Tag: pubmed

Eur J Radiol Open. 2025 Dec 10;16:100716. doi: 10.1016/j.ejro.2025.100716. eCollection 2026 Jun.

ABSTRACT

INTRODUCTION: Optimizing the diagnostic approach to thyroid nodules remains a crucial challenge. Ultrasound-based risk stratification systems such as EU-TIRADS have shown reasonable sensitivity and specificity. Therefore, we conducted a systematic review and meta-analysis to assess the diagnostic performance of Artificial Intelligence (AI) models in differentiating benign from malignant thyroid nodules on ultrasound data.

METHODS: A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science was performed up to January 1, 2025. Eligible studies included patients with thyroid nodules undergoing ultrasound, where AI-based models were validated against cytological or histological findings. The AI algorithms were developed using different types of ultrasound-derived data, including B-mode images, radiomics features. Pooled sensitivity, specificity, and area under the curve (AUC) were estimated using a hierarchical summary receiver operating characteristic (HSROC) model.

RESULTS: Twenty-seven studies comprising 146,332 patients and over 600,000 ultrasound images met inclusion criteria. Overall, pooled sensitivity was 87 % (95 % CI: 84-89 %) and specificity 83 % (95 % CI: 79-86 %). The summary operating point indicated a sensitivity of 88 % and specificity of 83 %, with an AUC of 91.9 % (95 % CI: 90.0-93.2 %). Although subgroup analysis suggested higher accuracy when cytology was used as the reference standard compared to histology, the mixed-effects meta-regression did not confirm a statistically significant association (p = 0.238 for sensitivity; p = 0.188 for specificity).

CONCLUSION: AI-based algorithms show excellent diagnostic performance in distinguishing benign from malignant thyroid nodules, with robust validation across external datasets. These findings support the potential integration of AI into clinical thyroid nodule management, although further multicenter, non-Asian, and histology-based studies are warrantee.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD420251108149).

PMID:41477624 | PMC:PMC12752752 | DOI:10.1016/j.ejro.2025.100716

J Vitreoretin Dis. 2025 Dec 29:24741264251404735. doi: 10.1177/24741264251404735. Online ahead of print.

ABSTRACT

Purpose: To investigate differences in gaze behavior among vitreoretinal surgeons of varying experience levels during simulated pars plana vitrectomy with epiretinal membrane peeling using a 3-dimensional heads-up display (HUD) system with integrated eye-tracking. Methods: Twenty-six ophthalmologists-postgraduate year 4 residents (n = 10), vitreoretinal fellows (n = 9), and attending surgeons (n = 7)-performed simulated vitrectomy on model eyes using a 3-dimensional HUD system with eye-tracking. Gaze metrics (fixations, saccades, field awareness, HUD focus, and tear angle) and surgical performance (International Council of Ophthalmology, Ophthalmology Surgical Competency Assessment Rubric vitrectomy score) were evaluated. Statistical analysis included Pearson correlation, analysis of variance (ANOVA), and post hoc Tukey tests. Results: Surgical performance increased with experience (postgraduate year 4: 26.6 ± 1.3; attending: 42.5 ± 1.6; P < .0001). Attendings demonstrated fewer fixations (3454.0 ± 548.0 vs postgraduate year 4: 6114.0 ± 1349.0; P < .0001), shorter fixation durations (0.21 ± 0.015 seconds vs 0.277 ± 0.034 seconds; P < .05), and smaller saccade lengths (0.168° ± 0.082° vs 0.325° ± 0.094°; P < .01). They also showed greater HUD utilization (76.3% ± 7.3% vs postgraduate year 4: 45.0% ± 8.9%; P < .01), broader visual field awareness (51.3% ± 9.7% vs 17.3% ± 5.7%; P < .001), and more controlled membrane peel angles (7.1° ± 2.6° vs postgraduate year 4: 89.5° ± 22.6°). Novices primarily focused on instrument tips, whereas experts exhibited feed-forward gaze strategies with anchored fixation and situational awareness. Conclusions: Expert vitreoretinal surgeons demonstrate distinct visual strategies characterized by efficient gaze behavior, broad field awareness, and HUD-focused attention. These gaze patterns correlate with surgical proficiency and may serve as benchmarks for training. Eye-tracking integrated with HUD systems may enhance surgical education by allowing trainees to model expert gaze behavior and improve operative performance.

PMID:41477619 | PMC:PMC12747874 | DOI:10.1177/24741264251404735

Front Psychol. 2025 Dec 16;16:1712176. doi: 10.3389/fpsyg.2025.1712176. eCollection 2025.

ABSTRACT

BACKGROUND: In the context of heightened social competition and increasing academic pressure, promoting the healthy development of adolescents has become a critical concern. This study investigates the impact and mechanisms through which adolescents’ social and emotional skills influence their health behavior. Specifically, we hypothesized that social and emotional skills would positively affect health behavior, with test and class anxiety mediating and satisfaction with interpersonal relationships moderating this relationship.

METHODS: Using data from the 2023 OECD Survey on Social and Emotional Skills, this study employed a moderated mediation model to analyze the relationships between variables. The sample consisted of 6,737 adolescents, comprising 3,454 10-year-olds (51.3%) and 3,283 15-year-olds (48.7%); 3,484 were boys (51.7%) and 3,253 were girls (48.3%). Key variables assessed included social and emotional skills (e.g., task performance, emotional regulation), health behaviors (e.g., diet, exercise, sleep), test and class anxiety, and satisfaction with interpersonal relationships. Statistical analyses included Harman’s single-factor test for common method bias, correlation analysis, regression analysis, and PROCESS macro in SPSS to test mediation and moderation effects.

RESULTS: The study found that adolescents’ social and emotional skills positively influence their health behavior, with a significant direct effect (β = 0.375, p < 0.001) and an indirect effect mediated by test and class anxiety [6.68% of total effect, 95% CI (0.017, 0.033)]. Satisfaction with interpersonal relationships moderated both the direct effect of social and emotional skills on health behavior and the reduction of test anxiety by these skills. Higher relationship satisfaction strengthened the direct effect (β = 0.340 vs. β = 0.250 for low vs. high satisfaction) and amplified the anxiety-reduction effect (β = -0.262 vs. β = -0.168 for high vs. low satisfaction).

CONCLUSION: This study highlights the critical role of social and emotional skills in promoting healthy behaviors among adolescents and underscores the importance of interpersonal relationships in moderating these effects. The results provide insights for policymakers and educators to design interventions that foster both social and emotional skills and supportive relational environments to enhance adolescent wellbeing.

PMID:41477605 | PMC:PMC12747996 | DOI:10.3389/fpsyg.2025.1712176

J Pharm Pharm Sci. 2025 Dec 16;28:15527. doi: 10.3389/jpps.2025.15527. eCollection 2025.

ABSTRACT

INTRODUCTION: Azathioprine (AZA) is an immunosuppressant approved for renal transplant rejection and rheumatoid arthritis. Recent FDA alerts have raised concerns about its link to intrahepatic cholestasis of pregnancy (ICP), a condition with serious maternal and fetal risks. This study used disproportionality analysis as a hypothesis-generating approach to evaluate the reporting association between AZA and ICP during pregnancy and to compare AZA with other drugs previously implicated in ICP.

METHODS: A retrospective pharmacovigilance study was conducted using the FDA Adverse Event Reporting System (FAERS) reports from 1968 to Q2 2024. Disproportionality analysis was performed using reporting odds ratios (RORs), with statistical significance defined as a lower limit of the 95% confidence interval (CI) >1 and at least three unique cases. Subgroup analyses were conducted by pregnancy status and underlying autoimmune indications, and comparative analyses were performed against drugs previously reported to induce ICP.

RESULTS: Among 35,576 AZA-related reports, 67 specifically documented ICP. A strong signal was detected for ICP ROR025 = 153.0; IC025 = 5.8; EBGM05 = 144.37), ranking among the highest AZA-associated adverse events. In pregnant women, ICP also showed a significant signal (ROR025 = 5.46; IC025 = 1.93; EBGM05 = 5.31). Subgroup analyses by indication revealed elevated risks in Crohn’s disease (ROR025 = 66.99; IC025 = 4.8; EBGM05 = 64.73), and Colitis ulcerative (ROR025 = 9.01; IC025 = 1.95; EBGM05 = 9.95). Comparative analyses demonstrated that AZA had a higher proportion of ICP cases than other drugs reported to induce ICP.

CONCLUSION: This pharmacovigilance analysis identifies a disproportionality signal suggesting a possible association between AZA and intrahepatic cholestasis of pregnancy. These hypothesis-generating findings underscore the importance of cautious use and clinical vigilance when prescribing AZA to women of reproductive age.

PMID:41477595 | PMC:PMC12748001 | DOI:10.3389/jpps.2025.15527

J Virus Erad. 2025 Oct 25;11(4):100614. doi: 10.1016/j.jve.2025.100614. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: The HIV/AIDS epidemic remains a critical public health challenge in Bangladesh, with complex epidemiological trends and sex-specific disparities requiring detailed investigation to guide effective interventions. This study comprehensively analyzes the temporal dynamics of HIV/AIDS burden from 1990 to 2021 and employs advanced statistical modeling to forecast future trends up to 2050, aiming to inform targeted public health strategies.

METHODS: Data on Disability-Adjusted Life Years (DALYs), deaths, incidence, prevalence, Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) were sourced from a robust epidemiological database for Bangladesh. Joinpoint regression analysis was utilized to detect significant trend changes, calculating the average annual percent change (AAPC) and annual percent change (APC) with 95 % confidence intervals (CIs). Sex-stratified analyses elucidated disparities between males and females. Autoregressive Integrated Moving Average (ARIMA) models were applied to project age-standardized rates (ASRs) for each metric through 2050, incorporating historical trends and variability to ensure robust predictions.

RESULTS: From 1990 to 2021, the HIV/AIDS burden in Bangladesh increased significantly across all metrics, with distinct sex-specific patterns. The overall AAPC for DALYs was 19.0332 % (95 % CI: 15.8145, 23.0026, p < 0.000001), with females showing a higher AAPC (21.7252 %, 95 % CI: 18.2308, 25.7026) than males (18.4703 %, 95 % CI: 15.1896, 22.5646). Deaths exhibited a similar trend, with an overall AAPC of 18.9645 % (95 % CI: 15.7008, 23.2166), higher in females (21.8808 %, 95 % CI: 18.4195, 25.9932) than males (18.4655 %, 95 % CI: 15.1992, 22.6832). Incidence rose with an AAPC of 15.7929 % (95 % CI: 11.6467, 19.1922), slightly higher in females (16.2581 %, 95 % CI: 12.1795, 20.0487) than males (15.1639 %, 95 % CI: 11.2952, 18.4817). Prevalence increased markedly (AAPC: 18.2239 %, 95 % CI: 14.5688, 22.2078), with females at 20.2887 % (95 % CI: 16.6453, 24.3006) and males at 18.1837 % (95 % CI: 14.6734, 21.841). YLDs and YLLs followed similar patterns, with females consistently showing higher AAPCs. Joinpoint analysis identified peak APCs in the 1990s and early 2000s, followed by moderated growth and declines post-2016, particularly from 2019 to 2021, reflecting potential intervention impacts. ARIMA forecasts project a decline in DALYs, deaths, and YLLs ASRs to negligible levels by 2050 for both sexes, with wide CIs indicating substantial uncertainty (e.g., DALYs overall: negligible, 95 % CI: 0, 583.3697). Incidence ASRs are expected to stabilize (e.g., overall: 0.963899, 95 % CI: 0, 3.819279), while prevalence ASRs are projected to rise dramatically, particularly for males (614.7463, 95 % CI: 0, 695680.4), highlighting significant long-term challenges.

CONCLUSIONS: The HIV/AIDS burden in Bangladesh has escalated significantly from 1990 to 2021, with females bearing a disproportionately higher burden across all metrics. Recent declines suggest the efficacy of public health interventions, but persistent sex disparities and projected prevalence increases underscore the need for targeted, sex-specific strategies. The considerable uncertainty in long-term forecasts emphasizes the importance of sustained surveillance, adaptive interventions, and resource allocation to mitigate the epidemic’s impact by 2050, ensuring equitable health outcomes.

PMID:41477584 | PMC:PMC12750090 | DOI:10.1016/j.jve.2025.100614

Hong Kong Physiother J. 2025 Dec;45(2):157-167. doi: 10.1142/S1013702525500131. Epub 2025 Nov 25.

ABSTRACT

OBJECTIVE: To investigate the effectiveness of the standardised stroke upper extremity rehabilitation program with stratification using shortened Fugl-Meyer assessment (S-FM).

METHODS: A new stroke upper extremity rehabilitation program was designed. Participants were randomly allocated to standardised program group or conventional training group. Both groups received training for 60-90 min/session, 5 sessions/week and 5-20 sessions in total. Outcome measures, including S-FM, functional test for the hemiplegic upper extremity (FTHUE) and modified Barthel index (MBI), were taken before and after training.

RESULTS: Outcomes of 19 participants in standardised program group and 20 participants in conventional training group were analysed. Both groups showed improvements in S-FM, FTHUE and MBI after training but there were no statistically significant interactions between the groups, upper extremity impairment levels and time. In participants with severe upper extremity impairment, the standardised program group showed greater improvements in S-FM and FTHUE compared to the conventional training group, with the change in S-FM exceeding the minimal clinically important difference. However, these differences did not reach statistical significance.

CONCLUSION: The standardised stroke upper extremity rehabilitation program with S-FM stratification may have slightly better upper extremity functional outcomes in people with stroke having severe upper extremity impairment when compared to the conventional training.Clinical trial registration number: NCT06902948.

PMID:41477567 | PMC:PMC12752676 | DOI:10.1142/S1013702525500131

Biol Sex Differ. 2025 Dec 31. doi: 10.1186/s13293-025-00783-8. Online ahead of print.

ABSTRACT

Computational phenotyping has emerged as a practical solution to the incomplete collection of data on gender in electronic health records (EHRs). This approach relies on algorithms to infer a patient’s gender using the available data in their health record, such as diagnosis codes, medication histories, and information in clinical notes. Although intended to improve the visibility of trans and gender-expansive populations in EHR-based biomedical research, computational phenotyping raises significant methodological and ethical concerns related to the potential misuse of algorithm outputs. In this paper, we provide a narrative review of computational phenotyping of gender and examine its challenges through a critical lens. We also highlight existing recommendations for biomedical researchers and propose priorities for future work in this domain.

PMID:41476311 | DOI:10.1186/s13293-025-00783-8

J Orthop Surg Res. 2025 Dec 31. doi: 10.1186/s13018-025-06550-0. Online ahead of print.

ABSTRACT

BACKGROUND: Degenerative spondylolisthesis (DS) is a common cause of low back pain and lumbar spinal stenosis, necessitating various surgical interventions. Traditional management includes fusion surgery, but recently decompression with or without dynamic stabilization has been explored. However, the relative efficacy and safety of these interventions, including their time-effect relationships, have not been comprehensively evaluated.

OBJECTIVE: To systematically assess and compare the effectiveness and safety of decompression alone, decompression plus dynamic stabilization, and decompression plus fusion in patients with low back pain due to DS, and to analyze the time-effect relationship among these interventions over a follow-up period of up to 12 years.

METHODS: A network meta-analysis was conducted involving 10 studies, including 9 randomized controlled trials, with a total of 1052 participants diagnosed with DS. The interventions compared were decompression alone, decompression plus dynamic stabilization, and decompression plus fusion. Primary outcomes included visual analog scale for low back pain (VAS-LBP), visual analog scale for leg pain (VAS-LP), and Oswestry disability Index (ODI). Secondary outcomes were complications, reoperation rate, operation time, and blood loss. We assessed global inconsistency, risk of bias, and conducted a time-effect analysis using the TE-max model.

RESULTS: The analysis did not reveal significant global inconsistency or a high risk of bias among the included studies. There were no significant differences between the three interventions regarding changes in VAS-LBP, VAS-LP, and ODI. Decompression alone was associated with significantly shorter operation time (MD = 89.5, 95% CI – 123.91 to – 55.12) and less blood loss (MD = 151.5, 95% CI 37.31 to 265.70) compared to both decompression with fusion and decompression with dynamic stabilization. The time-effect analysis predicted non-inferiority of decompression alone compared to other methods over a follow-up period of up to 12 years.

CONCLUSIONS: Decompression alone demonstrates non-inferiority in terms of efficacy for treating low back pain due to DS compared to fusion, with additional benefits in operation time and blood loss. The addition of dynamic stabilization to decompression does not yield significant benefits. Further research with larger cohorts and extended follow-up is necessary for definitive conclusions.

PMID:41476308 | DOI:10.1186/s13018-025-06550-0

J Health Popul Nutr. 2025 Dec 31. doi: 10.1186/s41043-025-01199-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore the effects of multivitamin combined with magnesium sulfate on placental hemodynamics, coagulation function, and maternal and infant outcomes in preeclampsia patients.

METHODS: A randomized controlled study was conducted among 194 pregnant women diagnosed with preeclampsia between April 2022 and April 2023. Participants were randomly assigned to either the control group (n = 97), receiving intravenous magnesium sulfate alone, or the observation group (n = 97), receiving magnesium sulfate combined with multivitamin supplementation. Magnesium sulfate was administered with a loading dose of 2.5-5 g via rapid IV infusion and a maintenance dose of 5-20 g by continuous drip. The observation group additionally received one oral multivitamin tablet (Bayer S.A., 30 tablets/box) once daily in the morning. The treatment duration for both groups was two weeks. Blood pressure, 24-hour urinary protein, placental Doppler indices (RI, PI, S/D), coagulation markers (PT, APTT, FIB, TT), and maternal-infant outcomes were measured and compared.

RESULTS: After treatment, both groups showed significant reductions in systolic and diastolic blood pressure, but there was no significant difference between them. However, the observation group had significantly lower 24-hour urinary protein levels (0.71 ± 0.31 g vs. 0.92 ± 0.28 g, P < 0.001). Coagulation function improved in both groups, with the observation group showing greater improvements: longer PT, APTT, and TT times, and lower FIB levels (P < 0.01). Placental hemodynamics also improved more in the observation group, with lower resistance indices and S/D ratios in both the umbilical and spiral arteries (P < 0.001). The observation group had better maternal and neonatal outcomes, including fewer cases of postpartum hemorrhage (10 vs. 22, P = 0.020), low birth weight (10 vs. 23, P = 0.013), and NICU admissions (9 vs. 21, P = 0.018). Eclampsia occurred only in the control group (3 cases), though this was not statistically significant (P = 0.081). Other outcomes, such as uterine inertia and neonatal asphyxia, were similar between groups. Subgroup analysis showed that patients with severe preeclampsia in the observation group experienced greater improvements in proteinuria and placental blood flow than those in the control group. Cesarean section rates were comparable (58 vs. 62), with main indications including fetal distress, failed labor, and poorly controlled PE. Logistic regression confirmed that multivitamin use was an independent factor for better outcomes (OR = 3.297; 95% CI: 1.731-6.282; P < 0.001), regardless of age, BMI, or gestational age.

CONCLUSION: Multivitamin supplementation combined with magnesium sulfate improves outcomes in preeclampsia more effectively than magnesium sulfate alone. It reduces proteinuria, enhances placental blood flow and coagulation function, and lowers the risk of complications such as postpartum hemorrhage, low birth weight, and NICU admission. These benefits are particularly notable in severe cases and are independent of baseline maternal factors, supporting the use of combined therapy in clinical practice.

PMID:41476304 | DOI:10.1186/s41043-025-01199-1

J Orthop Surg Res. 2026 Jan 1. doi: 10.1186/s13018-025-06586-2. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the risk factors for symptomatic hematoma (SH) after cervical spine surgery, thereby providing evidence-based guidance for the early prevention, timely intervention, and appropriate management.

METHODS: Relevant observational studies were retrieved from PubMed, Embase, the Cochrane Library, and Web of Science from inception to September 2025. Meta-analyses were performed to assess potential risk factors across several domains, including patient demographics, comorbidities, antithrombotic therapy, preoperative evaluation, and surgical factors. The odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (CI) were adopted to evaluate associated factors. Subgroup analyses, meta-regression, and sensitivity analyses were conducted.

RESULTS: Seventeen studies involving 564,700 patients were included. The overall incidence of SH was 0.11% (608/564,700), with individual study estimates ranging from 0.03 to 1.51%. The meta-analysis identified the male sex (OR = 1.68, 95% CI 1.39 to 2.03), advanced age (WMD = 2.53 years, 95% CI 1.57 to 3.48), presence of ossification of the posterior longitudinal ligament (OPLL) (OR = 3.38, 95% CI 1.54,7.41), and undergoing anterior cervical corpectomy and fusion (ACCF) (OR = 1.71, 95% CI 1.26 to 2.31) as being significantly associated with an increased risk of SH after cervical spine surgery Meta-regression revealed that male proportion significantly modified the OPLL-SH association. The subgroup analysis results showed that in study populations with a lower proportion of male participants, OPLL was significantly associated with an increased risk of postoperative SH (when the male proportion < 60%, OR = 7.89, 95% CI 4.02 to 15.49); whereas no significant association was observed in study populations with a higher male proportion (when the male proportion ≥ 60%, OR = 1.42, 95% CI 0.87 to 2.33). Prolonged operative duration was associated with SH (WMD = 13.66 min, 95% CI 3.97 to 23.35), but this relationship was substantially influenced by factors related to surgical complexity, as differences in the number of surgical segments explained a substantial portion (76.96%) of the heterogeneity observed across studies. No significant associations were observed for body mass index (BMI), smoking history, common comorbidities, antithrombotic therapies, and most laboratory parameters. A statistically significant but clinically small difference was noted for preoperative PT (WMD = 0.20 s, 95% CI 0.07 to 0.33).

CONCLUSIONS: Male sex, advanced age, OPLL, and ACCF were identified as being significantly associated with an increased risk of SH after cervical spine surgery. Importantly, male sex also acts as an effect modifier, substantially influencing the association between OPLL and hematoma risk. Prolonged operative duration was linked with an increased risk of SH, though this relationship was substantially influenced by factors related to surgical complexity. These findings underscore the importance of comprehensive preoperative risk assessment that considers both individual factors and their potential interactions, alongside meticulous surgical technique, for effective hematoma prevention.

PMID:41476302 | DOI:10.1186/s13018-025-06586-2