Nevin Manimala

JAMA Netw Open. 2025 Feb 3;8(2):e2459567. doi: 10.1001/jamanetworkopen.2024.59567.

ABSTRACT

IMPORTANCE: Dizziness symptoms account for nearly 2 million annual emergency department (ED) visits and present a diagnostic challenge for clinicians. Most dizziness research has focused on improving guideline-concordant care among clinicians, with little focus on developing patient-centered interventions to improve dizziness-related disability.

OBJECTIVE: To examine the feasibility of ED vestibular rehabilitation therapy (ED-VeRT) using a protocolized diagnostic classification algorithm and collection of longitudinal patient-reported outcomes.

DESIGN, SETTING, AND PARTICIPANTS: A pilot nonrandomized clinical trial of ED-VeRT vs usual care for patients presenting to the ED with dizziness at a single urban US ED was conducted from November 16, 2021, to February 6, 2023, with collection of 3-month outcomes through May 1, 2023. Patients were allocated to ED-VeRT or usual care at the discretion of the treating physician.

INTERVENTIONS: Use of ED-VeRT was delivered by an ED physical therapist via a protocolized diagnostic classification and treatment algorithm based on a diagnosis of benign paroxysmal positional vertigo, triggered undifferentiated dizziness, spontaneous undifferentiated dizziness, or unilateral peripheral hypofunction.

MAIN OUTCOMES AND MEASURES: Feasibility outcomes included participant screening, enrollment, and retention rates to inform the design of a future randomized clinical trial; retention was defined as completing any of 4 follow-up surveys over 3 months. The primary efficacy outcome was change in the Dizziness Handicap Inventory score; the secondary efficacy outcome was change in the Vestibular Activities Avoidance Inventory-9 score.

RESULTS: Of 366 patients screened, 125 participants were enrolled (median age, 52 [IQR, 40-66] years, 73 [58%] female, 61 [49%] White), and 105 retained (84.0%) in longitudinal data collection. Sixty-three participants (50.4%) received ED vestibular therapy and were assigned to primary diagnostic classifications of benign paroxysmal positional vertigo (23 [37.1%]), triggered undifferentiated dizziness (14 [22.6%]), spontaneous undifferentiated dizziness (14 [22.6%]), or unilateral peripheral hypofunction (9 [14.5%]). Despite having higher Dizziness Handicap Inventory and Vestibular Activities Avoidance Inventory scores at baseline, ED-VeRT participants reported lower dizziness handicap (difference: -1.68; 95% CI, -11.30 to 7.90) and vestibular activities avoidance (difference: -2.27; 95% CI, -8.40 to 3.86) at 3 months, although these differences were not statistically significant.

CONCLUSIONS AND RELEVANCE: In this nonrandomized clinical trial, ED vestibular therapy was feasibly delivered to patients presenting to the ED with undifferentiated dizziness symptoms. For participants receiving vestibular therapy the findings for dizziness-related disability over 3 months were not statistically significant, pointing to the need for a fully powered randomized clinical trial.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05122663.

PMID:39951266 | DOI:10.1001/jamanetworkopen.2024.59567

JAMA Netw Open. 2025 Feb 3;8(2):e2459754. doi: 10.1001/jamanetworkopen.2024.59754.

ABSTRACT

IMPORTANCE: The mechanisms through which chronic stressors may be associated with tumor biologic characteristics, immune response, and health disparities remain insufficiently understood.

OBJECTIVE: To investigate the proteomic, transcriptomic, and genomic effects associated with multilevel chronic stressors (perceived stress, perceived inadequate social support, perceived racial and ethnic discrimination, and neighborhood deprivation) in Black and White women with breast cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from February 28, 2012, to September 5, 2023, in which blood samples, breast tumors, and adjacent noncancerous tissues were collected from women with breast cancer. Participants, recruited at 2 Baltimore, Maryland, hospitals, completed demographic and psychosocial questionnaires. Data analysis was conducted from September 2023 to April 2024.

EXPOSURES: Perceived stress, perceived social support, perceived racial and ethnic discrimination, and the 2010 census tract-level neighborhood deprivation index, in which scores range from -2.51 to 6.77, with higher scores indicating greater deprivation.

MAIN OUTCOMES AND MEASURES: The main outcomes included levels of 92 circulating immune-oncologic markers and associated biologic pathways, tumor immune cell profiles, breast tissue gene expression, and tumor mutational burden. Data were analyzed using covariate-adjusted linear regression modeling for continuous outcomes with effect estimates presented as β values with 95% CIs.

RESULTS: The study included 121 women with breast cancer (mean [SD] age, 56.27 [12.62] years), of whom 56 (46.3%) were Black, and 65 (53.7%) were White. The analytic subsample sizes included 117 blood samples, 48 breast tumors, and 41 adjacent noncancerous tissues. Levels of perceived stress and social support were comparable by race, while Black women resided in more socioeconomically deprived neighborhoods (mean [SD] neighborhood deprivation index, 2.28 [2.30] for Black women compared with -0.22 [2.01] for White women). Greater perceived social support was associated with more favorable immune-stimulatory changes (eg, increased serum IL-5 [β, 0.06 (95% CI, 0.02-0.10); P = .003] and activated natural killer cells in noncancerous breast tissue of Black women [β, 0.11 (95% CI, 0.04-0.17); P = .002). Higher levels of perceived stress, exposure to discrimination, and neighborhood deprivation were associated with systemic inflammation (eg, serum IL-6 with both perceived stress [β, 0.04 (95% CI, 0.01-0.07); P = .006] and discrimination [β, 0.69 (95% CI, 0.15-1.23); P = .01]); deleterious immune cell profiles (eg, tumor-associated M2 macrophages with discrimination [β, 0.82 (95% CI, 0.14-1.51); P = .02]); and aggressive tumor biologic characteristics. Race-stratified analyses uncovered distinct immunologic features in Black women associated with stressors, including chemotaxis with stress (β, 0.28 [95% CI, 0.001-0.56]; P = .049) and immune suppression with stress (β, 0.37 [95% CI, -0.002 to 0.75]; P = .05) at the systemic level and increased tumor-associated myeloid cells (monocytes and M1 and M2 macrophages) at the tissue level. Perceived stress was associated with elevated tumor mutational burden (β, 0.02 [95% CI, 0.01-0.04]; P = .04).

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study of Black and White women with breast cancer suggest that perceived stress, perceived inadequate social support, perceived racial and ethnic discrimination, and neighborhood deprivation were associated with deleterious alterations to the systemic and tumor immune environment, particularly for Black women. Understanding biology as a possible mediator of cancer health disparities may inform prevention and public health interventions.

PMID:39951265 | DOI:10.1001/jamanetworkopen.2024.59754

JAMA Netw Open. 2025 Feb 3;8(2):e2459766. doi: 10.1001/jamanetworkopen.2024.59766.

ABSTRACT

IMPORTANCE: Continuing prostate-specific antigen (PSA) screening after age 70 years might benefit men at high risk of prostate cancer-specific mortality (PCSM) or metastatic prostate cancer (mPCa), but the relative value of clinical factors (race and ethnicity, competing mortality, and PSA history) in identifying men at higher vs lower risk is unknown.

OBJECTIVE: To examine the value of PSA levels, race and ethnicity, and competing mortality in risk stratification for PCSM and mPCa in men after age 70 years.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, clinical data of all men receiving health care through the Veterans Health Administration who turned age 70 years between 2008 and 2020 and had a normal screening PSA value between age 65 and 69 years (<4 ng/mL [baseline PSA]) and no prior history of prostate cancer or biopsy were examined. The data cutoff date was December 26, 2023.

EXPOSURE: The most recent screening PSA value from age 65 to 69 years, self-reported race and ethnicity, and competing mortality risk derived from a machine learning model.

MAIN OUTCOME AND MEASURES: The 10-year absolute risk of PCSM and mPCa were determined using regression modeling.

RESULTS: The cohort included 921 609 men who turned 70 years between 2008 and 2020; 11% of whom self-reported as Black and 82% as White race. Between age 65 and 70 years, 45% of patients had a baseline PSA of less than 1.00 ng/mL, and 32% had a baseline PSA of 1.00 to 1.99 ng/mL. Most patients (87%) continued to undergo screening past age 70 years, with little variation by competing mortality risk or race and ethnicity. The 10-year cumulative incidence of PCSM was 0.26% overall, and 95% of men had a 10-year risk less than 0.73%. Higher baseline PSA level between age 65 and 69 years was associated with 10-year PCSM risk (0.79% for 3.00-3.99 ng/mL vs 0.10% for 0.20-0.99 ng/mL), race and ethnicity (0.36% for Black vs 0.25% for White), and competing mortality (0.24% for the highest quintile vs 0.21% for the lowest quintile). Similar results were found for mPCa. Low PSA (0.20-0.99 ng/mL) was associated with very low PCSM and mPCa risk, even among Black men in the healthiest quintile of competing mortality risk (10-year PCSM risk, 0.08% [95% CI, 0.01%-0.44%]; 10-year mPCa risk 0.24% [95% CI, 0.10%-0.52%]).

CONCLUSIONS AND RELEVANCE: In this cohort study, the findings suggest that most men receiving care through the VHA continue PSA screening after age 70 years despite low absolute 10-year PCSM risks. The PSA values from age 65 to 69 years may be highly informative for adverse prostate cancer outcomes after age 70 years, with a PSA less than 1 ng/mL associated with a very low risk of long-term PCSM and mPCa.

PMID:39951264 | DOI:10.1001/jamanetworkopen.2024.59766

JAMA Netw Open. 2025 Feb 3;8(2):e2460012. doi: 10.1001/jamanetworkopen.2024.60012.

ABSTRACT

IMPORTANCE: Mental health problems often arise during adolescence and early adulthood, affecting up to 25% to 30% of young people. Enhancing the ability to identify children and adolescents at increased risk of mental health problems and uncover factors that promote mental health from childhood to adolescence is important.

OBJECTIVE: To investigate if cumulative lifestyle behaviors from childhood to adolescence are associated with perceived stress and depressive symptoms in adolescence.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in Finland using baseline data collected between October 2007 and November 2009 and 8-year follow-up data collected between December 2015 and December 2017 as part of the Physical Activity and Nutrition in Children (PANIC) study of children aged 6 to 9 years. Data were analyzed from January to February 2024.

EXPOSURES: Cumulative physical activity (PA), sedentary behavior (SB), sleep, and diet quality from childhood to adolescence. PA and screen time (ST) assessed by a questionnaire; PA at different intensities, SB, and sleep duration assessed by a combined movement and heart rate sensor; diet quality assessed by 4-day food records and the Baltic Sea Diet Score computed at baseline, 2-year follow-up, and 8-year follow-up examinations.

MAIN OUTCOMES AND MEASURES: Perceived stress assessed by the Finnish version of the Cohen Perceived Stress Scale, and depressive symptoms by the Beck Depression Inventory at 8-year follow-up examinations. Linear regression analyses were used to evaluate associations between cumulative lifestyle behaviors over 8 years with the outcomes.

RESULTS: Altogether, 187 adolescents (97 boys [51.9%]; mean age, 15.8 [0.4] years) had valid data on self-reported lifestyle behaviors, and 170 adolescents had valid data on device-assessed lifestyle behaviors. Perceived stress scores ranged from 2 to 33 and depressive symptoms scores from 0 to 31. Self-reported total PA and supervised exercise were inversely associated with perceived stress (standardized regression coefficient [β] = -0.15; 95% CI, -0.31 to -0.01 and β = -0.15; 95% CI, -0.29 to -0.01, respectively) and depressive symptoms (β = -0.17; 95% CI, -0.31 to -0.02 and β = -0.14; 95% CI, -0.29 to -0.0, respectively). Total ST (β = 0.27; 95% CI, 0.13 to 0.41), computer use (β = 0.16; 95% CI, 0.01 to 0.30), and mobile device use (β = 0.28; 95% CI, 0.16 to 0.41) were positively associated with perceived stress. Total ST (β = 0.30; 95% CI, 0.15 to 0.44) and mobile device use (β = 0.33; 95% CI, 0.19 to 0.46) were positively associated with depressive symptoms.

CONCLUSIONS AND RELEVANCE: This cohort study of Finnish children and adolescents found that higher PA and lower ST from childhood were associated with perceived stress and depressive symptoms in adolescence. These findings emphasize reducing screen time and increasing PA to promote mental health in youth.

PMID:39951263 | DOI:10.1001/jamanetworkopen.2024.60012

JAMA Netw Open. 2025 Feb 3;8(2):e2460018. doi: 10.1001/jamanetworkopen.2024.60018.

ABSTRACT

IMPORTANCE: Prior studies have revealed gender differences in workplace assessments of physicians, but little is known about differences by physician gender in patients’ online written reviews.

OBJECTIVE: To analyze whether patients’ perceptions of their physicians’ interpersonal manner and technical competence differ by physician gender and practicing specialty and are associated with review star ratings.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study sampled written reviews submitted by patients between October 16, 2015, and May 27, 2020, for physicians across the US from a commercial physician rating and review website. Physicians included primary care physicians (PCPs) listed under family medicine, internal medicine, and pediatrics and surgeons listed under general surgery; orthopedic surgery; and cosmetic, plastic, and reconstructive surgery. Hand-coded reviews were used to fine-tune a natural language processing algorithm to classify all reviews for the presence and valence of patients’ comments of physicians’ interpersonal manner and technical competence. Statistical analyses were performed from July 2022 to December 2024.

EXPOSURE: Female or male physician gender.

MAIN OUTCOMES AND MEASURES: Outcomes included the presence and valence of interpersonal manner and technical competence comments and receipt of high star ratings. Multilevel logistic regressions analyzed differences by female or male physician gender in interpersonal manner and technical competence comments and whether those comments were associated with review star ratings.

RESULTS: The analysis included 345 053 written reviews of 167 150 physicians (mean [SD] age, 55.16 [11.40] years); 60 060 physicians (35.9%) were female, and 36 132 (21.6%) were surgeons. Female physicians overall had higher odds than males of receiving any (odds ratio [OR], 1.19; 95% CI, 1.16-1.22) or negative (OR, 1.22; 95% CI, 1.18-1.26) patient comments for their interpersonal manner. Among PCPs, females had higher odds than males of receiving a negative comment for interpersonal manner (OR, 1.22; 95% CI, 1.18-1.27) and, when receiving that negative comment, had disproportionately lower odds of receiving a high star rating (OR, 0.62; 95% CI, 0.53-0.73). Female physicians overall (OR, 1.09; 95% CI, 1.05-1.13) and female PCPs (OR, 1.08; 95% CI, 1.04-1.13) had higher odds than their male counterparts of receiving a negative comment for their technical competence. When receiving a negative comment for technical competence, both female PCPs (OR, 0.60; 95% CI, 0.50-0.73) and female surgeons (OR, 0.67; 95% CI, 0.50-0.89) had disproportionately lower odds of receiving a high star rating compared with their male counterparts. Female PCPs also had lower odds than male PCPs of receiving a high star rating when receiving a positive comment for technical competence (OR, 0.82; 95% CI, 0.70-0.96).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of online written reviews, female and male physician gender were differently associated with patients’ perceptions of their physicians’ interpersonal manner and technical competence. The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.

PMID:39951262 | DOI:10.1001/jamanetworkopen.2024.60018

J Vet Med Educ. 2025 Feb 14:e20240117. doi: 10.3138/jvme-2024-0117. Online ahead of print.

ABSTRACT

Anatomy is a central pillar of veterinary education, and it is an ongoing goal to optimize teaching methods so that students are well-prepared for their future practice. In the present study, we investigated whether plastinated prosections could serve as valuable supplementary learning tools during organized dissection courses and for self-studies. To enable independent student use, we also created nomenclature charts describing the anatomical structures on the prosections. Our study involved 89 veterinary students in their third semester of veterinary education, studying organ-based anatomy. The teaching intervention took place during four dissection classes, where all students dissected formalin-fixed dog cadavers, and where half of the students had access to additional in-house plastinated prosections with associated nomenclature charts, while the remaining students did not. After each dissection class, the students were given an immediate knowledge test and were asked about their perceived learning benefits. Subsequently, the plastinated prosections and nomenclature charts were available for all students for self-study for exam preparation, in addition to digital access to the nomenclature charts. Our results showed that the students frequently used the learning supplements and expressed high satisfaction with the plastinated prosections and the nomenclature charts but did not perform significantly better on the knowledge tests. A postexam survey revealed that the plastinated prosections and nomenclature charts were among the top three most frequently used learning resources for the exam. In conclusion, plastinated prosections and associated nomenclature charts are valuable learning supplements in veterinary anatomy education, both during organized dissection courses and for self-studies.

PMID:39951257 | DOI:10.3138/jvme-2024-0117

Jpn J Radiol. 2025 Feb 14. doi: 10.1007/s11604-025-01748-y. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the age-related changes in magnetic resonance imaging (MRI) findings of lobular endocervical glandular hyperplasia (LEGH) during long-term follow-up.

MATERIALS AND METHODS: This multicenter study included 91 patients who underwent preoperative MRI and had a histopathological diagnosis of LEGH, atypical LEGH, or adenocarcinoma in situ (AIS) with LEGH after surgical resection. Thirty patients underwent follow-up MRIs at intervals of more than 3 months. According to the age and menopausal status, patients were categorized into four groups: group A, 31-40 years; group B, 41-50 years (premenopausal); group C, more than 50 years (premenopausal); group D, postmenopausal. Differences in the MRI findings (size and morphological pattern) were compared among the four groups.

RESULTS: The lesion volume was the largest in group C and smallest in group D, showing a statistically significant difference (p < 0.05). The typical cosmos pattern was seen in 60.0% of group A, 62.2% of group B, 75.0% of group C, and 29.2% of group D. The cosmos pattern was significantly less frequent in postmenopausal patients compared to premenopausal patients (p < 0.05). During follow-up, five of 12 individuals in group A exhibited the typical cosmos pattern. Among the seven individuals who did not initially show the cosmos pattern, two later developed the typical cosmos pattern. No changes in the lesion pattern were observed in participants in their 40 s up to the premenopausal 50 s. From the premenopausal 50 s to the postmenopausal period, the cosmos pattern changed to a microcystic pattern in one case of atypical LEGH.

CONCLUSIONS: LEGH increases in volume with age until menopause, along with an increasing frequency of the typical cosmos pattern in MRI. However, after menopause, both the volume of the lesion and frequency of the typical cosmos pattern decrease.

PMID:39951245 | DOI:10.1007/s11604-025-01748-y

Jpn J Radiol. 2025 Feb 14. doi: 10.1007/s11604-025-01747-z. Online ahead of print.

ABSTRACT

PURPOSE: To clarify the usefulness of electron density (ED) using dual-energy CT (DECT) parameters for predicting treatment response in patients with pulmonary embolism (PE).

MATERIALS AND METHODS: The study population comprised 30 patients with PE (49 thrombi) who underwent pretreatment DECT. The study coordinator diagnosed PE using contrast-enhanced CT (CECT) as the gold standard and annotated the location of thrombi on CECT prior to the DECT image analyses. CT attenuation values on conventional 120 kVp, 40 keV, and 70 keV virtual monochromatic (VM) images; effective atomic number; and ED of pretreatment pulmonary thrombi were measured on unenhanced CT. Thrombi were classified into dissolved and residual groups according to the findings of posttreatment follow-up CT. DECT parameters were compared between the two groups using the Mann-Whitney U test. For statistically significant parameters, receiver-operating characteristic (ROC) analysis was used to evaluate their performance for differentiating two groups. Diagnostic accuracy for predicting treatment response in patients with PE was determined by calculating the area under the ROC curve (AUC).

RESULTS: ED values, CT values on conventional 120 kVp imaging, and those on 70 keV VM imaging were significantly higher in thrombi in the dissolved group than the residual group (p < 0.001, p = 0.012, p = 0.009, respectively). AUC values for predicting dissolution response by ED, conventional 120 kVp imaging, and 70 keV VM imaging (cut-off value, 3.49 × 10²³/cm³, 53.4 HU, and 50.7 HU, respectively) were 0.856, 0.744, and 0.755, respectively. AUC was significantly higher for ED than for conventional 120 kVp imaging and 70 keV VM imaging (p = 0.032, p = 0.016).

CONCLUSIONS: ED derived from unenhanced DECT may help predict therapeutic efficacy in patients with PE.

PMID:39951244 | DOI:10.1007/s11604-025-01747-z

Curr Rev Musculoskelet Med. 2025 Feb 14. doi: 10.1007/s12178-025-09951-0. Online ahead of print.

ABSTRACT

BACKGROUND: Purpose of review Agili-C® (CartiHeal, Smith & Nephew) is an off-the-shelf aragonite-based (inorganic calcium carbonate) scaffold approved for clinical use in 2022 to treat chondral and osteochondral lesions eventually also in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). The successful preclinical studies justified the subsequent clinical trials which reported both clinical and radiological significant improvements over time as well as superiority over standard surgical techniques for cartilage lesions treatment (i.e. microfractures/debridement). The aim of the present review is to summarize the available preclinical and clinical evidence and to report the current indications, surgical techniques and outcomes of this novel and innovative osteochondral scaffold.

RECENT FINDINGS: A total of six clinical reports, four single cohorts studies and a recent double arm randomized control trial followed by an analysis differentiating between femoral and trochlear lesions, have been published on Agili-C® safety and efficacy. Supported with an excellent safety profile, Agili-C® provided statistically significant clinical benefits at short and medium-term follow up in patients affected by knee joint surface lesions also when presenting in the context of mild to moderate knee osteoarthritis (Kellgren-Lawrence 0-3). Agili-C® (CartiHeal, Smith & Nephew) is an innovative aragonite-based osteochondral scaffold. It is an CE-marked and FDA approved off-the-shelf, cell-free, and cost-effective implant designed to treat knee joint surface lesions in the form of chondral and osteochondral defects. Its indications, supported by consistent clinical evidence, are single or multiple knee joint surface lesions (ICRS grade III or IV), with a total treatable area of 1-7cm², without severe knee OA (Kellgren-Lawrence grade 0-3).

PMID:39951240 | DOI:10.1007/s12178-025-09951-0

Med Biol Eng Comput. 2025 Feb 14. doi: 10.1007/s11517-025-03310-4. Online ahead of print.

ABSTRACT

Left ventricular ejection fraction (LVEF) is a critical indicator of cardiac function, aiding in the assessment of heart conditions. Accurate segmentation of the left ventricle (LV) is essential for LVEF calculation. However, current methods are often limited by small datasets and exhibit poor generalization. While leveraging large models can address this issue, many fail to capture multi-scale information and introduce additional burdens on users to generate prompts. To overcome these challenges, we propose LV-SAM, a model based on the large model SAM-Med2D, for accurate LV segmentation. It comprises three key components: an image encoder with a multi-scale adapter (MSAd), a multimodal prompt encoder (MPE), and a multi-scale decoder (MSD). The MSAd extracts multi-scale information at the encoder level and fine-tunes the model, while the MSD employs skip connections to effectively utilize multi-scale information at the decoder level. Additionally, we introduce an automated pipeline for generating self-extracted dense prompts and use a large language model to generate text prompts, reducing the user burden. The MPE processes these prompts, further enhancing model performance. Evaluations on the CAMUS dataset show that LV-SAM outperforms existing SOAT methods in LV segmentation, achieving the lowest MAE of 5.016 in LVEF estimation.

PMID:39951230 | DOI:10.1007/s11517-025-03310-4