Author: Nevin Manimala

Pediatr Infect Dis J. 2025 Apr 29. doi: 10.1097/INF.0000000000004836. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to determine the incidence and clinical characteristics of infants evaluated and treated with a prolonged course of antibiotics for culture-negative sepsis in a quaternary Neonatal Intensive Care Unit (NICU) over a 4-year period.

STUDY DESIGN: Retrospective chart review of patients in the NICU at Children’s Hospital of Philadelphia who had negative blood cultures and received ≥5 days of antibiotics. Data collection included demographics, clinical and laboratory data, and underlying diagnoses. Statistical analysis included Mann-Whitney and chi-square tests, and multivariable logistic regression.

RESULTS: We identified 774 culture-negative sepsis evaluations where antibiotic treatment was continued ≥5 days. While the majority were attributed to a focal etiology, 146 had negative blood cultures and no focal source. Infants with no focal source were younger at the time of sepsis evaluation, of greater gestational age, and more frequently required extracorporeal membrane oxygenation (P < 0.001). In multivariable analysis, evaluations for early-onset disease and need for extracorporeal membrane oxygenation were increased among infants with no focal source (P < 0.01). Although rates of invasive ventilation, and central venous catheters were similar, length of stay and mortality were significantly higher in late-onset episodes (P < 0.001 and P = 0.029, respectively). Consultation with the infectious disease team increased during the study period (P = 0.002).

CONCLUSIONS: Although it is challenging to limit the initiation of antibiotics in infants with complex underlying disease processes with concern for sepsis, minimizing antibiotic use can be achieved by timely discontinuation when cultures are negative. A robust antimicrobial stewardship program can identify valid reasons for prolonged antibiotic administration and suggest approaches to minimize antibiotic exposure.

PMID:40294328 | DOI:10.1097/INF.0000000000004836

Cancer Control. 2025 Jan-Dec;32:10732748251339248. doi: 10.1177/10732748251339248. Epub 2025 Apr 28.

ABSTRACT

IntroductionOvarian cancer remains a leading cause of gynecologic cancer-related mortality worldwide. Identifying perioperative factors that influence survival outcomes is essential for optimizing care. This study evaluates the impact of perioperative factors such as intraoperative blood transfusions and hospital length of stay (LOS) on survival rates in ovarian cancer patients undergoing surgical debulking.MethodsThis retrospective study analyzed charts of 314 patients who underwent ovarian cancer surgery at a single institution between 2010 and 2018. Patients were grouped based on survival status: “Live” or “Death”. Variables included demographics, tumor size, comorbidity, anesthesia time, surgery time, estimated blood loss, transfusion, readmission, hospital stay length, and survival. Statistical analyses included log-rank tests and mean survival estimations: chi-square tests and Mann-Whitney U-test. Significance was set at P < .05.ResultsThe mean follow-up was 50.5 months (95% CI, 47.8-53.2). Prolonged LOS (>3 days) was significantly associated with reduced survival (47.4 vs 52.4 months, P = .015). Patients requiring intraoperative blood transfusions had poorer survival outcomes (42.0 months 95% CI, 36.3-47.7 vs 53.1 months 95% CI, 50.3-55.9, P < .001). The “Death” group experienced greater blood loss, longer surgical/anesthesia times, and higher intraoperative fluid requirements.ConclusionProlonged hospital stays and intraoperative blood transfusions are associated with worse survival outcomes in ovarian cancer patients undergoing surgery. These findings underscore the importance of perioperative optimization strategies, including minimizing transfusion requirements and reducing LOS through enhanced recovery protocols.

PMID:40294239 | DOI:10.1177/10732748251339248

J Cogn Neurosci. 2025 Apr 28:1-13. doi: 10.1162/jocn_a_02339. Online ahead of print.

ABSTRACT

In the past decade, studies have shown that attention fluctuates at ∼8 Hz, alternating between intervals of increased and decreased visual performance [Re, D., Karvat, G., & Landau, A. N. Attentional sampling between eye channels. Journal of Cognitive Neuroscience, 35, 1350-1360, 2023; Re, D., Inbar, M., Richter, C. G., & Landau, A. N. Feature-based attention samples stimuli report feature-based attention samples stimuli rhythmically. Current Biology, 1-7, 2019; Helfrich, R. F., Fiebelkorn, I. C., Szczepanski, S. M., Lin, J. J., Parvizi, J., Knight, R. T., et al. Neural mechanisms of sustained attention are rhythmic. Neuron, 99, 854-865, 2018; VanRullen, R. Perceptual cycles. Trends in Cognitive Sciences, 20, 723-735, 2016; Fiebelkorn, I. C., Saalmann, Y. B., & Kastner, S. Rhythmic sampling within and between objects despite sustained attention at a cued location. Current Biology, 23, 2553-2558, 2013; Landau, A. N., & Fries, P. Attention samples stimuli rhythmically. Current Biology, 22, 1000-1004, 2012]. This modulation of performance, which has been observed primarily in the visual modality, also manifests in behavior and has been termed “attentional sampling.” In this study, we investigate whether sampling goes beyond vision and serves as a domain general mechanism shared by other perceptual systems. Specifically, we examined the auditory modality, in which there is contradicting evidence for endogenous sampling at similar frequencies [see VanRullen, R., Zoefel, B., & Ilhan, B. On the cyclic nature of perception in vision versus audition. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences, 369, 20130214, 2014]. In addition, we sought to investigate a putative role for visual experience in sampling in audition. To this end, sighted (n = 21), sighted blindfolded (n = 26), individuals with acquired blindness (n = 13), and individuals with congenital blindness (n = 12) detected a brief target (an intensity decrement) within an ongoing white noise stimulus. We observed 8- to 10-Hz sampling in the congenitally blind group only. We discuss this finding within the context of two possible, and even compatible, accounts. The first is that brain plasticity in the congenitally blind brings about attentional sampling in audition. It is possible that the lack of early visual experience drives the recruitment of “visual” cortices for auditory inputs, resulting in the same attentional sampling dynamics typically observed in vision, for audition. The second is that auditory sampling also exists in the sighted brain but might be obscured by visual inputs and other reflexive visual processes or might unfold at an entirely different rhythm. In fact, the acquired blind and the two sighted samples exhibited a significant low-frequency fluctuation at 2 Hz in their auditory performance. Although the study was not designed to investigate sampling at delta, this finding is consistent with a role for delta-band activity in audition as well as in temporal expectation mechanisms due to the temporal statistics of the utilized target times [e.g., Herbst, S. K., & Obleser, J. Implicit temporal predictability enhances pitch discrimination sensitivity and biases the phase of delta oscillations in auditory cortex. Neuroimage, 203, 116198, 2019; Wilsch, A., Henry, M. J., Herrmann, B., Maess, B., & Obleser, J. Slow-delta phase concentration marks improved temporal expectations based on the passage of time. Psychophysiology, 52, 910-918, 2015; Stefanics, G., Hangya, B., Hernádi, I., Winkler, I., Lakatos, P., & Ulbert, I. Phase entrainment of human delta oscillations can mediate the effects of expectation on reaction speed. Journal of Neuroscience, 30, 13578-13585, 2010]. Interestingly, delta band sampling was absent in the congenitally blind group. To further substantiate a role for delta band sampling, it would be important to design paradigms better suited to study lower frequencies in behavior, both in sighted individuals and under different degrees of visual input processing.

PMID:40294234 | DOI:10.1162/jocn_a_02339

Global Spine J. 2025 Apr 28:21925682251339621. doi: 10.1177/21925682251339621. Online ahead of print.

ABSTRACT

Study DesignRetrospective cohort study.ObjectivesThis study aims to evaluate the impact of hospital volume on postoperative outcomes following single-level cervical disc arthroplasty (CDA), focusing on non-routine discharge rates, length of stay (LOS), and hospital costs.MethodsAfter applying the appropriate exclusion criteria, the National Inpatient Sample (NIS) was queried to identify 14,315 weighted cases of patients undergoing single-level CDA between 2016 and 2020. Patients were stratified by hospital volume into low, intermediate, and high categories based on annual case numbers. Multivariate logistic regression evaluated odds of non-routine discharge and complications, while linear regression analyzed LOS and hospital costs. Models were adjusted for age, sex, and comorbidities. Statistical significance was set at P < .05.ResultsPatients in high-volume hospitals had significantly lower odds of non-routine discharge compared to both intermediate-volume (OR: 0.63, 95% CI: 0.44-0.91, P = .014) and low-volume hospitals (OR: 0.66, 95% CI: 0.45-0.98, P = .040). Patients in high-volume hospitals also incurred significantly higher costs compared to low-volume hospitals (coefficient: $1,232.22, 95% CI: $189.05-$2,275.38, P = .021), while length of stay did not differ significantly across volume categories.ConclusionsHigh-volume hospitals are associated with improved discharge outcomes, but also increased costs following single-level CDA. These findings underscore the need to disseminate high-volume center practices to lower-volume hospitals while addressing cost management. Further research should explore the impact of outpatient settings and long-term outcomes to enhance care delivery for CDA patients.

PMID:40294232 | DOI:10.1177/21925682251339621

Health Psychol Rev. 2025 Apr 28:1-19. doi: 10.1080/17437199.2025.2492042. Online ahead of print.

ABSTRACT

Background: Introduction: Physical activity is essential in preventing and treating age-related chronic diseases and mortality. Retirement is a key period to promote health behaviours, as individuals restructure their routines. Thus, we aimed to identify effective components and behaviour change techniques (BCTs) in interventions promoting physical activity in retirement-age individuals. Methods: We conducted a meta-analysis. Included studies were randomised controlled trials that (p)targeted retirement-age adults (50-70 years), (i)applied BCTs, (c)had any comparator, and (o)promoted physical activity. Screening, full-text review, and data extraction were conducted independently by at least two reviewers. A multilevel random effects model with three effect sizes was fitted, and meta-regressions tested several moderators. Results: 67 studies (N = 12,147) were included. High risk of bias related to larger effects, so these studies were excluded from the main analyses. While individual effects were often non-significant, the overall pooled effect was small but statistically significant. Predictors varied across effect sizes and included action planning, motivational interviewing, and prompts/cues. Email and website delivery were associated with smaller effect sizes. Conclusions: The effectiveness of lifestyle interventions is heterogeneous and presented small effects; implementing action planning, motivational interviewing, and prompts could improve the effectiveness. However, many BCTs that are not frequently used remain unexplored.

PMID:40294226 | DOI:10.1080/17437199.2025.2492042

Eur J Prev Cardiol. 2025 Apr 28:zwaf270. doi: 10.1093/eurjpc/zwaf270. Online ahead of print.

ABSTRACT

BACKGROUND: The elucidation of the contributory role of multimorbidity to heart failure (HF) including the gut-heart axis has added a new dimension to our understanding of HF pathophysiology which is not reflected in currently available risk scores. The present investigation aimed to develop and validate a novel risk score model of multimorbidity for HF risk stratification.

METHODS: A risk model was developed based on the contribution of markers associated with HF multimorbidities on outcomes of mortality and/or rehospitalization due to HF (death/HF) at one year. Two independent HF cohorts were combined and randomly split 70:30 using a split-sample validation approach for training and validation cohorts which were not significantly different for investigated variables. Backward logistic regression was used to develop the risk model with a further scoring system to create a simple risk calculator.

RESULTS: A final 11-variable risk model (age, previous HF hospitalization, NYHA group III/IV, NT-proBNP, diastolic blood pressure, loop diuretic use, beta-blocker non-use, creatinine, COPD, diabetes, and combined gut metabolites) showed a diagnostic performance of 0.71 in the training cohort (C-statistic validation cohort, 0.70, p<0.001). A risk score/calculator was further developed based on this model with categorization into three (low-, mid- and high-) and two (low- and high-) risk groups, with both approaches demonstrating increased incidence of death/HF in patients at the highest risk (p<0.001).

CONCLUSION: A novel risk model and score were derived which showed the contribution of comorbidities including the added value of the gut-heart axis on risk stratification of HF patients on rehospitalization and death.

PMID:40294213 | DOI:10.1093/eurjpc/zwaf270

Eur J Prev Cardiol. 2025 Apr 28:zwaf269. doi: 10.1093/eurjpc/zwaf269. Online ahead of print.

ABSTRACT

AIMS: Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the effects of four different exercise programs on peak oxygen consumption (peakVO₂), Kansas City Cardiomyopathy Questionnaire (KCCQ) score and ChR in patients with the ChI HFpEF phenotype.

METHODS: In this randomized clinical trial, 80 symptomatic (NYHA class II-III/IV) patients with the ChI HFpEF phenotype were randomized (1:1:1:1) to one of four interventions: (a) a 12-week supervised aerobic training (AT) program, (b) AT with low-intensity strength training (AT/LRT), (c) AT with moderate- to high-intensity strength training (AT/HRT), or (d) non-supervised exercise recommendations (ER). The primary endpoint was the change in peakVO2 at 12 weeks. Secondary endpoints included changes in ChR and KCCQ. A linear regression model was used.

RESULTS: The mean age of 80 participants was 75.1±7.2 years, and 59.6% were women. Baseline values for peakVO2, chronotropic index, and KCCQ were 11.8±2.6 mL/kg/min, 0.4±0.2, and 63.5±17.9, respectively, with no significant differences across arms. All supervised training programs led to significant improvements in peakVO2 compared to ER: AT/HRT: Δ+4.0, (95% CI: 2.9 to 5.1, p< 0.001), AT/LRT: Δ+3.6, (95% CI: 2.5-4.6, p<0.001), and AT: Δ+2.9, (95% CI: 1.9-4.0, p<0.001). AT/HRT was superior over AT alone: Δ+1.1, (95% CI, 0.1 to 2.2, p=0.046). Likewise, supervised exercise improved ChR and KCCQ without statistical differences between groups.

CONCLUSIONS: Different supervised exercise training improved peakVO2, ChR and KCCQ in patients with ChI HFpEF phenotype.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT05649787).

PMID:40294211 | DOI:10.1093/eurjpc/zwaf269

Eur J Prev Cardiol. 2025 Apr 28:zwaf257. doi: 10.1093/eurjpc/zwaf257. Online ahead of print.

ABSTRACT

AIM: This meta-analysis aims to evaluate the effect of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RAs), on new-onset atrial fibrillation (AF) in randomized clinical trials (RCTs).

METHODS AND RESULTS: Twenty-six RCTs involving 48,583 participants (of whom 25,879 on semaglutide) with 541 new onset AF were analyzed. Semaglutide treatment resulted in a 17% reduction in AF incidence compared to controls (OR 0.83, 95% CI 0.70-0.98, p = 0.03) with no heterogeneity (I² = 0%). The effect was more pronounced with the oral formulation, which reduced AF incidence by 52% (OR 0.48, 95% CI 0.24-0.95, p = 0.04), while studies with active comparators showed a 59% reduction in AF risk (OR 0.41, 95% CI 0.20-0.83, p = 0.01). In trials without Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) concomitant therapy, there was a significant reduction of 21% in new-onset AF (OR 0.79, 95% CI, 0.63-0.99; p=0.04). Meta-regression revealed no influence of baseline covariates, including BMI and HbA1c. An additional meta-regression analysis evaluating the percentage of patients on SGLT2 inhibitors as a potential moderator revealed no statistically significant association (p= 0.336).

CONCLUSIONS: Treatment with semaglutide significantly reduces the incidence of new-onset AF. This effect appears more evident with the oral formulation and independent of baseline characteristics.

PMID:40294206 | DOI:10.1093/eurjpc/zwaf257

ACS Nano. 2025 Apr 28. doi: 10.1021/acsnano.5c01257. Online ahead of print.

ABSTRACT

Development of functional nanocrystals requires precise control over their composition and structure. Particularly, surface composition, defects, and doping play a central role in our ability to develop functional nanomaterials. As such, there is great interest in capturing these properties. Solid-state NMR spectroscopy is a powerful tool for probing structural and compositional features at the atomic scale, in particular, when it is coupled with the high sensitivity gained by dynamic nuclear polarization (DNP). DNP enhances NMR sensitivity by transferring high electron spin polarization to the surrounding nuclear spins. This dramatically improves the signal intensity, making it a valuable tool for detecting subtle structural features. Utilizing metal ion dopants as polarization agents for DNP has been shown to be an excellent approach to increasing ssNMR sensitivity in the bulk of inorganic solids. Here, we demonstrate the implementation of this approach to nanocrystals, focusing on Mn(II)-doped CdS, where homogeneous doping is known to be challenging while being critical for the DNP process. The intricate nature of the doping was elucidated by quantitative electron microscopy and electron paramagnetic resonance spectroscopy. We confirmed that Mn(II) doping is confined to the core of the nanocrystals and that statistically dopants are homogeneously distributed within each nanocrystal. DNP from Mn(II) dopants is then shown to increase ¹¹³Cd NMR sensitivity by an order of magnitude, enabling distinction between core and surface environments as well as the detection of defects in the bulk of the nanocrystals. We expect that the approach can be extended to other nanocrystals, providing an efficient route for characterizing their bulk and surface properties.

PMID:40294147 | DOI:10.1021/acsnano.5c01257

Vet Med Sci. 2025 May;11(3):e70357. doi: 10.1002/vms3.70357.

ABSTRACT

Fascioliasis is a common hepatic parasitic disease that is caused by Fasciola, resulting in significant economic losses by reducing production and consigning viscera in animals. Currently, there is little research regarding the impact of chemical compounds on the ultrastructure and motility of adult F. hepatica. The present study aims to assess the effect of Vanadate erbium/silver oxide (ErVO₄/AgO) and Vanadate iron/silver oxide (FeVO₄/AgO) nanoparticles against liver fluke F. hepatica, in vitro assay. Fasciola hepatica adult worms were collected from the livers and gallbladders of sheep and goats centrality of Iran. One hundred fresh worms were incubated with each nanoparticle concentration of 4.5-6 mg/mL FeVO₄/AgO and ErVO₄/AgO (test, groups) in comparison to triclabendazole 5-20 µg/mL (positive control) and RPMI media culture (negative control) after 12 and 24 hours of treatment. To ensure the reliability of the data, the tests on the sample were performed twice. The effectiveness of these compounds was evaluated by examining parasite movement, reaction to vital stain and changes in the tegument through scanning electron microscopy (SEM) using Fisher statistical tests and logistic regression. Analysis of variance was performed to compare Kaplan-Meier and Cox groups and models to analyse parasite survival. In addition, the anthelmintic efficacy was measured as the mortality rate based on the number of live and dead worms. The mortality ratios show that the anthelmintic activities of the compounds highly relied on time and concentration, as time and concentration increased, increasing the mortality rate. Lethal concentration 50 (LC₅₀) of FeVO₄/AgO and ErVO₄/AgO are 4, 4.7 and 5 mg/mL at 24 h, respectively. FeVO₄/AgO showed more lethal effects on F. hepatica than on ErVO₄/AgO and triclabendazole. SEM analysis of treated F. hepatica by both nanoparticles at a concentration of 6 mg/mL showed that the tegument surface of fasciola is swollen in some parts, the pores on the tegument surface are completely visible, the sensory papillae are lost, the tegument is severely damaged and the prominent network structure and its vesicles have completely disappeared. F. hepatica is more susceptible to the lethal effects of FeVO₄/AgO and ErVO₄/AgO nanoparticles. The effectiveness of these compounds depends on the concentration and time of the drug’s effect, in such a way that the effectiveness increases with the increase in concentration and time.

PMID:40294130 | DOI:10.1002/vms3.70357