Category: Nevin Manimala

Faraday Discuss. 2025 Jun 11. doi: 10.1039/d5fd00009b. Online ahead of print.

ABSTRACT

Imaging the orientations of crystallites in bone requires the usage of synchrotron X-ray radiation, which is a limited resource for researchers. Thus scans have historically been limited to either small regions or few samples. In the present study, we scan 16 full frontal cross sections of mouse femora. This makes it possible to study structure, orientation, and composition, statistically across many different bones and animals, while preserving the structural context. From the following analysis, we can deduce that while the trabecular bone in the shaft has a larger fraction of oriented crystallites than other regions in the bone, the oriented fraction is more well aligned in the cortical bone in the shaft compared to other regions in the bone. We also see that the crystallites in the cortical and trabecular bone are longer than those in the femoral head and the condyle. The study also shows a larger Sr content in the cortical bone compared to other regions, and a larger Zn content in the femoral head compared to other regions of the bones. This study shows the need for and possibility of scanning larger regions to understand bioinorganic materials.

PMID:40498542 | DOI:10.1039/d5fd00009b

Oper Neurosurg (Hagerstown). 2025 Jun 10. doi: 10.1227/ons.0000000000001654. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: The jugular foramen (JF) is rather a complex anatomical structure with internal configuration. Its osteomorphology was assessed to redefine this rather long bony passage as a jugular canal (JC) based on its morphometric data.

METHODS: The JF was endocranially and exocranially observed and measured by a digital Vernier caliper bilaterally in 402 dry skulls with opened cranial cavity. The following parameters were measured and analyzed statistically: (1) external and internal widths in the mediolateral dimension, (2) external and internal lengths in the anteroposterior dimension, and (3) depth between the external and internal planes of the foramen. The JF/canal was classified based on its appearance and its morphometric features.

RESULTS: The mean length of the JC was approximately 12 mm (12.25 mm-right, 11.76 mm-left) and was longer on the right side (P = .05, 95% CI). Its external opening was found to be slightly larger than the internal opening (P = .07-right, P = .06-left). The JC took 3 distinctive course patterns of straight (47.6%), curved (45.5%), and angulated (6.9%). Its openings exhibited 3 types based on their morphometric analysis: 14.4% Type-I (width = length ±1 mm), 9.8% Type-II (width > length), and 75.9% Type-III (width < length). The size of the external opening into the JC was larger than its internal opening (straight: P = .08-right and P = .07-left), (curved: P = .03-right and P = .03-left), (angulated: P = .03-right and P = .04-left).

CONCLUSION: The JF should be regarded clinically as a canal. It is composed of internal and external openings where the jugular fossa resides in between. The provided osteomorphological variations of the JC would enhance the diagnostics and surgical planning in JF syndromes radioimaging and surgical interventions.

PMID:40498516 | DOI:10.1227/ons.0000000000001654

JAMA Netw Open. 2025 Jun 2;8(6):e2514622. doi: 10.1001/jamanetworkopen.2025.14622.

ABSTRACT

IMPORTANCE: In 2023, new immunization strategies became available for preventing respiratory syncytial virus (RSV) hospitalizations in infants and older adults. Modeling studies to understand the population-level impact of their use are important for public health planning.

OBJECTIVE: To estimate the number of hospitalizations averted in 2023 to 2024 due to new RSV immunization strategies and provide scenario projections for future seasons.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model examined RSV hospitalizations in King County, Washington, from October 7, 2023, through April 26, 2025. The population of King County was disaggregated into infants younger than 6 months, infants aged 6 to 11 months, children aged 1 to 4 years, children/adults aged 5 to 59 years, adults aged 60 to 74 years, and adults aged 75 years or older.

EXPOSURES: Respiratory syncytial virus vaccination for adults aged 60 years or older, maternal RSV vaccination, and long-acting monoclonal antibodies (nirsevimab) for infants younger than 8 months.

MAIN OUTCOMES AND MEASURES: The proportion of RSV hospitalizations averted in adults aged 60 years or older and infants younger than 1 year were estimated using an RSV transmission model calibrated to RSV hospitalizations.

RESULTS: The RSV transmission model simulated the population of King County, which includes approximately 2.3 million individuals, with 23 700 infants younger than 1 year and 446 500 adults aged 60 years or older. During the 2023 to 2024 RSV season, 21.2% of adults aged 60 to 74 years, 32.7% of adults aged 75 years or older, and 33.0% of infants were protected through active or passive immunization. A total of 125 (95% projection interval [PI], 77-192) RSV hospitalizations were averted, with most of the benefit observed in infants younger than 6 months (28.6% [95% PI, 26.9%-30.5%] reduction from baseline) and adults aged 75 years or older (14.8% [95% PI, 14.3%-15.5%] reduction from baseline). For the 2024 to 2025 season, optimistic scenarios of high immunization coverage (50% in older adults and 80% in infants) projected reductions of 29.8% (95% PI, 29.1%-30.8%) in adults aged 75 years or older and 68.8% (95% PI, 66.0%-71.7%) in infants younger than 6 months compared with a counterfactual scenario with no immunizations. Targeting infants eligible for catch-up doses of nirsevimab early in the season increased the proportion of RSV hospitalizations averted in infants aged 6 to 11 months from 31.7% (95% PI, 29.4%-33.9%) to 40.4% (95% PI, 39.0%-42.1%). If vaccine protection in adults aged 75 years or older waned by 50% in the second year after immunization, the proportion of RSV hospitalizations averted was projected to decrease to 22.2% (95% PI, 21.7%-23.0%).

CONCLUSIONS AND RELEVANCE: In this decision analytical model of RSV immunizations, the results suggest a modest reduction in RSV-diagnosed hospitalizations during the 2023 to 2024 season due to limited availability of immunization products, particularly for infants. A higher uptake earlier in the season may lead to substantial reductions in RSV hospitalizations in the 2024 to 2025 season.

PMID:40498487 | DOI:10.1001/jamanetworkopen.2025.14622

JAMA Netw Open. 2025 Jun 2;8(6):e2514765. doi: 10.1001/jamanetworkopen.2025.14765.

ABSTRACT

IMPORTANCE: Lymphedema is a common treatment-related adverse effect among breast cancer survivors that can limit activity and mobility. Although exercise is associated with improved outcomes after breast cancer treatment, data are limited on the association of intense physical activity, including strength training, with lymphedema.

OBJECTIVE: To examine the association between resistance training and lymphedema among breast cancer survivors.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study conducted between September 15, 2022, and March 26, 2024, women from 3 prospective studies (EXERT-BC, EXERT-BCN, and EXERT-C) underwent thrice-weekly, dose-escalated resistance training for 3 months to promote strength, mobility, and hypertrophy.

MAIN OUTCOMES AND MEASURES: Lymphedema was assessed at baseline and completion using bioimpedance analysis to evaluate fluid and body composition metrics, distinguishing among intracellular water, extracellular water, and total body water.

RESULTS: A total of 115 women completed the exercise regimen (median age, 54 years; range, 24-71 years). Ninety-six participants (83%) underwent sentinel lymph node biopsy, whereas 14 (12%) underwent axillary lymph node dissection. At baseline, 15 women (13%) had clinical lymphedema: 8 (8%) in the sentinel lymph node biopsy group and 7 (37%) in the axillary lymph node dissection group. No participants experienced subjective or clinical worsening of lymphedema after completing the exercise regimen. Bilateral arm lean mass significantly increased after resistance training (affected arm: median [IQR], 5.64 [4.98-6.20] lb; 95% CI, 5.40-5.84 lb) vs baseline (median [IQR], 5.45 [4.92-6.08] lb; 95% CI, 5.34-5.67 lb) (s = 1789.5; P < .001). The edema index (extracellular water to total body water ratio) significantly improved in all patients, signifying a reduction in lymphedema at the completion of exercise (mean, 0.383; 95% CI, 0.382-0.385) compared with baseline (mean, 0.385; 95% CI, 0.384-0.386) (t110 = 4.05; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of breast cancer survivors, intense resistance training did not exacerbate lymphedema and was associated with improvements in fluid balance and lean mass in the upper extremities. These findings suggest support for the inclusion of structured resistance exercise as part of breast cancer treatment and survivorship care.

PMID:40498485 | DOI:10.1001/jamanetworkopen.2025.14765

JAMA Netw Open. 2025 Jun 2;8(6):e2514857. doi: 10.1001/jamanetworkopen.2025.14857.

ABSTRACT

IMPORTANCE: Alcohol-associated liver disease (ALD) is a major public health concern, accounting for one-quarter of cirrhosis-related deaths and becoming the leading indication for liver transplantation in the US, with concerning increases in mortality during and following the COVID-19 pandemic onset.

OBJECTIVE: To evaluate comprehensive national trends in ALD mortality in the US from 1999 to 2022, with a particular focus on disparities related to sex, race, ethnicity, and age.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional analysis used the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research mortality database from 1999 to 2022, examining death certificates across all 50 states and the District of Columbia. The study included individuals aged 25 years and older. Data analysis was performed from September to November 2024.

EXPOSURE: ALD mortality was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes (K70.xx) for both alcohol-associated hepatitis (K70.1x) and alcohol-associated cirrhosis (K70.3x).

MAIN OUTCOMES AND MEASURES: Primary outcomes included age-adjusted annual mortality rates per 100 000 population, stratified by sex, age groups (25-44, 45-64, 65-84, and ≥85 years), race and ethnicity, and geographic regions. Joinpoint regression analysis was used to calculate average annual percentage changes (AAPCs) and to identify significant trend changes.

RESULTS: In this study, a total of 436 814 ALD deaths were recorded (308 923 men [70.7%]), with ALD mortality increasing from 6.71 to 12.53 deaths per 100 000 between 1999 and 2022 and significant acceleration during 2018 to 2022 (annual percentage change [APC], 8.94%; 95% CI, 6.27% to 14.51%; P = .001). Women showed more rapid increases than men (AAPC, 4.29% [95% CI, 3.09% to 5.51%] vs 2.50% [95% CI, 1.51% to 3.51%]), whereas young adults (aged 25-44 years) demonstrated concerning trends (AAPC, 4.23%; 95% CI, 3.47% to 4.83%; P = .001). American Indian and Alaska Native populations experienced the highest mortality rates, increasing from 25.21 to 46.75 deaths per 100 000 (AAPC, 4.93%; 95% CI, 3.45% to 5.96%; P = .001). Alcohol-associated hepatitis mortality increased from 0.47 to 0.76 deaths per 100 000 (AAPC, 2.08%; 95% CI, 1.27% to 3.05%; P = .001), with women showing steeper increases than men (AAPC, 3.94% [95% CI, 2.58% to 5.46%] vs 1.56% [95% CI, 0.73% to 2.42%]). Alcohol-associated cirrhosis mortality increased from 4.09 to 9.52 deaths per 100 000 (AAPC, 4.00%; 95% CI, 3.63% to 4.40%; P = .001), with particularly concerning trends among women (APC from 2011 to 2022, 8.32%; 95% CI, 7.40% to 9.82%; P = .01) and adults aged 25 to 44 years (APC from 2018 to 2022, 19.51%; 95% CI, 15.00% to 28.53%; P = .001).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study using data from the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research database, ALD mortality increased significantly across demographic groups, with particularly concerning trends among women, younger adults, and American Indian and Alaska Native populations. These findings highlight the urgent need for targeted public health interventions and enhanced surveillance, especially given the sustained impact of COVID-19 pandemic-related changes in alcohol consumption patterns.

PMID:40498484 | DOI:10.1001/jamanetworkopen.2025.14857

JAMA Netw Open. 2025 Jun 2;8(6):e2514864. doi: 10.1001/jamanetworkopen.2025.14864.

ABSTRACT

IMPORTANCE: Racial and ethnic disparities in pathologic complete response (pCR) and overall survival (OS) have been reported in patients with triple-negative breast cancer (TNBC). In addition to socioeconomic factors and access to care, differences in tumor biology may affect outcomes. The association of ERBB2-low expression with outcomes in patients with TNBC has been minimally explored, including studies evaluating outcomes based on race and ethnicity.

OBJECTIVE: To investigate whether ERBB2-low expression among patients with TNBC varies by race and ethnicity and is associated with pCR and OS.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the National Cancer Database, a national hospital-based tumor registry, from 2010 to 2019. Participants included adult female patients with stages I to III TNBC treated with neoadjuvant chemotherapy followed by surgery. Tumors with immunohistochemistry scores of 1+ or 2+, in situ hybridization nonamplified, were classified as ERBB2-low; those with immunohistochemistry scores of 0, as ERBB2-zero. Primary analysis was conducted from September 18 to October 18, 2023.

MAIN OUTCOMES AND MEASURES: Rates of ERBB2-low vs ERBB2-zero TNBC by race and ethnicity and pCR and OS by race and ethnicity and by ERBB2 status.

RESULTS: Overall, 31 888 patients with TNBC were identified (median age, 53 [IQR, 44-61] years). Of those, 1078 patients (3.4%) were Asian; 7642 (24.0%), Black; 2578 (8.1%), Hispanic; 20 264 (63.5%), White; and 326 (1.0%), other. Over half of the study population (16 332 [51.2%]) displayed ERBB2-low expression and 15 556 (48.8%), ERBB2-zero expression. Patients with ERBB2-low expression demonstrated lower rates of pCR than those with ERBB2-zero expression (4675 [28.6%] vs 4787 [30.8%]; P < .001); ERBB2-low expression was associated with lower odds of pCR after adjustment for patient, socioeconomic, and tumor variables (odds ratio, 0.93; 95% CI, 0.88-0.99; P = .01). When patients were stratified by race and ethnicity, Hispanic patients had higher rates of ERBB2-zero expression than ERBB2-low expression (1391 of 2578 [54.0%] vs 1187 of 2578 [46.0%]; P < .001); no differences were noted among other racial and ethnic groups. Hispanic patients also had higher rates of pCR among those with ERBB2-low (Hispanic, 30.7%; Asian, 24.6%; Black, 29.5%; White, 27.1%) and ERBB2-zero (Hispanic, 33.2%; Asian, 32.1%; Black, 27.1%; White, 31.7%) TNBC. Non-Hispanic Asian patients had the highest 60-month OS among both those with ERBB2-zero (79%; 95% CI, 75%-83%) and ERBB2-low expression (84%; 95% CI, 80%-87%). Among Asian and White patients, ERBB2-low expression was associated with prolonged OS compared with ERBB2-zero expression (hazard ratios, 0.69 [95% CI, 0.50-0.95] [P = .02] and 0.85 [95% CI, 0.79-0.92] [P < .001], respectively). Black patients had lower pCR and OS rates regardless of ERBB2 status.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with TNBC, ERBB2-low expression and its association with clinical outcomes varied across racial and ethnic groups. These findings highlight the need for further research to understand the biological implications of ERBB2-low expression in diverse populations of patients with TNBC.

PMID:40498483 | DOI:10.1001/jamanetworkopen.2025.14864

JAMA Netw Open. 2025 Jun 2;8(6):e2514989. doi: 10.1001/jamanetworkopen.2025.14989.

ABSTRACT

IMPORTANCE: The Centers for Disease Control and Prevention offers a standardized antimicrobial administration ratio (SAAR) as an evaluation metric for inpatient antibiotic use through rankings and peer comparisons (ie, benchmarking). However, the SAAR model only accounts for facility- and unit-level factors without considering the hierarchical nature of the health care data, and it does not directly reflect patient-level factors or stewardship efforts to avoid overly broad-spectrum therapy.

OBJECTIVE: To examine the use of antimicrobial use risk adjustment methods and choice of basic metrics (eg, days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC], which do not and do consider antimicrobial spectrum, respectively) in hospital benchmarking.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using data from 117 acute care hospitals within the Veterans Health Administration (VHA) system. All patients admitted between January 1, 2021, and December 31, 2023, were included.

MAIN OUTCOMES AND MEASURES: Monthly antibiotic use was measured with 2 basic metrics and risk adjustment models created using baseline data for 2021 to 2022. Hospitals were benchmarked for 2023 use via 3 methods: (1) unadjusted comparison, (2) risk adjustment with hospital- and unit-level factors with single-level negative binomial regression models (method 1, similar in approach to the SAAR), and (3) risk adjustment with hospital-, unit-, and patient-level factors with hierarchical zero-inflated negative binomial regression models (method 2).

RESULTS: This study included 736 810 patients (median age, 70 [IQR, 61-76] years; 94.7% male). There was wide variability in unadjusted antibiotic use among hospitals (median, 477 [IQR, 420-523] DOT per 1000 days present [DP]; and median, 3115 [IQR, 2739-3602] DASC per 1000 DP). Risk adjustments with methods 1 and 2 resulted in moderate ranking changes, but there were only weak correlations between benchmarking results by the 2 methods (τB = 0.43 for DOT and 0.44 for DASC). The choice of basic metrics with or without consideration of antimicrobial spectrums (DOT vs DASC) had a modest correlation after risk adjustment (τB = 0.84).

CONCLUSIONS AND RELEVANCE: In this cohort study of the nationwide VHA system, there were substantial differences in risk-adjusted benchmarking results between models with only hospital- and unit-level factors and models with hospital-, unit-, and patient-level factors. Future studies should evaluate whether these models with higher content validity also have better construct validity and can inform hospitals and stewardship programs about their objective performance compared with other programs.

PMID:40498481 | DOI:10.1001/jamanetworkopen.2025.14989

Biomed Instrum Technol. 2025;59(1):108-116. doi: 10.2345/0899-8205-59.1.108. Epub 2025 Jun 11.

ABSTRACT

Healthcare staff rely on isolation gowns to provide a degree of protection against cross contamination from blood or body fluids. Gowns that meet standardized liquid barrier penetration test methods provide staff with a presumed assurance of safety. However, these test methods-namely impact penetration and resistance to hydrostatic pressure-were not drafted with personal protective equipment in mind and therefore may be inappropriate for testing products intended for use in a healthcare environment. This study found that adjusting testing parameters to better simulate clinical conditions altered the measured performance outcomes of the gowns. Specifically, increasing the temperature of the gown material’s preconditioning environment or test liquid resulted in statistically significant variations in results. Further, although hydrostatic pressure resistance is measured by the appearance of a third liquid droplet on the inner surface of the gown material, the first two droplets appeared at significantly lower pressures and likely would constitute contamination of healthcare staff. The results indicated that current isolation gown test protocols and regulations should be reevaluated to more accurately reflect healthcare scenarios and improve alignment with expected barrier performance.

PMID:40498446 | DOI:10.2345/0899-8205-59.1.108

Biomed Instrum Technol. 2025;59(1):117-127. doi: 10.2345/0899-8205-59.1.117. Epub 2025 Jun 11.

ABSTRACT

Objectives: This study sought to investigate whether and to what extent fluid strikethrough for disposable isolation gowns is underreported and to identify areas for improving healthcare worker (HCW) understanding of gown performance. Methods: Researchers developed a confidential, qualitative, online disposable isolation gown user experience survey with an intended audience of HCWs with experience either wearing disposable isolation gowns or selecting them for purchase. The unrestricted survey link was distributed from February to March 2024. Results: A total of 211 individuals completed the survey. When asked about selection, purchasers most frequently chose to purchase level 2 isolation gowns for patient care during nonsurgical applications. More than 40% of wearers stated that they did not have a choice regarding gown protection levels when donning personal protective equipment for patient care, and 34.3% experienced fluid strikethrough (i.e., penetration of fluid through a disposable isolation gown), yet nearly one-half never reported this problem. Discussion and Conclusion: To enhance safety, the healthcare community must work together to improve guidance on gown performance and selection based on fluid exposure risk. Frequent, underreported strikethrough incidents highlighted confusion among HCWs regarding gown classification and appropriate usage. A need exists for a unified, task-based framework that clearly links gown performance with clinical risk. Fostering a culture that normalizes reporting issues-while minimizing staff burden-combined with targeted education and streamlined reporting mechanisms, will enable more informed decision making and reinforce infection prevention efforts.

PMID:40498445 | DOI:10.2345/0899-8205-59.1.117

J Perianesth Nurs. 2025 Jun 11:S1089-9472(25)00048-6. doi: 10.1016/j.jopan.2025.02.010. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effect of suprazygomatic maxillary nerve block (SMB) in patients undergoing septoplasty surgery.

DESIGN: Randomized controlled trial.

METHODS: A total of 60 patients who met the inclusion criteria were enrolled in this prospective, randomized controlled study. The patients were divided into two groups: group C (control group) and group B (block group). The groups were compared in terms of demographic variables, American Society of Anesthesiologists scores, hemodynamic parameters (mean arterial pressure and heart rate), visual analog scale (VAS) pain scores, postoperative recovery quality (QoR-15 scores) (Quality of recovery-15 (QoR-15)), and the need for rescue analgesics.

FINDINGS: There were no statistically significant differences between the groups regarding age, gender, or American Society of Anesthesiologists scores (P > .05). Baseline hemodynamic parameters were similar between the groups (P > .05). However, mean arterial pressure and heart rate were significantly lower in group B at 15, 30, 45, and 60 minutes postoperatively (P < .05). Visual analog scale scores at 0, 2, 6, and 12 hours were significantly lower in group B (P < .05). QoR-15 scores were also significantly higher in group B (P < .05), while the patients need rescue analgesics was lower in this group (P < .05). There was no significant difference in the total number of postoperative analgesic doses between the two groups (P > .05).

CONCLUSIONS: The application of SMB during septoplasty surgery provides improved perioperative hemodynamic stability, reduced postoperative pain, and enhanced recovery quality. The SMB can be considered a valuable component of a multimodal analgesic approach in septoplasty surgeries.

PMID:40498428 | DOI:10.1016/j.jopan.2025.02.010