Nevin Manimala

Pediatr Cardiol. 2025 Dec 6. doi: 10.1007/s00246-025-04120-z. Online ahead of print.

ABSTRACT

In pediatric cardiac critical care, patients often require specific anesthesia and sedation considerations due to unique physiological vulnerabilities. This study assessed the incidence of propofol-related infusion syndrome (PRIS) in Pediatric Cardiac Intensive Care Unit (PCICU) patients receiving continuous propofol infusion for non-procedural sedation. We conducted a retrospective review of post-operative congenital heart disease patients < 18 years admitted to the PCICU from 1/1/2000-9/30/2024, who received continuous propofol infusions ≥ 12 hours and/or ≥ 2.4 mg/kg/hour. The primary outcome was the incidence of PRIS. Secondary outcomes included intensive care unit (ICU) length of stay and survival to hospital discharge. Statistical analyses included chi-square tests and the Kruskal-Wallis test, stratified by physiological complexity (single vs. double ventricle) and surgical mortality risk scores (The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery [STAT] score). A total of 641 patients were included. No statistically significant differences in propofol characteristics were found across physiologic or surgical risk groups. The median infusion rate was 1.2 mg/kg/hour, with a median duration of 22.7 hours. No cases of PRIS occurred. Survival to hospital discharge was 97%. The median ICU length of stay was 7.1 days. In this single center, retrospective study of post-operative congenital heart disease patients, continuous propofol infusion was not associated with any cases of PRIS. These findings support the cautious use of propofol in pediatric cardiac critical care. Further prospective studies are needed to evaluate safety across the heterogenous congenital heart disease population, including those with single ventricle physiology.

PMID:41351635 | DOI:10.1007/s00246-025-04120-z

Int J Colorectal Dis. 2025 Dec 6. doi: 10.1007/s00384-025-05048-9. Online ahead of print.

ABSTRACT

PURPOSE: Colorectal cancer (CRC) is becoming increasingly common in adults ≥ 60 years old, yet postoperative prognosis of curative-intent surgery for the advanced elderly (≥ 80 years) remains controversial.

METHODS: A retrospective cohort study included 971 CRC patients aged ≥ 60 years who underwent curative-intent surgery from January 2018 to December 2023 in Beijing Chaoyang Hospital. Patients were stratified into “ordinary elderly group” (OE) (60-79 years, n = 800) and “advanced elderly group” (AE) (≥ 80 years, n = 171). Clinicopathological variables, 30-day morbidity/mortality, disease-free survival (DFS), and overall survival (OS) were collected and analyzed the differences between the two groups. The study was presented in accordance with the STROBE reporting checklist.

RESULTS: The AE had more right-sided CRC (P < 0.001) and higher rate of preoperative obstruction (P < 0.001). They underwent more emergency (P = 0.002) and open procedures (P < 0.001), resulting in longer postoperative stays P = 0.030). Overall, 30-day morbidity was comparable (P = 0.76), but perioperative mortality rate was higher in AE (P = 0.041). The median follow-up was 36.1 ± 22.1 months, and recurrence rates (P = 0.58) and 5-year DFS (log-rank P = 0.42) did not differ between groups. Multivariate analysis identified TNM stage, perineural invasion, vascular invasion, preoperative intestinal obstruction, and proficient Mismatch Repair (pMMR) as independent predictors of DFS; age ≥ 80 years was not prognostic (p = 0.81).

CONCLUSIONS: Despite a higher burden of comorbidities and increased perioperative mortality, no statistically significant difference in long-term oncological outcomes was observed between AE and OE following rigorous patient selection and perioperative management in CRC patients. Advanced age alone should not preclude standard curative resection.

PMID:41351632 | DOI:10.1007/s00384-025-05048-9

J Robot Surg. 2025 Dec 6;20(1):58. doi: 10.1007/s11701-025-03003-y.

ABSTRACT

Distal pancreatectomy (DP) remains a technically challenging procedure associated with substantial morbidity. With the advent of robotic surgery, three primary techniques have emerged: robotic classic distal pancreatectomy (RCDP; including splenectomy), the vessel-preserving Kimura technique (KT), and the vessel-sacrificing Warshaw technique (WT). These approaches differ in splenic vessel management, leading to varying perioperative risks and long-term splenic outcomes. We performed a comprehensive meta-analysis comparing these techniques across multiple clinical endpoints. We systematically searched PubMed, Embase, and Cochrane CENTRAL from inception through December 2023, supplemented by manual citation screening. Eligible studies included randomized trials or comparative observational cohorts reporting ≥ 2 techniques with extractable data on operative time, blood loss, or spleen preservation. Data were pooled using random-effects models. Heterogeneity was assessed via I², with subgroup and sensitivity analyses conducted to explore variability. Twenty-two studies (total N ≈ 3,280), including 3 RCTs and 19 retrospective cohorts, met inclusion criteria. RCDP was associated with longer operative times compared with KT (mean difference [MD] 42.3 min, 95% CI 25.1-59.5) and WT (MD 38.7 min, 95% CI 22.4-55.0), but demonstrated reduced intraoperative blood loss versus KT (MD – 85 mL, 95% CI – 120 to – 50) and WT (MD – 78 mL, 95% CI – 110 to – 46). Spleen preservation was highest with KT (98.2%) and WT (96.5%), compared with RCDP (82.1%). No significant differences were observed in clinically relevant postoperative pancreatic fistula (POPF grade B/C), overall complications, or length of hospital stay. RCDP showed lower conversion rates (OR 0.32 vs. KT; OR 0.29 vs. WT). WT was associated with increased late complications, including gastric varices (8.3%) compared with KT (1.2%). Robotic approaches reduced splenic infarction in WT (7.6% robotic vs. 27.5% laparoscopic), and BMI > 28 kg/m², lesion size > 51 mm, and prior abdominal surgery were identified as independent predictors of conversion. RCDP offers superior hemorrhage control and lower conversion risk, but at the cost of reduced spleen preservation and longer operative time. KT and WT provide excellent spleen salvage with comparable short-term safety, though WT carries higher late splenic complication rates. Robotic platforms appear to mitigate some traditional limitations of WT, particularly splenic infarction. However, KT carries a previously underrecognized risk of splenic venous stenosis (41%), potentially leading to left-sided portal hypertension. Technique selection should be individualized based on tumor characteristics, surgical expertise, and patient-specific factors. Future randomized trials should focus on long-term splenic function and cost-effectiveness.

PMID:41351631 | DOI:10.1007/s11701-025-03003-y

Ann Emerg Med. 2025 Dec 5:S0196-0644(25)01301-0. doi: 10.1016/j.annemergmed.2025.10.007. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: Diagnosis of deep neck space infections is challenging in children due to subtle symptoms and examination findings. However, delays in diagnosis can contribute to increased morbidity in pediatric deep neck space infection. We aimed to determine (1) the most frequent discharge diagnoses associated with emergency department (ED) visits in the 10 days before deep neck space infection diagnosis and (2) use cohorts of pediatric ED visits with these frequent diagnoses to determine factors associated with return admission with deep neck space infection.

METHODS: Cross-sectional analysis of ED and inpatient visits for ages less than 18 years from the State Emergency Department and State Inpatient Datasets from 2018-2019. We linked deep neck space infection admissions (identified by primary International Classification of Diseases, Tenth Revision diagnosis J390) to 10-day antecedent ED visits and identified the most frequent discharge diagnoses in these visits. We then analyzed cohorts of ED encounters with these frequent discharge diagnoses: 1) localized neck symptoms (pain, mass, or torticollis), and 2) pharyngitis or tonsillitis; and compared patient and hospital characteristics of visits with and without a subsequent 10-day admission for deep neck space infection using descriptive statistics. Firth logistic regression was used to assess patient and hospital predictors of a deep neck space infection revisit.

RESULTS: Among 799 pediatric deep neck space infection admissions included in the study, 146 (18.3%) patients had more than or equal to 1 treat-and-release ED visits in the 10-day window before deep neck space infection admission. In the cohorts of ED treat-and-release visits for pharyngitis/tonsillitis (n=419,660) and localized neck symptoms (n=54,779), 10-day return visits for deep neck space infection were rare, representing 0.01% and 0.07% of visits, respectively. ED visits with neck imaging were associated with deep neck space infection revisit for both cohorts. Predictors of deep neck space infection in the localized neck symptoms cohort also included younger age and an ED diagnosis of fever, whereas in the pharyngitis cohort, deep neck space infection revisit was associated with ED diagnosis of localized neck symptoms, and negatively associated with a diagnosis of upper respiratory infection or respiratory symptoms.

CONCLUSIONS: In ED encounters where patients were discharged with neck pain/mass or torticollis, younger age and a diagnosis of fever were associated with a subsequent deep neck space infection admission. Among ED patients discharged with pharyngitis/tonsillitis, absence of upper respiratory infection/respiratory diagnosis, and neck pain/mass/or torticollis were associated with increased risk of return admission for deep neck space infection. Increased clinical suspicion for deep neck space infection (as manifested by laboratory findings/neck imaging at initial ED visit) was associated with increased risk of deep neck space infection revisit, representing an area for future research. Findings should be validated in datasets with more detailed clinical documentation.

PMID:41351602 | DOI:10.1016/j.annemergmed.2025.10.007

Health Technol Assess. 2025 Dec 3:1-42. doi: 10.3310/GJJL0404. Online ahead of print.

ABSTRACT

BACKGROUND: Behavioural weight management interventions are the primary treatment for obesity in the United Kingdom. These interventions focus on diet, physical activity and behaviour change, and are typically delivered over a period of 12 weeks. Although National Institute for Health and Care Excellence guidance makes recommendations on the content of behavioural weight management interventions, there are substantial variations in practice. As a result, what constitutes the most effective composition of behavioural weight management interventions is unclear.

OBJECTIVE: To determine the effectiveness of different types of behavioural weight management interventions in achieving weight loss, using individual participant data from randomised controlled trials and real-world services.

DESIGN: A network meta-analysis of individual participant data.

SETTING: Behavioural weight management interventions delivered in the community.

PARTICIPANTS: Anonymous individual participant data of adults (> 18 years), living in the United Kingdom and attending behavioural weight management interventions in the real world (n = 76,201) and randomised controlled trial’s (n = 4051).

MAIN OUTCOME MEASURE: Mean change in weight at 12 weeks.

METHODS: Two-staged Bayesian network meta-analysis of individual participant data from included randomised controlled trials and real-world services was performed. Risk of bias was assessed for randomised controlled trials using Cochrane Risk of Bias 2.0. Prior to analysis, received data were checked, for consistency with the requests and cleaned for all anomalies.

RESULTS: All behavioural weight management interventions resulted in weight loss compared to usual care. In the randomised controlled trials, the 52-week weightloss programme referrals for adults in primary care (WRAP) with participants attending intervention achieved the greatest weight reduction at 12 weeks (mean difference = -2.58 kg, 95% credible interval -3.19 to -1.96). However, when a male-only intervention (football fans in training) was included in a sensitivity analysis, it demonstrated the largest short-term weight loss (mean difference = -4.65 kg, credible interval -5.24 to -4.07). In the real-world services, several programmes achieved substantial weight loss, with greater programme attendance associated with improved outcomes.

CONCLUSIONS: The behavioural weight management intervention in both real-world services and randomised controlled trials are effective for weight loss, but there is a variation in the weight loss achieved at the end of active weight loss period depending upon the structure of intervention and participant engagement.

FUTURE WORK: Dismantling the interventions into component parts will help determine which components or combination of components are associated with greater weight loss.

FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR129523.

PMID:41351599 | DOI:10.3310/GJJL0404

J Phys Chem B. 2025 Dec 6. doi: 10.1021/acs.jpcb.5c05589. Online ahead of print.

ABSTRACT

Flavins (e.g., riboflavin, FMN, and FAD) are biologically ubiquitous molecules widely studied using spectroscopic techniques such as ultraviolet-visible (UV/vis), Fourier-transform infrared (FTIR), and Raman spectroscopies. Those spectroscopic methods typically involve the excitation of flavin’s vibrational modes either on the ground or excited state potential energy surfaces. In the case of UV/vis spectroscopy, this vibrational excitation is coupled to an electronic excitation and leads to a Franck-Condon progression that gives flavin its UV/vis absorption profile. To support experimental spectroscopy measurements, it is desirable to use computations that can accurately predict the vibrational frequencies for flavin’s ground and excited electronic states. However, commonly used computational approaches often rely on a harmonic approximation, which may lead to errors for modes that are not harmonic. By using time-dependent density functional theory (TD-DFT) on lumiflavin, a simplified model system to represent flavins, we mapped the ground- and excited-state potential energy surfaces computed along 3N-6 vibrational modes near the ground equilibrium structure and computed the corresponding excited-state energies along those modes. We fitted these computed potentials with second-order polynomials and used goodness-of-fit statistics as indicators of the harmonicity of vibrational modes. Among the modes that display anharmonic behavior, several are Franck-Condon active modes, which can help explain why flavin’s vertical excitation energies reported in the literature do not typically match well with the experimental wavelength of maximum absorption (λ_max). These calculations help inform future computational and experimental UV/vis, FTIR, and resonance Raman studies of flavins. Some of those potential scans also revealed low-lying conical intersections between the first and second singlet excited states. These intersections constitute potential photophysical deactivation channels that can compete with fluorescence, intersystem crossing, or photoredox chemistry when flavin is in a nonpolar environment.

PMID:41351574 | DOI:10.1021/acs.jpcb.5c05589

Palliat Med. 2025 Dec 6:2692163251395576. doi: 10.1177/02692163251395576. Online ahead of print.

ABSTRACT

BACKGROUND: Healthcare assistants play a critical role in providing palliative and end-of-life care in the community across many healthcare systems internationally. Despite working alone in emotionally demanding and unpredictable settings, no research has examined their psychological wellbeing or factors influencing turnover.

AIM: To investigate the correlations between mental wellbeing, intention to leave their role and workplace support in lone working healthcare assistants providing palliative and end-of-life care in the community.

DESIGN: Explanatory sequential mixed methods study, using cross-sectional survey (Warwick-Edinburgh Mental Well-being Scale and Turnover Intention Scale, project team-developed questions), followed by interviews. Quantitative data analysed using descriptive and inferential statistics, qualitative data analysed using framework approach.

SETTING/PARTICIPANTS: Lone working healthcare assistants from a UK non-profit organisation providing palliative and end-of-life care.

RESULTS: Among 218 survey respondents (22.5% response rate), 80% (n = 174) reported average to high mental wellbeing (mean = 52.2, SD = 8.6). Intention to leave was low (mean = 14.9, SD = 5.3). Higher wellbeing correlated with lower intention to leave (r(216) = -0.25, p < 0.001). Interviews (n = 14) and survey data revealed support from known individuals, particularly line managers, was most valued and accessed by 87.2% of respondents, significantly associated with higher wellbeing and lower turnover intention. Clinical supervision and peer support were frequently accessed and valued, though impact on wellbeing and retention varied. Anonymous online support services remained largely unused despite high awareness.

CONCLUSIONS: The study challenges assumptions about psychological distress experienced by this workforce while showing that targeted, personalised workplace support strategies could be key to retention, offering evidence-based pathways for strengthening workforce sustainability.

PMID:41351425 | DOI:10.1177/02692163251395576

Front Biosci (Landmark Ed). 2025 Nov 27;30(11):45912. doi: 10.31083/FBL45912.

ABSTRACT

BACKGROUND: The nucleotide “words” (k-mers) of the genome exhibit two essentially universal properties that follow probabilistically from the Conservation of Hartley-Shannon Information (CoHSI): (1) a Zipfian rank-ordered distribution of frequencies and (2) universal inverse symmetry. Here, we address the presence of these 2 properties in the transcriptome, a question of interest given the strong and specific structure/function constraints on RNAs, especially the protein-coding (CDS) sequences.

METHODS: CDS and ncRNA (non-coding RNA) databases were accessed at e!Ensembl. For determination of a power-law, statistical tests of both necessity (linearity) and sufficiency (confidence that a power-law distribution could not be rejected) were applied. Compliance with inverse symmetry was assessed by linearity and residual standard error.

RESULTS: The CDS and non-coding RNAs for 53 species were analyzed separately and the data presented as short movies. The results were consistent for all species analyzed, and taking the bonobo (Pan paniscus) as a representative species, the following results were obtained. For the Zipfian distribution of k-mer frequencies, statistically robust tests of both necessity (adjusted R-squared of 0.9932 and p ≤ 2.2 × 10^-16) and sufficiency were obtained for the CDS; for non-coding RNAs the test of necessity was robust (adjusted R-squared = 0.9982 and p ≤ 2.2 × 10^-16). Perturbations of inverse symmetry were observed in both CDS (slope = 0.91, adjusted R² = 0.77) and non-coding RNAs (slope = 1.02, adjusted R² = 0.84). The disruption of inverse symmetry in the CDS affected particularly the 3- and 6-mers and was shown to be associated with codon (especially stop codon) frequency in the open reading frame.

CONCLUSIONS: Whereas the CoHSI-predicted Zipfian distribution of k-mer frequencies was observed in both the protein-coding and non-coding RNAs of 53 species, in contrast the compliance with inverse symmetry was weaker. This weakening of compliance was seen to a greater extent in the CDS than in the non-coding portions of the transcriptome and may be associated with the necessity to maintain the integrity of the reading frame in the CDS. These results illustrate the general principle that local perturbations of an overall CoHSI-guided equilibrium state of a biological system can provide insight into the underlying causes of such perturbations.

PMID:41351398 | DOI:10.31083/FBL45912

Biomark Med. 2025 Dec 6:1-12. doi: 10.1080/17520363.2025.2597174. Online ahead of print.

ABSTRACT

OBJECTIVE: Colorectal cancer (CRC) is a major contributor to global cancer mortality. Reliable biomarkers like c-Jun and Interleukin-8 (IL-8) may improve prognosis and therapy. Considering the possible ethnic differences in CRC biomarkers, this study is the first to examine a distinct Southeast Asian cohort (Indonesia).

METHODS: A retrospective study analyzed 98 CRC patients using immunohistochemistry to evaluate c-Jun and IL-8 expression. Paraffin-embedded tissues were assessed for correlations with clinicopathological features. Statistical analyses were performed with p < 0.05 considered significant.

RESULTS: c-Jun expression was significantly higher in mucinous or serrated histology (median 1.80, range 0.90-2.30) compared to adenocarcinoma, NOS (median 1.60, range 0.70-2.50) (p = 0.04). Meanwhile, IL-8 expression showed no significant differences across all clinicopathological factors. Neither biomarkers showed significant association with most clinicopathological factors, including age, sex, tumor size, location, stage, grade, invasion, or metastasis.

CONCLUSIONS: c-Jun and IL-8 expression showed limited prognostic relevance for most clinicopathological features of CRC. However, elevated c-Jun expression may indicate its particular involvement in distinct CRC subtype pathogenesis.

PMID:41351394 | DOI:10.1080/17520363.2025.2597174

Rev Neurol. 2025 Nov 27;80(10):43204. doi: 10.31083/RN43204.

ABSTRACT

Although prospective studies directly estimate the influence of a factor on the onset of a disease, case-control sampling is often cheaper, faster, and sometimes the only feasible option. In these studies, a random sample of individuals with the disease (cases) is taken, and the proportion of them, P₁, who were exposed to the factor is evaluated. A random sample of individuals without the disease (controls) is also taken, and the proportion of them, P₀, who were exposed is evaluated. From these two proportions, the respective odds and their ratio, the odds ratio (OR), are calculated. When the incidence of the disease is small, say less than 10%, this OR value closely approximates the relative risk (RR), and therefore tells us, with good approximation, how much greater the risk of having the disease is if one is exposed to the factor. In all cases, case-control studies tend to have more confounding factors, which are not easily controllable, than prospective studies. However, under certain circumstances, they have a much higher statistical power than the prospective design.

PMID:41351392 | DOI:10.31083/RN43204