Ultrasound Outperforms Traditional Tests in Diagnosing Diaphragm Dysfunction: Study Finds

Netherlands: A recent prospective study published in Respiratory Medicine has spotlighted ultrasound as a reliable and effective diagnostic tool for assessing diaphragm dysfunction. It showed strong agreement with clinical diagnoses and solidified its potential role in routine respiratory evaluations.

Traditionally, diagnostic methods such as fluoroscopy and phrenic nerve conduction studies have been used to assess diaphragmatic function, but their reliance on specialized equipment limits accessibility in many clinical settings. Diaphragm dysfunction, a frequently overlooked cause of dyspnea, is typically identified through clinical history, symptoms, and imaging.

Given ultrasound’s advantages as a non-invasive, bedside, and widely available tool, M.D. Wytze S. de Boer, Department of Pulmonology, Isala Hospital, Zwolle, The Netherlands, and colleagues aimed to evaluate its construct validity by comparing ultrasound-based assessments with conventional diagnostic methods in detecting diaphragm dysfunction.

For this purpose, the researchers conducted a prospective, operator-blinded study across two centers in the Netherlands involving 36 adults with suspected diaphragm dysfunction. Participants underwent fluoroscopy, pulmonary function tests, and ultrasound examinations. The primary objective was to assess the agreement between predefined ultrasound diagnostic criteria and traditional methods. Secondary outcomes included evaluating the concordance of each diagnostic approach with the treating physician’s final diagnosis, assessing the performance of individual test parameters, and determining inter-rater reliability.

The study revealed the following findings:

  • Concordance between ultrasound and traditional test diagnostic criteria was observed in 55.6% of cases.
  • Ultrasound criteria aligned with the treating physician’s final diagnosis in 75.0% of cases, higher than traditional test criteria, which showed 63.9% concordance.
  • Visual ultrasound assessment, thickening fraction (TF), diaphragm excursion (DE), and fluoroscopy demonstrated high concordance with the final diagnosis at 91.4%, 90.3%, 88.3%, and 91.7%, respectively.
  • Inter-rater reliability was strong for fluoroscopy, visual ultrasound assessment, and diaphragm excursion, but was poor for thickening fraction.

The findings highlight ultrasound as a dependable and practical tool for diagnosing diaphragm dysfunction. It showed strong agreement with the treating physician’s final diagnosis and performed well across key parameters, such as visual assessment and diaphragm excursion. Moreover, the high inter-rater reliability of these measures reinforces the utility of ultrasound as a non-invasive, bedside alternative to traditional methods like fluoroscopy.

“Given its accessibility, ease of use, and diagnostic accuracy, ultrasound has the potential to become an integral part of routine clinical evaluation for suspected diaphragm dysfunction,” the authors concluded.

Reference:

Wytze S. de Boer, M., Krista L. Parlevliet, M., Leonie A. Kooistra, M., David Koster, M. P., Jellie A. Nieuwenhuis, M., Mireille A. Edens, P., Jan Willem K. van den Berg, M. P., Martijn F. Boomsma, M. P., Jos A. Stigt, M. P., Dirk Jan Slebos, M. P., & Marieke L. Duiverman, M. P. (2025). Ultrasound as Diagnostic Tool in Diaphragm Dysfunction: A Prospective Construct Validity Study. Respiratory Medicine, 108083. https://doi.org/10.1016/j.rmed.2025.108083

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Study confirms accuracy of blood test for early Alzheimer’s detection in Asian populations

A study in Alzheimer’s & Dementia, a leading journal in dementia research, has demonstrated the high accuracy of plasma p-tau217 as a blood-based biomarker for detecting abnormal brain beta-amyloid (Aβ) pathology, a hallmark of Alzheimer’s disease (AD). More significantly, the study validates its effectiveness even in individuals with cerebrovascular disease (CeVD), which is highly prevalent in Asian populations. This finding can enhance early diagnosis, improve patient risk stratification, and facilitate better clinical management of AD in diverse populations.

The study was led by Dr Mitchell Lai, Senior Lecturer at the Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), in collaboration with local and international experts from the National University Health System (NUHS), University of Gothenburg, Institute of Neurology at University College London, and Banner Sun Health Research Institute.

Bridging gaps in Alzheimer’s research for Asia

While blood biomarkers like p-tau217 have been extensively studied in Western populations-where CeVD is less common-this study uniquely focuses on a Singapore-based cohort, reflective of broader Asian demographics with a high CeVD burden. The results confirm that higher plasma p-tau217 levels correlate with faster cognitive decline, reinforcing its role not just as a diagnostic tool but also as a potential predictor of disease progression.

Transforming Alzheimer’s diagnosis: A potential game-changer for clinical practice

Potential clinical applications include:

  • Earlier and more precise detection: Plasma p-tau217 provides a highly sensitive and specific method for identifying Alzheimer’s pathology before severe cognitive decline occurs, potentially enabling earlier intervention and monitoring.
  • A simpler, minimally invasive diagnostic tool: Unlike costly and invasive positron emission tomography (PET) scans and cerebrospinal fluid tests, a blood-based biomarker could be easily integrated into routine clinical practice, making Alzheimer’s screening more accessible and scalable.
  • Patient risk stratification for optimised, personalised care: Adding plasma p-tau217 to routine clinical assessments allows doctors to efficiently categorise individuals into low, intermediate, and high-risk groups for Aβ pathology, enabling tailored follow-up strategies and potential early therapeutic interventions for patients.

Professor Christopher Chen, Director of the Memory, Ageing and Cognition Centre at NUHS and co-author of the study, said “This study provides strong evidence that plasma p-tau217 could be a game-changer for early detection of AD brain changes in Asian populations with high CeVD burden. A blood-based biomarker like p-tau217 brings us closer to a more accessible approach to diagnosing and managing AD in Singapore and beyond”.

Dr Joyce Chong, a Research Fellow with the Department of Pharmacology, NUS Medicine, and first author of the study, added “Although blood biomarkers are not expected to replace the current gold standard in clinical measures such as amyloid PET, their greatest value may lie in providing a cost-effective, minimally-invasive screening and risk-stratification tool to help reduce the proportion of individuals requiring confirmatory PET scans.”

Looking forward, the team hopes to expand the study both in the length of follow-up, as well as the diversity of investigated biomarkers. Dr Lai said, “There is increasing awareness that dementia is a chronic condition arising from complex, interacting processes, especially in our population where CeVD is likely to be an important contributor to the cognitive impairments associated with AD. Our long-term goal is to be able to produce a panel of multi-modal, clinically useful biomarkers which can both suggest novel therapeutic targets as well as help in the diagnosis and prognosis of this debilitating condition.”

Reference:

Joyce R. Chong, Saima Hilal, Boon Yeow Tan, Narayanaswamy Venketasubramanian, Michael Schöll, Henrik Zetterberg, Kaj Blennow, Nicholas J. Ashton, Christopher P. Chen, Mitchell K. P. Lai, Clinical utility of plasma p-tau217 in identifying abnormal brain amyloid burden in an Asian cohort with high prevalence of concomitant cerebrovascular disease, Alzheimer s & Dementia, https://doi.org/10.1002/alz.14502

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Less Can Be More: Study Finds Low-Dose Doxycycline Works Well for Scarring Alopecia, With Fewer AEs

USA: A recent study published in the Journal of the American Academy of Dermatology has highlighted the potential of low-dose doxycycline as an effective and better-tolerated treatment option for patients suffering from lymphocytic scarring alopecias. This group of conditions, which includes disorders like lichen planopilaris and frontal fibrosing alopecia, is characterized by irreversible hair loss due to inflammation and scarring of hair follicles.   

“Low-dose doxycycline demonstrated similar effectiveness to high-dose therapy in managing lymphocytic scarring alopecia while being associated with fewer adverse events and a lower rate of treatment discontinuation,” the researchers wrote.

To evaluate treatment outcomes with low-dose doxycycline in lymphocytic scarring alopecia, Carli Needle BA, The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, and colleagues conducted a retrospective review of 241 patients diagnosed between 2009 and 2023. The cohort had a mean age of 58.4 years and was predominantly female (82.6%), with 49.8% identifying as White and 14.1% as Black. The most frequently diagnosed conditions included lichen planopilaris (50.2%), frontal fibrosing alopecia (45.6%), and central centrifugal cicatricial alopecia (15.4%). Of the total, 64 patients (27.4%) received low-dose doxycycline (20 mg twice daily, 40 mg daily, or 50 mg daily), while 175 (72.6%) were treated with high-dose regimens (50 mg twice daily, 100 mg daily, or 100 mg twice daily).

All patients also received adjunctive therapies, most commonly intralesional corticosteroids (56.4%), topical corticosteroids (46.1%), and 5% topical minoxidil (31.5%). Treatment outcomes were assessed based on inflammation severity, scalp symptoms, hair loss stability, and patients’ perceptions of their condition.

Based on the study, the researchers reported the following findings:

  • No significant differences were observed between low- and high-dose doxycycline groups in terms of improvement in inflammation severity, hair loss stability, or the number of scalp symptoms.
  • There were similar results in the subgroup of patients with lichen planopilaris and frontal fibrosing alopecia, with no significant differences across inflammation, hair loss stability, or symptom count.
  • After adjusting for adjunctive treatments, patient-reported outcomes did not significantly differ between dose groups.
  • High-dose doxycycline was associated with a higher rate of adverse events (23.4%) compared to low-dose treatment (12.1%).
  • The most common adverse events were gastrointestinal symptoms (11.4% in high-dose vs 6.0% in low-dose) and photosensitivity or rash (6.9% vs 4.6%).
  • Doxycycline dosage had to be reduced or discontinued due to adverse events in 20.4% of high-dose patients versus 9.1% of low-dose patients.

The authors concluded that low-dose doxycycline offers comparable efficacy to high-dose regimens in managing lymphocytic scarring alopecias while demonstrating improved tolerability and fewer adverse events. They emphasized the potential of low-dose therapy as a safer treatment option and highlighted the need for prospective studies to further validate its effectiveness and long-term benefits in this patient population.

Reference:

Needle, C., Brinks, A., Pulavarty, A., Kearney, C., Nohria, A., Desai, D., Shapiro, J., & Lo Sicco, K. (2025). Efficacy and Tolerability of Low-Dose Versus High-Dose Doxycycline in the Management of Lymphocytic Scarring Alopecias. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2025.02.028

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Compared to non surgical treatment, Surgery exhibits long-term durability in ASLS: JAMA

According to a new study published in JAMA, long-term durability of surgical treatment for ASLS (Adult Symptomatic Lumbar Scoliosis) is promising and may aid in patient management and counseling, helping clinicians set realistic expectations and guide treatment decisions.

Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability. A study was done to assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS. The Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with randomized and observational cohorts designed to assess operative vs nonoperative ASLS treatment. Operative and nonoperative patients were compared using as-treated analysis of combined randomized and observational cohorts. Patients with ASLS aged 40 to 80 years were enrolled at 9 centers in North America. Data were analyzed from November 2023 to July 2024. Primary outcomes measures were the Oswestry Disability Index (ODI) and Scoliosis Research Society 22 (SRS-22) at 2-, 5-, and 8-year follow-up. Results The 286 enrolled patients (104 in the nonoperative group: median [IQR] age, 61.9 [54.4-68.8] years; 97 female [93%]; 182 in the operative group: median [IQR] age, 60.2 [53.5-66.6] years; 161 female [88%]) had follow-up rates at 2, 5, and 8 years of 90% (256 of 286), 70% (199 of 286), and 72% (205 of 286), respectively. At 2 years, compared with those in the nonoperative group, patients in the operative group had better ODI (mean difference = −12.98; 95% CI, −16.08 to −9.88; P < .001) and SRS-22 (mean difference = 0.57; 95% CI, 0.45-0.70; P < .001) scores, with mean differences exceeding the minimal detectable measurement difference (MDMD) for ODI (7) and SRS-22 (0.4). Mean differences at 5 years (ODI = −11.25; 95% CI, −15.20 to 7.31; P <.001; SRS-22 = 0.58; 95% CI, 0.44-0.72; P < .001) and 8 years (ODI = −14.29; 95% CI, −17.81 to −10.78; P <.001; SRS-22 = 0.74; 95% CI, 0.57-0.90; P < .001) remained as favorable as at 2 years without evidence of degradation. The treatment-related serious adverse event (SAE) incidence rates for operative patients at 2, 2 to 5, and 5 to 8 years were 22.24, 9.08, and 8.02 per 100 person-years, respectively. At 8 years, operative patients with 1 treatment-related SAE still had significant improvement, with mean treatment differences that exceeded MDMD (ODI = −9.49; 95% CI, −14.23 to −4.74; P < .001; SRS-22 = 0.62; 95% CI, 0.41-0.84; P < .001). Results of this nonrandomized clinical trial reveal that, on average, operative treatment for ASLS provided significantly greater clinical improvement than nonoperative treatment at 2-, 5- and 8-year follow-up, with no evidence of deterioration. Operative patients with a treatment-related SAE still maintained greater improvement than nonoperative patients. These findings suggest long-term durability of surgical treatment for ASLS and may prove useful for patient management and counseling.

Reference:

Smith JS, Kelly MP, Yanik EL, et al. Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up: A Nonrandomized Clinical Trial. JAMA Surg. Published online April 02, 2025. doi:10.1001/jamasurg.2025.0496

Keywords:

Smith JS, Kelly MP, Yanik EL, Operative, Nonoperative, Treatment, Adult, Symptomatic, Lumbar, Scoliosis, 8-Year Follow-Up

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Antenatal Corticosteroids may significantly reduce neurodevelopment in children born at 28–33weeks’ gestation: Study

Antenatal corticosteroids (ACS) are widely used before
preterm birth (before 37 weeks’ gestation) to reduce neonatal mortality,
respiratory distress syndrome and intraventricular haemorrhage. However,
potential overuse of ACS is a concern, as up to half of all babies exposed to
ACS are subsequently born at term (≥37 weeks’ gestation), when neonatal
benefits are minimal. Fetal overexposure to glucocorticoids may contribute to
programming of disease later in life. Evidence on long-term neurodevelopmental
outcomes associated with ACS exposure is conflicting. Better understanding of
associations between ACS exposure and childhood neurodevelopment would inform
clinical decision-making and elucidate how effects of ACS vary by gestational
age at birth, which is strongly associated with child neurodevelopment. This
longitudinal population-based study examined the associations of ACS exposure
with early childhood neurodevelopment, and whether these varied with
gestational age. Continuous and categorical neurodevelopmental assessments from
population-wide child health reviews at 27–30months of age were used.

It was a Population-based cohort study carried out at
Scotland, UK. 285 637 singleton children born at 28–41weeks’ gestation, between
1st January 2011 and 31st December 2017, who underwent health reviews at
27–30months of age were analysed. Logistic and linear regression analyses,
stratified by gestation at birth (28–33, 34–36, 37–38 and 39–41weeks’
gestation), were used to evaluate the associations between ACS exposure and
neurodevelopmental outcomes, and adjusted for maternal age, body mass index,
diabetes, antenatal smoking, parity, neighbourhood deprivation, birth year,
child sex and age at review. Practitioner-identified concerns about any
neurodevelopmental domain, and the average of five domain scores on
neurodevelopmental milestones from the parent-rated Ages and Stages
Questionnaire (ASQ-3).

After adjustment for covariates, ACS exposure was associated
with reduced neurodevelopmental concerns in children born at 28–33weeks’
gestation (OR=0.79, 95% CI=0.62–0.999) and with increased neurodevelopmental
concerns in children born at 34–36weeks’ gestation (OR=1.11, 95% CI=1.01–1.21).
No independent associations emerged in children born at later gestations. ACS
exposure was not associated with ASQ-3 scores in any gestational age group.

This large population-based cohort study of associations between
ACS exposure and neurodevelopmental outcomes at 27–30 months of age found that
in children born at 28–33weeks’ gestation, ACS exposure was associated with a
statistically significantly reduced odds of practitioner concerns about their
neurodevelopment. Children born at 34–36weeks’ gestation who were ACS-exposed
had statistically significantly increased odds of practitioner concerns about
neurodevelopment than non-ACS-exposed children born at this gestation. In
children born at 39–41weeks’ gestation, associations that were observed between
ACS exposure and increased odds of practitioner neurodevelopmental concerns
were attenuated to non-significance after adjusting for maternal and perinatal
confounders. ACS exposure was not associated with practitioner-identified
neurodevelopmental concerns in children born at 37–38weeks’ gestation, nor with
parent-assessed continuous neurodevelopment in any gestational age group.

This population-based cohort study of ACS exposure and
neurodevelopment in early childhood showed that after adjusting for child age,
sex, maternal and perinatal covariates, statistically significant associations
were observed between ACS exposure and reduced odds of practitioner-identified
neurodevelopmental concerns in children born at 28–33weeks’ gestation, and with
increased odds of practitioner-identified neurodevelopmental concerns in
children born at 34–36weeks’ gestation. Associations between ACS exposure and
increased odds of practitioner-identified neurodevelopmental concerns in
children born at 39–41weeks’ gestation were partly attenuated after adjustment
for maternal and perinatal covariates. However, the effect sizes of all the
aforementioned associations were small. No consistent associations between ACS
exposure and continuously assessed neurodevelopment were observed. Future
studies should include school performance and educational achievement outcomes
to assess potential associations of ACS with neurodevelopment beyond early
childhood.

Source: Emily M. Frier,
Marius Lahti-Pulkkinen, Chun Lin; BJOG: An International Journal of
Obstetrics & Gynaecology, 2025; 0:1–14

https://doi.org/10.1111/1471-0528.1810

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L-arginine promising for pre-eclampsia prevention and treatment, suggests research

Pre-eclampsia is the leading cause of iatrogenic preterm
birth. Despite this, few drugs are recommended for pre-eclampsia prevention—low
dose aspirin (when initiated before 20 weeks gestation) and calcium
supplementation (for women with low dietary intake). For treatment, only
antihypertensives for blood pressure (BP) control and magnesium sulphate to
prevent or treat seizures have been recommended. Research into promising new
drugs for pre-eclampsia prevention and treatment is urgently needed.

In 2022, the Accelerating Innovations for Mothers (AIM)
project identified L-arginine as one of five high-potential medicines under
investigation for pre-eclampsia prevention. L-arginine is a precursor for the
endogenous synthesis of nitric oxide, a potent vasodilator that mediates
vascular smooth muscle relaxation and inhibits platelet aggregation. Abnormal
placentation, dysregulation of angiogenesis, oxidative stress, and endothelial
dysfunction are important aspects of the pathogenesis of pre-eclampsia. Thus,
the availability of L-arginine opposes the vasoconstriction that occurs in
pre-eclampsia.

L-arginine is a semi-essential amino acid obtained through
dietary intake (fish, meats, soy, nuts and seeds), protein turnover and
endogenous synthesis from L-citrulline. In pregnancy, bioavailable L-arginine
levels may diminish due to increased metabolic demand resulting from fetal growth.
Also, when dietary L-arginine and/or L-citrulline intake is low, the de novo
endogenous synthesis of L-arginine from L-citrulline cannot increase to
compensate. Maternal infections such as malaria may further deplete endogenous
L-arginine, making pregnant women in malaria-endemic regions particularly
vulnerable to arginine deficiency. Therefore, L-arginine may be necessary to
provide the substrate for nitric oxide synthesis during pregnancy. L-arginine
or L-citrulline could be affordable and scalable interventions to improve birth
outcomes, particularly in resource-limited settings.

Recent reviews on L-arginine in pregnancy have not explored
the effects of L-arginine for prevention differently from the treatment of pre-eclampsia.
This has significant clinical implications for the optimal timing of
supplementation initiation and understanding which women would benefit from
L-arginine. Furthermore, no review has considered the effects of L-citrulline
during pregnancy on pre-eclampsia. This review examines the effects of
L-arginine and L-citrulline on prevention separately from the treatment of
pre-eclampsia and related maternal, fetal and neonatal outcomes.

To evaluate the effects of L-arginine and L-citrulline
(precursor of L-arginine) on the prevention and treatment of pre-eclampsia.
MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were
searched through 7 February 2024. Trials administering L-arginine or
L-citrulline to pregnant women, with the comparison group receiving placebo or
standard care, were included. Meta-analyses were conducted separately for
prevention or treatment trials, using random effects models.

Twenty randomised controlled trials (RCTs) (2028 women) and
three non-randomised trials (189 women) were included. The risk of bias was
‘high’ in eight RCTs and showed ‘some concerns’ in 12. In prevention trials,
L-arginine was associated with a reduced risk of pre-eclampsia (relative risk
[RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low-certainty evidence,
four trials) and severe pre-eclampsia (RR 0.23; 95% CI, 0.09, 0.55;
low-certainty evidence, three trials). In treatment trials, L arginine may
reduce mean systolic blood pressure (MD −5.64mmHg; 95% CI, −10.66, −0.62; very
low-certainty evidence, three trials) and fetal growth restriction (RR 0.46;
95% CI, 0.26, 0.81; low-certainty evidence, two trials). Only one study (36
women) examined L-citrulline and reported no effect on pre-eclampsia or blood
pressure.

This is the first systematic review to evaluate the evidence
on Larginine and L-citrulline for the prevention or treatment of preeclampsia,
separately. This distinction is critical for informing clinical practice and
policy, as different stages of the aetiology are targeted by prevention or
treatment trials. Authors found low certainty evidence that L-arginine in
pregnancy decreases the risk of pre-eclampsia and severe pre-eclampsia among
women at risk of pre-eclampsia. The evidence is very uncertain about the effect
of L-arginine on mean systolic BP, and L-arginine may decrease the risk of FGR
in treatment trials. L-arginine may also decrease the risk of preterm birth and
SGA and increase nitric oxide serum levels in prevention trials. Authors are
uncertain of the effects of L-arginine on other secondary outcomes.

Consistent with previous reviews, they found that L-arginine
may be promising for preventing pre-eclampsia. However, this data should be
interpreted with caution, as the certainty of the evidence is low, requiring
further research. This review defined trials including women without a
diagnosis of pre-eclampsia as prevention trials; however, only four trials
specifically examined the efficacy of L-arginine to prevent pre-eclampsia in
women at increased risk. These trials included women who were nulliparous, had
a previous history of pre-eclampsia, had pre-eclampsia in a first-degree
relative, had chronic hypertension, had gestational hypertension without
proteinuria or had a body mass index ≥30.

L-arginine is promising for pre-eclampsia prevention, and
authors are uncertain of its effect as a treatment for women with established
pre-eclampsia. L-arginine could constitute an important addition to the
management protocol of women at risk of preeclampsia, but further research is needed
to establish the population that would benefit, the optimal dose, time of
initiation and duration of supplementation. An individual participant data
meta-analysis may provide definitive answers to these questions. Future
L-arginine trials should use standardised pre-eclampsia screening tools, define
the type of pre-eclampsia experienced and investigate co-administration with
aspirin or calcium.

Source: Maureen Makama,
Annie R. A. McDougall, Jenny Cao; BJOG: An International
Journal of Obstetrics & Gynaecology, 2025; 0:1–11
https://doi.org/10.1111/1471-0528.18070

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Fatty Acids have contributory but Not Causal Relationship with Periodontitis: Study

Researchers have found in a new study that there was a significant associations between certain fatty acids and periodontitis, suggesting they may influence its severity. However, Mendelian randomization (MR) analyses did not support a direct causal relationship. Further findings of study emphasize the importance of a balanced dietary lipid profile in maintaining periodontal health.

The authors aimed to explore the association of fatty acids with periodontitis and its severity and to assess causality using Mendelian randomization (MR) analyses. Data for participants with complete data were extracted from the 2009-2014 National Health and Nutrition Examination Survey. Weighted logistic regression was used to explore the relationship between dietary fatty acids and periodontitis and its severity. Univariable and multivariable MR analyses were performed to explore the causal association between plasma fatty acids and periodontitis. Results: Two types of saturated fatty acids (hexadecanoic C16:0, octadecanoic C18:0) and monounsaturated fatty acids (hexadecenoic C16:1, docosenoic C22:1) and 3 types of polyunsaturated fatty acids (eicosatetraenoic C20:4, eicosapentaenoic C20:5, docosahexaenoic C22:6) were positively associated with periodontitis. Conversely, octadecadienoic (C18:2, a type of polyunsaturated fatty acid), total polyunsaturated fatty acids, and omega-6 fatty acids were negatively associated with periodontitis. Similar association patterns were also found between these fatty acids and the severity of periodontitis. Results of Mendelian randomization analyses revealed that no significant association was found between plasma fatty acids and periodontitis. The authors provided evidence of significant associations between certain fatty acids and periodontitis and its severity, highlighting their contributory role, although the evidence does not support a causal role based on the results of Mendelian randomization-based analyses. The results of this study support a contributory or inhibitory role of fatty acids in the progression of periodontitis, although not as a direct cause, and underscored the importance of maintaining a balanced dietary lipid profile for periodontal health.

Reference:

Association of dietary and plasma fatty acids with periodontitis. Xie, Bingqin et al. The Journal of the American Dental Association, Volume 156, Issue 3, 198 – 210.e28

Keywords:

Fatty Acids, contributory, Causal Relationship, Periodontitis, Study, The Journal of the American Dental Association, Fatty acids, periodontitis, NHANES Mendelian randomization analysis

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AI-powered model may predict prognosis and immunotherapy response in colorectal cancer patients: Study

By leveraging multi-omics analysis and machine learning techniques, the research team led by Professor Shuo Wang (Institute of Microbiology, the Chinese Academy of Sciences) developed an Immune Response-related Risk Score (IRRS) model to predict prognosis and immunotherapy response in colorectal cancer (CRC) patients. The study integrated clinical data and transcriptomic profiles from TCGA-CRC and six validation cohorts to identify a robust multi-gene signature.

Through machine learning-based feature selection, the team identified 13 core immune-related genes (IL18BP, RSAD2, G0S2, SIGLEC1, SFRP2, IFI44L, ISG20, IFIT1, OLR1, SAMHD1, HK3, PTAFR, CSF1) that play critical roles in the regulation of the tumor immune microenvironment and response to immunotherapy. The IRRS model, constructed using Random Survival Forest (RSF) and Lasso regression, was validated across multiple datasets and demonstrated superior predictive performance.

In the GSE91061, GSE78220, and IMvigor210 datasets, IRRS effectively stratified patients into high-risk and low-risk groups, with significant survival differences. The ROC analysis confirmed that IRRS outperformed TIDE in predicting immunotherapy response, with higher AUC values across all datasets. Notably, higher IRRS scores correlated with poorer survival and less immune activation, while low IRRS scores were associated with better prognosis and increased immune infiltration.

To further investigate the biological mechanisms underlying IRRS, the researchers conducted immune infiltration analysis and pathway enrichment studies. The results revealed that low-risk IRRS patients exhibited higher levels of immune cell infiltration, particularly CD8+ T cells and natural killer (NK) cells, suggesting an enhanced anti-tumor immune response. Additionally, epigenetic modifications, such as DNA methylation patterns, were analyzed, highlighting potential regulatory mechanisms affecting gene expression in high-risk versus low-risk patients.

“These findings demonstrate that immune-related molecular signatures can serve as reliable predictors of CRC prognosis and immunotherapy response,” said Dr. Wang. “The IRRS model provides a clinically relevant and superior alternative to existing predictive tools, paving the way for more personalized and effective immunotherapy strategies.”

While current scientific consensus suggests that traditional CRC risk models rely heavily on TNM staging, this study presents a paradigm shift by incorporating immune system dynamics into risk assessment. The findings underscore the importance of machine learning and multi-omics data integration in developing precision oncology tools for CRC management.

Future directions include expanding the IRRS model to other cancer types and refining its predictive power through multi-center clinical validation. The study sets the foundation for next-generation precision immunotherapy approaches, encouraging researchers to further explore immune signatures in cancer treatment. 

Reference:

Zhen Liu, Dou Yu, Pengyan Xia, Shuo Wang, Machine learning approach to predict prognosis and immunotherapy responses in colorectal cancer patients, hLife, https://doi.org/10.1016/j.hlife.2025.02.001.

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HC quashes criminal proceedings against doctor accused of medical negligence, hitting patient with motorcycle

Lucknow: Granting relief to a doctor who was first accused of medical negligence resulting in malignancy and then hitting the patient with a motorcycle, the Allahabad High Court recently quashed the criminal proceedings against him.

Apart from Dr. Srivastava, the HC bench comprising Justice Shree Prakash Singh also quashed the criminal proceedings against Advocate Ramesh Kumar Srivastava, as it held that the prosecution was instituted with mala fide and malicious intent.

“…the facts and circumstances of the present matter is indicative that the first information report has been lodged with a malafide and malicious intention,” observed the HC bench in its order dated April 10, 2025.

The case stems from a First Information Report (FIR) lodged on 8 February 2007 by a complainant who alleged that Dr. Srivastava had performed a negligent surgery at the Prathmik Swasthya Kendra, Malihabad, resulting in malignancy. Following this, when she was sitting on a dharna, both the doctor and the advocate had allegedly hit her with a motorcycle and threatened her with dire consequences. This led to a fracture in her left elbow, alleged the complainant. Ultimately, the complainant/patient died of cancer in 2009.

Based on the complaint, charges under Sections 325 and 506 IPC were framed based on the chargesheet dated 18 December 2007 and consequently, the Chief Judicial Magistrate, Lucknow, issued summoning orders on 19 December 2007 and 22 July 2013.

Also Read: HC quashes SC, ST Act, Negligence charges against MBBS doctor in gallbladder surgery death case

Challenging these proceedings, the doctor and the advocate approached the HC bench, and their counsel, Sanjay Kumar Srivastav, argued that the FIR was lodged after an unexplained delay of nearly two months. He also argued that the charge sheet was filed hurriedly without proper investigation and emphasized that the protection witnesses, including the complainant’s husband, were not eyewitnesses and relied solely on hearsay.

The applicants claimed that Dr. Srivastava was on emergency and Pulse Polio duty at P.H.C. Malihabad on the date of the alleged incident, and Ramesh Kumar Srivastava (another accused) was present at the High Court, where several of his cases were listed, supported by affidavits of four advocates.

It was further submitted that no evidence of medical negligence was found against Dr. Srivastava in an earlier departmental inquiry by Dr. M.K. Gupta, Deputy CMO, on 29.08.2006.

The doctor and the advocate, who were accused in the matter, further argued that the complaint was filed after the complainant failed to obtain compensation. They claimed that consequently, the complainant tried to falsely implicate them due to a personal grudge and failed extortion attempts.

On the other hand, the Additional Government Advocate submitted that the applicants were named in the FIR, and two rounds of investigations had been conducted. The initial investigation was done by the original Investigating Officer and then a second officer was appointed after the applicants applied for further investigation. The AGA submitted that the charge sheet and summoning orders were based on available evidence.

While considering the matter, the HC bench observed that Dr. Srivastava had been exonerated in the departmental inquiry, which had concluded that any medical negligence pertained to a private hospital, not the government facility.

“In so far as the present case is concerned, it is
prima-facie apparent that there being without any
cogent reason or evidence, the opposite party no.2
moved an application to the Chief Medical Officer with
the allegation that because of the operation conducted
by the applicant no. 2 (the doctor), she had suffered with
malignancy, though there is no medical report submitted in support of her complaint and when an
enquiry was conducted, it was found that the complaint
is false against the applicant no. 2 and thereafter, the
first information report has been lodged, while hatching
the applicants in a criminal conspiracy for personal
grudge.”

Further, the Court noted that when the complainant lodged the FIR on the incident dated 08.02.2007 while alleging the incident of 15.01.2007 even though “there is no explanation of the delay”.

Referring to the allegation that the applicants had hit the complainant with a motorcycle, leading to her fracture, the HC bench observed, “…having at glance the whole scenario, this is not understandable that for what reason and motive, the applicants would be intended to commit such offence.”

“It is also evident that the place where the incident is said to have occurred, is a public place, but there is no public eye witness of the incident, whereas, one of the witness namely, ****, who supported the version of the prosecution, is also not an ocular witness of the incident and he on the basis of receiving the information from the husband of the opposite party no. 2, has deposed before the police,” the bench further noted.

Regarding the claim by the applicants that Dr. Srivastava was on an emergency duty, from 14.01.2007 to 15.01.2007 and thereafter he was on Pulse Polio Duty, the Court noted that this fact had been certified by the Superintendent of P.H.C. Malihabad and “…this fact has not been denied anywhere in the Counter Affidavit filed on behalf of the State-respondent.”

At this outset, the Court also observed that the presence of Advocate Srivastava in the High Court on 15.01.2007 was supported by four other witnesses, “but, this fact seems to be ignored by the Investigating Officer as well as the learned trial court while issuing the summons. Further this fact has also not been denied by the State in it’s Counter Affidavit.”

The High Court bench referred to the Supreme Court’s order in the case State of Haryana vs. Bhajan Lal, and concluded that this case squarely fell under category (7) of mala fide prosecution.

“…the facts and circumstances of the present matter is indicative that the first information report has been lodged with a malafide and malicious intention, which is squarely covered with the ratio of the Judgment of the Hon’ble Apex Court in the case of Bhajan Lal(Supra),” observed the Court.

“It is trite law that it would not only be sufficient for the court to look into the averments made in the first information report/complaint alone to find out whether the necessary ingredients to constitute the alleged offence are disclosed, but, the court owes a duty to look into the other attending circumstances emerging from the record of the case over and above the averments and if it is required, the court with due care and caution, would try to read in between the lines. So far as the present case is concerned, the background of the circumstances indicates that the allegations levelled in the first information report, seem to be with a motive to wreaking vengeance and malafide,” it noted.

Accordingly, the Court quashed the criminal proceedings against the doctor and the advocate while noting that “the trial would result in a gross abuse of process of the law and would not serve the ends of justice.”

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/allahabad-hc-quashes-criminal-proceedings-282636.pdf

Also Read: SC quashes Culpable Homicide Charges against Doctor for prescribing injection over phone

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Doctor assaulted after patient’s death, services halted at Dhanbad Hospital

An on-duty senior resident doctor at the government-run Shaheed Nirmal Mahato Medical College and Hospital (SNMMCH) in Jharkhand’s Dhanbad was allegedly assaulted by relatives of a young patient who passed away while undergoing treatment for a snakebite at the hospital.

Medical services at the hospital were severely hit for over eight hours on Thursday as doctors went on a strike after a senior resident doctor was assaulted by relatives of a deceased patient, officials said.

For more information, click on the link below:

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