Nevin Manimala

JMIR Form Res. 2025 Aug 15;9:e67297. doi: 10.2196/67297.

ABSTRACT

BACKGROUND: Falls are a common and serious problem after stroke, often leading to injuries, loss of independence, and increased health care usage. Functional balance, a primary risk factor for falls, is frequently impaired in individuals with hemiparetic gait impairments. Previous research with the iStride gait device (Moterum Technologies, Inc) showed that functional balance improved immediately following 4 weeks of treatment. However, the long-term retention of these effects remains unknown and could improve the management of balance and mobility impairments after stroke.

OBJECTIVE: This study aimed to determine the long-term functional balance effects of treatment with the gait device for individuals with hemiparetic gait impairments from stroke.

METHODS: Eighteen individuals with chronic stroke (9 male, 9 female, mean age 57 years, and 60 months post stroke) participated in twelve 30-minute treatment sessions with the gait device. During each treatment session, the device was worn on the less affected lower extremity during overground ambulation in the participant’s home. All treatment and assessments were overseen by licensed physical therapists. Functional balance was evaluated using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Functional Gait Assessment (FGA) at baseline and 5 posttreatment follow-ups: 1 week, 1 month, 3 months, 6 months, and 12 months after treatment. Balance improvement was analyzed using repeated-measures ANOVA from baseline to each follow-up time frame, correlation analysis, comparison to each outcome’s minimal detectable change (MDC) value, evaluation of fall risk classification changes, and subjective questionnaires.

RESULTS: Participants retained statistically significant improvements on the BBS, TUG, and FGA compared with baseline at all posttreatment time frames (P<.05). All participants initially identified as being at risk for falls reduced their fall risk on at least one outcome during one or more follow-up assessments. At 12 months post treatment, the average improvement on all 3 outcomes remained above their respective MDC thresholds, demonstrated by a 5.9-point improvement on the BBS, a 4.9-second improvement on the TUG, and a 34.6% (3.8-point) improvement on the FGA. At least 72% of participants exceeded the MDC of BBS, at least 44% exceeded the MDC of TUG, and at least 66% exceeded the MDC of FGA at every posttreatment time point. Subjective questionnaire responses indicated that 88% of participants perceived functional balance improvement following treatment with the gait device.

CONCLUSIONS: The findings of this study indicate that treatment with the gait device may result in long-term functional balance improvement for individuals with hemiparetic gait impairments from stroke. Larger, controlled studies are recommended to confirm these findings.

PMID:40815786 | DOI:10.2196/67297

JBJS Rev. 2025 Aug 15;13(8). doi: 10.2106/JBJS.RVW.25.00101. eCollection 2025 Aug 1.

ABSTRACT

BACKGROUND: Although various total knee arthroplasty (TKA) philosophies exist, with different component and limb alignment targets, there is no consensus on which is superior. This study compared outcomes among randomized controlled trials (RCTs) of TKAs performed to achieve mechanical (MA), anatomical (AA), kinematic (KA), restricted KA (rKA), and functional alignment (FA).

METHODS: Scopus, Ovid/MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Registry of Controlled Trials were queried in April 2025 (PROSPERO: CRD420251017962). A frequentist model network meta-analysis of eligible prospective RCTs assessed complications, revisions, and patient-reported outcomes (PROs) using P-scores.

RESULTS: Among 3,605 studies, 22 RCTs totaling 1,411 patients (1,428 primary TKAs) with median (interquartile range) age of 68.2 years (6.8) and follow-up of 29.1 months (48) were included for meta-analysis. The distribution of alignment philosophies was MA (n = 708, 49.6%), AA (n = 101, 7.1%), KA (n = 394, 27.6%), rKA (n = 160, 11.2%), or FA (n = 65, 4.6%). Compared to MA, the mean Knee Society Score (KSS) knee score improvements from baseline were statistically lower (worse) with AA (mean difference [MD] -0.503; 95% confidence interval [CI] -0.96 to -0.04; p = 0.0320) and KA (MD -0.623; 95% CI -1.07 to -0.18; p = 0.006), and mean KSS combined changes were also statistically lower (worse) with KA (MD -0.314; 95% CI -0.55 to -0.08; p = 0.009) versus MA. However, each statistically significant change had high heterogeneity and failed to reach the minimum clinically important difference. There were no significant changes in the mean Western Ontario and McMaster Universities Osteoarthritis Indices, KSS function, Oxford Knee, or Forgotten Joint scores among each alignment philosophy. In addition, postoperative knee flexion, complications, and reoperation rates with or without implant removal were similar among all techniques.

CONCLUSION: This study found no clinically meaningful difference in PROs nor complication rates among TKA alignment philosophies, supporting comparable short-term to mid-term outcomes. However, longer follow-up is required to accurately assess implant failure and revision rates.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40815783 | DOI:10.2106/JBJS.RVW.25.00101

JMIR Med Educ. 2025 Aug 15;11:e65949. doi: 10.2196/65949.

ABSTRACT

BACKGROUND: Discussing weight remains a sensitive and often avoided topic in health care, despite rising prevalence of obesity and calls for earlier, more compassionate interventions. Many health care professionals report inadequate training and low confidence to discuss weight, while patients often describe feeling stigmatized or dismissed. Digital simulation offers a promising route to build communication skills through supporting repeatable and reflective practice in a safe space. VITAL-COMS (Virtual Training and Assessment for Communication Skills) is a novel simulation tool designed to support health care professionals in navigating weight-related conversations with greater understanding and skill.

OBJECTIVE: This study aimed to assess the potential of VITAL-COMS as a digital simulation training tool to improve weight-related communication skills among health care professionals.

METHODS: A mixed-method feasibility study was conducted online via Zoom (Zoom Video Communications) between January to July 2021, with UK-based nurses, doctors, and dietitians. The intervention comprised educational videos and 2 simulated patient scenarios with real-time verbal interaction. Pre- and posttraining self-assessments of communication skills and conversation length were collected. Participants also completed a feasibility questionnaire. Descriptive statistics were used to analyze the feasibility questionnaire, and open-ended feedback was analyzed using content analysis. Paired-samples t tests were used to assess changes in communication skills and conversation length before and post training.

RESULTS: In total, 31 participants completed the study. There was a statistically significant improvement in self-assessed communication skills following training (mean difference=3.9; 95% CI, 2.54-5.26; t30=-5.76, P=.001, Cohen d=1.03). Mean conversation length increased significantly in both scenarios: in the female patient scenario, from 3.73 (SD 1.36) to 6.08 (SD 2.26) minutes, with a mean difference of 2.35 minutes (95% CI, 1.71-2.99; t30=7.49, P=.001, Cohen d=1.34); and in the male scenario, from 3.61 (SD 1.12) to 5.65 (SD 1.76) minutes, a mean difference of 2.03 minutes (95% CI, 1.51-2.55; t30=8.03, P=.001, Cohen d=1.44). Participants rated the simulation positively, with 97% (95% CI 90%-100%) supporting wider use in health care and 84% (95% CI 71%-97%) reporting emotional engagement. Content analysis of feedback generated two themes: (1) adapting to this form of learning and (2) recognizing the potential of simulation to support reflective, skills-based training. A minority, 13% (95% CI 1%-25%) expressed a preference for alternative learning methods.

CONCLUSIONS: VITAL-COMS was feasible to implement and acceptable to a diverse group of health care professionals. Participants demonstrated significant improvements in self-assessed communication skills and patient-scenario engagement. The simulation was perceived as realistic, emotionally engaging, and well-suited for training in sensitive conversations. These findings support further development and integration of VITAL-COMS into health education programs. Next steps include the translation of the insights identified in this study to inform a tool supported by generative artificial intelligence.

PMID:40815779 | DOI:10.2196/65949

Opt Lett. 2025 Aug 15;50(16):5181-5184. doi: 10.1364/OL.569137.

ABSTRACT

Fourier ptychographic microscopy (FPM) enhances the spatial-bandwidth product of imaging systems, but its extension to color imaging remains challenging. Existing channel-split methods incur long acquisition times, while multiplexed-illumination approaches suffer from color leakage and require complex post-processing. In this work, we introduce a novel, to the best of our knowledge, color-faithful FPM framework under multiplexed illumination by integrating a physically interpretable color constraint into a differentiable FPM model. Unlike prior works, our method enforces color fidelity during optimization by constraining the first- and second-order moment of RGB channels, effectively preserving the true color tone in reconstructions. This statistical constraint not only improves color accuracy but also offers broad compatibility with existing differentiable FPM models. Numerical simulations and optical experiments show that our method ensures high color fidelity, providing a practical full-color FPM solution.

PMID:40815770 | DOI:10.1364/OL.569137

Opt Lett. 2025 Aug 15;50(16):5041-5044. doi: 10.1364/OL.566313.

ABSTRACT

Statistical estimation methods for localization microscopy (LM) estimate emitter locations using a parameterized statistical model presumed for the data, enabling derivations of estimators and theoretical accuracy bounds. The most widely used performance bound is the Cramér-Rao lower bound (CRLB), which provides a lower bound on the error covariance of any unbiased estimator of the model parameters (i.e., emitter locations) and characterizes the asymptotic performance of the maximum likelihood estimator (MLE). In practice, however, the presumed model is almost always mismatched to the true model that generates the data due to experimental uncertainties stemming from aberrations, calibration errors, and misalignment. As a result, the CRLB no longer provides an accurate lower bound on achievable localization accuracy, and a different performance bound called the Misspecified Cramér-Rao Bound (MCRB) must be considered. In this Letter, we derive the MCRB in different LM setups, with different Poisson statistics, and analyze the behavior of the derived MCRBs. Our analysis provides a quantitative framework for understanding how experimental imperfections affect the limits of achievable localization accuracy.

PMID:40815735 | DOI:10.1364/OL.566313

Sci Immunol. 2025 Aug 15;10(110):eadt3955. doi: 10.1126/sciimmunol.adt3955. Epub 2025 Aug 15.

ABSTRACT

Peripheral helper T (T_PH) cells can play pathogenic roles in human autoimmune diseases. T_PH cells are proposed to be the major B cell helpers in inflamed joints in rheumatoid arthritis (RA), but whether and how T_PH cells are engaged in tissue inflammation remains unclear. We demonstrate that T_PH cells comprise two subsets in RA: stem-like T_PH (S-T_PH) and effector T_PH (E-T_PH) cells. These two subsets differed in transcriptome, epigenome, B cell helper capacity, spatial localization, and cell interactions. S-T_PH cells displayed self-renewal capacity and were mainly found within tertiary lymphoid structures (TLSs) in synovial tissue together with B cells. S-T_PH cells potently induced B cells to produce immunoglobulins. By contrast, E-T_PH cells expressed effector molecules and colocalized with proinflammatory macrophages and CD8⁺ T cells outside TLSs. S-T_PH cells could differentiate into E-T_PH cells upon TCR stimulation and coculture with B cells. Collectively, our study shows that S-T_PH cells play a central role in promoting T_PH responses by undergoing self-renewal and seeding E-T_PH cells.

PMID:40815671 | DOI:10.1126/sciimmunol.adt3955

Postgrad Med J. 2025 Aug 15:qgaf113. doi: 10.1093/postmj/qgaf113. Online ahead of print.

ABSTRACT

BACKGROUND: Regional anesthetic techniques are applied in cardiac surgery to improve postoperative pain and accelerate recovery. Pecto-intercostal fascial block (PIFB) combined with rectus sheath block (RSB) has been proved to provide ideal analgesia for cardiac surgery, but the effects of combing regional anesthetic techniques on postoperative recovery are uncertain.

METHODS: This is a prospective and randomized controlled trial at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients undergoing elective cardiac surgery via cardiopulmonary bypass were randomized at a 1:1 ratio to be allocated in the intervention group (PIFB combined with RSB) or control group (without regional blocks). The primary outcome was the global score of the 15-item quality of recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at 72 h, postoperative pain scores, time to extubation, length of stay, medical expenses in hospital and postoperative morbidities.

RESULTS: The QoR-15 global score at 24 h after cardiac surgery was 122.35 ± 6.71 in the intervention group vs 115.30 ± 5.90 in the control group (P < .001). The proportion of patients experiencing better quality of recovery (Qor-15 ≥ 118) was higher in the intervention group (77.5% vs 55%, P = .033). Postoperative pain scores were 1.90 ± 0.18 in the intervention group compared to 2.95 ± 0.99 in the control group (P = .027) at 24 h. Time to extubation was earlier in the intervention group (274.40 ± 98.36 vs 741.28 ± 93.82 min, P < .001). There were no statistically differences in Qor-15 at 72 h and other recovery outcomes.

CONCLUSION: The administration of PIFB combined with RSB could improve quality of recovery and relieve postoperative pain for patients following cardiac surgery. Key message What is already known on this topic Previous studies have demonstrated that ultrasound-guided nerve blocks effectively reduce postoperative pain in cardiac surgery patients. However, whether these techniques further enhance overall postoperative recovery remained unclear. What this study adds This trial revealed that ultrasound-guided nerve blocks improved postoperative QoR-15 scores, and combined regional techniques further improved recovery without compromising analgesia. How this study might affect research, practice, or policy The findings support applying combined nerve blocks into enhanced recovery protocols for cardiac surgery, offering evidence to optimize postoperative analgesia strategies.

PMID:40815622 | DOI:10.1093/postmj/qgaf113

PLoS One. 2025 Aug 15;20(8):e0322845. doi: 10.1371/journal.pone.0322845. eCollection 2025.

ABSTRACT

Primary Sjögren’s syndrome (pSS) is an autoimmune disorder characterized by dry eyes and mouth, often with systemic involvement. This study aimed to investigate the clinical manifestations and laboratory features in pSS patients, particularly focusing on those with anti-centromere antibodies (ACA) and anti-SSA/Ro antibodies. We conducted a retrospective analysis of 152 patients diagnosed with pSS at Ningbo Medical Center Lihuili Hospital from 2018 to 2023, using the 2016 ACR/EULAR criteria. Additionally, 105 age- and sex-matched healthy controls were included to establish a comparative baseline for laboratory parameters. Clinical data were obtained from medical records, and patients were categorized into ACA-positive and SSA-positive groups based on their autoantibody profiles. Appropriate statistical analyses, including ANOVA, chi-square tests, correlation analysis, and multivariate regression analysis, were used to compare clinical and laboratory parameters in pSS patients. ACA-positive patients were significantly older and exhibited a higher prevalence of Raynaud’s phenomenon and left ventricular diastolic dysfunction, while SSA-positive patients presented with more marked hematological abnormalities. ACA-positive patients have a more prevalent occurrence of positive antinuclear antibodies (ANA) and anti-mitochondrial M2 antibodies (AMA-M2), as well as significantly higher levels of left ventricular end-diastolic diameter (LVEDD), IgM, and lactate dehydrogenase (LDH). In addition, SSA-positive patients exhibited elevated levels of globulins (GLB), IgG, IgA, and rheumatoid factor (RF), accompanied by decreased albumin (ALB) levels. ACA-positive patients had abnormal proportions of CD4+ and CD8+ T cells and had reduced counts of NK cells (CD16+CD56+), CD3+ T cells, and CD8+ T cells. Correlation and multivariate regression analyses revealed a significant association between NK cell and levels of IgG, IgM, GLB, and LDH. Furthermore, SSA-positive patients showed abnormal proportions of CD19+ B cells and NK cells, with reduced counts of CD3+ T cells (including CD4+ and CD8+ T cells) and NK cells. Correlation and multivariate regression analyses indicated a significant correlation between CD4+ T cell and levels of IgG, ALB, and GLB. Overall, T cell-mediated immunity plays a significant role in SSA-positive patients; NK cells are shown to be critically involved in the pathogenesis of ACA-positive pSS.

PMID:40815617 | DOI:10.1371/journal.pone.0322845

Cochlear Implants Int. 2025 Aug 15:1-10. doi: 10.1080/14670100.2025.2542049. Online ahead of print.

ABSTRACT

PURPOSE: A real-world study of the Ultra cochlear implant was completed in 2022, aiming to compare preoperative and postoperative performance. The use of two different electrode arrays and their ability to preserve residual hearing were also investigated.

METHODS: A TOTAL OF: 78 subjects were enrolled in this study. All participants completed the preoperative baseline assessment and postoperative speech and hearing tests. Subjective questionnaires were administered to participants under 6 years old. The development of impedance and M-levels over time was also analysed. For participants older than 6 years of age, pure tone audiometry was performed to evaluate hearing preservation.

RESULTS: The postoperative average aided hearing threshold and speech test results showed a statistically significant improvement compared to preoperative results (p < 0.05). No significant difference was observed between the two electrode arrays (p > 0.05). Overall, impedance and M-levels showed typical trends of progression. Most participants obtained good hearing preservation, while no significant difference in hearing deterioration was reported between the two electrodes (p = 0.20).

CONCLUSION: The Ultra implant can significantly improve hearing and speech abilities. No significant difference was observed in speech perception between the two arrays. Results confirmed that the Ultra implant is safe and effective for both paediatric and adult populations.

PMID:40815546 | DOI:10.1080/14670100.2025.2542049

JAMA Health Forum. 2025 Aug 1;6(8):e252043. doi: 10.1001/jamahealthforum.2025.2043.

ABSTRACT

IMPORTANCE: Little is known about how the prices and affordability of medicines included on the World Health Organization’s Model List of Essential Medicines vary across the globe.

OBJECTIVE: To compare the list prices and affordability of essential medicines across high-, middle-, and low-income markets.

DESIGN AND SETTING: This cross-sectional study examined data from 2022 on list prices and volumes of 549 essential medicines in 72 high-, middle-, and low-income markets (covering 87 countries). These data were obtained from IQVIA. The statistical analyses were performed between August 2024 and March 2025.

MAIN OUTCOMES AND MEASURES: Laspeyres price indices were used to compare average drug prices across countries, both in nominal and purchasing power parity-adjusted terms. The affordability of 8 essential medicines, used to treat major causes of death and disability globally, was assessed by calculating how many days of minimum wage would be required to pay for 1 month of treatment.

RESULTS: The availability of essential medicines ranged from 225 (41%) in Kuwait to 438 (80%) in Germany (base country). After accounting for purchasing power parities, prices of essential medicines in Lebanon were, on average, 18.1% of those in Germany (Lebanon price index, 18.1 vs Germany price index, 100), while average prices in the US were 3.0 times higher than in Germany (US price index, 298.2). A positive association was observed between countries’ gross domestic product per capita (expressed in logarithmic terms) and nominal drug prices (R = 0.30; P = .01), indicating that richer countries generally had higher drug prices. However, when adjusting for the purchasing power of different currencies, an inverse association was observed (R = -0.35; P = .003), suggesting that richer countries had lower real prices. Drug affordability, as measured by the number of days’ minimum wage needed to purchase a month’s treatment, varied widely, with median affordability highest in Europe and the Western Pacific, and lowest in Africa and Southeast Asia.

CONCLUSIONS AND RELEVANCE: The results of this cross-sectional analysis showed significant variation in the prices and affordability of 549 essential medicines across 72 markets in 2022. Strategies to promote equitable drug prices and improve drug affordability are urgently needed.

PMID:40815523 | DOI:10.1001/jamahealthforum.2025.2043