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Nevin Manimala Statistics

Pre-Operative Atrial Deformation Indices Predict Post-Operative Atrial Fibrillation in Patients Undergoing Lung Resection Surgery

Echocardiography. 2025 Feb;42(2):e70105. doi: 10.1111/echo.70105.

ABSTRACT

BACKGROUND: There are no established predictors of post-operative atrial fibrillation (POAF) in non-cardiac thoracic surgery. Pre-operative left atrial imaging has been shown to identify patients with POAF undergoing cardiac surgery. The purpose of this study was to determine whether pre-operative left atrial strain (LAS) predicts POAF in patients undergoing lung resection.

METHODS: One hundred forty-nine patients who underwent cancer lung resection were retrospectively analyzed. Pre-operative imaging involved conventional transthoracic echocardiography with comprehensive speckle-tracking strain. The additional advanced LAS analysis involved three components of atrial function: reservoir, conduit, and booster.

RESULTS: POAF occurred in 17 (11.4%) patients. We found no differences in demographics and peri-operative variables. Patients with POAF were more likely to have atrial fibrillation history (6.8% vs. 29.4%, p = 0.003). Preoperative imaging analysis revealed an increased LA volume index in patients with POAF (25.9 ± 8.8 vs. 32.3 ± 11.9 mL/m2, p = 0.046). All three components of LAS were reduced in the POAF group. The most prominent reduction was reservoir-compliance strain (35.5% ± 4.6% vs. 24.2% ± 6.6%, p < 0.001), then conduit strain (-18.3% ± 8.7% vs. -12.6% ± 4.7%, p < 0.001), and booster strain (-18.3% ± 8.7% vs. -12.6% ± 4.7%, p < 0.001). On univariable analysis, LAS reservoir strain was associated with POAF status (OR: 0.86 [95% CI: 0.78-0.92]), with a c-index of 0.81. Optimized multivariable model considering left atrial volume index, reservoir LAS, and atrial fibrillation history improved c-statistic to 0.880.

CONCLUSION: Reduced LAS metrics are more specific and sensitive than conventional demographics and standard echocardiography in predicting POAF. Preoperative LA imaging might aid with identifying patients undergoing lung resection who are high-risk and benefit from prophylactic therapy.

PMID:39950391 | DOI:10.1111/echo.70105

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Association of treatment methods and survival in esophageal neuroendocrine carcinoma population of Surveillance, Epidemiology, and End Results database: a retrospective cohort study

Dis Esophagus. 2025 Jan 7;38(1):doaf008. doi: 10.1093/dote/doaf008.

ABSTRACT

Esophageal neuroendocrine carcinoma (ENEC) is an uncommon and highly aggressive tumor with an obscure etiology. Thus, this study aimed to investigate the best treatment option for patients with ENEC. This study identified patients with ENEC from the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2021. Clinicopathological characteristics were analyzed using descriptive statistics, and prognostic factors were determined through Cox regression analysis. Kaplan-Meier survival analysis was used to assess five-year overall survival (OS). Patients were divided into a combined radiotherapy and chemotherapy group and a surgery group based on treatment modality. Propensity score matching (PSM) was performed to balance baseline characteristics between the two groups. A total of 604 participants were included; univariate and multivariate analyses indicated that ENEC patients with localized or regional disease had significantly higher survival rates (HR = 0.38, 95% CI 0.29-0.51, P < 0.001 and HR = 0.56, 95% CI 0.44-0.71, P < 0.001) than those with distant metastases. The combination of radiotherapy and chemotherapy (HR = 0.34, 95% CI 0.25-0.46, P < 0.001) and surgical treatment (HR = 0.43, 95% CI 0.31-0.59, P < 0.001) significantly improved survival. Kaplan-Meier analysis showed significant differences in OS among treatments (P < 0.0001), with the combination therapy and surgery groups having similar rates of 7.04% and 8.77%, respectively, and outperforming other methods. The combination therapy group maintained the best survival rate over time. The synergistic application of radiotherapy and chemotherapy has markedly enhanced the five-year survival rate of patients with ENEC, offering invaluable insights for clinical management strategies.

PMID:39950356 | DOI:10.1093/dote/doaf008

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Comparison of Intense Pulsed Light With Nonablative Fractional Laser and Picosecond Alexandrite Laser With Diffractive Lens Array for Noninvasive Facial Rejuvenation

Lasers Surg Med. 2025 Feb 14. doi: 10.1002/lsm.23879. Online ahead of print.

ABSTRACT

BACKGROUND: Both nonablative fractional (NAFL) laser combined with intense pulsed light (IPL) and picosecond alexandrite laser (PSAL) with diffractive lens array (DLA) have been documented for their efficacy in facial rejuvenation.

OBJECTIVE: To observe the safety and efficacy of PSAL-DLA and IPL-NAFL in the rejuvenation of Chinese individuals.

METHODS: Each subject (n = 18) received three treatments on half of their face, with 1-month interval between treatments. One side of the face was randomly treated with PSAL-DLA, and the other side with IPL-NAFL. Quantitative data of wrinkles, pores, brown spots, and red areas were calculated using the VISIA-CR imaging system 3 months after the final treatment. Secondary outcomes included a 10-point VAS for patient-rated pain sensation, incidence of post-inflammatory hyperpigmentation (PIH), erythema and edema, and overall satisfaction. Adverse events were recorded after each treatment and at each follow-up.

RESULTS: A total of 17 Chinese female patients aged 28.2 ± 4.3 years completed the study and the 3-month follow-up. The IPL-NAFL side showed a statistically significant improvement in pores compared to baseline (p < 0.05); the PSAL-DLA side showed a statistically significant improvement in brown spots compared to baseline (p < 0.01). Compared to PSAL-DLA, the improvement in enlarged pores was better for IPL-NAFL (81.8 ± 128.1 vs. 20.8 ± 132.4, p < 0.01). In terms of pain, IPL-NAFL was more painful than PSAL-DLA (6 ± 1 vs. 4 ± 1, p < 0.01), a longer recovery time for erythema and edema (5 ± 1 vs. 2 ± 1, p < 0.001), and a higher incidence of PIH (58.8% vs. 23.5%, p < 0.05). Patient satisfaction was higher for PSAL-DLA than for IPL-NAFL (3 ± 1 vs. 4 ± 0.5, p < 0.01).

CONCLUSION: Our study results indicated that both IPL-NAFL and PSAL-DLA could improve the photoaging, but within the same number of treatments, IPL-NAFL was slightly more effective for enlarged pores than PSAL-DLA, while PSAL-DLA was more effective for brown spots than IPL-NAFL. Patients were more satisfied with PSAL-DLA, with a shorter postoperative recovery period and a lower incidence of PIH.

PMID:39950332 | DOI:10.1002/lsm.23879

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Using Win Odds to Improve Commit-to-Phase-3 Decision-Making in Oncology

Stat Med. 2025 Feb 28;44(5):e70024. doi: 10.1002/sim.70024.

ABSTRACT

Making good decisions about whether to commit-to-phase 3 clinical trials is challenging. This is especially true in oncology because the relationships between the registration endpoint, overall survival, and endpoints such as progression-free survival and confirmed objective response are often poorly understood. We present a framework for decision-making based on a three-endpoint win odds. We discuss properties of the win odds and suggest that it can be interpreted, for decision-making, as the reciprocal of an average hazard ratio for overall survival. We confirm the performance of the decision-making method using simulation studies and a clinical trial case study. As part of this work, we describe the simulation of correlated patient-level oncology endpoints using a multi-state model of disease. This model can provide clinically realistic data for testing the performance of analysis methods. We conclude that the win odds can improve commit-to-phase-3 decision-making compared with other methods.

PMID:39950312 | DOI:10.1002/sim.70024

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Mental Health Rehabilitation in Gaza: Addressing the Impact of Ongoing War Conflict on Access and Challenges, a Systematic Review

Disaster Med Public Health Prep. 2025 Feb 14;19:e33. doi: 10.1017/dmp.2025.34.

ABSTRACT

OBJECTIVE: The ongoing conflict in Gaza, intensified since October 2023, has critically disrupted mental health services, exacerbating issues such as post-traumatic stress disorder (PTSD), anxiety, and depression among the population. This systematic review aims to identify and assess the challenges faced in mental health rehabilitation during this period.

METHODS: Utilizing the Arksey & O’Malley framework and PRISMA guidelines, a comprehensive literature search was conducted across 6 databases. Studies focusing on barriers to mental health services for Gazan residents were selected, and data were extracted using the Critical Appraisal Skills Program (CASP) for quality assessment.

RESULTS: Eight studies were included, revealing significant barriers to accessing mental health services, including extensive damage to health care infrastructure, a shortage of trained professionals, economic hardships, and a pervasive distrust in health care institutions.

CONCLUSIONS: The findings underscore the urgent need for tailored interventions and strategies to enhance access to mental health services and rebuild trust within the community. Addressing these barriers is essential for effective psychological rehabilitation and long-term recovery for the affected population in Gaza.

PMID:39950297 | DOI:10.1017/dmp.2025.34

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Therapeutic Potential of Mesenchymal Stem Cells or their Secretome in Diabetic Mice with or without Preconditioning Treatment

Recent Adv Inflamm Allergy Drug Discov. 2025 Feb 7. doi: 10.2174/0127722708323777250121224618. Online ahead of print.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) is an autoimmune disease with difficult management, affecting the quality of life. Stem cell therapy has been proven to have regenerative ability. Using the existing stem cell therapy and modifying it, the current study aims to evaluate the effect of umbilical cord-derived mesenchymal stem cells (UCMSC), condition media (CM), and UCMSC and CM preconditioned with methotrexate, reservetrol, and vitamin D for its ability to manage T1DM in Swiss albino mice.

MATERIALS & METHODS: Disease condition was established in the animals by using a diabetesinducing agent streptozotocin (STZ). Then the animals were grouped into normal control, disease control, standard, and test groups; and the treatments were given accordingly. The total study period for this experiment was 28 days. During this period, the animals were supervised for blood glucose levels, food-water intake, and body weight twice a week. At the end of 28 days, the biochemical estimations for serum insulin level, C-peptide, pro-inflammatory cytokines, and anti-inflammatory cytokines level were done. Also, histopathology of the pancreas was performed.

RESULTS: The test groups showed a significant decline in the blood glucose level, an increase in C-peptide level, and a decrease in pro-inflammatory cytokines as compared to the disease group. A statistically significant change was not observed within the groups in terms of serum insulin and anti-inflammatory cytokine levels. There were improvements in diabetic symptoms in treatment groups, such as polyphagia, polydipsia, and weight loss. Treatment groups also showed pancreatic regeneration, indicating improved insulin secretion.

CONCLUSION: In the present study, we concluded that UCMSC, CM, and UCMSC and CM preconditioned with synthetic and natural immunosuppressants and immunomodulators have the ability to regenerate damaged pancreatic beta cells and have an antidiabetic activity, along with an immunomodulating effect. This therapy is a promising choice for future research.

PMID:39950288 | DOI:10.2174/0127722708323777250121224618

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Opioid Use After Hip Fracture and Subsequent Fracture Outcomes: A Self-Controlled Case Series Design

Pharmacoepidemiol Drug Saf. 2025 Feb;34(2):e70118. doi: 10.1002/pds.70118.

ABSTRACT

PURPOSE: Hip fractures in older adults cause severe pain that often necessitates opioid use. However, opioids may trigger falls that result in subsequent fractures. Studies examining the effects of opioids on subsequent fractures are often limited by unmeasured confounding between opioid-treated and untreated persons. To overcome this limitation, we used a self-controlled case series (SCCS) design to investigate subsequent fracture risk during periods of opioid use after hip fracture.

METHODS: The retrospective cohort included Medicare beneficiaries aged > 65 years who had a subsequent hip fracture within one year after an incident hip fracture (2012-2018). We estimated the risk of subsequent hip fracture in three exposure intervals according to the duration of opioid exposure: (1) The first 0-14 days of opioid exposure, (2) days 15-42 of exposure, and (3) opioid use beyond 42 days. We employed several approaches to modify the SCCS design to be more robust to assumptions, including adjustment for event-dependent exposures.

RESULTS: The rate of subsequent fracture was greatest during opioid use across a variety of approaches. The effect within the first 14 days after initiating opioids was robust to SCCS design choices, ranging from IRR 1.12 (95%CLs 0.98, 1.28) to IRR 1.77 (95%CLs 1.52, 2.07). The effect of extended opioid use (> 42 days) ranged from IRR 2.49 (95%CLs 1.95, 3.18) to IRR 4.08 (95%CLs 3.06, 5.46).

CONCLUSIONS: Analyses indicate a consistent increased risk of subsequent fracture associated with opioid use and demonstrate the importance that SCCS assumptions must be carefully investigated for real-world applications.

PMID:39950251 | DOI:10.1002/pds.70118

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Geographic and Temporal Patterns in Biologic Prescriptions for Inflammatory Bowel Diseases in the Public Healthcare System in Brazil: An Ecological Study

Pharmacoepidemiol Drug Saf. 2025 Feb;34(2):e70114. doi: 10.1002/pds.70114.

ABSTRACT

PURPOSE: To analyze the geographic and temporal patterns of biologic prescriptions for inflammatory bowel disease (IBD) in Brazil’s public national unified health system (SUS).

METHODS: This ecological study used data from patients with IBD in the SUS Outpatient Information System between 2008 and 2022. Prais-Winsten regression was used to estimate the trends in prescription rate of biologics. For geographic analysis, average prescription rate of biologics was calculated by state for three periods: 2008-2012, 2013-2017, and 2018-2022. Global Moran’s index (GMI) and local indicators of spatial autocorrelation (LISA) were used to assess spatial autocorrelation and identify spatial clusters of biologic prescriptions, respectively.

RESULTS: The prescription rate of biologics increased from 3.0% to 16.7%. Infliximab was the most prescribed drug from 2008 to 2012 (3.0%-4.2%), and adalimumab was the most widely prescribed drug from 2013 to 2022 (4.3%-9.1%). Higher prescription rates of biologics were observed in patients with Crohn’s disease than in those with ulcerative colitis (40.5% vs. 3.2%). Biologics were primarily prescribed in the Southeast and South; however, the central-western and northern regions showed greater changes in prescription rates over time. There were increased clusters of high biologic prescriptions across the three evaluated periods.

CONCLUSIONS: The increase in biologic prescriptions over time may be attributed to their enhanced efficacy in inducing and maintaining IBD remission. Biologic prescriptions in Brazil are experiencing temporal and geographical changes, indicating that disparities in drug prescriptions may decrease with universal, equitable healthcare access, despite administrative challenges in obtaining these medications through SUS.

PMID:39950239 | DOI:10.1002/pds.70114

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SPIN-IT and Quit It: A Nurse-Driven Protocol to Improve Inpatient Interventions for Tobacco Use Disorder [Formula: see text]

J Am Psychiatr Nurses Assoc. 2025 Feb 14:10783903251315744. doi: 10.1177/10783903251315744. Online ahead of print.

ABSTRACT

INTRODUCTION: Tobacco smoking remains a leading cause of preventable disease and death in the U.S., with a high prevalence among individuals with mental health disorders (MHD). Despite regulatory efforts to increase tobacco use disorder (TUD) treatment in psychiatric inpatient units (an ideal setting), compliance of offering and using these interventions remains suboptimal.

AIMS: This project aims to examine the effectiveness of a nurse-driven protocol, Smoking treatment Protocol for Inpatients via Nurse-driven Interventions & Teaching (SPIN-IT), on improving compliance with evidence-based TUD treatment interventions in an inpatient psychiatric unit.

METHODS: SPIN-IT was developed and implemented in a 20-bed inpatient psychiatric unit. The protocol allowed registered nurses (RNs) to deliver TUD counseling and prescribe nicotine replacement medication based on an algorithm without an independently licensed provider (LIP). Data on compliance with CMS tobacco measures (TOB-2 and TOB-2a) were collected for 12 months before and after SPIN-IT implementation and analyzed for statistical significance.

RESULTS: The project included 835 patients over 2 years. Postintervention TOB-2 compliance increased significantly from 84.7% to 99.3% (p < .001), and TOB-2a compliance rose from 24% to 56% (p < .001). The protocol resulted in more patients being offered and receiving TUD treatment counseling and medications.

CONCLUSION: The SPIN-IT protocol significantly improved TUD treatment compliance in an inpatient psychiatric setting. It supports the effectiveness of nurse-driven protocols in enhancing patient outcomes and adherence to TUD treatment measures. Further research is needed to evaluate the long-term impact on TUD treatment and to explore the perceptions of nursing staff, physicians, and patients related to the protocol.

PMID:39950238 | DOI:10.1177/10783903251315744

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Expanding the OMOP Common Data Model to Support Perinatal Research in Network Studies

Pharmacoepidemiol Drug Saf. 2025 Feb;34(2):e70106. doi: 10.1002/pds.70106.

ABSTRACT

OBJECTIVES: The Observational Medical Outcomes Partnership common data model (OMOP-CDM) is a useful tool for large-scale network analysis but currently lacks a structured approach to pregnancy episodes. We aimed to develop and implement a perinatal expansion for the OMOP-CDM to facilitate perinatal network research.

METHODS: We collaboratively developed a perinatal expansion with input from domain experts and stakeholders to reach consensus. The structure and vocabularies followed the OMOP-CDM ontological framework principles. We tested the expansion using SIDIAP and Norwegian databases. We developed a diagnostics package for quality control assessment and conducted a descriptive analysis on the captured perinatal data mapped to the OMOP-CDM.

RESULTS: The perinatal expansion consists of a pregnancy table and an infant table, each with required and optional variables incorporated into standardized vocabularies. Quality assessment of the perinatal expansion table in SIDIAP and Norwegian databases demonstrated accurate capture of perinatal characteristics. Descriptive analysis measured the number of pregnancies (SIDIAP: 646 530; Norway: 746 671), pregnancy outcomes (e.g., 0.5% stillbirths in SIDIAP and 0.4% in Norway), gestational length (median [IQR] in days, SIDIAP: 273 [56-280]; Norway: 280 [273-286]), number of infants (Norway: 758 806), and birth weight (median [IQR] in grams, Norway: 3520 [3175-3860)], among other relevant variables.

DISCUSSION AND CONCLUSION: We developed and implemented a perinatal expansion that captures important variables for perinatal research and allows interoperability with existing tables in the OMOP-CDM, which is expected to facilitate future network studies. The publicly available diagnostics package enables testing the implementation of the extension table and the quality and completeness of available data on pregnancy and pregnancy-related outcomes in databases mapped to the OMOP CDM.

PMID:39950235 | DOI:10.1002/pds.70106