Category: Nevin Manimala

Urol Oncol. 2025 Oct 3:S1078-1439(25)00346-1. doi: 10.1016/j.urolonc.2025.08.027. Online ahead of print.

ABSTRACT

INTRODUCTION: Consistent urologic oncology follow-up after radical cystectomy (RC) improves survival. However, there is scarce literature describing postoperative communication. We aimed to identify differences in postoperative communication patterns and healthcare utilization among English-speaking patients (ESPs) and patients with limited English proficiency (LEP) following RC.

METHODS: We conducted a single-institution, retrospective cohort study, examining patients who underwent RC for bladder cancer. We used propensity score matching to match 50 ESPs and 50 patients with LEP on age and sex. We abstracted patient demographics, postoperative communication and healthcare utilization within 90 days of surgery. We fit multivariable linear regression to investigate factors associated with postoperative communication frequency.

RESULTS: Postoperative communication was common, with 82% of patients placing ≥1 phone call/message. ESPs communicated more than patients with LEP (6.04 vs. 3.80 average calls/messages), though this difference was not statistically significant (P = 0.08). ESPs were more likely to initiate the communication themselves and have postoperative communication result in reassurance from the surgical team (P = 0.03), while patients with LEP were more likely to have a family member communicate on their behalf (P < 0.001) and have postoperative communication result in outpatient evaluation/treatment (P = 0.01). Patients with a neobladder reconstruction placed an increased number of phone calls/messages. There were no differences in postoperative healthcare utilization between the 2 groups.

CONCLUSIONS: Postoperative communication is frequent following RC. ESPs communicated nearly twice as often as patients with LEP, suggesting a clinically relevant difference in patient communication following radical cystectomy. Primary language spoken is not associated with differences in postoperative healthcare utilization.

PMID:41046200 | DOI:10.1016/j.urolonc.2025.08.027

ISA Trans. 2025 Sep 26:S0019-0578(25)00527-0. doi: 10.1016/j.isatra.2025.09.022. Online ahead of print.

ABSTRACT

In this research paper, a state estimation framework for a class of descriptor linear systems with MIMO is provided by using auxiliary modulating dynamical systems. First, the considered model is transformed into a simpler form involving the derivatives of inputs and outputs, based on which the auxiliary systems are applied. Then, the state variables are expressed through modulating integrals without the need for initial conditions, guaranteeing non-asymptotic convergence within fixed-time. This framework does not require the calculation of the derivatives of noisy outputs in discrete cases, reducing sensitivity to high-frequency noise in the estimation. Finally, the performance of the proposed method is validated through numerical simulations, which provide practical insights into its effectiveness and enable a comparison with some observers.

PMID:41046198 | DOI:10.1016/j.isatra.2025.09.022

ISA Trans. 2025 Sep 17:S0019-0578(25)00509-9. doi: 10.1016/j.isatra.2025.09.004. Online ahead of print.

ABSTRACT

The malicious attack design helps to accurately assess the vulnerability of cyber-physical systems under attacks. Based on this, an off-line generated attack model with time-varying covariance is proposed under the energy constraint, which aims to maximize the system estimation error while satisfying the ϵ-stealthiness. Subsequently, the problem is equivalently transformed by quantifying the optimization objective based on the derivation of error covariance and deriving the stealthiness condition according to the statistical properties of mutual information and Kullback-Leibler divergence. Due to the coupling relationship between the designed covariance and scheduling, the covariance is derived as a function of the attack scheduling by the Lagrange multiplier method. Then, the optimal attack scheduling is proved to be fixed according to the uniqueness of the optimal parameters. Finally, some numerical simulations are given to validate the effectiveness of results.

PMID:41046197 | DOI:10.1016/j.isatra.2025.09.004

ISA Trans. 2025 Sep 25:S0019-0578(25)00530-0. doi: 10.1016/j.isatra.2025.09.025. Online ahead of print.

ABSTRACT

In this paper, we propose a novel event-triggered (ET) distributed neurodynamic (DND) approach that integrates a distributed controller to tackle distributed time-varying optimization problems (DTOP). The approach achieves optimization of a global cost function in real time while simultaneously steering agent states toward consensus. Two key features distinguish the proposed method from prior works. First, communication among agents is governed by ET schemes, allowing updates only at specific triggering moments, which helps conserve communication energy. Second, the ET distributed controller eliminates the computation of the inverse of the Hessian matrix of the local objective function, which effectively reduces the computational cost. Finally, a case study of the battery charging problem demonstrates the effectiveness of the proposed approach.

PMID:41046194 | DOI:10.1016/j.isatra.2025.09.025

Clin Breast Cancer. 2025 Sep 4:S1526-8209(25)00251-4. doi: 10.1016/j.clbc.2025.09.001. Online ahead of print.

ABSTRACT

INTRODUCTION/BACKGROUND: Breast cancer affects over 61,000 women annually in France. While only 5-10% of breast cancers are hereditary, BRCA1/2 mutations significantly increase the lifetime risk of breast and ovarian cancer, with cumulative invasive breast cancer risks of 72% (BRCA1) and 69% (BRCA2) by age 80. Surgical management in this population is crucial, as it directly impacts quality of life (QoL). However, prospective comparative data on surgical strategies are lacking.

MATERIALS AND METHODS: This prospective study analyzed data from the CANTO cohort to assess the impact of different surgical approaches on QoL in BRCA1/2 mutation carriers diagnosed with invasive breast cancer. Four surgical options were compared: breastconserving surgery (BCS), mastectomy, immediate breast reconstruction (IBR), and delayed breast reconstruction (DBR). Patient-reported outcomes were evaluated over time, focusing on body image, future perspective, sexual functioning, and physical symptoms.

RESULTS: BCS and IBR were associated with better preservation of body image throughout follow-up. DBR significantly improved body image, future perspective, and sexual functioning beginning at the time of surgery. Breast and arm symptoms were overall moderate, but mastectomy resulted in increased arm symptoms, likely due to the higher rate of axillary lymphadenectomy.

CONCLUSION: When feasible, BCS should be preferred for BRCA1/2 mutation carriers, as it best preserves QoL. For patients requiring mastectomy, IBR is a valuable option, while DBR offers long-term benefits in body image and psychosocial well-being. Psychological support and structured postsurgical rehabilitation are strongly recommended to alleviate symptoms and optimize patient quality of life.

PMID:41046190 | DOI:10.1016/j.clbc.2025.09.001

Oral Surg Oral Med Oral Pathol Oral Radiol. 2025 Aug 27:S2212-4403(25)01195-2. doi: 10.1016/j.oooo.2025.08.016. Online ahead of print.

ABSTRACT

OBJECTIVE: Oral submucous fibrosis (OSF) is a progressive disease with an increased risk of developing oral cancer. There exists a notable scarcity of evidence on treatments that can promote tissue regeneration in OSF. Autologous platelet-rich plasma (PRP) is an emerging therapy with limited applications in OSF.

STUDY DESIGN: A prospective case-series was conducted in 10 patients with a histopathologically confirmed diagnosis of OSF. Baseline data included sociodemographic and risk habits, self-reported burning sensation to food was recorded using a visual analogue scale, and inter incisor distance at maximum mouth opening was measured in cm. Autologous PRP was infiltrated into bilateral buccal mucosa, once a month, and measurements were repeated at 6 months. Thresholds for clinically significant improvement were defined at ≥ 50% change in burning sensation, and ≥ 25% change in mouth opening. Data analysis was done using a paired sample T test and effect size (Cohen’s D).

RESULTS: Patients were aged 31 to 69 years, female to male ratio was 1:4 with mild to moderate disease severity. Clinically significant change in mouth opening was reported in 60% of patients, whereas 100% reported significant reduction in burning sensation, no side effects were reported. There were statistically significant differences (P < .05) on mouth opening and burning sensation following PRP therapy.

CONCLUSIONS: Based on this exploratory evidence, we propose intralesional PRP therapy as a safe and clinically effective treatment for mild to moderate OSF. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

PMID:41046183 | DOI:10.1016/j.oooo.2025.08.016

Eur Urol. 2025 Oct 3:S0302-2838(25)04687-1. doi: 10.1016/j.eururo.2025.09.4144. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Our aim was to evaluate the effect of addition of radical prostatectomy (RP) to best systemic therapy (BST) on cancer-specific mortality (CSM) in patients with oligometastatic prostate cancer (omPC).

METHODS: This randomised controlled trial included patients with omPC with a low metastatic burden (1-5 bone metastases with/without nodal involvement) on conventional or PET imaging. Patients were randomised to receive either RP with pelvic lymph-node dissection plus BST (RP + BST) or BST alone. The primary endpoint was CSM. Secondary endpoints included clinical progression and overall survival (OS). Study accrual was stopped early because of a change in medical practice. Statistical analyses included cumulative incidence plots, Gray’s test, competing-risks regression, Kaplan-Meier estimates, and log-rank tests.

KEY FINDINGS AND LIMITATIONS: Between May 2015 and December 2018, 132 patients were randomised. The median age was 67 yr (interquartile range 63-71) and median prostate-specific antigen was 20 ng/ml (interquartile range 10-39). The 5-yr CSM cumulative incidence was 13% for RP + BST and 23% for BST alone (p = 0.037), with a hazard ratio of 0.39 (95% confidence interval 0.16-0.98; p = 0.045). The 5-yr cumulative incidence of clinical progression including CSM was 59% for RP + BST and 60% for BST alone. The 5-yr OS rate was 81% for RP + BST and 74% for BST alone. Clavien-Dindo grade ≥III surgery-related complications occurred in nine of 66 (14%) patients in the RP + BST arm. Limitations include early discontinuation of study accrual and the lack of statistical significance for the OS benefit.

CONCLUSIONS AND CLINICAL IMPLICATIONS: While this trial has substantial limitations, the results support addition of RP as local therapy to BST in omPC. This trial is registered on ClinicalTrials.gov as NCT02454543.

PMID:41046179 | DOI:10.1016/j.eururo.2025.09.4144

Eur J Clin Microbiol Infect Dis. 2025 Oct 4. doi: 10.1007/s10096-025-05276-5. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to investigate the impact of our institutional sepsis protocol on the empirical treatment of carbapenem-resistant Gram-negative bacteria in a setting where infectious disease consultation (ID) is available 7 days / 24 h and broad-spectrum antibiotic use requires ID approval.

METHODS: A total of 612 patients (168 patients pre-guideline, 444 patients post-guideline) who received empirical antibiotics for suspicion of sepsis before documentation of antibacterial susceptibility were included. Demographic, clinical and microbiological data were collected from the hospital’s electronic medical record system, retrospectively. Compliance with institutional guidelines and the rate of appropriate antibiotic use prior to the availability of antibiograms were assessed.

RESULTS: There was a statistically significant increase in the utilization rate of empirical antibacterial treatment based on pre-defined risk factors of multidrug resistance [OR (95% CI) 1.73 (1.21-2.48), p = 0.003]. Furthermore, appropriateness of the initial antibacterial treatment according to the antibiogram results increased significantly in the post-guideline period [OR (95% CI) = 3.25 (2.09-5.06), p < 0.001]. The rate of compliance with guideline recommendations (p = 0.004) and the rate of appropriate empirical antibiotic treatment (p < 0.001) by each year were significant when compared with the pre-guideline period. Also, practices that improve drug pharmacokinetics such as loading dose, prolonged infusion of meropenem and adjusting antibiotic doses according to renal function increased statistically after the release of guideline.

CONCLUSION: An institutional sepsis protocol based on risk factors for multidrug resistance and local epidemiology increased the rate of appropriate empirical antibiotic treatment even in a setting where ID consultation is readily available.

PMID:41045444 | DOI:10.1007/s10096-025-05276-5

Cancer Causes Control. 2025 Oct 4. doi: 10.1007/s10552-025-02073-5. Online ahead of print.

ABSTRACT

PURPOSE: Epidemiological studies have reported the influence of legume consumption on multiple cancers risk, but the association in esophageal cancer (EC) remains unclear. This study aimed to investigated the prospective associations between legume consumption and EC risk, especially among Chinese populations.

METHODS: We conducted a prospective cohort study with 15,184 participants aged 40 to 69 years from two high-risk areas of EC in China between 2005 and 2009, with follow-up until 2022. A validated questionnaire was used to collect the consumption frequency of major food groups at baseline and subsequent resurveys, including legume. The Cox proportional hazard regression was used to evaluate the multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of legume consumption and EC risk. To quantify the linear association of legume consumption and EC risk and to account for regression dilution bias, the mean usual consumption amount for each baseline group was estimated by combining the consumption level at both baseline and the second resurvey.

RESULTS: The final study sample included 15,184 participants in the cohort (mean [SD] baseline age, 51.8 [7.5] years). During a follow-up of 219,365 person-years, a total of 176 new EC cases were identified. Legume consumption was inversely associated with EC risk, with a 63% reduction in risk for participants who consumed legume regularly compared with nonconsumption (HR: 0.37; 95% CI 0.16, 0.84; p for trend = 0.022). After correction for regression dilution bias, each 10 g/day increased legume consumption was associated with a HR of 0.35 (0.13, 0.96) for esophageal squamous cell carcinoma (ESCC) risk. The associations were consistent across most subgroups and sensitivity analyses.

CONCLUSION: Higher frequency of legume consumption was associated with lower risk of EC among Chinese adults, particularly ESCC. Our findings suggest legume consumption may play an important role in preventing the development of EC.

PMID:41045426 | DOI:10.1007/s10552-025-02073-5

Hepatol Int. 2025 Oct 4. doi: 10.1007/s12072-025-10920-5. Online ahead of print.

NO ABSTRACT

PMID:41045421 | DOI:10.1007/s12072-025-10920-5