Nevin Manimala

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

Lipids Health Dis. 2025 Jul 9;24(1):234. doi: 10.1186/s12944-025-02653-z.

ABSTRACT

AIM: Cardiovascular diseases (CVD) remain the predominant contributor to global mortality and morbidity, necessitating enhanced strategies for primary prevention and early detection. This investigation sought to characterize the associations between estimated glucose disposal rate (eGDR), high sensitivity C-reactive protein (hsCRP), and incident CVD.

METHODS: The research used data from China Health and Retirement Longitudinal Study (CHARLS). The primary exposures included eGDR and hsCRP. Incident CVD served as the primary study endpoint. All statistical analyses were performed utilizing SPSS software (version 25.0) and R software (version 4.4.4).

RESULTS: The analysis of 7,742 participants revealed incident CVD in 1,981 cases (25.6%), with Kaplan-Meier curves demonstrating significantly elevated cumulative incidence among individuals exhibiting both reduced eGDR and elevated hsCRP levels. Significant interactions were observed between these biomarkers, including an additive effect (relative excess risk due to interaction = 0.09, 95% confidence interval [CI]: 0.03-0.14) and a multiplicative effect (hazard ratio = 1.02, 95% CI: 1.01-1.03). Mediation analyses indicated bidirectional relationships, with eGDR accounting for 5.81% (95% CI: 2.13-9.49%) of the hsCRP-CVD association and hsCRP mediating 8.52% (95% CI: 3.87-13.17%) of the eGDR-CVD relationship. Notably, in individuals with diabetes, the combined predictive capacity of eGDR and hsCRP (area under the curve: 0.645) demonstrated superior discriminative performance compared to either biomarker alone (AUC: 0.645).

CONCLUSION: eGDR and hsCRP exert significant joint, interactive and mediating effects on incident CVD in middle-aged and elderly Chinese population. Using eGDR (10.52 mg/kg/min) and hsCRP (1 mg/L) thresholds can be an affordable screening tool in primary care, especially where advanced diagnostics are lacking. Incorporating these assessments into regular check-ups may lower long-term CVD complications and reduce economic burdens.

PMID:40634999 | DOI:10.1186/s12944-025-02653-z

BMC Med Educ. 2025 Jul 9;25(1):1027. doi: 10.1186/s12909-025-07592-y.

ABSTRACT

BACKGROUND: Developing students’ ability to accurately diagnose various types of keratitis is challenging. This study aims to compare the effectiveness of teaching methods-real cases, artificial intelligence (AI)-generated images, and real medical images-on improving medical students’ diagnostic accuracy of bacterial, fungal, and herpetic keratitis.

METHODS: 97 consecutive fourth-year medical students who had completed basic ophthalmology educational courses were included. The students were divided into three groups: 30 students in the group (G1) using the real cases for teaching, 37 students in the group (G2) using AI-generated images for teaching, and 30 students in the group (G3) using real medical images for teaching. The G1 group had a 1-hour study session using five real cases of each type of infectious keratitis. The G2 group and the G3 group each experienced a 1-hour image reading sessions using 50 AI-generated or real medical images of each type of infectious keratitis. Diagnostic accuracy for three types of infectious keratitis was assessed via a 30-question test using real patient images, compared before and after teaching interventions.

RESULTS: All teaching methods significantly improved mean overall diagnostic accuracy. The mean accuracy improved from 42.03 to 67.47% in the G1 group, from 42.68 to 71.27% in the G2 group, and from 46.50 to 74.23% in the G3 group, respectively. The mean accuracy improvement was highest in the G2 group (28.43%). There were no statistically significant differences in mean accuracy or accuracy improvement among the 3 groups.

CONCLUSIONS: AI-generated images significantly enhance the diagnostic accuracy for infectious keratitis in medical students, performing comparably to traditional case-based teaching and real patient images. This method may standardize and improve clinical ophthalmology training, particularly for conditions with limited educational resources.

PMID:40634997 | DOI:10.1186/s12909-025-07592-y

Popul Health Metr. 2025 Jul 9;23(1):37. doi: 10.1186/s12963-025-00401-0.

ABSTRACT

BACKGROUND: Utilization of unhygienic menstrual products has been associated with various adverse health consequences, particularly in many low- and middle-income countries (LMICs), including Bangladesh. In this context, this study attempted to measure socioeconomic inequalities in sanitary napkin use among women aged 15-49 and assess its spatial pattern at the disaggregated level (district).

METHODS: We used the latest available nationally representative cross-sectional Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 data. The analytical sample size was 54,702 reproductive-aged (15-49 years) women. The Erreygers Index (EI) and the Wagstaff Index (WI) were employed to measure and decompose the socioeconomic inequalities in sanitary napkin use. Natural Break (Jenks) classification method, Global Moran’s I and the Cluster and Outlier Analysis were used to analyze the spatial pattern of socioeconomic inequalities at the district level.

RESULTS: The findings reveal that approximately 26.22% of women used sanitary napkins at the national level. Both the EI (0.41208; p-value < 0.001) and the WI (0.53251; p-value < 0.001) indicate a pro-rich inequality in sanitary napkin use. Decomposition results indicated that wealth status, educational attainment, household characteristics (particularly educational attainment of household head) and exposure to media were the most important factors accounting for socioeconomic inequalities. From the spatial analyses, we found significant district-level variations in both sanitary napkin use and its socioeconomic inequalities. Global Moran’s I value indicated positive spatial autocorrelation, meaning that similar values tend to cluster together. Notably, a northwestern and southeastern divide was found between High-High and Low-Low clusters of socioeconomic inequalities.

CONCLUSIONS: Our study provides evidence for informed policymaking targeting women from the lower socioeconomic stratum, especially those living in the northwestern and southeastern regions to increase sanitary napkin use.

PMID:40634993 | DOI:10.1186/s12963-025-00401-0

J Orthop Surg Res. 2025 Jul 9;20(1):635. doi: 10.1186/s13018-025-06027-0.

ABSTRACT

INTRODUCTION: This study aims to describe a novel axial fluoroscopic imaging technique for visualizing the anterior column fixation corridor (ACFC) of the acetabulum in the supine position, define the patient-specific optimal antegrade entry point (OAEP), and evaluate the feasibility of screw placement using this approach.

MATERIALS AND METHODS: Pelvic computed tomography (CT) data from 500 healthy adults (250 men and 250 women) were collected. Using Fujifilm-Synapse 3D software, 3D reconstructions of the pelvis were created. Through fluoroscopy simulation, the axial view of the ACFC and OAEP was obtained for each individual. To simulate screw placement radiologically, a cylinder was placed through the OAEP, completely filling the corridor without protruding. The position was verified using both fluoroscopic simulations and three different CT sections (axial, coronal, sagittal). The corridor’s diameter (ACFC-R), length (ACFC-L), and the coronal plane inclination (CPI) and sagittal plane inclination (SPI) required for fluoroscopic visualization of the OAEP were measured in all pelvic models.

RESULTS: The axial view and patient-specific optimal antegrade entry point (OAEP) of the fixation corridor were successfully visualized in all pelvises. Radiological virtual screw placement was successfully performed in all models by visualizing the OAEP, enabling precise axial screw insertion through the corridor. The average ACFC diameters were 6.2 mm in females and 8.6 mm in males (p < 0.001); ACFC lengths were 116.8 mm in females and 122.5 mm in males (p < 0.001). The SPI was 14.3 degrees in females and 14.7 degrees in males (p = 0.263). The CPI was 35.5 degrees in females and 33.2 degrees in males (p < 0.001). Except for the SPI, statistically significant differences were observed in all parameters between genders.

CONCLUSION: The axial fluoroscopic imaging technique enables accurate identification of patient-specific entry points and screw placement that fills the fixation corridor without boundary breach, potentially enhancing the precision and safety of anterior column fixation.

PMID:40634986 | DOI:10.1186/s13018-025-06027-0

BMC Oral Health. 2025 Jul 9;25(1):1135. doi: 10.1186/s12903-025-06499-w.

ABSTRACT

BACKGROUND: Those living with mental illnesses have an increased risk of poor oral health exacerbated by lack of motivation for self-care and reduced help-seeking behaviors. Poor oral health status may lead to reduced oral health-related quality of life (OHRQoL) among this population, including the dimensions of Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact. Despite this, oral health is often neglected in the management of mental illnesses, particularly in inpatient treatment facilities. The purpose of this research is to investigate the relationship between the oral health status and OHRQoL in adults receiving inpatient psychiatric care.

METHODS: This retrospective, cross-sectional study examined data from medical records of adults between the ages of 18 and 80 receiving inpatient psychiatric care, who had not opted out of research, were English-speaking, and were seen by a hospital dental hygienist between August 1st, 2024 and January 31st, 2025 in response to a consultation request by hospital staff. Oral health status was measured using the Oral Health Assessment Tool (OHAT), and the four dimensions of OHRQoL was measured using the 5-item Oral Health Impact Profile (OHIP-5). Summary scores were analyzed using means and standard deviations. OHAT and OHIP-5 item analysis was completed using frequencies and percentages. Relationships between outcomes were examined using Pearson correlations, with p < 0.05 considered statistically significant.

RESULTS: Twenty-four patient records met inclusion criteria for analysis. The average time from patient admittance to dental hygiene consult was 17 days, with dental pain being the most common reason for consultation (n = 16). Frequency and percentages showed dental pain, natural teeth, and gums and tissues were most frequently scored as unhealthy on the OHAT assessment. Analysis of OHIP-5 summary scores indicated a mean of (M = 11.17, SD = 6.55), suggesting a moderate average impact on OHRQoL within the sample. Further analysis would be required to determine statistically significant differences or associations. Dental pain was positively correlated with all four dimensions of OHRQoL. No other oral condition was associated with summary or individual items of OHIP-5.

CONCLUSIONS: Results showed generally poor oral health among individuals hospitalized for psychiatric care. OHIP-5 summary scores showed oral health problems were associated with moderate impairment of OHRQoL. Findings emphasize the need for interprofessional preventative care and support oral health integration in psychiatric settings. Future research should incorporate baseline and follow-up oral health assessments to evaluate the impact of targeted oral health interventions on oral health status and OHRQoL.

PMID:40634985 | DOI:10.1186/s12903-025-06499-w