Nevin Manimala

Biopsychosoc Med. 2025 Jul 9;19(1):11. doi: 10.1186/s13030-025-00333-z.

ABSTRACT

BACKGROUND: The prolonged COVID-19 pandemic has significantly affected the clinical care and the mental health of patients in psychosomatic medicine. Between late 2021 and early 2022, the Japanese Society of Psychosomatic Medicine (JSPM) and the Japanese Society of Psychosomatic Internal Medicine (JSPIM) conducted a nationwide physician survey to assess these effects. The survey identified difficulties in outpatient and inpatient care, increased use of telemedicine, and rises in patient numbers and symptom severity. Due to inconsistent findings in prior studies on long-term mental health effects of the pandemic, a follow-up survey was needed.

METHODS: This study is the one-year follow-up survey conducted by JSPM and JSPIM. A cross-sectional, web-based survey was conducted among physicians of the two societies from December 21, 2022, to February 14, 2023. The questionnaire examined trends in outpatient and inpatient care, telemedicine use, and changes in the mental health of patients with psychosomatic disorders, eating disorders, adjustment disorders, mood disorders, and anxiety disorders. Descriptive statistical analyses were performed.

RESULTS: A total of 251 physicians responded. While outpatient numbers showed partial recovery, 28% of the respondents reported persistent declines compared to pre-pandemic levels. Telemedicine remained in use at 62% of their institutions, but 70% of the respondents reported difficulties in symptom assessment. Compared to the previous year, more respondents reported an increase in the number of patients across all surveyed disorders. Regarding the psychosocial factors that affected patients, fear of infection was the predominant factor for anxiety disorders, as in the previous survey, whereas restrictions on daily and social activities were the most influential for psychosomatic disorders, mood disorders, and adjustment disorders.

CONCLUSIONS: The COVID-19 pandemic has had a lasting effect on patients receiving psychosomatic treatment. Outpatient numbers are gradually recovering, and telemedicine has contributed to the continuity of care. However, concerns about patient assessment in telemedicine persist. The impact of the prolonged pandemic on mental health appears to have evolved, with shifts in the psychosocial factors that influence different aspects of mental health deterioration. Future studies that incorporate clinical data will provide valuable insights into the long-term consequences of the pandemic and help guide future clinical practice.

PMID:40635104 | DOI:10.1186/s13030-025-00333-z

Eur J Med Res. 2025 Jul 9;30(1):603. doi: 10.1186/s40001-025-02864-1.

ABSTRACT

BACKGROUND: Rib fractures are often treated conservatively, but for cases with significant displacement or instability, surgical intervention may be necessary. Traditional open reduction and internal fixation (ORIF) has been the standard surgical approach; however, the tunnel minimally invasive technique is emerging as a less invasive alternative. This study compares the efficacy of these two surgical methods in terms of incision length, postoperative pain, surgical time, and hospital stay.

METHODS: A retrospective evaluation was conducted from June 2022 to December 2024 at our hospital, including 167 patients with rib fractures. Patients were divided into two groups: 86 receiving traditional ORIF (control group) and 81 undergoing the tunnel minimally invasive technique (observation group). Surgical outcomes, including incision length, surgical duration, pain scores (measured by the Visual Analogue Scale), and hospital stay, were compared. Statistical analysis was performed using SPSS 27.0 software, and results were considered significant with a P-value of < 0.05.

RESULTS: The observation group demonstrated significantly shorter incision lengths (3.65 ± 1.08 cm vs. 9.10 ± 3.65 cm), lower postoperative pain scores (2.02 ± 0.93 vs. 3.52 ± 0.82), and shorter hospital stays (9.58 ± 2.68 days vs. 12.60 ± 3.33 days) compared to the control group (P < 0.001 for all). However, the surgical time was significantly longer for the tunnel technique (151.55 ± 39.81 min vs. 121.40 ± 29.37 min, P < 0.001).

CONCLUSIONS: The tunnel minimally invasive technique offers significant advantages over traditional ORIF, including smaller incisions, reduced postoperative pain, and shorter hospital stays, despite a longer surgical duration. Further studies with larger sample sizes and longer follow-up periods are required to confirm its long-term benefits and cost-effectiveness.

PMID:40635080 | DOI:10.1186/s40001-025-02864-1

Glob Health Res Policy. 2025 Jul 9;10(1):27. doi: 10.1186/s41256-025-00421-1.

ABSTRACT

BACKGROUND: Cancer prevention is a critical public health challenge in China, especially among rural residents. This study aimed to examine the mediating role of cancer cognition in the relationship between e-health literacy and cancer prevention consciousness.

METHODS: A multi-stage stratified random sampling method was used to recruit 486 rural residents from Shandong Province for a questionnaire survey. Data from 453 valid responses were analyzed using descriptive statistics, univariate and multiple linear regression. Path analysis was used to examine the mediating role of cancer cognition in the relationship between e-health literacy and cancer prevention consciousness.

RESULTS: The mean score of cancer prevention consciousness among rural residents in this study was 7.46 out of a maximum of 10. Regression analysis showed that e-health literacy (β = 0.146, P < 0.001) and cancer cognition (β = 0.150, P < 0.001) influenced cancer prevention consciousness. Gender and the perceived necessity of cancer-related knowledge were also influencing factors (P < 0.001). The direct effect value of e-health literacy on cancer prevention consciousness was 0.155, which accounted for 84.87% of the total effect. The indirect effect value through cancer cognition level is 0.028, accounting for 15.13% of the total effect.

CONCLUSIONS: We found an above-average level of cancer prevention consciousness among the rural residents. E-health literacy can enhance the consciousness among individuals by increasing their cancer cognition. Policymakers should leverage e-health technologies to strengthen residents’ capacity to understand cancer-related information, with culturally tailored interventions further supporting effective prevention and global health efforts.

PMID:40635047 | DOI:10.1186/s41256-025-00421-1

Plant Methods. 2025 Jul 9;21(1):95. doi: 10.1186/s13007-025-01416-2.

ABSTRACT

Stomatal morphology plays a critical role in regulating plant gas exchange influencing water use efficiency and ecological adaptability. While traditional methods for analyzing stomatal traits rely on labor-intensive manual measurements, machine learning (ML) tools offer a promising alternative. In this study, we evaluate the suitability of a U-Net-based interactive ML software with corrective annotation for stomatal morphology phenotyping. The approach enables non-ML experts to efficiently segment stomatal structures across diverse datasets, including images from different plant species, magnifications, and imprint methods. We trained a single model based on images from five datasets and tested its performance on unseen data, achieving high accuracy for stomatal density (R² = 0.98) and size (R² = 0.90). Thresholding approaches applied to the U-Net segmentations further improved accuracy, particularly for density measurements. Despite significant variability between datasets, our findings demonstrate the feasibility of training a single segmentation model to analyze diverse stomatal data sets. Validation approaches showed that a semi-automatic approach involving correcting segmentations was five times faster than manual annotation while maintaining comparable accuracy. Our results also illustrate that ML metrics, such as the F1 score, correlate with accuracy in the statistical analysis of trait measurements with improvements diminishing after 2:30 h model training. The final model achieved high precision, allowing the detection of highly significant biological differences in stomatal morphology within plant, between genotypes and across growing environments. This study highlights interactive ML with corrective annotation as a robust and accessible tool for accelerating phenotyping in plant sciences, reducing technical barriers and promoting high-throughput analysis.

PMID:40635039 | DOI:10.1186/s13007-025-01416-2

BMC Rheumatol. 2025 Jul 9;9(1):85. doi: 10.1186/s41927-025-00539-2.

ABSTRACT

BACKGROUND: It is well-documented that systemic lupus erythematosus (SLE) is associated with asthma. However, the causal relationship between SLE and asthma, and the potential mediator need to be explained. This study aims to confirm the cause-and-effect relationship between SLE and asthma, and evaluate the mediation effect of lipid in European ancestry.

METHODS: A Two-sample Mendelian randomization (MR) study was applied to analyze the causal relationships between SLE and asthma. A two-step MR design was used to explore whether low-density lipoprotein cholesterol (LDL-C) mediates the causal pathway from SLE to asthma outcome. Cochran’s Q statistic methods and MR-Egger regression were used to assess heterogeneity and pleiotropy. Leave-one-out (LOO) sensitivity test was adopted to estimate the effect of removing one of the selected individual SNPs on the overall results. Funnel and forest plots were also conducted to detect the pleiotropy directly.

RESULTS: SLE was significantly associated with higher asthma risk according to inverse-variance weighted (IVW) method [OR (95%CI): 1.093 (1.024-1.166)] (P = 0.007), MR Egger method [OR (95%CI): 1.192 (1.077-1.319)] (P = 0.028) and Maximum likelihood [OR (95%CI): 1.094 (1.036-1.155)] (P = 0.001), which were robust across adequate sensitivity analysis. On the contrary, asthma has no causal relationship with SLE. In addition, LDL-C may mediate a proportion of 6.15% of the total effect between SLE and asthma.

CONCLUSION: This study demonstrates that patients with SLE may have a higher risk of developing asthma, which may be mediated by LDL-C. Understanding this relationship provides insight into potential mechanisms underlying asthma development in SLE patients and offers a foundation for developing targeted treatment strategies to manage these risks effectively.

PMID:40635038 | DOI:10.1186/s41927-025-00539-2

J Transl Med. 2025 Jul 9;23(1):760. doi: 10.1186/s12967-025-06579-z.

ABSTRACT

BACKGROUND: The objective of this prospective, triple-blind, randomized clinical controlled trial is to investigate and compare the expressions of interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) in the periapical tissues of teeth with symptomatic apical periodontitis following the placement of calcium hydroxide (Ca(OH)₂) and simvastatin as intracanal medicaments (ICM). Additionally, the study aims to evaluate pre-treatment and interappointment pain levels. This research could lead to improved treatment protocols for symptomatic apical periodontitis, enhancing patient comfort and outcomes.

METHODS: The study adhered to CONSORT guidelines. A total of 34 patients aged 14 to 60 years with single-rooted teeth diagnosed with pulp necrosis and symptomatic apical periodontitis underwent root canal procedures. They were randomly divided into two groups based on the ICM used: Group I received Ca(OH)₂, while Group II received simvastatin. Tissue fluid samples were collected at three time points (T0, T1, T2) using paper points inserted into the periapical tissues immediately after access opening, after cleaning and shaping, and 7 days after ICM placement. The samples were stored at – 20 °C for analysis. Pain levels were recorded using the Heft Parker Visual Analogue Scale (HP-VAS) at various intervals. All samples underwent enzyme-linked immunosorbent assay (ELISA) to estimate IL-6, IL-10, and MMP-9 levels in pg/ml. Statistical analysis included the Mann-Whitney U test and Quade nonparametric ANCOVA for inter-group comparisons, while intra-group comparisons were performed using the Friedman test.

RESULTS: Statistically significant differences were observed in IL-6 and MMP-9 levels within groups but not in IL-10 across time points (p < 0.05). In intergroup comparisons at T2, simvastatin showed significantly lower expressions of IL-6 and MMP-9 compared to Ca(OH)₂ (p < 0.05). IL-10 levels increased in both groups without significant differences. Pain scores were significantly lower following simvastatin treatment compared to Ca(OH)₂ (p < 0.05).

CONCLUSIONS: The expression of these biomarkers indicates that simvastatin is effective in reducing inflammation and pain in teeth with pulpal necrosis and symptomatic apical periodontitis when used as an intracanal medicament compared to Ca(OH)₂.

TRAIL REGISTRATION: Clinical Trial Registry of India CTRI/2022/08/044749; Registered 18 August 2022 https://drive.google.com/file/d/17JXArM3qoqvTMiUa9ITMTQTGLEvsxpW_/view?usp=sharing.

PMID:40635035 | DOI:10.1186/s12967-025-06579-z

BMC Oral Health. 2025 Jul 9;25(1):1131. doi: 10.1186/s12903-025-06527-9.

ABSTRACT

BACKGROUND: This study investigated the appropriate surface treatment protocols for repairing various hybrid and non-hybrid ceramics.

METHODS: Ceramic samples with a thickness of 2 mm were prepared from two resin-hybrid CAD/CAM blocks (Vita Enamic (hybrid-VE) and Lava Ultimate (hybrid-LU)) and two non-hybrid ceramics (VITABLOCS Mark II (non-hybrid-VM) and zirconia). The samples underwent 10,000 thermocycles. Their surfaces were then subjected to the following treatments before silanization and repair with resin composite using Tygon tubes with 1 mm diameter (n = 12): (1) no surface treatment, (2) grinding with silicon carbide, (3) sandblasting, and (4) etching with 9% hydrofluoric acid (HF). Then, ceramics were repaired using a universal adhesive agent (Clearfill Universal Bond; Kuraray, Tokyo, Japan) and composite resin. The microshear bond strength (µSBS) was measured and compared among the groups using two-way ANOVA and Tukey tests (α = 0.05).

RESULTS: The type of ceramic and the surface treatment significantly influenced the repair µSBS (P < 0.05). The highest µSBS values for hybrid-VE, hybrid-LU, and non-hybrid-VM were respectively associated with surface preparation using silicon carbide grinding, sandblasting, and 9% HF etching (P < 0.05). For zirconia ceramics, the µSBS value was highest when treated with sandblasting, though this difference was not statistically significant. When no surface treatment was applied, or the samples were sandblasted, hybrid-LU and non-hybrid-zirconia showed the highest µSBS values (P < 0.05). When the surface was etched with 9% HF or ground with silicon carbide paper, hybrid-VE, and non-hybrid-VM demonstrated the lowest repair µSBS values, respectively (P < 0.05).

CONCLUSION: The optimal surface treatments for repairing hybrid-VE, hybrid-LU, and non-hybrid-VM ceramics were silicon carbide grinding, sandblasting, and 9% HF etching, respectively. However, surface treatments did not significantly affect the performance of zirconia ceramics.

PMID:40635017 | DOI:10.1186/s12903-025-06527-9

Environ Health. 2025 Jul 9;24(1):47. doi: 10.1186/s12940-025-01201-7.

ABSTRACT

Pregnant women are regularly exposed to a variety of environmental toxicants in daily life, posing a potential threat of kidney injury before presence of clinical manifestations. As there is a paucity of studies employing an exposome-based approach of kidney health in pregnant women, this study utilizes the above-mentioned strategy to identify the most significant environmental toxicants associated with early kidney injury in pregnant women in the cohort of TMICS (Taiwan Maternal and Infant Cohort Study). A total of 1,139 third-trimester pregnant women (weeks 29-40) were recruited between 2012 and 2015, and one-spot urine samples were successfully collected for study. Sixteen biomonitoring chemicals were measured in urine, including exposure measurements of melamine, 9 phthalate metabolites, nonylphenol (NP), bisphenol A (BPA), methylparaben (MP), ethylparaben (EP), propylparaben (PP), and butylparaben (BP), and outcome measurements of NAG (N-acetyl-β-d-glucosaminidase) and albumin-to-creatinine ratio (ACR). A two-tier strategy of statistical analyses was employed and data was randomly and evenly split to both training (n = 569) and validation (n = 570) sets. Using a weighted quantile sum (WQS) regression in the training set and subsequently a multivariate regression in the validation set, we found that NP was the most important chemical to link with early markers of kidney injury, both ACR and NAG. Our findings indicate that short-term exposure to NP is associated with markers of subclinical kidney injury in pregnant women in Taiwan. Further research is warranted to determine whether NP exposure is linked to clinically relevant kidney outcomes.

PMID:40635015 | DOI:10.1186/s12940-025-01201-7

Head Face Med. 2025 Jul 9;21(1):48. doi: 10.1186/s13005-025-00526-5.

ABSTRACT

BACKGROUND: Patients undergoing oral mucosa harvesting for urethroplasty may experience several challenges during recovery like scarring or changes in oral sensitivity, which can lead to long-term discomfort. In this retrospective study long-term donor site complications after harvesting of oral mucosa for urethroplasty were evaluated and a new measurement method for oral volume differences between the non-operated and operated sides was applied.

METHODS: Thirty adult male patients who underwent urethroplasty with buccal mucosa grafting were included. At a median of 43 months after surgery, a standardized questionnaire was used, and clinical examinations were conducted to measure the postoperative elasticity of the buccal mucosa. This measurement compared the non-operated side with the operated side. Additionally, we examined descriptive statistics and the influence of smoking status, diabetes mellitus, immunosuppression, alcohol consumption, and graft size.

RESULTS: In total, 36% of the patients reported persistent subjective postoperative impairments, such as tightness in the oral cavity or numbness. In all patients, a difference in buccal volume was observed between the operated side and the non-operated side. This volume difference ranged from 3 to 15 ml (mean 8.10 ml, SD ± 3.4; p < 0.001). As the size of the harvested transplant increased, the postoperative buccal volume difference also increased significantly (p < 0.001). In one patient, follow-up surgery was required due to the severity of scarring. The presence of diabetes mellitus, immunosuppressive medication, smoking status, and alcohol consumption had no statistically significant effect on postoperative buccal elasticity or mouth opening.

CONCLUSIONS: The use of buccal mucosa grafts for urethroplasty is an established procedure in urology, but the oral harvesting procedure can lead to scarring within the buccal area, which is associated with a statistically significant decrease in buccal volume compared with the non-operated site. The volume analysis was performed by applying a new measurement method, which enables, for the first time, the quantification of oral donor site morbidity.

PMID:40635013 | DOI:10.1186/s13005-025-00526-5

BMC Med Inform Decis Mak. 2025 Jul 10;25(1):257. doi: 10.1186/s12911-025-03094-5.

ABSTRACT

BACKGROUND: Intradialytic Hypotension (IDH) is a frequent complication in hemodialysis, yet predictive modeling is challenged by class imbalance. Traditional oversampling methods often struggle with complex clinical data. This study evaluates an enhanced conditional Wasserstein Generative Adversarial Network with Gradient Penalty (CWGAN-GP) framework to improve IDH prediction by generating high-utility synthetic data for balancing.

METHODS: A CWGAN-GP was developed using multi-level hemodialysis data. Following rigorous preprocessing, including a strict temporal train-test split, the CWGAN-GP generated minority class samples exclusively on the training data. eXtreme Gradient Boosting (XGBoost) models were trained on the original imbalanced data and datasets balanced using the proposed CWGAN-GP method, benchmarked against traditional Synthetic Minority Over-sampling Technique(SMOTE) and Adaptive Synthetic Sampling Approach(ADASYN) balancing. Performance was evaluated using metrics sensitive to imbalance (e.g., Precision-Recall Area Under the Curve) and statistical comparisons, with SHapley Additive exPlanations (SHAP) analysis for interpretability.

RESULTS: The study population consisted of 40 chronic hemodialysis patients (45% male, mean age 66.30[Formula: see text] 10.68 years). An initial dataset, where intradialytic hypotension (IDH) events occurred in 14.85% of records (19,124 instances overall), was temporally split (75:25 ratio). This yielded an Original Training dataset of 95,856 samples (14.73% IDH rate) and a test set (15.21% IDH rate). From this Original Training dataset, a Generative Adversarial Network (GAN) was employed to construct a balanced dataset comprising 163,470 samples. The GAN Balanced dataset yielded the highest predictive performance, demonstrating statistically significant improvements over the Original Training dataset across metrics, including Precision-Recall Area Under the Curve (PR-AUC) (mean 0.735 vs 0.724) and Accuracy (mean 0.900 vs 0.892). In contrast, the GAN Augmented dataset (191,712 samples) showed mixed results (improved Accuracy/F1, decreased Receiver Operating Characteristic Curve Area Under Curve (ROC-AUC)/PR-AUC). In comparison, ADASYN (163,326 samples) and SMOTE (163,470 samples) balanced datasets significantly underperformed on PR-AUC. SHAP analysis identified Dialysis Date (as a proxy for temporal patterns like day-of-week) and hemodynamic indicators (e.g., Systolic Diastolic Difference, Previous Systolic Pressure) as key IDH predictors.

CONCLUSION: The proposed CWGAN-GP framework effectively balances complex hemodialysis data, leading to significantly improved and interpretable IDH prediction models compared to standard approaches. This work supports leveraging advanced generative models like GAN to overcome data imbalance in clinical prediction tasks, which is pending further validation.

PMID:40635002 | DOI:10.1186/s12911-025-03094-5