Category: Nevin Manimala

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

J Assoc Physicians India. 2025 Dec;73(12):e4-e7. doi: 10.59556/japi.73.1269.

ABSTRACT

BACKGROUND: The intensive care unit (ICU) is an area within a medical facility equipped with advanced technologies such as ventilators and personnel trained to provide intensive, advanced life-supportive care to critically ill patients. These units can be general or specialized. Intensive care beds are always in demand in any tertiary care center. Getting ICU beds is a challenging task. In 2008, the cost of critical care was 17-39% of hospital costs and 5.2-11% of the total healthcare budget. On one hand, where needy patients do not get ICU beds, there are instances when patients are kept just for observation in intensive care. So, we planned this study to analyze our status regarding the effective utilization of medical intensive care beds.

AIMS AND OBJECTIVES: To audit our admissions and discharges on the grounds of the criteria laid by the American Critical Care Medicine (ACCM) in the year 2016, and to strengthen our admission and discharge policies with standard protocols to make the best utilization for society.

MATERIALS AND METHODS: Retrospectively, we analyzed the medical records of 6 months (July 1-December 31, 2021). We analyze admission criteria and discharges in those patients. We recorded the sequential organ failure assessment (SOFA) score, the quick sequential organ failure assessment (qSOFA) score, the length of stay in ICU, the total length of stay, and the outcomes of the patients. The analysis was done with SPSS.

RESULTS: We collected records of 355 patients admitted in the medicine ICU during the defined period. There was a male preponderance in our study. The mean age of patients admitted was 54.75 ± 17.53 (range 16-82). Most patients were transferred in from the ward (53.5%), and the rest (46.5%) were directly from the emergency department. When we categorized the patients’ admission according to ACCM Guidelines, 39.4% of patients were in category I, 11.3% patients in category II, 36.6% in category III, 7% in category IV, and 5.6% in category V. When we compared the SOFA score along with the admissions category, there was no significant association. Mean ICU length of stay was 6.11 ± 4.99. There was no association found between the category of admission and the mean ICU length of stay. Overall, out of 355 patients, 255 patients (71.8%) transferred out, 20 patients (5.6%), and 80 patients (22.6%) could not be saved. In our study, 80.3% of transfers out were unplanned (this also includes the death of patients). There was a significant association between the admission category of patients and their outcome in the ICU.

CONCLUSION: The intensive care unit is an expensive setup. It is yet to be used in its maximum capacity for those who really need it. Triaging patients for the ICU is a must for better utilization of resources. Admissions and discharge policies should be followed stringently for optimum utilization of facilities.

PMID:41391086 | DOI:10.59556/japi.73.1269

J Assoc Physicians India. 2025 Dec;73(12):44-46. doi: 10.59556/japi.73.1275.

ABSTRACT

BACKGROUND: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with the severity of systolic dysfunction. However, the relationship between SUA and left ventricular ejection fraction (LVEF) remains unclear.

METHODOLOGY: A cross-sectional study was conducted at DY Patil University School of Medicine, Navi Mumbai, involving 60 patients diagnosed with HF. Patients were categorized based on LVEF into HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). SUA levels were measured, and patients were classified into hyperuricemia or normal uric acid level groups. Demographics, comorbidities, and clinical symptoms were also recorded. Statistical analysis was performed to determine the correlation between SUA and LVEF.

RESULTS: Of the 60 patients enrolled, 65% were female, with a mean age of 61-70 years. The majority had HFrEF (70%), followed by HFmrEF (26.67%) and HFpEF (3.3%). Hyperuricemia was observed in 38.3% of patients. A weak negative correlation was found between LVEF and SUA (r = -0.070), which was not statistically significant (p = 0.599). Although hyperuricemia was more prevalent in HFrEF, no significant relationship was established between SUA levels and severity of systolic dysfunction.

CONCLUSION: The study found a weak and statistically insignificant correlation between SUA levels and LVEF in HF patients. This suggests that SUA may not be a reliable biomarker for assessing the severity of systolic dysfunction. Further studies involving larger, more diverse populations are needed to clarify the prognostic role of SUA in HF.

PMID:41391081 | DOI:10.59556/japi.73.1275

J Assoc Physicians India. 2025 Dec;73(12):40-43. doi: 10.59556/japi.73.1263.

ABSTRACT

BACKGROUND: Sarcopenia is a frequent and prognostically significant complication of liver cirrhosis. Hand grip strength (HGS) has emerged as a simple, noninvasive tool for assessing muscle function, yet limited data exist on its utility in Indian cirrhotic populations.

AIM: To evaluate the association of HGS with established prognostic scores and biochemical parameters in Indian patients with cirrhosis.

MATERIALS AND METHODS: In this cross-sectional observational study, 100 adult cirrhotic patients were assessed between August 2022 and December 2023. HGS was measured using a validated hand-held dynamometer. Correlations between HGS and clinical scores of severity of cirrhosis [Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD)] and biochemical markers were analyzed using appropriate statistical methods.

RESULTS: Mean patient age was 59.2 ± 8.46 years; 85% were male. The most common etiologies were alcohol (46%) and viral hepatitis (26%). HGS declined significantly with increasing liver disease severity: CTP A (34.0 ± 1.48 kg), B (21.63 ± 1.07 kg), and C (13.5 ± 2.87 kg) (p < 0.0001). HGS was inversely correlated with MELD score (r = -0.820) and showed strong positive correlations with serum albumin (r = +0.872) and hemoglobin (r = +0.59). Age, international normalized ratio (INR), and bilirubin were negatively correlated with HGS.

CONCLUSION: HGS is strongly associated with liver disease severity and key biochemical indicators. As a bedside, radiation-free tool, it offers a practical method for assessing sarcopenia in cirrhosis, especially in resource-limited settings.

PMID:41391080 | DOI:10.59556/japi.73.1263

J Assoc Physicians India. 2025 Dec;73(12):37-39. doi: 10.59556/japi.73.1271.

ABSTRACT

OBJECTIVES: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates.

METHODS: A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols.

RESULTS: The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use.

CONCLUSION: The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.

PMID:41391079 | DOI:10.59556/japi.73.1271