Nevin Manimala

Eur Radiol. 2025 May 18. doi: 10.1007/s00330-025-11684-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to develop and validate a predictive model for preoperative extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) using MRI features.

METHODS: We retrospectively analyzed 140 confirmed PTC cases, divided into training (n = 84) and validation (n = 56) groups. MRI features such as T2-weighted imaging, multiphase contrast-enhanced MRI, and diffusion-weighted imaging were evaluated along with clinical data. Univariate and multivariate logistic regression identified independent predictors of ETE and developed a predictive nomogram. We evaluated the nomogram’s discrimination, calibration, and clinical utility, and performed subgroup analyses to explore the relationships between risk factors and baseline data. Predictive performance was assessed using ROC curves and DeLong tests.

RESULTS: Age, protrusion value, and apparent diffusion coefficient_Brightest_rate (ADC_Best_rate) were independent predictors of ETE. The nomogram effectively differentiated ETE from no-ETE, showing strong discrimination, clinical utility, and calibration in both the training (AUC = 0.826, Hosmer-Lemeshow p = 0.882) and validation cohorts (AUC = 0.805, Hosmer-Lemeshow p = 0.585). The model performed consistently across different MRI systems (1.5 T and 3.0 T) and gender subgroups. Notably, ADC_Best_rate (AUC = 0.742) outperformed ADC_mean_rate and ADC_minimum_rate. A significant interaction between ADC_Best_rate and gender (p = 0.02) showed that ADC_Best_rate predicted ETE in PTC more accurately in males (AUC = 0.897) compared to females (AUC = 0.644).

CONCLUSION: Our nomogram model, incorporating age, protrusion value, and ADC_Best_rate, effectively predicted preoperative ETE in PTC patients, aiding surgeons in optimizing therapeutic decision-making. ADC_Best_rate may be a promising potential indicator in MRI functional imaging.

KEY POINTS: Question This study addresses the challenge of accurately predicting extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) to improve surgical decision-making. Findings A predictive nomogram incorporating age, protrusion value, and ADC_Best_rate effectively differentiates ETE from no-ETE, showing strong performance in both training and validation cohorts. Clinical relevance This nomogram aids surgeons in identifying patients at risk for ETE, enhancing therapeutic decision-making and potentially improving patient outcomes in PTC management.

PMID:40382730 | DOI:10.1007/s00330-025-11684-0

ACS Sens. 2025 May 18. doi: 10.1021/acssensors.4c03397. Online ahead of print.

ABSTRACT

Surface-enhanced Raman spectroscopy (SERS) is a transformative tool for infectious disease diagnostics, offering rapid and sensitive species identification. However, background spectra in biological samples complicate analyte peak detection, increase the limit of detection, and hinder data augmentation. To address these challenges, we developed a deep learning framework utilizing dual neural networks to extract true virus SERS spectra and estimate concentration coefficients in water for 12 different respiratory viruses. The extracted spectra showed a high similarity to those obtained at the highest viral concentration, validating their accuracy. Using these spectra and the derived concentration coefficients, we augmented spectral data sets across varying virus concentrations in water. XGBoost models trained on these augmented data sets achieved overall classification and concentration prediction accuracy of 92.3% with a coefficient of determination (R²) > 0.95. Additionally, the extracted spectra and coefficients were used to augment data sets in saliva backgrounds. When tested against real virus-in-saliva spectra, the augmented spectra-trained XGBoost models achieved 91.9% accuracy in classification and concentration prediction with R² > 0.9, demonstrating the robustness of the approach. By delivering clean and uncontaminated spectra, this methodology can significantly improve species identification, differentiation, and quantification and advance SERS-based detection and diagnostics.

PMID:40382719 | DOI:10.1021/acssensors.4c03397

JMIR Res Protoc. 2025 May 15. doi: 10.2196/72528. Online ahead of print.

ABSTRACT

BACKGROUND: The aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in elderly individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “Promoting Oral Health in Nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.

OBJECTIVE: To assess the acceptability of the expert standard among nursing staff providing care for elderly individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, Care Rationed or Missed (CROM), and the standard’s acceptability.

METHODS: This quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic TFA (Theoretical Framework of Acceptability), a questionnaire to measure acceptability of interventions across seven domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile (OHLP) and competence in mouth care using the questionnaire developed by the German Network for Quality Development in Nursing (DNQP). Barriers to implementation will be evaluated according to the Acute Care Nurses’ Questionnaire on Oral Hygiene and CROM using the oral care related question from Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of firstly calculating mean acceptability with 95% confidence interval for each recommended intervention of the expert standard. Secondly, repeated measures ANOVA are used to examine mean differences of acceptability between these interventions. Thirdly, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi square tests of independence are used to compare CROM with already published rates in German speaking countries.

RESULTS: Results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025.

CONCLUSIONS: This study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in the elderly. By focusing on acceptability as a prerequisite for implementation, the study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.

PMID:40382708 | DOI:10.2196/72528

Schizophr Bull. 2025 May 18:sbaf065. doi: 10.1093/schbul/sbaf065. Online ahead of print.

ABSTRACT

BACKGROUND: Foundational models of the psychoses included course as a core element differentiating patients. Current models, ICD-11 and DSM-5, only require symptom criteria to be met to make a diagnosis. We explore the proposition that making course designation essential, again, would improve the categorization of patients with psychotic disorders.

STUDY DESIGN: We briefly discuss the history by which symptoms, alone, became the primary elements required for diagnosis. We review past and recent evidence on the best models for differentiating among psychoses.

STUDY RESULTS: The use of course designations, along with symptoms, produces the best fit to the way in which psychotic disorders present and progress. It also matches how clinicians assess patients and choose therapeutic interventions. A model including course as a factor is more accurate and complete than models using symptoms alone. And it produces groups of patients that are likely to be more homogeneous than purely symptom-based models. The degree of heterogeneity among patients classified together within current International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) categories can lead to false findings in research and a lack of clarity on the best treatment in individual cases. Increasing homogeneity in diagnostic groups, by including course designations, could advantage clinical care, clinical trials, and research on underlying pathogenic mechanisms.

CONCLUSIONS: Adding a course as a diagnostic element is practical. Clinicians already consider it. Specifying courses can be required in making a diagnosis. Doing so is evidence based and enhances the accuracy and value of diagnoses. We recommend restoring the course as a core element of any new diagnostic system.

PMID:40382705 | DOI:10.1093/schbul/sbaf065

Arch Iran Med. 2025 Apr 1;28(4):207-216. doi: 10.34172/aim.31947. Epub 2025 Apr 1.

ABSTRACT

BACKGROUND: The increasing demand for healthcare services and some associated factors including lack of physicians, lack of trust in physicians, ineffectiveness of treatments and high costs may be have led to a rise in non-physician-provided services. This study aims to assess health services delivery by non-physicians and its associated factors in Iran.

METHODS: This study was a cross-sectional study conducted using a convenience sampling method in the Iranian community in 2023. A standard questionnaire with 45 questions was developed based on focus group discussions and a validation process to assess the status of receiving services in six medical areas including traditional medicine, abortion, traditional dentistry, obesity and slimming diets, bone setting, and addiction treatment. Data collection was carried out using online questionnaires on Iranian and non-Iranian social media platforms. Descriptive and analytical statistics were used to analyze the data, with logistic regression adjusting for various demographic factors.

RESULTS: Out of 1713 participants, 53.9% (95% CI: 51.5%-56.3%) were women, and the majority were in the 30-40 age group. Traditional Islamic medicine was the most commonly sought service, with 56% (95% CI: 51.2%-60.8%) of users receiving it from non-physicians. Satisfaction with non-physician services varied, with 32.1% (95% CI: 25.8%-38.4%) reporting high satisfaction for traditional medicine, but only 49.4% (95% CI: 40.5%-58.3%) for experimental dentistry. Key reasons for choosing non-physician providers included the effectiveness of traditional treatments and fear of modern medicine’s side effects.

CONCLUSION: The result showed that the use of non-physician services can be considerable and that necessary interventions should be designed to standardize treatments and deal with substandard providers who may be harmful to the health of the community.

PMID:40382692 | DOI:10.34172/aim.31947

Arch Iran Med. 2025 Apr 1;28(4):189-197. doi: 10.34172/aim.31306. Epub 2025 Apr 1.

ABSTRACT

BACKGROUND: Comparing the trends of mortality rates provides valuable insight for policy discussions and promotes awareness of health issues. This study aimed to investigate the changes in mortality rate and life expectancy from 2011 to 2021 and the effect of COVID-19 period on these indices.

METHODS: We investigated the data of all-cause deaths between 2011 and 2021 by age group, sex and year using Excel spreadsheets from the National Organization for Civil Registration (NOCR), via collected the census method. Joinpoint regression was used to calculate the trend of mortality rate during the study period.

RESULTS: During the study period, there were 262,708 deaths, of which 148,919 were men (56.68%). The trend of mortality rate in both sexes has been increasing. Life expectancy in men and women decreased from 76.71 and 80.82 in 2011 to 74.43 and 77.53 in 2021, respectively. From 2018 to 2021, there was a significant increase in standardized mortality rate in men (APC=14.74; 95% CI=5.73; 28.65) and women (APC=14.29; 95% CI=4.67; 28.97). However, from 2011 to 2018, we observed a yearly 2.65% decreasing trend in men which was statistically significant (APC=-2.95, 95% CI=-7.67, -0.84). In women, no significant trend was seen.

CONCLUSION: With the emergence of the COVID-19 epidemic in 2019, the trend of mortality rate and life expectancy changed completely, with additional deaths and decreasing life expectancy. Therefore, prevention, control and treatment of epidemic diseases should be a serious concern of policy makers.

PMID:40382690 | DOI:10.34172/aim.31306

Arch Iran Med. 2025 Apr 1;28(4):182-188. doi: 10.34172/aim.33193. Epub 2025 Apr 1.

ABSTRACT

BACKGROUND: A healthy diet is essential for managing metabolic syndrome (MetS), but moderation and dietary adequacy remain ambiguous.

METHODS: Data from the recruiting phase of the Shiraz University of Medical Sciences Employees Health Cohort Study (SUMS EHCS) were utilized to conduct this cross-sectional analysis. A validated 168-item semi-quantitative food frequency questionnaire (FFQ) was used to collect dietary data in the Persian cohort. In the current study, the healthy eating index (HEI-2015) includes two components, namely adequacy and moderation which were used to evaluate the quality of the diet.

RESULTS: The study included 3380 health workers, with a mean age of 41.81±7 years and 55.2% female. Among them, 22.3% met the ATP III criteria for MetS. The mean total HEI, adequacy, and moderation scores were 63.89±9.53, 41.03±5.88, and 20.13±4.90, respectively. Adjusted model analysis showed no significant correlation between diet adequacy and MetS or its components, but found a significant association between diet moderation and MetS (OR: 1.03 [1.008-1.05]), abdominal obesity (OR: 1.02 [1.003-1.04]), elevated serum triglycerides (TGs) (OR: 1.02 [1-1.03]), and elevated fasting blood sugar (FBS) (OR: 1.03 [1.005-1.05]).

CONCLUSION: This study found that there was a significant correlation between diet moderation and abdominal obesity, elevated serum TGs, elevated FBS, and MetS. Future studies on the topic are recommended.

PMID:40382689 | DOI:10.34172/aim.33193

Acta Otolaryngol. 2025 May 17:1-7. doi: 10.1080/00016489.2025.2504032. Online ahead of print.

ABSTRACT

BACKGROUND: Single-sided deafness (SSD) encompasses the presence of a profoundly deaf ear with a normal, contralateral one. Patients with SSD may have difficulty with speech intelligibility in noise and localizing sounds.

AIMS/OBJECTIVES: This retrospective study aims to evaluate the long-term effectiveness of bone conduction implant (BCI) in a group of patients with SSD.

MATERIAL AND METHODS: Audiologic benefit was assessed through conventional speech audiometry and adaptive Matrix test. Impact on quality of life was evaluated with the Glasgow Benefit Inventory (GBI) questionnaire. BCI usage data were also obtained from each subject.

RESULTS: Thirty-two patients were included. No statistically significant improvements were found at standard audiometric tests using BCI, but at Matrix test the mean SRT is reached at S/N -1.16 dB without BCI and -2.07 with BCI with a statistically significant difference (p = 0.026). The mean GBI score was 25.12, ranging from -8.3 to 47.2. Ten subjects (31%) discontinued the BCI use overtime.

CONCLUSIONS AND SIGNIFICANCE: Benefit assessment of BCI in SSD recipients can be difficult. Adaptive audiometric test could be useful. Quality of life measures seem to suggest potential ‘beyond-auditory’ benefits. SSD recipients can be inconsistent users of BCI.

PMID:40382679 | DOI:10.1080/00016489.2025.2504032

J Transl Med. 2025 May 17;23(1):557. doi: 10.1186/s12967-025-06553-9.

ABSTRACT

BACKGROUND: There is a dearth of population-based studies on the association between the diversity of the oral microbiome and the risk of chronic obstructive pulmonary disease (COPD). The study aims to investigate the association between oral microbiome diversity and COPD.

METHODS: In this cross-sectional study, data from the National Health and Nutrition Examination Survey (NHANES 2009-2012) were analyzed. The association between the oral microbiome α-diversity and COPD risk was examined via multivariable logistic regression, with Restricted cubic splines revealing potential non-linear trends. The β-diversity disparities between COPD and non-COPD groups were delineated using Principal Coordinate Analysis (PCoA) and Permutational Multivariate Analysis of Variance (PERMANOVA).

RESULTS: A total of 6061 participants were included in this study. For α-diversity, the observed ASVs were significantly associated with COPD risk (OR = 0.964, 95%CI: 0.936-0.993, P = 0.016). Similarly, Faith’s phylogenetic Diversity showed a significant association with COPD risk (OR = 0.955, 95%CI: 0.919-0.993, P = 0.020). The Shannon-Weiner index was also associated with COPD risk (OR = 0.829, 95%CI: 0.702-0.981, P = 0.029). For β-diversity, PCoA and PERMANOVA analysis showed statistically significant differences in Bray-Curtis, unweighted, and weighted UniFrac distances (all P < 0.01) between the COPD and non-COPD groups.

CONCLUSIONS: Significant differences in oral microbiome α-diversity and β-diversity were found between COPD and non-COPD populations, with α-diversity (observed ASVs, Faith’s Phylogenetic Diversity, Shannon-Weiner index) being negatively associated with the risk of COPD.

PMID:40382665 | DOI:10.1186/s12967-025-06553-9

Int Breastfeed J. 2025 May 17;20(1):38. doi: 10.1186/s13006-025-00726-4.

ABSTRACT

BACKGROUND: Despite the health benefits of breastfeeding only 57% of infants were exclusively breastfed at 4 months postpartum in Germany in 2017-2019. Due to the gap between the actual exclusive breastfeeding (EBF) rates and recommendations, we aimed at investigating further factors influencing breastfeeding duration.

METHODS: This prospective observational study conducted in Berlin, Germany from 11/2022-05/2024 implemented a mixed-methods design with concurrent triangulation. We present quantitative results here. First-time mothers were surveyed at birth and 2, 6 and 12 months postpartum. Breastfeeding status was assessed by asking “How are you currently feeding your child?” and, if anything other than EBF (defined as supply of breastmilk without liquids or solids) was indicated, “I breastfed exclusively until [date]”. Maternal perception was assessed by asking “How comfortable do you currently feel with breastfeeding/feeding your child?”, with comfort referring to well-being/statisfaction/feeling good (German = wohlfühlen). Obstetric and newborn characteristics were collected from recruiting hospital’s health records: an anthroposophic baby-friendly certified hospital (a-BF), a baby-friendly certified hospital (BF) and a university hospital not certified as baby-friendly (non-BF). Data were analysed descriptively and through multivariate analysis.

RESULTS: Most of the 326 participating mothers had initiated breastfeeding in the delivery room (94.7%). Mothers reported EBF for a median duration of 5.7 months, with 76.6% achieving ≥ 4 months. High levels of maternal comfort with breastfeeding 2 months postpartum were significantly associated with an EBF duration ≥ 4 months (aOR 7.25, CI 95% 2.11, 24.9). An intended EBF duration of 4-7 months (aOR 4.08, CI 95% 0.29, 57.77), higher breastfeeding comfort shortly after birth (aOR 1.79, CI 95% 0.49, 6.59), delivery in the a-BF clinic (aOR 1.59, CI 95% 0.41, 6.14) and high satisfaction regarding breastfeeding support in the hospital (aOR 1.39, CI 95% 0.41, 4.70) increased likeliness of EBF ≥ 4 months.

CONCLUSION: Our results emphasize the pivotal role of the mother’s comfort in the breastfeeding process and it’s impact on breastfeeding duration. Strategies to enhace maternal comfort therefore need to be specifically included in maternal care. To explore key aspects of maternal comfort qualitative interviews will address the individual experiences in the breastfeeding journey and identify parent-centred strategies for sustainable breastfeeding.

PMID:40382664 | DOI:10.1186/s13006-025-00726-4