Nevin Manimala

Cureus. 2025 Sep 12;17(9):e92118. doi: 10.7759/cureus.92118. eCollection 2025 Sep.

ABSTRACT

Background Caries-affected dentin is a partially demineralized substrate that retains its collagen matrix and has the potential to be remineralized. Recent biomimetic materials have shown potential in enhancing remineralization and improving composite bonding. The study aimed to compare the shear bond strength of composite resin to demineralized dentin after remineralization with three agents: silver diamine fluoride (SDF), nanohydroxyapatite (nHAp), and self-assembling peptide P11-4 (SAP P11-4). Materials and methods An in vitro, non-randomized, experimental study was conducted using sixty premolars with a single root, collected post-extraction, and equally divided into four groups: control, SDF, nHAp, and SAP. Remineralizing agents were applied to exposed dentin surfaces, followed by the placement of composite resin. After surface treatment with remineralizing agents, the resin-based composite was applied, and a universal testing machine was utilized to determine the shear bond strength. The modes of failure were examined using a stereomicroscope. One-way ANOVA and Tukey’s post hoc test were used (p < 0.001). Results The SAP P11-4 group showed the highest mean bond strength (28.13 N), followed by the SDF groups and nHAP groups, while the control group demonstrated the lowest values. All remineralized groups exhibited significantly higher bond strength compared to the control (p < 0.001). Intergroup comparisons revealed statistically significant differences among all test groups, with SAP P11-4 significantly outperforming SDF and nHAP. Failure mode analysis revealed that SAP P11-4 predominantly resulted in cohesive failure, whereas SDF and nHAP primarily exhibited adhesive failure. Conclusions Among the three remineralizing agents tested, SAP P11-4 demonstrated the highest shear bond strength to demineralized dentin. Its superior performance highlights its potential to enhance the longevity and durability of resin-based restorations in minimally invasive dentistry. The predominance of cohesive failure further supports its effectiveness in creating a strong, integrated bond between the composite resin and dentin substrate.

PMID:41084714 | PMC:PMC12515371 | DOI:10.7759/cureus.92118

Cureus. 2025 Sep 10;17(9):e91972. doi: 10.7759/cureus.91972. eCollection 2025 Sep.

ABSTRACT

INTRODUCTION: Heart failure (HF) is one of the causes of morbidity and mortality. High-intensity interval training (HIIT) has been suggested as a positive intervention that can be practiced to help optimize heart function and overall health. However, the effect of HIIT in the long-term on heart functioning, the level of symptoms shown by patients with HF, and the survival of the affected people are poorly understood. This study explores the effects of a long-term HIIT intervention on individuals who have HF.

METHODS: This was a longitudinal observational study conducted in the cardiac department of Pakistan Institute of Medical Sciences (PIMS) in Islamabad, Pakistan, from July 2024 to January 2025. Purposive non-probability sampling was used to recruit all HF patients, with 158 patients aged 30 years and older participating. The demographic information and research instruments used at baseline, three months, and six months include the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), Duke Activity Status Index (DASI) questionnaires, and New York Heart Association (NYHA) classification. IBM SPSS version 26 (IBM Corp., Armonk, NY, US) was used to conduct statistical tests, including repeated-measures ANOVA, Pearson correlation, and multiple linear regression.

RESULTS: The sample size consisted of 158 participants (N = 113, 71.0% men; N = 45, 29.0% women), with a mean age of 56.3 ± 12.4 years. There was a significant improvement in both KCCQ-12 and DASI (p < 0.01), whereas the NYHA classification worsened (p < 0.001). Increased levels of HIIT were associated with improved functional capacity and quality of life (r = 0.392, p < 0.01 for DASI; r = 0.215, p < 0.01 for KCCQ-12) and reduced symptom severity (r = -0.265, p < 0.01 for NYHA). The main predictors of these outcomes identified through regression analysis included HIIT, age, gender, and comorbidities. Gender differences were demonstrated by women reporting better outcomes and men exhibiting worse indicators concerning symptoms.

CONCLUSION: Long-term HIIT is highly effective in improving cardiac performance, decreasing the severity of HF symptoms, and improving the quality of life among HF patients. These findings demonstrate the promising potential of HIIT as an effective adjunctive treatment in managing HF, as it can bring significant benefits to patients of diverse ages and backgrounds. Early HIIT, tailored to the individual needs of each patient, has the potential to improve clinical outcomes and increase survival rates in HF populations.

PMID:41084708 | PMC:PMC12515264 | DOI:10.7759/cureus.91972

Cureus. 2025 Sep 10;17(9):e92014. doi: 10.7759/cureus.92014. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: Multidisciplinary cancer conferences (MCCs) are essential forums for collaborative oncology decision-making. However, existing literature has primarily examined the role of attending specialists and has rarely differentiated effects by specialty. The contributions of trainees, particularly in nuclear medicine, have been largely overlooked, leaving a gap in understanding how their participation influences both educational outcomes and patient management. This study addresses this gap by systematically evaluating the perceived impact of nuclear medicine trainees in MCCs.

METHODS: A cross-sectional survey was distributed to 73 healthcare professionals at a tertiary medical center, including nuclear medicine specialists, trainees, and clinicians from surgery, oncology, and radiology. The survey included Likert-scale and multiple-choice questions to assess perceptions of trainee contributions to interprofessional collaboration, clinical decision-making, and patient outcomes. Descriptive statistics were calculated, and analysis of variance (ANOVA) and chi-square tests were applied to analyze Likert-scale responses and compare responses between nuclear medicine and non-nuclear medicine specialists. P-values < 0.05 were considered statistically significant.

RESULTS: Of the 73 respondents, 57 (78.1%) indicated that nuclear medicine trainees enhanced interprofessional collaboration, while 56 (76.7%) reported a positive influence on patient care. Additionally, 60 (82.2%) perceived an educational benefit through enriched clinical knowledge. Chi-square analysis revealed no significant differences in perceptions across professional groups (p = 0.568). Reported barriers included inconsistent attendance, limited clinical experience, and time constraints.

CONCLUSION: Nuclear medicine trainees play a valuable role in MCCs by enriching clinical discussions, supporting patient care, and contributing to professional development. To maximize their impact, structured learning opportunities, increased mentorship, and improved logistical support are recommended. These findings emphasize the importance of formally integrating trainees into MCC workflows to enhance both educational and clinical outcomes.

PMID:41084706 | PMC:PMC12515522 | DOI:10.7759/cureus.92014

Cureus. 2025 Sep 11;17(9):e92105. doi: 10.7759/cureus.92105. eCollection 2025 Sep.

ABSTRACT

INTRODUCTION: Knee osteoarthritis (KOA) is a chronic degenerative condition characterized by joint space narrowing (JSN), pain, and functional limitations, affecting a significant portion of the population in India. Radiographic evaluation (standing anteroposterior (AP) view – standard technique) is crucial for diagnosing and grading KOA. The aim of this study was to evaluate the efficacy of the Rosenberg posteroanterior (PA) view compared to the standard anteroposterior (AP) view in grading KOA and to estimate the correlation between joint space width (JSW), radiographic grading, and the Oxford knee score (OKS).

MATERIALS AND METHODS: A total of 384 knees (192 patients) aged 40 years and above, presenting with knee pain, were included in this cross-sectional study. Radiographs of the standing AP and Rosenberg views were taken, and the medial and lateral tibiofemoral JSW were measured digitally on calibrated images. KOA was graded using the International Knee Documentation Committee (IKDC) classification. Statistical analysis included Spearman’s rho correlation coefficient, with significance set at p<0.05.

RESULTS: The mean medial JSW was 3.91±0.89 mm in the AP view and 3.52±1.02 mm in the Rosenberg view, with a strong correlation (p<0.0001). The mean lateral JSW was similar between views (5.88±0.47 mm in AP and 5.89±0.43 mm in Rosenberg), showing moderate correlation (p<0.0001). The Rosenberg view identified more severe KOA grades, with 41.9% of patients classified as IKDC Grade 3 or higher, compared to 27.6% in the AP view. Additionally, 18.2% of patients were reclassified to a more severe grade in the Rosenberg view, indicating its superior sensitivity in detecting early disease progression.

CONCLUSION: The Rosenberg view is more effective in detecting early and severe KOA, providing a more accurate assessment of disease severity for improved management.

PMID:41084705 | PMC:PMC12515347 | DOI:10.7759/cureus.92105

Cureus. 2025 Sep 12;17(9):e92153. doi: 10.7759/cureus.92153. eCollection 2025 Sep.

ABSTRACT

Background Type 2 diabetes mellitus (T2DM) is often associated with overweight and obesity, contributing to poor glycemic control and increased risk of complications. Lifestyle modification is a cornerstone in the management of T2DM, but its real-world impact on anthropometric measures like weight and body mass index (BMI) requires further evaluation. Objective The objective of the study was to assess the effectiveness of lifestyle modification counseling on weight and BMI reduction among people with T2DM over a six-month period. Methods This randomized controlled trial included 110 participants with T2DM, equally divided into intervention (n=55) and control (n=55) groups. The intervention group received structured lifestyle counseling, including dietary advice, physical activity recommendations, and behavioral strategies, while the control group received routine clinical care. Anthropometric parameters (weight and BMI) were recorded at baseline and at the six-month follow-up. Statistical analysis was performed using paired and unpaired t-tests with significance set at p<0.05. Results At baseline, there were no significant differences between groups in weight, BMI, or waist-hip ratio (p>0.05), confirming comparability. At six months, the intervention group showed a significant mean weight reduction of 2.04 ± 2.30 kg (p<0.001) and BMI reduction of 0.792 ± 1.009 kg/m² (p<0.001). The control group showed non-significant changes in both parameters. Between-group comparisons revealed a significantly greater weight reduction in the intervention group (p=0.001), although the BMI difference was not statistically significant (p=0.924). Conclusion Structured lifestyle modification counseling significantly improved weight and BMI in people with T2DM over six months, highlighting its role as an effective, non-pharmacological strategy for obesity management in diabetes care.

PMID:41084691 | PMC:PMC12515480 | DOI:10.7759/cureus.92153

Cureus. 2025 Sep 11;17(9):e92103. doi: 10.7759/cureus.92103. eCollection 2025 Sep.

ABSTRACT

Introduction Blunt abdominal trauma (BAT) is a major cause of morbidity and mortality, most frequently resulting from road traffic accidents and falls. Focused assessment with sonography in trauma (FAST) is a rapid, non-invasive, bedside imaging technique used to detect intra-abdominal free fluid. While FAST is widely accessible and radiation-free, its diagnostic accuracy varies with time and clinical context. This study is aimed to evaluate the diagnostic accuracy of serial FAST performed at 4, 8, and 12 hours after injury, using contrast-enhanced computed tomography (CECT) whole abdomen as the reference. Materials and methods This was a prospective observational study, conducted at the Department of General Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Uttar Pradesh, India, between April 2024 and April 2025. A total of 132 adult patients presenting with BAT in emergency were enrolled based on strict inclusion and exclusion criteria. FAST was performed at 4, 8, and 12 hours post-injury. Diagnostic performance was assessed by comparing FAST findings with CECT results in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results Liver injuries were the most common (37.12%), followed by splenic and gastrointestinal injuries (18.18% each). Sensitivity of FAST improved from 64.4% at 4 hours to 76.3% at 8 hours and 88.1% at 12 hours. Specificity also increased from 64.3% to 85.7% across the same intervals. PPV remained consistently high (>93%), whereas NPV increased from 17.6% to 46.2%. The diagnostic improvement over time was statistically significant (p < 0.05 for 8 and 12 hours). Conclusion Serial FAST enhances diagnostic accuracy in BAT, particularly when performed at delayed intervals. While a positive FAST is highly predictive of injury, a negative FAST, especially at earlier time points, should be interpreted with caution. Integration of serial FAST into trauma protocols can improve injury detection and clinical outcomes.

PMID:41084686 | PMC:PMC12515346 | DOI:10.7759/cureus.92103

J Assist Reprod Genet. 2025 Oct 13. doi: 10.1007/s10815-025-03706-z. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to compare clinical pregnancy rate after IUI-D in heterosexual couples (HC), lesbian couples (LC), and single women (SW).

METHODS: This retrospective multicentric study was conducted in two university-based ART centers in France in all consecutive IUI-D cycles performed after stimulation with gonadotropins in 2021-2023. The primary outcome was clinical pregnancy rate (CPR). Cumulative clinical pregnancy rate was also calculated. Comparisons were made between groups taking HC as the control group and adjusting for age.

RESULTS: A total of 962 patients undergoing 2737 IUI-D cycles were included in the analysis, 234 HC women (24.3%), 478 LC women (49.7%), and 250 (30%) single women (SW). SW were significantly older than HC and LC. Clinical pregnancy rate (CPR) per cycle was significantly lower in LC and SW than in HC in univariate analysis. Age was negatively associated with clinical pregnancy. After adjusting for age, no statistically significant relationship was found between category and clinical pregnancy (p = 0.07). Cumulative clinical pregnancy rates (CCPR) and the average number of cycles required to achieve pregnancy were not significantly different between HC, LC and SW.

CONCLUSIONS: This first study conducted in France after change in law allowing ART access for LC and SW confirms that CPR after IUI-D is not significantly associated with relationship status after adjusting for age.

PMID:41083664 | DOI:10.1007/s10815-025-03706-z

Clin Transl Oncol. 2025 Oct 13. doi: 10.1007/s12094-025-04068-9. Online ahead of print.

ABSTRACT

PURPOSE: Recent studies have suggested a change in the epidemiologic pattern of testicular germ-cell tumors (TGCTs) and advances in therapeutic strategies have led to significant changes in their treatment over the last decades. Treatment guidelines for early-stage testicular cancer recommend de-escalation of therapy by the adoption of surveillance strategies. This study aimed to describe trends in TGCTs diagnosed over the last 30 years at our center and evaluate the impact of evolving treatment strategies.

METHODS: We retrospectively analyzed 277 TGCT patients treated from 1994 to 2023. Clinical characteristics, treatment patterns, and outcomes were assessed across three 10-year periods. Survival and relapse rates were estimated using Kaplan-Meier methods; significance was set at p < 0.05.

RESULTS: A significant increase in incidence was observed (p < 0.05), along more stage I diagnoses (p < 0.05) and older age at diagnosis, including a higher proportion aged ≥ 40 years (p < 0.001). Seminoma incidence doubled, while non-seminoma remained stable. In stage I disease, the use of active surveillance increased significantly, while adjuvant chemotherapy declined (p < 0.0005). Recurrence rates slightly decreased but were not statistically significant. Cause-specific 10-year survival improved from 95% to 97.2%, with overall survival stable at ~ 94%. The risk of second primary malignancies was notable, including contralateral testicular cancer (2.9%) and second malignant neoplasms (SMNs) (5.0%). A substantial burden of non-cancer-related causes of death were also observed.

CONCLUSIONS: A real increase in the incidence of TGCTs and age at diagnosis was confirmed. These trends highlight a shift toward less aggressive treatment while maintaining excellent outcomes. However, the notable occurrence of SMNs and non-cancer mortality underscores the need for long-term follow-up that includes survivorship care beyond oncological monitoring.

PMID:41083654 | DOI:10.1007/s12094-025-04068-9

Breast Cancer. 2025 Oct 13. doi: 10.1007/s12282-025-01791-7. Online ahead of print.

ABSTRACT

AIMS: Autoimmune rheumatological diseases (ARDs) have historically represented an absolute or relative contraindication for radiotherapy (RT) due to increased RT-related toxicity and the potential exacerbation of rheumatologic disease. ARDs are more frequent in females (F:M 4:1). Breast cancer (BC) is the most common malignancy, accounting alone for 31% of female cancers. This study compared acute and late cutaneous toxicity in ARDs and non-ARDs population undergoing adjuvant breast RT.

METHODS: Data of patients with BC and ARDs treated between 2013 and 2023 were retrospectively reviewed. The ARDs group was compared with a control group in a 1:2 ratio, homogeneous by age, type of treatment, RT total doses and fractionations, and target volumes’ prescription. Acute and late toxicity were recorded using RTOG scales.

RESULTS: We included 44 women with ARDs (median age 61 years) and 88 woman (median age 62 years) as control group. In ARDs group, the most used RT schedules were conventional fractionation (72.7%), while hypofractionation schedule (40-44 Gy) was administered in 12 patients (27.3%). In the control group, 64 patients (72.7%) received RT with conventional fractionation and 24 patients (27.3%) hypofractionation (40-44 Gy). Overall acute skin toxicity rate was 80.4% in the control group vs 86.4% in the ARDs group (p = 0.681). Specifically, G2 toxicity was 22.0% in the control group vs 31% in the ARDs group, while G3 acute toxicity was 2.3% in both groups. Overall late skin toxicity was 21.6% in the control group vs 27.3% in ARDs group (p = 0.067). Statistically significant difference was observed in late G2 toxicity with a 0% rate in the control group vs 6.8% in the experimental group (p = 0.035), respectively.

CONCLUSIONS: ARDs do not seem to represent an absolute or relative contraindication in BC RT in terms of acute and late cutaneous toxicity. Hypofractionated schedule showed less toxicities in both group and, particularly, in ARDs group.

PMID:41083653 | DOI:10.1007/s12282-025-01791-7

Sci Rep. 2025 Oct 13;15(1):35690. doi: 10.1038/s41598-025-19472-y.

ABSTRACT

The aim of the study was to assess Life’s Essential 8 (LE8) trajectories by glycemic status change and examine their association with diabetes progression risk in young adults with prediabetes (preDM). We used the Coronary Artery Risk Development in Young Adults study (CARDIA) Year 7-30 data to estimate trends of LE8 scores among preDM participants (impaired fasting glucose, impaired oral glucose tolerance, and/or HbA1c 5.7-6.4%) by status of progression, consistent preDM, and regression. We used logistic regression to evaluate the progression risk with LE8. Among 974 preDM participants, 34% progressed to diabetes, 28% remained preDM, and 38% regressed to euglycemia. Over a mean follow-up of 13 years, the progression group had the greatest decline in LE8 scores. Ideal LE8 scores (vs. moderate or poor) were associated with a 40-90% reduction in the progression risk. In conclusion, maintaining optimal cardiovascular health may prevent diabetes progression among young adults with preDM.

PMID:41083649 | DOI:10.1038/s41598-025-19472-y