACKGROUND: Patellar component design in total knee arthroplasty (TKA) can influence patellofemoral kinematics and clinical outcomes. The medialized dome design (MDD) aligns the patella apex more medially, while the anatomic patella design (APD) aims to replicate the native patella’s shape and tracking. Although biomechanical studies suggest potential benefits of APD, clinical evidence remains inconclusive.

METHODS: A systematic review and meta-analysis following PRISMA guidelines was conducted to compare the clinical outcomes of MDD and APD in a modern posterior-stabilized TKA (ATTUNE system). We searched PubMed, Scopus, Embase, and Web of Science on January 10, 2025, without language or date restrictions. Eligible studies included randomized controlled trials (RCTs) and comparative cohort designs evaluating patient-reported outcome measures (PROMs), revisions, complications, range of motion (ROM), and radiologic measures of patellar stability. Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for cohort studies. Pooled effect sizes were calculated using Hedges’s g and random-effects modeling.

RESULTS: Seven studies, including three RCTs and four cohort studies, with a total of 1,069 patients and 1,113 knees (507 APD vs. 606 MDD), were included. The meta-analysis demonstrated no significant difference in PROMs (Hedges’s g = 0.09; 95% CI [-0.04 to 0.22]; P = 0.17) or ROM (Hedges’s g = 0.02; 95% CI [-0.21 to 0.26]; P = 0.83) between APD and MDD. While revision rates and complications were higher for APD, the differences were not statistically significant compared to MDD (14 vs 9). Radiographic measures showed inconsistencies and did not definitively favor either design.

CONCLUSIONS: Current evidence suggests that APD offers no clear clinical advantage over MDD in the ATTUNE posterior-stabilized TKA. Both designs yield broadly comparable PROMs and knee function outcomes. Larger RCTs with extended follow-up are warranted to clarify the safety of APD.

LEVEL OF EVIDENCE: III.

PMID:40319293 | DOI:10.1186/s13018-025-05858-1