Nevin Manimala

Cancer Cytopathol. 2025 Sep;133(9):e70046. doi: 10.1002/cncy.70046.

ABSTRACT

BACKGROUND: Rapid on-site evaluation (ROSE) of thyroid fine-needle aspiration biopsy (FNAB) improves diagnostic adequacy and facilitates ancillary molecular testing. In this prospective, multireader study, the authors evaluated the feasibility of using whole-slide images (WSIs) for ROSE to determine specimen adequacy and preliminary categorization (according to The Bethesda System for Reporting Thyroid Cytopathology [Bethesda]) of image-guided thyroid FNABs compared with conventional light-microscopic (LM) examination of the same specimens in a referral cancer center.

METHODS: The authors evaluated 98 ultrasound-guided thyroid FNAB cases. Smears were stained with Papanicolaou and Diff-Quik and were scanned at ×20 magnification using a Leica Aperio CS2 scanner. Five cytopathologists evaluated specimen adequacy and Bethesda categorization using WSI followed by LM assessment after a 2-week washout. Intraobserver and interobserver agreements were calculated using Cohen and Fleiss kappa (κ) statistics. Scan time, interpretation time, and the need for ×40 magnification or z stacking were recorded.

RESULTS: In total, 463 slides were scanned, with mean scan time of 5.48 minutes. WSI quality was acceptable in most cases. Z stacking and ×40 magnification were requested in 23% and 14% of reviews, respectively. Intrareader agreement between WSI and LM examination was excellent (κ = 0.86-0.95). Inter-reader agreement was moderate for both WSI (κ = 0.48) and LM examination (κ = 0.56). Concordance was highest for Bethesda categories I and VI and lowest for categories III-V. Interpretation with WSI took significantly longer than with LM examination (p < .0001).

CONCLUSIONS: WSI is a feasible alternative to LM examination for ROSE of thyroid FNABs, with high intrareader agreement and comparable inter-reader agreement. The limited need for high magnification and z stacking supports its practical utility.

PMID:40889104 | DOI:10.1002/cncy.70046

Ophthalmol Ther. 2025 Sep 1. doi: 10.1007/s40123-025-01226-8. Online ahead of print.

ABSTRACT

INTRODUCTION: This study investigated the long-term natural history of peripapillary pachychoroid syndrome (PPS), analyzing both morphological and functional outcomes.

METHODS: This retrospective study included 24 eyes from 14 participants diagnosed with PPS. No interventions were administered. Baseline and follow-up assessments comprised best-corrected visual acuity (BCVA), measured on the LogMAR scale, inner nasal (IN) and outer nasal (ON) macular thickness measured using the ETDRS (Early Treatment Diabetic Retinopathy Study) subfields. To account for repeated measures and the hierarchical structure of eyes nested within participants, and to appropriately handle incomplete longitudinal data, linear mixed-effects models were utilized for all statistical analyses.

RESULTS: The mean age was 74 ± 7 years, and 71% of patients had bilateral PPS. All patients had peripapillary atrophy at baseline. The mean baseline BCVA was 0.05 and showed only small variations over time. ON macular thickness showed a significant decrease at 2 years (Δ = – 36.9 µm, p = 0.034), whereas IN macular thickness decreased significantly at both 2 years (Δ = – 40.75 µm, p = 0.023) and 3 years (Δ = – 39.97 µm, p = 0.042). One-quarter of participants developed a serous pigment epithelium detachment with subretinal fluid, suggesting an overlapping PPS/CSC (central serous chorioretinopathy) phenotype.

CONCLUSIONS: Peripapillary atrophy appears to be an important anatomical predisposition for PPS. Waxing and waning of intraretinal fluid were observed during the natural course of PPS, with a significant reduction at 2 years. Most patients remained asymptomatic and maintained stable BCVA throughout long-term follow-up, indicating a generally favorable prognosis in the absence of intervention.

PMID:40889090 | DOI:10.1007/s40123-025-01226-8

CNS Drugs. 2025 Sep 1. doi: 10.1007/s40263-025-01215-2. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize multinational trends and patterns of opioid analgesic prescribing by sex and age.

DESIGN, SETTING, AND PARTICIPANTS: We studied opioid analgesic prescribing from 2001 to 2019 with common protocol using population-based databases from eighteen countries and one special administrative region.

MAIN OUTCOME MEASURES: We measured opioid prescribing by geographical region, sex and age, estimating annual prevalent, incident, and nonincident opioid prescribing per 100 population with a 95% confidence interval (CI) and meta-analyzed the multinational and regional opioid prescribing with a random-effects model. Time trends were reported through average annual absolute changes, estimated using linear mixed models. We further explored the effect of sex and age on prevalent opioid prescribing in the multivariable analysis.

RESULTS: Over 248 million individuals were included. Pooled multinational opioid prescribing prevalence was 9.0% amongst included countries/regions. Opioid prescribing prevalence in 2015 ranged from 2.7% in Japan to 19.7% in Iceland. Average annual absolute changes in opioid prescribing prevalence per year ranged from – 1.53% (95% CI – 2.06, – 1.00; United States Medicaid) to + 1.24% (95% CI 1.02, 1.46; South Korea). Pooled multinational incident opioid prescribing (4.9%; 95% CI 4.1, 5.9) was higher than pooled multinational nonincident opioid prescribing (3.7%; 95% CI 2.9, 4.8). The female sex and older age were associated with higher opioid prescribing. Main limitations of this study include the absence of data from study duration or individuals not covered by the data sources and the lack of information on medication adherence and indication.

CONCLUSIONS: Opioid prescribing remains unbalanced across geographical regions; however, results suggest a tendency to convergence across countries/regions. Differences in opioid prescribing by sex and age were identified.

PMID:40889082 | DOI:10.1007/s40263-025-01215-2

AIDS Behav. 2025 Sep 1. doi: 10.1007/s10461-025-04822-8. Online ahead of print.

ABSTRACT

Female sex workers (FSW) are a key population who experience a disproportionately high burden of HIV and sexually transmitted infections (STIs). A growing body of evidence suggests that financial incentives can reduce risky sexual behavior and reduce HIV/STI incidence, however few studies have examined a lottery-based incentive mechanism or been conducted with FSW. We examined the effect of a lottery intervention on combined HIV/HSV2 incidence among FSW. The RESPECT II trial was an unmasked, two-arm, parallel group randomized controlled trial conducted in Dar es Salaam, Tanzania (AEA RCT registry: AEARCTR-0002677). Individuals who were ≥ 18 years of age, HIV-negative, not currently pregnant, exchanged sex for money in the past six months, and living in Dar es Salaam were eligible. Participants were randomized in a 1:1 ratio to the basic test group (control) which included testing and counseling for HIV and biweekly text messages with information on safe sex practices, or to the lottery group, which provided the basic test group intervention plus entry into a weekly lottery with a 100,000 TZS (~ $50 USD) reward offered to ten randomly selected participants, conditional on negative test results for syphilis and trichomonas. The primary outcome was combined HIV/HSV2 incidence after 36 months. Between August 2018-February 2019, 2,489 individuals screened for eligibility and 2,206 were enrolled in the trial and randomized. Participants were followed for up to 36 months; 1089 (49.4%) were lost to follow-up at endline and 1,117 were included in the primary intent to treat analysis (609 lottery, 508 control). At 36 months, there was no effect of the lottery intervention on the incidence of combined HIV/HSV2 (unadjusted RD: – 0.006, 95% CI – 0.05, 0.04; adjusted RD – 0.001, 95% CI – 0.05, 0.05). However, the results may have been affected by disruption from the COVID-19 pandemic, and unexpectedly high study attrition levels made it impossible to statistically rule out possible moderate-sized effects.

PMID:40889079 | DOI:10.1007/s10461-025-04822-8

Matern Child Health J. 2025 Sep 1. doi: 10.1007/s10995-025-04174-8. Online ahead of print.

ABSTRACT

OBJECTIVES: This study uses 2022 National Vital Statistics System natality data to identify characteristics associated with infertility treatment among nulliparous individuals 35 years or older, comparing pregnancy and birth outcomes between no infertility treatment and assisted reproductive technology (ART) or fertility-enhancing drugs or intrauterine insemination (IUI).

METHODS: The likelihood of infertility treatment was estimated after controlling for maternal age, education, race and ethnicity, insurance status, Women, Infants and Children (WIC) support, pre-pregnancy body mass index (BMI), chronic hypertension, diabetes, and smoking during pregnancy. Maternal outcomes (gestational diabetes, hypertensive disorders of pregnancy, cesarean birth, maternal morbidity) and neonatal outcomes (preterm birth, low birth weight, neonatal intensive care, and congenital anomalies) were compared for singleton and multifetal births separately.

RESULTS: Among 173,399 births, 13.6% had infertility treatment (10.9% ART, 2.4% IUI). As compared to people who identified as white or Asian, infertility treatment was over one-third less likely for non-Hispanic Black and Hispanic individuals and 2.4 times more likely for those with a graduate degree as compared to those with less than high school. Infertility treatment was associated with significantly higher rates of all adverse maternal and neonatal outcomes, and among multifetal births, ART was associated with a higher rate of maternal morbidity and more frequent gestational diabetes.

CONCLUSIONS FOR PRACTICE: Disparities in infertility treatment exist. ART was associated with modest but significantly worse outcomes, particularly for singleton births. Continued monitoring of infertility treatment selection and birth outcomes is needed for informed clinical and public policy decisions.

PMID:40889057 | DOI:10.1007/s10995-025-04174-8

Matern Child Health J. 2025 Sep 1. doi: 10.1007/s10995-025-04156-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Child vaccination is a crucial public health indicator, especially in conflict-affected regions. Despite the benefits, vaccination rates in Yemen remain suboptimal. This study evaluates vaccination coverage and its correlates among children aged 12-35 months in Yemen.

METHODS: Data from the Yemen Multiple Indicator Cluster Survey (MICS) 2022-23 were used. The survey covered 22 governorates, using a two-stage household selection process, and included 7,796 children. Vaccination status was assessed using a binary composite variable for full immunization. Multilevel logistic regression with robust error variance identified predictors of full vaccination.

RESULTS: The overall vaccination coverage was 29%, with urban areas (41%) having higher rates compared to rural areas (25%). Female children had slightly lower odds of being fully vaccinated than male children, though not statistically significant. First-born children had the highest vaccination rates (31%), with odds decreasing with higher birth order. Mothers’ secondary or higher education (AOR: 1.59, 95% CI: 1.19-2.13), receiving prenatal care (AOR: 1.97, 95% CI: 1.26-3.07), and reading newspapers at least once a week (AOR: 1.72, 95% CI: 1.21-2.44) were significant positive predictors. Higher fathers’ education, fewer children under five in the household, higher household wealth, and urban residence were also associated with higher vaccination rates. Other factors such as hospital delivery, TV watching, internet access, and mobile phone ownership were not significantly associated with full vaccination after adjustment.

CONCLUSION: Significant gaps in immunization coverage among children in Yemen, particularly in rural areas, highlight the need for educational programs for parents, enhanced healthcare infrastructure, and improved health communication strategies.

PMID:40889054 | DOI:10.1007/s10995-025-04156-w

Int J Implant Dent. 2025 Sep 1;11(1):57. doi: 10.1186/s40729-025-00645-3.

ABSTRACT

INTRODUCTION: Peri-implantitis (PI) is a biofilm-related condition driven by bacterial colonization on dental implant surfaces, leading to inflammation of the peri-implant connective tissue and progressive bone loss. Despite advancements, effective strategies for eradicating these biofilms remain elusive. While high-intensity focused ultrasound (HIFU) has been popularized in medicine, its effects on dental implant-attached biofilms remain unclear. This study presents in vitro findings on the effects of HIFU treatment on titanium (Ti)-attached Streptococcus mutans (S. mutans) biofilms and evaluates its impacts on the surface roughness and chemical composition of the Ti disc substrates.

METHODS: To optimise the HIFU parameters, four quadrants of a pair of Ti discs [machined (M) and alumina grit blasted (AB)] were marked using laser etching (MD Waterlase, US). HIFU beams, generated by a 254 kHz transducer and operated at intensities of 0 W, 10 W, 20 W, and 30 W, were applied to each quadrant for 2 min (min) in a water medium. The roughness of the treated surfaces was measured using Atomic Force Microscopy (AFM), and the surface composition was analyzed using Scanning Electron Microscope-Energy Dispersive Spectrometry (SEM-EDS). To investigate the biofilm debridement, 10-day-old S. mutans cultures were grown on 20 pairs of similar Ti discs, and then the optimized HIFU intensity of 20W was applied to five test pairs. Qualitative analyses were performed using a Dual Fluorescence/Reflection Confocal Laser Scanning Microscope (FRCLSM) and SEM imaging. Quantitative data on cell viability were collected using crystal violet (CV), (3-[4,5-dimethylthiazol-2-yl]-2,5 2,5-diphenyl tetrazolium bromide) (MTT), and flow cytometry (FCM) assays. Data from these test conditions were analyzed alongside cultures on biofilms that were untreated (control). Statistical data were calculated using ANOVA and appropriate t-tests for repeated measures.

RESULTS: The surface roughness of AB Ti discs showed a highest and significant increase (p < 0.05) following HIFU exposure at 20 W through three roughness parameters (Sa, Sq, and Sdr), compared to the controls (1207 nm, 1455 nm, 62% compared to 842 nm, 1042 nm and 30% respectively). This optimized HIFU treatment not only significantly reduced the bacterial counts of the biofilms (76% of total bacteria from M discs, 59% on AB discs in FCM assays) but also created areas of complete biofilm removal in SEM images.

CONCLUSION: This study provides preliminary in vitro evidence that HIFU can remove bacterial biofilms. Further research is required to determine its feasibility as a potential non-surgical approach for the prevention and management of peri-implantitis.

PMID:40889051 | DOI:10.1186/s40729-025-00645-3

J Robot Surg. 2025 Sep 1;19(1):544. doi: 10.1007/s11701-025-02707-5.

ABSTRACT

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical approach for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) seeking bowel continuity. While laparoscopy improves recovery, robotic-assisted surgery may offer advantages in pelvic procedures. However, its comparative efficacy remains unclear. This systematic review followed PRISMA guidelines to compare short-term outcomes of robotic-assisted IPAA with laparoscopic and open techniques. Literature was searched across PubMed, Embase, Web of Science, and the Cochrane Library for studies from January 2000 to June 2025. Included studies compared adult patients (≥ 18 years) undergoing IPAA for malignancy, UC or FAP. Primary outcomes were operative time, blood loss, hospital stay, and complications; secondary outcomes included conversion to open surgery, readmission, and reoperation. Meta-analysis was performed using pooled odds ratios, mean difference and 95% confidence intervals. Ten studies including 3,166 patients met inclusion criteria. Robotic IPAA was associated with a shorter length of stay (WMD – 1.1 days, 95% CI – 1.8 to – 0.3) and a non-significant trend toward fewer conversions to open surgery (OR 0.33, 95% CI 0.10-1.13). However, robotic procedures had longer operative times. Estimated blood loss did not differ significantly, and no significant differences were found in postoperative complications, anastomotic leaks, readmissions, or reoperations. Robotic-assisted IPAA is a safe and viable alternative to laparoscopic and open surgery, offering benefits in shorter hospital stay and conversion rates. Although operative times are longer, morbidity is comparable. Further prospective studies are needed to confirm these findings and evaluate long-term functional outcomes.

PMID:40889021 | DOI:10.1007/s11701-025-02707-5

J Egypt Natl Canc Inst. 2025 Sep 1;37(1):63. doi: 10.1186/s43046-025-00313-y.

ABSTRACT

BACKGROUND: The potential involvement of JC polyomavirus (JCPyV) in prostate cancer (PCa) remains a subject of debate, as existing in vitro studies have produced conflicting results. Understanding the viral oncogenic mechanisms underlying prostate cancer could offer valuable insights into its etiology. This study aimed to explore the association between JCPyV infection and prostate cancer by detecting the viral large T-antigen gene in prostate tissue specimens.

METHODS: A case-control study was conducted from February 2022 to March 2023, including 100 participants: 50 diagnosed with prostate cancer (cases) and 50 with benign prostatic hyperplasia (BPH) as controls. Formalin-fixed paraffin-embedded (FFPE) prostate tissue samples were collected from all participants. Nested polymerase chain reaction (PCR) was employed to detect JCPyV large T-antigen DNA using specific primers. Demographic and clinical data were obtained via a structured questionnaire. Statistical analysis was carried out using SPSS version 20, and associations between JCPyV presence and prostate cancer were analyzed using logistic regression.

RESULTS: The mean age of the prostate cancer group was 67.5 ± 10.9 years, compared to 70.9 ± 8.9 years in the control group. JCPyV large T-antigen DNA was detected in 29 out of 50 (58%) prostate cancer cases, compared to 19 out of 50 (38%) controls (P = 0.045; odds ratio = 1.45; 95% confidence interval: 1.011 to 5.019). Within the prostate cancer group, patients testing positive for the JCPyV T-antigen had a mean age of 73.3 ± 8.7 years, significantly higher than T-antigen-negative patients, whose mean age was 67.0 ± 8.3 years (P = 0.029).

CONCLUSION: The prevalence of JCPyV large T-antigen gene was significantly higher in prostate cancer patients than in individuals with benign prostatic hyperplasia. These findings suggest that JCPyV infection may be linked to an increased risk of prostate cancer, reinforcing prior studies that imply a potential oncogenic role for the virus in prostate carcinogenesis. Further investigations are necessary to elucidate the molecular mechanisms driving this association and its potential clinical implications.

PMID:40888995 | DOI:10.1186/s43046-025-00313-y

Support Care Cancer. 2025 Sep 1;33(9):828. doi: 10.1007/s00520-025-09881-0.

ABSTRACT

PURPOSE: The impact of a cancer diagnosis on racial differences in financial well-being and treatment related financial toxicity has not been well characterized. The purpose of this study was to compare relative disparities in financial distress by race among respondents with and without a history of cancer.

METHODS: We performed a retrospective cohort study based on the National Health Interview Survey (2010 to 2018). Primary outcomes included financial hardship questions about medication adherence, worry about medical costs, and worry about monthly bills. Multivariable logistic regression analysis examined the association of a cancer diagnosis and racial disparities in financial hardship using an interaction term of race and history of cancer.

RESULTS: We included 204,754 participants without a history of cancer and 19,094 cancer survivors. Black participants with a history of cancer reported higher rates of medication modification due to financial constraints (9.2%), compared to Black participants without cancer (4.8%) and White participants with (5.1%) or without (3.8%) cancer. By multivariable analysis, a history of cancer significantly worsened Black-White disparities in financial-related medication adherence measures and problems with medical bills, with Black patients more likely to report that they took less medicine to save money (OR 1.48, 95% CI 1.17-1.88, P = 0.001), delayed filling prescriptions to save money (OR 1.42, 95% CI 1.13-1.77, P = 0.002), and asked for lower-cost medications to save money (OR 1.27, 95% CI 1.07-1.50, P = 0.005), had problems paying medical bills (OR 1.29, 95% CI 1.08-1.53, P = 0.003), paid off medical bills over time (OR 1.45, 95% CI 1.24-1.69, P < 0.001), and delayed medical care because of worry about cost (OR 1.31, 95% CI 1.03-1.66, P = 0.023).

CONCLUSIONS: Black-White disparities in self-reported medical financial hardship among insured adults are worsened by a diagnosis of cancer. Policy- and system-level interventions are required to improve long-term financial distress among Black cancer survivors.

PMID:40888994 | DOI:10.1007/s00520-025-09881-0