Nevin Manimala

Surg Endosc. 2025 Dec 22. doi: 10.1007/s00464-025-12479-6. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is an important surgical treatment for choledocholithiasis; however, the choice between indwelling T-tube placement and primary suture remains controversial. This study aimed to evaluate the safety and feasibility of LCBDE coupled with primary suture using a prospective cohort design, as well as to summarize the key techniques of primary suturing.

METHODS: Patients with choledocholithiasis who met the inclusion criteria between January 2019 and March 2023 were enrolled. The primary suture group comprised patients who underwent LCBDE with primary closure, while the T-tube drainage group consisted of those who received LCBDE with T-tube drainage. Perioperative data and follow-up outcomes were collected and statistically analyzed for both groups.

RESULTS: Operative time (120.00 [100.00-139.50] vs. 99.00 [85.00-118.50] min; P = 0.000) and postoperative hospital stay (7.00 [5.00-9.00] vs. 5.00 [4.00-6.00] days; P = 0.000) differed significantly between groups. No significant differences were observed in estimated blood loss (40.7 ± 24.1 vs. 41.4 ± 23.7 mL; P = 0.537), conversion rate to laparotomy (2.38% vs. 2.27%; P = 0.918), time to gastrointestinal function recovery (2.1 ± 0.7 vs. 2.0 ± 0.6 days; P = 0.317), or postoperative complication rate (2.92% vs. 3.18%; P = 0.959). During follow-up, one case of common bile duct (CBD) stenosis and one case of extrahepatic cholangiocarcinoma occurred in the T-tube group; no such complications were observed in the primary suture group. The rates of residual stones (1.75% vs. 0.45%; P = 0.225) and recurrent stones (1.75% vs. 1.81%; P = 0.980) were without statistical significance.

CONCLUSION: In our grouping situation, LCBDE and primary suture is safer and more feasible than T-tube drainage in operative time and postoperative hospital stay. This conclusion has certain reference value for clinicians to choose the surgical method in laparoscopic surgery for choledocholithiasis.

PMID:41430465 | DOI:10.1007/s00464-025-12479-6

Eur Arch Otorhinolaryngol. 2025 Dec 22. doi: 10.1007/s00405-025-09932-6. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate and compare the diagnostic accuracy of two multimodal large language models-ChatGPT-5.0 Plus and Gemini 2.5-in interpreting pure tone audiograms. The primary hypothesis was that ChatGPT-5.0 Plus would outperform Gemini 2.5 in identifying auditory thresholds, determining type and degree of hearing loss, detecting masking, and providing treatment recommendations based on standardized visual inputs.

DESIGN: A diagnostic simulation study was conducted using 80 software-generated audiograms representing common hearing loss profiles, including normal, conductive, sensorineural, and mixed types. Each audiogram was interpreted by both models using a structured seven-question diagnostic prompt aligned with professional audiological guidelines. Two independent evaluators-an audiologist and an otolaryngologist with audiology expertise-rated each model’s response using a five-point Likert scale. Inter-rater agreement and comparative analyses were performed using non-parametric statistical tests.

RESULTS: ChatGPT-5.0 Plus outperformed Gemini on six of seven diagnostic items and in the overall score. Inter-rater agreement for ChatGPT was almost perfect overall (κ = 0.951), with moderate concordance on Q1 (κ = 0.490) and very high agreement across the remaining items (κ = 0.912-0.981). Gemini also showed strong but lower consistency (overall κ = 0.823; item-level 0.833-0.949), with the weakest agreement on treatment recommendation (Q7). Comparative analyses revealed statistically significant advantages for ChatGPT in air and bone conduction threshold identification, classification of hearing loss type and degree, and diagnostic accuracy. Differences in masking evaluation (Q5) were not significant. Median score differences of 1-2 points on the 5-point scale underscored the clinical relevance of ChatGPT’s superior performance.

CONCLUSIONS: ChatGPT-5.0 Plus demonstrated superior accuracy and consistency in interpreting pure tone audiograms compared to Gemini 2.5. While not suitable as standalone diagnostic tools, large language models may serve as useful adjuncts in primary care and telehealth environments for preliminary audiological assessment. Further validation in real-world clinical settings is necessary before broader implementation.

PMID:41430450 | DOI:10.1007/s00405-025-09932-6

Eur Arch Otorhinolaryngol. 2025 Dec 22. doi: 10.1007/s00405-025-09904-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the prognostic value of hematological inflammatory biomarkers in predicting hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with combined systemic and intratympanic corticosteroids.

METHODS: This retrospective study included 125 patients diagnosed with ISSNHL between 2012 and 2021 who received both oral prednisone and intratympanic methylprednisolone. Clinical data and pre-treatment blood samples were collected. Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Hearing outcomes were classified as complete, partial, or no recovery based on pure tone average (PTA) thresholds. Univariate and multivariable logistic regression analyses were performed to identify predictors of recovery.

RESULTS: Of the 125 patients, 33 (26.4%) had no recovery, 50 (40.0%) partial recovery, and 42 (33.6%) complete recovery. Dizziness, current smoking, delayed treatment initiation (> 7 days), elevated triglycerides (≥ 98 mg/dL), and high PLR (≥ 142) were independently associated with a lower probability of hearing recovery. A higher LMR (≥ 3.0) showed a positive trend but did not reach statistical significance in adjusted models.

CONCLUSIONS: In patients with ISSNHL treated with dual-route corticosteroids, several clinical and hematologic factors, particularly elevated PLR and delayed treatment, are independently associated with reduced odds of hearing recovery. Inflammatory blood markers may serve as accessible prognostic tools to support early risk stratification.

PMID:41430443 | DOI:10.1007/s00405-025-09904-w

Sci Rep. 2025 Dec 22. doi: 10.1038/s41598-025-33179-0. Online ahead of print.

ABSTRACT

Accurate prenatal diagnosis of high-risk placenta accreta spectrum (PAS) is vital for maternal safety and can mitigate severe complications. We aimed to investigate the diagnostic value of a novel MRI sign, “increased intra-myometrial vascularity (IIMV),” and to evaluate its contribution to an optimal MRI sign combination for differentiating high-risk placenta accreta spectrum (PAS), specifically placenta increta (PI) and percreta (PP), from placenta accreta (PA) or normal placenta. This retrospective study reviewed 166 high-risk pregnant women who underwent MRI. Two radiologists independently assessed the presence of the seven established risk signs from the SAR-ESUR consensus and the novel IIMV sign. The IIMV sign was defined as continuous tubular or tortuous flow-void structures confined within the myometrium, associated with architectural distortion. Univariate logistic regression and interobserver agreement (kappa statistics) were used to select significant signs, which were then incorporated into a multivariate model to construct diagnostic combinations. AUCs were compared between combinations (with and without IIMV sign) in differentiating PI + PP group from PA + Normal groups. The novel IIMV sign demonstrated the highest specificity (0.91) and was independently associated with the differentiation between the PI + PP and Normal + PA groups. The optimal sign combination, which included IIMV, placental bulge, myometrial thinning, and bladder wall interruption, achieved an area under the curve (AUC) of 0.84. In contrast, the combination without IIMV showed a decreased AUC of 0.79 (p = 0.1203). The “increased intra-myometrial vascularity” sign is a highly specific marker for high-risk PAS. Its inclusion in an MRI-based diagnostic model improves the performance for identifying invasive placental disorders compared to combinations that do not utilize this novel sign.

PMID:41430431 | DOI:10.1038/s41598-025-33179-0

Sci Rep. 2025 Dec 23. doi: 10.1038/s41598-025-32913-y. Online ahead of print.

ABSTRACT

Carbohydrate antigen 125 (CA125) is increasingly recognized as a biomarker in heart failure (HF). However, its response to sodium-glucose co-transporter 2 inhibitors (SGLT2i) after acute myocardial infarction (AMI) remains insufficiently explored. In this study, CA125 levels were measured from plasma samples collected in the EMMY trial, and robust linear mixed-effects models (R-LMEMs) were applied to assess the effects of empagliflozin on CA125 levels, their changes over a 26-week period, and their associations with established HF biomarkers. Our analysis showed that empagliflozin had no statistically significant effect on log-transformed CA125 levels. CA125 exhibited minor fluctuations at 6 weeks before declining at 26 weeks to a level below baseline, which had been measured shortly after AMI. Log-transformed CA125 was significantly associated with log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) and multiple echocardiographic parameters, including left ventricular ejection fraction (LVEF), end-diastolic and end-systolic dimensions, and volumes (LVEDD, LVEDV, LVESD, LVESV), and the ratio of early diastolic transmitral inflow velocity to early diastolic mitral annular velocity (E/e’). Notably, CA125’s associations with NT-proBNP and E/e’ were modified by empagliflozin. In conclusion, although CA125 showed significant associations with established HF biomarkers, it did not exhibit a parallel response to empagliflozin after AMI.

PMID:41430429 | DOI:10.1038/s41598-025-32913-y

Sci Rep. 2025 Dec 23. doi: 10.1038/s41598-025-32485-x. Online ahead of print.

ABSTRACT

Heavy-metal (HM) contamination undermines soil functions and food safety, while risk appraisals often rely on chemical indices that can be unstable in the presence of extremes and only indirectly reflect biological integrity. We present an integrative framework that couples standardized contamination metrics with soil microbiome profiling to deliver stable, interpretable classifications and actionable bioindicators. Twelve peri-urban soils from Southern Italy were analysed for potentially toxic elements, including Arsenic (As), Cadmium (Cd), Chromium (Cr), Copper (Cu), Nickel (Ni), Lead (Pb), and Zinc (Zn) and profiled by shotgun metagenomics. We introduce a Standardized Ecological Risk index (SPERI) that preserves the ranking conveyed by conventional composites yet reduces outlier leverage. SPERI strongly agreed with Improved Potential Ecological Risk Index (IPERI) while stabilizing variance (R² = 0.896) and improved between-site comparability. Along the contamination gradient, community structure shifted consistently: families such as Pseudomonadaceae, Xanthomonadaceae and Rhodospirillaceae increased with risk, whereas Geodermatophilaceae and Nocardiaceae declined. Simple decision-tree models trained on family-level relative abundances reliably separated SPERI classes and repeatedly selected Zn- and Cd-enriched sites as primary split drivers, aligning microbial signals with chemical risk. By combining open, reproducible analytics with jointly chemical- and microbiome-informed endpoints, this workflow improves the interpretability and transferability of ecological risk assessment and supports targeted remediation and monitoring in contaminated agro-ecosystems.

PMID:41430427 | DOI:10.1038/s41598-025-32485-x

BMC Psychol. 2025 Dec 22. doi: 10.1186/s40359-025-03867-7. Online ahead of print.

ABSTRACT

BACKGROUND: Against the backdrop of building an education powerhouse, this study aims to explore the relationship between moral education and anomie behaviors in university physical education classes, and to examine the serial mediating role of attitudes toward sports norms and self-efficacy in this relationship.

METHODS: A questionnaire survey was conducted among 2,340 undergraduate students from 20 universities across the country. The collected data were organized and analyzed using SPSS Statistics 27.0.

RESULTS: Moral education exerted a significant negative predictive effect on anomie behaviors in physical education classes. This influence was primarily mediated through the serial mediation pathway of attitudes toward sports norms and self-efficacy. The effect sizes for these three pathways were -0.051, -0.018, and -0.013, accounting for 45.54%, 16.07%, and 11.61% of the total effect, respectively.

CONCLUSION: Moral education directly influences anomie behaviors in university physical education classes. Attitudes toward sports norms and self-efficacy for sports-related norms play a serial mediating role in the relationship between moral education and anomie behaviors in physical education classes.

PMID:41430349 | DOI:10.1186/s40359-025-03867-7

Sci Rep. 2025 Dec 22. doi: 10.1038/s41598-025-32529-2. Online ahead of print.

ABSTRACT

The number of human infections with Plasmodium knowlesi, a malaria parasite typically found in long-tailed and pig-tailed macaques, have increased and P. knowlesi has become the sole cause of indigenous cases of malaria in Malaysia since 2018. The reasons for the increase are multifactorial and could include human-to-human transmission through mosquito bites. Such transmission would require viable gametocytes circulating in the blood of infected individuals as this is the only parasite blood stage transmissible to mosquitoes. The objectives of this study were to determine the proportion of P. knowlesi malaria patients with viable gametocytes and to determine the association between gametocyte load and duration of illness prior to hospital admission, and with total parasitaemia. The mRNA transcripts of pks25, a gene expressed in mature female P. knowlesi gametocytes, were measured by a real-time PCR assay in blood samples from 295 patients at Kapit Hospital, Sarawak, Malaysian Borneo with PCR-confirmed single infections of P. knowlesi. Viable gametocytes were present in 67.5% (199/295) of patients. A positive correlation was seen between gametocyte load and total parasitaemia (ρ = 0.32, p = 0.01), whereas there was no statistically significant association between gametocyte carriage and duration of illness prior to hospitalisation (ρ = 0.28, p = 0.7). Forty (20%) of 199 gametocyte-positive samples had fewer than 500 pks25 transcript copies/µL, but 25 (12.5%) of 199 gametocyte-positive patients had elevated levels of gametocytes; 13 (10.8%) had between 10,001 and 100,000 and 12 (6%) had > 100,000 pks25 transcript copies/µL. Our findings demonstrate the presence of viable gametocytes in a substantial proportion of patients, including some with relatively high densities. This observation, taken together with other findings, underscores the potential of humans to serve as infectious hosts of P. knowlesi, but they do not constitute direct evidence of human-to-human transmission. Significant gaps still remain in our understanding of P. knowlesi gametocyte biology and infectivity. Addressing these gaps is essential to ascertain whether human-to-human transmission of P. knowlesi, which was experimentally demonstrated in the 1960s, occurs in natural settings. Continued surveillance of human P. knowlesi infections together with studies on gametocyte biology, vector bionomics, and monitoring of macaque host populations in relation to environmental alterations are vital to understand changes in the dynamics of P. knowlesi malaria transmission, and to inform strategies for its control and prevention.

PMID:41430347 | DOI:10.1038/s41598-025-32529-2

Diagn Pathol. 2025 Dec 22. doi: 10.1186/s13000-025-01744-w. Online ahead of print.

ABSTRACT

BACKGROUND: Recent studies have shown that tumor cell membranes exhibit lower polarity than normal cell membranes, a characteristic that can be harnessed for cancer diagnosis. TPAS (viscosity-responsive plasma membrane probe), a recently developed staining method using cell membrane polarity probes, may selectively visualize cervical cancer cells by targeting membrane polarity differences, offering a potential new approach for cervical cancer screening.To investigate the diagnostic value of TPAS staining combined with liquid-based thin-layer cytological testing (TCT) and human papillomavirus (HPV) testing in detecting cervical cancer.

METHODS: A total of 100 patients with suspected cervical precancerous lesions from the People’s Hospital of Shaanxi Province between May 2024 and May 2025 were studied. All patients underwent TPAS testing, HPV testing and TCT. Biopsy results were the gold standard for evaluating positivity rates and diagnostic values of the tests, both individually and in combination.

RESULTS: Among the 100 participants, the positive rates of the tests were as follows: TPAS detection rate was 86.7%, HPV detection rate was 80%, TCT rate 66.7%, and TCT + HPV rate was 35.00%. The combined TPAS + HPV testing showed higher accuracy (72.00%) and sensitivity(70.6%) than TCT + HPV (58.0%)and (54.1%), and the differences were statistically significant ((χ2 = 14.00,P = 0.0002).

CONCLUSION: TPAS combined with HPV testing has high specificity, sensitivity and accuracy, making it a promising approach for cervical cancer diagnosis.

PMID:41430333 | DOI:10.1186/s13000-025-01744-w

J Occup Med Toxicol. 2025 Dec 22. doi: 10.1186/s12995-025-00493-2. Online ahead of print.

ABSTRACT

BACKGROUND: Pneumoconiosis is among the most frequently diagnosed occupational diseases in Turkey, with the ceramic industry accounting for a considerable proportion. This study aimed to assess the frequency of pneumoconiosis among ceramic industry workers referred to an occupational medicine clinic with suspected pneumoconiosis, to identify high-risk departments, and to evaluate the referral process and workplace case management practices.

METHODS: In this cross-sectional study, 295 ceramic industry workers aged 18-64 years who were referred to an occupational medicine clinic for suspected pneumoconiosis by three medium-sized companies between 2013 and 2018 were analyzed. Data were obtained from referral forms and clinic records. Pneumoconiosis diagnosis was established by occupational medicine specialists based on chest radiographs, high-resolution computed tomography, and occupational history. The Kolmogorov-Smirnov test was used to assess the normality of the distribution. Pearson’s chi-square and Mann-Whitney U tests were used for statistical analysis.

RESULTS: Of the 295 workers, 56.3% were current smokers, and 32.5% were diagnosed with pneumoconiosis. The frequency of pneumoconiosis was lower among never-smokers compared with the current and ex-smokers (p < 0.01). The highest diagnosis rates were observed in shaping (41.9%), glazing (38.6%), and raw material processing (36.6%) departments. Referral documents often lacked essential information, with workplace duties missing in 89.5%, workplace exposures in 84.1%, and hygiene assessments in 100% of cases. Among the workers diagnosed with pneumoconiosis who attended at least one follow-up visit, 49.2% were reassigned to different duties. Of the smokers within this follow-up group, 79.0% continued smoking.

CONCLUSIONS: Pneumoconiosis is a significant occupational disease among ceramic workers in Turkey, requiring coordinated preventive action at both workplace and national levels. The critical lack of adequate exposure data in referral documents and the absence of structured post-diagnosis follow-up reveal weaknesses in current occupational hygiene and workplace health surveillance practices. Strengthening accurate assessment and documentation of exposure, standardizing referral protocols, ensuring effective periodic screenings, and promoting structured post-diagnosis follow-up, including smoking cessation interventions, are fundamental to improve disease management. To ensure effective control of pneumoconiosis in the ceramic industry in Turkey, existing legislation and occupational safety and health principles must be translated into well-monitored preventive actions at the workplace.

PMID:41430293 | DOI:10.1186/s12995-025-00493-2