Nevin Manimala

Sci Rep. 2026 Jun 11. doi: 10.1038/s41598-026-57682-0. Online ahead of print.

ABSTRACT

Automated ICD-10-CM coding is critical for hospital reimbursement under Diagnosis-Related Group (DRG) payment systems, yet standard metrics weight all errors equally. This study evaluated 11 models on MIMIC-IV under heterogeneous conditions (the full 7942-code space, top-50 self-trained baselines, and 200-admission zero-shot LLM samples) and proposed two revenue-sensitive metrics: the Revenue Sensitivity Index (RSI) and Coding Reimbursement Score (CRS). Performance was compared across US Medicare Severity DRG (MS-DRG) and Taiwan DRG (Tw-DRG) systems, with five human-AI review strategies simulated. PLM-ICD achieved the highest micro-averaged F1 (0.5934), while open-source zero-shot LLMs performed markedly worse in this exploratory comparison. A 26.5% CRS gap separated the best and worst fine-tuned models. Rankings were identical under both DRG schemes (Spearman ρ = 1.00), indicating stability under a tiered Tw-DRG approximation (93.9% coverage), not the official grouper. At a 20% review rate, revenue-targeted prioritization achieved 43.2% CRS reduction versus 20.0% for random sampling, reaching 91% of the oracle bound. Revenue-aware evaluation captures financially meaningful differences missed by standard metrics, and revenue-guided human-AI collaboration emerges as a candidate deployment framework requiring prospective validation.

PMID:42277410 | DOI:10.1038/s41598-026-57682-0

Hypertens Res. 2026 Jun 11. doi: 10.1038/s41440-026-02707-4. Online ahead of print.

ABSTRACT

Prior research has established a positive correlation between blood pressure (BP) and ischemic stroke in the general population; however, this association has not been investigated in dementia patients. A population-based cohort of 73,130 individuals with newly diagnosed dementia who underwent a Korean national health checkup after diagnosis was followed up until the end of 2019. Individuals were classified according to their systolic (SBP) and diastolic BP (DBP) during health checkups. Multivariable Cox proportional hazards regression was performed, calculating the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident ischemic stroke. During a mean follow-up of 3.6 years, 4446 (6.1%) patients developed ischemic stroke. In all-cause dementia patients, the risk of ischemic stroke increased after SBP/DBP exceeded 130/90 mmHg compared with SBP 120-129 mmHg and DBP 70-79 mmHg (reference) (both P for trend <0.001). Similar trends were observed in patients with Alzheimer’s disease and vascular dementia. In particular, SBP/DBP ≥ 140/90 mmHg and SBP 100-109 mmHg were associated with incrementally higher risks of ischemic stroke and a decreased risk of Alzheimer’s disease, respectively (both P for trend <0.001). The positive linear association of SBP and DBP with ischemic stroke in all-cause dementia remained after stratification by sex and antihypertensive medication use, and the association between SBP and ischemic stroke was greater among younger individuals (40-79 years old). In conclusion, both SBP and DBP showed positive linear relationships with the risk of incident ischemic stroke in dementia patients. Achievement of the target BP may be important for stroke prevention in individuals with dementia.

PMID:42277407 | DOI:10.1038/s41440-026-02707-4

Ir J Med Sci. 2026 Jun 12. doi: 10.1007/s11845-026-04482-0. Online ahead of print.

ABSTRACT

BACKGROUND: Prostate cancer (PCa) diagnosis relies heavily on PSA screening, which suffers from low specificity, leading to unnecessary biopsies and overdiagnosis. Distinguishing PCa from benign prostatic hyperplasia (BPH) remains a significant clinical challenge. Extracellular vesicles (EVs) protect molecular cargo, such as microRNAs (miRNAs), from degradation and reflect the physiological state of their parental cells. Given their stability and accessibility in biological fluids, EV-associated miRNAs represent ideal liquid biopsy candidates to overcome the limitations of current diagnostic markers and improve risk stratification.

AIMS: This study investigated the potential of a specific plasma EV-derived miRNA panel (miR-16, miR-141, miR-10b, miR-373, miR-409, miR-34a, miR-205, miR-145, and miR-550a) to differentiate between healthy controls, BPH, localized PCa (LPCa), and metastatic PCa (MPCa).

METHODS: Plasma EVs were isolated using a precipitation-based method, followed by total RNA extraction. EV-derived miRNA expression profiles were quantified via qRT-PCR. Statistical analyses were performed to compare expression levels across clinical groups and to assess their diagnostic potential.

RESULTS: Significant differential expression was observed for EV-derived miR-141, miR-10b, and miR-550a. miR-141 was significantly downregulated in BPH and LPCa compared to healthy controls (p < 0.05). Notably, EV-derived miR-10b and miR-550a levels were significantly lower in the MPCa group compared to BPH. When comparing all PCa cases (LPCa+MPCa) against non-cancerous groups (BPH+Control), EV-derived miR-10b and miR-550a were significantly downregulated, while miR-16 showed upregulation in the cancer cohort.

CONCLUSION: Our findings demonstrate that specific plasma EV-derived miRNA signatures can distinguish prostate pathologies and disease stages. These results suggest that EV-derived miR-10b, miR-141, miR-16 and miR-550a hold promise as non-invasive biomarkers for differentiating PCa from BPH, potentially reducing overdiagnosis and informing clinical management.

PMID:42277406 | DOI:10.1007/s11845-026-04482-0

J Magn Reson Imaging. 2026 Jun 11. doi: 10.1002/jmri.70377. Online ahead of print.

ABSTRACT

BACKGROUND: Muscle mass decline, associated with strength decline, is a hallmark of aging. Yet, strength decline greatly exceeds mass decline. This indicates that aspects of muscle quality and architecture-not reflected by mass-also influence force generating capacity. Additionally, shape modeling enables analysis of the shape variations of muscles beyond size.

PURPOSE: To predict muscle strength using muscle features beyond muscle quantity.

STUDY TYPE: Retrospective cross-sectional study.

POPULATION: Twenty-four healthy subjects normally distributed over an age range between 30 and 79 years old with a balanced sex distribution (12 female).

FIELD STRENGTH/SEQUENCE: 3 T MRI using multi-echo Dixon and Stejskal-Tanner DTI.

ASSESSMENT: Shape-only and shape + architecture models were generated using water-only and DTI images of the quadriceps. Multiple linear mixed-effects models were produced using (1) volume, (2) shape-only, and (3) shape + architecture. Volume was not added to the shape-only and shape + architecture models. Features reaching statistical significance within the models were retained for further analysis. Models’ performance was evaluated using leave-one-subject-out (LOSO) cross-validation (CV).

STATISTICAL TESTS: Pairwise, subject-level bootstrapping comparison was conducted and ∆R² and ∆RMSE with 95% confidence interval (CI) were calculated. The improvement was considered statistically significant when both ∆R² and ∆RMSE are positive and the 95% CI did not contain zero. Positive ∆R² and ∆RMSE indicate an increase in R² and a decrease in RMSE values.

RESULTS: Shape-only features demonstrated an improvement in the model performance compared to muscle volume. Models were significantly improved for the vastus lateralis to predict eccentric torque-∆R² = 0.16 (0.01-0.29), ∆RMSE = 5.0 (0.4-9.7); and for the vastus intermedius predicting isometric torque-∆R² = 0.19 (0.02-0.36), ∆RMSE = 6.5 (0.7-12.0). Shape + architecture features did not significantly improve the performance (all p ≥ 0.131).

DATA CONCLUSION: Shape-only models are promising to quantify variations of muscle shape related to force production, and have the potential to develop imaging-based biomarkers for muscle strength in diseases.

EVIDENCE LEVEL: 3.

TECHNICAL EFFICACY: Stage 2.

PMID:42277391 | DOI:10.1002/jmri.70377

Eur Radiol. 2026 Jun 11. doi: 10.1007/s00330-026-12629-x. Online ahead of print.

ABSTRACT

OBJECTIVES: To establish evidence-based consensus statements on imaging of scaphoid fractures.

MATERIALS AND METHODS: Nineteen hand surgeons formulated a preliminary list of eleven questions on imaging of scaphoid fractures. Based on this preliminary list, radiologists crafted statements considering literature and their clinical experience, then refined them through an iterative Delphi process to revise the questions and statements. A maximum of three Delphi rounds was scheduled until group consensus was achieved for an individual statement, whichever arose first. Twenty-eight radiologists drafted the statements and acted as Delphi panellists. Panellists rated their level of agreement with each statement on an 11-point numeric rating scale, the score ‘0’ indicated complete disagreement and the score ’10’ indicated complete agreement, respectively. Group consensus was specified as a score of ‘8’ or higher for ≥ 23/28 panellists.

RESULTS: Eight of eleven questions and statements achieved group consensus in the first Delphi round. The remaining three questions and statements achieved group consensus in the second Delphi round, indicating more controversial topics. It was agreed that radiographs are the initial imaging technique of choice for suspected scaphoid fractures. MRI or CT are advocated for suspected radiographically occult scaphoid fractures. CT is the method of choice for assessment of osseous consolidation. Contrast-enhanced MRI is the preferred imaging modality for assessing vascularisation of scaphoid nonunion. CT is the most valuable technique in the postoperative evaluation of scaphoid fractures.

CONCLUSION: Delphi-based consensus statements suggest imaging pathways to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.

KEY POINTS: Question How can an international and interdisciplinary team of hand surgeons and musculoskeletal radiologists develop practical consensus statements on imaging of scaphoid fractures? Findings All eleven statements achieved group consensus among experts using the Delphi technique for consensus-building. Imaging pathways were suggested to diagnose and assess scaphoid fractures. Clinical relevance statement International, interdisciplinary and evidence-based consensus statements on imaging of scaphoid fractures were achieved using the Delphi technique. The focus of the statements was to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.

PMID:42277387 | DOI:10.1007/s00330-026-12629-x

Atten Percept Psychophys. 2026 Jun 11;88(5):147. doi: 10.3758/s13414-026-03293-w.

ABSTRACT

We investigated the impact of flanker size and horizontal flanker eccentricity in the reading version of the flankers task. Critical targets and the corresponding flankers were words that could either be the same or different. Target size did not change, and flankers could either be the same size as targets or larger. Flankers could be located close to targets (normal spacing – close flankers) or separated from targets by seven spaces (distant flankers). Results revealed significant effects of flanker relatedness (same word as the target or a different word) that interacted with both flanker size and flanker eccentricity in the analysis of response times. The three-way interaction was not significant. The only significant effect in the analysis of error rates was that of flanker relatedness. We replicated prior findings showing that increasing flanker eccentricity diminishes the effect of flanker relatedness, and we further demonstrated that increasing flanker size increases the magnitude of flanker effects. Crucially, an increase in flanker size was not found to compensate for the negative impact of an increase in flanker eccentricity on effects of flanker relatedness. These results suggest that eccentricity is one key visual factor influencing the spatial integration of orthographic information, and that the impact of eccentricity overrides the impact of flanker size. This provides support for the hypothesized scale-invariant gaze-centered processing of letter identities during the initial phase of orthographic processing.

PMID:42277380 | DOI:10.3758/s13414-026-03293-w

Neurol Sci. 2026 Jun 12;47(7):564. doi: 10.1007/s10072-026-09136-8.

ABSTRACT

BACKGROUND: Gait impairments in Parkinson’s disease (PD) worsen under cognitive load and often persist despite medication. Combining treadmill training with gamified virtual reality environments (GVRE) and transcranial direct current stimulation (tDCS) may address both motor and cognitive contributors. This study evaluated the effects and experiences of a cognitive-motor gait training program integrating GVRE and tDCS.

METHODS: In this mixed-methods RCT, 23 participants with mild-to-moderate PD were randomized to: (1) treadmill (n = 8), (2) treadmill+GVRE (n = 8), or (3) treadmill+GVRE+tDCS (n = 7). Participants completed 12 sessions over six weeks. Primary outcomes included spatiotemporal gait parameters and executive function under single- and dual-task conditions. Secondary outcomes included balance, motor severity, fear of falling and quality of life. Interviews explored perceived effects and motivational factors.

RESULTS: The intervention was safe and well tolerated, with high attendance (92%). No statistically or clinically meaningful changes were observed in gait speed. Balance improved across groups (MiniBESTest + 1.48 points; p = 0.0003). A timepoint-specific improvement in cadence during motor dual-task walking was observed in the treadmill+GVRE+tDCS group compared with treadmill. Interviews revealed increased walking confidence and adoption of mobility strategies in complex walking situations.

CONCLUSIONS: This preliminary mixed-methods RCT supports the feasibility and acceptability of combining treadmill training with GVRE and tDCS in people with mild-to-moderate PD. While the intervention did not yield clinically meaningful improvements in gait speed, exploratory outcomes offered insight into participant experiences. Reported gains in confidence, self-monitoring, and walking strategies provide useful context. Findings should be interpreted cautiously. Larger, adequately powered, sham-controlled trials are needed to determine efficacy.

PMID:42277373 | DOI:10.1007/s10072-026-09136-8

Cell Mol Neurobiol. 2026 Jun 11. doi: 10.1007/s10571-026-01765-z. Online ahead of print.

ABSTRACT

T-lymphokine-activated killer-cell-originated protein kinase (TOPK), was widely overexpressed in various malignant tumors, and played critical roles in their growth, differentiation and metastasis. However, its levels and potential clinical significance in acute ischemic stroke (AIS) was unknown. We detected the plasma TOPK protein level and mRNA level of neutrophilic TOPK in AIS patients using ELISA and RT-PCR, and analyzed their association with functional outcomes statistically. Among 330 patients with AIS, plasma TOPK concentrations differed significantly between patients present with excellent outcomes or not at 3 months. Plasma TOPK ≥ 69.95 pg/mL independently predicted excellent functional outcomes. In the subgroup of patients received rt-PA treatment, patients with TOPK ≥ 69.95 pg/ml also predicted excellent functional outcomes. Addition of plasma TOPK to clinical predictors for excellent outcomes post AIS as well as outcomes after rt-PA treatment improved their reclassification and discrimination. Although TOPK mRNA levels were significantly elevated in the neutrophils of AIS patients, no significant predictive value was observed for excellent outcomes. Conclusively, higher plasma TOPK levels (especially TOPK ≥ 69.95 pg/ml) might emerge as a prognostic indicator for the 3-month excellent functional outcomes post AIS and possessed predictive value in identifying patients with 3-month excellent functional outcomes after rt-PA treatment.

PMID:42277369 | DOI:10.1007/s10571-026-01765-z

Atten Percept Psychophys. 2026 Jun 11;88(5):146. doi: 10.3758/s13414-026-03286-9.

ABSTRACT

Recent work has shown that people are sensitive to coarse differences in network topology, including network features like “holes,” “crosses,” and “T-junctions.” Even children as young as 4 years old will readily distinguish between items that differ slightly in their network topology. But how robust is this sensitivity? Here, we evaluate whether people are not only sensitive to differences in the presence or absence of certain topological features, but also to their exact spatial arrangement. In a first experiment, we show that people distinguish figures which possess all the same topological features as other figures in a set if the features differ in spatial arrangement. In a second experiment, we show that people also match figures based on exact spatial arrangement. Finally, we show that memory encodes the correct relational structure of the figures: People are more likely to falsely indicate having seen an item if it shared the precise arrangement of topological features of other items they had seen (compared to a closely matched item which had the same features arranged in a different way). Combined, these results bolster the theory that people intuitively appreciate the precise spatial arrangement of topological features.

PMID:42277366 | DOI:10.3758/s13414-026-03286-9

Eur J Clin Nutr. 2026 Jun 11. doi: 10.1038/s41430-026-01773-8. Online ahead of print.

ABSTRACT

We previously found the glycaemic index (GI) of 3 foods to be similar in subjects aged >40 y (mean 49 y) versus <40 y (mean 29 y), but a more recent study reported the GI of 2 foods to be higher in subjects aged >55 y (mean 70 y) vs. <33 y (mean 24 y). Here, we compared the GI or relative glycaemic response (RGR, analogous to GI but using a different reference food) of the younger (age <33 y) vs. the older (age >55 y) subjects who participated in previously published studies that included n ≥ 9 in each group. Study 1, (GI, 3 foods) had n = 19:9 younger:older subjects; Study 2, (GI, 2 foods) n = 14:10; Study 3, (RGR, 1 food), n = 68:16. The GI or RGR of the 6 foods varied from 36 to 88; none differed significantly in younger vs. older and the overall means were equivalent, 63.2 vs. 63.7, respectively. The GI or RGR values for 5 foods from 3 additional studies not meeting the inclusion criteria above were also similar in younger vs. older subjects. Therefore, we found no evidence from n = 11 comparisons that GI values differ in younger vs. older subjects. However, there are insufficient data to determine if GI values are equivalent in older vs. younger subjects, something that requires a different statistical test.

PMID:42277346 | DOI:10.1038/s41430-026-01773-8