Nevin Manimala

Cardiovasc Diabetol. 2025 May 21;24(1):218. doi: 10.1186/s12933-025-02783-9.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index serves as a crucial indicator for evaluating insulin resistance (IR) and cardiovascular risk among patients with type 2 diabetes mellitus (T2DM). Concurrently, hyperuricemia (HUA) strongly correlates with adverse cardiovascular outcomes. However, the prognostic value of the TyG index, particularly in patients exhibiting both conditions, remains inadequately defined. This study assessed the association between TyG index measurements and the incidence of major adverse cardiovascular events (MACEs) among patients simultaneously diagnosed with T2DM and HUA.

METHODS: This retrospective, single-center cohort study included 628 patients diagnosed with both T2DM and HUA at the Chaohu Hospital (Anhui Medical University) between 2019 and 2024. Participants were stratified into tertiles based on their TyG index values. Kaplan-Meier survival curves with log-rank tests estimated the risk of MACEs, and Cox regression analyses calculated hazard ratios. The additional predictive contribution of the TyG index was evaluated using C statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) metrics.

RESULTS: During the 38.00 ± 8.78 months follow-up period, 74 MACEs were recorded. A significant proportional relationship emerged between the TyG index and cardiovascular events-patients in the highest tertile demonstrated markedly increased risk compared with those in the lowest tertile (HR = 2.45, 95% CI 1.23-4.95). A pivotal threshold was identified at TyG > 8.40, beyond which each standard deviation increase corresponded to a 66% higher probability of MACEs (HR = 1.66, 95% CI 1.36-2.36, P = 0.014). Integrating the TyG index into traditional risk models significantly improved predictive performance (C statistic increase: 0.64 → 0.67, P = 0.029; NRI = 0.14, IDI = 0.02, both P < 0.05).

CONCLUSION: The TyG index constitutes an autonomous MACE predictor specifically within the distinctive cohort of patients manifesting both T2DM and HUA. This study is the first to validate the TyG > 8.40 threshold in T2DM patients with HUA and identify a synergistic interaction between serum uric acid (SUA) and TyG, providing a novel stratification tool for managing dual metabolic disorders.

PMID:40399902 | DOI:10.1186/s12933-025-02783-9

Mar Environ Res. 2025 May 16;209:107225. doi: 10.1016/j.marenvres.2025.107225. Online ahead of print.

ABSTRACT

This study examined the effect of aquaculture on benthic macrophytes growing on coastal hard substrates across Greece. Stations were categorized into ‘near’ (60-80 m from fish farms), ‘far’ (more than 80 m), and ‘no farm’ (potential future aquaculture sites). Photographic samples were taken between July and September 2021, followed by analysis of macrophyte identification, diversity indices, and ecological assessments. Additionally, the composition of epiphytic microalgae on macrophytes was studied. The overall observation of macrophyte communities revealed a difference between “near” and “far”/”no farm” stations, and a possible shift of the algal communities driven by the aquacultures. Based on the EEI-c index, all – except one – stations, were found to be in a Good or High Ecological Status, in accordance with the provisions of the Water Framework Directive. However, diversity indices, such as the Shannon-Wiener index, provided more nuanced insights into biodiversity changes, revealing differences. For all indicators, but also for the composition of the biocommunities of macrophytes, the effect of the geographical area emerged as statistically significant, but it was not found to show interactions with the distance factor. The photographic sampling method used in the study is easy, economical, and non-destructive, allowing cost effective, long-term monitoring, while improvement actions for the better application for the calculation of EEI-c were suggested. Regarding epiphytic microalgae, the analysis revealed no statistically significant differences between “near”/”far” sites, but no definitive conclusion can be drawn on the impact of aquaculture, as nutrient availability, especially the N:P ratio, exerts a stronger influence on community composition. This study highlights the importance of combining multiple ecological tools and indices to gain a comprehensive understanding of aquaculture’s impact on coastal ecosystems, as reliance on a single indicator may lead to misleading conclusions.

PMID:40398006 | DOI:10.1016/j.marenvres.2025.107225

Eur J Radiol. 2025 May 14;189:112167. doi: 10.1016/j.ejrad.2025.112167. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the clinical value of the deep learning image reconstruction (DLIR) algorithm compared with conventional adaptive statistical iterative reconstruction-Veo (ASiR-V) in image quality, diagnostic confidence, and intestinal lesion detection in 100-kVp CT enterography (CTE) for patients with wide-range body mass index (BMI).

METHODS: A total of 84 patients underwent 100-kVp dual-phase CTE were included. Images were reconstructed using filtered back projection (FBP), ASiR-V 30 %, ASiR-V 60 %, and DLIR with low, medium, and high levels (DLIR-L, DLIR-M, and DLIR-H). The CT value, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of small and large intestines were compared using repeated measures analysis of variance with the Bonferroni correction or Friedman test. The correlation between relative CNR increment and BMI was analyzed using Pearson’s correlation coefficient. The overall image quality and diagnostic confidence scores were evaluated. Additionally, lesion detection of intestinal disease was conducted by three readers with different experience and compared between DLIR-M and ASiR-V 60 % images using McNemar’s test.

RESULTS: SD decreased sequentially from FBP, ASiR-V 30 %, DLIR-L, ASiR-V 60 %, DLIR-M, to DLIR-H, which corresponded with improvements in CNR and SNR (all p < 0.001). The relative CNR increment of DLIR exhibited a significantly positive linear correlation with BMI (r:0.307-0.506, all p ≤ 0.005). For overall image quality scores, the ranking was: FBP < ASiR-V 30 % < ASiR-V 60 % ≈DLIR-L < DLIR-M ≈ DLIR-H. DLIR-M outperformed ASiR-V 60 % in diagnostic confidence (p ≤ 0.018 for all three readers). In lesion detection, for the two junior readers, DLIR-M exhibited higher sensitivity for inflammatory lesions compared to ASiR-V 60 % (0.700 (95 % confidence interval [95 % CI]: 0.354-0.919) vs. 0.300 (95 % CI: 0.081-0.646) for reader 1 and 0.700 (95 %CI: 0.354-0.919) vs. 0.500 (95 % CI: 0.201-0.799) for reader 2), though no statistical significance was reached.

CONCLUSION: DLIR effectively reduces noise and improves image quality in 100-kVp dual-phase CTE for wide-range BMIs. DLIR-M exhibits superior performance in image quality and diagnostic confidence, also provide potential value in improving intestinal inflammatory lesion detection in junior readers and sheds lights on benefiting clinical decision making, which needs further investigation.

PMID:40398003 | DOI:10.1016/j.ejrad.2025.112167

Rheumatology (Oxford). 2025 May 21:keaf265. doi: 10.1093/rheumatology/keaf265. Online ahead of print.

ABSTRACT

OBJECTIVES: ANCA-associated vasculitis (AAV) is a group of systemic autoimmune diseases affecting small blood-vessels. Class-II HLA genes often reported as major genetic determinants. We conducted a systematic review and meta-analysis to evaluate the susceptibility conferred by HLA genes in AAV and five sub-types i.e. PR3+AAV, MPO+AAV, Granulomatosis with polyangiitis (GPA), Microscopic polyangiitis (MPA) and Eosinophilic granulomatosis with polyangiitis (EGPA).

METHODS: Relevant articles were retrieved until March 2024, from electronic databases using appropriate keywords. Eligible studies were included following inclusion-exclusion criteria. Funnel plots, Newcastle-Ottawa Scale and GRADE tools were used to evaluate the quality of evidence and research findings. Statistical analyses were performed by RevMan 5.4.1. The meta-odds ratio and Z test p-value were considered to check the HLA associations.

RESULTS: Meta-analysis of HLA-alleles identified 30 significant associations with AAV and its sub-types of which 17 withstood Bonferroni corrections. rs9277554-C from HLA-DPB1 (Meta-OR = 3.92(3.27-4.69)), rs1049072-A from HLA-DQB1 (Meta-OR = 1.39(1.27-1.52)) and rs9277341-C from HLA-DPA1 (Meta-OR = 0.41(0.03-0.57)) were significantly associated (p < 0.00001) with AAV and GPA respectively. DRB1*09:01 was significantly (p < 0.00001) predisposing allele in AAV (Meta-OR = 1.72(1.46-2.03)) and MPO+AAV (Meta-OR = 1.65(1.41-1.93)) and MPA (Meta-OR = 1.75(1.41-2.19)). Significant association (p ≤ 0.0005) was also observed for DPB1*01:01 (Meta-OR = 0.38(0.24-0.62)) and DRB1*11:01 (Meta-OR = 2.11(1.39-3.20)) for AAV and MPA respectively. Sensitivity analysis identified additional significant (p ≤ 0.001) predisposing alleles DPB1*04:01 and DPB1*02:01 in AAV and more than one sub-types.

CONCLUSION: Multiple alleles from HLA-DRB1 and DPB1 were found to provide predisposition to AAV and sub-types. Predisposition by DPB1*04:01 and protection by DPB1*02:01 were specific for AAV, PR3+AAV and GPA. Predisposition by DRB1*09:01 was observed among AAV, MPO+AAV and MPA.

PMID:40397991 | DOI:10.1093/rheumatology/keaf265

Rheumatology (Oxford). 2025 May 21:keaf272. doi: 10.1093/rheumatology/keaf272. Online ahead of print.

ABSTRACT

OBJECTIVES: The role of neutrophil extracellular traps (NETs) in immunoglobulin A vasculitis (IgAV) pathogenesis is emerging, with NETosis-associated markers potentially linked to disease activity. This study aimed to explore the relationship between NETosis biomarkers and IgAV disease phases.

METHODS: A longitudinal study involving 33 pediatric IgAV patients and 26 healthy controls was conducted. Blood and urine samples were collected from healthy controls and patients during active and inactive disease phases. NETosis markers, including cell-free DNA (cf-DNA), neutrophil elastase (NE), myeloperoxidase (MPO), and citrullinated histone H3 (cit-H3) were measured using ELISA kits. Statistical analyses were conducted to compare differences for NETosis markers between groups and to evaluate correlations among variables using appropriate statistical tests.

RESULTS: There was no significant difference in gender and age between the patient and control groups. The serum cf-DNA level was significantly higher in the active patient group compared with the control and inactive patient groups (p= 0.04; p= 0.04, respectively). In urine, MPO levels were significantly lower in the active phase of patients than controls (p= 0.009), while cit-H3 levels were higher in both active and inactive phases compared with controls (p= 0.01 and p= 0.03, respectively). A cf-DNA threshold of 935 ng/ml was identified, which achieved a sensitivity of 93% (correctly identifying 93% of active patients) and a specificity of 72% (correctly identifying 72% of healthy controls).

CONCLUSION: Elevated serum cf-DNA and urine cit-H3 suggest a potential role for NETosis in IgAV activity, highlighting these markers as potential indicators for disease monitoring. Further studies are warranted to establish standardized protocols for NETosis marker assessment in IgAV.

PMID:40397989 | DOI:10.1093/rheumatology/keaf272

J Clin Ethics. 2025 Summer;36(2):121-131. doi: 10.1086/734771.

ABSTRACT

AbstractContext: As advance directives (ADs) become more frequently utilized, opportunities increase for conflict between a patient’s designated healthcare power of attorney (POA) and the treatment preferences outlined in their living will (LW). Little is known about patient preferences regarding how to resolve these conflicts.

OBJECTIVES: To assess patient preferences regarding whether their POA or LW should have authority in times of conflict.

METHODS: In this mixed methods study, we completed a retrospective chart review to analyze patient selections in their AD, including selections in a novel section of the AD called the “Binding Guidance” section that gives patients the ability to designate whether their POA or LW should have authority when there is conflict between the two. Additionally, willing patient participants were asked two interview questions about their selections to further elucidate their perspectives.

RESULTS: Out of 143 patients, 48.3 percent (n = 69) chose to have their LW followed over their POA and 51.7 percent (n = 74) chose to have their POA followed over their LW. Several statistically significant associations were identified regarding binding guidance selections. Seventy-four (51.75%) of these patients also answered the additional interview questions, with the participants evenly distributed (n = 37 each) in their binding guidance selections.

CONCLUSION: Patients have varying preferences regarding whether their POA or LW should have authority in times of conflict. ADs should reflect this variation in preferences and allow patients the ability to designate whether they prefer their POA or LW to have ultimate authority when in conflict.

PMID:40397975 | DOI:10.1086/734771

PLoS One. 2025 May 21;20(5):e0324231. doi: 10.1371/journal.pone.0324231. eCollection 2025.

ABSTRACT

Rising global food insecurity driven by population growth needs urgent measure for universal access to food. This research employs Comparative Performance Analysis (CPA) to evaluate the Global Food Security Index (GFSI), its components [Affordability (AF), Availability (AV), Quality & Safety (Q&S) and Sustainability & Adaptation (S&A)] in tandem with Annual Population Change (APC) for world’s five most populous countries (India, China, USA, Indonesia and Pakistan) using dataset spanning from 2012 to 2022. CPA is applied using descriptive analysis, correlation analysis, Rule of Thumb (RoT) and testing of hypothesis etc. RoT is used with a new analytical approach by applying the significance measures for correlation coefficients. The study suggests that India should enhance its GFSI rank by addressing AF and mitigating the adverse effects of APC on GFSI with a particular focus on Q&S and S&A. China needs to reduce the impact of APC on GFSI by prioritizing AV and S&A. The USA is managing its GFSI well, but focused efforts are still required to reduce APC’s impact on Q&S and S&A. Indonesia should improve across all sectors with a particular focus on APC reduction and mitigating its adverse effects on AF, AV, and S&A. Pakistan should intensify efforts to boost its rank and enhance all sectors with reducing APC. There is statistically significant and negative relation between GFSI and APC for China, Indonesia and found insignificant for others countries. This study holds promise for providing crucial policy recommendations to enhance food security by tackling its underlying factors.

PMID:40397971 | DOI:10.1371/journal.pone.0324231

Chem Biodivers. 2025 May 21:e00561. doi: 10.1002/cbdv.202500561. Online ahead of print.

ABSTRACT

Teucrium montanum is an evergreen shrub that is widespread in Europe. The aim of this study was to determine the composition of the essential oils of T. montanum and their relationship to ecology, morphology and genetics. The essential oils were analysed by gas chromatography-mass spectrometry and the data were evaluated by multivariate statistics and multiple regression. This species showed a remarkable variability of essential oils in the Balkan Peninsula. All registered compounds were used to define four chemotypes that showed no spatial regularity and did not correlate with most bioclimatic parameters. The classification of samples into chemotypes and different categorical variables proved to be completely independent. Moreover, the identified compounds showed no correlation with the bioclimatic parameters, including other categorical variables. To study such a complex phenomenon as the variation of essential oils of T. montanum, a different sampling approach must be adopted (e.g., ‘one individual, one sample’), but this could affect the viability of the population of this species.

PMID:40397960 | DOI:10.1002/cbdv.202500561

PLoS One. 2025 May 21;20(5):e0324497. doi: 10.1371/journal.pone.0324497. eCollection 2025.

ABSTRACT

This paper presents a novel longitudinal study examining interactions in healthcare expenditure (HCE). Utilizing fuzzy-set qualitative comparative analysis (fsQCA), the study constructs a consumption-provision-finance model to investigate factors influencing HCE. Data from the Organization for Economic Cooperation and Development (OECD) database for the years 2010-2022 are analyzed, covering 37 OECD countries (excluding Luxembourg due to insufficient data). By treating each country-year OECD observation as a case, causal recipes are identified and interpreted. The characteristics of the panel data set are examined by assessing the stability of causal patterns over multiple years and exploring the consistency of these patterns within individual countries across various years. The findings of this study offer significant insights for policy management and future research, particularly in relation to the diverse annual relationships observed between factors and HCE in different countries. Additionally, comparisons are drawn between panel fsQCA and cross-sectional fsQCA conducted for specific years.

PMID:40397958 | DOI:10.1371/journal.pone.0324497

PLoS One. 2025 May 21;20(5):e0323815. doi: 10.1371/journal.pone.0323815. eCollection 2025.

ABSTRACT

The COVID-19 pandemic highlighted the crucial role of vaccines in controlling the virus. Despite their effectiveness, however, vaccine hesitancy remained a challenge, particularly within certain population groups. This multi-disciplinary study investigates the diverse socio-demographic factors influencing COVID-19 vaccination decisions in the United States. Through a nationally representative survey of 5,240 people, the research explores the interplay of information sources, religious beliefs, political party, and demographic characteristics of the respondents. Our findings reveal associations of main sources of information with vaccination likelihood, with the Centers for Disease Control and Prevention demonstrating the highest association with full vaccination. Religious beliefs are significant determinants, with Evangelical Protestants exhibiting the lowest vaccination rates. We also highlight the intricate relationship between political leanings and vaccination behavior, emphasizing higher levels of vaccination among Democrats. Demographic variables, including age, education, gender, and race/ethnicity, also play pivotal roles, exposing disparities in vaccination access and decisions. In particular, older individuals and those with higher levels of education show a greater inclination to achieve full vaccination, while women and African Americans are less likely to attain complete vaccination. Lastly, while major ethnoracial groups seem to respond to different sources of information similarly, there are also nuanced differences, such as Asians being especially likely to be fully vaccinated if they depend on the CDC or other health sources while more disadvantaged groups seem less responsive to these sources. Overall, this research provides a comprehensive analysis of the nuanced factors shaping vaccination behavior. It contributes valuable knowledge to public health strategies, emphasizing the need for targeted communication campaigns tailored to diverse communities.

PMID:40397952 | DOI:10.1371/journal.pone.0323815