Nevin Manimala

BMC Cancer. 2025 May 7;25(1):840. doi: 10.1186/s12885-025-14149-1.

ABSTRACT

OBJECTIVE: The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS: The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS: Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I² = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I² = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I² = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I² = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I² = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I² = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I² = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I² = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I² = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I² = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I² = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I² = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I² = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I² = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I² = 79%).

CONCLUSIONS: This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.

PMID:40336054 | DOI:10.1186/s12885-025-14149-1

Reprod Biol Endocrinol. 2025 May 7;23(1):63. doi: 10.1186/s12958-025-01397-w.

ABSTRACT

BACKGROUND: Borderline ovarian tumors (BOTs) are neoplasms of low malignant potential that predominantly affect women of reproductive age. Fertility preservation through fertility-sparing surgery is widely practiced; however, concerns remain regarding the risk of tumor recurrence and the reproductive outcomes following in vitro fertilization (IVF). This study aimed to evaluate IVF/ intracytoplasmic sperm injection (ICSI) outcomes in BOTs patients post-FSS and to assess the association between ovarian stimulation parameters and tumor recurrence.

METHODS: In this retrospective cohort study conducted at Sixth Hospital of Sun Yat-sen University from May 2010 to May 2023, 65 women with a history of FSS for BOTs who underwent IVF/ICSI were identified. After propensity score matching, 61 BOTs patients were compared with 181 control patients without ovarian tumors. Key outcomes evaluated included ovarian stimulation parameters, live birth rates, neonatal outcomes and risk factors for tumor recurrence.

RESULTS: The BOTs and control groups exhibited similar outcomes regarding the number of oocytes retrieved, the quality and number of embryos, and live birth rates from the first IVF/ICSI cycles. The cumulative live birth rate over 13 years and neonatal parameters (gestational age, birth weight, and body length) were also comparable between groups. Tumor recurrence was observed in 8.62% of BOTs patients, with no significant association identified between recurrence and ovarian stimulation parameters or peak estradiol levels.

CONCLUSIONS: IVF/ICSI following fertility-sparing surgery for BOTs patients yields reproductive and neonatal outcomes comparable to those in patients without BOTs and does not increase the risk of tumor recurrence. These findings support the safety and efficacy of IVF as a fertility treatment option for BOTs patients after conservative surgery. Further prospective studies with larger cohorts are warranted to validate these results and refine ovarian stimulation strategies.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40336050 | DOI:10.1186/s12958-025-01397-w

BMC Urol. 2025 May 7;25(1):116. doi: 10.1186/s12894-025-01810-x.

ABSTRACT

INTRODUCTION: Radical prostatectomy is a key treatment for prostate cancer. However, the impact of the learning curve of the surgeon has on the pentafecta is unclear. This meta-analysis aims to determine the impact of a procedure being performed in the initial learning curve has on the surgical results.

MATERIALS AND METHODS: A systematic review of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar was conducted up to March 2024, focusing on learning curves in prostatectomy. Primary outcome was biochemical recurrence rate (BCR); secondary outcomes included positive surgical margin (PSM) rate, continence, potency, operative time, blood loss, and complications (Clavien-Dindo classification). Bias was assessed using the ROBINS-I tool, and statistical analysis was done via Review Manager 5.4.

RESULTS: Sixteen studies with 21,851 patients were included. No significant difference in BCR rates was found between initial and advanced learning curves (OR1.44;95%CI0.97,2.13;p = 0.07;I²=74%). No significant difference in continence rates was also observed. (RD-0.05;95CI-0.10,0.01;p = 0.08;I²=86%). However, advanced learning curves showed lower PSM rates (OR1.61;95%CI1.19,2.17;p = 0.002;I²=88%), higher potency, less blood loss, shorter operative time, and fewer complications. Although randomized trials are unlikely in this context, further high-quality prospective studies are needed to validate these findings.

CONCLUSION: This meta-analysis highlights that achieving favorable outcomes in key pentafecta parameters-particularly potency, continence, and complication rates-increases with surgical experience. These findings emphasize the value of structured mentorship and establishing surgical volume benchmarks in training programs. Our analysis suggests that reaching a threshold of 100 cases may be necessary to consistently attain optimal functional and perioperative results.

PMID:40336044 | DOI:10.1186/s12894-025-01810-x

Clin Epigenetics. 2025 May 7;17(1):78. doi: 10.1186/s13148-025-01880-6.

ABSTRACT

BACKGROUND: Epigenetic aging estimators commonly track chronological and biological aging, quantifying its accumulation (i.e., epigenetic age acceleration) or speed (i.e., epigenetic aging pace). Their scores reflect a combination of inherent biological programming and the impact of environmental factors, which are suggested to vary at different life stages. The transition from adolescence to adulthood is an important period in this regard, marked by an increasing and, then, stabilizing epigenetic aging variance. Whether this pattern arises from environmental influences or genetic factors is still uncertain. This study delves into understanding the genetic and environmental contributions to variance in epigenetic aging across these developmental stages. Using twin modeling, we analyzed four estimators of epigenetic aging, namely Horvath Acceleration, PedBE Acceleration, GrimAge Acceleration, and DunedinPACE, based on saliva samples collected at two timepoints approximately 2.5 years apart from 976 twins of four birth cohorts (aged about 9.5, 15.5, 21.5, and 27.5 years at first and 12, 18, 24, and 30 years at second measurement occasion).

RESULTS: Half to two-thirds (50-68%) of the differences in epigenetic aging were due to unique environmental factors, indicating the role of life experiences and epigenetic drift, besides measurement error. The remaining variance was explained by genetic (Horvath Acceleration: 24%; GrimAge Acceleration: 32%; DunedinPACE: 47%) and shared environmental factors (Horvath Acceleration: 26%; PedBE Acceleration: 47%). The genetic and shared environmental factors represented the primary sources of stable differences in corresponding epigenetic aging estimators over 2.5 years. Age moderation analyses revealed that the variance due to individually unique environmental sources was smaller in younger than in older cohorts in epigenetic aging estimators trained on chronological age (Horvath Acceleration: 47-49%; PedBE Acceleration: 33-68%). The variance due to genetic contributions, in turn, potentially increased across age groups for epigenetic aging estimators trained in adult samples (Horvath Acceleration: 18-39%; GrimAge Acceleration: 24-43%; DunedinPACE: 42-57%).

CONCLUSIONS: Transition to adulthood is a period of the increasing variance in epigenetic aging. Both environmental and genetic factors contribute to this trend. The degree of environmental and genetic contributions can be partially explained by the design of epigenetic aging estimators.

PMID:40336042 | DOI:10.1186/s13148-025-01880-6

BMC Urol. 2025 May 7;25(1):115. doi: 10.1186/s12894-025-01799-3.

ABSTRACT

OBJECTIVES: Flexible ureteroscopy (FURS) is a commonly chosen technique for kidney stone treatment. The use of ureteral access sheaths (UAS) enhances both access and the procedure’s effectiveness. This study performs a systematic review and meta-analysis to assess the efficacy and safety of flexible and navigable suction UAS (FANS-UAS) versus standard UAS (S-UAS) in FURS.

METHODS: This systematic review and meta-analysis involved searching databases such as PubMed/Medline, Scopus, Embase, Cochrane, and Web of Science until October 2024. The results were categorized into two groups: FANS-UAS as the intervention and S-UAS as the control. The outcomes measured included stone-free rate (SFR), duration of lithotripsy, length of hospitalization, and incidence of complications.

FINDINGS: Eight studies were incorporated into the analysis. The findings revealed that the SFR on the first day in the intervention group was over twice that of the control group (RR = 2.12, 95% CI: 1.13-3.98, P = 0.019). Furthermore, the SFR during follow-up was 15% greater in the intervention group than in the control group (RR = 1.15, 95% CI: 1.06-1.25, P = 0.0008), with these differences being statistically significant. However, the standardized mean differences for the outcomes of duration of lithotripsy and postoperative hospitalization between the groups were minimal and not statistically significant (P > 0.05). The intervention group had 67% fewer fevers (RR = 0.33, 95% CI: 0.22-0.48, P < 0.001) and 43% fewer cases of sepsis (RR = 0.57, 95% CI: 0.23-1.39, P = 0.215) than the control group.

CONCLUSION: Use of FANS-UAS significantly improves both first-day SFR and follow-up SFR. It is superior to S-UAS in minimizing postoperative complications. Both these factors contribute to significantly improved perioperative outcomes in flexible ureteroscopy.

PMID:40336020 | DOI:10.1186/s12894-025-01799-3

BMC Public Health. 2025 May 7;25(1):1677. doi: 10.1186/s12889-025-22871-5.

ABSTRACT

BACKGROUND: In recent years, medical interventional treatment for children with autism spectrum disorder (ASD) has been gradually introduced in medical institutions in the Guangxi Zhuang Autonomous Region in southern China. However, the allocation of these medical resources has been uneven. This study describes the spatial allocation of medical resources for children with ASD in Guangxi, evaluates their supply and utilization, and expounds on their correlations with socioeconomic and demographic conditions.

METHODS: This study was based on a special survey conducted from 2021 to 2022 by the Guangxi Disabled Rehabilitation Research Center. The number of medical institutions for children with ASD (MIIs), average number of ASD technicians per 10,000 target people (CTPP), and coverage rate of medical interventions (CMI) were set as dependent variables, while population density, proportion of town residents, total retail sales of consumer goods, disposable income per capita gross domestic product per capita (GDPpc), and number of enterprises above designated size were set as independent variables, all of which were included in the spatial statistical model. The main analysis methods was multiscale geographically weighted regression (MGWR).

RESULTS: The allocation of MIIs (Moran’s I = 0.119, p = 0.007), CTPP (Moran’s I = 0.208, p = 0.017), and CMI (Moran’s I = 0.251, p = 0.004) in Guangxi showed significant spatial autocorrelation. The medical resources formed high-value hot spots in major districts of core cities, while the medical resources were scarce in some remote ethnic minority counties and densely populated areas in southeastern Guangxi. MIIs showed significant spatial correlations with population density (EV=-0.225, p = 0.001), proportion of town residents (EV = 0.255, p = 0.002), total retail sales of consumer goods (EV = 0.806, p < 0.001), and disposable income per capita (EV=-0.267, p < 0.001). CTPP showed significant correlations with population density (EV = 0.211, p = 0.019), GDPpc (EV = 0.267, p = 0.002), total retail sales of consumer goods (EV = 0.382, p < 0.001), and number of enterprises above designated size (EV=-0.242, p = 0.005). CMI showed a significant association with proportion of town residents (EV = 0.415, p < 0.001), total retail sales of consumer goods (EV = 0.273, p = 0.006), and number of enterprises above designated size (EV=-0.236, p = 0.003).

CONCLUSIONS: The spatial allocation of medical resources for children with ASD in Guangxi is heterogeneous, and correlates varyingly with regional socioeconomic conditions as well as urbanization and demographic conditions.

PMID:40336016 | DOI:10.1186/s12889-025-22871-5

BMC Public Health. 2025 May 7;25(1):1692. doi: 10.1186/s12889-025-22803-3.

ABSTRACT

BACKGROUND: The European Code Against Cancer (ECAC) aims to increase the awareness of modifiable cancer risk factors among the general public. A goal set by the European Commission was that 80% of European citizens should be aware of this code by 2025. This study aims to examine the awareness and attitudes towards the ECAC among the general public in Sweden.

METHODS: A randomly selected sample of 1520 Swedes (18-84 years old) were recruited from a survey panel and invited to respond to an online study-specific questionnaire. The questionnaire included general questions regarding cancer prevention, as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, using post-stratification weights based on gender, age, education, and expressed political party orientation.

RESULTS: In total, 3.7% of the respondents had heard about the ECAC before taking this survey. Respondents with a college/university education were more likely to have heard about the ECAC (odds ratio [OR] 2.23; 95% confidence interval [CI] 1.23-4.06). Males (OR 0.56; 95% CI 0.32-0.99), and those living alone (OR 0.47; 95% CI 0.23-0.95) were less likely to have heard about the ECAC. In total, 60.6% of the respondents agreed with the ECAC recommendations, while 27.4% reported that their motivation to improve their lifestyle increased after reading the ECAC.

CONCLUSIONS: Awareness of the ECAC among the general public in Sweden is very low. Still, a majority seem to agree with its recommendations. The results also indicate that the ECAC motivates some, but far from all, to improve their lifestyle habits to reduce their cancer risk. Consequently, further research is warranted on how the ECAC best could and should be used in order to improve cancer prevention awareness and motivation.

PMID:40336012 | DOI:10.1186/s12889-025-22803-3

BMC Med Educ. 2025 May 7;25(1):666. doi: 10.1186/s12909-025-07250-3.

ABSTRACT

BACKGROUND: Large language models (LLMs) like GPT-4o have shown promise in advancing medical decision-making and education. However, their performance in Spanish-language medical contexts remains underexplored. This study evaluates the effectiveness of single-agent and multi-agent strategies in answering questions from the EUNACOM, a standardized medical licensure exam in Chile, across 21 medical specialties.

METHODS: GPT-4o was tested on 1,062 multiple-choice questions from publicly available EUNACOM preparation materials. Single-agent strategies included Zero-Shot, Few-Shot, Chain-of-Thought (CoT), Self-Reflection, and MED-PROMPT, while multi-agent strategies involved Voting, Weighted Voting, Borda Count, MEDAGENTS, and MDAGENTS. Each strategy was tested under three temperature settings (0.3, 0.6, 1.2). Performance was assessed by accuracy, and statistical analyses, including Kruskal-Wallis and Mann-Whitney U tests, were performed. Computational resource utilization, such as API calls and execution time, was also analyzed.

RESULTS: MDAGENTS achieved the highest accuracy with a mean score of 89.97% (SD = 0.56%), outperforming all other strategies (p < 0.001). MEDAGENTS followed with a mean score of 87.99% (SD = 0.49%), and the CoT with Few-Shot strategy scored 87.67% (SD = 0.12%). Temperature settings did not significantly affect performance (F2,54 = 1.45, p = 0.24). Specialty-level analysis showed the highest accuracies in Psychiatry (95.51%), Neurology (95.49%), and Surgery (95.38%), while lower accuracies were observed in Neonatology (77.54%), Otolaryngology (76.64%), and Urology/Nephrology (76.59%). Notably, several exam questions were correctly answered using simpler single-agent strategies without employing complex reasoning or collaboration frameworks.

CONCLUSIONS AND RELEVANCE: Multi-agent strategies, particularly MDAGENTS, significantly enhance GPT-4o’s performance on Spanish-language medical exams, leveraging collaboration to improve diagnostic accuracy. However, simpler single-agent strategies are sufficient to address many questions, high-lighting that only a fraction of standardized medical exams require sophisticated reasoning or multi-agent interaction. These findings suggest potential for LLMs as efficient and scalable tools in Spanish-speaking healthcare, though computational optimization remains a key area for future research.

PMID:40336004 | DOI:10.1186/s12909-025-07250-3

BMC Oral Health. 2025 May 7;25(1):689. doi: 10.1186/s12903-025-06069-0.

ABSTRACT

BACKGROUND: Effective patient education is critical in enhancing treatment outcomes and reducing anxiety in dental procedures. This study compares the effectiveness of AI-generated educational materials with traditional methods in improving patient comprehension and reducing anxiety during endodontic and restorative dental treatments.

METHODS: A cross-sectional, comparative study was conducted with 100 participants undergoing restorative or endodontic procedures. Patients were randomized into two groups: those receiving AI-generated instructional materials (via ChatGPT) and those receiving traditional education (verbal explanations and pamphlets). Baseline knowledge and post-intervention knowledge retention were assessed using structured tests. Patient perceptions of clarity, usefulness, comprehensiveness, trust, and anxiety were measured using Likert-scale surveys. Three dental experts evaluated the educational content for accuracy and suitability. Statistical analysis included t-tests and Cohen’s kappa to measure inter-rater reliability.

RESULTS: AI-generated materials significantly outperformed traditional methods in all measured dimensions, including clarity (4.42 vs. 3.25), usefulness (4.63 vs. 3.50), comprehensiveness (4.50 vs. 3.29), trust (4.00 vs. 2.96), and anxiety reduction (mean anxiety score: 2.63 vs. 3.38, p < 0.001). Pre- and post-intervention knowledge assessments revealed substantial knowledge improvement in the AI group. Expert evaluations confirmed the accuracy and suitability of AI-generated materials, with high inter-rater reliability (κ = 0.75, p < 0.001).

CONCLUSIONS: AI-generated educational materials demonstrate superior effectiveness in improving patient comprehension and reducing anxiety compared to traditional methods. Their integration into dental practice could enhance patient satisfaction and streamline the educational process, particularly for complex or anxiety-inducing procedures. Future research should explore their application in diverse dental specialties and assess long-term impacts on patient behavior and clinical outcomes.

PMID:40335999 | DOI:10.1186/s12903-025-06069-0

J Pediatr Nurs. 2025 May 6;83:154-159. doi: 10.1016/j.pedn.2025.04.033. Online ahead of print.

ABSTRACT

BACKGROUND & OBJECTIVE: Identifying the care needs of parents of children with epilepsy using a reliable tool can help improve the quality of life for both parents and children, enhance care provision, and facilitate disease management. This study aimed to design and psychometrically evaluate the Needs of Parents Caring for Children with Epilepsy Questionnaire (NPCEQ).

METHODS: This study employed a two-stage exploratory sequential mixed-methods design. In the first stage, 13 semi-structured interviews were conducted to clarify the concept of “parental care needs for children with epilepsy.” A conventional content analysis of the interview transcripts was performed to identify subscales and items for inclusion in the instrument. In the second stage, the psychometric properties of the questionnaire were evaluated. The NPCEQ utilizes a 5-point Likert scale. Face validity was assessed by 20 parents, and content validity was evaluated by 35 faculty members. Reliability was tested in a random sample of 331 caregivers.

RESULTS: The final NPCEQ consists of five dimensions with 31 items, accounting for 59.07 % of the total variance. The overall CVR was 0.853, and CVI was 0.877, both indicating very good levels. Internal consistency was assessed using Cronbach’s alpha (0.761). Internal stability was evaluated using the intraclass correlation coefficient (ICC), which was found to be adequate (ICC = 0.62-0.86). The NPCEQ demonstrated evidence of content validity, construct validity, internal consistency, and stability.

CONCLUSION: The NPCEQ demonstrated evidence of content validity, construct validity, internal consistency, and stability. The statistical analysis of the NPCEQ provided an objective tool for assessing the care needs of parents of children with epilepsy in clinical and domestic contexts.

PMID:40334568 | DOI:10.1016/j.pedn.2025.04.033