Tag: pubmed

Folia Biol (Praha). 2025;71(2):73-78. doi: 10.14712/fb2025071020073.

ABSTRACT

Medulloblastoma (MB) in children is associated with distinct molecular subgroups, reflecting substantial biological heterogeneity. The presence of isocitrate dehydrogenase 1 (IDH1) and IDH2 mutations in paediatric MB has been rarely reported and not routinely investigated. Our study included 23 samples from paediatric patients diagnosed with MB. Hotspot alterations at codons IDH1 R132 and IDH2 R172 were examined using Sanger sequencing following polymerase chain reaction (PCR). The mean age of the patients was 10 years (SD: 4.25), comprising 17 males and 6 females. All cases exhibited classical histological features of MB. β-Catenin expression was observed in four cases (17.4 %), while 19 cases (82.6 %) showed no expression. No statistically significant differences in progression-free survival (PFS) were found between MBs with positive or negative β-catenin expression (P = 0.6). Radiotherapy alone was administered to four patients (17.4 %), while 19 patients (82.6 %) received combined radiotherapy and chemotherapy. The median PFS was 383 days (1 year and 18 days). IDH1 R132 or IDH2 R172 hotspot mutations were not detected in any of the samples. The absence of IDH1 or IDH2 mutations in paediatric MB may be attributed to differences in mutational profiles and cellular origins in childhood MB, despite its histomolecular similarities with adult MB.

PMID:40627836 | DOI:10.14712/fb2025071020073

JMIR Cardio. 2025 Jul 8;9:e68817. doi: 10.2196/68817.

ABSTRACT

BACKGROUND: Heart failure management involves comprehensive lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring, placing additional responsibility on patients and caregivers, with successful adherence often requiring extensive counseling and understandable patient education materials (PEMs). Prior research has shown PEMs related to cardiovascular disease often exceed the American Medical Association’s fifth- to sixth-grade recommended reading level. The large language model (LLM) ChatGPT may be a useful tool for improving PEM readability.

OBJECTIVE: We aim to assess the readability of heart failure-related PEMs from prominent cardiology institutions and evaluate GPT-4’s ability to improve these metrics while maintaining accuracy and comprehensiveness.

METHODS: A total of 143 heart failure-related PEMs were collected from the websites of the top 10 institutions listed on the 2022-2023 US News & World Report for “Best Hospitals for Cardiology, Heart & Vascular Surgery.” PEMs were individually entered into GPT-4 (version updated July 20, 2023), preceded by the prompt, “Please explain the following in simpler terms.” Readability was assessed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. The accuracy and comprehensiveness of revised GPT-4 PEMs were assessed by a board-certified cardiologist.

RESULTS: For 143 institutional heart failure-related PEMs analyzed, the median FKGL was 10.3 (IQR 7.9-13.1; high school sophomore) compared to 7.3 (IQR 6.1-8.5; seventh grade) for GPT-4’s revised PEMs (P<.001). Of the 143 institutional PEMs, there were 13 (9.1%) below the sixth-grade reading level, which improved to 33 (23.1%) after revision by GPT-4 (P<.001). No revised GPT-4 PEMs were graded as less accurate or less comprehensive compared to institutional PEMs. A total of 33 (23.1%) GPT-4 PEMs were graded as more comprehensive.

CONCLUSIONS: GPT-4 significantly improved the readability of institutional heart failure-related PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed health care professional for patients living with heart failure. Further rigorous testing and validation is needed to investigate its safety, efficacy, and impact on patient health literacy.

PMID:40627825 | DOI:10.2196/68817

JCO Clin Cancer Inform. 2025 Jul;9:e2500078. doi: 10.1200/CCI-25-00078. Epub 2025 Jul 8.

ABSTRACT

PURPOSE: Cancer is a leading cause of morbidity and mortality in the United States. Mapping electronic health record (EHR) data to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) may standardize data structure and allow for multiple database oncology studies. However, the number of oncology studies produced with the OMOP CDM has been low. To investigate the discrepancy between the public health impact of cancer and the output of OMOP CDM clinical cancer studies, we evaluated (EHR) data quality of five surgical oncology cohorts in the All of Us Research Program: mastectomy, prostatectomy, colectomy, melanoma excision, and lung cancer resection.

METHODS: We selected procedure codes that were the basis of each phenotype. We used a data quality checklist to evaluate five domains systematically: conformance, completeness, concordance, plausibility, and temporality.

RESULTS: Most phenotype-defining source codes were mapped to Current Procedural Terminology 4, which is an EHR standard. All cohorts had low concept prevalence. Most bivariate correlations between concepts were weak (⍴ ≤ 0.5). The small number of biomarkers available for use limited our plausibility analysis. The median time between biopsy and surgery varied across cohorts.

CONCLUSION: We identified multiple data completeness issues, which limited the fitness for use evaluation. Also, using the OMOP CDM procedure concepts and mappings presented challenges for our study. Variable amounts of missingness in OMOP CDM surgical oncology data may affect the fitness for use of cancer data. Further research is warranted to improve the quality of that data.

PMID:40627823 | DOI:10.1200/CCI-25-00078

JMIR Mhealth Uhealth. 2025 Jul 8;13:e60173. doi: 10.2196/60173.

ABSTRACT

BACKGROUND: Timely and appropriate care is critical for patients with ST-elevation myocardial infarction (STEMI). Effective communication and prompt sharing of test results, particularly electrocardiograms (ECGs), between the referring emergency medicine (EM) physician or emergency medical service (EMS) paramedic and the interventional cardiologist (IC) are essential. This exchange relies on fax or SMS text messages. The SmartAMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction) App was developed to streamline communication. It is user friendly and privacy compliant, and enables rapid, secure ECG sharing to support faster, informed clinical decision-making.

OBJECTIVE: This paper details the results of targeted preimplementation surveys to establish barriers and enablers of using a smartphone app to transmit ECG images among ICs, EM physicians, and EMS paramedics to help tailor implementation interventions.

METHODS: To assess the proposed acceptability and uptake of the app, preimplementation surveys were disseminated to ICs, EM physicians, and EMS paramedics in one region of Ontario, Canada. Questions were generated based on selected components of the Consolidated Framework for Implementation Research, results from a pilot study carried out at a regional hospital where the SmartAMI-ACS app was previously implemented, and predicted barriers based on expert guidance. The preimplementation surveys consisted of 7-point Likert scale questions (1=strongly disagree and 7=strongly agree) and open-ended questions. Open-ended data were extracted verbatim and analyzed using an inductive qualitative approach, with transcripts coded into descriptive qualitative codes and then collapsed into themes.

RESULTS: Survey uptake was acceptable, with 9 of the invited 10 ICs, 51 of the invited 223 EM physicians, and 93 of the invited 1138 EMS paramedics responding. All groups recognized that current practices for sharing ECGs allowed room for improvement, accepting that fax can be inconvenient and SMS text messages may not be secure. When asked whether there was a need for a smartphone app to transmit ECGs, ICs (mean 6.67, SD 0.5), EM physicians (mean 5.57, SD 1.3), and EMS paramedics (mean 5.79, SD 1.45) consistently agreed. Commonly reported barriers were concerns over technological challenges, privacy issues, and cell phone reception strength. Through the identification of the barriers in each stakeholder group, implementation strategies were developed that facilitated the scale-up of this system-change intervention.

CONCLUSIONS: Results from the 3 web-based preimplementation surveys to identify key barriers and enablers to the implementation of the app helped inform the selection of tailored implementation strategies to support the rollout of the app across the health region. The surveys identified key barriers around technology, privacy, and access to required Wi-Fi that needed to be addressed during app implementation to facilitate uptake and use. Results from the surveys, and ongoing evaluation of effectiveness, are informing the expansion of the app intervention to local ambulance services and other health regions.

PMID:40627818 | DOI:10.2196/60173

Neurology. 2025 Aug 12;105(3):e213854. doi: 10.1212/WNL.0000000000213854. Epub 2025 Jul 8.

ABSTRACT

BACKGROUND AND OBJECTIVES: Recent literature suggests no elevated risk of cardiovascular disease in patients having nonfocal transient neurologic attacks (TNAs), yet the origin of these attacks remains unclear. Therefore, we investigated their incidence and potential risk factors in a prospective cohort study, hypothesizing associations with cardiovascular risk factors.

METHODS: Within the Dutch population-based Rotterdam Study, community-living individuals aged 45 years or older underwent assessment for demographic and cardiovascular risk factors in study cohorts initiated in 1990, 2000, and 2006. Participants were subsequently followed until January 1, 2021, for disease incidence through automated linkage of the study database with medical records from participants’ general practitioners. For this study, participants free from TNA at baseline were selected and followed up for the outcome of a nonfocal TNA. The risk of nonfocal TNA was determined through age-specific incidence rates (IRs). Potential risk factors of nonfocal TNA were identified using cause-specific, multivariable, Cox proportional hazard modeling accounting for age, sex, education (university or higher vocational vs lower education level), cardiovascular risk factors, ultrasound markers of carotid atherosclerosis, antithrombotic medication use, and a history of vascular diseases. Sensitivity analyses consisted of conducting this regression among participants without any history of vascular disease at study entrance.

RESULTS: After 204,474 person-years of follow-up in 14,096 participants (mean [SD] age 65.5 [10.3] years, 59.0% female), 518 index nonfocal TNAs (3.7%) occurred. The incidence of nonfocal TNA increased with age, with an IR in those aged between 55 and 59 years of 65.5 (95% CI 33.6-116.2) per 100,000 person-years of follow-up to 424.0 (95% CI 348.0-512.0) in those aged 85 years or older. Older age (hazard ratio [HR] 1.08, 95% CI 1.07-1.09), a lower education level (HR 1.62, 95% CI 1.15-2.29), plaque presence on carotid ultrasound (HR 0.80, 95% CI 0.65-1.00), and the use of antithrombotics (HR 0.59, 95% CI 0.39-0.90) were all independently associated with the risk of nonfocal TNA. After restricting analyses to the 12,499 individuals without history of vascular disease, only the associations of age and a higher maximum attained education level with the risk of nonfocal TNA remained statistically significant.

DISCUSSION: Nonfocal TNAs predominantly affect older adults and those with lower educational attainment, suggesting that these attacks originate from socioeconomic determinants rather than from established cardiovascular risk factors.

PMID:40627815 | DOI:10.1212/WNL.0000000000213854

JMIR Ment Health. 2025 Jul 8;12:e70458. doi: 10.2196/70458.

ABSTRACT

BACKGROUND: The dual nature of suicide-related internet use (SRIU) as preventative or harmful is well-documented, but its characteristics in the mental health patient population remain underresearched. Some evidence suggests mental health patients engage in SRIU differently from the general population.

OBJECTIVE: This study aims to explore the types, motivations, frequency, and perceived impacts of SRIU in suicidal mental health patients, as well as their engagement with web-based prevention resources.

METHODS: A cross-sectional study was conducted using an anonymous web-based survey distributed between June and December 2023. Participants (n=696) were UK adults with secondary mental health service contact and recent suicidal thoughts or behaviors. Of these, 523 (75%) participants engaged in SRIU. Collected data included sociodemographic details, clinical history, types and motivations for SRIU, and interactions with suicide prevention resources. Analysis used descriptive statistics, chi-square, and Wilcoxon tests, with multiple testing corrections applied.

RESULTS: The most common SRIU type was searching for suicide-related content (456/523, 87.4%), followed by connecting with others (271/523, 51.8%). Motivations included seeking information on suicide methods (313/523, 60.8%) and support for suicidality (271/523, 57.2%), with significant overlap. Participants perceived SRIU as neither harmful nor helpful overall, with those seeking suicide methods rating it as more harmful. Most participants encountered suicide prevention messaging, but less than half engaged with it. Only 27.5% (n=144) participants disclosed their SRIU to clinicians, with only 1 in 10 being asked about it by their clinician.

CONCLUSIONS: This study underscores the dual role of SRIU as both a source of support and a potential risk for mental health patients. Despite high exposure to suicide prevention messaging, engagement was limited, suggesting inefficiencies in current intervention designs. Clinicians rarely inquired about SRIU, and voluntary disclosure by patients was low, representing missed opportunities for intervention. Proactive discussions about SRIU in clinical settings could improve risk identification and support planning. Addressing its harmful aspects while leveraging its potential for support requires integrated online and offline strategies.

PMID:40627808 | DOI:10.2196/70458

JMIR Form Res. 2025 Jul 8;9:e75215. doi: 10.2196/75215.

ABSTRACT

BACKGROUND: The synthesis of evidence in health care is essential for informed decision-making and policy development. This study aims to validate The Umbrella Collaboration (TU), an innovative, semiautomated tertiary evidence synthesis methodology, by comparing it with traditional umbrella reviews (TURs), which are currently the gold standard.

OBJECTIVE: The primary objective of this study is to evaluate whether TU, an artificial intelligence-assisted, software-driven system for tertiary evidence synthesis, can achieve effectiveness comparable to that of TURs, while offering a more timely, efficient, and comprehensive approach.

METHODS: This comparative study evaluated TU against TURs across 8 matched projects in geriatrics. For each selected TUR, a parallel TU project was conducted using the same research question. Outcomes of interest (OoIs), effect sizes, certainty ratings, and execution times were systematically compared. Effect sizes were assessed both quantitatively, by transforming TUR metrics to Cohen d and correlating them with TU’s RTU metric, and qualitatively, through categorical classifications (trivial, small, moderate, and large). Certainty levels were compared by mapping Grading of Recommendations Assessment, Development, and Evaluation (GRADE) ratings and TU’s sentiment analysis scores onto a common 0-1 scale. Execution time was measured precisely in TU, while TUR durations were estimated from literature benchmarks. Statistical analyses included chi-square tests and Spearman correlations.

RESULTS: Eight TURs in geriatrics were matched with parallel projects using TU. TU replicated 73 of the 86 (85%) OoIs identified by TURs and reported an additional 337 OoIs, representing a 4.77-fold increase in outcome identification. In the comparison of effect size classifications, full concordance was observed in 24 of the 48 (50%) cases, and consistent concordance (full plus 1-level deviation) in 45 of the 48 (94%) cases, with a moderate strength of association (Cramér V=0.339). The correlation of transformed certainty values between TU and GRADE yielded a statistically significant Spearman coefficient (ρ=0.446; P=.02). The average execution time per TU project was 4 hours and 46 minutes, compared with estimated durations of 6-12 months for TURs.

CONCLUSIONS: The TU demonstrated high concordance with TURs, replicating 73 of the 86 (85%) outcomes identified by TURs and identifying nearly 5 times as many additional outcomes. The experimental effect size metric (RTU) showed moderate agreement with conventional measures, and the certainty ratings derived from sentiment analysis correlated acceptably with GRADE-based assessments. While further validation is needed, TU appears to be a valid and efficient approach for tertiary evidence synthesis, offering a scalable and time-efficient alternative when rapid results are required.

PMID:40627806 | DOI:10.2196/75215

J Am Acad Orthop Surg. 2025 Jul 1. doi: 10.5435/JAAOS-D-24-01183. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study is to determine the incidence and risk factors of yoga-related injuries to generate guidelines for safely practicing yoga.

METHODS: The National Electronic Injury Surveillance System was searched from 2004 to 2023 for injury codes including yoga. Narrative descriptions were reviewed by two authors to select entries specifically addressing yoga practice. Descriptive statistics were done, and the Stata svyset function (SE 17.0; StataCorp) was used to calculate national estimates. Athletes were also categorized based on age into <45 years and ≥45 years, and significance between age groups was determined using adjusted Wald tests to compare proportions in the setting of complex weighted survey data.

RESULTS: The initial data search yielded 160,521 entries. The narrative review process (Cohen kappa = 0.76) resulted in 1,615 entries for analysis, corresponding to a national estimate of 63,280 yoga-related injuries. Patients were disproportionately female and White (mean age = 46.5 years, SD = 18.0). Most injuries occurred in places of recreation (42.4%) and the home (10.0%). The most common type of injury was strains/sprains (32.5%). The trunk was the most injured body region (lower trunk = 24.2%, shoulder = 9.0%). In the lower limb region, the knee was most often affected (9.4%). Wald tests revealed that for body region injured, in the <45 category, head injuries contributed to a markedly larger proportion of total injuries (P < 0.005). In the ≥45 category, hip injuries (subset of trunk) contributed to a markedly larger proportion of total injuries (P < 0.001).

CONCLUSION: Yoga can involve strenuous physical activity resulting in injury, especially strains/sprains. Given that hip injuries contributed to a markedly larger proportion of injuries in patients ≥45 years, athletes in this age range should be counseled about these risks to maximize the safety of all participants.

PMID:40627803 | DOI:10.5435/JAAOS-D-24-01183

Plast Aesthet Nurs (Phila). 2025 Jul-Sep 01;45(3):163-172. doi: 10.1097/PSN.0000000000000609. Epub 2025 Jul 9.

ABSTRACT

This real-world data evaluation assesses the effectiveness of a hyaluronic acid-based product (Profhilo®, IBSA Farmaceutici Italia, Lodi, Italy) for improving neck skin laxity, firmness, tone, and texture in a satisfaction survey involving 26 patients from Malaysia (n = 9), Singapore (n = 9), and Indonesia (n = 8). Each patient received two treatments: the first at baseline, and the second on Day 30. Using the IBSA Neck Skin Laxity Scale (IBSA NSLS), physicians evaluated photographs of the patients’ necks at baseline, Day 30, and Day 90. Before treatment on Day 30 and at the follow-up visit on Day 90, physicians and patients assessed clinical improvement and satisfaction related to skin laxity, firmness, and texture. After each treatment, the patients recorded their pain level using a visual analogue scale. The mean IBSA NSLS grades for all patients significantly decreased from 3.08 at baseline to 2.12 at follow-up (p < .0001). At Day 90, the most frequent response from all participants was that their neck laxity and skin firmness and tone was either improved or much improved and their skin texture was very much improved. Following the injections, the patients reported low to moderate pain levels. In this real-world satisfaction survey involving patients from Malaysia, Singapore, and Indonesia, the physicians concluded that Profhilo® was an effective and well tolerated treatment for improving neck skin laxity, firmness, tone, and texture in patients of varying ages, genders, and baseline skin laxity and wrinkle severity.

PMID:40627798 | DOI:10.1097/PSN.0000000000000609

PLoS One. 2025 Jul 8;20(7):e0327121. doi: 10.1371/journal.pone.0327121. eCollection 2025.

ABSTRACT

In this study, we introduce a novel Field-Agnostic Riemannian-Kernel Alignment (FARKA) method to advance the classification of motion imagination in Brain-Computer Interface (BCI) systems. BCI systems enable direct control of external devices through brain activity, bypassing peripheral nerves and muscles. Among various BCI technologies, electroencephalography (EEG) based on non-intrusive cortical potential signals stands out due to its high temporal resolution and non-invasive nature. EEG-based BCI technology encodes human brain intentions into cortical potentials, which are recorded and decoded into control commands. This technology is crucial for applications in motion rehabilitation, training optimization, and motion control. The proposed FARKA method combines Riemannian Alignment for sample alignment, Riemannian Tangent Space for spatial representation extraction, and Knowledge Kernel Adaptation to learn field-agnostic kernel matrices. Our approach addresses the limitations of current methods by enhancing classification performance and efficiency in inter-individual MI tasks. Experimental results on three public EEG datasets demonstrate the superior performance of FARKA compared to existing methods.

PMID:40627787 | DOI:10.1371/journal.pone.0327121