Nevin Manimala

BMC Pediatr. 2025 Apr 14;25(1):290. doi: 10.1186/s12887-025-05586-9.

ABSTRACT

OBJECTIVE: To retrospectively investigate the utilization patterns and clinical indications of acupuncture within the pediatric population in general hospitals from 2015 to 2020, including disease spectrum characteristics and relevance to pediatric subspecialties.

METHODS: The clinical data of pediatric inpatients consulted by Acupuncture-Moxibustion and Tuina Department of Qilu Hospital of Shandong University was collected from January 1, 2015, to December 31, 2020. The data collected include the number of wards in which consultation was requested, the diseases that require consultation, the distribution of pediatric tertiary disciplines and the system of disease affiliation.

RESULTS: This study summarizes 55 types of pediatric diseases treated with acupuncture. The most common health issues addressed include peripheral facial paralysis, diarrhea, reduced limb mobility or decreased muscle strength, postoperative bloating, and Guillain-Barré syndrome. Acupuncture is utilized across all pediatric subdisciplines, with notable applications in neurology, critical care medicine, general surgery, respiratory medicine, and orthopedics. The classification of diseases for acupuncture consultations primarily focuses on disorders of the nervous system, respiratory system, neoplasms, and digestive system (according to ICD-11).

CONCLUSIONS: In summary, acupuncture has a broad range of applications in the treatment of pediatric diseases and can serve as a valuable complementary and alternative therapy. The advancement of Traditional Chinese Medicine (TCM) acupuncture in general hospitals is closely linked to the involvement of pediatric practices. The findings of this study provide valuable insights for clinical practice, acupuncture education, pediatric healthcare systems, and social research.

PMID:40223074 | DOI:10.1186/s12887-025-05586-9

BMC Oral Health. 2025 Apr 13;25(1):564. doi: 10.1186/s12903-025-05895-6.

ABSTRACT

BACKGROUND: Ni-Ti instruments with varying design features may lead to different levels of postoperative pain, which is a significant clinical concern, particularly in previously asymptomatic teeth. Therefore, the purpose of this randomized clinical trial is to compare postoperative pain following instrumentation with TruNatomy versus ProTaper Next Ni-Ti systems in mandibular molars with asymptomatic apical periodontitis.

METHODS: 90 healthy participants were randomly assigned to two groups: TruNatomy (TN) or ProTaper Next (PTN) instruments. After single-visit root canal treatments, participants were asked to rate their postoperative pain levels at 6, 12, 24, 48, and 72 h and seven days later, using the Numerical Rating Scale (NRS) through an online questionnaire. In cases of pain, 400 mg of ibuprofen was prescribed. Data from 80 participants were finally included in the analysis. Data were analyzed using the Mann-Whitney U, Friedman, and Fisher’s Chi-Square tests (p < 0.05).

RESULTS: There was no statistically significant difference in postoperative pain intensity at 6, 12, 24, and 48 h and seven days between the groups (p > 0.05). At the 72-hour time point, TN group showed statistically higher postoperative pain intensity (p < 0.05). No statistically significant differences in the incidence of postoperative pain were observed at any of the time points (p > 0.05). Analgesic intake and flare-up incidence were not significantly different between the groups (p > 0.05).

CONCLUSION: Postoperative pain levels were not significantly influenced by the type of rotary Ni-Ti instrument. Both TN and PTN instruments led to low-level and similar postoperative pain intensity, minimal analgesic use, and a low incidence of flare-ups in teeth with asymptomatic apical periodontitis.

TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06545773, Registration Date 8 August 2024 (retrospectively registered).

PMID:40223067 | DOI:10.1186/s12903-025-05895-6

BMC Oral Health. 2025 Apr 13;25(1):560. doi: 10.1186/s12903-025-05961-z.

ABSTRACT

OBJECTIVES: Mini implant retained overdentures have been treated in edentulous patients with promising long-term results. However, various attachment systems in this process remain insufficiently investigated. This systematic review and meta-analysis aimed to compare the effects of the ball and other attachments used in mini-implant overdentures. Marginal bone loss, bite force, implant survival rate, prosthetic maintenance, and complications were assessed.

MATERIALS AND METHODS: A systematic search was conducted across PubMed, Cochrane Library, and Scopus databases until 25th February 2025. This systematic review aimed to find studies that compare ball attachments with other attachment systems in mini dental implant (MDI) overdentures. The primary outcome was marginal bone loss, while the secondary outcomes were maximum bite force, implant survival rate, prosthetic maintenance, and complications. The risk of bias was assessed using the Cochrane risk-of-bias tool for RCTs, and a quantitative meta-analysis was performed.

RESULTS: Of the 561 publications, six randomized clinical trials (101 participants, 234 mini-implants) met the inclusion criteria. Risk of bias assessment revealed three studies with a low risk of bias and three studies with some concerns for risk of bias. There was no significant difference in the marginal bone loss between the ball attachments and others (WMD = 0.15, 95% CI -0.50 to 0.81, p = 0.65), though ball attachments performed better than telescopic ones (P < 0.05) in subgroup analysis. No significant difference in bite force was found (WMD = -5.29, 95% CI -33.46 to 22.87, p = 0.71). Two-year survival rates were 90.9% for ball and 97.8% for bar attachments. The ERA^® (Extra-Coronal Resilient Attachment) group required five interventions (sore spot adjustments, relining, nylon replacements), while the ball attachment group required only two (denture repair, nylon cap replacement) over the one-year follow-up period.

CONCLUSIONS: Within the limitations of the study, it can be concluded that ball, bar, and ERA^® attachments yield similar outcomes in marginal bone loss while telescopic attachments show more statistically significant marginal bone loss (p < 0.05). The type of attachment does not significantly affect maximum bite force.

PROSPERO REGISTRATION NUMBER: CRD42024610018.

PMID:40223059 | DOI:10.1186/s12903-025-05961-z

BMC Oral Health. 2025 Apr 13;25(1):563. doi: 10.1186/s12903-025-05955-x.

ABSTRACT

PURPOSE: To evaluate the influence of guide support on the accuracy of sCAIS using a keyless guiding system in different cases of partial edentulism.

METHODS: Sixty polyamide models of partially edentulous maxillae, simulating anterior and posterior single-tooth gaps as well as anterior and distal extended edentulous areas, were fabricated. Full-arch, 2-teeth, and 4-teeth supported surgical guides were used to place implants at FDI 15, 17, 21, 26 sites in Model A and at FDI 12, 22, 15 sites in Model B. In total, 210 replica implants were placed using 120 surgical guides in seven implantation sites. Three-dimensional crestal and apical, angular and vertical deviations from the planned implant positions were compared using the Kruskal-Wallis H test with Dunn’s procedure for multiple pairwise comparisons.

RESULTS: Overall median 3D crestal and apical deviations of implants placed with 2-teeth guide support (0.62 mm [0.45-0.84], 0.92 mm [0.69-1.25]) and 4-teeth guide support (0.65 mm [0.52-0.81], 1.01 mm [0.8-1.26]) were significalty lower compared to the full-arch support group (0.86 mm [0.63-0.98], 1.26 mm [0.98-1.52]) with values of p < 0.017. Overall angular and vertical deviations of implants placed with 2-teeth guide support (2.61° [1.71-3.75], 0.32 mm [0.15-0.44]) were significantly lower compare to the full-arch support group (3.22° [2.25-4.41], 0.46 mm [0.24-0.62]). In the subgroup analysis, implants placed at the FDI 12, 22, and 15 positions exhibited significantly higher 3D and angular deviations with full-arch guide support, whereas the 3D apical and angular deviations of were significantly lower with 2-teeth guide support at the FDI 21 site.

CONCLUSIONS: The deviations in all guide support groups did not exceed the recommended safety margins. Statistically significant differences were found between guide support groups, with influence of guide support on the accuracy of sCAIS varying across different implantation sites.

TRIAL REGISTRATION: Not applicable.

PMID:40223057 | DOI:10.1186/s12903-025-05955-x

BMC Med. 2025 Apr 14;23(1):214. doi: 10.1186/s12916-025-04028-8.

ABSTRACT

BACKGROUND: Public adherence to cancer screening remains low and is influenced by both rational and non-rational factors, including decision biases that underestimate screening benefits. Digital nudge interventions have shown promise in promoting screening behaviors among at-risk populations, but systematic evidence is still lacking. This study aims to synthesize the effects of digital nudge interventions on promoting cancer screening behaviors in high-risk individuals.

METHODS: A systematic search of 10 electronic databases was conducted, and studies published before April 1, 2024, were included. Eligible studies were randomized controlled trials (RCTs) that compared the effects of digital nudge interventions on cancer screening behavior with those of a control group and reported at least one outcome. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Data on cancer screening uptake rates were pooled using a random-effects model. Subgroup analyses were performed for cancer types, intervention media, delivery conditions, and sensitivity. The study identified digital nudge strategies via the MINDSPACE framework and explored their influence on screening behavior through the HSM.

RESULTS: Of the 14 randomized controlled trials included, 10 reported statistically significant results. The types of interventions in these studies were heterogeneous and available across multiple delivery channels based on the web, computer programmes, DVDs, telephones, patient navigation, or apps that tailored or served interactive information to participants to better understand screening risks and options. A random-effects model showed that digital nudge intervention strategies significantly improved adherence to cancer screening behavior (OR = 1.81, 95% CI = 1.35-2.44, p < 0.001). Differences between cancer types, intervention media, and delivery conditions were noted. Based on the MINDSPACE framework and HSM, eight nudge strategies were designed to promote screening behaviors, with the most common being the default strategy (n = 9). Most nudge tools were designed to leverage unconscious System 1 thinking, aiming to influence behavior in a more spontaneous and subtle way.

CONCLUSIONS: While digital nudge interventions have demonstrated significant positive effects in promoting early cancer screening participation among high-risk individuals, their impact varies. More robust research is needed to address methodological limitations and facilitate broader adoption and application of these interventions.

PMID:40223053 | DOI:10.1186/s12916-025-04028-8

BMC Ophthalmol. 2025 Apr 14;25(1):203. doi: 10.1186/s12886-025-04041-8.

ABSTRACT

PURPOSE: To evaluate the pupillary dynamics in patients with serum vitamin D (25(OH)-D) levels below normal and compared with healthy controls.

METHODS: This study included 132 patients and 76 healthy controls. Serum 25(OH)-D concentrations within the range of 10 to 30 ng/mL were classified as vitamin D insufficiency (VDI, Group 1), while those at or below 10 ng/mL were categorized as vitamin D deficiency (VDD, Group 2). The static phase of pupillometry, including scotopic, mesopic, and photopic pupil diameters, was evaluated. Additionally, in the dynamic phase of pupillometric evaluation, pupil dilation velocity (mm/sec) was calculated. These values were compared between patient and control groups.

RESULTS: In static pupil diameters, only photopic pupil diameters were significantly different between Groups 1 and 2 compared to the control group (p = 0.012 and p = 0.008, respectively). In dynamic measurements, the pupil diameter values showed a statistically significant difference between the patient and control groups (p = 0.003). In intragroup comparison, the mean pupil diameter was 3.42 ± 0.81 mm in group 1 and 3.94 ± 0.96 mm in group 2 (p = 0.029). Mean pupil dilation velocity was significantly slower in the patient group (p < 0.001). In intragroup comparison, the mean pupil dilation velocity was 0.162 ± 0.049 mm/sec in group 1 and 0.088 ± 0.032 mm/sec in group 2 (p < 0.001).

CONCLUSION: We demonstrated that VDD alters pupillary functions with objective measurements. Our study may shed light on the role of vitamin D in multisystemic diseases since it is expressed in many tissues and has multiple functions. Multicenter studies with a large number of participants are needed in the future.

PMID:40223050 | DOI:10.1186/s12886-025-04041-8

BMC Oral Health. 2025 Apr 13;25(1):557. doi: 10.1186/s12903-025-05964-w.

ABSTRACT

BACKGROUND: Titanium is commonly used for dental implants due to its high biocompatibility and durability. However, concerns about metal ion release and aesthetic limitations in certain tissue biotypes have driven the search for alternative materials. Polyetherketoneketone (PEKK), a high-performance polymer, has emerged as a promising option due to its biomimetic properties. Surface modifications, such as treatment with sulfuric acid (H2SO4), may further enhance its osteogenic potential.

AIM: The study aimed to evaluate the osteogenic efficacy of H2SO4-modified PEKK implants in comparison to titanium implants.

METHODOLOGY: Three groups were assessed: Titanium, unmodified PEKK and H2SO4-modified PEKK(SPEKK). Surface characteristics were analyzed using scanning electron microscopy (SEM). Wettability was checked through contact angle evaluation. Cell viability was evaluated through MTT assays. Implants were placed in rat mandibles, and bone formation was analyzed after 6 weeks using nano-CT and histological assessments. Toxicity was as Statistical comparisons were performed using one-way ANOVA and Tukey’s post-hoc test.

RESULTS: Acid-modified PEKK implants exhibited the highest bone formation (280.09 ± 12.03) significantly outperforming Titanium (265.12 ± 11.08) and unmodified PEKK (266.52 ± 7.28) (p < 0.05).

CONCLUSIONS: H2SO4-modified PEKK (SPEKK) implants demonstrated superior osteogenic properties compared to titanium, suggesting that these modified polymers could be viable alternatives for aesthetic implants.

PMID:40223045 | DOI:10.1186/s12903-025-05964-w

J Holist Nurs. 2025 Apr 13:8980101251330394. doi: 10.1177/08980101251330394. Online ahead of print.

ABSTRACT

Purpose: The purpose of this study is to evaluate if integrating a holistic mindfulness modality into group therapy can decrease violence with-injury on an inpatient psychiatric unit. Design: The research used a mixed experimental design. Method: Allied Therapy Services (ATS) staff was trained in the mindfulness modality Brief Intentional Grounding and implemented it within group therapy twice daily in two different acute psychiatric units. Six months of post-intervention data on workplace violence with-injury incidents was compared to 6-month pre-intervention statistics on workplace violence with-injury. Qualitative data included patient and staff surveys on benefits of the intervention. Findings: The study revealed the use of Brief Intentional Grounding correlated with a significant reduction in workplace violence with-injury in two adult acute inpatient psychiatric units over a 6-month period when compared to the previous six months. The qualitative survey-data showed significant improvement in patients’ emotional regulation, ability to manage stress, interpersonal connectivity, and gratitude after practicing Brief Intentional Grounding. Furthermore, staff reported practicing Brief Intentional Grounding was beneficial and improved their well-being. Conclusions: Integrating Brief Intentional Grounding into group therapy on an acute adult inpatient psychiatric unit improved patients’ ability to regulate their emotions and led to reductions in violence with-injury, providing a safer work environment for nursing staff.

PMID:40221990 | DOI:10.1177/08980101251330394

J Parkinsons Dis. 2025 Apr 13:1877718X251323914. doi: 10.1177/1877718X251323914. Online ahead of print.

ABSTRACT

BackgroundParkinson’s disease (PD) has marked phenotypic variability. Increased lipids have been suggested as being neuroprotective whilst hyperglycemia may increase α-synuclein aggregation.ObjectiveWe have tested whether high total cholesterol and high-density lipoprotein cholesterol (HDL-C) and low levels of fructosamine are associated with better PD phenotypes and predict less rapid progressionMethodsNon-fasting serum HDL-C, total cholesterol, and fructosamine were measured at baseline in 866 patients with early PD (median duration, 0.96; IQR, 0.43-1.98 years) from the Oxford Discovery cohort. These biomarkers were compared against our data-derived PD subtypes using multinomial logistic regression. We used multilevel models to predict longitudinal motor and non-motor outcomes (e.g., cognition, mood).ResultsHDL-C and total cholesterol differed across baseline PD phenotype clusters, with reduced levels associated with the most severe motor and non-motor phenotypes (psychological well-being, cognitive impairment, REM sleep behavior disorder, and daytime sleepiness). Higher HDL-C and total cholesterol, although the latter was attenuated after adjustment for statin use, were associated with better baseline activities of daily living (e.g., UPDRS-II score with 1 SD increase in HDL-C -0.74, 95%CI -1.22 to -0.26, p = 0.002) and non-motor features. Neither predicted the rate of motor or non-motor progression. Fructosamine levels were not associated with phenotypic variability or rate of disease progression.ConclusionsHypercholesterolemia was associated with a better motor/non-motor disease subtype and daily living impairment at presentation, but did not predict longitudinal change. Future research needs to determine if these associations are causally related or secondary to disease onset by examining prodromal subjects.

PMID:40221968 | DOI:10.1177/1877718X251323914

Stat Methods Med Res. 2025 Apr 13:9622802241313283. doi: 10.1177/09622802241313283. Online ahead of print.

ABSTRACT

Balancing influential covariates is crucial for valid treatment comparisons in clinical studies. While covariate-adaptive randomization is commonly used to achieve balance, its performance can be inadequate when the number of baseline covariates is large. It is, therefore, essential to identify the influential factors associated with the outcome and ensure balance among these critical covariates. In this article, we propose a novel adaptive randomization approach that integrates the patients’ responses and covariates information to select sequentially significant covariates and maintain their balance. We establish theoretically the consistency of our covariate selection method and demonstrate that the improved covariate balancing, as evidenced by a faster convergence rate of the imbalance measure, leads to higher efficiency in estimating treatment effects. Furthermore, we provide extensive numerical and empirical studies to illustrate the benefits of our proposed method across various settings.

PMID:40221962 | DOI:10.1177/09622802241313283