Category: Nevin Manimala

J Surg Res. 2025 Dec 16;317:355-364. doi: 10.1016/j.jss.2025.11.058. Online ahead of print.

ABSTRACT

INTRODUCTION: Firearm-related injuries have become the leading cause of death for US children. Although a “volume-outcome” relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.

METHODS: Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.

RESULTS: Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, P < 0.001) and longer ventilator duration (3.22 d in q1 versus 4.90 d in q4, P < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, P = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, P = 0.016).

CONCLUSIONS: This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.

PMID:41406543 | DOI:10.1016/j.jss.2025.11.058

Eur J Surg Oncol. 2025 Dec 12;52(2):111354. doi: 10.1016/j.ejso.2025.111354. Online ahead of print.

ABSTRACT

INTRODUCTION: Oesophageal resection carries significant morbidity and mortality. Artificial intelligence (AI) advances in medical research enable enhanced predictions, flexibility, and interpretability, especially for complex interactions and nonlinear relationships.

MATERIAL AND METHODS: We used a register-based case-control design nested within prospectively collected data from the Swedish National Quality Register for Oesophageal and Gastric Cancer (NREV) to perform traditional logistic regression (LR) and machine learning (ML) with explainable AI (XAI) to predict 90-day mortality and anastomotic leakage in 1846 patients who underwent oesophageal resection between November 2005 and February 2018.

RESULTS: The 90-day mortality was 6.0 % and anastomotic leakage was 12.4 %. XAI models yielded an area under the curve (AUC) of 0.95 for 90-day mortality, compared to 0.88 for LR. For anastomotic leakage, the AUC was 0.84 with XAI versus 0.74 with LR. LR identified significant odds ratios for 90-day mortality associated with age, ASA 2-3, BMI, and anastomotic leakage. ML models identified the same variables plus year of surgery as significant. For anastomotic leakage, LR was significant only for ASA 3, whereas ML found all examined variables to be significant predictors. XAI showed age and perioperative bleeding as important survival factors, while high BMI and age were significant risk factors for anastomotic leakage. All factors demonstrated nonlinear associations. XAI also visualises individual risk assessments for each procedure.

CONCLUSIONS: By applying XAI, we advance surgical understanding of anastomotic leakage and mortality after oesophagectomy. Our data contain significant nonlinear relationships that cannot be visualised LR. With XAI, we extract personalised risk assessments, bringing oesophageal surgery closer to personalised medicine.

PMID:41406537 | DOI:10.1016/j.ejso.2025.111354

Rev Invest Clin. 2025 Dec 16;77(6):100030. doi: 10.1016/j.ric.2025.100030. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy and safety of thrombolytics within the first 4.5h of ischemic stroke symptom onset are well documented; however, evidence beyond this timeframe remains contentious.

OBJECTIVE: To assess the efficacy and safety of delayed thrombolysis (4.5-24-h window) for ischemic stroke.

METHODS: We conducted a systematic search to identify studies comparing thrombolytics to placebo or standard care in ischemic stroke patients treated within 4.5-24h of symptom onset. The primary outcome was functional independence at 90 days, with additional efficacy outcomes exploring recanalization and reperfusion at 24h, as well as safety outcomes of 90-day mortality and symptomatic intracranial hemorrhage. The statistical analysis was performed using R studio.

RESULTS: We included five randomized controlled trials with 1398 patients. The mean age was 70.2 years, 61% were male, and the median NIHSS score was 10.2. Compared with controls, thrombolysis improved functional independence at 90 days (OR 1.32; 95% CI: 1.06-1.63; p=0.01; I²=0%), although it increased the risk of symptomatic intracranial hemorrhage (OR 2.5; 95% CI: 1.10-5.71; p=0.02; I²=0%). No significant difference in mortality at 90 days was observed (OR 1.15; 95% CI: 0.84-1.57; p=0.39; I²=0%).

CONCLUSIONS: In ischemic stroke, thrombolytics administered within 4.5-24h improve functional independence at 90 days, also increasing the risk of symptomatic intracranial hemorrhage. At this point, careful and individualized patient selection, including advanced imaging, is mandatory for thrombolysis beyond the conventional 4.5-h treatment window.

PMID:41406536 | DOI:10.1016/j.ric.2025.100030

J Hazard Mater. 2025 Dec 14;501:140832. doi: 10.1016/j.jhazmat.2025.140832. Online ahead of print.

ABSTRACT

The environmental behavior of uranium (U) in soils is predominantly governed by its speciation, which is mediated by soil properties and environmental conditions. Soil water content is a critical driver of soil properties, but the specific mechanisms underlying its impacts on U speciation and stability remain poorly understood. Here, we investigated the mechanisms controlling U fraction and stability in U-contaminated soils under different water content conditions, by employing soil incubation experiments, chemical extraction, stirred-flow experiments, kinetic modeling, and statistical analyses. Results revealed that, relative to soils with a lower water content (e.g., 28 %), those with a higher water content (e.g., 58 %) significantly enhanced U stability, due to the prevalent reducing microenvironments (e.g., low redox potential). Such reducing conditions promoted the transformation of Fe/Mn oxide-U to organic matter-U during the microbial reductive dissolution of Fe minerals (e.g., hematite), and favored U(VI) reduction by Fe(III)-reducing bacteria (e.g., Pseudomonas and Anaeromyxobacter). Furthermore, dry-wet cycle process suppressed U release into soil solution by facilitating the formation of more stable U species (e.g., organic matter-U and residual U), a transformation mediated by Fe(III) reduction under wet conditions and Fe(II) oxidation/Fe mineral precipitation under dry conditions. Statistical analyses identified reactive Fe minerals and soil DOM as the two most critical drivers of U fraction. Additionally, the exchangeable U fraction was the most labile component governing release kinetics, while organic matter-U and carbonate-U fractions dominated U stabilization. Our results provide insights into the migration and transformation behavior of U in contaminated soils surrounding U tailings ponds.

PMID:41406526 | DOI:10.1016/j.jhazmat.2025.140832

Mar Pollut Bull. 2025 Dec 16;224:119005. doi: 10.1016/j.marpolbul.2025.119005. Online ahead of print.

ABSTRACT

Understanding the mechanisms that regulate carbon accumulation in mangrove ecosystems remains critical for supporting coastal climate-mitigation strategies. In this study, we integrate high-resolution airborne LiDAR data, sediment geochemistry, and hydrodynamic modeling to quantify the multi-scale controls on biomass and sediment carbon stabilization across 14 representative mangrove stands in subtropical and tropical China. Unlike previous regional assessments that emphasize latitudinal patterns, our approach focuses on how forest structural complexity, root-zone redox conditions, and hydrological connectivity shape long-term carbon storage. We found that stands characterized by dense prop-root networks and high canopy heterogeneity stored up to 47 % more sediment carbon than structurally simple forests. Sediment profiles revealed that prolonged anoxic conditions enhanced organic matter preservation, whereas periodic oxygenation events caused by storm-driven tidal surges accelerated carbon mineralization. Hydrodynamic simulations indicated that limited water exchange-not tidal amplitude alone-was the strongest predictor of belowground carbon retention. Metal pollutants and suspended solids played only secondary roles and mainly affected carbon stabilization in areas with restricted flushing. Nitrogen availability influenced productivity non-linearly: moderate ammonium enrichment enhanced growth, but high concentrations suppressed both net primary production and root respiration. Our findings highlight the importance of forest structure, micro-scale sediment chemistry, and hydrological isolation in governing China’s mangrove carbon balance, providing a new framework for restoration programs targeting long-term carbon sequestration rather than biomass recovery alone.

PMID:41406510 | DOI:10.1016/j.marpolbul.2025.119005

EBioMedicine. 2025 Dec 16;123:106075. doi: 10.1016/j.ebiom.2025.106075. Online ahead of print.

NO ABSTRACT

PMID:41406507 | DOI:10.1016/j.ebiom.2025.106075

EBioMedicine. 2025 Dec 16;123:106081. doi: 10.1016/j.ebiom.2025.106081. Online ahead of print.

ABSTRACT

BACKGROUND: Treatment decisions in patients with unresectable colorectal liver metastases (CRLM) are largely guided by radiological response to induction systemic therapy. However, radiological assessment alone provides an imprecise estimate of underlying tumour biology or treatment response. Circulating tumour DNA (ctDNA) is an emerging biomarker that can support clinical decision-making. This study evaluated the independent prognostic value of radiological tumour burden and DELFI-TF, a tumour tissue- and mutation-independent cell-free DNA (cfDNA) fragmentome-based ctDNA assay.

METHODS: We analysed 202 plasma samples and CT scans collected at baseline and following induction systemic therapy from 101 patients with unresectable, liver-limited CRC enrolled in the phase-III CAIRO5 trial (NCT02162563), treated with FOLFOX/FOLFIRI plus bevacizumab. Total tumour volume (TTV) was centrally quantified via semi-automated segmentation of liver metastases. ctDNA was measured using the DELFI-TF score. Associations with overall survival (OS) and early recurrence were evaluated using multivariable Cox regression models.

FINDINGS: At baseline, TTV (median = 139 mL, IQR = 23-497 mL) strongly correlated with DELFI-TF (median = 0.29, IQR = 0.13-0.41; Spearman’s ρ = 0.70). DELFI-TF showed a more pronounced reduction than TTV on-treatment (-97.6% vs -49.9%). Baseline levels and on-treatment changes of DELFI-TF (P = 0.001; P = 0.012) and TTV (P = 0.002; P = 0.002) were independently associated with OS in the multivariable model; their combination improved prognostic performance (Uno’s C-statistic 0.78 vs 0.73; P = 0.036). Baseline (P = 0.016) and on-treatment DELFI-TF (P = 0.001) also predicted early recurrence after local therapy.

INTERPRETATION: Following further validation, integrating cfDNA fragmentome-based testing with radiological tumour volume may provide complementary and clinically meaningful insights for prognostication and treatment response in patients with unresectable CRLM. This exploratory study supports a multimodal biomarker approach to guide personalised treatment strategies.

FUNDING: German Research Foundation (DFG, 513004649), Heidelberg Medical Faculty, Dutch Cancer Society/KWF Kankerbestrijding (10438), PPP Allowance via Health ∼ Holland (LSHM22027), Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, Stand Up To Cancer (SU2C)in-Time Lung Cancer Interception Dream Team Grant, SU2C-Dutch Cancer Society International Translational Cancer Research Dream Team Grant (SU2C-AACR-DT1415), Gray Foundation, Commonwealth Foundation, Cole Foundation, Delfi Diagnostics (research grant), US National Institutes of Health (CA121113, CA233259, CA271896).

PMID:41406506 | DOI:10.1016/j.ebiom.2025.106081

Physiol Res. 2025 Dec 15;74(6):981-987.

ABSTRACT

This study aimed to evaluate the predictive value of serum 25 hydroxyvitamin D (25(OH) D) levels in relation to the onset and glycemic control of gestational diabetes mellitus (GDM). This retrospective study analyzed clinical data of pregnant women who received routine prenatal care and were hospitalized at the Second People’s Hospital of Hefei between January 2023 and January 2025. The study included 200 pregnant women diagnosed with GDM (study group) and 200 gestational age-matched pregnant women with normoglycemia (control group), selected through random sampling. Within the study group, 146 participants exhibited standard glycemic control (Y1 group), while 54 participants exhibited non-standard glycemic control (Y2 group) during hospitalization in the third trimester. Significant differences in serum 25(OH)D levels were observed between the control and study groups across all trimesters (53.82 ± 9.43), (56.73 ± 11.28), (49.65 ± 10.65) nmol/L, and (45.87 ± 8.45), (44.42 ± 10.04), (46.63 ± 9.87) nmol/L (p < 0.05). In the second trimester, serum 25(OH)D levels were negatively correlated with the oral glucose tolerance test (OGTT) values in the study group (p < 0.05). Comparison of the 25(OH)D levels in the third trimester between the Y1 group (48.95 ± 9.46) and the Y2 group (42.75 ± 10.23) nmol/L indicated that there was no significant statistical difference between the study group and the control group (49.65 ± 10.65 nmol/L) (p > 0.05). A receiver operating characteristic curve for first trimester 25(OH)D levels of pregnant women in the study group yielded an area under the curve of 0.84. Lower serum 25(OH)D levels were associated with an elevated risk of developing GDM and with poorer glycemic control in affected women. These findings indicate that first trimester serum 25(OH)D levels may serve as a valuable biomarker for the early prediction and management of GDM. Keywords Blood glucose ” Correlation ” Gestational diabetes mellitus ” Pregnant women ” 25-hydroxyvitamin D.

PMID:41406483

JMIR Mhealth Uhealth. 2025 Dec 17;13:e69795. doi: 10.2196/69795.

ABSTRACT

BACKGROUND: Effective follow-up and management after organ transplantation are crucial for transplant recipients. Mobile health (mHealth) interventions have emerged as a significant approach for facilitating follow-up and management. However, there is a lack of systematic reviews and meta-analyses of their effectiveness.

OBJECTIVE: This study aimed to systematically review and synthesize evidence regarding the effectiveness of mHealth interventions in enhancing follow-up and management for transplant recipients.

METHODS: This study included both randomized controlled trials (RCTs) and nonrandomized studies of interventions (NRSIs) that compared the effects of mHealth interventions with usual care in transplant recipients by searching PubMed, Web of Science, Scopus, Embase, CINAHL, and CENTRAL from database inception to June 2025. The primary outcomes included self-care ability, medical regimen adherence, self-monitoring, communication and counseling, medication adherence, physical activity, nutrition, all-cause mortality, complications, rehospitalization, and emergency and outpatient department visits. The risk of bias for each study was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk of Bias in Nonrandomized Studies of Interventions tool for NRSIs. Data extraction and quality assessment were conducted by 2 reviewers independently. Data synthesis was conducted using Review Manager. Both a meta-analysis and a narrative synthesis were carried out.

RESULTS: A total of 23 studies (n=15, 65% RCTs and n=8, 35% NRSIs) with 2022 transplant recipients were included. Compared to the control group, mHealth interventions significantly improved self-care ability (mean difference 14.49, 95% CI 9.61-19.36; P<.001) and reduced rehospitalization (odds ratio [OR] 0.49, 95% CI 0.34-0.71; P<.001). The meta-analysis demonstrated no statistically significant difference in mortality rates (OR 0.73, 95% CI 0.39-1.35; P=.31), rejection (OR 0.55, 95% CI 0.25-1.19; P=.13), or infection (OR 0.33, 95% CI 0.06-1.82; P=.20) between the mHealth intervention and control groups. The narrative synthesis indicated that mHealth interventions could effectively promote adherence to medical regimens and medications, facilitate self-monitoring, and improve communication and consultation.

CONCLUSIONS: mHealth interventions significantly improved self-care ability and reduced rehospitalization rates among organ transplant recipients. However, these interventions did not demonstrate a significant effect on all-cause mortality or complications. mHealth interventions showed potential benefits for various self-management behaviors in organ transplant recipients, but these findings need to be further verified. Future research should prioritize high-quality studies that investigate the impact of mHealth on physical activity, nutrition, and other patient-centered outcomes.

TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-Analysis Protocols INPLASY202480101; https://inplasy.com/inplasy-2024-8-0101/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.37766/inplasy2024.8.0101.

PMID:41406471 | DOI:10.2196/69795

JMIR Form Res. 2025 Dec 17;9:e84251. doi: 10.2196/84251.

ABSTRACT

BACKGROUND: Assessment of medical information provided by artificial intelligence (AI) chatbots like ChatGPT and Google’s Gemini and comparison with international guidelines is a burgeoning area of research. These AI models are increasingly being considered for their potential to support clinical decision-making and patient education. However, their accuracy and reliability in delivering medical information that aligns with established guidelines remain under scrutiny.

OBJECTIVE: This study aims to assess the accuracy of medical information generated by ChatGPT and Gemini and its alignment with international guidelines for sepsis management.

METHODS: ChatGPT and Gemini were asked 18 questions about the Surviving Sepsis Campaign guidelines, and the responses were evaluated by 7 independent intensive care physicians. The responses generated were scored as follows: 3=correct, complete, and accurate; 2=correct but incomplete or inaccurate; and 1=incorrect. This scoring system was chosen to provide a clear and straightforward assessment of the accuracy and completeness of the responses. The Fleiss κ test was used to assess the agreement between evaluators, and the Mann-Whitney U test was used to test for the significance of differences between the correct responses generated by ChatGPT and Gemini.

RESULTS: ChatGPT provided 5 (28%) perfect responses, 12 (67%) nearly perfect responses, and 1 (5%) low-quality response, with substantial agreement among the evaluators (Fleiss κ=0.656). Gemini, on the other hand, provided 3 (17%) perfect responses, 14 (78%) nearly perfect responses, and 1 (5%) low-quality response, with moderate agreement among the evaluators (Fleiss κ=0.582). The Mann-Whitney U test revealed no statistically significant difference between the two platforms (P=.48).

CONCLUSIONS: ChatGPT and Gemini both demonstrated potential for generating medical information. Despite their current limitations, both showed promise as complementary tools in patient education and clinical decision-making. The medical information generated by ChatGPT and Gemini still needs ongoing evaluation regarding its accuracy and alignment with international guidelines in different medical domains, particularly in the sepsis field.

PMID:41406470 | DOI:10.2196/84251