Category: Nevin Manimala

Ann Surg Oncol. 2025 May 26. doi: 10.1245/s10434-025-17484-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions.

PATIENTS AND METHODS: We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I² statistics.

RESULTS: In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31).

CONCLUSIONS: Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.

PMID:40415155 | DOI:10.1245/s10434-025-17484-6

CNS Drugs. 2025 May 25. doi: 10.1007/s40263-025-01193-5. Online ahead of print.

ABSTRACT

BACKGROUND: Levodopa, dopamine agonists (DA) and monoamine oxidase inhibitors (MAOI) are all approved first-line therapies for Parkinson’s disease (PD), as monotherapy or in combination. Data on their use in the early management of patients with PD in real-life are lacking. Our objective was to assess the impact of early therapeutic strategies on the development of motor and neuropsychiatric complications using a nationwide PD cohort.

METHODS: NS-PARK is a cohort of patients with PD recruited between 2011 and 2021 from 26 expert centres for PD in France. We analysed the patients with less than 5-years disease duration and no motor complications at inclusion. We used interval censoring survival models to assess the associations between therapeutic strategies (levodopa monotherapy, levodopa alternative therapies or levodopa combinations) and motor fluctuations, dyskinesia, impulse control and related behaviours (ICRBs), apathy, psychosis/hallucination and daytime sleepiness. Analyses were adjusted for sex, age, disease duration, dopaminergic dose and disease severity.

RESULTS: We included 1722 patients (38.4% female, median age 67.7 years). At inclusion, 41% received levodopa monotherapy, 31% received levodopa alternative therapies and 28% received levodopa combinations. Compared with levodopa monotherapy, levodopa alternative therapies were associated with a lower dyskinesia risk (hazard ratio (HR) 0.48, 95% confidence interval (CI)[0.28-0.84]), but there was no significant difference in motor fluctuations. Both levodopa alternative and combinations therapies increased ICRBs risk (HR 4.06, 95% CI [2.48-6.67]; HR 5.16, 95% CI [3.00-8.86]) and decreased apathy risk (HR 0.36, 95% CI [0.26-0.49]; HR 0.52, 95% CI [0.39-0.69]). No association was found with psychosis/hallucination or daytime sleepiness.

CONCLUSIONS: In this real-life cohort, our data supported an association between levodopa alternative therapies and a lower risk of dyskinesia and apathy, but a higher risk of ICRBs compared with levodopa monotherapy.

GOV IDENTIFIER: NCT04888364. Registered June 2021.

PMID:40415148 | DOI:10.1007/s40263-025-01193-5

Clin Rheumatol. 2025 May 26. doi: 10.1007/s10067-025-07496-8. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic sclerosis (SSc), is an autoimmune disease that affects multiple organs. Although physician’s Global Assessment (PGA) has been proved to be a useful tool in assessing the risk of outcomes in SSc patients, reliable grading criteria for SSc remain lacking. Early cardiac involvement particularly remains a diagnostic challenge.

OBJECTIVES: This study aims to assess the differences of clinical and cardiac magnetic resonance (CMR) in SSc patients with different duration and states, as indicated by PGA, identifying risk factors indicating potential cardiac involvement.

METHODS: SSc patients aged 18-70 years old without cardiac symptoms were recruited and underwent CMR at 3.0 T. PGA score was used to grade the SSc disease state: mild, the PGA score ranged from 0 to 1; and moderate/severe, the PGA score ranged from 1 to 3. The relationship between PGA and myocardial T1 values was analyzed using Spearman correlation coefficient. The inter-rater agreement in assessing PGA and the agreement between PGA and European Systemic sclerosis study group activity index (EScSG-AI) were evaluated using Kappa analysis. Linear regression analyses were conducted to evaluate the association between PGA and myocardial native T1 values.

RESULTS: Weak correlation was found between myocardial native T1 values and PGA score (r = 0.379, P = 0.002), particularly in SSc patients in moderate/severe disease state (r = 0.336, P = 0.008). Univariate linear regression analysis revealed that PGA was significantly associated with myocardial native T1 value (β, 15.316; 95%CI, 29.699-90.971; P < 0.001). Multivariate regression analysis showed that the association between PGA and myocardial native T1 value remained statistically significant after adjusting age and sex (model 1: β, 14.788; 95% CI, 35.257-94.461; P < 0.001), age, sex and myositis (model 2: β, 61.110; 95% CI, 32.177-90.043; P < 0.001), and age, sex, myositis, disease duration (model 3: β, 63.895; 95% CI 33.281-94.519; P < 0.001).

CONCLUSION: PGA was associated with myocardial native T1 values in asymptomatic SSc patients, suggesting that PGA might be a useful tool to evaluate subclinical myocardial involvement of SSc. Key Points • The Physician’s Global Assessment (PGA) may offer a low-cost, non-invasive method for identifying subclinical myocardial involvement in SSc patients, potentially enhancing screening and disease management. • These findings provide a basis for further longitudinal studies with larger cohorts to validate the role of PGA in predicting cardiac outcomes in SSc.

PMID:40415132 | DOI:10.1007/s10067-025-07496-8

J Community Health. 2025 May 26. doi: 10.1007/s10900-025-01478-2. Online ahead of print.

ABSTRACT

Occupational medicine and safety are now very well-established specialties world-wide. They bring together the essentials of clinical medicine and public health. However, the adoption of the principles of occupational medicine and safety was a long process in which both indifference and opposition had to be overcome. A leading pioneer in these fields, P.J. Imperato, MD, launched remarkable initiatives in the workplace some seventy years ago. He did so in the fields of heavy and marine construction. He first entered the field of occupational medicine in the late 1930’s when he served as the physician for the Sullivan Drydock and Repair Corporation, a ship yard in Brooklyn, New York. Some ten years later he was appointed Director of the Medical and Safety Department of the Merritt-Chapman and Scott Corporation (MC&S). His comprehensive initiatives led to measurable positive outcomes through a process of formative assessment. These assessments focused on injuries and deaths. As a result of the initiatives he implemented in a high-risk heavy construction industry, injuries and deaths statistically declined leading to savings in workers’ compensation and liability insurance payments. Imperato achieved all of this in the context of the high-risk construction of bridges, dams, tunnels, and housing developments by one of the leading construction companies in the United States.

PMID:40415125 | DOI:10.1007/s10900-025-01478-2

Neurosurg Rev. 2025 May 26;48(1):442. doi: 10.1007/s10143-025-03593-z.

ABSTRACT

The treatment of diffuse brainstem tumors is prescribed in most cases without morphological or molecular genetic verification. “Liquid biopsy” is a minimally invasive technique that provides information about the biology of tumors without a standard biopsy. We set out to determine the informativeness of this diagnostic method for detecting H3K27 and BRAF V600E mutations in patients with diffuse brainstem tumors. Thirty patients (10 children, 20 adults) with radiologically verified brainstem tumors underwent CSF collection via lumbar puncture. Cell-free DNA (cfDNA) isolated from the CSF was used for detection of H3F3A K28M and BRAF V600E mutations via digital droplet PCR. In 23 patients, the study of these mutations was performed in parallel in the pool of cfDNA and DNA isolated from tumor tissue obtained during a standard tumor biopsy. A mutation in the BRAF gene was not detected in any patient. The H3F3A K28M mutation was detected in 7 samples of cfDNA and 8 samples of DNA isolated from tumor tissue obtained from 23 patients for whom the study was performed in parallel. The sensitivity and specificity of H3F3A K28M mutation detection in CSF and tumor tissue were 87.5% and 100%, respectively (P < 0.001, relative risk = 0.063, 95% CI: 0.009-0.417). Minimally invasive diagnosis of diffuse brainstem tumors via the “liquid biopsy” method is informative for the detection of specific H3F3A K28M mutations and allows the verification of the diagnosis of diffuse midline glioma with H3K27 (H3K28M) alterations without a standard biopsy. Despite the promising results, an important limitation of the work is the small sample size, which affects the statistical results and conclusions. Large multicenter studies are needed to further investigate the value of liquid biopsy in brainstem gliomas.

PMID:40415124 | DOI:10.1007/s10143-025-03593-z

Sci Rep. 2025 May 25;15(1):18206. doi: 10.1038/s41598-025-03511-9.

ABSTRACT

Endometriosis is a common gynecological disorder that is associated with chronic pelvic pain, infertility, and metabolic complications. Sarcopenia, characterized by progressive skeletal muscle loss, predominantly affects older adults. This study explored the incidence and risk factors for sarcopenia in endometriosis patients using the NHANES dataset, which included 373 participants. Endometriosis was confirmed through self-report questionnaire, and sarcopenia was diagnosed via dual-energy X-ray absorptiometry. Covariates encompassed age, race, marital status, education attainment, poverty income ratio, smoking habits, and comorbidities. Statistical analyses were conducted using SPSS version 26.0, incorporating four multivariate regression models. The average age was 40.3 and 40.0 years in endometriotic participants with and without sarcopenia, respectively. Minority ethnicity had higher odds for sarcopenia (OR 6.00, 95% CI 1.24-29.07). A disease duration of endometriosis less than five years was associated with higher sarcopenia risk (OR 4.83, 95% CI 2.57-9.09). Conversely, lower educational levels were linked to a reduced chance of developing sarcopenia (OR 0.42, 95% CI 0.21-0.86). These findings were consistent across all regression models, indicating that ethnic minority status, higher educational attainment, and shorter disease duration are significant risk factors for concurrent sarcopenia in endometriosis patients.

PMID:40415119 | DOI:10.1038/s41598-025-03511-9

Sci Rep. 2025 May 25;15(1):18261. doi: 10.1038/s41598-025-99042-4.

ABSTRACT

In computational pathology, extracting and representing spatial features from gigapixel whole slide images (WSIs) are fundamental tasks, but due to their large size, WSIs are typically segmented into smaller tiles. A critical aspect of analyzing WSIs is how information across tiles is aggregated to predict outcomes such as patient prognosis. We introduce a model that combines a message-passing graph neural network (GNN) with a state space model (Mamba) to capture both local and global spatial relationships among the tiles in WSIs. The model’s effectiveness was demonstrated in predicting progression-free survival among patients with early-stage lung adenocarcinomas (LUAD). We compared the model with other state-of-the-art methods for tile-level information aggregation in WSIs, including statistics-based, multiple instance learning (MIL)-based, GNN-based, and GNN-transformer-based aggregation. Our model achieved the highest c-index (0.70) and has the largest number of parameters among comparison models yet maintained a short inference time. Additional experiments showed the impact of different types of node features and different tile sampling strategies on model performance. Code: https://github.com/rina-ding/gat-mamba .

PMID:40415116 | DOI:10.1038/s41598-025-99042-4

Sci Rep. 2025 May 26;15(1):18284. doi: 10.1038/s41598-025-94067-1.

ABSTRACT

Cervical cancer is the second most common cancer among females in Cameroon, with human papillomavirus (HPV) being the primary cause. While HPV vaccines are highly effective and have been introduced by Cameroon’s Ministry of Health (MOH), uncertainties persist regarding the determinants of HPV-related vaccine hesitancy. This study investigated the factors associated with parental HPV and cervical cancer awareness as well as parental HPV vaccine hesitancy in Cameroon. This cross-sectional study included 1,187 participants residing in Buea Health District (BHD) from August 2023 to March 2024. A pretested questionnaire adapted from the WHO’s vaccine hesitancy tool was used for data collection. Multivariable logistic regression generated adjusted odds ratios for lack of awareness and vaccine hesitancy. Younger ages and lower education levels were significantly associated with greater odds of HPV and cervical cancer unawareness. Parents with lower educational attainment and those unaware of HPV and cervical cancer had higher odds of vaccine hesitancy. Additionally, concerns about vaccine safety and side effects, distrust in the MOH and pharmaceutical companies, and lack of support from religious leaders were associated with parental vaccine hesitancy. In contrast, parents with a history of chronic illness had lower odds of being hesitant. The study identified several factors associated with parental HPV vaccine hesitancy. Addressing these factors could play a key role in improving vaccine uptake among children and eventually reducing cervical cancer rates in Cameroon.

PMID:40415103 | DOI:10.1038/s41598-025-94067-1

Sci Rep. 2025 May 25;15(1):18200. doi: 10.1038/s41598-025-03434-5.

ABSTRACT

This study aimed to assess the clinical management of warfarin therapy in Western China by investigating: the rate of international normalized ratio (INR) target achievement and its influencing factors, and the incidence and risk factors for hemorrhagic complications. The primary goal was to identify high-risk patient populations requiring intensified monitoring in this resource-limited region with distinct demographic challenges including multi-ethnic populations and limited healthcare access. We conducted a retrospective cohort analysis of 154 consecutive inpatients prescribed warfarin at a tertiary care center in Western China. Data were systematically collected from: baseline demographics, detailed medication histories, INR monitoring results, and documentation of bleeding events. Statistical analysis employed Pearson chi-square tests to evaluate associations between clinical variables and primary outcomes: achievement of target INR ranges (2.0-3.0 for most indications; 1.8-2.5 for mechanical valves) and development of hemorrhagic complications. Secondary analysis examined factors influencing bleeding severity. The study revealed several critical findings regarding INR control: the overall therapeutic achievement rate was 32.3% for the 2.0-3.0 range (n = 130) and 50.0% for the 1.8-2.5 range (n = 24). Notably, we observed universal therapeutic failure (0% achievement) in three high-risk subgroups: octogenarians (≥ 81 years), underweight patients (BMI < 18.5 kg/m²), and amiodarone users. In contrast, structured physician education demonstrated substantial benefit (72.13% achievement rate vs 27.87% without instruction). Regarding safety outcomes, Bleeding complications were strongly associated with heart failure (16.07% vs 83.93% without), pulmonary infections (20.72% vs 79.28% without), and PPI use (42.86% vs 57.14%). A striking disparity emerged in bleeding severity: cardiothoracic surgery patients experienced minor bleeding at markedly higher rates (66.7%) compared to other departments (≤ 6.7%). This study identifies three high-risk populations in Western China requiring prioritized monitoring: vulnerable patients (advanced age, low BMI), individuals with cardiopulmonary comorbidities, and those prescribed interacting medications (amiodarone, PPIs). These findings have important clinical implications, particularly for resource-limited settings, we propose: implementation of Structured Medication Education Programs, intensive medication monitoring for high-risk patients, development of specialty-specific monitoring protocols in cardiothoracic departments, and establishment of multidisciplinary anticoagulation management teams. These findings underscore the need for context-specific strategies to optimize warfarin therapy in ethnically diverse, under-resourced regions, while highlighting critical areas for future research.

PMID:40415097 | DOI:10.1038/s41598-025-03434-5

Sci Rep. 2025 May 26;15(1):18287. doi: 10.1038/s41598-025-03106-4.

ABSTRACT

To establish and compare the prediction effect of SES and SARIMA model, and select the best prediction model to predict the number of patients in neurology department. The data came from HIS and medical record management system of a Grade-A hospital in Zhejiang Province. The number of inpatients from January 2019 to September 2023 was selected to establish SES and SARIMA model, respectively. Compare the fitting parameters, The larger the R²_adjusted, R², the smaller the RMSE, MAPE, MAE and standardized BIC, The better model is selected. Finally, the established model was used to predict the number of hospital admissions from October to December 2023, and the prediction effect of the MRE judgment model was compared. The number of admissions to the department of neurology shows a cyclical change, and drops sharply in January-February each year and rises rapidly in March. The best fitting models of SES model and SARIMA model were Winters addition model and SARIMA(0,1,1)(0,1,1)₁₂ model, respectively. The two models were selected to predict the number of admissions in the Department of neurology from October to December 2023, and the average relative error was 0.04 and 0.03, respectively. The prediction effect of SARIMA(0,1,1)(0,1,1)₁₂ model was better. Age and Spring Festival may be the factors that affect the periodic change of the number of admissions in neurology department. Both SES and SARIMA model can be used to predict the number of admissions in the department of neurology, and the SARIMA model may be better.

PMID:40415093 | DOI:10.1038/s41598-025-03106-4