Category: Nevin Manimala

Isr J Health Policy Res. 2025 Dec 15;14(1):77. doi: 10.1186/s13584-025-00733-0.

ABSTRACT

Globally, 46.2% of all adults report having gambled in the previous 12 months. While most experience no negative repercussions from gambling, individuals who are highly engaged in gambling are at greater risk of problem gambling (PG). Studies point to the psycho-social, environmental, and socio-demographic risk factors associated with gambling and PG, and the associated harm to individuals, families, and society, making it a public health concern worldwide. Israel has a relatively regulated conservative gambling market where casinos and electronic gambling machines are banned, and online gambling is only permitted for sports betting. Nevertheless, Israel has a relatively high percentage of PG. This study was designed to characterize involvement in gambling behavior during the previous year in non-gamblers, low-frequency, and high-frequency gamblers as a function of socio-demographic, health, and psycho-social risk and protective factors, and differentiate between problem and non-problem high-frequency gamblers. A representative sample of 3224 Israeli Jews and Arabs filled in an online questionnaire in 2022. The findings showed that 50.7% were non-gamblers, 33.8% were low-frequency gamblers, and 15.5% were high-frequency gamblers. Compared to non-gamblers, low-frequency and high-frequency gamblers were associated with Jewish ethnicity, low levels of financial self-efficacy and neighborhood cohesion, a greater likelihood to smoke and drink, and having a significant other (family/social network member) with perceived excessive gambling. Male gender and traditional self-perceived religiosity were associated with both low-frequency and high-frequency gamblers as well, but to a greater extent with high-frequency than low-frequency gamblers. Online gambling, stress, low financial self-efficacy, using social welfare allowances for gambling, having a significant other who engages in perceived excessive gambling, and identifying as an Israeli Arab were all associated with PG in high-frequency gamblers. These findings suggest that despite its conservative regulated market, gambling in Israel exceeds international averages. The similarities between low-frequency and high-frequency gamblers in terms of risk factors may hint at a type of gambling normalization. Regulatory reforms informed by public health policies are recommended to decrease access to gambling, including banning online gambling and curbing special gambling offers timed to coincide with welfare payments. Awareness campaigns, culturally sensitive prevention programs are recommended, as well as studies to monitor gambling harm.

PMID:41392257 | DOI:10.1186/s13584-025-00733-0

Biomed Eng Online. 2025 Dec 14. doi: 10.1186/s12938-025-01499-x. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 may impair autonomic and cardiorespiratory function, even in mild cases, resulting in reduced heart rate variability (HRV) and diminished functional capacity. Given their shared regulatory pathways, resting HRV may serve as a non-invasive predictor of oxygen uptake (V̇O₂) during the six-minute step test (6MST).

OBJECTIVE: To investigate whether resting short-term HRV can predict V̇O₂ during the 6MST in individuals recovering from post-COVID.

METHODS: In this cross-sectional study, adults recovering from mild COVID underwent assessment of autonomic modulation via short-term HRV and cardiorespiratory response during 6MST. HRV was recorded under standardized resting conditions. Gas exchange was measured throughout the 6MST. Spearman correlation and multiple linear regression analyses were performed to test associations between HRV parameters and V̇O₂ expressed in milliliters per kilogram per minute (mL·kg^-1·min^-1).

RESULTS: Data from 45 participants were analyzed. Several HRV variables demonstrated statistically significant correlations with V̇O₂ and were therefore included in the simple linear regression analysis: SDNN (ms) (rho = 0.587), RMSSD (ms) (rho = 0.430), RR Tri (rho = 0.594), TINN (rho = 0.596), SD1 (ms) (rho = 0.431), SD2 (ms) (rho = 0.609), ApEn (rho = – 0.388), and DFA α2 (rho = – 0.404). Multiple linear regression showed that SD2 (ms) and sex were significant predictors of V̇O₂ (mL·kg^-1·min^-1) at the peak of the 6MST, while weight (kg) and age (years) were not. The model explained 50.7% of the variance (adjusted R² = 0.507, p < 0.001).

CONCLUSION: Several HRV parameters were significantly correlated with V̇O₂, indicating associations between cardiac autonomic modulation and aerobic performance. Among these, SD2 together with sex, emerged as significant predictors of VO₂ at the peak of the 6MST. Future studies will be needed to combine HRV indices with clinical outcomes in order to determine the mechanisms of V̇O₂ variability in post-COVID populations.

PMID:41392249 | DOI:10.1186/s12938-025-01499-x

BMC Pregnancy Childbirth. 2025 Dec 15. doi: 10.1186/s12884-025-08559-z. Online ahead of print.

ABSTRACT

BACKGROUND: Elevated uric acid (UA) has become a global health concern. We aimed to investigate the impact of UA in women during early pregnancy on the subsequent risk of gestational diabetes mellitus (GDM).

METHODS: Pregnant women in their first trimester were recruited from a birth cohort study conducted in Xi’an, China, between July 2018 and December 2023. A generalized linear model (GLM) was used to calculate risk ratios (RRs) and 95% confidence intervals (CIs) for the effects of UA levels.

RESULTS: Compared with the first quartile of UA, the second (RR = 1.15, 95% CI = 1.04-1.28), third (RR = 1.27, 95% CI = 1.15-1.41), and fourth (RR = 1.46, 95% CI = 1.32-1.61) quartiles were associated with an increased risk of GDM. Moreover, UA was the strongest predictor among all variables in the random forest model except for BMI. Importantly, higher UA levels were associated with an increased risk of GDM (OR = 1.39, 95% CI = 1.29-1.50) as long as BMI exceeded 18.5 kg/m². The highest GDM risk was observed in high UA/high BMI combinations.

CONCLUSIONS: This study demonstrated that higher UA levels during early pregnancy were associated with an increased risk of GDM. These findings suggest a link that warrants further investigation to determine if UA plays a causal role or is a marker of underlying pathology.

PMID:41392244 | DOI:10.1186/s12884-025-08559-z

Sports Med Open. 2025 Dec 14;11(1):159. doi: 10.1186/s40798-025-00959-x.

ABSTRACT

INTRODUCTION: World-wide, endurance races, including road races, trail races, cycling events, and triathlons, attract millions of participants each year. While these events promote health, fitness, and exercise, there exists significant risk for morbidity and mortality. The World Academy of Endurance Medicine (WAEM) created the Race Emergency Medicine Course (REMC) to train and certify race organizers and medical directors regarding planning and response for medical emergencies at endurance events. The course includes asynchronous e-learning modules, in person lectures, hands-on simulation sessions, and race-day observation.

METHODS: 599 participants from 20 courses conducted in Europe, Asia, North and South America were surveyed. A 5-point Likert scale was utilized to assess participants’ impressions regarding the format, quality and effectiveness of the course. A paired t-test was utilized to evaluate participants’ self-assessments of their confidence in managing critical siutations both before and after participating in the course. Descriptive statistics were used to evaluate responses to open-ended questions.

RESULTS: Participants rated the overall REMC 4.7 out of 5. Pre-course e-learning modules were rated 4.4 out of 5 while the lectures, hands-on sessions, and race-day observation activity scored 4.6 out of 5. Overall self-confidence in managing race-related critical situations increased from a mean score of 5.0 to 6.1 on a 7-point scale (p < 0.01). 73% of participants indicated that they plan to modify their practice based on what they learned.

CONCLUSION: The REMC is a valuable educational tool to promote medical care and safety at endurance events.

PMID:41392227 | DOI:10.1186/s40798-025-00959-x

Ann Surg Oncol. 2025 Dec 14. doi: 10.1245/s10434-025-18890-6. Online ahead of print.

ABSTRACT

BACKGROUND: The 2024 Kyoto guidelines for the management of intraductal mucinous neoplasms (IPMNs) build on previous guidelines that consider worrisome features (WF) and high-risk stigmata (HRS) to recommend surveillance or resection. These new guidelines have not yet been validated.

METHODS: Patients undergoing pancreatectomy for an IPMN at an academic medical center between 2012 and 2023 were included. IPMNs were categorized as low-grade dysplasia (LGD), high-grade dysplasia (HGD), or invasive carcinoma (IC). Preoperative imaging was used to determine HRS and WF in accordance with the 2024 Kyoto guidelines. We compared IPMNs with LGD to those with HGD or IC using univariate analyses and evaluated logistic regression models with c-statistics.

RESULTS: Of 211 patients, 84 (40%) had LGD, 49 (23%) had HGD, and 78 (37%) had IC. Among HRS, obstructive jaundice (p = 0.004), pancreatic duct ≥ 10 mm (p < 0.001), and suspicious or positive cytology (p < 0.001) were significantly associated with HGD/IC. An increasing number of HRS were associated with higher rates of HGD/IC. Among WFs, an abrupt change in the caliber of pancreatic duct with distal pancreatic atrophy (p = 0.001) and cystic growth ≥ 2.5 mm/year (p = 0.033) were significantly associated with higher rates of HGD/IC. Increasing numbers of WFs were also associated with higher rates of HGD/IC. The 2024 Kyoto model showed improved discrimination (area under the curve [AUC] = 0.849) compared with the 2017 Fukuoka model (AUC=0.780, p = 0.06).

CONCLUSION: The risk of HGD/IC in IPMNs increased in a stepwise fashion as the number of WFs increased. The 2024 guidelines represent an advancement over the 2017 guidelines, notably with the inclusion of suspicious cytology as an HRS.

PMID:41392225 | DOI:10.1245/s10434-025-18890-6

Sci Rep. 2025 Dec 14. doi: 10.1038/s41598-025-32035-5. Online ahead of print.

ABSTRACT

The rapid adoption of the Industrial Internet of Things (IIoT) model has exposed methods to inadequate security measures. False data injection attacks (FDIAs) pose a significant security threat in IIoT, as they aim to mislead industrial platforms by manipulating sensor readings. In IIoT, owing to the data attacker’s changeability, the FDIA is the most critical intrusion network. As aggressive devices permitted in the network perform their typical data-collecting tasks, identifying an FDIA becomes a nontrivial effort due to potential attacks. Conventional attack detection models have proven insufficient in addressing FDIAs, and most current countermeasures focus on the need to legalise data, primarily in the context of data clustering services. Presently, deep learning (DL) systems are employed for detecting FDIA in real-time and supply personalised protective measures to the threat. This paper presents an Intelligent Management of False Data Injection Attacks Using Feature Selection and Voting Classifier (IMFDIA-FSVC) technique in IIoT systems. The primary purpose of the IMFDIA-FSVC technique is to develop a model for detecting and mitigating FDIAs to ensure safe and trustworthy operations of IIoT systems. Initially, the data pre-processing stage involves two stages: missing value analysis and normalisation to standardise the input data for an effective study. For an effective feature selection, the IMFDIA-FSVC model utilises a statistical and information-theoretic selection (SITS) technique to select optimal features from the input data. Finally, the classification process is mainly deployed by three models: the temporal convolutional network (TCN), the deep belief network (DBN), and the autoencoder (AE). An ensemble classifier is then performed using the voting classifier. The comparison study of the IMFDIA-FSVC method showed a superior accuracy value of 99.15% compared to existing models on the IIoT and FDIA datasets.

PMID:41392216 | DOI:10.1038/s41598-025-32035-5

Cardiovasc Intervent Radiol. 2025 Dec 14. doi: 10.1007/s00270-025-04290-6. Online ahead of print.

ABSTRACT

PURPOSE: To report up to 6-month outcomes of genicular artery embolization (GAE) using polyethylene glycol microspheres vs ethiodized oil emulsion in patients with medically refractory symptomatic knee osteoarthritis (KOA).

MATERIAL AND METHODS: In this single-center retrospective study, sixty-eight patients (65 y.o, M/F (11/57)) underwent GAE from 9/2021 to 3/2025 using a permanent agent: 200-micron microspheres (HydroPearl®, n = 42), or a temporary agent: emulsion of ethiodized oil (LipioJoint, n = 46). Outcomes were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and Pain sub-score at baseline, 1, 3, and 6 months post-GAE. Adverse events (AEs) were reported by the CIRSE AE classification system. A descriptive statistical and multivariable analysis was performed.

RESULTS: Eighty-eight knees treated with KOA severity: Kellgren-Lawrence (KL) 2: 10 vs 23%, KL 3: 57 vs 33%, KL4: 33 vs 44%, respectively (permanent vs temporary, P = 0.051). Pain sub-scale score decreased by 27 vs 44%, 25 vs 37%, and 23 vs 36% at 1, 3, and 6 months, respectively. There was higher percent WOMAC pain reduction in ethiodized oil emulsion at 1 but not at 3 and 6 months (P = 0.020-0.119). Adverse events included: skin changes without ulceration (n = 14), knee swelling requiring prednisone (n = 5), and access site hematoma (n = 2). A lower AE rate was observed for total AEs and skin changes with ethiodized oil emulsion (P = 0.018).

CONCLUSION: GAE shows positive short-term outcomes up to 6 months post-treatment for KOA with temporary and permanent embolic agents. Ethiodized oil may offer a better short-term efficacy and lower risk of skin discoloration compared to polyethylene glycol microspheres.

PMID:41392215 | DOI:10.1007/s00270-025-04290-6

Cardiovasc Intervent Radiol. 2025 Dec 14. doi: 10.1007/s00270-025-04297-z. Online ahead of print.

ABSTRACT

PURPOSE: To assess the feasibility and safety of percutaneous gallbladder cryoablation combined with gallstone extraction for calculous cholecystitis and cryoablation alone for acalculous cholecystitis.

MATERIALS AND METHODS: A dual-tertiary center retrospective case series included 12 patients (median age, 66.0 years; three females and nine males) with benign gallbladder disease who underwent percutaneous gallbladder cryoablation between April 2023 and May 2025. Ten patients underwent percutaneous cholangioscopy-guided gallstone extraction prior to cryoablation, while two patients without gallstones received cryoablation alone. Descriptive statistics were collected for patient demographics, clinical presentation, procedural details, technical success, adverse events, symptom recurrence and resolution rates, and imaging findings.

RESULTS: The median follow-up was 540.5 days. Technical success was achieved in 91.7% (11/12), with one procedure aborted due to the inability to safely hydrodissect the colon from the gallbladder. All 11 patients who underwent successful cryoablation reported complete symptom resolution at 1-month and during subsequent follow-up. Follow-up imaging demonstrated progressive involution of the devitalized, nonenhancing gallbladder. No immediate procedure-related complications occurred, and all patients were discharged within 24 h. One patient developed a minor procedure-related adverse event on post-procedure day 4 (self-limited scrotal edema), and another experienced transient biliary obstruction 3 months later, presumably related to the choledochocele.

CONCLUSIONS: Gallbladder cryoablation, performed alone for acalculous cholecystitis or in combination with gallstone extraction for calculous cholecystitis, is technically feasible, safe, and associated with effective symptom relief.

PMID:41392213 | DOI:10.1007/s00270-025-04297-z

Cardiovasc Intervent Radiol. 2025 Dec 14. doi: 10.1007/s00270-025-04301-6. Online ahead of print.

ABSTRACT

PURPOSE: This clinical study presents a new technique in tract embolisation to prevent pneumothorax formation in lung ablation. The tandem needle technique pleural blood patch (TNT PBP) involves insertion of a needle adjacent to the ablation applicator for injection at the pleura during applicator withdrawal.

MATERIAL AND METHODS: Retrospective case series including TNT PBP embolisation procedures performed concomitantly with lung ablations within a one-year period at a tertiary institution. Patient factors, technical aspects, clinical and radiological outcomes are reviewed. Clinical success is defined as successful administration of blood patch and avoidance of need for chest drain. Descriptive and inferential statistical tests are performed.

RESULTS: 12 patients underwent ablation/TNT PBP procedures for 14 lung tumours. All patients had multiple comorbidities and were considered high risk of pneumothorax formation. TNT PBP was successfully administered to all patients. 1/12 patients required a post-procedural chest drain. All but 1 patient experienced expected post-operative clinical pathway and were discharged the next day. On latest follow-up (233.7 ± 67.8 days), no procedure-related complications were demonstrated.

CONCLUSION: TNT PBP showed promising safety and efficacy profile. Further evaluations are required, and this is currently being investigated in a randomised controlled trial (Oxford Pleural Embolisation Trial, OxPET, NCT06651658).

PMID:41392212 | DOI:10.1007/s00270-025-04301-6

Sci Rep. 2025 Dec 14. doi: 10.1038/s41598-025-31890-6. Online ahead of print.

ABSTRACT

B lymphocytes are known for their anti-tumor role in hepatocellular carcinoma (HCC), but recent studies suggest that tumor-tamed B cells can promote cancer progression in other malignancies. It remains unclear whether a similar subset exists in HCC. We analyzed single-cell RNA RNA-seq (GSE162616) to compare B lymphocytes in normal and HCC samples. Weighted correlation network analysis (WGCNA) identified tumor-associated B lymphocyte module genes. Furthermore, we utilized 101 machine learning algorithms to construct a prognostic model, which was further compared with other published prognostic models using statistical comparisons, including P-values and confidence intervals. The model was further tested for its ability to predict responses to HCC-specific immunotherapy and chemotherapy in available public datasets; non-HCC cohorts were exploratory. A distinct subset of B lymphocytes was significantly elevated in HCC, exhibiting increased IgG secretion and TGFBR1 expression. Functional validation experiments confirmed that siRNA-mediated knockdown of SOX4 and TGFBR1 significantly suppressed HCC cell proliferation, supporting their tumor-promoting roles. WGCNA identified key module genes associated with these tumor-associated B cells. The RSF + plsRcox model generated the tumor-associated B lymphocyte score (TABLS), which demonstrated superior predictive performance for overall survival (OS) and relapse-free survival (RFS) compared to other prognostic models. Patients with low TABLS were more likely to respond favorably to immunotherapy and chemotherapy. External validation was performed in publicly accessible HCC cohorts with individual-level outcomes; prospective validation in additional HCC-specific immunotherapy cohorts will further strengthen clinical relevance. TABLS is a promising prognostic biomarker for HCC, with potential clinical applications in therapy selection.

PMID:41392192 | DOI:10.1038/s41598-025-31890-6