Tag: nevin manimala

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09547-x. Online ahead of print.

ABSTRACT

OBJECTIVE: We conducted this systematic review and meta-analysis to investigate the efficacy and safety of the use of serial intralesional steroid injection (SILSI) in patients with subglottic stenosis (SGS).

DATA SOURCES: PubMed, Web of Science, and Scopus databases, from inception until December 2024.

REVIEW METHODS: Database search used the following keywords: “Subglottic stenosis” AND “Intralesional.” The meta-analysis pooled the mean difference (MD) and standardized mean difference (SMD) for outcomes measured on different scales, based on pre-operative and post-operative values, with 95% confidence interval (CI). For categorical variables, we used Open MetaAnalyst software to calculate the rate of different outcomes and the effect estimates. Heterogeneity was assessed using the I² statistic.

RESULTS: The use of SILSI in SGS patients increases the surgery-free survival duration with a MD = 395.27 days (95% CI: 166.14, 624.39, p = 0.0007), I² = 81%, p = 0.0003. Additionally, the use of SILSI was associated with an increase in peak expiratory flow (PEF: MD = 30.6; 95% CI: 16.1, 45.1; p < 0.0001), I² = 100%, p < 0.00001. The effect estimates for categorical outcomes were success rate (0.92; 95% CI: 0.872, 0.969), adverse events (0.257; 95% CI: -0.043, 0.556), and recurrence rate (0.451; 95% CI: -0.058, 0.960).

CONCLUSION: SILSI has shown a high success rate, extended surgery-free survival, and improved PEF, with a relatively low recurrence rate and minimal risk of adverse events. Given this high efficacy and favorable safety profile, SILSI is recommended for use in SGS.

PMID:41176560 | DOI:10.1007/s00405-025-09547-x

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09785-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to compare the evaluation of obstructive sleep apnea (OSA) by ten super-experts using responses from a 10-question survey answered by 3 different artificial intelligence chatbots, Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists specialized in sleep medicine.

METHODS: A 10-question survey regarding OSA management was answered by Chat GPT-3.5, Chat GPT-4.0, Gemini, and a panel of 100 otolaryngologists. The responses were assessed by ten super-experts in sleep medicine for their agreement with expert consensus, using a Likert scale. Statistical analyses were performed to evaluate the level of agreement and significance.

RESULT: Expert consensus had the highest mean score (4.5 ± 0.9), significantly outperforming all AI models. ChatGPT-3.5 was the best among AI systems, with a score of 4.1 ± 1.2 (p=0.003), followed by ChatGPT-4 with 3.9 ± 1.4 (p<0.001) and Gemini with 3.6 ± 1.5 (p<0.001). Perfect agreement with expert consensus was achieved in specific scenarios, particularly regarding indications for bariatric surgery and lateral pharyngoplasty. However, there were significant differences in complex clinical scenarios that required integration of multiple factors, particularly in therapeutic management questions where the performance of AI models was significantly below that of expert consensus (p<0.01).

CONCLUSIONS: Although AI models are promising in the management of OSA, especially for well-defined clinical scenarios, they at present serve best as complementary tools rather than replacements for expert clinical judgment. Most surprisingly, ChatGPT-3.5 outperformed its newer versions in many aspects, indicating that model updates with general capabilities may not always lead to better performance in specialized medical domains. These findings emphasize the potential of AI as a supportive resource while emphasizing the continuing need for human expertise in complex clinical decision-making.

PMID:41176557 | DOI:10.1007/s00405-025-09785-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09793-z. Online ahead of print.

ABSTRACT

BACKGROUND: The auricular cough reflex (Arnold’s reflex) is a vagally mediated somato-visceral response triggered by stimulation of the external auditory canal (EAC). While classically considered rare, its clinical relevance in otologic procedures remains underexplored.

OBJECTIVE: This study aimed to evaluate the prevalence, lateralization, and potential risk factors of the Arnold reflex during routine otologic examinations, with particular attention to examiner handedness, hearing aid use, and EAC inflammation.

METHODS: In this prospective observational study, 404 consecutive patients undergoing bilateral ear wax removal in a university otology clinic were assessed for reflex-induced coughing. Reflex occurrence, laterality, instrument type, hearing aid use, signs of local infection, age, and sex were documented. Statistical analyses included chi-square tests, logistic regression, and McNemar’s test.

RESULTS: A cough reflex was elicited in 52 patients (12.9%), predominantly right-sided (73.1%, p < 0.001). The reflex was most frequently triggered by curettes (84.6%). No significant association was found between reflex presence and hearing aid use, local infection, age, or sex. The strong right-ear predominance, observed exclusively with a right-handed examiner, suggests that handedness and canal wall anatomy may influence reflex induction.

CONCLUSION: The Arnold cough reflex occurs more commonly than historically reported, with a notable right-sided predominance potentially linked to examiner handedness and procedural factors. Routine otologic variables such as age, sex, hearing aid use, and local inflammation had no measurable effect. These findings underscore the importance of examiner awareness and gentle technique in the EAC. Future studies should explore anatomical mapping, neurophysiological mechanisms, and the potential role of habituation in chronic ear stimulation.

PMID:41176556 | DOI:10.1007/s00405-025-09793-z

Eur Arch Otorhinolaryngol. 2025 Nov 1. doi: 10.1007/s00405-025-09756-4. Online ahead of print.

ABSTRACT

PURPOSES: Allergic rhinitis (AR) is increasingly recognized for its broader impacts on health, including possible links to various vestibular disorders. This study aims to investigate the association between prior AR and peripheral vestibular disorder (PVD) within Taiwan’s National Health Insurance system.

METHODS: Utilizing the Longitudinal Health Insurance Database 2010, this case-control study analyzed data from patients diagnosed with PVD (n=78,503) and 235,509 propensity-score-matching controls. To evaluate the association between prior AR and PVD, we carried out multiple logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: The Chi-squared test indicates a notable contrast in prior AR occurrence between individuals with PVD and those under control (32.2% vs. 22.8%, p<0.001). Furthermore, our findings reveal significant statistical differences in AR prevalence among patients with Meniere’s disease (32.1% vs. 22.8%, p<0.001), benign paroxysmal positional vertigo (32.2% vs. 22.8%, p<0.001) as well as vestibular neuritis (32.6% vs.22.8, p <0.001) relative to controls. The adjusted OR for prior AR among sampled PVD patients was found to be 1.605 (95% CI=1.577~1.634). After making similar adjustments for MD, BPPV, and VN cases; we discovered that adjusted ORs of AR were respectively recorded as: 1.598 (95% CI=1.530~1.668), 1.597 (95% CI=1.534~1.662), and finally at 1.636 (95 % CI =1.552 ~1.725).

CONCLUSION: The study suggests a significant link between prior AR and the occurrences of PVD. However, given the distinct pathophysiological mechanisms of these disorders and the high prevalence of AR in the general population, the findings should be interpreted with caution. These results are hypothesis-generating and underscore the need for prospective and mechanistic studies to clarify whether the observed associations reflect causal relationships or coincidental comorbidity.

PMID:41176555 | DOI:10.1007/s00405-025-09756-4

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12092-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the diagnostic performance of ¹⁸F-fluoro-L-ascorbic acid ([¹⁸F]FAA) positron emission tomography-computed tomography (PET/CT) in detecting metastatic differentiated thyroid cancer (DTC) and compare it with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) PET/CT.

MATERIALS AND METHODS: Data were retrospectively collected from patients who were clinically suspected or diagnosed with postoperative metastatic DTC between September 2023 and May 2024. Quantification was performed using the maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR). Histopathological outcomes and clinical follow-up served as the reference standard for final diagnosis. Diagnostic accuracy was compared using McNemar’s test, and tracer uptake was analyzed via the Wilcoxon signed-rank test.

RESULTS: A total of 85 participants (median age, 51 years; IQR, 38-61 years; 45 women) were evaluated. For cervical lymph nodes (LNs), [¹⁸F]FAA showed superior sensitivity (88% vs. 67%), accuracy (82% vs. 69%), and negative predictive value (78% vs. 57%) (all p < 0.001), with comparable specificity (72% vs. 74%, p = 0.64) and positive predictive value (84% vs. 81%; p = 0.44) than [¹⁸F]FDG. For distant metastases, [¹⁸F]FAA PET/CT demonstrated higher sensitivity than [¹⁸F]FDG for pulmonary metastases (53% vs. 27%), and bone metastases (72% vs. 21%) (all p < 0.001). Semiquantitatively, [¹⁸F]FAA had higher SUVmax in the cervical LN metastasis (10.3 vs. 5.4), pulmonary metastasis (4.7 vs. 2.8), and bone metastasis (16.1 vs. 3.0), as well as higher TBR in cervical LN (18.1 vs. 6.8) and bone metastasis (6.9 vs. 1.9) (all p < 0.01).

CONCLUSION: [¹⁸F]FAA PET/CT outperforms [¹⁸F]FDG PET/CT in the depiction of metastatic thyroid cancer, particularly in neck LNs, pulmonary, and bone metastases.

KEY POINTS: Question Is 6-Deoxy-6-[¹⁸F]fluoro-L-ascorbic acid PET/CT ([¹⁸F]FAA) PET/CT an imaging method that can identify metastatic lesions after thyroid cancer surgery, and is it superior to [¹⁸F]FDG PET/CT? Findings [¹⁸F]FAA exhibited higher sensitivity and elevated SUVmax values compared to [¹⁸F]FDG in the detection of lymph node, lung, and bone metastases of metastatic thyroid cancer. Clinical relevance [¹⁸F]FAA is a reliable diagnostic tool that can accurately locate metastatic sites after thyroid cancer surgery. This helps tailor treatment plans and predict prognosis based on different metastatic scenarios.

PMID:41176553 | DOI:10.1007/s00330-025-12092-0

Eur Radiol. 2025 Nov 1. doi: 10.1007/s00330-025-12115-w. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess treatment response in osteosarcoma, two automated convolutional neural networks (CNNs) were developed to quantify tumour volumes and predict response to induction chemotherapy using histopathology as the reference standard.

MATERIALS AND METHODS: This retrospective, multicentre study included magnetic resonance imaging (MRI) scans from osteosarcoma patients acquired between January 2006 and July 2024. A 3D U-Net CNN segmented tumours and calculated volumes at baseline and post-chemotherapy. A second CNN predicted treatment response based on MRI-derived tumour volume changes using histopathologic necrosis (≥ 90%) as the reference standard. Both models were trained on 162 scans from 81 patients (Centre A) and validated on 40 scans from 20 patients (10 per centre) with Centre B as the external test set. Human readers measured 3D tumour diameters and volumes, compared with CNN-derived volumes using Spearman’s correlation, Bland-Altman plots, and Dice coefficients. Prediction performance was assessed using accuracy, sensitivity, and specificity, with significance determined by agreement metrics.

RESULTS: Patients from Centre A had a mean age of 15 ± 5 years (52 males), and from Centre B a mean age of 13 ± 0 years (8 males). CNN- and human-derived tumour volumes showed strong correlation (Centre A: r = 0.98, Centre B: r = 0.95; p < 0.001). Dice coefficients were 0.86 (Centre A) and 0.81 (Centre B), with median Hausdorff distances of 15.0 mm and 14.2 mm. The response prediction model classified 16/20 cases (80% accuracy) with 90% sensitivity and 70% specificity.

CONCLUSION: CNN-derived tumour volume measurements were comparable to human assessments. CNN-based volume changes predicted histopathologic response to chemotherapy in paediatric osteosarcoma.

KEY POINTS: Question Accurate, noninvasive assessment of treatment response in paediatric osteosarcoma is limited by its reliance on manual tumour measurements and post-surgical histopathology. Findings Automated deep learning accurately measured tumour volumes on MRI and predicted chemotherapy response with 80% accuracy, 90% sensitivity, and 70% specificity. Clinical relevance Automated deep learning enables accurate tumour volume assessment and prediction of chemotherapy response in paediatric osteosarcoma, offering a noninvasive tool to support and refine patient management.

PMID:41176552 | DOI:10.1007/s00330-025-12115-w

Pain Ther. 2025 Nov 2. doi: 10.1007/s40122-025-00787-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic pelvic pain syndrome (CPPS) in women is a debilitating condition with a high prevalence (5-25%), yet its etiology remains unclear. This prospective observational study aimed to identify clinical and medical history covariates associated with CPPS to elucidate potential pathophysiological mechanisms.

METHODS: A total of 225 women were evaluated in a gynecological pain clinic in Germany, including 41 patients with CPPS (≥ 6 months of lower abdominal pain) and 184 control patients undergoing routine gynecological screening. Exclusion criteria included pregnancy, pelvic malignancy, acute pelvic inflammation, and abnormal uterine bleeding. Covariates were assessed through structured clinical history and physical examination.

RESULTS: Significant associations with CPPS were observed for prior pelvic surgery (72% vs. 45%, p = 0.003), bowel constipation (37% vs. 11%, p = 0.002), history of endometriosis (33% vs. 10%, p = 0.043), and prior trauma (27% vs. 11%, p = 0.013). In contrast, there were no significant differences in rates of depression (p = 0.376), use of psychopharmaceuticals (p = 0.757), pelvic floor abnormalities (p = 0.503), uterine retroversion (p = 0.330), or pelvic congestion (p = 0.455). Dysmenorrhea (59% vs. 42%) and vulvar pain (31% vs. 8%) were more frequent in the CPPS group, though not statistically significant. No differences were found in delivery mode, use of intrauterine devices, analgesics, hormonal replacement therapy, and other medications, or comorbidities such as diabetes, thyroid disease, hypertension, other pain diseases, or musculoskeletal disorders.

CONCLUSIONS: CPPS was not associated with several commonly suspected cofactors, including psychosomatic factors, pelvic congestion, or pelvic floor dysfunction. The findings suggest the existence of two subgroups of CPPS, the endometriosis-associated type and the neurovegetative type, associated with prior pelvic surgery, constipation, and trauma. This concept allows for the development of new targeted therapeutic strategies to successfully treat CPPS.

PMID:41176550 | DOI:10.1007/s40122-025-00787-7

Med Health Care Philos. 2025 Nov 1. doi: 10.1007/s11019-025-10306-2. Online ahead of print.

ABSTRACT

Recent and ongoing advances in medical AI promise to revolutionise medicine by improving the accuracy, speed, and efficiency of clinical care. These promises are responses to the continuous quest of modern medicine to eliminate uncertainty and find answers to crucial questions of diagnosis, prognosis and treatment, while the impressive reported results of medical AI have raised the question of whether medical AI can be perceived as an epistemic authority that challenges the authority of doctors. In this paper, we examine this question by approaching it from the standpoint of what epistemic goods medical AI can offer, or else, what medical AI can claim to “know”. Using Popowicz’ account of epistemic authority in medical practice, which he locates in the scientific method that underpins the practice, we argue that medical AI uses a different scientific method to the one that has given rise and forms the epistemic foundations of traditional western medicine, and this presents a problem. As long as we are seeking not only statistically accurate correlations, but empirically grounded causations in medicine, AI cannot be treated as an epistemic authority in this field. We conclude that until medical practice finds ways to successfully incorporate such epistemological differences, medical AI should submit to the epistemic authority of medical practice and take its place on the long list of important and useful epistemic tools doctors can use to improve the health of patients.

PMID:41176529 | DOI:10.1007/s11019-025-10306-2

J Optom. 2025 Oct 31:100583. doi: 10.1016/j.optom.2025.100583. Online ahead of print.

ABSTRACT

PURPOSE: To assess the feasibility of a novel method for simulating a Rigid Gas Permeable Contact Lenses (RGP-CL) fitting using 3-D printed sclero-corneal surfaces (SCSs).

METHODS: The experiment involved the fabrication of two resin SCSs with biconic corneal geometry and the participation of 22 optician-optometrists as observers. Participants compared the fluorescein patterns of three RGP-CL fitted on each SCS with theoretical patterns generated through computer simulation. To standardize visualization, comparisons were conducted through a multiple-choice questionnaire composed of 6 questions. Each question presented one main fluorescein pattern (either theoretical or experimental) and four additional patterns obtained using the other technique. Optometrists were required to select the fluorescein pattern more similar to the main pattern. A statistical analysis was performed to evaluate the accuracy of the comparison between the two methods.

RESULTS: The surface quality of the printed SCSs was sufficient to produce consistent and interpretable fluorescein patterns. In all questions, at least 70 % of optometrists selected the correct pattern. In four questions, more than 90 % identified the correct pattern, and in one question accuracy reached 100 %. The correct option was always the most frequently chosen, with a significantly higher rate than the second most selected option (p = 0.05).

CONCLUSIONS: The ability of most optometrists to correctly identify patterns suggests that, even without polishing, 3-D printed SCSs can simulate fluorescein patterns closely resembling theoretical ones. This approach shows promise as a supportive tool for training in RGP-CL fitting.

PMID:41176486 | DOI:10.1016/j.optom.2025.100583

Radiography (Lond). 2025 Oct 31:103215. doi: 10.1016/j.radi.2025.103215. Online ahead of print.

ABSTRACT

INTRODUCTION: Women with dense breast tissue are at increased risk for breast cancer, and standard mammography often fails to detect cancer in this population. Supplementary screening modalities offer improved detection, yet practices across Europe remain inconsistent. This study explores the requirements for implementing supplementary breast cancer screening across Europe by surveying current guidance and practices, examining workforce awareness and perceptions of existing protocols, identifying barriers to practice change, and evaluating staff willingness to adopt these screenings.

METHODS: A mixed-methods cross-sectional survey was distributed online to radiographers and radiologists in breast cancer screening units across Europe. Descriptive and inferential statistics, including the Friedman and Chi-Square tests, were used to analyse quantitative data. Qualitative data from open-ended questions were analysed using content analysis.

RESULTS: Eighty-three respondents from 39 countries responded over a six-month period. The majority (95.2 %) of respondents worked in breast screening programs. Hand-held ultrasound (45.8 %), Digital Breast Tomosynthesis (32.5 %), and Magnetic Resonance Imaging (22.9 %) were the most used supplementary modalities. Main barriers included waiting lists (mean = 3.99), cost (mean = 3.98), and workload (mean = 3.95). Only 34.9 % of the respondents recorded breast density. Awareness of guidelines varied significantly by profession (p = 0.009). Themes from open-ended responses highlighted technological needs, staffing gaps, training needs, and cost barriers.

CONCLUSION: Despite high awareness, implementation of supplementary screening remains limited due to systemic barriers. Standardized guidelines, resource investment, and targeted education are needed to ensure equitable breast cancer screening across Europe.

IMPLICATIONS FOR PRACTICE: Addressing disparities in training, resources, and guideline implementation is essential to support healthcare professionals in delivering effective supplementary screening for women with dense breasts. These findings can inform the development of standardized protocols and targeted professional education across Europe.

PMID:41176479 | DOI:10.1016/j.radi.2025.103215