Tag: pubmed

JMIR Med Inform. 2025 Apr 2;13:e66466. doi: 10.2196/66466.

ABSTRACT

BACKGROUND: The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA. Structured data are unavailable, with PROMs often embedded within clinic text notes as unstructured data requiring time-intensive, peer-conducted chart review for evaluation. Natural language processing (NLP) of clinic text notes is one promising solution to extracting care quality data from unstructured text.

OBJECTIVE: This study aims to test NLP approaches to identify PROMs documented in VHA chiropractic text notes.

METHODS: VHA chiropractic notes from October 1, 2017, to September 30, 2020, were obtained from the VHA Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort. A rule-based NLP model built using medspaCy and spaCy was evaluated on text matching and note categorization tasks. SpaCy was used to build bag-of-words, convoluted neural networks, and ensemble models for note categorization. Performance metrics for each model and task included precision, recall, and F-measure. Cross-validation was used to validate performance metric estimates for the statistical and machine-learning models.

RESULTS: Our sample included 377,213 visit notes from 56,628 patients. The rule-based model performance was good for soft-boundary text-matching (precision=81.1%, recall=96.7%, and F-measure=88.2%) and excellent for note categorization (precision=90.3%, recall=99.5%, and F-measure=94.7%). Cross-validation performance of the statistical and machine learning models for the note categorization task was very good overall, but lower than rule-based model performance. The overall prevalence of PROM documentation was low (17.0%).

CONCLUSIONS: We evaluated multiple NLP methods across a series of tasks, with optimal performance achieved using a rule-based method. By leveraging NLP approaches, we can overcome the challenges posed by unstructured clinical text notes to track documented PROM use. Overall documented use of PROMs in chiropractic notes was low and highlights a potential for quality improvement. This work represents a methodological advancement in the identification and monitoring of documented use of PROMs to ensure consistent, high-quality chiropractic care for veterans.

PMID:40173367 | DOI:10.2196/66466

J Am Chem Soc. 2025 Apr 2. doi: 10.1021/jacs.5c00968. Online ahead of print.

ABSTRACT

Visualizing the sliding dynamics of a topological network can provide critical insight into determining the design and properties of mechanically interlocked materials. Although several auxiliary techniques have been proposed to infer the microscopic motion of rotaxanes, employing intuitive and convenient methods to explore the microscopic dynamics of a mechanically interlocked polymer remains a significant challenge. Herein, this work introduces a mechanically interlocked network (MIN) into the patterned surfaces for visualizing and regulating the sliding process of [2]rotaxane units through the evolution of surface wrinkles. Upon the photodimerization of the anthracene-functionalized polymer chain, the surface wrinkle can be formed after thermal treatment and subsequent cooling to room temperature. Specifically, the cross-linked films exhibit visible changes in wrinkle topography through the disruption of host-guest recognition by alkaline stimuli. Moreover, by leveraging the unique mechanical properties of surface wrinkles, we prolonged and amplified the originally extremely transient and difficult-to-detect sliding motion of rotaxane units in terms of time scale. Through statistical analysis of the changes in wrinkle morphology, we were able to correspondingly deconstruct the three processes of the rotaxane sliding motion: (I) unrestricted rapid sliding following host-guest dissociation; (II) restricted sliding; and (III) termination of sliding. The novel approach we propose opens a new avenue for studying the microscopic molecular motion of mechanically interlocked materials, facilitating the advancement and application of mechanically interlocked structures. In addition to using macroscopic surface patterns to visualize and explore microscopic molecular motion, the motion of microscopic molecules can also be used to regulate macroscopic surface patterns.

PMID:40173364 | DOI:10.1021/jacs.5c00968

Oral Dis. 2025 Apr 2. doi: 10.1111/odi.15336. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the necessity of adjuvant radiotherapy for oral squamous cell carcinoma patients with a pN1 stage and no adverse pathological features.

PATIENTS AND METHODS: This was a multicenter cohort study including 231 patients.

RESULTS: Among the enrolled patients, 171 received adjuvant radiotherapy, and 60 did not. According to the Kaplan-Meier survival analysis, there were no significant differences between the two groups in terms of disease-free survival (59.5% vs. 58.3%, p = 0.938), overall survival (73.1% vs. 75.0%, p = 0.936), and disease-specific survival (74.9% vs. 76.7%, p = 0.914). In patients with local/regional recurrence after surgery, after-recurrence survival (34.8% vs. 44.0%, p = 0.197) was not significantly different. Analysis by T stage revealed no significant differences in disease-free survival (60.9% vs. 75.0%, p = 0.084), overall survival (73.6% vs. 90.6%, p = 0.053) and disease-specific survival (75.8% vs. 90.6%, p = 0.072) for T1-2 patients between the radiotherapy and non-radiotherapy groups. The results revealed statistically significant differences in disease-free survival (57.9% vs. 39.3%, p = 0.030), overall survival (72.4% vs. 57.1%, p = 0.034) and disease-specific survival (73.7% vs. 60.7%, p = 0.049) between the two groups.

CONCLUSIONS: Adjuvant radiotherapy does not improve the prognosis of T1-2N1M0 patients without adverse pathological features; however, adjuvant radiotherapy should be recommended for T3-4aN1M0 patients.

PMID:40173300 | DOI:10.1111/odi.15336

Ultrasound Q. 2025 Mar 24;41(2):e00712. doi: 10.1097/RUQ.0000000000000712. eCollection 2025 Jun 1.

ABSTRACT

Noninvasive assessment of liver fat content is crucial due to the high global prevalence of nonalcoholic fatty liver disease. Algorithms based on ultrasound (US) attenuation coefficient (AC) for estimating liver fat content are commercially available, but a lack of consensus exists regarding the best estimation protocol. The aim of our study was to evaluate the influence of the size of the region of interest (ROI) on the US AC.A prospective study was conducted. An abdominal US was done for 86 outpatients. A sampling box was positioned within the liver parenchyma, approximately 2 cm beneath the liver capsule with a ROI, measuring about 2 × 4 cm and then 4 × 5 cm, precisely placed at the center of this sampling box. Five readings of the AC were captured, and the average of these measurements was employed to assess the severity of hepatic steatosisA statistically significant difference between AC with 2 different ROI sizes was shown (P < 0.001) with AC values with 2 × 4 cm ROI were higher than those obtained with 4 × 5 cm ROI (AC mean 0.668 VS 0.653). However, the agreement between AC values obtained with 2 different ROI sizes was excellent (correlation coefficient 0.941)An ROI size dependence is observed in the measurement of AC in the liver. A standardized acquisition protocol with a fixed size of the ROI needs to be developed to minimize differences in AC measurements and to assess changes in serial measurements reliably.

PMID:40173292 | DOI:10.1097/RUQ.0000000000000712

Diabet Med. 2025 Apr 2:e70036. doi: 10.1111/dme.70036. Online ahead of print.

ABSTRACT

AIMS: To investigate the cost-effectiveness of early initiation of metformin and usual care for gestational diabetes mellitus (GDM).

METHODS: Economic evaluation from a healthcare perspective, based on the EMERGE randomised controlled trial. In total, 535 women with GDM were randomised to placebo in addition to usual care or metformin in addition to usual care. Economic outcomes included incremental healthcare costs and quality adjusted life years (QALYs) and expected cost-effectiveness at cost-effectiveness threshold values of €20,000, €45,000 and €100,000 per QALY gained. Uncertainty was explored using parametric, non-parametric, deterministic and probabilistic methods and heterogeneity using subgroup analysis.

RESULTS: On average, relative to the placebo arm, the early metformin arm was associated with non-statistically significant mean increases of €193.07 (95% CI: -€789.88, €1176.01; p = 0.700) and 0.002 QALYs (95% CI: -0.009, 0.013; p = 0.771). In terms of expected cost-effectiveness at threshold values of €20,000, €45,000 and €100,000 per QALY gained, the probability of the early metformin arm being more cost-effective was estimated at 0.423, 0.452 and 0.524. Exploratory subgroup analyses provided more favourable but not definitive evidence in favour of the early metformin arm for cohorts with previous GDM and previous caesarean section.

CONCLUSIONS: We do not find definitive evidence that early initiation of metformin in addition to usual care for GDM was more cost-effective than usual care alone. The clinical and economic evidence may be considered equivocal, but worthy of further examination.

PMID:40173275 | DOI:10.1111/dme.70036

Eur Heart J. 2025 Apr 2:ehaf211. doi: 10.1093/eurheartj/ehaf211. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Epidemiology of pulmonary embolism (PE) may have shifted since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe temporal trends in PE epidemiology in the Netherlands since 2015.

METHODS: Using nationwide data from Statistics Netherlands, all Dutch inhabitants (>16 million) without a history of PE were dynamically identified on 1 January of each year to assemble eight cohorts of PE-free Dutch inhabitants in 2015-22. They were individually followed until the end of that respective year to determine 1-year risk of PE (identified by hospital diagnoses/primary cause of death) and establish relevant risk factors. The PE cases were subsequently studied to determine 1-year all-cause mortality following PE. Multivariable logistic regression with cluster-robust standard errors and robust Poisson regression were respectively employed to evaluate relative differences in PE incidence and mortality between years.

RESULTS: Pulmonary embolism incidence in the Dutch population decreased from 2015 to 2019 but markedly increased by 23% (95% confidence interval 20%-26%), 52% (48%-56%), and 7% (4%-9%) in 2020-22 (vs. 2019), respectively. Most traditional PE risk factors remained associated with PE in 2020-22 but generally with a weaker association. Pulmonary embolism mortality was stable until 2019 but then increased by 10% (6%-14%) in 2020 and 9% (6%-13%) in 2021, while the increase [2% (-1% to 6%)] was insignificant in 2022. The above-mentioned changes since 2020 were generally greater in males than females.

CONCLUSIONS: The seemingly favourable pre-pandemic temporal trends in PE epidemiology in the Netherlands reversed during the COVID-19 pandemic but appear to revert to pre-pandemic levels after 2022.

PMID:40172984 | DOI:10.1093/eurheartj/ehaf211

J Craniofac Surg. 2025 Apr 2. doi: 10.1097/SCS.0000000000011351. Online ahead of print.

ABSTRACT

INTRODUCTION: Alveolar bone grafting during the mixed dentition period is a common treatment, but the optimal surgical timing remains unclear. This study aims to evaluate how age influences the outcomes of secondary alveolar cleft repair, focusing on bone formation and midfacial symmetry.

MATERIALS AND METHODS: This study retrospectively analyzed patients who underwent autologous iliac cancellous bone grafting for alveolar cleft repair from January 2019 to August 2023. Preoperative and 1-year postoperative skull CT data were used to measure osteogenesis rate and midface bony structures, with statistical analysis conducted using R.

RESULTS: A total of 68 patients aged 8 to 12 years were included in the study, with no significant differences in baseline data. Autologous iliac bone grafting for alveolar cleft repair resulted in significant improvements in the symmetry of the midfacial skeletal structure, with younger patients showing more pronounced improvements. Univariate linear regression analysis revealed a linear relationship between age and osteogenesis rate, which was further confirmed by multiple linear regression analysis. Age was identified as the most significant factor influencing the osteogenesis rate (β=-0.037, P=0.003), while the deviation of the nasal septum was also found to significantly affect the osteogenesis rate (β=0.004, P=0.009).

CONCLUSIONS: Age significantly impacts the outcomes of alveolar cleft repair using autologous iliac cancellous bone grafting. Younger patients have better bone formation and facial symmetry improvements, suggesting that earlier surgery may be more beneficial. Preoperative nasal septal deviation assessment is also essential for optimizing surgical planning.

PMID:40172976 | DOI:10.1097/SCS.0000000000011351

J Craniofac Surg. 2025 Apr 2. doi: 10.1097/SCS.0000000000011321. Online ahead of print.

ABSTRACT

The surgery for dental implants in atrophic sites is a constant challenge. The sinus lift has some recognized techniques; however, the use of low morbidity and low-cost techniques is a trend in surgery. This study aims to identify implant stability observed in dental implants installed in an atrophic maxillary sinus using the lateral window technique without bone graft or biological barrier. A clinical series included 20 patients with 25 conical design dental implants installed, with 1 year of follow-up performed. Bone height was analyzed in the preoperative stage and at 1 year of follow-up using panoramic radiography. All the implants were installed using a lateral window sinus lift, respecting a minimum insertion torque of 35N. Four months later, the second surgery installed the healing abutment and then the prosthetic abutment; the fixed prosthesis on the implant was performed conventionally. After 1 year of follow-up, only one implant was lost at the healing abutment installation stage, the remaining 24 implants were rehabilitated conventionally with no issues. All the implants were stable 1 year after surgery; an average bone gain of 4.9 mm was observed between the preoperative stage and the 1-year follow-up, a statistically significant increase (P > 0.05). The immediate implant with primary stability in maxillary sinus lift using the lateral window approach, without bone grafts or biological barriers, has a high survival rate and facilitates new bone formation around the implant.

PMID:40172973 | DOI:10.1097/SCS.0000000000011321

J Craniofac Surg. 2025 Apr 1. doi: 10.1097/SCS.0000000000011304. Online ahead of print.

ABSTRACT

INTRODUCTION: Evaluating pediatric airways is challenging, particularly in identifying those at risk for difficult intubation, which is often linked to craniofacial malformations. Limited cooperation from preschoolers further complicates this evaluation.

OBJECTIVE: To evaluate the predictive accuracy of the Arné Score in identifying risk factors for difficult intubation in preschool-aged children (under 6 y) and develop a model to prevent difficult laryngoscopy and intubation. Secondary objectives include determining the incidence of difficult intubation and the appropriate age for preanesthetic airway assessments.

METHODS: This retrospective observational study analyzed 1385 patients aged 0 to 16 years, all undergoing general anesthesia and tracheal intubation in 2018 at a tertiary hospital in Barcelona. Among them, 708 were under 6 years. Predictive tests included the Arné Score, with difficult intubation defined by Cormack-Lehane scores, intubation attempts, and alternative device use. Logistic regression analyzed predictors with significant odds ratios.

RESULTS: Unrecorded Mallampati test values were common in children under 6 years (99.04%). Of those without a history, 8.07% faced intubation difficulties, compared with 50% with a history. Relative risk was 6.23, and the odds ratio was 11.46. Among 202 classified with airway difficulties, 82.67% had no intubation issues. Statistically significant associations highlighted greater risks for those with a difficult intubation history.

CONCLUSIONS: Arné Score tests are impractical for children under 6. If no history or airway pathology exists, there’s a 95.14% chance of successful intubation. The history of difficult intubation increases risks more than airway pathology alone.

PMID:40172950 | DOI:10.1097/SCS.0000000000011304

Pain Med. 2025 Apr 2:pnaf039. doi: 10.1093/pm/pnaf039. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examines the relationship between racial discrimination and physical pain outcomes.

METHODS: A geographically representative sample of 887 individuals was recruited online through CloudResearch from diverse racial backgrounds, including Black/African American, Latine/Hispanic American, Asian American, and White/European American adults. Participants completed measures on racial and ethnic discrimination, racial microaggressions, pain severity, depression symptoms, and coping styles. Statistical analyses included multiple regression and mediation models.

RESULTS: Our findings indicate that racialized participants experienced greater ethnic discrimination and racial microaggressions compared to their non-Hispanic White counterparts. Hispanic/Latine participants also reported greater pain severity than other groups. Lifetime experiences of discrimination, depression symptoms, avoidant coping style, and age emerged as significant predictors of pain severity, while mediation analyses revealed that lifetime discrimination partially mediated the relationship between race/ethnicity and pain severity for racially marginalized participants, compared to non-Hispanic White participants. Further, greater reliance on avoidant coping combined with greater lifetime discrimination experiences was associated with increased severity of pain.

CONCLUSIONS: The findings indicate how racism may result in worse pain outcomes in people of color, with potentially amplified adverse effects for those who engage in avoidant coping. While therapeutic interventions targeting avoidance may benefit racialized individuals, ultimately, the results highlight the critical need for large-scale policy interventions targeting racial discrimination to improve health equity and reduce the burden of pain among racialized populations.

PMID:40172915 | DOI:10.1093/pm/pnaf039