Nevin Manimala

JAMA Otolaryngol Head Neck Surg. 2025 Mar 6. doi: 10.1001/jamaoto.2024.3738. Online ahead of print.

ABSTRACT

IMPORTANCE: Patients with head and neck squamous cell cancer (HNSCC) are at a greater risk of developing pulmonary metastases and/or second primary lung cancer. However, it remains uncertain whether lung screening in these patients, when the initial staging studies are negative, confers any survival benefit.

OBJECTIVE: To evaluate long-term cancer survival outcomes in patients with HNSCC undergoing chest radiography vs low-dose computed tomography screening for pulmonary metastasis and/or second primary lung cancer.

DESIGN, SETTING, AND PARTICIPANTS: This randomized parallel trial was conducted at a large academic hospital in Canada enrolling treatment-naive patients with de novo HNSCC from September 2015 to December 2022. Eligible patients did not meet the criteria for lung screening established by the US National Comprehensive Cancer Network guidelines. Participants were randomized to chest radiography or low-dose computed tomography screening groups. Data were analyzed from March to August 2024.

INTERVENTION OR EXPOSURE: Comparison of chest radiography vs low-dose computed tomography screening methods.

MAIN OUTCOMES AND MEASURES: Primary outcomes were the lung cancer detection rate measured by comparing the sensitivity and specificity of low-dose computed tomography with chest radiography. Secondary outcomes were overall survival and disease-free survival.

RESULTS: A total of 137 patients (mean [SD] age, 65.1 [14.1] years; 34 [24.8%] females and 103 [75.2%] males) were included and randomized, 68 (49.6%) to chest radiography and 69 (50.4%) to low-dose computed tomography. Nine of 137 patients (6.5%) developed a second primary lung cancer (6 patients) or lung metastases (3 patients). There were no clinically meaningful differences in survival outcomes between the 2 groups (hazard ratio, 1.2; 95% CI, 0.4-3.9). Chest radiography exhibited a relatively low sensitivity of 66.7% but a specificity of 100%. Low-dose computed tomography demonstrated both high sensitivity (100%) and specificity (100%), for an overall accuracy of 100%.

CONCLUSIONS AND RELEVANCE: The findings of this randomized parallel trial indicate that low-dose computed tomography exhibits statistically significant superior sensitivity compared with chest radiography for diagnosing lung metastases and second primary lung cancer. However, there were no important differences in survival rates. These results hold practical significance, offering valuable insights to clinicians who are guiding decisions regarding lung screening protocols.

TRIAL REGISTRATION: ISRCTN10954990.

PMID:40048159 | DOI:10.1001/jamaoto.2024.3738

JMIR Mhealth Uhealth. 2025 Mar 6;13:e63805. doi: 10.2196/63805.

ABSTRACT

BACKGROUND: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear.

OBJECTIVE: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations.

METHODS: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model.

RESULTS: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model’s actor effects were valid (β=.26-0.45; P<.001), the partner effects were partially valid (β=.08-0.20; P<.05), and the mediation effects were valid (β=.002-0.242, 95% CI 0.003-0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model’s actor effect partially held (β=.17-0.71; P<.01), the partner effect partially held (β=.15; P<.01), and the mediation effect partially held (β=.355-0.584, 95% CI 0.234-0.764; P<.001).

CONCLUSIONS: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients’ mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients’ perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary.

PMID:40048155 | DOI:10.2196/63805

JMIR Pediatr Parent. 2025 Mar 6;8:e59215. doi: 10.2196/59215.

ABSTRACT

BACKGROUND: Over the past 3 decades, digital and screen media have evolved from broadcast, stationary platforms to a complex environment of interactive, omnipresent, mobile media. Thus, clinical guidance centered around unidimensional concepts such as “screen time” must be modernized to help families navigate the intricate digital ecosystems of readily available entertainment and information.

OBJECTIVE: This study aimed to identify and examine distinct latent profiles of media use in families with young children. We hypothesized that latent profile analysis (LPA) would identify different media use profiles characterized by more heavy, reactive, individual, and permissive media use and more intentional, regulated, or shared uses of media.

METHODS: We analyzed data from 398 preschool-aged children. English-speaking parents were recruited through community settings. Participants completed surveys regarding several aspects of family media use, such as child device use or activities, parent concerns and attitudes, limit setting and mediation, parent media use, and technology interference, examined in an LPA. The number of latent media profiles was determined using Bayesian Information Criteria. Parents also completed validated scales of parenting stress, depression symptoms, parenting style, child behavior, child sleep, and household disorganization. Multivariable logistic regression was used to examine parent, child, and household predictors of group membership.

RESULTS: The LPA yielded 2 distinct groups that differed in the duration of media used by parents and children, to calm children or help them fall asleep. Statistically significant differences between groups included: families in group 1 (n=236, which we termed social-emotional drivers) had parents who preferred interactions via text or email to in-person (P=.01) and were more likely to use media to calm their children (P=.03); in contrast, families in group 2 (n=162, intentional media) used more task-oriented media, like audio and nongame apps (P=.01), had more concerns about effects of media on child language development (P=.04), and used more media restrictions (P=.01). In regression models, female sex of the parent respondent, greater number of siblings, and later child sleep midpoint independently predicted group 1 membership.

CONCLUSIONS: Findings suggest divergent family media use patterns that can be categorized into 2 main media user groups: those using media to buffer social situations or regulate emotions and those planning mobile device use around functional purposes and concerns around media exposure. Profiles were associated with household size and child sleep. More research is needed to examine the impact of social and emotional uses of media on child outcomes.

PMID:40048153 | DOI:10.2196/59215

Musculoskelet Surg. 2025 Mar 6. doi: 10.1007/s12306-025-00888-8. Online ahead of print.

ABSTRACT

BACKGROUND: Given the increased life expectancy, an increasing number of proximal femur fractures (PFFs) will occur in centenarian patients. In these patients, PFF has a serious impact on quality of life with high morbidity and mortality and an increase in total cost of care. Therefore, it is important to understand the surgical outcome for this group of patients defining preoperative risk factors.

MATERIAL AND METHOD: From January 1, 2010, to December 31, 2020, 33 centenarian patients with PFF were treated with locked nail or hemiarthroplasty. Mortality risk factors were assessed. Several survival-related factors were evaluated using the log-rank test and univariate Cox regression statistical analysis for categorical and quantitative variables, respectively. Significative variables at the univariate analysis were included in the Cox multivariate model, using Backward Elimination technique. A P value of < 0.05 was considered statistically significant for all tests. Software STATA 17.0 was used for statistical analysis.

RESULTS: Centenarians with femoral neck and pertrochanteric fracture were treated with hemiarthroplasty and locked nail, respectively. At the time of admission, only 21% had normal hemoglobin value. Postoperatively, a moderate anemia was observed in 45% of patients and a severe dementia was observed in 18%. In 85% of patients, Charlson Index was less than 3. At the time of admission, 30% of them were considered independent in walking and activity of daily living (ADL), but at discharge ambulation was worsened and none of them were independent in ADL at one month. Postoperative delirium was observed in 30% of patients preventing a complete rehabilitation program. One month after discharge 27% of patients were readmitted in hospital for complications. Mortality was 16%, 59%, and 66% at 1-6-12 months, respectively. At a multivariate evaluation, male, severe anemia and Functional Ambulation Categories (FAC) score < 3 at admission were the only variables statistically related to high risk of mortality.

CONCLUSION: The anemia value was found to be related to mortality, and a quick restoration of these values is necessary. Geriatric and functional status scores, especially FAC score, are related to survival, providing an accurate prognosis. In our study, a high percentage of patients are unable to return to their pre-fracture level of independence. This suggests that the prognosis for centenarian patients with PFF may be as poor as previously thought.

PMID:40048138 | DOI:10.1007/s12306-025-00888-8

J Assoc Res Otolaryngol. 2025 Mar 6. doi: 10.1007/s10162-025-00978-1. Online ahead of print.

ABSTRACT

PURPOSE: Cochlear implants (CI) are a highly successful neural prosthesis that can restore hearing in individuals with sensorineural hearing loss. However, the extent of hearing restoration varies widely. Two major factors likely contribute to poor performance: (1) the distances between electrodes and surviving spiral ganglion neurons and (2) the density of those neurons. Reprogramming the CI at a poor electrode-neuron interface, using focused tripolar stimulation or remapping the electrodes, would benefit from understanding the cause of the poor interface.

METHODS: We used a cochlear model with simplified geometry and neuronal composition to investigate how the interface affects stimulation thresholds. We then inverted the model to infer electrode distance and neuronal density from monopolar and tripolar threshold values obtained behaviorally. We validated this inverted model for known scenarios of electrode distance and neuronal density. Finally, we assessed the model using data from 18 CI users whose electrode distances were measured from CT imaging.

RESULTS: The inverted model accurately inferred electrode distance and neuronal density for known scenarios. It also reliably reproduced behavioral monopolar and tripolar threshold profiles for CI users, with mean prediction errors within 1 dB for 17/18 subjects. Fits of electrode distance were more variable; accuracy depended on the assumed value of temporal bone resistivity. Twelve subjects had minimum distance error (0.31 mm) using low resistivity (70 Ω-cm) while the others had better fits (0.30 mm) with higher resistivity (250 Ω-cm).

CONCLUSION: This inverted model shows promise as a simple, practical tool to better assess and understand the electrode-neuron interface.

PMID:40048122 | DOI:10.1007/s10162-025-00978-1

Neurol Sci. 2025 Mar 6. doi: 10.1007/s10072-025-08074-1. Online ahead of print.

ABSTRACT

BACKGROUND: We investigated the risk of ischemic stroke in ALS and analyzed the effect of ALS-related physical disability using the Korean National Health Insurance Service database.

METHODS: A total of 2,251 ALS patients diagnosed between January 1, 2012, and December 31, 2015, and 1:10 age- and sex-matched control populations were included. Cases that participated in the national health check-up programs were selected. A Cox hazard regression model was used to examine the hazard ratios (HRs) for ischemic stroke in ALS after adjusting for potential confounders.

RESULTS: A total of 681 ALS patients and 10,934 non-ALS participants were selected. ALS patients were slightly younger than the control group (60.3 ± 10.1 years vs. 61.0 ± 10.5 years, p = 0.105), and the proportion of male patients was similar between the two groups (61.6% vs. 60.9%, p = 0.722). ALS patients were more likely to have a lower body mass index (23.1 ± 2.92 vs. 24.0 ± 3.1, p < 0.001) and obstructive sleep apnea syndrome (0.59% vs. 0.06%, p < 0.001) than the controls. In ALS patients, the incidence rate of ischemic stroke was 6.32 per 1,000 person-years, and the adjusted HR of ischemic stroke was 2.58 (95% confidence interval 1.38 – 4.82) compared with the matched group. The risk of ischemic stroke did not differ by the presence of disability in ALS patients.

CONCLUSIONS: Our findings suggest that ALS patients have an increased risk of ischemic stroke compared with controls, but the risk did not differ by the presence of disability in ALS.

PMID:40048117 | DOI:10.1007/s10072-025-08074-1

3D Print Med. 2025 Mar 6;11(1):10. doi: 10.1186/s41205-025-00259-w.

ABSTRACT

BACKGROUND: The maturation of 3D printing technologies has opened up a new space for patient advancements in healthcare from trainee education to patient specific medical devices. Point-of-care (POC) manufacturing, where model production is done on-site, includes multiple benefits such as enhanced communication, reduced lead time, and lower costs. However, the small scale of many POC manufacturing operations complicates their ability to establish quality assurance practices. This study presents a novel low-cost quality assurance protocol for POC 3D printing.

METHODS: Four hundred specially designed quality assurance cubes were printed across four material jetting printers (J5 Medijet, Stratasys, Eden Prairie, Minnesota, USA) at two large medical centers. Three inner dimension and three outer dimension measurements as well as edge angles were measured for every cube by trained research personnel. The delta and absolute error was calculated for each cube and then compared across variables (axis, material, inner vs. outer dimension, swath and machine/site/personnel) using ANOVA analysis.

RESULTS: Print axis and inner vs. outer dimension of the model produced statistically significant differences in error while there was no statistically significant difference in the error for material, print swath, or machine/site/personnel. For the print axes, the printers produced an average error of 26, 53, and 57 μm and the error at three sigma was found to be 100, 158, and 198 μm for the Z, R, and Theta axes, respectively.

CONCLUSION: This study demonstrates that this novel protocol is both feasible and reliable for quality assurance in POC 3D printing across multiple sites. This protocol offers an adaptable framework that allows users to tailor the QA process to their specific needs. Through the comprehensive method, users can measure and identify all relevant factors that might introduce error into their printed product and then follow the most critical aspects for their situation across every print. The QA cubes produced via this protocol can provide guidance on print quality and alert users to unsatisfactory machine operation which could cause prints to fall outside of engineering and clinical tolerances.

PMID:40048107 | DOI:10.1186/s41205-025-00259-w

Br J Clin Pharmacol. 2025 Mar 6. doi: 10.1002/bcp.70025. Online ahead of print.

ABSTRACT

AIMS: This review aimed to synthesise the evidence related to the incidence of serious and non-serious adverse events with the use of monoclonal antibodies (mAbs) among COVID-19 patients.

METHODS: Databases were searched from January 2020 to September 2023 for randomized clinical trials (RCTs) that used mAbs for the treatment of COVID-19 regardless of disease severity. Study screening, data extraction and data analysis were performed independently by two reviewers. The Cochrane risk of bias 1.0 tool was used for methodological quality assessment.

RESULTS: Sixteen studies were identified for analysis with 9682 participants in the intervention arm and 10 115 participants in the control arm. Seven trials reported hepatoxicity and there was a statistically significant increase in the chance of hepatoxicity among patients treated with mAbs compared to those given standard of care (SoC) or placebo with risk ratio (RR) = 1.70, 95% confidence interval (CI) 1.29-2.24. Five trials reported for neutropenia and there was a statistically significant association of neutropenia with the use of mAbs compared to SoC or placebo with RR = 4.03, 95% CI 1.74-9.34. Ten trials reported any disease-related serious adverse events related to the disease and there was a reduction of risk compared to SoC/placebo, although this reduction was not statistically significant (RR = 0.88, 95% CI 0.70-1.11).

CONCLUSIONS: The use of mAbs was found to be associated with an increased risk of hepatoxicity and neutropenia compared to SoC/placebo among COVID-19 patients with moderate certainty of evidence. Long-term observational studies are recommended to observe post-COVID adverse events related to the use of mAbs.

PMID:40047167 | DOI:10.1002/bcp.70025

Vet Med Sci. 2025 Mar;11(2):e70265. doi: 10.1002/vms3.70265.

ABSTRACT

The skull is a very important structure, and it is the centre of many vital functions. There have been many studies on the skulls of mammals, but not many studies on the prenatal period. The aim of this study is to examine developmental sheep foetal skulls from the last two trimesters of pregnancy. A total of 40 sheep foetuses, 20 in the 2nd trimester (10 females and 10 males) and 20 in the 3rd trimester (10 females and 10 males), were examined. On the basis of CT scans of foetal skulls, morphometric measurements were performed by creating a three-dimensional (3D) model. Total skull length was statistically significant between males and females in the third trimester (p < 0.01). In the second trimester, the tooth length parameter was statistically significant between males and females (p < 0.01). In the second trimester, M3 was found to be statistically significant in the sheep foetus mandible (p < 0.01). It was determined that there was developmental sexual dimorphism between males and females.

PMID:40047137 | DOI:10.1002/vms3.70265

Eur J Neurol. 2025 Mar;32(3):e70091. doi: 10.1111/ene.70091.

ABSTRACT

BACKGROUND: Iatrogenic cerebral amyloid angiopathy (iCAA) is a recently identified clinico-neuroradiological syndrome associated with medical procedures, particularly neurosurgical treatments involving cadaveric dura mater (e.g., Lyodura). iCAA can manifest as intracerebral hemorrhages, focal seizures, and cognitive impairment, with the risk following exposure currently unknown. We aim to evaluate the risk of developing iCAA in patients who underwent childhood neurosurgical treatment with Lyodura compared to those who did not.

METHODS: This retrospective cohort study analyzed hospital records from the Christian-Doppler University Hospital in Salzburg, along with mortality data provided by the Austrian Federal Institute of Statistics (Statistik Austria). The study included all patients aged 0-18 who underwent neurosurgical procedures between January 1970 and January 1996. The primary endpoint was the diagnosis of iCAA and iCAA-related death.

RESULTS: Of 569 pediatric neurosurgical patients, 388 (68%) were further analyzed. Four patients (1%) were diagnosed with probable iCAA at a median age of 42 years (IQR 40-47), with a median latency from surgery to symptom onset of 38 years (IQR 36-41). Only Lyodura recipients developed iCAA, with an incidence rate of 12% (OR 56, 95% CI: 6-2667). The overall incidence of symptomatic iCAA among recipients of any dura material was 5% (OR 19, 95% CI: 2-903).

CONCLUSIONS: Cadaveric dura mater, especially Lyodura, poses a long-term risk for developing iCAA. Further research is needed to determine susceptibility factors in Lyodura-exposed individuals.

PMID:40047134 | DOI:10.1111/ene.70091