Author: Nevin Manimala

JAMA Netw Open. 2025 Apr 1;8(4):e255522. doi: 10.1001/jamanetworkopen.2025.5522.

ABSTRACT

IMPORTANCE: Crossmatched packed red blood cells (pRBC) that are not transfused result in significant waste of this scarce resource. Efficient utilization should be part of a patient blood management strategy.

OBJECTIVE: To develop and validate a prediction model to identify surgical patients at high risk of intraoperative pRBC transfusion.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study used hospital registry data from 2 quaternary hospital networks from January 2016 to June 2021 (development: Montefiore Medical Center [MMC], Bronx, New York), June 2021 to February 2023 (internal validation: MMC), and January 2008 to June 2022 (external validation: Beth Israel Deaconess Medical Center [BIDMC], Boston, Massachusetts). Participants were patients aged 18 years or older undergoing surgery.

MAIN OUTCOME AND MEASURES: The outcome was intraoperative transfusion of 1 or more pRBC units. Based on a priori-defined candidate predictors, stepwise backward regression was applied to develop a computational model of independent predictors for intraoperative pRBC transfusion.

RESULTS: The development and validation cohorts consisted of 816 618 patients (273 654 at MMC: mean [SD], age 57.5 [17.2] years; 161 481 [59.0%] female; 542 964 at BIDMC: mean [SD] age, 56.0 [17.1] years; 310 272 [57.1%] female). Overall, 18 662 patients (2.3%) received at least 1 unit of pRBC. The final model contained 24 preoperative predictors: nonambulatory surgery; American Society of Anesthesiologists physical status; international normalized ratio; redo surgery; emergency surgery or surgery outside of regular working hours; estimated surgical duration of at least 120 minutes; surgical complexity; liver disease; hypoalbuminemia; thrombocytopenia; mild, moderate, or severe anemia; and surgery type. The area under the receiver operating characteristic curve (AUC) was 0.93 (95% CI, 0.92-0.93), suggesting high predictive accuracy and generalizability. Positive predictive value (PPV) and negative predictive value (NPV) were 8.9% (95% CI, 8.7%-9.2%) and 99.7% (95% CI, 99.7%-99.7%), respectively, with increased predictive values for operations with a higher a priori risk of pRBC transfusion. The model’s performance was confirmed in internal and external validation. The prediction tool outperformed the established Transfusion Risk Understanding Scoring Tool (AUC, 0.64 [0.63-0.64]; PPV, 2.6% [95% CI, 2.5%-2.6%]; NPV, 99.2% [95% CI, 99.1%-99.3%]) (P < .001) and was noninferior to 3 machine learning-derived scores.

CONCLUSIONS AND RELEVANCE: In this prognostic study of surgical patients, the Transfusion Forecast Utility for Surgical Events (TRANSFUSE) model for predicting intraoperative pRBC transfusion was developed and validated. The instrument can be used independently of machine learning infrastructure availability to inform preoperative pRBC orders and to minimize waste of nontransfused red blood cell units.

PMID:40244584 | DOI:10.1001/jamanetworkopen.2025.5522

JAMA Netw Open. 2025 Apr 1;8(4):e255532. doi: 10.1001/jamanetworkopen.2025.5532.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic has been associated with risk factors for cognitive decline, such as bereavement and SARS-CoV-2 infection.

OBJECTIVE: To examine whether the COVID-19 pandemic and pandemic-related exposures are associated with cognitive function among middle-aged women.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from the Nurses’ Health Study II, an ongoing study of registered nurses in the US. The present study focused on women aged 51 to 76 years who completed 2 to 8 objective cognitive assessments both prior to (October 1, 2014, to February 29, 2020) and during the COVID-19 pandemic (March 1, 2020, to September 30, 2022). Statistical analyses were performed from January 2023 to January 2025.

EXPOSURE: COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES: Two standardized (ie, z-scored) composite cognitive scores (psychomotor speed and attention, learning and working memory) and a global score constituted the primary outcomes. Higher scores indicated better cognitive function. Cognitive function was assessed using the Cogstate Brief Battery, a computer-administered cognitive test battery. Participants completed cognitive assessments every 6 to 12 months.

RESULTS: A total of 5191 women (mean [SD] age at first cognitive assessment, 63.0 [4.8] years) completed both prepandemic and during-pandemic measures, contributing 23 678 cognitive assessments. After adjustment for age at cognitive assessment, educational level for both participants and their parents, cognitive test practice effects, and comorbidities (eg, diabetes, hypertension), no difference in cognitive function was observed between assessments taken during vs before the pandemic (psychomotor speed and attention: β = -0.01 SD [95% CI, -0.05 to 0.02 SD]; learning and working memory: β = 0.00 SD [95% CI, -0.03 to 0.03 SD]; global score: β = 0.00 SD [95% CI, -0.03 to 0.02 SD]). Among 4456 participants who responded to the COVID-19 substudy (ie, surveys about pandemic-related events), those with a history of SARS-CoV-2 infection (164 [3.7%]) or post-COVID-19 conditions (PCC; 62 [1.4%]), at a median (IQR) 20.0 (18.5-22.1) months after initial infection, had reduced cognitive function compared with women without infection or PCC; however, these differences did not reach statistical significance, and the wide CIs suggested considerable uncertainty.

CONCLUSIONS AND RELEVANCE: This cohort study of middle-aged women found that the COVID-19 pandemic and pandemic-related events were not associated with cognitive decline up to 2.5 years after the onset of the pandemic. Future studies are needed to examine the long-term implications of SARS-CoV-2 infection and PCC for cognitive function.

PMID:40244583 | DOI:10.1001/jamanetworkopen.2025.5532

JAMA Oncol. 2025 Apr 17. doi: 10.1001/jamaoncol.2025.0522. Online ahead of print.

ABSTRACT

IMPORTANCE: Effective treatment of locally advanced gastric cancer (GC) or gastroesophageal junction (GEJ) cancer remains a challenge.

OBJECTIVE: To compare the efficacy and safety of atezolizumab plus trastuzumab plus capecitabine and oxaliplatin chemotherapy (XELOX) vs trastuzumab plus XELOX in Chinese patients with locally advanced human epidermal growth factor receptor 2 (ERBB2; formerly HER2)-positive GC or adenocarcinoma of the GEJ.

DESIGN, SETTING, AND PARTICIPANTS: This was an open-label phase 2 randomized clinical trial conducted at 8 study sites in China. Patient recruitment started on February 25, 2021, and this study is ongoing as participants are still being actively followed up. Chinese patients eligible for surgery with locally advanced ERBB2-positive GC or adenocarcinoma of the GEJ were included. Data were analyzed from March 2021 to October 2023.

INTERVENTIONS: Eligible patients were enrolled and randomly assigned 1:1 to perioperative treatment with either atezolizumab plus trastuzumab plus XELOX (arm A) or trastuzumab plus XELOX (arm B) for 3 neoadjuvant cycles (3 weeks per cycle) and 5 adjuvant cycles.

MAIN OUTCOMES AND MEASURES: The primary efficacy end point was the pathological complete response (pCR) rate following completion of neoadjuvant therapy and surgery.

RESULTS: In total, 42 patients were screened and randomly assigned to arm A (n = 21) or arm B (n = 21). The median (range) ages were 61 (33-72) years and 65 (49-72) years in arm A and arm B, respectively, and 39 patients (93%) were male. The pCR rate was significantly higher in arm A (8 [38%]) than arm B (3 [14%]; difference, 23.8%; 90% CI, 1.3-44.7). Age younger than 65 years, male sex, and intestinal Lauren classification were significantly associated with a better pCR rate in arm A. Median event-free survival, disease-free survival, and overall survival were not reached. Based on the same way of interpretation, major pathologic response should be statistically significantly different between the 2 arms, while other outcome measures remained not significantly different. The incidence of treatment-emergent adverse events was 100% (21 of 21) and 100% (21 of 21) in arms A and B, respectively; grade 3 or higher TEAEs, 57% (12 of 21) and 67% (14 of 21), respectively; and serious TEAEs, 29% (6 of 21) and 10% (2 of 21), respectively.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, add-on atezolizumab to trastuzumab plus XELOX therapy demonstrated promising efficacy in this patient population, and no new safety concerns were raised.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04661150.

PMID:40244574 | DOI:10.1001/jamaoncol.2025.0522

Int J Gynaecol Obstet. 2025 Apr 17. doi: 10.1002/ijgo.70168. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the ovarian reserve and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes after various laparoscopic approaches in infertile patients with endometriomas and suspected compromised ovarian reserve, and the operated and non-operated/healthy ovaries were also compared, aiming to determine the most appropriate laparoscopic approach for each patient.

METHODS: A total of 132 infertile patients with endometriomas and suspected compromised ovarian reserve (anti-Müllerian hormone [AMH] <2.0 ng/mL or antral follicle count [AFC] <8) were treated by various laparoscopic approaches at the Sir Run Run Shaw Hospital from January 2021 to December 2023, followed by IVF/ICSI. Patients were divided into three groups-group A (n = 33) received anhydrous alcohol instillation, group B (n = 65) underwent fenestration/coagulation, and group C (n = 34) underwent ovarian cystectomy. The clinical characteristics, ovarian reserve, and IVF/ICSI outcomes were evaluated among the three groups. The operated side and non-operated/healthy side in patients undergoing initial surgery were also compared.

RESULTS: The proportion of bilateral endometriomas was higher in group A (63.6%, 21/33) than in group B (40.0%, 26/65) and group C (32.4%, 11/34) (P = 0.023). There was no statistically significant difference in serum AMH in group A before and after surgery (median 1.32 [0.84-1.86 ng/mL] vs. 1.13 [0.59-1.86 ng/mL], P = 0.098). However, significant postoperative decreases were observed in groups B (median 1.30 [0.97-1.76 ng/mL] vs. 0.91 [0.50-1.23 ng/mL], P = 0.009) and C (median 1.52 [1.02-1.81 ng/mL] vs. 1.15 [0.76-1.67 ng/mL], P = 0.006). In group C, the follicle-stimulating hormone/luteinizing hormone ratio also increased postoperatively (median 1.75 [1.33-2.50] vs. 2.29 [1.84-3.61], P = 0.005), while no significant differences were seen in groups A (median 1.72 [1.56-2.80] vs. 2.89 [1.89-3.54], P = 0.096) and B (median 2.14 [1.67-2.82] vs. 2.37 [1.83-3.03], P = 0.189). The clinical pregnancy rate was significantly higher in group A than in group C (60.6%, 20/33 vs. 36.4%, 12/33; P = 0.042), but not significantly different between groups A and B (60.6%, 20/33 vs. 46.9%, 30/64; P = 0.143) or groups B and C (P = 0.220). Compared with the control group, there was a statistically significant difference in preoperative AFC in the group anhydrous ethanol instillation side (median 4.0 [2.0-5.0] vs. 2.0 [0.75-3.25], P < 0.001), the group fenestration/coagulation side (median 2.0 [0-3.0] vs. 2.0 [0.75-3.25], P < 0.001), and the group ovarian cystectomy side (median 2.0 [0-4.0] vs. 2.0 [0.75-3.25], P = 0.003), with no significant differences among the three groups themselves. Compared with the control group, significant differences were also observed between the group fenestration/coagulation side (median 2.0 [1.0-3.75] vs. 2.0 [1.0-3.0], P = 0.014) and the group ovarian cystectomy side (median 2.0 [1.0-4.0] vs. 2.0 [1.0-3.0], P = 0.040), in the 15-20 mm follicles, while no significant differences were found in the group anhydrous ethanol instillation side (median 3.0 [2.0-5.0] vs. 2.0 [1.0-3.0], P = 0.108).

CONCLUSION: This study suggests that laparoscopic anhydrous ethanol treatment prior to IVF/ICSI in infertile patients with ovarian endometrioma and suspected compromised ovarian reserve may be superior to fenestration/coagulation and ovarian cystectomy.

PMID:40244566 | DOI:10.1002/ijgo.70168

Acta Otolaryngol. 2025 Apr 17:1-6. doi: 10.1080/00016489.2025.2485435. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease with varying patterns across regions.

OBJECTIVE: This study aims to investigate the clinical and histopathological features of CRSwNP in Xizang, a high-altitude region in China.

MATERIALS AND METHODS: We retrospectively analyzed the histopathological features of CRSwNP patients from Shanghai and Xizang who underwent functional endoscopic sinus surgery (FESS) between 2017 and 2024. Polyp tissue samples were assessed, and statistical analyses compared features between the two regions in CRSwNP, eosinophilic CRSwNP (eCRSwNP), and noneosinophilic CRSwNP (neCRSwNP) patients.

RESULTS: Twenty-eight patients from Xizang and 35 from Shanghai were analyzed. All Shanghai patients were Han Chinese, and all Xizang patients were Tibetan. Compared to Shanghai, Tibetan patients had significantly lower rates of smoking and asthma. Overall inflammation levels in Xizang were lower, while eosinophil counts were lower in eCRSwNP patients. Neutrophil infiltration, mucosal ulceration, and squamous metaplasia were higher in Xizang patients, while neCRSwNP patients exhibited more neutrophil infiltration and less subepithelial edema.

CONCLUSIONS: The study revealed that Tibetan patients with CRSwNP have lower eosinophilic inflammation but higher neutrophil infiltration and squamous metaplasia compared to Shanghai patients, indicating the impact of high-altitude environments on inflammatory patterns.

PMID:40244564 | DOI:10.1080/00016489.2025.2485435

Indian J Ophthalmol. 2025 Apr 17. doi: 10.4103/IJO.IJO_962_24. Online ahead of print.

ABSTRACT

This meta-analysis evaluates optical coherence tomography angiography (OCTA) results in macular telangiectasia (MacTel) type 2, a rare retinal condition marked by vascular abnormalities. We analyzed 26 studies for OCTA findings in MacTel type 2. We examined parameters like best corrected visual acuity (BCVA), foveal avascular zone (FAZ), and superficial and deep capillary plexus densities. The pooled mean BCVA was 0.37 log of minimum angle of resolution (20/50). FAZ enlargement was observed, with a pooled mean FAZ size of 0.39 mm2. Foveal deep vascular density (FDVD) and parafoveal superficial vascular density (PSVD) were significantly reduced (P = 0.021 and P < 0.001, respectively). Parafoveal deep vascular density (PDVD) and foveal superficial vascular density (FSVD) did not decrease significantly (P = 0.067 and 0.114, respectively). MacTel type 2 has unique OCTA characteristics, including reduced FDVD, PSVD, and enlarged FAZ. However, FSVD and PDVD did not statistically decrease in patients. Future studies using more parameters are required to expand our understanding.

PMID:40244563 | DOI:10.4103/IJO.IJO_962_24

Environ Sci Pollut Res Int. 2025 Apr 17. doi: 10.1007/s11356-025-36386-4. Online ahead of print.

ABSTRACT

The recirculating aquaculture system is a modern method for managing indoor fish culture and ensuring maximum output. The focus of this research was to see how water physical and chemical characteristics influenced the productivity of tilapia in fish tanks (size: dia-3.35 m and depth-1.5 m) of constant water capacity (10,000 l) using three stocking densities such as 1200 fish/tank (89 fish per m³), 1000 fish/tank (74 fish per m³), and 800 fish/tank (59 fish per m³) in Treatments I, II, and III, respectively. Ninety fish samples were randomly obtained every 2 weeks over 4 months; they were weighed, measured, and returned to the tank. The average range of different physical-chemical parameters was within the limit, with some variations observed in certain readings. It was noted how much weight the fish gained on average and their specific growth rates (SGR) for Treatments I, II, and III at the end of the experiment. The treatments indicated statistically substantial differences ( P < 0.05 ) considering the specific growth rate, final mean weight, and weight gain. Treatment III which was the controlled group had a significantly higher SGR than the other treatments. Correlation between length, weight, specific growth rate (based on weight), and physical-chemical parameters was observed and tabulated. The regression between fish growth and physical-chemical parameters was also calculated. The results of this study consistently indicate that stocking density is a more important factor in determining the overall yield than water quality indicators in RAS.

PMID:40244553 | DOI:10.1007/s11356-025-36386-4

EJNMMI Phys. 2025 Apr 17;12(1):40. doi: 10.1186/s40658-025-00749-0.

ABSTRACT

BACKGROUND: Textural Analysis features in molecular imaging require to be robust under repeat measurement and to be independent of volume for optimum use in clinical studies. Recent EANM and SNMMI guidelines for radiomics provide advice on the potential use of phantoms to identify robust features (Hatt in EJNMMI, 2022). This study applies the suggested phantoms to use in SPECT quantification for two radionuclides, ^{99 m}Tc and ¹⁷⁷Lu.

METHODS: Acquisitions were made with a uniform phantom to test volume dependency and with a customised ‘Revolver’ phantom, based on the PET phantom described in Hatt (EJNMMI, 2022) but with local adaptations for SPECT. Each phantom was filled separately with ^{99 m}Tc and ¹⁷⁷Lu. Sixty-seven Textural Analysis features were extracted and tested for robustness and volume dependency.

RESULTS: Features showing high volume dependency or high Coefficient of Variation (indicating poor repeatability) were removed from the list of features that may be suitable for use in clinical studies. After feature reduction, there were 39 features for ^{99 m}Tc and 33 features for ¹⁷⁷Lu remaining.

CONCLUSION: The use of a uniform phantom to test volume dependency and a Revolver phantom to identify repeatable Textural Analysis features is possible for quantitative SPECT using ^{99 m}Tc or ¹⁷⁷Lu. Selection of such features is likely to be centre-dependent due to differences in camera performance as well as acquisition and reconstruction protocols.

PMID:40244535 | DOI:10.1186/s40658-025-00749-0

Eur Geriatr Med. 2025 Apr 17. doi: 10.1007/s41999-025-01208-w. Online ahead of print.

ABSTRACT

PURPOSE: Slower gait is prevalent in older adults. Multiple factors contribute to the slowness in older adults. However, whether these factors affect gait speed similarly or differently remains unknown. The primary purpose of this study was to explore the relative importance of eight modifiable factors (body mass index, leg muscle strength, power, dorsiflexion range of motion, tactile sensation, balance, fear of falling, and cognition) affecting gait speed in community-living older adults.

METHODS: Eighty-five community-living older adults (mean ± standard deviation age: 72.3 ± 5.5 years; 51 females and 34 males) were enrolled in this cross-sectional study. A motion capture system assessed their gait speed. Those eight factors that could slow gait speed in older adults were also evaluated. A multiple linear regression model and relative weight analysis were utilized to determine the relative importance of each factor in contributing to the gait speed variation.

RESULTS: All eight factors were significantly correlated with the gait speed. Together, they accounted for about 50% of the observed variation in gait speed. Six factors (body mass index, strength, power, range of motion, balance, and fear of falling) each explained a statistically significant portion of the gait speed variation. The most important factor was the leg muscle power (relative weight = 0.124), contributing 25.2% of the explained speed variation.

CONCLUSION: Leg muscle power could be a principal factor determining gait speed in older adults. Other factors also significantly influence gait speed in this population. The findings could guide prioritizing actions to improve gait speed in older individuals.

PMID:40244530 | DOI:10.1007/s41999-025-01208-w

J Endocrinol Invest. 2025 Apr 17. doi: 10.1007/s40618-025-02583-8. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to quantitatively assess the effectiveness of tamoxifen, anastrozole, and radiotherapy in preventing bicalutamide-induced breast events-specifically gynecomastia and breast pain-in patients with prostate cancer.

METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted according to PRISMA-P guidelines. A comprehensive search was performed in PubMed, Scopus, and Web of Science for English-language studies without temporal restrictions. Studies were included if they involved prostate cancer patients treated with bicalutamide receiving preventive interventions (tamoxifen, anastrozole, or radiotherapy) compared to bicalutamide alone (or bicalutamide plus placebo/sham). Data extraction focused on the incidence of gynecomastia and breast pain, and study quality was assessed using the Jadad scale. Risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models, and heterogeneity was evaluated with the I² statistic. Publication bias was explored via funnel plots and the trim-and-fill method.

RESULTS: Nine RCTs met the inclusion criteria. Tamoxifen significantly reduced the risk of breast events by 82% (RR: 0.18, 95% CI: 0.08-0.38 for gynecomastia and RR: 0.18, 95% CI: 0.07-0.43 for breast pain). Radiotherapy reduced gynecomastia risk by 52% (RR: 0.48, 95% CI: 0.38-0.59) and breast pain by 34% (RR: 0.66, 95% CI: 0.48-0.90). Anastrozole did not show significant benefit.

CONCLUSION: Tamoxifen appears to be the most effective strategy for preventing bicalutamide-induced breast events, with radiotherapy serving as a viable alternative, and anastrozole offering no benefit. Further large-scale, high-quality studies are needed to confirm these findings and refine preventive treatment recommendations.

PMID:40244528 | DOI:10.1007/s40618-025-02583-8