Nevin Manimala

BMC Med Educ. 2025 Jul 31;25(1):1130. doi: 10.1186/s12909-025-07699-2.

ABSTRACT

BACKGROUND: The aim of the study was to evaluate periodontal treatment success in patients treated by undergraduates. The findings shall be used to gain implications for future curriculum frameworks.

METHODS: In this retrospective cohort study, the medical records of 107 patients (median age 58 years, 48% female) diagnosed with stage III periodontitis who were treated by students were analyzed. Anamnestic and periodontal clinical parameters (bleeding on probing (BOP%), periodontal pocket depths (PD), plaque control record (PCR) were extracted at baseline (T0), re-evaluation (T1, median 3mth), and last SPC visit (T2, median 47mth after T0). The primary outcome was assessing the relative proportion of patients achieving specific treatment endpoints at T1 (EP1 = BOP < 20% and EP2 = ≤ 4site with PD ≥ 5 mm), secondary outcomes included identification of factors influencing these specific endpoints at T1 and T2.

RESULTS: All parameters (BOP, PD, PCR) improved statistically significantly during step 1, 2 and 4 of periodontal therapy. In contrast, a worsening of PCR between T1 and T2 (p = 0.049) was observed. Achieving EP1 at T1 was achieved by 49% of al patients. It was positively affected by being female and negatively by T0 BOP (OR3.90, p = 0.008, OR0.95, p < 0.001), EP2 at T1 was achieved by 29% of all patients and influenced by the number of PD ≥ 6 mm at T0 (OR0.98, p < 0.001). At T2 the relative proportion of patients dropped to 37%(EP1) and 26%(EP2), with EP1 significantly affected by plaque control at T2 (OR0.96, p = 0.003) and EP2 significantly affected by PD ≥ 6 mm at T1 (OR0.69, p < 0.001).

CONCLUSIONS: Non-surgical therapy performed by students significantly improves periodontal outcomes in Stage III periodontitis. Particularly residual pockets and plaque seemed to affect unmet treatment targets.

PMID:40739220 | DOI:10.1186/s12909-025-07699-2

Gynecol Oncol. 2025 Jul 29;200:105-111. doi: 10.1016/j.ygyno.2025.07.021. Online ahead of print.

ABSTRACT

OBJECTIVE: The laparoscopic hysterectomy readmission score (LHRS) was developed to identify patients at low risk for readmission following laparoscopic surgery. Its performance in patients with endometrial cancer (EC), a population increasingly undergoing laparoscopic hysterectomy, remains unassessed, particularly across racial and ethnic groups. This study evaluates LHRS discrimination and calibration in predicting readmission among patients with EC overall and by race and ethnicity.

METHODS: Using the National Surgical Quality Improvement Program database (2014-2020), we identified patients who underwent laparoscopic hysterectomy. The LHRS was calculated as previously described by Jennings et al. Model performance was assessed using the area under the receiver operating curve (AUC), true positive rate (TPR) and false positive rate (FPR). Logistic regression estimated 30-day readmission odds in the overall cohort and by race and ethnicity. The LHRS was analyzed as a continuous (0-8) and dichotomous (<3 vs. ≥3) variable.

RESULTS: Among 27,981 patients with EC (Asian = 1367; American Indian/Alaska Native = 115; Black = 2120; Latine = 1676; Native Hawaiian/Pacific Islander = 305; White = 22,398), readmission rates were low (3.1 %). The LHRS demonstrated poor discrimination, with an AUC only marginally better than chance overall (0.52, 95 % CI = 0.51, 0.53) across all racial and ethnic groups. TPRs and FPRs were uniformly low. Patients with LHRS ≥3 has higher readmission odds (OR = 3.10, 95 % CI = 2.31, 4.15) with similar associations in race and ethnicity-stratified models.

CONCLUSIONS: Although a higher LHRS was associated with increased readmission odds, the score failed to predict readmission better than chance in this EC cohort, underscoring the need for improved risk stratification tools for readmission in this population.

PMID:40737731 | DOI:10.1016/j.ygyno.2025.07.021

Lung Cancer. 2025 Jul 28;206:108682. doi: 10.1016/j.lungcan.2025.108682. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) have shown limited efficacy in EGFR-mutated NSCLC, and their role in later-line settings remains unclear. This study aimed to evaluate the real-world effectiveness of ICI monotherapy compared to chemotherapy in patients with EGFR-mutated NSCLC who had limited remaining treatment options.

METHODS: We conducted a target trial emulation using data from the Cancer Public Library Database under the K-CURE project, which integrates national cancer registry, mortality, medical check-up and health insurance claims data in Korea. Eligible patients were aged ≥ 18 years, had EGFR-mutated NSCLC with progression after both EGFR-TKI and platinum-based chemotherapy, and initiated ICI monotherapy or chemotherapy between August 2017 and December 2020. Propensity score matching was used to balance treatment groups. Overall survival was analyzed using time-dependent statistical methods to account for non-proportional hazards.

RESULTS: Of 1,914 eligible patients, 663 matched pairs were analyzed. While standard Cox analysis showed no significant OS difference (HR 0.91, 95 % CI 0.80-1.03), time-dependent analyses revealed a late survival benefit for ICI beyond 6.8 months (HR 0.72, 95 % CI 0.59-0.88). Subgroup analyses revealed heterogeneous treatment effects, with greater long-term benefits in patients of older age, those with concurrent malignancies, and those without prior osimertinib exposure. Sensitivity analyses suggested a potential role for high PD-L1 expression as a biomarker of ICI response in this setting.

CONCLUSION: ICI monotherapy may offer time-dependent survival benefits over chemotherapy in selected patients with EGFR-mutated NSCLC after standard treatment failure, supporting its consideration in later-line clinical decision-making.

PMID:40737730 | DOI:10.1016/j.lungcan.2025.108682

Cancer Genet. 2025 Jul 26;296-297:182-195. doi: 10.1016/j.cancergen.2025.07.014. Online ahead of print.

ABSTRACT

BACKGROUND: Universal cancer screening based on methylation analysis of circulating cell-free DNA (cfDNA) enables multi-organ cancer detection, thereby reducing all-cause mortality and preventing cancer misdiagnosed by guideline-based cancer-specific screening. This study aims to establish a gene methylation panel for blood-based multi-cancer early detection.

MATERIALS AND METHODS: Bioinformatics analysis and in-house DNA sequencing of various human cancer cell lines and blood from healthy persons were carried out to identify candidate pan-cancer methylation sites. Methylation-sensitive restriction enzymes-quantitative PCR (MSRE-qPCR) was then used for DNA methylation analysis. Blood cfDNA from 103 patients with diverse cancer types and 40 healthy subjects was extracted for methylation analysis.

RESULTS: By bioinformatics analysis and in-house DNA sequencing, we identified two candidates pan-cancer methylation sites, HIST1H4F and CDO1. A long stretch of methylation was found on the promoters of HIST1H4F and CDO1 across various cancer cell lines, while these genomic regions are unmethylated in healthy persons. When tested with clinical samples, the detection sensitivity and specificity of our gene methylation panel in detecting pan-cancer were 47.57 % and 90.00 %, respectively. When analyzed by cancer subtypes, the detection sensitivity was the highest in lung cancer (76.92 %), followed by colorectal cancer (63.64 %) and gastric cancer (50.00 %).

CONCLUSIONS: Our newly established gene methylation panel provides an alternative assay for multi-cancer screening tests. As no bisulfite conversion and invasive procedures are required, it can accelerate cancer diagnosis and streamline the operation for pan-cancer screening.

PMID:40737714 | DOI:10.1016/j.cancergen.2025.07.014

J Am Acad Orthop Surg. 2025 Jul 29. doi: 10.5435/JAAOS-D-25-00062. Online ahead of print.

ABSTRACT

INTRODUCTION: Early exposure to surgical specialties markedly affects medical students’ career interests and preparedness. This study evaluates the effectiveness of a novel Orthopaedic Surgery Summer Immersion Program in fostering interest, enhancing knowledge, and building mentorship connections among medical students.

METHODS: The program targeted rising 2nd-year medical students and provided surgical and clinical shadowing, academic lectures, hands-on workshops, and mentorship opportunities. A mixed-methods approach was used, including pre- and postprogram surveys analyzed for quantitative and qualitative data. Participants self-reported knowledge, skills, and career intentions using Likert scales. Changes in responses were assessed using paired t-tests, with significance set at P < 0.05.

RESULTS: Three years of programming were successfully completed, and survey results were provided for the later 2 programming years, including 2023 summer and 2024 summer. Among 20 survey participants’ self-reported knowledge of musculoskeletal anatomy, physiology, and pathology increased from 4/10 pre-program to 8/10 postprogram (P < 0.001). Subjective confidence in reading radiographic images (4/10 to 9/10, P < 0.001) and performing basic orthopaedic physical examinations (3/10 to 7/10, P < 0.001) also improved. Students’ self-reported operating room etiquette and fundamental surgical principles improved from 5/10 to 8/10 (P < 0.001). Interest in pursuing orthopaedic surgery rose from 50% preprogram to 95% postprogram. Participants rated program effectiveness as 10/10 and 85% reported connecting with at least one potential mentor.

CONCLUSION: The Orthopaedic Surgery Summer Immersion Program markedly enhanced participants’ self-reported knowledge, skills, and career intentions in orthopaedics. Statistically significant improvements in educational outcomes and mentorship highlight the program’s value as a replicable model for introducing medical students to orthopaedic surgery and addressing gaps in early musculoskeletal education.

PMID:40737701 | DOI:10.5435/JAAOS-D-25-00062

JMIR Med Educ. 2025 Jul 30;11:e72495. doi: 10.2196/72495.

ABSTRACT

BACKGROUND: Traditional laboratory teaching of pathogenic cocci faces challenges in biosafety and standardization across medical specialties. While virtual simulation shows promise, evidence from large-scale, multidisciplinary studies remains limited.

OBJECTIVE: The study aims to evaluate the effectiveness of integrating virtual simulation with traditional laboratory practice in enhancing medical microbiology education, focusing on the identification of biosafety level 2 pathogenic cocci. The study assessed improvements in student performance, theoretical understanding, laboratory safety, and overall satisfaction, while achieving standardization and cost reduction across multiple medical specialties.

METHODS: This randomized controlled trial involved 1282 medical students from 9 specialties. The experimental group (n=653) received virtual simulation training-featuring interactivity and intelligent feedback-prior to traditional laboratory practice, while the control group (n=629) did not receive such training. Our virtual system focused on biosafety level 2 pathogenic cocci identification with dynamic specimen generation.

RESULTS: The experimental group showed significantly improved performance across specialties (P<.05 for each specialty), particularly in clinical medicine, in which the experimental group score was 89.88 (SD 13.09) and the control group score was 68.34 (SD 17.23; P<.001). The students reported that virtual simulation enhanced their theoretical understanding (1268/1282, 98.9%) and laboratory safety (1164/1282, 90.8%) while helping them achieve standardization (790/1282, 61.6%,) and cost reduction (957/1282, 74.6%). Overall student satisfaction reached 97.2% (1246/1282), with distinct learning patterns observed across specialties. The test scores were significantly higher in the experimental group, with a mean of 80.82 (SD 17.10), compared to the control group, with a mean of 67.45 (SD 16.81).

CONCLUSIONS: This large-scale study demonstrates that integrating virtual simulation with traditional methods effectively enhances medical microbiology education, providing a standardized, safe, and cost-effective approach for teaching high-risk pathogenic experiments.

PMID:40737700 | DOI:10.2196/72495

Chaos. 2025 Jul 1;35(7):073153. doi: 10.1063/5.0269914.

ABSTRACT

Recording (multidimensional) time series from dynamical systems in experiments or numerical studies on coupled systems is common. In many cases, we want to find relationships between systems or subsystems, but multidimensional data prevent simple graphical tests. We here develop statistics that test the data for basic, fundamental relationships, like the existence of continuous functions between the subsystems. These are common fundamental questions that should be answered before diving into function fitting and other data handling schemes since lacking continuity and, possibly, smoothness in data relations guarantees that other more specific data fitting attempts will fail or be meaningless. We develop useful testing statistics by creating data-driven versions of basic topological concepts including continuity, differentiability, point set distance comparisons, diffeomorphisms, and embeddings. As an application we show how such statistics can aid in the analysis of the dynamics of reservoir computer systems, many of which rely on there being specific relations (like embeddings) between the drive and the reservoir computer.

PMID:40737694 | DOI:10.1063/5.0269914

Chaos. 2025 Jul 1;35(7):073150. doi: 10.1063/5.0276714.

ABSTRACT

Phase reduction is an effective theoretical and numerical tool for studying the synchronization of coupled deterministic oscillators. Stochastic oscillators require new definitions of the asymptotic phase. The Q-function, i.e., the slowest decaying complex mode of the stochastic Koopman operator (SKO), was proposed as a means of phase reduction for stochastic oscillators. In this paper, we show that the Q-function approach also leads to a novel definition of “synchronization” for coupled stochastic oscillators. A system of coupled oscillators in the synchronous regime may be viewed as a single (higher-dimensional) oscillator. Therefore, we investigate the relation between the Q-functions of the uncoupled oscillators and the higher-dimensional Q-function for the coupled system. We propose a definition of synchronization between coupled stochastic oscillators in terms of the eigenvalue spectrum of Kolmogorov’s backward operator (the generator of the Markov process, or the SKO) of the higher-dimensional coupled system. We observe a novel type of bifurcation reflecting (i) the relationship between the leading eigenvalues of the SKO for the coupled system and (ii) qualitative changes in the cross-spectral density of the coupled oscillators. Using our proposed definition, we observe synchronization domains for symmetrically coupled stochastic oscillators that are analogous to Arnold tongues for coupled deterministic oscillators.

PMID:40737692 | DOI:10.1063/5.0276714

JMIR Form Res. 2025 Jul 30;9:e64602. doi: 10.2196/64602.

ABSTRACT

BACKGROUND: Wearable Internet of Things (IoT) devices are powerful tools for remotely collecting intensive longitudinal data. The TDK Silmee W22, a wristband-type wearable IoT device with a built-in 3-axis acceleration sensor, provides minute-by-minute physical activity data such as estimated metabolic equivalents (METs) and step counts. These measurements can be aggregated to daily estimates; however, their accuracies have not been fully explored in adults under free-living settings.

OBJECTIVE: This study aims to assess the agreement between the TDK Silmee W22 and the research-grade activity monitor, ActiGraph wGT3X-BT, in estimating daily steps and time spent in moderate to vigorous physical activity (MVPA ≥3 METs) in adults under free-living settings.

METHODS: A convenience sample of young to older adults was recruited from communities across several prefectures in Japan. Participants concurrently wore a TDK Silmee W22 on their nondominant wrist and an ActiGraph wGT3X-BT on the left side of the waist during waking hours for 7 consecutive days. Data were aggregated to daily steps and time spent in MVPA (≥1952 vertical axis counts/minute for ActiGraph) for each participant. A valid day was defined as having ≥ 10 hours of accumulated ActiGraph wear time with ≥100 and <50,000 accumulated steps from both devices. Each valid day was classified as either an active day (≥10,000 steps/day or ≥21.4 minutes MVPA per day) or an inactive day. Bland-Altman plots combined with multilevel analysis and κ statistics were used to assess the agreement between physical activity estimates from the devices.

RESULTS: A total of 129 participants (n=66, 51.2% women) aged 23-89 years provided the final dataset of 884 observations (5 to 7 daily observations/participant). The TDK Silmee W22 estimated an overall mean of 6369 (SE 242) steps/day and 40.3 (SE 1.9) minutes/day spent in MVPA. Although Bland-Altman plots suggested no obvious proportional bias, fixed biases were observed; the TDK Silmee W22 estimated -1203 steps/day (95% limits of agreement [LoA] -4202 to 1796) and +5 minutes/day (LoA-23 to 34) spent in MVPA compared with those estimated by the ActiGraph wGT3X-BT. TDK Silmee W22 and ActiGraph wGT3X-BT, respectively, classified 14% and 23.1% as active by daily step counts (κ=0.65, 95% CI 0.59-0.72), and 70.4% and 60.9% as active by daily time spent in MVPA (κ=0.64, 95% CI 0.59-0.69), both indicating moderate agreement.

CONCLUSIONS: TDK Silmee W22 underestimated step counts and overestimated time spent in MVPA compared with the research-grade ActiGraph wGT3X-BT, which may lead to misclassification of active and inactive days. Caution is warranted when using TDK Silmee W22 data over relatively short periods, as discrepancies-particularly when compared with research-grade monitors-may affect feedback or goal setting.

PMID:40737677 | DOI:10.2196/64602

Georgian Med News. 2025 May;(362):209-213.

ABSTRACT

INTRODUCTION AND OBJECTIVE: The relationship between thyroid hormones and glucose metabolism is complex. Thyroid hormones, particularly triiodothyronine (FT3) and thyroxine (FT4), play crucial roles in regulating basal metabolic rate, lipid metabolism, and glucose homeostasis. Alterations in these hormones can influence insulin sensitivity and secretion. This study aims to evaluate serum TSH, FT3, FT4, and fasting blood glucose levels to demonstrate the association between thyroid dysfunction and T2DM.

METHODOLOGY: This study included 219 male and female participants aged 23 to 74 years; 149 patient participants diagnosed with T2DM using the American Diabetes Association’s (ADA) criteria compared with 70 non-diabetic patients. Thyroid function tests, including serum Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (FT3), and Free Thyroxine (FT4) levels, were performed. The patients divided into three age groups based on WHO age group classification: Young Adults (23-30), Middle-aged adults (31-45) and Old-aged adults (>45). Statistical analysis by SPSS 26 used to determine the relationship between fasting blood glucose and thyroid hormone levels.

RESULTS: This study conducted on 219 diabetic and non- diabetic patient males and females 149 males and females’ diabetics compared with 70 males and females with non- diabetes mullites disease, age of two groups between 23- 74 years and classified into three groups young adults, middle-aged adults, and old-aged adults. Observed from these results significant difference in the mean levels of FBG in the diabetic patients (116.4±21.1 mg/dL) compared to non-diabetic individuals (96.7±14.1 mg/dL) with a P value=0.031. TSH levels were significantly lower in diabetic patients (2.18±0.97 µIU/mL) than in non-diabetics (3.05±1.09 µIU/mL; P value=0.029). The results showed significant elevated of FT3 levels in diabetic patients (1.81±0.52 pg/mL) compared to non-diabetic’s individuals (1.35±0.25 pg/mL; P value=0.048). Also, FT4 levels significantly higher in the diabetic patients (114±17.7 ng/L) compared to the non-diabetic individuals (107±18.4 ng/L; P value=0.018). These results demonstrated that diabetes mellitus play important role associated with changed in both glucose metabolism and thyroid hormone profiles.

CONCLUSION: Significant differences in fasting blood glucose and thyroid hormone levels between the diabetic and non-diabetic patients were observed in this study. The correlation between diabetes, thyroid and glucose metabolism was demonstrated by a negative correlation with TSH and positive correlations with FT3, FT4, and glucose.

PMID:40737671