Nevin Manimala

Dent Med Probl. 2026 Jul-Aug;63(4):875-883. doi: 10.17219/dmp/200179.

ABSTRACT

BACKGROUND: Hypertension (HTN) is a prevalent condition affecting a significant proportion of the population. It requires careful management due to its potential systemic complications. While the overall effects of HTN are well documented, its specific impact on implant dentistry procedures, such as sinus augmentation, remains less clear.

OBJECTIVES: The present study aimed to investigate the influence of HTN and antihypertensive medications on early implant failure (EIF) following sinus augmentation.

MATERIAL AND METHODS: A retrospective cohort study was conducted at a tertiary referral center between 2013 and 2021. Data from 425 implants in 152 patients were analyzed. The primary outcome was EIF. Univariate and multivariable analyses were performed to identify potential risk factors. A p-value <0.05 was considered statistically significant.

RESULTS: Hypertension did not significantly affect EIF. However, beta-blocker therapy was identified as an independent risk factor at both the patient and implant levels (OR (odds ratio) = 4.05; p = 0.018 and OR = 3.13; p = 0.045, respectively). A higher number of implants per patient and tobacco smoking were also associated with an increased risk of EIF (OR = 1.49; p = 0.039 and OR = 8.52; p < 0.001, respectively). Other antihypertensive medications were not significantly associated with EIF.

CONCLUSIONS: Hypertension was not a significant risk factor for EIF following sinus augmentation. However, beta-blocker therapy was associated with an increased risk of failure, whereas other antihypertensive agents, including diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs), were not significantly associated with EIF.

PMID:42664374 | DOI:10.17219/dmp/200179

Dent Med Probl. 2026 Jul-Aug;63(4):893-906. doi: 10.17219/dmp/202926.

ABSTRACT

BACKGROUND: Clear aligner treatment (CAT) may induce masticatory muscle tenderness and trigger temporomandibular disorders (TMD). Considering that CAT may interfere with the masticatory system, it is important to understand the relationship between CAT and occlusal changes.

OBJECTIVES: This study aimed to analyze occlusal changes during CAT and assess the influence of postorthodontic occlusion on masticatory performance. A secondary objective was to determine whether the case complexity, the facial biotype and malocclusion were associated with occlusal alterations, masticatory performance, or the onset of TMD signs and symptoms during CAT.

MATERIAL AND METHODS: Forty-two individuals who underwent and completed CAT were evaluated at 3 time points: before treatment (T0); at the end of treatment (T1); and 3 months after treatment, during which time clear aligners (CAs) were used only at night (T2). Temporomandibular disorders were assessed using Axis I of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) at T0, T1 and T2. Masticatory performance was evaluated at T1 and T2 using a two-colored chewing gum test and colorimetric analysis. Occlusal area and anterior and posterior occlusal contacts were evaluated digitally. Non-parametric statistical tests were used, with the significance level set at p < 0.05.

RESULTS: The occlusal area decreased significantly from T0 to T1 (p = 0.016). At T1, normodivergent individuals had significantly more anterior contacts than hyperdivergent patients (p = 0.013). Masticatory performance increased with the number of posterior occlusal contacts (p < 0.05), and individuals with Class I molar relationship had more anterior contacts than Class II patients (p = 0.004). At T2, Class III individuals showed higher values than Class II patients (p = 0.011).

CONCLUSIONS: The number of occlusal contacts and occlusal contact area decreased during treatment. Nighttime use of CAs slightly enhanced occlusal contact recovery. Complex cases presented more posterior contacts at T0; simple cases presented a greater occlusal area at the end of CAT. Class I individuals presented more anterior contacts at T0. These movements increased the anterior contacts in Class III molar cases at the end of treatment and 3 months later. No significant differences in masticatory performance were found according to the molar relationship, the facial biotype or the case complexity; no TMD signs and symptoms were found during or after CAT.

PMID:42664370 | DOI:10.17219/dmp/202926

Sci Adv. 2026 Aug 28;12(35):eaed4172. doi: 10.1126/sciadv.aed4172. Epub 2026 Aug 28.

ABSTRACT

Behavior modulates the activity of sensory systems in multiple ways: from gain changes in individual neurons to changing interactions in neural populations. These effects are not universal; while movement has a strong influence on sensory coding in rodents, its impact on primates is less prominent. The diversity of effects that locomotion exerts on sensory neurons, as well as disparities between species, raises questions about the existence of universal principles that may underlie sensation during behavior. We propose that sensory systems are internally modulated to match systematic changes in stimulus statistics caused by locomotion, to facilitate an accurate and efficient sensory code. We find that model neurons, adapted to stimuli recorded during movement in natural environments, predict and reproduce a broad spectrum of experimental observations in rodents and primates. This simple principle of maintaining coding efficiency across behavioral states reconciles the diversity of ways in which locomotion modulates visual coding in different animal species.

PMID:42664357 | DOI:10.1126/sciadv.aed4172

PLoS One. 2026 Aug 28;21(8):e0353752. doi: 10.1371/journal.pone.0353752. eCollection 2026.

ABSTRACT

With the rapid growth of digital data transmission, secure image encryption has become a critical requirement for protecting visual information against unauthorized access and cryptanalytic attacks. Existing chaotic-based encryption schemes often suffer from limited resistance to statistical and differential attacks due to weak key dependence, low-dimensional chaotic behavior, or the partial use of image features during encryption. To overcome these limitations, this study proposes a novel four-dimensional (4D) hyperchaotic image encryption mechanism that is independent of image statistical features and semantic information, thereby making cryptanalysis highly infeasible. The proposed algorithm utilizes a 4D Lorenz hyperchaotic system to generate the primary pseudo-random key sequences, which are then processed using mathematical and modular operations to produce dynamic subkeys for each encryption stage. The encryption process consists of three structured phases: (1) initial pixel sorting based on the first and second keys; (2) Circular Radius-Angle Transformation (CRAT) using the third and fourth keys to remap pixel positions in a nonlinear circular coordinate space; and (3) a final diffusion phase using the fifth key to perform XOR-based confusion. Experimental evaluations confirm that the proposed approach achieves high key sensitivity, a vast key space, and strong resistance to statistical, differential, and chosen-plaintext attacks. Furthermore, the encrypted images demonstrate uniform histograms, minimal pixel correlation, high information entropy, and excellent computational efficiency, highlighting the algorithm’s robustness and applicability for secure image transmission in real-world scenarios.

PMID:42664317 | DOI:10.1371/journal.pone.0353752

PLOS Digit Health. 2026 Aug 28;5(8):e0001554. doi: 10.1371/journal.pdig.0001554. eCollection 2026 Aug.

ABSTRACT

The multiple sclerosis (MS) therapeutic landscape has evolved over time. We conducted a knowledge graph-guided analysis of MS-specific disease-modifying therapy (DMT) prescription trends using longitudinal real-world clinical data. We analyzed registry-linked electronic health record (EHR) data from two large independent healthcare systems between 2004 and 2022, including both academic and community practices. We developed an unsupervised phenotyping algorithm that leverages a publicly available knowledge graph and informative EHR features to identify patients with MS. After identifying MS cases, we combined the two cohorts and constructed annual time-varying knowledge graphs that capture co-occurrence patterns between DMTs and MS diagnosis. For each year, we analyzed co-occurrence patterns between DMTs and MS diagnosis using Shifted Positive Pointwise Mutual Information transformation and singular value decomposition to generate embeddings. We computed patient-wise cosine similarities and confidence intervals to quantify MS-specific DMT usage patterns. The phenotyping algorithm achieved robust performance in predicting MS diagnosis (AUROC: MGB = 0.994, UPMC = 0.922), identifying 29,169 MS patients in the combined dataset. Among commonly used standard-effectiveness DMTs, MS-specific prescriptions declined after 2011 for interferon-beta (DMT-MS cosine similarity slope = -0.019 ± 0.011, p = 0.002) and glatiramer acetate (slope = -0.013 ± 0.012, p = 0.026), from 2013-2020 for fumarates (slope = -0.028 ± 0.015, p = 0.004), and after 2014 for S1P receptor modulators (slope = -0.026 ± 0.016, p = 0.005). Among commonly used higher-effectiveness DMTs, B-cell depletion therapies (slope = 0.051 ± 0.027, p = 0.001), particularly ocrelizumab (slope = 0.020 ± 0.016, p =0.032), showed a marked increase since 2018. Natalizumab usage peaked in 2011 (slopepre-2011 = 0.063 ± 0.013, ppre-2011 < 0.001; slopepost-2011= -0.027 ± 0.008, ppost-2011 < 0.001). Other DMT classes such as cell proliferation inhibitors and chemotherapy agents, showed low usage during follow-up. These findings provide real-world evidence from two large EHR-based MS cohorts, highlighting distinct temporal shifts in the complex MS therapeutic landscape toward higher-effectiveness DMTs, particularly B-cell depletion therapy.

PMID:42664299 | DOI:10.1371/journal.pdig.0001554

Jpn J Clin Oncol. 2026 Aug 28:hyag145. doi: 10.1093/jjco/hyag145. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, there are no large cohort studies comparing the clinical outcomes of triplet therapy with those of androgen receptor pathway inhibitor (ARPI)-based doublet therapy for patients with metastatic castration-sensitive prostate cancer (mCSPC) representing real-world practice. Therefore, the present study aimed to compare whether triplet or doublet therapy is more effective in patients with mCSPC.

METHODS: This large-scale retrospective cohort study used TriNetX electronic medical record data from August 2018 to July 2026, enrolling patients with mCSPC categorized as receiving triplet [darolutamide + docetaxel + androgen deprivation therapy (ADT)] or doublet therapy (enzalutamide or apalutamide + ADT). The primary outcome was overall survival (OS), while the secondary outcome was the proportion of patients achieving a PSA level ≤ 0.2 ng/ml. Propensity score matching (PSM) (1:1) was conducted to adjust for confounding variables between groups.

RESULTS: Overall, 1841 patients met the eligibility criteria. Following PSM (n = 329), triplet therapy was associated with a statistically significant improvement in OS compared with doublet therapy (hazard ratio: 0.601; 95% confidence interval: 0.420-0.862; log-rank P = .005). The proportions of patients achieving PSA ≤0.2 ng/ml were 26.4% vs. 17.0% at 3 months (P = .003), 37.4% vs. 27.7% at 6 months (P = .008), 43.8% vs. 35.9% at 12 months (P = .038), and 50.5% vs. 40.1% at any time (P = .008) in the triplet and doublet groups, respectively.

CONCLUSIONS: In this real-world analysis using the TriNetX database, triplet therapy including darolutamide significantly improved OS and PSA decline compared with ARPI-based doublet therapy.

PMID:42664274 | DOI:10.1093/jjco/hyag145

PLoS One. 2026 Aug 28;21(8):e0357123. doi: 10.1371/journal.pone.0357123. eCollection 2026.

ABSTRACT

BACKGROUND: Suicidality is a critical public health concern among LGBTQ+ youth, yet evidence from Vietnam remains limited. This study estimated the prevalence of suicidal ideation, plans, and attempts and examined associated sociodemographic and psychological factors among Vietnamese LGBTQ+ youth.

METHODS: We conducted a community-based, online cross-sectional survey from February to April 2025. Participants included 384 LGBTQ+ individuals aged 18-24 years residing in Vietnam. Participants were recruited through the LGBTQ+ -led or LGBTQ+ -supportive social media and community networks. Suicidality was assessed alongside symptoms of depression, anxiety, and stress using the Depression Anxiety Stress Scales (DASS-21). Monthly income was self-reported and categorized into USD bands. Multivariable logistic regression models were employed to identify factors associated with lifetime suicidal outcomes.

RESULTS: The lifetime prevalence of suicidal ideation, plans, and attempts was 56.5%, 32.1%, and 16.9%, respectively. Recent (past 12 months) prevalence was 5.5%, 3.6%, and 3.1%. In multivariable analyses, stress [AOR = 4.52 (95% CI: 2.35-8.72)] and anxiety [AOR = 2.12 (95% CI: 1.03-4.34)] were associated with higher odds of suicidal ideation and plans. Anxiety emerged as the sole independent predictor of suicide attempts [AOR = 4.30 (95% CI: 1.28-14.41)]. Conversely, higher income (≥USD 386/month) and rural residence were associated with lower odds of suicidal ideation.

CONCLUSIONS: Suicidality is highly prevalent among this accessible, predominantly urban, and connected subpopulation of LGBTQ+ youth in Vietnam. Anxiety and stress are the most robust proximal correlates of suicidal behaviors. Suicide prevention strategies for this population must incorporate routine screening for anxiety and stress, deliver LGBTQ + -affirming care, and address underlying economic vulnerabilities.

PMID:42664272 | DOI:10.1371/journal.pone.0357123

PLoS One. 2026 Aug 28;21(8):e0357040. doi: 10.1371/journal.pone.0357040. eCollection 2026.

ABSTRACT

Reliable flood forecasts must be translated into timely, accountable warnings, particularly in small mountainous basins with short concentration times and limited historical records. This study links a Bidirectional Long Short-Term Memory (BiLSTM) rainfall-runoff model with Jiangxi Province’s hierarchical “631” response mechanism. Twenty flood events from the Xiangshui River Basin were divided chronologically into 14 training events and six independent test events. The final network contains four stacked BiLSTM layers and a fully connected output layer; it does not contain convolutional or pooling layers. Against LSTM, GRU and Xin’anjiang baselines, BiLSTM obtained a mean Nash-Sutcliffe efficiency of 0.90 and a mean denormalised RMSE of 11.2 m3/s. All six paired NSE differences favoured BiLSTM, but the small test set precludes confirmatory statistical inference; results are therefore reported with event-level differences and leave-one-event-out sensitivity rather than interpreted from the Wilcoxon p-value alone. SHAP marginal attribution identified Qingxi, Yingfang and Zhongcun as the most influential stations and the two most recent input lags as the dominant time steps. A marginal-consistent station-lag diagnostic further localised the strongest first-order contributions to upstream rainfall at t-1 and t-2, while explicitly not being treated as a SHAP interaction estimate. Forecast skill declined from NSE = 0.90 at 1 h to 0.58 at 6 h, indicating that quantitative precipitation forecasts are required for operational 3-6 h prediction. The revised integration framework therefore assigns observation-driven BiLSTM forecasts to the short-lead “1” stage and QPF-informed forecasts to the “3” and “6” stages. The findings support a focused, auditable pathway from data-driven prediction to warning action while defining the limits imposed by event scarcity and missing future rainfall forcing.

PMID:42664266 | DOI:10.1371/journal.pone.0357040

PLoS One. 2026 Aug 28;21(8):e0356989. doi: 10.1371/journal.pone.0356989. eCollection 2026.

ABSTRACT

INTRODUCTION: Shared decision-making (SDM) can enhance patient involvement in treatment and care decisions. Still, questions remain on how multiple myeloma (MM) patients perceive and evaluate their current and desired roles in these decisions and whether characteristics influence their willingness to be involved. This study aimed to identify I) the current knowledge of the concept SDM among MM patients and healthcare professionals (HCPs) involved in MM care, II) how MM patients are and want to be involved in decisions, and III) differences in the willingness to be involved in view of participants’ characteristics (e.g., age, gender, health literacy).

METHODS: An online survey for MM patients and HCPs involved in MM care was launched in October and December 2023, respectively. The data was statistically analyzed.

RESULTS: 558 patients and 89 HCPs completed the survey. Most patients lived in the Netherlands (28.7%), Israel (23.5%) and Belgium (15.8%), and most HCPs lived in France (39.3%) and Israel (24.7%). 56.6% of the patients and 28.1% of the HCPs had not previously heard of SDM. Almost all patients (96.1%) indicated wanting to be involved in treatment decisions. 3.9% of patients indicated not wanting to be involved, because they did not know whether they would have enough knowledge to decide or because they were used to the HCP deciding. All HCPs believed that MM patients should be involved if they want to. Patients had higher involvement scores at recent consultations and desired to be more involved in initial decisions following diagnosis. The survey revealed no significant differences in participants’ involvement and their characteristics.

CONCLUSION: MM patients want to be involved in decisions and HCPs are willing to involve MM patients. However, challenges remain concerning the practical implementation of involvement and SDM. This highlights the importance of understanding SDM and patient involvement and assessing the individual needs and preferences of MM patients.

PMID:42664265 | DOI:10.1371/journal.pone.0356989

PLoS One. 2026 Aug 28;21(8):e0357471. doi: 10.1371/journal.pone.0357471. eCollection 2026.

ABSTRACT

As learners increasingly use open online resources for informal language learning, YouTube has become an important setting for self-directed English learning. However, less is known about how learners’ motivation, confidence in using YouTube for learning, and perceptions of content quality are associated with behavioral engagement and learning satisfaction in this context. This study examined the associations of perceived usefulness, perceived enjoyment, YouTube learning self-efficacy, and content quality with behavioral engagement and learning satisfaction in YouTube-based informal English learning (YIEL). It also examined whether behavioral engagement statistically mediated the associations of these four constructs with learning satisfaction. Data were collected through a cross-sectional survey of 393 undergraduate students in Taiwan and analyzed using partial least squares structural equation modeling (PLS-SEM). All hypothesized associations were supported, and the model explained 47.6% of the variance in behavioral engagement and 64.7% of the variance in learning satisfaction. Behavioral engagement also statistically mediated the associations between these four constructs and learning satisfaction. The findings indicate that perceived usefulness, perceived enjoyment, YouTube learning self-efficacy, and content quality were associated with both behavioral engagement and learning satisfaction, and that behavioral engagement was also associated with learning satisfaction. Together, these findings extend current understanding of YIEL by highlighting behavioral engagement both as an outcome associated with these four focal constructs and as a statistical mediator of their associations with learning satisfaction.

PMID:42664247 | DOI:10.1371/journal.pone.0357471