Category: Nevin Manimala

J Laparoendosc Adv Surg Tech A. 2025 Feb 26. doi: 10.1089/lap.2024.0382. Online ahead of print.

ABSTRACT

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; P = .04; I² = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; P = .01; I² = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; P < .01; I² = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; P = .36; I² = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; P = .42; I² = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; P = .98; I² = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; P = .40; I² = 0%). Conclusion: In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.

PMID:40009351 | DOI:10.1089/lap.2024.0382

Behav Res Methods. 2025 Feb 26;57(4):101. doi: 10.3758/s13428-024-02532-y.

ABSTRACT

Established strategies commonly used to address latent quadratic and interaction effects within structural equation models, such as the unconstrained product indicator (UPI) approach or the latent moderated structural equations (LMS) approach, tend to perform effectively in models featuring only a limited number of nonlinear effects. However, as the complexity of the model increases with a higher number of nonlinear terms, the feasibility of joint or one-step methods such as UPI and LMS progressively diminishes. In response to this challenge, this paper advocates the adoption of structural after measurement (SAM) approaches to overcome this limitation. In a SAM approach, estimation proceeds in two stages. In a first stage, we estimate the parameters related to the measurement part of the model, while in a second stage, we estimate the parameters related to the structural part of the model. In this paper, we discuss three SAM approaches already documented in the literature and introduce a novel method based on the local SAM approach. To illustrate the utility of these SAM approaches, we conduct a modest simulation study, demonstrating that SAM approaches for latent quadratic and interaction effects offer a practical and viable alternative to the well-established one-step approaches.

PMID:40009313 | DOI:10.3758/s13428-024-02532-y

Clin Rheumatol. 2025 Feb 26. doi: 10.1007/s10067-025-07379-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate the differences between neuropsychiatric systemic lupus erythematosus (NPSLE) patients with and without white matter hyperintensity (WMH) on magnetic resonance imaging (MRI) and to identify factors independently associated with the development of WMH in NPSLE.

METHOD: A comparative analysis was conducted on 84 NPSLE patients hospitalized at Peking University People’s Hospital from 2015 to 2022 at the initial diagnosis of NPSLE. Patients were categorized based on the presence of WMH on brain MRI scans. Demographic data, clinical characteristics, and laboratory parameters were reviewed and statistically analyzed.

RESULTS: The study included 84 NPSLE patients, 50% exhibiting WMH (NPSLE-WMH +). At the initial diagnosis of NPSLE, the NPSLE-WMH + group showed significantly higher levels of antinuclear antibody (ANA) titer, anti-double-stranded DNA antibody (anti-dsDNA), anti-nucleosome antibody (ANuA), and lower serum C3 levels. The proportion of patients with reduced WBC, elevated anti-dsDNA, elevated ANuA, elevated anticardiolipin antibody (ACA), positive urinary protein (UPR), and positive ANA was higher in the NPSLE-WMH + group. Univariate and multivariate analyses revealed that positive UPR (p = 0.040), positive ANA (p = 0.025), elevated anti-dsDNA (0.047), and elevated ACA (p = 0.025) were potentially independent factors associated with WMH development in NPSLE patients.

CONCLUSIONS: This study provides novel insights into the clinical and laboratory differences between NPSLE patients with and without WMH, identifying specific independently associated factors for WMH development. These findings may contribute to a better understanding of this intricate disease. Key Points • Although WMH is one of the most frequently observed lesions on MRI in patients with NPSLE, previous literature has given limited attention to it. This study focuses on the differences between NPSLE patients with and without WMH, unveiling independently associated factors for developing WMH in this disease.

PMID:40009312 | DOI:10.1007/s10067-025-07379-y

Emerg Radiol. 2025 Feb 26. doi: 10.1007/s10140-025-02321-w. Online ahead of print.

ABSTRACT

PURPOSE: Vertigo and dizziness are common complaints at emergency departments (ED), often leading to computed tomography (CT) and CT angiography (CTA) studies, which when used non-selectively, have low clinical utility. The study assesses whether two quality improvement interventions (educational rounds and clinical decision making support tool) can better align CTA ordering rates with clinical practice guidelines in the ED workup of vertigo/dizziness at a large community hospital.

METHODS: CTA head and neck imaging rates were collected for patients presenting to the hospital’s ED with dizziness/vertigo as the chief complaint during 6-month pre- and post-intervention periods and compared rates using the Chi-Square Test. The interventions were joint ED/Diagnostic Imaging/Stroke Neurology rounds discussing CTA head/neck indications and dissemination of a clinical decision making support tool.

RESULTS: The absolute reduction was 5.79% (N = 4,230, p < 0.001) in CTA rates for patients presenting with dizziness/vertigo between the pre- and post-intervention periods. For vertigo, the absolute reduction was 12.27% (N = 402, p < 0.005). For dizziness, the absolute reduction was 5.17% (N = 3828, p < 0.001). Despite the global decrease in CTA studies, there was no statistically significant decrease in CTA rates for the patients who were diagnosed with cerebrovascular accident or transient ischemic attack in the ED, indicating that the interventions were effective in limiting to the targeted CTA studies.

CONCLUSIONS: This project was effective in improving patient safety and system efficiency, while providing a framework for low-burden, effective, practice-modifying quality improvement initiatives.

PMID:40009296 | DOI:10.1007/s10140-025-02321-w

Biomech Model Mechanobiol. 2025 Feb 26. doi: 10.1007/s10237-025-01931-0. Online ahead of print.

ABSTRACT

In this work, we present the derivation of a novel model for the myocardium that incorporates the underlying poroelastic nature of the material constituents as well as the electrical conductivity. The myocardium has a microstructure consisting of a poroelastic extracellular matrix with embedded poroelastic myocytes, i.e. a double poroelastic material. Due to the sharp length scale separation that exists between the microscale, where the individual myocytes are clearly resolved from the surrounding matrix, and the length of the entire heart muscle, we can apply the asymptotic homogenization technique. The novel PDE model accounts for the difference in the electric potentials, elastic properties as well as the differences in the hydraulic conductivities at different points in the microstructure. The differences in these properties are encoded in the coefficients and are to be computed by solving differential cell problems arising when applying the asymptotic homogenization technique. We present a numerical analysis of the obtained Biot’s modulus, Young’s moduli as well as shears and the effective electrical activity. By investigating the poroelastic and electrical nature of the myocardium in one model, we can understand how the differences in elastic displacements between the extracellular matrix and the myocytes affect mechanotransduction and the influence of disease.

PMID:40009273 | DOI:10.1007/s10237-025-01931-0

Mol Neurobiol. 2025 Feb 26. doi: 10.1007/s12035-025-04783-y. Online ahead of print.

ABSTRACT

Post-stroke cognitive impairment (PSCI) leads to poor long-term stroke outcomes, severely increasing social and economic burdens. It is helpful to identify and intervene in PSCI in the early stage. This study intends to develop a new clinical risk score for identifying stroke survivors at significant risk of PSCI from the acute phase to 6 months of onset and to validate the new score using both internal and external cohorts. Analysis aiming to evaluate prognostic factors of acute-phase cognitive impairment lasting 6 months was carried out using two independent datasets, with one for model development and the other for validation. All enrolled patients completed baseline demographic, clinical, and imaging data collection and cognitive function scale assessment. The follow-up period was 6 months after the stroke, and interviews and cognitive function assessments were completed. A multivariate logistic regression analysis was performed, and the most important predictors were finally screened for modeling a prediction model. Six months post-stroke, 39.19% maintained PSCI in the development dataset. The final nine-point SHACEA (Stenosis, Hyperintensity, Age, Chronic cortical infarcts, Education, Atrophy) had an AUROC of 0.87 (95% CI 0.69-0.92) and was overall predictive of PSCI (LR χ² statistic of 89.34; p < 0.001). In the validation cohort, the SHACEA risk score was still relatively reliable in the validation cohort with an AUC of 0.74 (95% CI 0.71-0.80). The SHACEA risk score adequately identified acute stroke patients with cognitive impairment who are at an increased risk of developing PSCI after 6 months.

PMID:40009260 | DOI:10.1007/s12035-025-04783-y

Arch Dermatol Res. 2025 Feb 26;317(1):496. doi: 10.1007/s00403-025-03943-3.

ABSTRACT

Pain is the most impactful and burdensome symptom of hidradenitis suppurativa (HS) and profoundly affects patients’ quality of life. There is variation in how trials measure HS pain, with some reporting maximum and others reporting average 7-day pain. It remains unknown whether there is a difference between these measures and which is more strongly associated with quality of life in HS. This is a retrospective cross-sectional study of 257 adults with HS who received care in an HS Specialty Clinic from January 2019 to August 2021. Patients self-reported their average pain and maximum pain severity in the past 7 days measured on a numerical rating scale (0-10). The absolute difference between patient-reported average and maximum pain was calculated and assessed for statistical differences using a paired t-test. Multivariable linear regression was used to assess the correlation between the average versus maximum pain score with Skindex-16 quality of life (QoL) score. The maximum pain scores were significantly higher than the average, with a mean absolute difference of 0.83 points (95% CI: 0.74, 0.92) (p < 0.0001). The association between Skindex-16 QoL and average pain was not significantly different from Skindex-16 QoL correlation with maximum pain severity (p = 0.52). This study highlights a small but statistically significant difference in HS patients’ maximum and average 7-day pain severities. Both maximum and average 7-day score correlated with skin-related QoL, suggesting equipoise as outcome measures for clinical HS studies.

PMID:40009252 | DOI:10.1007/s00403-025-03943-3

Pediatr Surg Int. 2025 Feb 26;41(1):86. doi: 10.1007/s00383-024-05933-4.

ABSTRACT

PURPOSE: To explore differences based on level of pediatric spinal cord injury (SCI), we compared cervical and thoracic SCI in pediatric trauma patients (PTPs), hypothesizing higher mortality and length of stay (LOS) for cervical SCI.

METHODS: The 2017-2021 Trauma Quality Improvement Program was queried for all PTPs ≤ 17 years-old with cervical or thoracic SCI. Bivariate analyses compared the two groups. The primary outcome was mortality and secondary outcomes included hospital LOS and injury severity scores (ISS). Logistic regression models were used to determine independent risk factors for death and prolonged ventilation.

RESULTS: Of 5280 PTPs, 2538 (65.9%) had cervical SCI and 1316 (34.1%) had thoracic SCI. Motor vehicle collisions were the most common cause of both cervical and thoracic SCI (37.8 and 41.9%). PTPs with thoracic SCI had higher rates of positive drug screen as compared to cervical SCI (39.2 vs 29.8%, p = 0.001). PTPs with thoracic SCI had higher median ISS (25 vs 16, p < 0.001), while cervical SCI had higher mortality (13 vs 6.1%, p < 0.001) but decreased hospital LOS (median 9 vs 5 days, p < 0.001. Cervical SCI were associated with a nearly fourfold increase in the risk of death (95% CI 2.750-5.799, p < 0.001) and a 1.6-fold increase in the risk of prolonged ventilator requirement (95% CI 1.228-2.068, p < 0.001).

CONCLUSIONS: PTPs with cervical SCI have higher mortality while those with thoracic SCI have higher ISS and hospital LOS. Cervical SCI were associated with a fourfold higher risk of death. MVC was the most common cause of injury, and both groups had high rates of positive drug screens. Understanding differing outcomes may assist providers with prognostication and injury prevention.

PMID:40009251 | DOI:10.1007/s00383-024-05933-4

Exp Appl Acarol. 2025 Feb 26;94(3):40. doi: 10.1007/s10493-025-01009-7.

ABSTRACT

Species from various animal taxa have been found to use pheromonal communication underwater. Although the use of pheromones in water mites has been previously suggested, experimental evidence for it remains sparse. We examined the behavioral responses of male and female Arrenurus globator to water in which conspecifics of the same and the opposite sex had been kept, in order to test the hypothesis that chemical communication occurs between sexes. Results suggest a putative female-produced sex pheromone that stimulates at least the initial steps of mating behavior in males. Males exhibited arrestant behavior, leg fanning and readiness posture more in female-conditioned water than in male-conditioned or control water. In contrast, females showed no response to either male-conditioned water or female-conditioned water.

PMID:40009247 | DOI:10.1007/s10493-025-01009-7

Graefes Arch Clin Exp Ophthalmol. 2025 Feb 26. doi: 10.1007/s00417-025-06777-x. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the relationship between retinal layer thickness and cognitive function in elderly Chinese, accounting for the influence of axial length.

METHODS: The participants of the Beijing Eye Study 2011 which is a population-based cross-sectional study without any retinal or optic nerve disease underwent a series of ocular examinations including spectral-domain optical coherence tomography (OCT) of the retina. Using a multiple-surface OCT segmentation algorithm, the retina was automatically segmented into 9 layers. Cognitive function was evaluated applying the Mini Mental Statement Examination (MMSE). Cognitive impairment was defined as an MMSE score < 26.

RESULTS: The study included 2067 participants (56.7% women) (2067 eyes) with a mean age of 61.4 ± 8.4 years. After adjusting for age, gender and axial length, a lower cognitive function was related with a thinning of the ganglion cell layer (GCL) (P = 0.029, B = 0.04) and photoreceptor outer segment layer (POS) (P = 0.042, B = 0.04), while the retinal nerve fiber layer (RNFL) thickness (P = 0.144) was not significantly associated with the cognitive function score. For every unit decrease in MMSE score, the GCL and POS thickness separately decreased by 0.06 µm (95%CI: 0.01 µm, 0.12 µm), and 0.05 µm (95%CI: 0.002 µm, 0.10 µm). As compared with cognitively normal participants, those with cognitive impairment had a significantly thinner GCL (P = 0.019, OR = 1.04), and POS (P = 0.022, OR = 1.04) in multivariate logistic regression.

CONCLUSION: After adding axial length as dependence in multivariate analysis, cognitive impairment was not significantly associated with the thickness of RNFL, while the association between a lower cognitive function score and thinner GCL and POS was statistically associated in current study.

PMID:40009225 | DOI:10.1007/s00417-025-06777-x