Nevin Manimala

World J Mens Health. 2025 Sep 9. doi: 10.5534/wjmh.250144. Online ahead of print.

ABSTRACT

PURPOSE: Artificial intelligence (AI) tools have demonstrated considerable potential for the dissemination of medical information. However, variability may exist in the quality and readability of prostate-cancer-related content generated by different AI platforms. This study aimed to evaluate the quality, accuracy, and readability of prostate-cancer-related medical information produced by ChatGPT and DeepSeek.

MATERIALS AND METHODS: Frequently asked questions related to prostate cancer were collected from the American Cancer Society website, ChatGPT, and DeepSeek. Three urologists with over 10 years of clinical experience reviewed and confirmed the relevance of the selected questions. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was used to assess the understandability and actionability of AI-generated content. The DISCERN instrument was used to evaluate the quality of the treatment-related information. Additionally, readability was assessed using four established indices: Automated Readability Index (ARI), Flesch Reading Ease Score, Gunning Fog Index, and Flesch-Kincaid Grade Level.

RESULTS: No statistically significant differences were observed between ChatGPT and DeepSeek in PEMAT-P scores (70.66±8.13 vs. 69.35±8.83) or DISCERN scores (59.07±3.39 vs. 58.88±3.66) (p>0.05). However, the ARI for DeepSeek was higher than that for ChatGPT (12.63±1.42 vs. 10.85±1.93, p<0.001), indicating greater textual complexity and reading difficulty.

CONCLUSIONS: AI tools, such as ChatGPT and DeepSeek, hold significant potential for enhancing patient education and disseminating medical information on prostate cancer. Nevertheless, further refinement of content quality and language clarity is needed to prevent potential misunderstandings, decisional uncertainty, and anxiety among patients due to difficulty in comprehension.

PMID:41047358 | DOI:10.5534/wjmh.250144

Endocr J. 2025 Oct 4. doi: 10.1507/endocrj.EJ25-0179. Online ahead of print.

ABSTRACT

Few studies have investigated the distribution of blood pressure (BP) and associated factors in pediatric patients with X-linked hypophosphatemic rickets (XLH). We analyzed snapshot baseline data from the SUNFLOWER study, a longitudinal observational cohort study of patients with XLH in Japan and South Korea (NCT03745521/UMIN000031605). We used data from pediatric participants aged 5-17 years who were 120-189.9 cm (males) and 120-179.9 cm (females) in height and had a history of conventional treatment. Systolic and diastolic BP (SBP and DBP, respectively) were categorized into percentile ranks based on age, sex, and height. Ordinal logistic regression analyses were performed to investigate the association between BP and exposure factors, including estimated glomerular filtration rate, serum intact parathyroid hormone levels, serum intact fibroblast growth factor 23 levels, urinary calcium/creatinine ratio, and body mass index standard deviation score (BMI-SDS). Forty-five participants were eligible for the subgroup analysis. Of these, 44 were evaluated after one patient with missing BP data was excluded. After height adjustment, three patients (6.8%) were at or above the 95th percentile for SBP, and five (11.4%) were at or above the 95th percentile for DBP. Regarding age adjustment, one patient (2.3%) was at or above the 95th percentile for SBP and three (6.8%) were at or above the 95th percentile for DBP. In the association analysis, age- and height-adjusted BP was positively correlated with BMI-SDS. These results suggest that some pediatric patients with XLH exhibit high BP and that a high BMI-SDS may be a risk factor.

PMID:41047346 | DOI:10.1507/endocrj.EJ25-0179

Environ Health Prev Med. 2025;30:78. doi: 10.1265/ehpm.25-00173.

ABSTRACT

BACKGROUND: This cross-sectional study examined meal patterns based on daily energy intake distribution and their associations with nutrient and food intake, diet quality, and body mass index (BMI).

METHODS: Body height, weight, habitual dietary intake and the Healthy Eating Index (HEI)-2020 score by eating occasion were assessed using the validated Meal-based Diet History Questionnaire among employees (465 males and 193 females aged 20-75 years) in the Tokyo Metropolitan Area. Meal patterns were extracted based on % energy intake from breakfast, lunch, dinner, and snacks using K-means clustering by sex. Dietary intake, HEI-2020 score, and BMI were then compared between sex-specific meal patterns.

RESULTS: The identified patterns were “large lunch and dinner” (n = 299), “three meals-balanced” (n = 97), and “large dinner” (n = 69) patterns in males and “large dinner” (n = 79); “large afternoon snack” (n = 54) and “large lunch” (n = 60) patterns in females. The HEI-2020 scores were the highest for dinner, followed by breakfast, lunch, and snacks in any meal pattern. Males with the “large dinner” pattern had lower intakes of rice, bread, carbohydrates, dietary fibre, and thiamine; higher intake of alcoholic beverages; and higher HEI-2020 scores than those with other patterns. Females with a “large dinner” pattern had a lower intake of bread, confectionery, total and saturated fats, and carbohydrates; higher intake of fish, meat, and alcoholic beverages; higher HEI-2020 scores; and lower BMI. Thus, a meal pattern with higher energy intake distribution at dinner was associated with higher diet quality among males and females and lower BMI among females in Japanese workers.

CONCLUSIONS: These findings suggest that improving the quality of the meal with the highest energy contribution could help enhance overall dietary quality and metabolism.

PMID:41047335 | DOI:10.1265/ehpm.25-00173

Urol Oncol. 2025 Oct 4:S1078-1439(25)00355-2. doi: 10.1016/j.urolonc.2025.09.001. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of IsoPSA density for detecting clinically significant prostate cancer (csCaP), and its utility in guiding biopsy decision-making.

MATERIALS AND METHODS: We conducted a retrospective review of 574 patients who underwent IsoPSA testing, prostate MRI, and image-guided biopsy within 1 year. IsoPSA density was calculated as IsoPSA value divided by MRI-derived prostate volume. Multivariable logistic regression, receiver operating characteristic (ROC) analysis, and decision curve analysis were used to assess predictive value. Subgroup analyses were performed in patients with large prostates (>70 ml) and negative MRI (PI-RADS 1-2).

RESULTS: The overall prevalence of csCaP on biopsy was 33.8%. IsoPSA density was an independent predictor of csCaP and performed similarly to PSA density, while outperforming PSA and IsoPSA in ROC and decision curve analyses. In the full cohort, IsoPSA density achieved an AUC of 0.69 and demonstrated a high negative predictive value (NPV) of 79% at the optimal cutoff of 0.21. Among men with negative MRI (n = 238), an IsoPSA density threshold of 0.17 yielded an NPV of 97% and sensitivity of 85% for ruling out csCaP. In men with large prostates, higher IsoPSA density trended with increased csCaP risk, though not statistically significant.

CONCLUSIONS: IsoPSA density performed comparably to PSA density and outperformed traditional clinical predictors of csCaP. In MRI-negative men, its high negative predictive value supports its use as a non-invasive tool to reduce unnecessary biopsies. IsoPSA density may serve as a valuable adjunct in contemporary prostate cancer diagnostic pathways and warrants further validation.

PMID:41047326 | DOI:10.1016/j.urolonc.2025.09.001

Oral Surg Oral Med Oral Pathol Oral Radiol. 2025 Sep 2:S2212-4403(25)01196-4. doi: 10.1016/j.oooo.2025.08.018. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical and radiographic outcomes of temporomandibular joint (TMJ) total joint replacement (TJR) in osteoporotic patients receiving preoperative antiresorptive therapy.

STUDY DESIGN: This retrospective chart review included osteoporotic patients who underwent TMJ TJR at a single institution. Data collected included demographics, medical history, type and duration of antiresorptive therapy, surgical details, and postoperative outcomes. Clinical parameters included range of motion (ROM), joint noise, and dietary limitations. Radiographic assessment evaluated periprosthetic bone changes and implant stability. Descriptive statistics summarized outcomes.

RESULTS: Eight patients (62.5% female; mean age 61.5 ± 11.4 years) with osteoporosis and history of antiresorptive therapy were analyzed. The average therapy duration was 3.75 ± 3 years. Mean clinical and CBCT follow-up was 16 ± 9.6, and 6.5 ± 3.6 months respectively. No patients developed medication-related osteonecrosis of the jaw (MRONJ), prosthetic failure, hardware loosening, or periprosthetic osteolysis. Functional outcomes were favorable, with mean postoperative ROM of 35.1 ± 4.8 mm and no joint noise.

CONCLUSION: Preoperative antiresorptive therapy in osteoporotic patients does not appear to increase the risk of complications or impair functional outcomes following TMJ TJR. Larger sample sizes, possibly through multicenter investigations, are critical to establishing high-level evidence regarding its safety and efficacy.

PMID:41047323 | DOI:10.1016/j.oooo.2025.08.018

BMJ Open. 2025 Oct 5;15(10):e099692. doi: 10.1136/bmjopen-2025-099692.

ABSTRACT

INTRODUCTION: Achieving universal health coverage requires the use of health research evidence in decision-making; however, this remains understudied in lower and middle-income countries (LMICs) such as Tanzania. Despite several health sector reforms and the availability of locally generated research, evidence indicates that the use of such research in health planning and decision-making remains limited in Tanzania, creating a gap between research production and its practical application. This study examined the extent of research evidence used in health planning and the factors influencing its use among health planning teams.

METHODS AND ANALYSIS: A sequential exploratory mixed-methods design was employed, starting with qualitative data from focus group discussions (N=6) and KIIs (N=34) with health planners from selected regions in Tanzania, recruited based on their direct involvement in health planning, using semistructured guides informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This was followed by a quantitative survey of 422 participants meeting the same inclusion criteria, administered with a structured questionnaire derived from the model. The COM-B framework guided both tool development and analysis. Qualitative data were thematically analysed using a framework approach, yielding three themes, while quantitative data were analysed using descriptive statistics and binary logistic regression.

RESULTS: Qualitative findings revealed barriers such as limited knowledge and skills, inadequate access to knowledge translation tools, poor dissemination processes, financial and technical constraints, and lack of training. Opportunities included supportive guidelines, research coordinators, collaborations, dedicated budgets and improved internet access. Motivators such as job promotions, professional development, allowances and targeted training were also identified. Quantitative results showed moderate evidence use (66.2%), slightly higher than in other LMICs. Barriers included suboptimal dissemination (74.5%; OR=2.035, p=0.0008), inadequate resources (70.0%; OR=0.965, p=0.8759) and lack of training (63.7%; OR=1.361, p=0.1806). Integrated findings highlighted convergence on dissemination, resource and training challenges, with divergence in statistical significance between methods.

CONCLUSIONS: Barriers related to dissemination, resources and training hinder evidence use. Interventions such as digital repositories, guideline development and capacity building, alongside institutionalised frameworks, resource allocation and accountability mechanisms, are essential to strengthen evidence-based health planning in Tanzania.

PMID:41047277 | DOI:10.1136/bmjopen-2025-099692

BMJ Open. 2025 Oct 5;15(10):e103724. doi: 10.1136/bmjopen-2025-103724.

ABSTRACT

OBJECTIVE: This study aims to develop a methodology to retrieve, harmonise and evaluate the completeness of national body mass index (BMI) data from linked electronic health record (EHR) sources to build a longitudinal research-ready data asset (RRDA).

DESIGN: A longitudinal study of BMI records spanning 23 years (1 January 2000 to 31 December 2022) from four data sources.

SETTING: The national BMI RRDA is created within the Secure Anonymised Information Linkage (Databank), encompassing the entire population of Wales, UK.

PROCEDURE AND PARTICIPANTS: We built a methodology that provides a reproducible framework for extracting and harmonising BMI data from four major linked EHRs across two age groups: children and young people (CYP; 2-18 years old) and adults (19 years and older). The methodology is adaptable across different trusted research environments. We evaluated the completeness and retention of records over 1-, 5- and 23-year periods by calculating the proportion of missing data relative to each year’s population.

RESULTS: We retrieved 53.4 million records for 3.2 million individuals across Wales from 1st January 2000 to 31 December 2022. Among these, 3% of CYP and 34% of adults had repeat BMI measurements recorded over periods ranging from 5 to 23 years. Throughout the entire population of Wales during this period, 49% of CYP and 26% of adults had at least one BMI reading recorded, resulting in a missingness rate of 51% for CYP and 74% for adults. Preserving BMI information by retaining the most recently recorded BMI over 1-, 5- and 23-year intervals from 2022 showed coverage rates of 10%, 33% and 68%, respectively, for CYP, and 25%, 51% and 73%, respectively, for adults.

CONCLUSIONS: Our findings highlight substantial variations in BMI data availability and retention across CYP and adults, as well as time periods within EHR in Wales. Wider adoption of this approach can enhance standardised approaches in using accessible measures like BMI to assess disease risk in population-based studies, strengthening public health initiatives and research efforts.

PMID:41047276 | DOI:10.1136/bmjopen-2025-103724

BMJ Open. 2025 Oct 5;15(10):e096130. doi: 10.1136/bmjopen-2024-096130.

ABSTRACT

OBJECTIVES: To evaluate temporal trends in the epidemiology of hip osteoarthritis (OA) in the USA from 1990 to 2019, with stratification by sex and geographic region.

DESIGN: Cross-sectional time-series analysis using secondary data from the Global Burden of Disease (GBD) study.

SETTING: US population-based analysis, stratified by the four US Census Bureau regions: Northeast, Midwest, South and West.

PARTICIPANTS: De-identified, aggregate population-level data representing all adults in the USA from 1990 to 2019, drawn from the GBD database.

PRIMARY AND SECONDARY OUTCOME MEASURES: Age-standardised rates per 100 000 population for years lived with disability (YLDs), prevalence and incidence of hip OA. Outcomes were stratified by sex and region. Statistical significance was defined as p<0.05.

RESULTS: Between 1990 and 2019, hip OA in the USA increased by 23.91% in YLDs, 24.67% in prevalence and 25.22% in incidence. In 2019, the mean YLDs were 28.30 in women versus 25.48 in men; prevalence was 49.55 versus 41.08; and incidence was 919.29 versus 818.10 (all p<0.001). Regionally, the Northeast had the highest mean YLDs (30.1), prevalence (52.4) and incidence (950.5), while the South had the lowest (YLDs: 24.5, prevalence: 40.7, incidence: 805.2). These sex-based and region-based disparities were statistically significant (p<0.05).

CONCLUSIONS: There has been a substantial rise in the burden of hip OA in the USA over the past three decades. Women and residents of the Northeastern USA are disproportionately affected. These findings underscore the need for targeted public health strategies that account for geographic and sex-based disparities in hip OA burden.

PMID:41047275 | DOI:10.1136/bmjopen-2024-096130

Inflammopharmacology. 2025 Oct 5. doi: 10.1007/s10787-025-01995-5. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic low-grade inflammation plays a central role in the pathophysiology of both type 2 diabetes mellitus (T2DM) and hypertension, contributing to increased cardiovascular risk. Telmisartan, an angiotensin receptor blocker with partial peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist activity, may offer anti-inflammatory benefits in addition to its antihypertensive effects.

AIMS: This study compares the effects of telmisartan versus other standard antihypertensive agents on inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), in patients with diabetes and newly diagnosed hypertension.

METHODS: This is a randomized, open-label, parallel-group, active-controlled trial. Seventy eligible patients were randomized to receive telmisartan (N = 34) or another antihypertensive agent [amlodipine (n = 22), cilnidipine (n = 12), or ramipril (n = 2)] (N = 36). Secondary outcome parameters included inflammatory biomarkers such as highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-α) measured at baseline and 12 weeks following treatment. Data are presented as median and interquartile range (IQR). Between-group comparisons at 12 weeks were performed using the Mann-Whitney U test. The trial is registered with the Clinical Trial Registry of India (CTRI/2023/04/051878).

RESULTS: At baseline, hsCRP, IL-6, and TNF-α levels were comparable between groups. In the telmisartan group, hsCRP declined from 3.4 mg/L (IQR: 2.0, 13.7) to 1.8 mg/L (IQR: 1.2, 5.0), IL-6 from 4.3 pg/mL (IQR: 2.9,9.5) to 3.4 pg/ml (IQR: 2.2, 6.8), and TNF-α from 19.4 pg/ml (IQR: 8.9, 43.7) to 13.8 pg/ml (IQR: 3.5, 32.4). In the active control group, hsCRP changed from 3.1 mg/L (IQR: 1.7, 8.0) to 2.9 mg/L (IQR: 1.7, 4.9), IL-6 from 4.1 pg/ml (IQR: 3.0,7.6) to 4.2 pg/ml (IQR: 2.9, 7.8), and TNF-α from 20.2 pg/ml (IQR: 10.4, 48.6) to 16.9 pg/ml (IQR: 3.3, 30.3). The differences between groups at 12 weeks were not statistically significant for hsCRP (P = 0.07), IL-6 (P = 0.24), or TNF-α (P = 0.93).

CONCLUSION: The anti-inflammatory markers were reduced in both groups at 12 weeks without any statistically significant difference across groups. However, telmisartan was associated with greater reductions in hsCRP, IL-6, and TNF-α in patients with T2DM and hypertension following 12 weeks of treatment. These findings may indicate a potential anti-inflammatory effect of telmisartan that requires confirmation in adequately powered trials.

PMID:41046489 | DOI:10.1007/s10787-025-01995-5

J Robot Surg. 2025 Oct 5;19(1):663. doi: 10.1007/s11701-025-02752-0.

ABSTRACT

Accurate flexion-extension gap balancing is critical in total knee arthroplasty (TKA), influencing postoperative stability and longevity. Femoral component flexion in the sagittal plane has been suggested as a means to adjust gap balance; however, its impact across different implant designs remains unclear. This study compares the influence of femoral component flexion on gap balancing between single-radius and multi-radius femoral components using robotic-assisted TKA. A prospective observational cohort study was conducted on 200 patients (100 in each cohort) undergoing primary robotic-assisted TKA for varus deformity with end-stage osteoarthritis. Patients were randomized to receive either single-radius (Stryker MAKO with Stryker Triathlon implants) or multi-radius (Meril CUVIS with Maxx-Freedom implants) femoral components. Intraoperative medial and lateral flexion-extension gaps were assessed at femoral flexion increments from 0° to 6° using robotic measurement software, and statistical analyses were done. Femoral component flexion had distinct impacts on gap balancing depending on implant design. Multi-radius implants showed significant variability with extension medial gaps progressively loosened (mean Change 0.19 mm/degree of flexion, p < 0.001), and flexion medial and lateral gaps progressively tightened (mean Changes 0.21 mm/degree, p < 0.001 and 0.24 mm/degree, p < 0.05, respectively). Conversely, single-radius implants demonstrated minimal variability in all gap measurements across degrees of femoral flexion (p > 0.05). Femoral component flexion significantly affects gap balancing during robotic-assisted TKA, particularly in multi-radius femoral components. Multi-radius designs require careful sagittal alignment to prevent undesirable gap variations, whereas single-radius implants exhibit more predictable gap balancing profiles, potentially simplifying intraoperative adjustments. Future research should evaluate long-term clinical outcomes related to these findings.

PMID:41046480 | DOI:10.1007/s11701-025-02752-0