Nevin Manimala

Br J Radiol. 2026 Feb 24:tqag044. doi: 10.1093/bjr/tqag044. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the influence of fat on the assessment of liver fibrosis in chronic liver disease using two-point Dixon water-only Look-Locker T1 mapping by comparing water-only derived sequence (W-Dixon) with in-phase (IP) and opposed-phase (OP)-based sequences.

METHODS: 2.89-T MRI included 2D two-point Dixon Look-Locker T1 mapping and proton density fat fraction (PDFF) mapping. The correlations between liver T1 values and PDFF were assessed using Spearman correlation coefficient. T1 values on each T1 map were compared among three FIB-4 index range groups (FIB-4 < 1.3, 1.3-2.67, > 2.67) in patients with and without hepatic steatosis using one-way analysis of variance and Kruskal-Wallis test.

RESULTS: 204 patients with chronic liver disease were retrospectively evaluated. T1 values on IP or OP images were significantly correlated with PDFF (r = -0.373, 0.220), while no significant correlation was found between T1 values on W-Dixon images and PDFF (r = -0.071). In patients without hepatic steatosis, T1 values on each T1 map in FIB-4 > 2.67 group were significantly higher than in FIB-4 1.3-2.67 group (p < 0.01). Conversely, in patients with hepatic steatosis, only W-Dixon sequence statistically differentiated FIB-4 > 2.67 group from FIB-4 1.3-2.67 group based on T1 values (p < 0.05).

CONCLUSIONS: The assessment of liver fibrosis based on T1 values obtained by Dixon water-only T1 mapping was less influenced by the presence of fat.

ADVANCES IN KNOWLEDGE: Two-point Dixon water-only Look-Locker T1 mapping minimizes the confounding effect of fat, enabling proper assessment of liver fibrosis in steatotic chronic liver disease.

PMID:41734280 | DOI:10.1093/bjr/tqag044

Pain. 2025 Nov 19. doi: 10.1097/j.pain.0000000000003869. Online ahead of print.

ABSTRACT

An estimated 50% to 75% of patients with mild traumatic brain injury (mTBI) report chronic pain. Symptomatology evolution, subtypes, and risk factors remain poorly understood. We evaluated patient-reported pain intensity and interference with daily function in a longitudinal U.S. mTBI cohort. The Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study prospectively enrolled patients with TBI across 18 trauma centers who received head computed tomography (CT) within 24 hours post-injury. Subjects aged ≥17 years with arrival Glasgow Coma Scale = 13 to 15, Marshall CT Score = 1 to 2, and PROMIS-Pain Intensity and Interference assessments at 2 weeks, 3 months, 6 months, and 12 months post-injury were included. Subjects with cranial surgery, major extracranial injury, or pre-injury musculoskeletal pain were excluded. Healthy controls (HCs) completed assessments at all timepoints. Pain assessment T-scores were compared using mixed-effect linear regressions. Adjusted mean differences (aMDs; [95% confidence intervals]) were reported. In 906 subjects (mTBI = 710, HC = 196), mean age was 39.6 ± 16.7-years, 64% were male, and 75% were White/Caucasian. In subjects with mTBI, 35% were CT positive, ≥80% reported pain intensity or interference symptoms at 2 weeks post-injury, and <20% received TBI care postdischarge. Compared with HCs, CT-negative subjects had statistically elevated pain intensity (aMD; 2 weeks: +12.8 [10.9-14.6], 3 months: +4.6 [2.7-6.6], 6 months: +3.4 [1.4-5.4], 12 months: +2.7 [0.7-4.7]) and interference (aMD; 2 weeks: +12.3 [10.7-13.9], 3 months: +4.6 [3.0-6.2], 6 months: +3.1 [1.4-4.8], 12 months: +2.1 [0.4-3.8]). Similarly vs HCs, CT-positive subjects had statistically elevated pain intensity (aMD; 2 weeks: +12.5 [10.4-14.6], 3 months: +3.8 [1.7-5.9], 6 months: +2.8 [0.6-5.0], 12 months: +2.4 [0.2-4.6]) and interference (aMD; 2 weeks: +11.7 [9.9-13.5], 3 months: +4.0, [2.2-5.8], 6 months: +2.9 [1.1-4.7], and 12 months: +2.2 [0.3-4.0]). Pain intensity and daily interference symptoms remained longitudinally elevated in patients with mTBI. The majority did not receive follow-up care for TBI, underscoring opportunities for preventative and therapeutic interventions.

PMID:41734261 | DOI:10.1097/j.pain.0000000000003869

Am J Audiol. 2026 Feb 24:1-15. doi: 10.1044/2025_AJA-25-00241. Online ahead of print.

ABSTRACT

PURPOSE: Cochlear synaptopathy, the loss of the synapses between the inner hair cells and their auditory nerve fiber targets, is expected to be a common type of auditory deficit resulting from noise exposure or aging. Unfortunately, there is currently no means for diagnosing cochlear synaptopathy or other forms of cochlear deafferentation. Wideband middle ear muscle reflexes (MEMRs) have been proposed as a potential diagnostic indicator of cochlear deafferentation, but we lack normative ranges for MEMR magnitude. The objective of this study was to develop normative ranges for wideband MEMR magnitude that can be used to identify patients with abnormally weak MEMRs.

METHOD: Normative ranges were generated for ipsilateral and contralateral wideband MEMR magnitude in a population at low risk for cochlear synaptopathy due to young age, normal hearing thresholds, and minimal noise exposure history. The normative ranges were statistically adjusted for average distortion product otoacoustic emission (DPOAE) levels to account for possible impacts of outer hair cell dysfunction. To evaluate the ability of the normative ranges to differentiate between populations at low versus high risk of synaptopathy, measurements were also collected from military Veterans with normal hearing thresholds who reported at least one of the auditory complaints predicted to result from synaptopathy-tinnitus, speech perception in noise difficulty, or decreased sound tolerance.

RESULTS: For individuals with poorer DPOAEs, it is not possible to fall below the lower bounds of the wideband MEMR normative ranges. For individuals with more robust DPOAEs, the lower bounds are very close to an MEMR magnitude indicating an absent reflex. Few individuals from the high-risk sample fell below the normative ranges, suggesting that these normative ranges do not identify significant cochlear deafferentation as expected.

CONCLUSION: Wideband MEMR magnitude normative ranges will not be effective as a stand-alone indicator of cochlear deafferentation.

PMID:41734241 | DOI:10.1044/2025_AJA-25-00241

PLoS One. 2026 Feb 24;21(2):e0343034. doi: 10.1371/journal.pone.0343034. eCollection 2026.

ABSTRACT

Additional properties and generalizations are explored for a recently introduced concentration index CK. The CK is based on both the distribution of a set of proportions (probabilities) as well as their ranks. The CK is closely related to and proposed as a preferred alternative to the widely used Q that equals the sum of quadratic terms (proportions). Besides the use of CK and Q as measures of market or industry concentration, with the proportions being market shares, CK or its potential transformations can be used as alternative measures in a variety of real measurement situations for which Q has been applied. The extended analysis of CK includes the proof that CK is a convex function, which makes it capable of decomposition analysis. The sensitivity and transfer effect of CK due to changes in the distribution of the proportions is studied. Derivation is given for the so-called numbers equivalent of CK and for its probability interpretation. Generalizations of CK are considered for changing the relative emphasis of the component proportions. Randomly generated distributions exemplify the limited effect on CK from excluding the smallest proportions that are often unavailable in real situations. Numerical comparisons between CK and other concentration indices are presented for a wide variety of firms or industries. A statistical inference procedure is presented for appropriate situations.

PMID:41734214 | DOI:10.1371/journal.pone.0343034

PLOS Digit Health. 2026 Feb 24;5(2):e0001252. doi: 10.1371/journal.pdig.0001252. eCollection 2026 Feb.

ABSTRACT

In urgent care settings, efficient medical history-taking is paramount for making timely and accurate treatment decisions. Medical history-taking apps have emerged as a means to streamline this process but their effectiveness in enhancing diagnostic accuracy remains unclear. We aimed to investigate whether using a medical history-taking app before consultation improves diagnostic accuracy. In two German out-of-hours practices (OOHP), patients were recruited over a 12-months period. Within each practice, weeks were randomized to either an intervention or control group, resulting in a cluster-randomized trial (CRT) with clustering in weeks within the same practice. Patients in the intervention group used an app to report their complaints before their consultation, enabling physicians to review their medical history details beforehand. In contrast, patients in the control group used the app after their consultation, and no summary of their medical history was available to the physician. Diagnostic accuracy was defined as the agreement between the OOHP physician’s diagnoses and those determined by an expert committee (EC) after reviewing patient files. As a secondary outcome, we compared OOHP and EC physicians’ treatment recommendations against patients’ self-reported actual treatment (e.g., specialist care, hospital admissions) from a follow-up survey. We analyzed data from 986 patients and found no significant intervention effect on diagnostic accuracy (Odds Ratio 0.94 (95%CI 0.73 – 1.21), 57.6% in intervention vs 59.1% in control group). Additionally, the app had no significant effect on the prediction of further treatment. The only significant factors affecting these outcomes were the number of diagnoses (positively associated with diagnostic accuracy) and a self-reported severe condition (associated with higher likelihood of requiring further treatment). Individual differences between physicians were more pronounced than those between the intervention and control group for the secondary outcome. The study’s findings suggest that this medical history-taking app does not enhance diagnostic accuracy in urgent care settings.

PMID:41734202 | DOI:10.1371/journal.pdig.0001252

PLoS One. 2026 Feb 24;21(2):e0342985. doi: 10.1371/journal.pone.0342985. eCollection 2026.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) is a global threat, mainly linked to inappropriate use and prescription of antibiotics, Antimicrobial stewardship (AMS) programs have proved to promote responsible antibiotic use and decrease the burden of AMR. The aim of this study is to benchmark antibiotic prescribing patterns and evaluate stewardship practices using the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology in a tertiary care public sector hospital in Karachi.

METHOD: A cross-sectional, prospective PPS was conducted over four weeks in July 2024 at Dow University Hospital, Karachi. The data were extracted from the medical records of the patients using a validated WHO PPS tool by a trained infectious disease physician and pharmacist. All inpatients admitted before or at 8:00 a.m. on survey day, without a planned discharge were included, excluding those from emergency, acute care, day-care surgery, dialysis, and oncology units. Descriptive analysis of the data was performed using Stata version 14.

RESULTS: Out of 224 hospitalized patients at the day of survey, 186 inpatients (adults and children across medical, surgical and critical care wards) were included in the study meeting the inclusion criteria. The study included 50.5% male and 49.5% females, having mean age of 45 (±18) years. The point prevalence of antibiotic use was 83.3% (95% CI: 77.5-88.2%). Community-acquired infections 55.5% (95% CI: 48.7-62.1%) were the most common indication of use. Most antibiotics 99.2%, (95% CI: 95.6-99.9%) were prescribed empirically, with predominant parenteral administration 89.2% (95% CI: 84.5-92.9%) and limited Intravenous-to-oral switch 2.9% (95% CI: 1.3-6.2%). Ceftriaxone (18.5%), piperacillin-tazobactam (18.1%), and meropenem (16.2%) were most frequently used antibiotics. According to WHO Access, Watch and Reserve (AWaRe) classification, 80.8% (95% CI: 75.2-85.6%) of antibiotics belonged to the ‘Watch’ category, 17.3% (95% CI: 12.6-23.2%) to ‘Access’, and 1.8% (95% CI: 0.7-4.6%) to ‘Reserve’. Cultures showed no growth in 64.8% (95% CI: 55.2-73.6%) of cases. Stewardship interventions were found applicable in 55.4% (95% CI: 48.7-62.0%) of prescriptions due to overuse, dosing errors, and absence of antimicrobial guideline in the hospitals.

CONCLUSION: This study demonstrates that antibiotic utilization exceeded global averages, highlighting the urgent need to develop institutional antimicrobial guidelines, enhance stewardship programs, and improve diagnostic stewardship to curb AMR.

PMID:41734200 | DOI:10.1371/journal.pone.0342985

PLoS One. 2026 Feb 24;21(2):e0343525. doi: 10.1371/journal.pone.0343525. eCollection 2026.

ABSTRACT

Treatment-related myeloid neoplasms (t-MN) represent a severe complication of cancer therapy, characterized by poor prognosis and limited treatment options. This study presents a preliminary, exploratory bioinformatic analysis aimed at characterizing the expression landscape and potential regulatory roles of pyroptosis-related genes (PRGs) in a murine model of t-MN. Utilizing RNA-seq data (GEO: GSE135866), differential expression analysis identified 1286 DEGs. Cross-referencing 367 curated mouse PRGs revealed 46 pyroptosis-related DEGs (PRDEGs). Functional enrichment analysis (GO, KEGG) showed these PRDEGs are significantly involved in autophagy, inflammatory regulation, apoptosis, NOD-like receptor signaling, and the AMPK pathway. GSEA associated the broader gene set with PI3K-Akt and Notch signaling. Protein-protein interaction network analysis identified five critical hub genes: Trp53, Mtor, Gpx3, Foxo3, and Cybb. ROC curve analysis confirmed these hub genes exhibit significant differential expression and high diagnostic accuracy (AUC > 0.9) in distinguishing t-MN from controls. Furthermore, immunoinfiltration analysis (CIBERSORT) revealed significant differences in immune cell composition between t-MN and control samples and identified notable correlations between hub gene expression and specific immune cell abundances. Importantly, given the limited sample size and the use of murine bone marrow data, the statistical findings should be interpreted strictly at the exploratory and hypothesis-generating level. This study does not support definitive biological conclusions or causal inferences but rather aims to delineate the pyroptosis-related molecular profile in a preclinical t-MN model. The results are intended to inform and guide future investigations-including validation in larger cohorts, independent experimental models, and human clinical samples-to assess the translational potential of these candidate biomarkers and therapeutic targets.

PMID:41734196 | DOI:10.1371/journal.pone.0343525

PLoS One. 2026 Feb 24;21(2):e0342920. doi: 10.1371/journal.pone.0342920. eCollection 2026.

ABSTRACT

OBJECTIVE: In Xining City, Qinghai Province, which is located in a high-altitude hypoxic environment, this study employs high-throughput sequencing technology to conduct large-scale deafness-related gene screening among newborns. It aims to assess the carrier rate and variant types of deafness-related genes in local newborns; and based on different genotypic characteristics, provide targeted health education and clinical guidance to the parents of children with deafness, with the goal of achieving early diagnosis, early prevention, and early intervention of deafness. At the same time, this study also provides scientific basic data support for deafness prevention and treatment-related research in Qinghai Province.

METHODS: From March 2023 to March 2025, the research team of the Affiliated Hospital of Qinghai University strictly abided by ethical norms. With the full informed consent of the participants, the team systematically and continuously collected heel blood samples from multi-ethnic newborns living in areas at different altitudes, and successfully obtained 3,615 complete blood samples required for the study. Subsequently, high-throughput sequencing technology was applied to detect these samples, and accurate data on deafness susceptibility-related genes were obtained. During the analysis phase, the research team took altitude (low altitude, medium altitude, high altitude), ethnicity (Tibetan, Hui, Han, Salar, Tu, etc.), and genotype (15 loci of 4 common deafness-causing genes: GJB2, SLC26A4, mitochondrial 12SrRNA, and GJB3) as the core dimensions. By comprehensively using statistical analysis and bioinformatics methods, a systematic multi-dimensional analysis was conducted to deeply explore the association characteristics between different factors and the carriage of deafness susceptibility genes.

RESULTS: This study collected a total of 3,615 cases of newborn blood spot specimens. After excluding 549 cases of substandard specimens, a valid screening cohort of 3,066 newborns was eventually formed. Within this valid cohort, 165 carriers of deafness-susceptible genes were identified, with an overall carriage rate of 5.38%. Stratified analysis by altitude showed that: in medium-altitude areas (with a sample size of 2,319 cases), 132 carriers were detected, corresponding to a carriage detection rate of 5.69%; in high-altitude areas (with a sample size of 742 cases), 33 carriers were detected, with a carriage detection rate of 4.45%. Statistical analysis indicated that the carriage detection rate of deafness-susceptible genes among newborns in high-altitude areas was significantly lower than that in medium-altitude areas. Genotyping data showed: GJB2 gene: A total of 73 mutations (2.38%) were detected, with the 235 del C mutation site being the most common, accounting for 67.12% of the total mutations in this gene. Among them, 58 cases were detected in medium-altitude areas and 15 cases in high-altitude areas, accounting for 20.55% (15/73) of the total GJB2 gene mutations. SLC26A4 gene: A total of 67 mutations (2.19%) were detected, with the IVS7-2 mutation site having the highest frequency, accounting for 47.76% of the total mutations in this gene. Among them, 59 cases were detected in medium-altitude areas and 8 cases in high-altitude areas, accounting for 11.94% (8/67) of the total SLC26A4 gene mutations. Mitochondrial 12S rRNA gene: A total of 33 mutations (1.08%) were detected, with the 1555 A > G mutation site being the main one, accounting for 96.97% of the total mutations in this gene. Among them, 25 cases were detected in medium-altitude areas and 8 cases in high-altitude areas, accounting for 24.24% (8/33) of the total mitochondrial 12S rRNA gene mutations. GJB3 gene: Only 1 rare mutation (0.03%) was detected at the 538 C > T site, and no such mutation was found in high-altitude areas. Analysis of the ethnic distribution of the 3,066 neonates showed: Han ethnicity: A total of 1,983 cases, with 115 cases detected (5.80%), accounting for 69.70% of all carriers. Hui ethnicity: A total of 476 cases, with 24 cases detected (5.04%), accounting for 14.55% of all carriers. Tibetan ethnicity: A total of 535 cases, with 24 cases detected (4.49%), accounting for 14.55% of all carriers. Mongolian ethnicity: A total of 24 cases, with 2 cases detected (8.33%), accounting for 1.21% of all carriers.

CONCLUSION: 1. Overall level: The overall carriage rate of deafness susceptibility genes in neonates from Xining, Qinghai is significantly lower than the national average for newborns (6.67%). Within the medium and high altitude regions of Qinghai Province, compared with the medium-altitude areas (altitude > 1,500 meters and ≤ 2,500 meters), the carriage rate of deafness susceptibility genes in neonates from high-altitude areas (altitude > 2,500 meters and ≤ 4,500 meters) shows a downward trend, which suggests that within the medium and high altitude range of the province, the detection rate of deafness susceptibility genes decreases with the increase of altitude. 2. Gene level: Among GJB2 gene mutations, the 235 delC gene mutation remains the most dominant type, and the detection rates of both GJB2 and GJB3 genes are lower than the national level. Notably, the detection rates of mitochondrial 12S rRNA gene mutations and SLC26A4 gene mutations in neonates from this region are both higher than the national average, with the detection rate of mitochondrial 12S rRNA gene mutations being more significantly higher. Since deafness caused by these two types of gene mutations can be effectively reduced in terms of onset risk through health education, conducting genetic testing targeting these specific genes has important clinical significance and public health value. 3. Ethnic background level: The detection rate of deafness susceptibility genes in Tibetan neonates is low, especially for the IVS7-2 A > G mutation site, and this phenomenon is more prominent in high-altitude areas. On the contrary, the detection rate of deafness susceptibility genes in Mongolian and Hui neonates in high-altitude areas shows an increasing trend.

PMID:41734195 | DOI:10.1371/journal.pone.0342920

PLoS One. 2026 Feb 24;21(2):e0333816. doi: 10.1371/journal.pone.0333816. eCollection 2026.

ABSTRACT

PURPOSE: Intimate partner violence (IPV) among military personnel harms service members and their partners and has implications for military readiness. Understanding modifiable risk and protective factors for IPV perpetration in this context is important for prevention and response.

METHOD: Data from the Millennium Cohort Study (2011-2013) were used as a baseline in a hypothesized prospective path model predicting IPV perpetration. IPV outcomes were operationalized as reports to the Department of Defense Family Advocacy Program Central Registry that occurred after baseline and met Department of Defense criteria for psychological or physical domestic abuse.

RESULTS: A posttraumatic stress symptom cluster indicative of general negative affect and alcohol dependence mediated the effects of other posttraumatic stress symptoms-as well as the effects of protective factors (i.e., socioeconomic, psychosocial, physical health)-on risk of IPV perpetration. Only socioeconomic status had indirect, direct, and moderated effects on IPV perpetration.

CONCLUSIONS: Findings suggest future program development and evaluation should consider whether common protective factors-such as economic stability, better health (e.g., sleep quantity and quality), career satisfaction, and psychosocial factors (e.g., social support)-can be modified through integrated prevention to reduce risk for multiple interrelated outcomes (e.g., posttraumatic stress disorder, substance dependence, and IPV).

PMID:41734193 | DOI:10.1371/journal.pone.0333816

PLoS One. 2026 Feb 24;21(2):e0342696. doi: 10.1371/journal.pone.0342696. eCollection 2026.

ABSTRACT

This study aims to identify the stylistic features of the literary mode Yan Lianke terms as “mythorealism” in the English translations of his novels, through corpus stylistic analysis. Using a corpus of nine translated works by Yan and a reference corpus of English translations of contemporary Chinese fiction, the analysis employs Wmatrix to detect statistically overused semantic domains and LancsBox to investigate their collocational networks and usage contexts. Combining quantitative and qualitative methods, the study identifies five foregrounded semantic patterns: political discourse, spatial narrative, natural environment, color symbolism and the supernatural. The findings show that political discourse intertwines historical events with allegorical critique; spatial narrative delineates symbolic boundaries between social and psychological worlds; color symbolism, particularly the recurrent use of red, conveys culturally resonant yet ambivalent meanings; and supernatural elements extend realism into metaphysical and philosophical realms. Supported by a representative bilingual case study which illustrates the retention of core semantic structures, the study suggests that despite translator mediation, these patterns largely reflect the enduring thematic and stylistic characteristics of Yan’s fiction. These findings offer a corpus-based empirical grounding for mythorealism and present a replicable framework for bridging semantic-domain statistics and stylistic interpretation in the study of translated literature.

PMID:41734160 | DOI:10.1371/journal.pone.0342696