Nevin Manimala

Eur J Surg Oncol. 2025 May 13;51(9):110109. doi: 10.1016/j.ejso.2025.110109. Online ahead of print.

ABSTRACT

BACKGROUND: Therapeutic mammoplasty (TM) is a Level 2 oncoplastic procedure that improves cosmetic outcome in patients undergoing breast conserving surgery (BCS) for breast cancer. The contralateral reduction may be performed at the same time as the index procedure (synchronous) or later (metachronous); commonly cited reasons for the latter include fewer complications, reduced need for revisional surgery and less delay to adjuvant therapies. This study aims to compare synchronous and metachronous approaches to therapeutic mammoplasty.

MATERIALS AND METHODS: A database between 2010 and 2019 was hand searched. The primary outcome measure was the trend of synchronous vs unilateral operating by year. Secondary outcome measures included demographic variables, type of mammoplasty, tumour biology, revisional surgery rate, type and timing of planned revisional surgery, complications, type and time to adjuvant therapy, type of axillary surgery, and tumour trends by year.

RESULTS: 155 patients had synchronous mammoplasties and 107 patients had unilateral procedures, of which 26 had delayed contralateral symmetrising surgery. There was a significant increase in the total number of TMs (p < 0.03) and synchronous TMs (p < 0.02) over time. There were no differences in time to chemotherapy (p > 0.05), time to radiotherapy (p > 0.05) or time till re-excision of margins/revision mastectomies (p > 0.05). In the unilateral group, mean time to contralateral symmetrising surgery was 14 months.

CONCLUSIONS: Synchronous TMs are increasingly popular and appear safe for patients undergoing BCS for breast cancer. Further work is necessary to establish patient preferences between the two groups.

PMID:40388851 | DOI:10.1016/j.ejso.2025.110109

Ann Plast Surg. 2025 Apr 28. doi: 10.1097/SAP.0000000000004361. Online ahead of print.

ABSTRACT

PURPOSE: The use of a concomitant panniculectomy (PAN) during a ventral hernia repair (VHR) has been debated because of concerns of higher wound complications and longer operative times. However, PAN offers significant advantages including increased intraoperative exposure, improved patient quality of life, and offering an aesthetic benefit. In the treatment of large hernia defects the senior author utilizes the component separation technique with onlay placement of acellular dermal matrix (ADM). Additionally, the ADM is secured using progressive quilting suturing. This study aimed to evaluate the outcomes of patients who underwent VHR + PAN utilizing the component separation technique alongside onlay placement of ADM.

METHODS: A single-center retrospective analysis was conducted on the senior author’s technique in treating VHR + PAN over 10 years. The patients were identified utilizing Current Procedural Codes for ventral hernia repairs and myofascial muscle flaps. Following identification of patients, they were further stratified for undergoing a panniculectomy. Patients treated without the use of onlay acellular dermal matrix placement or with fewer than 6 months of follow-up time were excluded from the study. Descriptive statistics were used to summarize the findings.

RESULTS: A total of 29 patients met the inclusion criteria, with the majority being obese (79.3%) and female (93.1%). Most patients (82.8%) had a history of previous hernia repair, with majority undergoing previous mesh placement. No hernia recurrences were observed during an average follow-up period of 21.3 months. Seromas were the most common postoperative complication (34.4%, all managed in clinic), followed by wound necrosis (20.7%) and infection (6.9%).

CONCLUSIONS: Combining VHR with panniculectomy offers potential functional, aesthetic, and quality-of-life benefits while reducing the need for multiple surgeries, particularly in patient populations with large hernia defects and prior hernia repairs. The absence of recurrences and acceptable complication rates in this study highlights the safety and efficacy of utilizing the component separation technique with onlay placement of ADM secured by progressive quilting sutures. Further research with larger, multicenter cohorts is warranted to validate these outcomes and explore strategies for optimizing complication management.

PMID:40388842 | DOI:10.1097/SAP.0000000000004361

JMIR AI. 2025 May 18. doi: 10.2196/68144. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is transforming medical imaging, with large language models such as ChatGPT-4 emerging as potential tools for automated image interpretation. While AI-driven radiomics has shown promise in diagnostic imaging, the efficacy of ChatGPT-4 in liver ultrasound analysis remains largely unexamined.

OBJECTIVE: This study evaluates the capability of ChatGPT-4 in liver ultrasound radiomics, specifically its ability to differentiate fibrosis, steatosis, and normal liver tissue, compared to conventional image analysis software.

METHODS: Seventy grayscale ultrasound images from a preclinical liver disease model, including fibrosis (n=31), fatty liver (n=18), and normal liver (n=21), were analyzed. ChatGPT-4 extracted texture features, which were compared to those obtained using Interactive Data Language (IDL), a traditional image analysis software. One-way ANOVA was used to identify statistically significant features differentiating liver conditions, and logistic regression models were employed to assess diagnostic performance.

RESULTS: ChatGPT-4 extracted nine key textural features-echo intensity, heterogeneity, skewness, kurtosis, contrast, homogeneity, dissimilarity, angular second moment, and entropy-all of which significantly differed across liver conditions (p < 0.05). Among individual features, echo intensity achieved the highest F1-score (0.85). When combined, ChatGPT-4 attained 76% accuracy and 83% sensitivity in classifying liver disease. ROC analysis demonstrated strong discriminatory performance, with AUC values of 0.75 for fibrosis, 0.87 for normal liver, and 0.97 for steatosis. Compared to Interactive Data Language (IDL) image analysis software, ChatGPT-4 exhibited slightly lower sensitivity (0.83 vs. 0.89) but showed moderate correlation (R = 0.68, p < 0.0001) with IDL-derived features. However, it significantly outperformed IDL in processing efficiency, reducing analysis time by 40%, highlighting its potential for high throughput radiomic analysis.

CONCLUSIONS: Despite slightly lower sensitivity than IDL, ChatGPT-4 demonstrated high feasibility for ultrasound radiomics, offering faster processing, high-throughput analysis, and automated multi-image evaluation. These findings support its potential integration into AI-driven imaging workflows, with further refinements needed to enhance feature reproducibility and diagnostic accuracy.

PMID:40388838 | DOI:10.2196/68144

Medicine (Baltimore). 2025 May 16;104(20):e41975. doi: 10.1097/MD.0000000000041975.

ABSTRACT

This study aimed to determine whether the D-dimer/high-sensitivity troponin I (hs-TnI) ratio is useful in the differential diagnosis of acute pulmonary embolism (APE) and/or non-ST-elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department with chest pain. The study included 219 patients with APE and 385 patients with NSTEMI over the age of 18 who presented to the emergency department with chest pain and were diagnosed with either APE or NSTEMI. Using statistical analysis, D-dimer, hs-TnI, creatine kinase myocardial band (CK-MB) levels, D-dimer/CK-MB, and D-dimer/hs-TnI ratios were compared in patients with APE and NSTEMI. The D-dimer/hs-TnI ratio in patients with APE was found to be considerably greater than in patients with NSTEMI. Similarly, the D-dimer/CK-MB levels in patients with APE were significantly higher than in individuals with NSTEMI. Patients with APE had higher D-dimer levels, while those with NSTEMI had higher hs-TnI levels. The D-dimer/hs-TnI ratio can be useful for emergency clinicians because it is affordable, quickly calculated, and easily accessible.

PMID:40388792 | DOI:10.1097/MD.0000000000041975

Medicine (Baltimore). 2025 May 16;104(20):e42411. doi: 10.1097/MD.0000000000042411.

ABSTRACT

Currently, there remains a significant gap in effective pharmacologic interventions for neonatal respiratory distress syndrome (NRDS). To address this critical unmet medical need, we aimed to systematically identify novel therapeutic targets and preventive strategies through comprehensive integration and analysis of multiple publicly accessible datasets. In this study, we employed an integrative approach combining druggable genome data, cis-expression quantitative trait loci (cis-eQTL) from human blood and lung tissues, and genome-wide association study summary statistics for neonatal respiratory distress. We performed two-sample Mendelian randomization (TSMR) analysis to investigate potential causal relationships between druggable genes and neonatal respiratory distress. To strengthen causal inference, we performed Bayesian co-localization analyses. Furthermore, we conducted phenome-wide Mendelian randomization (Phe-MR) to systematically evaluate potential side effects and alternative therapeutic indications associated with the identified candidate drug targets. Finally, we interrogated existing drug databases to identify actionable pharmacological agents targeting the identified genes. All 3 genes (LTBR, NAAA, CSNK1G2) were analyzed by Bayesian co-localization (PH4 > 75%). CSNK1G2 (lung eQTL, odds ratio [OR]: 0.419, 95% CI: 0.185-0.948, P = .037; blood eQTL, OR: 4.255, 95% CI: 1.346-13.455, P = .014; Gtex whole blood eQTL, OR: 4.966, 95% CI: 1.104-22.332, P = .037). LTBR (lung eQTL, OR: 0.550, 95% CI: 0.354-0.856, P = .008; blood eQTL, OR: 0.347, 95% CI: 0.179-0.671, P = .002; Gtex whole blood eQTL, OR: 0.059, 95% CI: 0.0.007-0.478, P = .008). NAAA (lung eQTL, OR: 0.717, 95% CI: 0.555-0.925, P = .011; Gtex whole blood eQTL, OR: 0.660, 95% CI: 0.476-0.913, P = .012). Drug repurposing analyses support the possibility that etanercept and asciminib hydrochloride may treat neonatal respiratory distress by activating LTBR. This study demonstrated that LTBR, NAAA, and CSNK1G2 may serve as promising biomarkers and therapeutic targets for NRDS.

PMID:40388790 | DOI:10.1097/MD.0000000000042411

Medicine (Baltimore). 2025 May 16;104(20):e42454. doi: 10.1097/MD.0000000000042454.

ABSTRACT

This study aimed to assess the diagnostic value of non-enhanced CT radiomics in preoperatively differentiating early-stage (T1-T2) from locally advanced (T3-T4) colon cancer, addressing the limitations of conventional empirical staging. A retrospective analysis was conducted on 170 patients with surgically confirmed primary colon cancer who underwent non-enhanced CT scans within 1 week before surgery. Three-dimensional segmentation of colonic tumors was performed on the non-enhanced images, followed by automated extraction of radiomic features. Feature selection was executed using the minimum redundancy maximum relevance (mRMR) algorithm, and key features associated with cancer stage were identified using the least absolute shrinkage and selection operator logistic regression. The performance of the radiomics model was compared with conventional T-staging by radiologists. The cohort comprised 170 patients with an average age of 61.69 ± 13.22 years, 43.3% of whom were female, and 75 (44.1%) presented with early-stage disease. Eight radiomic features from non-enhanced imaging were ultimately included. The radiomics model achieved an area under the curve (AUC) of 0.85 (95% confidence interval: 0.78-0.92) in the training set and 0.84 (95% confidence interval: 0.74-0.95) in the test set, with corresponding accuracies of 0.70 and 0.78, sensitivities of 0.87 and 0.87, and specificities of 0.69 and 0.71, respectively. Additionally, in the training set, the radiomics model (AUC = 0.85) significantly outperformed empirical T-staging by radiologists (AUC = 0.71, P < .009). A similar trend was observed in the test set, where the radiomics model (AUC = 0.85) surpassed empirical T-staging (AUC = 0.76), although this difference was not statistically significant (P = .27). Non-enhanced CT radiomics demonstrated superior performance over conventional radiologists’ T-staging in distinguishing early from advanced colon cancer stages.

PMID:40388788 | DOI:10.1097/MD.0000000000042454

Medicine (Baltimore). 2025 May 16;104(20):e42306. doi: 10.1097/MD.0000000000042306.

ABSTRACT

There is limited evidence regarding the association between myocardial function requiring extracorporeal membrane oxygenation (ECMO) and long-term survival rate in patients who reach hospital discharge. This study investigates the association between myocardial function parameters collected at different times from weaning from ECMO to long-term follow-up and the long-term mortality rate. This retrospective study investigates the effect of EF timing in the long-term. A cohort of 403 patients successfully weaned from veno-arterial ECMO (VA-ECMO) was identified from 1300 patients who underwent VA-ECMO between 2003 and 2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database (CGRD). The study revealed that a notable improvement in ejection fraction (EF) percentile between ECMO placement and successful weaning was significantly linked to reduced cumulative mortality as were higher EF values before discharge. However, no significant association was found between lower long-term mortality and EF change from discharge to mid-term follow-up, or the maximum EF at mid-term follow-up. Improvements in cardiac function following the use of VA-ECMO and better baseline cardiac function are associated with lower long-term mortality. The study showed that EF monitoring at ECMO insertion and before discharge can inform physicians regarding patients’ long-term outcomes. EF percentile improvement from insertion to weaning could be a positive indicator of successful weaning.

PMID:40388785 | DOI:10.1097/MD.0000000000042306

Medicine (Baltimore). 2025 May 16;104(20):e42385. doi: 10.1097/MD.0000000000042385.

ABSTRACT

BACKGROUND: Sugammadex sodium can antagonize aminosteroidal muscarinic drugs precisely and rapidly, so it has been widely used in fast-track anesthesia in recent years. However, it is not known whether there is an advantage of the antagonistic effect of sugammadex sodium over neostigmine at different doses and time points. In this single-center, randomized controlled study, we compared the effects of sugammadex sodium with neostigmine on postoperative myorelaxation recovery in patients undergoing suspension laryngoscopic surgery.

METHODS: A total of 90 patients scheduled for elective general anesthesia suspension laryngoscopy were selected, aged 18 to 65 years, body mass index 18 to 28 kg/m², and American Society of Anesthesiologists I-II grade. Patients were randomly divided into 3 groups: the sugammadex group (experimental groups, S1, S2), and the neostigmine group (control group, N), each comprising 30 patients. After the operation, group S1 received an intravenous injection of sugammadex sodium 2 mg/kg immediately, S2 received it when train-of-four COUNT (TOF-COUNT) > 2, and group N received intravenous injections of atropine 0.02 mg/kg + neostigmine 0.04 mg/kg when TOF-COUNT > 2. The mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index were recorded at various times: upon room entry (T1), during tracheal intubation (T2), at surgery start (T3), surgery end (T4), at extubation (T5), and upon room exit (T6). The duration of surgery, muscle relaxation recovery time from TOF-COUNT 0-2 at surgery end, and time from surgery end to extubation were recorded for each group, as well as the incidence of adverse reactions.

RESULTS: There were no statistically significant differences among the 3 groups in mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index at the 6 time points (T1, T2, T3, T4, T5, and T6). In terms of extubation timing, the S1 group showed a significantly shorter time compared with the S2 and N groups (P < .05). Compared with the S2 group, N group had significantly prolonged extubation times, showing a statistical difference. Compared with the N group, S1 and S2 groups had a significantly reduced incidence of bradycardia and increased secretions (P < .05).

CONCLUSION: The use of sugammadex sodium in otolaryngological suspension laryngoscopy surgeries offers certain advantages over neostigmine in terms of muscle relaxation recovery. Administering sugammadex sodium 2 mg/kg directly after surgery as compared with waiting until TOF-COUNT > 2 allows for earlier removal of the tracheal tube without increasing adverse reactions.

PMID:40388779 | DOI:10.1097/MD.0000000000042385

Medicine (Baltimore). 2025 May 16;104(20):e42469. doi: 10.1097/MD.0000000000042469.

ABSTRACT

This study aimed to quantify the lumbar skeletal muscle index (SMI) to predict the incidence and risk of lower back pain and to develop preventive strategies to reduce the incidence of sarcopenia and lower back pain. A total of 29 patients with low back pain in our hospital between September 2022 and March 2024 were enrolled, and lumbar computed tomography data were collected, including age, sex, and visual analog scale (VAS) score for low back pain. This study included 29 patients with an average age of (53.72 ± 18.82) years and an average height of (1.65 ± 0.43) m. The degree of lower back pain was evaluated using the visual analog scoring method, with an average score of (5.14 ± 1.382). Using AutoCAD drawing software, the total cross-sectional area of the skeletal muscles at the level of the lumbar vertebrae was calculated, with an average area of (105.63 ± 27.73) cm2. The SMI at the level of the lumbar vertebrae 3 was calculated as the ratio of the total cross-sectional area of the skeletal muscles at the level of the lumbar vertebrae to height2, (38.27 ± 8.07). Statistical analysis showed a significant negative correlation (P < .01) between SMI, age, and VAS score in patients with sarcopenia, whereas there was no significant difference in SMI between the sexes in patients with sarcopenia(P > .05). There was a significant negative correlation between SMI and age as well as VAS score, indicating that lower back pain is caused by a decrease in SMI. As people age, their muscle mass and strength gradually decreases.

PMID:40388778 | DOI:10.1097/MD.0000000000042469

Medicine (Baltimore). 2025 May 16;104(20):e42489. doi: 10.1097/MD.0000000000042489.

ABSTRACT

Medical staff hold dual roles as advocates and potential blood donors, yet systemic barriers within high-pressure clinical environments hinder their participation. Understanding their motivations and challenges is critical for strengthening blood supply systems. This cross-sectional study aimed to identify determinants of donation willingness and policy expectations among medical staff to inform evidence-based interventions. A structured questionnaire, developed via Delphi methodology with hematologists, policy experts, and psychologists, was administered to medical staff at a tertiary Grade A hospital in Chongqing, China. Stratified random sampling ensured representation across demographics. Data were collected via an encrypted online platform (SoJump.com) and analyzed using SPSS 22.0 and GraphPad Prism 6. Among 1096 participants, the observation group (non-donors, n = 460, 41.97%) exhibited statistically significant demographic divergences from the control group across gender, age, educational attainment and professional category (all P < .05). Multivariate logistic regression identified these variables as independent predictors of donation status (P < .05). Despite 83.26% of the observation group endorsing blood donation and 69.34% comprehending deferral criteria, key participation barriers included occupational workload saturation (59.13%), inadequate promotional mechanisms (49.57%), adverse physiological reactions (43.04%), and insufficient motivation (26.52%). For intervention optimization, respondents in the observation group prioritized structured promotional mechanisms (80.22%), establishing policy guidance protocols (53.26%), and systematizing regular donor recruitment activities (46.74%). Young, male, and highly educated medical staff exhibited higher donation rates. Structural reforms to alleviate occupational burdens, optimize donor recruitment paradigms, and institutionalize periodic mobilization are imperative to align clinical demand with donor supply.

PMID:40388772 | DOI:10.1097/MD.0000000000042489