Tag: nevin manimala

J Thromb Thrombolysis. 2025 Nov 8. doi: 10.1007/s11239-025-03193-0. Online ahead of print.

ABSTRACT

Endovascular thrombectomy (EVT) is the standard of care in acute ischemic stroke (AIS), yet functional outcomes remain suboptimal. Normobaric hyperoxia (NBHO) is a potential neuroprotective strategy. This study is the first systematic review and meta-analysis to assess NBHO as a potential neuroprotective adjunctive to improve outcomes in EVT-treated patients. A comprehensive search of electronic databases, including PubMed, Scopus, Cochrane, and Web of Science, was performed in February 2025. The inclusion criteria targeted randomized controlled trials (RCTs) comparing NBHO and EVT to EVT alone or with sham oxygen therapy. Statistical analyses were performed using RevMan software. Four RCTs comprising 648 patients with AIS due to large vessel occlusion in the anterior circulation were included in the study. For the primary efficacy endpoint of excellent functional outcome, defined as the number of patients who had a Modified Rankin Scale (mRS) score of ≤ 1 at 90 days, the overall odds ratio with a subgroup based on the oxygen delivery duration at 2, 4, and 6 h was in favor of the NBHO group compared to the control (OR = 1.66, 95% CI [1.13, 2.45], P = 0.01, I2 = 0%). The subgroup of 4-hour oxygen delivery duration was the only significant subgroup (OR = 1.6, 95% CI [1.01, 2.51], P = 0.04). Safety outcomes showed no significant differences between the NBHO group and the control group across all reported measures. NBHO as an adjunct to EVT appears to be effective and safe. A 4-hour duration was found to be the most effective. Further RCTs are needed to confirm our results and establish the optimal treatment protocol.

PMID:41206375 | DOI:10.1007/s11239-025-03193-0

Med Phys. 2025 Nov;52(11):e70131. doi: 10.1002/mp.70131.

ABSTRACT

BACKGROUND: Type 2 diabetes mellitus (T2DM) and Alzheimer’s disease (AD) are two major global health challenges, both associated with increased incidence and mortality. Although their pathologies differ, mounting evidence points to a shared vascular dysfunction that may drive the onset and progression of both conditions. Ultrasound localization microscopy (ULM) offers a promising approach for high-resolution imaging and quantification of cerebral microvasculature.

PURPOSE: To investigate changes in cerebral micro-vessels induced by T2DM, AD, and their coexistence, aiming to uncover the underlying interactions between the two diseases.

METHODS: Twenty-four Sprague Dawley (SD) rats were randomly assigned into four groups: (1) normal, (2) DM combined with AD, (3) DM, and (4) AD. Cerebral vascular density in the caudate putamen (CPu), thalamus (TH), and hippocampus (HIP) was quantified using ULM. Statistical analysis was conducted using one-way ANOVA followed by Tukey’s honestly significant difference (HSD) post-hoc test, after confirming normality and homogeneity of variance (Shapiro-Wilk and Levene’s tests). A p-value < 0.05 was considered statistically significant. To validate the model and examine the relationship between T2DM and AD, pathological staining was performed to assess cellular and neuronal changes, as well as Aβ deposition.

RESULTS: Both single diseases and their combination led to a reduction in cerebral vascular density across all three brain regions. The blood glucose-vessel density distributions in the DM and DM&AD groups showed substantial overlap, indicating similar patterns of cerebrovascular changes. In the CPu region, vascular density in diabetic rats decreased by 34.13% compared to controls (p = 0.003), while in the HIP of the DM&AD group, vascular density was reduced by 29.98% (p = 0.002).

CONCLUSION: T2DM triggers an increased risk of AD. ULM provides the possibility to be used as an emerging technological tool to detect early cerebral microangiopathy.

PMID:41206345 | DOI:10.1002/mp.70131

J Prosthet Dent. 2025 Nov 7:S0022-3913(25)00851-0. doi: 10.1016/j.prosdent.2025.10.039. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The accuracy of dental implant placement influences prosthetic outcomes, biological complications, and long-term success. While guided surgery aims to improve precision, its advantages over conventional freehand techniques regarding survival, marginal bone stability, and complications remain unclear.

PURPOSE: The purpose of this umbrella review was to synthesize evidence from systematic reviews comparing clinical outcomes of guided versus freehand dental implant placement, focusing on accuracy, marginal bone loss, survival, and complications.

MATERIAL AND METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and PROSPERO registration, the PubMed, Scopus, Embase, Google scholar, and Cochrane Library databases were searched for studies published between January 2000 and July 2025. Eligible studies were systematic reviews and meta-analyses comparing guided (static or dynamic) and freehand implant placement. Methodological quality was assessed using a measurement tool to assess systematic reviews 2 (AMSTAR-2). Extracted data included implant placement accuracy, marginal bone loss, survival, and complications. Effect sizes and statistical outcomes were extracted directly from the included meta-analyses, and results were synthesized descriptively without conducting a new meta-analysis.

RESULTS: Thirteen systematic reviews were included. Guided and computer-assisted placement showed better accuracy than freehand methods (Standardized mean difference [SMD] for coronal deviation -0.97; 95% Confidence Interval [CI] -2.27 to -0.32; P<.01). Marginal bone loss and implant survival were comparable across techniques (Risk ratio [RR]1.02; 95% CI 0.98-1.06; P=.28), both remaining high. Complication rates were low, with guided techniques potentially reducing iatrogenic risk (RR 0.88; 95% CI 0.74-1.04; P=.11).

CONCLUSIONS: Guided implant surgery was found to improve placement accuracy and may reduce surgical risk in complex treatments. Freehand placement remained reliable with comparable long-term outcomes when performed by experienced clinicians. Selection should consider treatment complexity, clinician expertise, and available resources.

PMID:41206337 | DOI:10.1016/j.prosdent.2025.10.039

J Prosthet Dent. 2025 Nov 7:S0022-3913(25)00847-9. doi: 10.1016/j.prosdent.2025.10.041. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Understanding the determinants of willingness to pay (WTP) for missing tooth replacement is essential for promoting oral health.

PURPOSE: This study aimed to examine the factors associated with both the WTP and WTP amount for replacing missing anterior and posterior teeth among older Japanese adults.

MATERIAL AND METHODS: This cross-sectional study used data from the Japan Gerontological Evaluation Study (JAGES) conducted in 2022, which targeted independent adults aged ≥65 years. Thirty-two explanatory variables were used, including demographic, socioeconomic, oral health-related, and general health indicators, and 2 primary outcome variables for both anterior and posterior teeth: whether participants were willing to pay for missing tooth replacement and the amount they were willing to pay. Dominance analysis was used to determine the relative importance of all candidate variables.

RESULTS: A total of 4616 participants were included (men: 57.9%). The mean ±standard deviation age was 71.9 ±4.8 years. Of the participants, 95.6% and 94.9% expressed WTP to replace missing anterior and posterior teeth. The mean WTP amounts for anterior and posterior teeth were 71 300 Japanese Yen (JPY) and 61 100 JPY (544 and 466 USD). Dominance analysis showed that the absence of depressive symptoms was the strongest positive predictor of WTP (18.3% of the total explained variance for anterior teeth and 22.4% for posterior teeth). Wealth was the most influential factor in WTP amount (21.3% for anterior teeth and 19.2% for posterior teeth). Other key predictors included educational level, preventive dental visit, income, population density, and frequency of meeting friends.

CONCLUSIONS: While the absence of depressive symptoms emerged as the strongest predictor of whether individuals expressed WTP to replace missing teeth among older adults, wealth emerged as the most influential factor in determining the amount they were willing to pay for both anterior and posterior teeth. WTP is largely explained by economic, psychological, and social factors. These findings suggest that promoting oral health may require integrated strategies addressing financial barriers, mental health support, and social engagement.

PMID:41206333 | DOI:10.1016/j.prosdent.2025.10.041

Curr Probl Diagn Radiol. 2025 Oct 31:S0363-0188(25)00200-2. doi: 10.1067/j.cpradiol.2025.10.021. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the diagnostic accuracy and longitudinal outcomes of PI-RADS 3 lesions assessed with biparametric (bpMRI) versus multiparametric MRI (mpMRI), in a multi-reader setting.

METHODS: This retrospective single-center study included 196 patients, of whom 49 presented with at least one PI-RADS 3 lesion. Three radiologists with varying levels of experience independently reviewed both biparametric (bpMRI) and multiparametric (mpMRI) datasets. Diagnostic performance, inter-reader agreement, lesion evolution over time, and detection rates were analyzed in relation to lesion location and MRI protocol. Receiver operating characteristic (ROC) curve analysis, Cohen’s kappa and intraclass correlation coefficients (ICCs) were used for statistical evaluation.

RESULTS: Reader 1 showed the highest diagnostic accuracy (AUC = 0.767), followed by Reader 2 (AUC = 0.637) and Reader 3 (AUC = 0.504). There were no significant differences between bpMRI and mpMRI for any reader and intra-reader concordance was excellent for all readers (κ > 0.8). Detection was significantly lower in the peripheral zone across all readers. Inter-reader agreement was substantial between Readers 1 and 2 (ICC = 0.704), and poor between the other pairs (ICC < 0.4). During follow-up, 84-92 % of PI-RADS 3 lesions remained stable, 6-8 % decreased, and 8-16 % increased in size. Seven lesions were biopsied based on PSA progression or dimensional growth, all of which were confirmed as clinically significant cancer.

CONCLUSION: BpMRI provided comparable diagnostic performance to mpMRI for PI-RADS 3 lesions. Reader experience and lesion location significantly affected detection. Most lesions remained stable over time, supporting surveillance strategies in selected cases.

PMID:41206329 | DOI:10.1067/j.cpradiol.2025.10.021

Transplant Proc. 2025 Nov 7:S0041-1345(25)00516-0. doi: 10.1016/j.transproceed.2025.09.011. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney transplantation is the preferred treatment for end-stage renal disease. In Pakistan, living related kidney donors constitute the primary source of kidney transplantation. However, data on postdonation outcomes in this population remain limited.

OBJECTIVE: This study aims to evaluate the short- and intermediate-term effects of unilateral nephrectomy on donor kidney function, physical parameters, and glycemic status among living related kidney donors in Pakistan.

METHODS: This retrospective observational cohort study was conducted at the Pakistan Kidney and Liver Institute from March 2018 to February 2021. Predonation data were obtained from hospital records, and postdonation follow-up assessments were conducted at intervals ranging from 6 months to 3 years.

RESULTS: A total of 132 donors donated a kidney, and 100 participated in follow-up assessments. The mean postdonation serum creatinine increased significantly by 0.27 mg/dL (P < .05), while estimated glomerular filtration rate decreased by 30 mL/min (P < .05). Systolic blood pressure increased slightly (by 1.35 mm Hg), while diastolic blood pressure decreased, although neither change was statistically significant (P > .05). Body mass index showed a minor increase of 0.5 kg/m², and HbA1c levels remained stable with no significant postdonation changes (P > .05).

CONCLUSIONS: The study findings suggest that while kidney donation results in a significant decline in renal function in the short term, compensatory mechanisms contribute to gradual improvement over time. These results highlight the importance of continued postdonation monitoring to ensure donor health and identify potential long-term risks.

PMID:41206328 | DOI:10.1016/j.transproceed.2025.09.011

Dent Mater. 2025 Nov 7:S0109-5641(25)00808-5. doi: 10.1016/j.dental.2025.11.001. Online ahead of print.

ABSTRACT

OBJECTIVE: This randomized clinical trial investigated the 96-month clinical performance of a universal adhesive (Adhese Universal Vivapen, Ivoclar Vivadent) applied in etch-and-rinse (ER) and self-etch (SE) modes in Class II bulk-fill composite restorations.

MATERIALS AND METHODS: Thirty-five patients, each with at least two Class II carious lesions, were enrolled. Using a split-mouth design, cavities were randomly assigned to ER or SE adhesive application. All restorations were placed with a high-viscosity bulk-fill resin composite (Tetric EvoCeram Bulk Fill, Ivoclar Vivadent). In total, 84 restorations were evaluated at baseline and at 12, 24, 36, 48, 60, 72, 84 and 96 months by two calibrated, blinded examiners according to modified USPHS criteria. Statistical analyses were performed with Chi-square, Friedman, Cochran’s Q, and McNemar tests (α=0.05).

RESULTS: At 96 months, 74 restorations in 33 participants were examined. No loss of retention/fractures occurred. Seven restorations were replaced (six due to secondary caries-ER: 1, SE: 5 and one due to unacceptable marginal adaptation-SE), yielding crude cumulative replacement rates of 2.4 % (ER) and 14.3 % (SE). Kaplan-Meier analysis showed significantly higher survival for ER than SE (97.4 % vs 85.2 %, p = 0.049). Marginal discoloration was consistently higher with SE from 36 months onward (p < 0.05), whereas marginal adaptation showed no differences between groups at any recall. Other criteria were comparable, and no postoperative sensitivity was recorded.

CONCLUSIONS: Despite a statistically higher incidence of marginal discoloration in the SE approach, both strategies demonstrated comparable long-term outcomes, with no retention loss after 96 months. The ER showed a higher cumulative survival. These findings confirm the clinical acceptability of universal adhesives in Class II bulk-fill composite restorations over extended service periods.

CLINICAL SIGNIFICANCE: Universal adhesives demonstrated durable adhesion and predictable performance in posterior bulk-fill restorations with both strategies, while the ER approach provided additional benefits in marginal discoloration and lower cumulative replacement needs over the long term.

PMID:41206301 | DOI:10.1016/j.dental.2025.11.001

Eur Urol. 2025 Nov 7:S0302-2838(25)04778-5. doi: 10.1016/j.eururo.2025.10.015. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: There is uncertainty over medium-term cancer outcomes for men who avoid biopsy (Bx) after nonsuspicious magnetic resonance imaging (MRI), and men with a negative Bx after suspicious MRI findings. We report on cancer diagnosis, treatment, and Bx rates for this population over a period of 5 yr.

METHODS: This single-centre cohort study followed men discharged from the RAPID prostate cancer diagnostic pathway between 2017 and 2023 with either negative MRI or negative prostate Bx, with at least 3 mo of follow-up. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) or Likert score of 1-2 on MRI or a score of 3 and prostate-specific antigen (PSA) density (PSAD) of <0.12 ng/ml² underwent PSA monitoring, while those with a score of 3 and PSAD >0.12 ng/ml² or a score of 4-5 were offered prostate Bx. Primary outcomes were grade group (GG) ≥2 diagnosis-free survival (Dx-FS) and treatment-free survival (TFS). Secondary outcomes were GG ≥3 Dx-FS, GG 1 Dx-FS, Bx-free survival (Bx-FS), cancer-specific survival, metastasis, and re-referral. Data were collected using a prospective data registry and electronic clinical records; patients with no recent follow-up (>1 yr) were directly contacted. Kaplan-Meier plots and multivariable Cox regression were used for statistical analysis.

KEY FINDINGS AND LIMITATIONS: Of 2334 men investigated within the RAPID pathway, 1266 (927 no Bx, 339 negative Bx) were evaluated. Median follow-up was 3.4 yr (interquartile range 2.4-4.9). Seventy-four had GG ≥2 cancer and seven had GG 1 cancer. The 5-yr Dx-FS rates were 91.9% (95% confidence interval [CI] 90.0-93.9%) GG ≥2, 96.3% (95% CI 95.0-97.7%) for GG ≥3, and 99.4% (95% CI 98.9-99.8%) for GG 1. The 5-yr TFS rate was 94.4% (95% CI 92.6-95.9%). The 5-yr Bx-FS rate in the no-Bx group was 79.6% (95% CI 73.7-85.8%), leaving 39% (899/2334) of the original cohort Bx-free. No metastases or cancer-related deaths occurred. Higher PSAD and PI-RADS score and negative Bx, including atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasm findings, did not predict GG ≥2 diagnosis and treatment. Limitations include data excluded because of short follow-up (19%) and the single-centre evaluation.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The RAPID MRI-directed pathway is safe in triaging men for Bx. At 5 yr, only one in 13 patients discharged from the RAPID pathway had GG ≥2 cancer and one in 20 required cancer treatment, while four in ten avoided Bx.

PMID:41206290 | DOI:10.1016/j.eururo.2025.10.015

Australas Emerg Care. 2025 Nov 7:S2588-994X(25)00085-5. doi: 10.1016/j.auec.2025.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: First-line pharmacological management of acute renal colic pain may vary influenced by preference, structural and staffing issues with emergency departments. The aim of this study was to explore the variation in renal colic pain management and contributing factors within emergency departments in Australia METHODS: A specifically designed survey was sent to relevant national professional colleges and organisations for distribution. The survey presented respondents with four acute renal colic scenarios. Descriptive statistics summarised quantitative data, while free text responses were explored using content analysis.

RESULTS: Responses from 180 nurses, paramedics and medical doctors were analysed. Opioids were the most commonly prescribed analgesia (4 scenarios) in combination with either paracetamol (3 scenarios) or rectal NSAIDs (1 scenario). Free text responses provided context to the preference of opioids and identified workload, clinician availability and scope of practice limitations to timely analgesia provision. Most respondents (91.2 %) would support research into non-pharmacological alternatives to opioids.

CONCLUSION: Opioids remain the first line preference for many clinicians in managing acute renal colic pain despite current guideline recommendations for NSAIDs. Departmental and clinician capacity, and practice limitations contribute to delays in providing analgesia. Greater consistency and predictability in prescribing, review of limitations on nurse prescribing and exploring novel low risk first line non-pharmacological analgesics may improve management of acute renal colic.

PMID:41206284 | DOI:10.1016/j.auec.2025.10.004

Acad Radiol. 2025 Nov 7:S1076-6332(25)00988-2. doi: 10.1016/j.acra.2025.10.030. Online ahead of print.

ABSTRACT

RATIONALE AND OBJECTIVES: To assess the impact of a deep learning-based noise reduction (DLD) technique on image quality and diagnostic accuracy for the evaluation of coronary arteries in transcatheter aortic valve implantation (TAVI) CT imaging.

MATERIALS AND METHODS: Two hundred patients with severe aortic stenosis who underwent CT scans for pre-TAVI planning between October 2022 and April 2024 were retrospectively enrolled. Conventional images were reconstructed and denoised images were generated using dedicated software. Objective image quality was evaluated by measuring the mean Hounsfield unit (HU) and standard deviation (SD) in regions of interest within the aortic root, coronary arteries, and subcutaneous fat to calculate signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). For subjective assessment, two readers used a 5-point Likert scoring system to evaluate sharpness, noise, contrast and overall image quality. The diagnostic performance of both datasets was assessed using invasive coronary angiography as reference standard.

RESULTS: Denoised reconstructions showed significantly higher SNR (37.5±12.8 vs.12.3±4.1) and CNR (45.3±15.4 vs. 14.7±4.4), and lower noise (16.9±7.9 vs. 47.9±11.6 HU) (all p<0.001). Subjective assessment demonstrated that denoised images received the highest score for sharpness, noise, contrast and overall image quality (all p<0.001). For the evaluation of diagnostic accuracy, a total of 800 vessels and 1787 segments were analyzed. The per-segment diagnostic performance of the DLD for detection of CAD revealed an AUC of 90% (95% CI: 88.5-91.3), with accuracy of 93.9% (95% CI: 92.7-95), 85.7% (95% CI: 78.7-90.4) sensitivity and 94.7% (95% CI: 93.5-95.7) specificity, in the absence of a statistically significant difference compared with the evaluation performed on standard images (p=0.056).

CONCLUSION: The DLD substantially improves image quality without affecting diagnostic accuracy for the evaluation of coronary arteries in patients undergoing pre-TAVI CT scans.

PMID:41206269 | DOI:10.1016/j.acra.2025.10.030