Nevin Manimala

Front Neurol. 2025 May 13;16:1589742. doi: 10.3389/fneur.2025.1589742. eCollection 2025.

ABSTRACT

INTRODUCTION: Blast injuries and subclinical effects are of significant concern among those Service Members (SMs) participating in military operations and tactical trainings. Studies of SMs repeatedly exposed during training find concussion-like symptomology with transient decrements in neurocognitive performance, and alterations in blood biomarkers. How prior mild TBI (mTBI) history interacts with low-level blast (LLB) exposure, however, remains unexplored, which we investigate in the present study, to identify interindividual biomarker changes from LLB exposures influenced by prior history of mTBI.

METHODS: Gene transcript and amyloid-beta (Aβ40 and Aβ42) protein levels were assayed using timeseries blood specimens collected at pre-blast, post-blast (within ~1 h), and follow-up-blast (~16 h) after LLB exposure for 30 SMs (age 30.3 ± 7.5) via RNA-seq and Single Molecule Array (SIMOA). Statistical models with timepoint and mTBI status interaction adjusted for age were used, and p-values adjusted for multiple testing.

RESULTS: We found enrichment of genes involved in blood brain barrier, inflammatory, and immune responses associated with blast exposure, with significant elevated expression of target genes among SMs with mTBI history. Levels of Aβ40 and Aβ42 did not differ pre-blast vs. post/follow-up-blast LLB exposure when comparing SMs by prior mTBI history. Aβ40 and Aβ42 levels were significantly decreased in response to blast at the follow-up (~16 h) LLB exposure timepoint, concomitant with elevated expression of genes involved in amyloid-beta regulation and clearance in SMs with mTBI.

CONCLUSION: Findings show inter-individual differences in biomarker levels following exposures to blast that may be attributed to prior mTBI history.

PMID:40433620 | PMC:PMC12106048 | DOI:10.3389/fneur.2025.1589742

Front Neurol. 2025 May 13;16:1579909. doi: 10.3389/fneur.2025.1579909. eCollection 2025.

ABSTRACT

BACKGROUND: Brain injury is a major public health issue causing cognitive impairment. Key types include traumatic, ischemic, neurological, infectious, metabolic injuries, and stroke. As populations age, brain injury rates rise, making effective cognitive rehabilitation methods increasingly urgent. Virtual reality sports games, blending immersion and training, offer a new rehab solution.

METHODS: Firstly, we registered in the International Prospective Systematic Review Registry (PROSPERO) website. A total of 12 randomized controlled trials were included in this Meta-analysis. Data were analyzed by Meta-analysis using the random effects model in State statistical software. The primary outcome indicator of the study was cognitive function.

RESULTS: This study included 12 RCTs with 540 participants to evaluate the impact of virtual reality exercise on cognitive function in brain-injured patients. The analysis revealed significant cognitive improvement with an SMD of 0.88 (95% CI: 0.59, 1.17), p = 0.019, and I² = 51.9% using a random effects model. Sensitivity analysis confirmed robust findings with no significant single study effects. Symmetric funnel plots indicated no publication bias. These results support virtual reality as an effective cognitive intervention for brain-injured patients.

CONCLUSION: Virtual reality (VR) sports games significantly enhanced cognitive function, coordination, and reaction speed in brain-injured patients, thereby boosting their learning motivation and engagement.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024581533.

PMID:40433613 | PMC:PMC12108802 | DOI:10.3389/fneur.2025.1579909

BMC Oral Health. 2025 May 27;25(1):813. doi: 10.1186/s12903-025-05866-x.

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the Fractal Dimension (FD) of bone structure in different regions of the mandible and investigate its relationship with serum intact parathyroid hormone (iPTH) and other serum analytes in a population of male patients with end-stage renal disease who will undergo kidney transplantation due to chronic kidney disease (CKD).

METHODS: The study included a total of 65 male CKD patients (130 jaws) and 15 healthy male individuals (30 jaws), with FD calculated from four different regions of interest (ROIs) on panoramic radiographs using the box-counting method. The mean age of the patients was 39.02 years (range 18-70). The mean age of individuals in the control group was 37.13 years (range 32-41). Serum biomarkers including serum total calcium (Ca), inorganic phosphorus (P), estimated glomerular filtration rate (eGFR), and iPTH were recorded, and patients were stratified into subgroups based on iPTH levels. Statistical significance was determined at p < 0.05.

RESULTS: It was observed that as the severity of CKD increased, the blood P levels rose while eGFR decreased compared to reference values. Despite the decrease in Ca levels with the progression of CKD severity, the mean Ca levels remained within the reference range. Additionally, as iPTH levels increased, the severity of CKD also increased. Statistically significant differences were found between the control group and each subgroup of iPTH for ROI-1, ROI-2, and ROI-3 regions (p < 0.05). When examining FD values in CKD patients, it was found that FD values in ROI-1 (Mean: 1.303), ROI-2(Mean: 1.301), and ROI-3 (Mean: 1.157), regions were lower than those in the control group (ROI 1 Mean:1.494 / ROI 2 Mean:1.448 / ROI 3 Mean:1.248) (p < 0.05). Furthermore, as iPTH levels increased, lower FD values in different regions of the mandible compared to the control group were observed.

CONCLUSION: FD measurements in panoramic radiographs by dental professionals could be used to determine the severity of CKD in addition to the iPTH scale. Furthermore, correlating Ca, P, and PTH levels with bone morphology can contribute to understanding bone metabolism in these patients and to the development of personalized approaches to treatment.

CLINICAL TRIAL NUMBER: Not applicable- retrospective analysis.

PMID:40426186 | DOI:10.1186/s12903-025-05866-x

BMC Nutr. 2025 May 27;11(1):104. doi: 10.1186/s40795-025-01065-7.

ABSTRACT

BACKGROUND: Minimum Dietary Diversity for Women (MDD-W) has been identified as a promising indicator for monitoring diets globally. MDD-W questionnaires have been integrated into, amongst others, the Demographic and Health Surveys (DHS) and the Gallup World Poll (GWP). Disagreement between estimates of healthy diet metrics for the same country collected in the same year is not desirable.

OBJECTIVES: To determine the measurement agreement of MDD-W estimates collected through DHS and GWP (i.e., precision), to assess the impact of survey characteristics on potential discordance, and to examine the comparative validity of the brief data collection instruments used to estimate MDD-W (i.e., accuracy).

METHODS: Using meta-data from DHS and GWP, we quantified the percentage points (pp) difference in food group consumption and MDD-W prevalence. Furthermore, we qualitatively examined the differences of four survey characteristics: food groups and sentinel foods used in the MDD-W questionnaire, sampling framework, survey timing, and data collection modality. In addition, using data from two non-inferiority studies in Ethiopia – which used either a weighed food record (WFR) or quantitative 24-hour recall (24-HR) as the reference method – we simulated the total magnitude of errors associated with non-quantitative open or list-based 24-HRs, and subsequently compared the pp differences in simulated food group consumption and MDD-W prevalence.

RESULTS: MDD-W estimates from the GWP were significantly higher than those from the DHS in five of nine country-year sets, one difference was non-significant, and three estimates could not be statistically compared due to lack of reporting on margins of error. The absolute difference between MDD-W estimates from the DHS and GWP were >|5| pp for all country-year sets (range: -17 to + 21 pp). There was poor agreement between the DHS and GWP questionnaires regarding the choice and number of sentinel foods used for each food group in the same country (range: 21 to 65%). In general, GWP data collection covered fewer months and questionnaires were enumerated in fewer languages than the DHS, but the number of sentinel foods used per food group was more standardized across countries. Simulations indicated that the magnitude of errors associated with pilot tested non-quantitative open and extensive list-based 24-HRs were marginally lower than sentinel list-based 24-HRs in Ethiopia.

CONCLUSION: For global monitoring, standards must be defined for the preferred data collection instrument and survey platform for each healthy diet metric. This would facilitate cross-country comparability and help mitigate misinterpretations of change over time within countries and the selective reporting of national statistics. A harmonized methodology for developing, pilot testing, and continuously updating sentinel food lists is needed to further improve the accuracy of MDD-W questionnaires.

PMID:40426185 | DOI:10.1186/s40795-025-01065-7

BMC Surg. 2025 May 27;25(1):231. doi: 10.1186/s12893-025-02965-y.

ABSTRACT

OBJECTIVE: To investigate the effects of the pneumoperitoneum positive-pressure exhaust technique on mesh fixation and postoperative recovery in laparoscopic transabdominal preperitoneal prosthetic (TAPP) hernia repair.

METHODS: A retrospective cohort analysis was conducted on 655 patients who underwent TAPP between January 2019 and December 2023. Patients were divided into a direct suture group (n=304) and a positive-pressure exhaust group (n=351) on the basis of preperitoneal space management. In the exhaust group, a 20G needle or drainage tube was placed percutaneously before peritoneal closure. After suturing, 12 mmHg pneumoperitoneum pressure was maintained to evacuate residual gas from the preperitoneal space through the externalized needle/tube. The primary outcomes included postoperative complications (bleeding, mesh infection, seroma, reoperation) and hospitalization duration.

RESULTS: Baseline characteristics were not significantly different (P>0.05). Although not statistically significant, there were clinically meaningful differences between the groups; the exhaust group had lower seroma (11.97% vs. 16.78%, P=0.079) and mesh infection (0.28% vs. 1.32%, P=0.189) incidence rates than the direct suture group did. The exhaust group had a significantly shorter hospital stay than the direct suture group (median 7 vs. 7 days, P=0.013) and had a 0% recurrence rate at the 1-year follow-up (vs. 1.32% for the direct suture group).

CONCLUSION: The positive-pressure exhaust technique facilitates mesh fixation by eliminating dead space through improved tissue apposition. This simple, cost-effective approach may reduce the risk of recurrence, although larger prospective studies are needed to validate its long-term efficacy.

PMID:40426184 | DOI:10.1186/s12893-025-02965-y

Cardiooncology. 2025 May 27;11(1):50. doi: 10.1186/s40959-025-00343-4.

ABSTRACT

BACKGROUND: The effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on reducing cardiovascular events in different subgroups of diabetic patients are under investigation. The current systematic review and meta-analysis investigated the effects of SGLT2 inhibitors on preventing cardiovascular events and mortality and their adverse events in patients with active cancer and diabetes undergoing cardiotoxic cancer treatment.

METHODS: We searched PubMed, Embase, Web of Science, and Scopus to find studies investigating the effects of SGLT2 inhibitors on patients with diabetes and confirmed cancer until 19 August 2024. Meta-analyses were conducted using the random-effects model to compare all-cause mortality, cancer-associated mortality, heart failure (HF) hospitalization, arrhythmia, and adverse event rates such as ketoacidosis, hypoglycemia, urinary tract infection, and sepsis between patients with or without SGLT2 inhibitors use. Risk ratios (RRs) with 95% confidence intervals (CI) were used to compare outcomes between SGLT2 inhibitors and non-SGLT2 inhibitors groups.

RESULTS: Eleven studies were included with 88,096 patients with confirmed cancer (49% male). Among the total population, 20,538 received SGLT2 inhibitors (age 61.68 ± 10.71), while 67,558 did not receive SGLT2 inhibitors (age 68.24 ± 9.48). The meta-analysis found that the patients who received SGLT2 inhibitors had a significantly lower mortality rate than those who did not receive SGLT2 inhibitors (RR 0.46, 95% CI 0.34 to 0.63, p-value < 0.0001). Similarly, the cancer-associated mortality rate was also lower (RR 0.29, 95% CI 0.27 to 0.30, p-value < 0.0001). Further analysis found that the SGLT2 inhibitor group had a lower rate of HF hospitalization, compared to controls (RR 0.44, 95% CI 0.27 to 0.70, p-value = 0.0007). Moreover, patients receiving SGLT2 inhibitors had a statistically lower rate of arrhythmia (RR 0.38, 95% CI 0.26 to 0.56, p-value < 0.0001). Finally, patients in the SGLT2 inhibitors group had a lower rate of adverse events (RR 0.51, 95% CI 0.42 to 0.62, p-value < 0.0001).

CONCLUSIONS: SGLT2 inhibitors are effective in reducing mortality (all-cause and cancer-associated), HF hospitalization, arrhythmia, and drug adverse events in patients with cancer. If confirmed in future studies, these agents could be a potentially ideal candidate to prevent cardiotoxicity of cancer therapies.

PMID:40426171 | DOI:10.1186/s40959-025-00343-4

BMC Public Health. 2025 May 27;25(1):1954. doi: 10.1186/s12889-025-23051-1.

ABSTRACT

BACKGROUND: The Washington Group/UNICEF Child Functioning Module (WG/UNICEF CFM) was developed to identify children and youth with disabilities by assessing functional difficulties. This study focuses on the cognitive, emotional, and behavioral components of the WG/UNICEF CFM, as these domains are particularly relevant to understanding child and youth mental health and developmental functioning. The objective of this study was to examine the latent structure of these domains using a graded response scale in a nationally representative sample of Canadian children and youth aged 5-17 years and to evaluate how this approach captures the dimensional nature of functional difficulties.

METHODS: Data for analyses come from the 2019 Canadian Health Survey on Children and Youth (n = 33,420). Survey data were collected by Statistics Canada using an electronic questionnaire that was either self-completed online or interviewer-administered by telephone. To assess the latent structure of the WG/UNICEF CFM, analyses were conducted in four linked phases focusing on the following 9 domains: self-care, communication, learning, remembering, concentrating, accepting change, behavior, relationships, and emotions. An exploratory factor analysis (EFA) was conducted first, followed by, confirmatory factor analysis (CFA), then evaluations of measurement invariance across age and sex and external validity using structural equation modeling and instrumental variables.

RESULTS: Results indicated that a two-factor model best described the data, χ2(26, N = 16,810) = 619.076, p < 0.002, CFI = 0.98, TLI = 0.97, RMSEA = 0.037). Factor one represented Cognitive, Behavioural and Interpersonal Functional Difficulties; while Factor two represented Emotional Functional Difficulties. The construct validity tests supported the distinction between the two factors by demonstrating stronger associations with instrumental variables measuring similar underlying constructs.

CONCLUSIONS: This study extends existing research by demonstrating the utility of the WG/UNICEF CFM in assessing cognitive, behavioral, interpersonal, and emotional functional difficulties at the population level in a high-income country. The measure’s strong psychometric properties, ease of use, and cost-free administration support its applicability in general population health surveys of children and youth. Findings highlight the value of a dimensional approach to functional difficulties, offering a more comprehensive understanding of population-level variations in functioning. Integrating this measure into large-scale surveys can facilitate trend monitoring, improve data-driven policy interventions, and support strategic planning for education, healthcare, and social services. These insights contribute to optimizing resource allocation and ensuring equitable access to services that address the diverse functional needs of children and youth.

PMID:40426169 | DOI:10.1186/s12889-025-23051-1

Crit Care. 2025 May 27;29(1):216. doi: 10.1186/s13054-025-05447-y.

ABSTRACT

BACKGROUND: Fluid management is an essential component of renal replacement therapy (RRT) in critically ill patients. Both a positive cumulative fluid balance (CFB) and a high net ultrafiltration (NUF) rate have been reported to be associated with adverse outcomes in epidemiological studies, although the overall trajectory of fluid balance after RRT initiation is not well-described. We aimed to characterize trajectories of fluid management parameters during RRT and analyse the effect of CFB/NUF on outcomes as a trajectory rather than single or aggregated time points over the first week after initiation of RRT.

METHODS: This is a secondary analysis using fluid balance data focusing on individuals enrolled in the standard-strategy arm of the STARRT-AKI trial who initiated RRT. Cumulative fluid balance (CFB) following RRT initiation and daily net ultrafiltration (NUF) adjusted for body weight during the first 7 days after initiation of RRT were the main independent exposures. We modeled the trajectory of fluid parameters using spline functions and used latent trajectory analysis methods to identify predominant trajectories to compare patients’ characteristics and outcomes. We employed logistic regression and multivariable joint longitudinal models to compare the odds and determine the time-dependent association between fluid parameters (CFB and NUF) and 90-day mortality across and within the trajectory classes identified.

RESULTS: We included 855 patients in the primary analysis. After excluding erroneous fluid balance data, we identified two distinct CFB/NUF trajectories. Class A (82.8%) was characterized by a slight increase in CFB and low/stable NUF during the week following RRT initiation while class B (17.2%) was characterized by an increasingly negative CFB with initially higher daily NUF during the first 4 days followed by a stabilization after day 4. In an adjusted analysis, individuals classified in class B were at lower risk for 90-day mortality (aOR: 0.48 CI 0.32; 0.70) p < 0.001) compared to class A. Time-dependent analysis revealed higher CFB was associated with mortality only in those with a class A trajectory (aHR 1.29, 95% CI 1.03-1.55, p = 0.03).

CONCLUSIONS: Distinct CFB/NUF trajectories convey prognostic information beyond single-day fluid balance or NUF values and should be considered when formulating or interpreting fluid management strategies.

PMID:40426163 | DOI:10.1186/s13054-025-05447-y

BMC Public Health. 2025 May 27;25(1):1949. doi: 10.1186/s12889-025-23212-2.

ABSTRACT

BACKGROUND: Although it is widely recognized that insulin resistance (IR) plays a critical role in the development of erectile dysfunction (ED), the specific relationship between IR and ED among non-diabetics has been little studied, and no relevant large-scale studies have been conducted. The purpose of this study is to examine the association between different IR surrogates and the risk of ED in non-diabetic populations.

METHODS: National Health and Nutrition Examination Survey (NHANES) 2001-2004 data were used for this cross-sectional analysis. Weighted multivariable logistic regression and restricted cubic spline curves (RCS) were performed to evaluate the relationship between homeostasis model assessment (HOMA-IR), triglyceride glucose (TyG), TyG with body mass index (TyG-BMI), TyG with waist circumference (TyG-WC) and TyG with waist-to-height ratio (TyG-WHtR), and ED risk. When segmenting effects were detected, recursive algorithms were used to determine potential inflection points. Then log-likelihood ratio test and weighted segmented regression were carried out. In the sensitivity analysis, stratified and interaction analyses were performed.

RESULTS: A total of 1569 (weighted: 76450963) individuals eventually were enrolled in the study. After adjusting for all confounders, the TyG did not correlate with ED (P > 0.05), whereas the other IR surrogates, HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR, remained positively correlated with ED [ORs (95% CIs) were 1.02 (0.95, 1.10), 1.01 (1.00, 1.02), 1.00 (1.00, 1.01), 1.17 (0.84, 1.63), respectively; all P < 0.05]. Furthermore, we found the risk of ED was significantly higher when TyG-BMI > 328.94 or TyG-WC > 1128.25 or TyG-WHtR > 6.42 [the ORs (95% CIs) were 1.05 (1.02, 1.08), 1.02 (1.01, 1.03) and 51.30 (4.46, 453.64), respectively]. No interactions were found between these IR surrogates and the stratification variables.

CONCLUSIONS: In the non-diabetic population, ED risk was positively associated with elevated HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR.

PMID:40426154 | DOI:10.1186/s12889-025-23212-2

BMC Oral Health. 2025 May 27;25(1):815. doi: 10.1186/s12903-025-06240-7.

ABSTRACT

OBJECTIVE: The purpose of this in vitro study was to investigate the shear bond strength of high translucent monolithic zirconia and titanium alloy (Ti6Al4V) after various surface treatments using resin cement.

MATERIALS AND METHODS: Ninety Ti6Al4V specimens were randomly allocated into six groups (n = 15 per group): untreated titanium (CT; control), 50-µm alumina airborne-particle abrasion (AB), 9.5% hydrofluoric acid (HF), anodization (AN), AB followed by AN (AB-AN), and HF followed by AN (HF-AN). Representative specimen from each group was examined using a scanning electron microscope and laser confocal microscopy. The specimens were bonded with 50-µm alumina air-abraded high translucent monolithic zirconia specimen using 10-methacryloyloxydecal dihydrogen phosphate (10-MDP)-containing primer and 10-methoxyl methyl methacrylate (MMA)-based resin cement. The failure mode of was classified using a stereomicroscope. Results were analyzed by one-way ANOVA with Tukey’s adjustment for multiple comparisons (p < 0.05).

RESULTS: The mean bond strength of AB (36.9 ± 1.6 MPa) and HF (32.5 ± 3.4 MPa) groups were statistically significantly higher than other groups (p < 0.05). The AN group showed the lowest bond strength (29.55 ± 3.62 MPa); however, there was no significant difference between CT, AN, AB-AN, and HF-AN. The stereomicroscopic analysis revealed that the AN, AB-AN, and HF-AN groups predominantly showed mixed failure modes.

CONCLUSION: The surface treatment of Ti6Al4V with either 50-µm alumina airborne-particle abrasion or 9.5% hydrofluoric acid improved the bond strength between Ti6Al4V and high translucent monolithic zirconia. Anodization did not improve the bond strength, regardless of the surface treatments.

PMID:40426153 | DOI:10.1186/s12903-025-06240-7