Nevin Manimala

Hong Kong Med J. 2025 Dec 9. doi: 10.12809/hkmj2412577. Online ahead of print.

ABSTRACT

INTRODUCTION: Faculty development for trainers and nurturing feedback literacy in trainees is crucial for effective workplace-based assessments (WBAs) to support trainee competency development. Separate training sessions for trainers and trainees can be challenging when resources are limited. Combined training can optimise resources and foster mutual understanding, although such approaches face challenges related to power dynamics. This study aimed to evaluate the effectiveness of a conjoint WBA workshop in enhancing trainer engagement, improving trainee feedback literacy, and exploring the benefits and challenges of integrating trainers and trainees in a shared learning environment.

METHODS: A mixed-methods study was conducted with 13 trainers and five trainees from the Hong Kong College of Otorhinolaryngologists. Quantitative data were collected using the Feedback Literacy Behaviour Scale for trainees and the Continuing Professional Development-Reaction Questionnaire for trainers. Pre- and post-intervention comparisons were analysed using paired t tests. Qualitative data from focus group interviews were thematically analysed.

RESULTS: Quantitative analysis showed statistically significant increases in trainee feedback literacy (P<0.001) and improvements in trainers’ beliefs about capabilities and engagement intentions (P<0.05). The qualitative analysis supported these findings and identified three key factors: mutual understanding, clarification of the WBA purpose, and effective instructional design. Participants valued the mutual understanding fostered in the conjoint setting, which aligned expectations and created a supportive learning environment.

CONCLUSION: Conjoint WBA workshops may effectively promote trainer engagement and trainee feedback literacy, aligning expectations and fostering a positive feedback culture. Further research is needed to explore the longitudinal impact and applicability to other specialties.

PMID:41362934 | DOI:10.12809/hkmj2412577

Iran Endod J. 2025;20(1):e41. doi: 10.22037/iej.v20i1.49169. Epub 2025 Oct 29.

ABSTRACT

INTRODUCTION: The dental pulp is a specialized connective tissue responsible for maintaining tooth vitality through a complex interplay of cellular, vascular, and immunological components. Despite the clinical use of conventional capping materials, their limited regenerative potential often results in pulp devitalization and compromised structural integrity. Recent advances in tissue engineering, particularly the application of three-dimensional scaffolds, have demonstrated promising outcomes in promoting dentin-pulp complex regeneration and biomimetic tissue repair. This systematic review and meta-analysis evaluated the efficacy of three-dimensional matrices, with or without bioactive materials, as direct pulp capping agents in animal models. Outcomes included cellularity, dentin thickness, dentin bridge formation, dystrophic calcification, inflammation control, and pulp organization compared to commercial materials.

MATERIALS AND METHODS: A comprehensive search was conducted in indexed databases and gray literature. A random-effects meta-analysis used standardized mean differences and the inverse variance method. Heterogeneity (I²), publication bias (Egger’s and Begg’s tests), and risk of bias (SYRCLE’s RoB tool) were assessed. Statistical analyses were conducted using RevMan (P<0.05).

RESULTS: Seventeen studies met the inclusion criteria, with 13 included in the meta-analysis. The risk of bias was predominantly low, yet the certainty of evidence was very low. Scaffolds significantly enhanced cellularity (P=0.02; I²=91%), dentin thickness (P<0.00001; I²=87%), and inflammation control (P=0.03; I²=20%) compared to controls. No significant differences were observed for dentin bridge formation (P=0.30; I²=63%), dystrophic calcification (P=0.14; I²=32%), or pulp organization (P=0.10; I²=0%).

CONCLUSION: Three-dimensional scaffolds demonstrated potential in promoting cellular activity, dentin formation, and inflammation control. However, their impact on dentin bridge formation, pulp organization, and dystrophic calcification remains inconclusive. Further high-quality studies are required to validate their clinical applicability.

PMID:41362914 | PMC:PMC12682324 | DOI:10.22037/iej.v20i1.49169

J Public Health Res. 2025 Dec 4;14(4):22799036251401951. doi: 10.1177/22799036251401951. eCollection 2025 Oct.

ABSTRACT

OBJECTIVES: To investigate and highlight the factors associated with smoking relapse and to demonstrate the withdrawal symptoms related to smoking cessation.

METHODS: This study is part of a larger historical cohort involved 490 participants who attended smoking cessation clinics in primary health care settings. A total of 143 relapsed after they initially quit smoking and included in this study. The participants were interviewed by phone using a structured questionnaire after obtaining informed consent. Frequency distribution tables and proportions were used to describe the study results.

RESULTS: More than half (55.9%) of participants who initially quit smoking by attending the smoking cessation clinics reported that relationships with smokers were the main reason for smoking relapse. Emotional or social problems led to relapse among 38.5% of the participants. Withdrawal symptoms were relatively low (14.7%). An increase in appetite was prevalent among 74.8% of smoking quitters as the main withdrawal symptom. This was followed by weight gain in 72%, craving for cigarettes/smoking in 71.3%, and feelings of anger in 53.1%. All the tested sociodemographic variables, namely: age, sex, nationality, income, education, and marital status, failed to show a statistically significant association with early timing of relapse (1-6 months).

CONCLUSION: The study identified various factors linked to smoking relapse among individuals using smoking cessation services. Relationships with smokers and emotional or social problems were the most common reasons. Additional research is needed to investigate strategies and interventions specifically targeting early smoking relapse to attain the desired health outcomes from smoking cessation services.

PMID:41362898 | PMC:PMC12681661 | DOI:10.1177/22799036251401951

Cardiovasc Ther. 2025 Nov 30;2025:4097327. doi: 10.1155/cdr/4097327. eCollection 2025.

ABSTRACT

BACKGROUND AND AIMS: Arrhythmias and major adverse cardiac events remain significant complications following ST-segment elevation myocardial infarction (STEMI). Shenfu injection, a traditional Chinese medicine formulation, has shown cardioprotective effects in preclinical studies. This trial is aimed at investigating whether Shenfu injection as an adjunctive therapy to standard treatment could reduce arrhythmias and improve clinical outcomes in patients with STEMI undergoing percutaneous coronary intervention (PCI).

METHODS: A single-center, prospective, randomized, controlled trial was conducted at Shanghai Ninth People’s Hospital among 245 patients with STEMI undergoing PCI. Participants were randomized to receive either standard therapy plus Shenfu injection (50 mL, administered intravenously twice daily for five consecutive days) (n = 123) or standard therapy alone (n = 122). The primary endpoint was the incidence of in-hospital arrhythmias. Secondary endpoints included major adverse cardiac events (MACEs) during the 12-month follow-up period and cardiac magnetic resonance imaging parameters.

RESULTS: A total of 245 patients underwent randomization (123 assigned to Shenfu injection group and 122 assigned to control group). During hospitalization, patients assigned to Shenfu injection had a significantly lower incidence of arrhythmias compared with the control group (24.4% vs. 38.5%, p = 0.017), with the most pronounced effect on frequent ventricular premature contractions (7.3% vs. 15.5%, p = 0.042). After adjustment for key baseline covariates including age, coronary artery disease extent, myocardial injury markers (CK-MB max and TNI max), left ventricular ejection fraction, B-type natriuretic peptide, door-to-balloon time, hypertension, and diabetes mellitus, Shenfu injection remained independently associated with reduced risk of in-hospital arrhythmias (adjusted OR 0.454, 95% CI: 0.249-0.827, p = 0.010). Cardiac magnetic resonance imaging performed in 174 patients revealed significantly smaller infarct size (16.1 ± 9.1 vs. 20.8 ± 13.1 g, p = 0.007) and lower incidence of microvascular obstruction (45.0% vs. 65.0%, p = 0.008) in the Shenfu group, with both parameters showing significant positive correlations with arrhythmia occurrence. During the 12-month follow-up, patients receiving Shenfu injection had a higher event-free rate from MACEs compared with the control group (12-month Kaplan-Meier event-free rate estimates, 84.6% vs. 73.0%, respectively; p = 0.028).

CONCLUSIONS: Treatment with Shenfu injection as an adjunctive therapy to standard treatment in patients with STEMI undergoing PCI significantly reduced in-hospital arrhythmias, infarct size, microvascular obstruction, and major adverse cardiac events during a 12-month follow-up period. The independent effect on arrhythmias after comprehensive statistical adjustment and the demonstrated correlation between reduced myocardial damage and arrhythmia prevention suggest the potential therapeutic value of Shenfu injection in improving both short-term and long-term outcomes in STEMI patients.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2200066918.

PMID:41362880 | PMC:PMC12682446 | DOI:10.1155/cdr/4097327

Genet Med Open. 2025 Oct 13;3:103464. doi: 10.1016/j.gimo.2025.103464. eCollection 2025.

ABSTRACT

PURPOSE: The long-term developmental outcomes of children with a prenatal diagnosis of a copy-number variant of uncertain significance (VUS) remain unclear. This study compared the developmental, social-emotional, and health outcomes of children with and without a prenatal VUS, assessed maternal perceptions of their child’s health and development, and examined the reclassification rate of VUS after more than 2 years.

METHODS: Women who underwent prenatal chromosomal microarray testing in Victoria, Australia (2013-2019), were recruited retrospectively (2021-2023). Children with a VUS (cases) were compared with controls without a VUS. We assessed a range of cognitive, developmental, and health outcomes in the children, who were on average 6 years old. Statistical analyses compared group outcomes and adjusted for maternal sociodemographic factors.

RESULTS: The study included 134 mother-child pairs (46 with a VUS and 88 controls). No significant differences were found between groups in intellectual functioning, adaptive behavior, or social-emotional measures. Maternal perceptions of their child and family well-being were also similar. Reanalysis reclassified 66.0% of VUS as benign and 8.5% as pathogenic.

CONCLUSION: Children with a prenatal VUS diagnosis have developmental outcomes and family well-being comparable to those without. These findings contribute valuable evidence to support prenatal genetic counseling and clinical laboratory reporting practices.

PMID:41362834 | PMC:PMC12681968 | DOI:10.1016/j.gimo.2025.103464

Anesthesiol Res Pract. 2025 Dec 7;2025:7816719. doi: 10.1155/anrp/7816719. eCollection 2025.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the effects of acupuncture on pain, prostaglandin E2 (PGE2), and interleukin-6 (IL-6) levels during septorhinoplasty surgeries.

MATERIALS AND METHODS: This randomized, controlled study included 70 patients. The patients were divided into two groups: an acupuncture group (n = 35) and a control group (n = 35). The acupuncture group received bilateral press needle acupuncture at the PC 6 and ST 36 points 24 h before surgery. Blood samples were collected for analysis and comparison of preoperative and postoperative levels of IL-6 and PGE2. The primary outcomes were the postoperative visual analog scale (VAS) scores.

RESULTS: In terms of evaluating postoperative pain, no statistically significant differences were observed between the study groups with regard to VAS scores. At 30 min after surgery, fewer patients in the acupuncture group needed analgesics than in the control group (p = 0.044). Postoperative IL-6 levels were lower in the acupuncture group than in the control group (p = 0.014). There was no significant difference in postoperative PGE2 levels between the groups (p = 0.568). The acupuncture group had lower diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) at 30 min intraoperatively and lower DBP at 60 min (p = 0.012, p = 0.026, and p = 0.012, respectively). At 15 min into the operation, the heart rate was higher in the acupuncture group than in the control group (p = 0.039). After surgery, the acupuncture group had lower blood pressure at 5 min and 6 h after surgery than the control group (p = 0.034 and p = 0.041, respectively).

CONCLUSIONS: The evidence from this study suggests that acupuncture can reduce the need for pain medication after septorhinoplasty surgery, and by decreasing IL-6 levels, it may contribute to the inflammatory process.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT04009070.

PMID:41362812 | PMC:PMC12682433 | DOI:10.1155/anrp/7816719

J Med Educ Curric Dev. 2025 Dec 5;12:23821205251405327. doi: 10.1177/23821205251405327. eCollection 2025 Jan-Dec.

ABSTRACT

BACKGROUND: Pathophysiology bridges basic and clinical sciences, offering essential insights into disease mechanisms, diagnosis, and treatment. However, lecture-based learning remains predominant in China, often lacking dynamic evaluation systems. In alignment with the “Healthy China 2030” initiative, innovative methods such as problem-based learning (PBL), case-based learning (CBL), team-based learning (TBL), and seminar are increasingly explored to enhance integrated and competency-based medical education.

METHODS: Sixty third-year clinical medicine students were randomly assigned to either a traditional instruction group or a Combi-Method group following a standardized preclass exam. The Combi-Method integrated PBL, CBL, TBL, and seminars. Instruction was based on real-world clinical cases. Knowledge acquisition was assessed through a postclass quiz, including multiple-choice, short-answer, and case study questions on renal, pulmonary, and hepatic insufficiency.

RESULTS: The 2 groups exhibited comparable baseline characteristics in age, gender, and preclass scores. The Combi-Method group achieved significantly higher scores in several domains, particularly in renal and pulmonary insufficiency, and demonstrated superior clinical reasoning and knowledge application. Although some areas showed no statistical difference, the overall performance favored the Combi-Method.

CONCLUSIONS: The Combi-Method proves to be an effective instructional model for pathophysiology, promoting deeper understanding, enhanced clinical reasoning, and knowledge integration. This approach aligns with the goals of competency-based medical education and supports its broader adoption in undergraduate medical curricula.

PMID:41362786 | PMC:PMC12681592 | DOI:10.1177/23821205251405327

Leukemia. 2025 Dec 8. doi: 10.1038/s41375-025-02804-2. Online ahead of print.

ABSTRACT

Childhood acute lymphoblastic leukemia (ALL) is a genetically heterogeneous disease, and while somatic alterations inform diagnosis and treatment stratification, germline variants – particularly common host genome variants – rarely influence clinical care. Over the past decade, various host genome variant studies have uncovered numerous common variants associated with ALL susceptibility, treatment efficacy, and toxicity risk. Yet, less than a handful have reached clinical implementation, with TPMT and NUDT15 variants being the only ones widely used clinically. Whether a variant can be readily translated into the clinical setting primarily depends on four features: (1) Phenotype severity, (2) phenotype rarity and the proportion of cases (overall or in subsets of patients) accounted for by genetic variants, (3) the application of the variant as an add-on clinical decision support tool, and (4) the availability, cost, and potential side effects of interventions and/or prophylaxis. Key barriers for such clinical translation include insufficient effect sizes, lack of replication across diverse populations, and lack of well-established treatment modification strategies. However, large-scale international collaborations can generate the necessary statistical power, including enabling more complex bioinformatic approaches, such as polygenic risk scores and more advanced machine learning strategies. In this review, we outline the necessary steps toward bridging the gap between genetic discovery and clinical practice.

PMID:41361660 | DOI:10.1038/s41375-025-02804-2

Calcif Tissue Int. 2025 Dec 9;116(1):149. doi: 10.1007/s00223-025-01463-w.

ABSTRACT

Studies evaluating habitual dietary copper intake and bone mineral density have garnered significant interest due to copper’s indispensable role in collagen cross-linking and osteogenesis. These investigations, which employ dietary assessment tools alongside DXA measurements of skeletal sites, have nonetheless yielded heterogeneous results regarding the impact of copper consumption on bone health. Consequently, elucidating the nature and magnitude of this association is of paramount importance for both nutritional epidemiology and osteoporosis prevention. The review was conducted in accordance with PRISMA guidelines and registered in Prospero (CRD42024617075). Electronic literature searches were performed up to February 2025 in EMBASE, PubMed, OVID, Scopus, and Web of Science to identify observational studies assessing dietary copper intake and DXA-measured BMD, and study quality was appraised using the Newcastle-Ottawa Scale. Data were pooled via a generic inverse-variance random-effects model, with heterogeneity assessed by the Q test and I² statistic. A random-effects meta-analysis of three studies (n = 9059) found that higher dietary copper intake was associated with a modest but significant increase in lumbar spine BMD (MD 0.02 g/cm²; 95% CI 0.00-0.04; p = 0.04; I² = 36%), whereas a separate meta-analysis of four studies (n = 14,345) for hip BMD showed a similar MD of 0.02 g/cm² that did not reach significance (95% CI – 0.00-0.04; p = 0.07; I² = 74%). Higher dietary copper intake is modestly associated with increased lumbar spine BMD, while evidence for hip BMD remains inconclusive, underscoring copper’s potential role in osteoporosis prevention.

PMID:41361655 | DOI:10.1007/s00223-025-01463-w

Nat Biomed Eng. 2025 Dec 8. doi: 10.1038/s41551-025-01589-0. Online ahead of print.

NO ABSTRACT

PMID:41361600 | DOI:10.1038/s41551-025-01589-0