Nevin Manimala

Nat Med. 2025 Aug 13. doi: 10.1038/s41591-025-03880-8. Online ahead of print.

ABSTRACT

Paranoia is a distressing and prevalent symptom in schizophrenia spectrum disorders. Virtual reality-based cognitive behavioral therapy for paranoia (VR-CBTp) has been proposed to augment behavioral interventions by providing controlled and safe virtual environments in which social situations inducing paranoid anxiety can be manipulated, allowing for new therapeutical possibilities such as gradual exposure and repetition. This assessor-masked, randomized parallel group superiority trial investigated the efficacy of VR-CBTp compared to standard CBTp. Participants were randomized to receive ten sessions of VR-CBTp or CBTp, both on top of treatment as usual. Intention-to-treat analyses included 254 participants (VR-CBTp: n = 126, CBTp: n = 128). Outcomes were assessed at baseline, treatment cessation and follow-up (6 months after treatment cessation). The primary outcome was Ideas of Persecution subscale from the Green Paranoid Thoughts Scale, measured at treatment cessation. There was not a statistically significant between-group difference on the primary outcome at endpoint (effect estimate: 2% in favor of VR-CBTp; 95% confidence interval: -11% to +17%; Cohen’s d = 0.04; P = 0.77, based on exponentiated log-transformed data). No deaths or violent incidents involving law enforcement occurred during the study. In conclusion, VR-CBTp was not superior to CBTp in reducing schizophrenia-spectrum-disorders-related paranoia. ClinicalTrials.gov registration: NCT04902066 .

PMID:40804323 | DOI:10.1038/s41591-025-03880-8

Sci Rep. 2025 Aug 13;15(1):29632. doi: 10.1038/s41598-025-14701-w.

ABSTRACT

Oxidative stress, an imbalance between reactive oxygen species and antioxidants, contributes to chronic diseases. Almonds, rich in vitamin E, polyphenols, and monounsaturated fats, exhibit antioxidant potential, though their overall effects on oxidative biomarkers are unclear. This systematic review and meta-analysis evaluate almond supplementation’s impact on these biomarkers in adults. Following PRISMA guidelines, PubMed, Scopus, and Web of Science were searched up to January 2025. Randomised controlled trials (RCTs) and crossover trials assessing biomarkers of antioxidant and oxidation status (e.g., malondialdehyde [MDA], superoxide dismutase [SOD], glutathione peroxidase [GPx], 8-hydroxy-2′-deoxyguanosine [8-OHdG], uric acid [UA]) were included. Risk of bias was evaluated using the Cochrane Tool, and random-effects models calculated weighted mean differences (WMDs) with 95% confidence intervals (CIs). Eight studies (5 RCTs, 3 crossover trials; n = 424) were included. Almond doses of > 60 g/day significantly reduced MDA (WMD = -0.46, p = 0.002), 8-OHdG (WMD = -5.83, p < 0.001), and UA (WMD = -0.64, p = 0.009), while increasing SOD (WMD = 2.02, p = 0.008). No effect was found for GPx (p = 0.270). High heterogeneity (I² = 92-96%) indicated variability in study design, dosage, and population. Almond supplementation (> 60 g/day) significantly improves oxidation status by reducing MDA, 8-OHdG, and UA while enhancing SOD activity. These findings support almonds as a functional food for oxidation management. However, high heterogeneity underscores the need for standardized trials to confirm optimal dosage, duration, and conditions. Trial registration: Prospero-CRD42025646264.

PMID:40804320 | DOI:10.1038/s41598-025-14701-w

Sci Rep. 2025 Aug 13;15(1):29758. doi: 10.1038/s41598-025-15070-0.

ABSTRACT

Nicotine pouches are becoming increasingly popular. However, there’s still a lack of comprehensive data on how widespread nicotine pouch use and its side effects in Saudi Arabia. This study aims to investigate the prevalence and associated side effects of the use of nicotine pouches among smokers and the public in Saudi Arabia. This study also investigated their utilization in smoking cessation. This study used an online cross-sectional questionnaire-based design. The study population included individuals over the age of 18 living in Saudi Arabia. The questionnaire was distributed through social media platforms. Statistical analysis was conducted using SPSS software. Descriptive statistics were used to generate means and percentages. Regression analysis was performed to predict factors associated with the use of nicotine pouches for the purpose of smoking cessation. A total of 657 participants were included in the analysis. Regarding age distribution, the majority were aged between 18 and 30 years. Most participants were male (422; 64.2%). Regarding the prevalence of nicotine pouches use, (21.2%) had tried the pouches before. Among those who had used nicotine pouches, 57 participants (41.0%) reported success in quitting smoking, while 53 participants (38.1%) experienced only a little success, and 29 participants (20.9%) were unsuccessful. The most common adverse effect was nausea (88, 13.4%), followed by fatigue (44, 6.7%) and headache (43, 6.5%). Participants who smoked 4-6 cigarettes per day, 7-9 cigarettes per day, or more than 10 cigarettes per day had higher odds of nicotine pouch use (OR = 3.70,95% CI = 1.14-11.96, p = 0.02), (OR = 6.74,95% CI = 1.71-26.5, p = 0.006) and (OR = 2.59,95% CI = 1.07-6.26, p = 0.03). This study showed a promising result of the use of nicotine pouches and success in quitting smoking in Saudi Arabia population. Most of the side effects reported in the study were mild. However, future studies with larger sample size and analytical design are needed.

PMID:40804318 | DOI:10.1038/s41598-025-15070-0

Sci Rep. 2025 Aug 13;15(1):29645. doi: 10.1038/s41598-025-12296-w.

ABSTRACT

Tracking the development of disability conditions presents significant challenges due to uncertainty, imprecision, and dynamic health progression patterns. Traditional multi-criteria decision-making (MCDM) techniques often struggle with such complex and fuzzy medical data. To address this gap, we propose a novel classification framework based on Tamir’s complex fuzzy Aczel-Alsina weighted aggregated sum product assessment (WASPAS) approach. This hybrid model incorporates complex fuzzy logic to handle multidimensional uncertainty and utilizes the Aczel-Alsina function for flexible aggregation. We apply this method to evaluate and classify AI-powered predictive models used for monitoring disability progression. The proposed framework not only improves classification accuracy but also enhances decision support in healthcare planning. A case study validates the robustness, sensitivity, and effectiveness of the proposed method in real-world disability tracking scenarios.

PMID:40804312 | DOI:10.1038/s41598-025-12296-w

Eur J Nucl Med Mol Imaging. 2025 Aug 14. doi: 10.1007/s00259-025-07511-9. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the feasibility of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) radiomics in preoperative prediction of visceral pleural invasion (VPI) status in invasive adenocarcinoma (IAC) with a maximum diameter ≤ 3 cm.

MATERIALS AND METHODS: A total of 590 IAC patients with a maximum diameter ≤ 3 cm were enrolled and divided into training set (n = 364), validations set 1 (n = 156) and validation set 2 (n = 70). A conventional model was built based on clinical and PET/CT imaging features by logistic regression. Radiomics features extracted from CT and PET images were screened using interclass correlation coefficients, Pearson correlation analysis and the least absolute shrinkage and selection operator. These selected features were used to calculate the CT and PET rad-scores. Finally, a combined model was constructed using multivariate logistic regression.

RESULTS: Tumor type [odds ratio (OR): 3.258, P = 0.012], distance between tumor and pleura (OR: 0.464, P = 0.001), and maximum standardized uptake value (SUVmax) (OR: 1.109, P = 0.002) were used to construct the conventional model. Ten CT radiomics features and six PET radiomics features were used to establish the CT and PET rad-score models. The area under the curve (AUC) value of the combined model (0.824) was higher than conventional model (0.734), CT rad-score model (0.790) and PET rad-score model (0.748) in the training set, and the differences were statistically significant as tested by Delong test (P < 0.05). In the validation set 1 and validation set 2, the combined model exhibited the highest AUC values (0.835 and 0.787), and the difference between the combined model and PET rad-score model (validation set 1: 0.835 vs. 0.747, P = 0.028; validation set 2: 0.787 vs. 0.657, P = 0.043) and CT rad-score model (validation set 2: 0.787 vs. 0.694, P = 0.025) was statistically significant.

CONCLUSION: The combined model based on PET/CT radiomics is an effective and non-invasive tool for preoperative predicting VPI status in IAC patients.

PMID:40804299 | DOI:10.1007/s00259-025-07511-9

Int J Drug Policy. 2025 Aug 12;145:104937. doi: 10.1016/j.drugpo.2025.104937. Online ahead of print.

ABSTRACT

BACKGROUND: Swedish law states that any handling or use of narcotics, including cannabis, is illegal. Nightlife is known to have high concentrations of illicit drug use and related problems. ‘Clubs against Drugs’ was implemented in 2003 and is a community-based, multi-component prevention program targeting illicit drug use and problems in licensed premises. Previous studies of the program have demonstrated improvements in staff interventions over time.

AIMS: The study evaluated the long-term effects of the program on staff intervention frequency rates of dealing with obviously drug intoxicated patrons.

METHODS: Cross-sectional data was collected in 2023 and compared to earlier assessments conducted in 2003, 2004, and 2008. Three teams, each consisting of two actors and three observers, visited licensed premises with doormen and open until 1 am or later in Stockholm city, Sweden on weekends. Professional male actors (pseudo-patrons) were trained by an expert panel to enact three standardized scenes of intoxication by stimulant drugs.

RESULTS: In 2023, a total of 137 visits were made. The results reveal an intervention rate of 56.9 % [CI 0.49-0.65] which is considerably higher than the 7.5 % [CI -0.01-0.16] at baseline (p < 0.001). However, the rate was lower than that at the 2008 follow-up (65.5 % [CI 0.53-0.78]), although the difference was not statistically significant (p < 0.28).

CONCLUSIONS: The effects of the ‘Clubs against Drugs’ program has been sustained for over 20 years indicated by the high level of staff interventions targeting obviously drug-intoxicated patrons, suggesting consistency in the work with different components of the preventive program.

PMID:40803022 | DOI:10.1016/j.drugpo.2025.104937

ESMO Open. 2025 Aug 12;10(8):105538. doi: 10.1016/j.esmoop.2025.105538. Online ahead of print.

ABSTRACT

BACKGROUND: HRAS mutations define a distinct biologic subset of head and neck squamous-cell carcinoma (HNSCC). There are limited data regarding HRAS-mutant (mut) tumors’ sensitivity to immunotherapy. We sought to evaluate the mutational landscape and transcriptional profile, as well as analyze the tumor microenvironment (TME) of HRAS-mut tumors to provide the conceptual framework for combinatorial treatment approaches.

MATERIALS AND METHODS: We analyzed mutational and transcriptome data from The Cancer Genome Atlas (TCGA). In addition, genomic DNA from baseline tumor biopsies was targeted for sequencing. Our study included 10 patients with HRAS-mut and 40 with HRAS-wild-type (WT) HNSCC. Programmed death-ligand 1 (PD-L1) expression in formalin-fixed paraffin-embedded tumor samples was assessed using the PD-L1 IHC 22C3 pharmDx assay. We characterized subpopulations of exhausted CD8(+) T cells by measuring the expression of T-cell factor-1 (TCF1) and programmed cell death protein 1 (PD-1) in both the center and the periphery of the tumors using multiplex immunohistochemistry, followed by analysis using a manually trained algorithm in QuPath software.

RESULTS: The analysis of TCGA HNSCC mutation and mRNA expression data demonstrated that 6% of HNSCCs harbor mutant HRAS. Transcriptome analysis showed that HRAS-mut HNSCCs are infiltrated by immune cells (CD8A, CD8B, CD2) and have higher expression levels of CXCL11, CXCL10, CXCL9 and CCL4 chemokines. Moreover, the percentage of HRAS-mut samples increased in higher PD-L1 score groups (11% versus 20% versus 100% in tumor positive scores <1%, 1%-49% and ≥50%, respectively, P = 0.006). The analysis of TME showed that HRAS-mut tumors have a statistically significant higher number of total immune cells (5123.17/mm² versus 3527.93/mm², P = 0.002) and a higher percentage of pre-exhausted CD8(+) PD-1(+) TCF1(+) T cells in the periphery (384.67/mm² versus 51.18/mm², P = 0.040) than HRAS-WT tumors.

CONCLUSIONS: HRAS-mut HNSCCs are characterized by a significantly increased number of pre-exhausted PD-1(+) TCF1(+) T cells and PD-L1 expression, suggesting a potential sensitivity to immunotherapy.

PMID:40803018 | DOI:10.1016/j.esmoop.2025.105538

Phys Life Rev. 2025 Aug 8;54:221-224. doi: 10.1016/j.plrev.2025.08.003. Online ahead of print.

NO ABSTRACT

PMID:40803014 | DOI:10.1016/j.plrev.2025.08.003

J Vestib Res. 2025 Aug 13:9574271251367672. doi: 10.1177/09574271251367672. Online ahead of print.

ABSTRACT

ObjectiveThe study aims to assess the high-frequency Vestibulo-Ocular Reflex (VOR) gain across three pairs of semicircular canals using the EyeSeeCam device and to determine normative values.MethodsA total of 105 volunteers, aged 19 to 69 years with no history of vestibular disorders, were enrolled. This cohort included 50 males (mean age 41.11 ± 15.98) and 55 females (mean age 35.52 ± 15.07), with no statistically significant age difference between the genders (P = 0.078). Participants were categorized into six age brackets: 11-20, 21-30, 31-40, 41-50, 51-60, and 61-70. For each test, the recording device was consistently positioned on the left side of the goggles, and the tests were conducted by a right-handed operator.ResultsThe average regression gain for left anterior-right posterior canals (LARP) was 1.44 ± 0.19, significantly surpassing that of right anterior-left posterior canals (RALP) at 1.09 ± 0.13 (p < 0.001) and horizontal semicircular canals (HSC) at 1.11 ± 0.07 (p < 0.001). No significant difference was observed between the VOR gains of RALP and HSC (p = 0.1077). Additionally, VOR gain values did not show significant variation across different age groups. In a gender-based analysis, a marginally higher HSC gain was observed in females (1.13 ± 0.07) compared to males (1.11 ± 0.07; p = 0.042), while no significant gender disparity was noted for RALP gains (females: 1.09 ± 0.11; males: 1.10 ± 0.14; p = 0.641). Females exhibited significantly higher LARP gain values (1.49 ± 0.18) than males (1.41 ± 0.20; p = 0.002).ConclusionThis study underscores the stability of high-frequency VOR gain values across ages. However, it also reveals a significant asymmetry in vertical canal gains (LARP vs RALP), suggesting a possible vertical canals monocular directional preponderance. This finding highlights that normative values can be highly specific to the recording and testing protocol. Thus, laboratories should develop their own normative values, customized to their equipment and testing protocols.

PMID:40803006 | DOI:10.1177/09574271251367672

JMIR Med Inform. 2025 Aug 13;13:e65365. doi: 10.2196/65365.

ABSTRACT

BACKGROUND: Asthma is a chronic inflammatory airway disease requiring long-term management. Artificial intelligence (AI)-driven tools such as large language models (LLMs) hold potential for enhancing patient education, especially for multilingual populations. However, comparative assessments of LLMs in disease-specific, bilingual health communication are limited.

OBJECTIVE: This study aimed to evaluate and compare the performance of two advanced LLMs-ChatGPT-4o (OpenAI) and DeepSeek-v3 (DeepSeek AI)-in providing bilingual (English and Chinese) education for patients with asthma, focusing on accuracy, completeness, clinical relevance, and language adaptability.

METHODS: A total of 53 asthma-related questions were collected from real patient inquiries across 8 clinical domains. Each question was posed in both English and Chinese to ChatGPT-4o and DeepSeek-v3. Responses were evaluated using a 7D clinical quality framework (eg, completeness, consensus consistency, and reasoning ability) adapted from Google Health. Three respiratory clinicians performed blinded scoring evaluations. Descriptive statistics and Wilcoxon signed-rank tests were applied to compare performance across domains and against theoretical maximums.

RESULTS: Both models demonstrated high overall quality in generating bilingual educational content. DeepSeek-v3 outperformed ChatGPT-4o in completeness and currency, particularly in treatment-related knowledge and symptom interpretation. ChatGPT-4o showed advantages in clarity and accessibility. In English responses, ChatGPT achieved perfect scores across 5 domains, but scored lower in clinical features (mean 3.78, SD 0.16; P=.02), treatment (mean 3.90, SD 0.05; P=.03), and differential diagnosis (mean 3.83, SD 0.29; P=.08).

CONCLUSIONS: ChatGPT-4o and DeepSeek-v3 each offer distinct strengths for bilingual asthma education. While ChatGPT is more suitable for general health education due to its expressive clarity, DeepSeek provides more up-to-date and comprehensive clinical content. Both models can serve as effective supplementary tools for patient self-management but cannot replace professional medical advice. Future AI health care systems should enhance clinical reasoning, ensure guideline currency, and integrate human oversight to optimize safety and accuracy.

PMID:40802989 | DOI:10.2196/65365