Nevin Manimala

Rev Assoc Med Bras (1992). 2025 Jun 2;71(4):e20241621. doi: 10.1590/1806-9282.20241621. eCollection 2025.

ABSTRACT

OBJECTIVE: Cardiac implantable electronic devices are widely used today. Therefore, research is ongoing to provide better device implantation in technical terms. The aim of this study was to investigate the relationship between pre-procedural regional right ventricular strain and post-procedural endocardial R-wave amplitude in patients scheduled to receive an implantable cardiac defibrillator.

METHODS: A total of 112 patients who underwent single-chamber implantable cardiac defibrillator implantation were included in the study. Right ventricular strain analysis was performed before the procedure, and the following parameters were recorded: four-chamber strain, free wall strain, septal strain, and apical strain. The relationship between R-wave amplitude, calculated after lead implantation in the apical region, and strain parameters was statistically analyzed.

RESULTS: All strain parameters were statistically significantly better in the group with a high R-wave amplitude. Correlation analysis showed that a higher R-wave amplitude was associated with improved right ventricular four-chamber strain (p<0.001, correlation coefficient=0.436), right ventricular free wall strain (p<0.001, correlation coefficient=0.532), right ventricular septal strain (p<0.001, correlation coefficient=0.394), and right ventricular apical strain (p<0.001, correlation coefficient=0.814). In univariable regression analysis, all strain parameters were identified as dependent predictors; however, in multivariable regression analysis, only right ventricular apical strain (p<0.001) was found to be an independent predictor of high R-wave amplitude.

CONCLUSION: Our study revealed a relationship between the right ventricular apical endocardial R-wave amplitude and all right ventricular strain parameters, especially right ventricular apical strain. We recommend that clinicians perform regional right ventricular strain analysis before implantable cardiac defibrillator implantation in cases where lead positioning is uncertain.

PMID:40465994 | DOI:10.1590/1806-9282.20241621

Rev Assoc Med Bras (1992). 2025 Jun 2;71(4):e20241615. doi: 10.1590/1806-9282.20241615. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the risk of obstructive sleep apnea and sleep quality in adolescents with and without polycystic ovary syndrome.

METHODS: A case-control study was conducted on 82 adolescent girls admitted to the pediatric endocrinology clinic of a training and research hospital in Turkey. Data were collected using the Participant Information Form, Stop and Stop-Bang Questionnaire, Cleveland Adolescent Sleepiness Questionnaire, Sleep Quality Scale, and Sleep Variables Questionnaire.

RESULTS: It was determined that the mean Stop and Stop-Bang scores of adolescents in the healthy and polycystic ovary syndrome groups were similar and had a high level of obstructive sleep apnea risk. Daytime sleepiness levels were similar in both groups, but daytime sleepiness mean scores were a little higher in healthy adolescents. In addition, it was determined that the level of sleepiness at school and during transportation was statistically significant and high in the healthy group, and the sleep quality of all adolescents was moderately similar.

CONCLUSION: Our data reveal the importance of a comprehensive assessment of sleep health, including obstructive sleep apnea, as well as duration, timing, and quality in adolescents when considering polycystic ovary syndrome. Healthcare professionals should consider the sleep health of all adolescents presenting to endocrine outpatient clinics.

PMID:40465993 | DOI:10.1590/1806-9282.20241615

Rev Assoc Med Bras (1992). 2025 Jun 2;71(4):e20241551. doi: 10.1590/1806-9282.20241551. eCollection 2025.

ABSTRACT

OBJECTIVE: The aim of this study was to develop a scale to assess the self-efficacy of caregivers of individuals with serious mental illnesses and to determine its psychometric properties.

METHODS: This study used a methodologic, cross-sectional, and descriptive design. A draft of a 26-item scale was developed based on interviews with caregivers and a literature review. The construct validity of the scale was tested by exploratory factor analysis. The reliability of the scale was tested. Caregivers of 348 individuals with serious mental illnesses participated in the study.

RESULTS: The exploratory factor analysis produced a 20-item scale defined by three factors. Reliability coefficient values were adequate.

CONCLUSION: The caregiver self-efficacy scale for caregivers of individuals with serious mental illnesses developed in this study is a valid and reliable instrument that can be used for measuring the self-efficacy of caregivers of individuals with serious mental illnesses.

PMID:40465990 | DOI:10.1590/1806-9282.20241551

Melanoma Res. 2025 May 27. doi: 10.1097/CMR.0000000000001047. Online ahead of print.

ABSTRACT

Nomograms are commonly used in oncology to assist clinicians in individualized decision-making processes, such as considering sentinel node biopsy (SNB) for melanoma patients. Concurrently, artificial intelligence (AI) is increasingly being utilized in medical predictions. This study aims to compare the predictive accuracy of nomograms and AI platforms for SNB positivity in a real-world cohort of melanoma patients. A retrospective analysis of melanoma patients who underwent SNB from 2020 to 2024 in a single institution was performed. Three open-access nomograms and three public AI platforms were employed to assess SNB positivity based on comprehensive clinical and pathological characteristics. Our cohort comprised 62 melanoma patients who have undergone SNB, of whom 12 (19.4%) were positive. There was no concordance among the three nomograms, nor among AI platforms (P < 0.001). Only the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram scored statistically different between positive and negative SNB (P = 0.04), and ChatGPT was the only AI platform that was also statistically significant (P = 0.02). Only ChatGPT score was statistically significant for SNB positivity after univariate logistic regression (odds ratio: 1.05; 95% confidence interval: 1.004-1.108; P = 0.03). A receiver operating characteristic curve based on ChatGPT predictions generated a model with an area under the curve (AUC) of 0.702. Integrating MSKCC predictions marginally improved the model’s predictive performance, enhancing the AUC to 0.715. In conclusion, SNB positivity could be better performed by an AI platform in this cohort of patients. Enhancing AI platforms could provide better populations for nomogram validation, which would lead to better predictive models.

PMID:40465322 | DOI:10.1097/CMR.0000000000001047

Invest Ophthalmol Vis Sci. 2025 Jun 2;66(6):18. doi: 10.1167/iovs.66.6.18.

ABSTRACT

PURPOSE: Fuchs endothelial corneal dystrophy (FECD) is frequently associated with trinucleotide repeat (TNR) expansion in the TCF4 gene intron. The aim of this study was to establish a novel FECD mouse model with TNR expansion.

METHODS: We used CRISPR/Cas9-mediated genome editing to generate knock-in mice carrying 100 CTG repeats in the Tcf4 intron. Corneal endothelial phenotypes were evaluated using specular microscopy and transmission electron microscopy. Transcriptome analysis was performed using RNA sequencing of corneal endothelial tissue from Tcf4(CTG)100/(CTG)100 and wild-type mice.

RESULTS: Tcf4+/(CTG)100 and Tcf4(CTG)100/(CTG)100 mice developed characteristic FECD features, including progressive guttae formation and decreased corneal endothelial cell density. At 60 weeks, Tcf4+/(CTG)100 mice showed increased guttae percentage (0.314% ± 0.145%) versus wild-type (0.170% ± 0.089%), although not statistically significant. Tcf4(CTG)100/(CTG)100 mice exhibited significantly higher guttae formation (0.563% ± 0.293%) compared to controls. Similarly, endothelial cell density showed non-significant reduction in Tcf4+/(CTG)100 (1629 ± 71 cells/mm2) versus wild-type (1704 ± 68 cells/mm2), whereas Tcf4(CTG)100/(CTG)100 mice demonstrated significant decrease (1600 ± 76 cells/mm2). RNA sequencing identified 3221 differentially expressed genes (579 upregulated, 2,642 downregulated), with enrichment in pathways related to adaptive immune response, chemokine signaling, and cytokine-cytokine receptor interaction.

CONCLUSIONS: Our study demonstrates that TNR expansion in the Tcf4 intron, on its own, is sufficient to induce FECD phenotypes in vivo. This mouse model provides a valuable tool for investigating FECD pathogenesis and developing targeted therapeutics.

PMID:40465262 | DOI:10.1167/iovs.66.6.18

Melanoma Res. 2025 May 27. doi: 10.1097/CMR.0000000000001043. Online ahead of print.

ABSTRACT

Pregnancy-associated melanoma is melanoma that can develop up to 1 year postpregnancy. There is no solid evidence on how pregnancy can affect melanoma survival, recurrence, or mortality. This systematic review and meta-analysis aims to analyze the overall survival (OS), recurrence, and mortality rate in pregnant women diagnosed with melanoma. A comprehensive search was performed on Medline, Embase, and Web of Science to identify studies comparing melanoma in pregnant versus nonpregnant women. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects model. Heterogeneity was evaluated using the I2 statistic, and significance was defined as P values less than 0.05. Statistical analyses were conducted using RStudio 4.4.1. Our meta-analysis included 15 studies, consisting of 29 095 patients; 2917 (10%) were pregnant women. In the OS outcome, statistically significant differences were observed, favoring pregnant women in comparison to nonpregnant women; both groups were diagnosed with melanoma (HR: 0.81, 95% CI: 0.69-0.95, P = 0.012, I2 = 85.4%). The OS at 5 years did not show statistically significant differences (OR: 1.08, 95% CI: 0.50-2.35, P = 0.83, I2 = 57.9%). Similarly, the outcomes of melanoma recurrence (RR: 1.19, 95% CI: 0.95-1.48, P = 0.12, I2 = 0%) and mortality (RR: 1.60, 95% CI: 0.82-3.13, P = 0.16, I2 = 73.5%) also showed no statistically significant differences between groups. According to this systematic review and meta-analysis, pregnant women diagnosed with melanoma have a higher OS rate than nonpregnant women.

PMID:40465258 | DOI:10.1097/CMR.0000000000001043

JAMA Psychiatry. 2025 Jun 4. doi: 10.1001/jamapsychiatry.2025.0801. Online ahead of print.

ABSTRACT

IMPORTANCE: Major depressive disorder (MDD) and obesity are common noncommunicable disorders associated with substantial disease burden, which frequently occur comorbidly. Intriguingly, converging lines of evidence from animal models and genetic and observational studies have suggested a biological link between obesity, metabolic syndrome, and depression. Several small randomized clinical trials (RCTs) have suggested the antidepressive potential of statins.

OBJECTIVE: To examine whether simvastatin added to escitalopram is efficacious in improving depressive symptoms compared with add-on placebo.

DESIGN, SETTING, AND PARTICIPANTS: This was a confirmatory, double-blind, placebo-controlled, multicenter RCT. Adults with MDD and comorbid obesity from 9 tertiary care settings in Germany were enrolled in this analysis. Data were analyzed from July to October 2024.

INTERVENTIONS: Simvastatin (40 mg per day) or placebo as add-on to escitalopram (10 mg for the first 2 weeks, then increased to 20 mg until the end of study) in a double-blind fashion for 12 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline (week 0) to week 12.

RESULTS: From August 21, 2020, to June 06, 2024, a total of 161 patients were enrolled at 9 sites in Germany, of which 160 patients were included in the intention-to-treat analysis (placebo: n = 79, simvastatin: n = 81; mean [SD] age, 39.0 [11.0] years; 126 female [79%]). Retention in the trial was excellent (95.6%), and blinding was effectively maintained. There were 4 serious adverse events with no difference between the groups. Primary end point analysis in the intention-to-treat sample showed no significant treatment effect of add-on simvastatin in MADRS scores (mixed models for repeated measures least squares mean difference, 0.47 points; 95% CI, -2.08 to 3.02; P = .71). No effects of simvastatin treatment were observed in any of the mental health-related secondary end points. However, simvastatin treatment significantly reduced low-density lipoprotein cholesterol (simvastatin, -40.37 mg/dL; 95% CI, -47.41 to -33.33 mg/dL; placebo, -3.78 mg/dL; 95% CI, -11.18 to 3.62 mg/dL; P < .001), total cholesterol (simvastatin, -39.07 mg/dL; 95% CI, -49.42 to -28.73 mg/dL; placebo, -4.89 mg/dL; 95% CI, -15.64 to 5.87 mg/dL; P < .001), and C-reactive protein (simvastatin, -1.04 mg/L; 95% CI, -1.89 to -0.20 mg/L; placebo, 0.57 mg/L; 95% CI, -0.28 to 1.42 mg/L; P = .003) compared with placebo.

CONCLUSIONS AND RELEVANCE: The study failed to meet its primary end point. This demonstrates that simvastatin did not exert additional antidepressive effects when added to escitalopram in patients with comorbid MDD and obesity, despite improving the cardiovascular risk profile.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04301271.

PMID:40465256 | DOI:10.1001/jamapsychiatry.2025.0801

Chaos. 2025 Jun 1;35(6):063115. doi: 10.1063/5.0270132.

ABSTRACT

Time-series analysis plays a crucial role in understanding the dynamics of real-world systems across various scientific and engineering disciplines. We in this paper propose a novel approach to identifying chaotic dynamics by a geometric method based on deep learning. Specifically, we construct a map from the observed time-series data and seek the existence of a topological horseshoe in the map, which indicates chaotic behavior. We demonstrate the effectiveness of our method by numerical experiments on the Hénon map, the Lorenz system, and the Duffing system. The results show that the topological horseshoe theory combined with deep neural works provides a valuable tool for detection of chaos in complex nonlinear systems from time series.

PMID:40465250 | DOI:10.1063/5.0270132

Melanoma Res. 2025 May 27. doi: 10.1097/CMR.0000000000001046. Online ahead of print.

ABSTRACT

Wide local excision (WLE) is the standing surgical choice for acral lentiginous melanoma (ALM), yet research is scarce in evaluating other surgical options for ALM and its recurrence rates remain two to five times more likely than other melanoma subtypes. This study evaluates the overall survival outcomes associated with different surgical modalities in patients with stage 0-II ALM. This retrospective cohort study surveyed the National Cancer Database from 2004 to 2021 for International Classification of Diseases-10 codes specific for all skin structures with histologically confirmed ALM for stage 0-II patients. Using IBM SPSS, statistical analyses were conducted via variable frequency with crosstabulations and Chi-squared tests, Kaplan-Meier survival curves with log-rank pairwise comparisons, and Cox proportional hazards regression models. Data for 6737 patients showed significantly greater overall survival for biopsy followed by gross excision (BFGE) than WLE [median overall survival = 204.8 months (P < 0.001); hazard ratio = 0.77 (95% confidence interval, 0.68-0.87)]. Median overall survival for WLE was 181.6 months. Cross analysis of Breslow depth (BD) with surgical procedures revealed the majority (21.8%) of WLEs were completed for lesions with a BD of 0.1-5 mm followed by 16.8% for lesions greater than 3 cm (P < 0.001). Crossanalysis of surgical margins of the primary site with surgical procedures, showed no residual tumor in 92.1% of all BFGE patients, which is 3.7% and 3.3% less patients than major amputation and WLE. This study highlights significant differences across ALM surgery options, suggesting each modality has their own niche and BFGE should be investigated further.

PMID:40465243 | DOI:10.1097/CMR.0000000000001046

Oncologist. 2025 Jun 4;30(6):oyaf104. doi: 10.1093/oncolo/oyaf104.

ABSTRACT

BACKGROUND: The efficacy and safety of chemotherapy combined with programmed cell death protein-1 (PD-1) inhibitors in postoperative adjuvant therapy of pancreatobiliary subtype ampullary adenocarcinoma (AAC) are uncertain. This study aims to evaluate the effect of such treatment on the survival of this patient population.

METHODS: We retrospectively collected patients with pancreatobiliary subtype AAC who underwent surgical treatment at the Sun Yat-sen Memorial Hospital from January 2018 to December 2022. Patients with high-risk recurrence factors after surgery were divided into surgery alone group, adjuvant chemotherapy group, and adjuvant chemoimmunotherapy group. The Kaplan-Meier method was used to plot survival curves, and the Log-Rank method was used to compare the differences in overall survival (OS) and recurrence-free survival (RFS) between groups.

RESULTS: A total of 71 people were enrolled, including 24 patients received surgery alone, 31 patients received adjuvant chemotherapy, and 16 patients received adjuvant chemoimmunotherapy. The median time of clinical follow-up was 17.8 [IQR 8.3-28.4] months. The 1-year OS rates of the surgery alone group, adjuvant chemotherapy group, and adjuvant chemoimmunotherapy were 41.7%, 71.0%, and 93.3%, respectively. The 2-year OS rates were 28.6%, 47.7%, and 84.0%, respectively. The median OS was 6.8 months and 22.1 months, but the adjuvant chemoimmunotherapy group did not reach (P = .0002). The median RFS was 4.7 months, 15.7 months, and 14.8 months, respectively, but the differences were not statistically significant (P = .0613). Univariate and multivariate Cox analysis results showed that tumor size >2.3 cm (HR = 2.06, 95% CI, 1.06-4.04; P = .034) and the treatment regimen were independent factors affecting prognosis, compared to surgery alone and adjuvant chemotherapy (HR = 0.521, 95% CI, 0.26-1.04; P = .065), adjuvant chemoimmunotherapy (HR = 0.106, 95% CI, 0.02-0.47; P = .003) significantly improves patient survival. There was no statistically significant difference in any complications between the 3 groups (P > .05). Compared with the adjuvant chemotherapy group, patients in the adjuvant chemoimmunotherapy group are more likely to experience hypothyroidism (P = .044) and pruritus (P = .022). There is no statistically significant difference in other AEs between the 2 groups (P > .05).

CONCLUSION: Compared with surgery alone or adjuvant chemotherapy, patients with pancreatobiliary subtype AAC who received adjuvant chemoimmunotherapy showed better OS, and the drug-related toxicity was acceptable.

PMID:40465242 | DOI:10.1093/oncolo/oyaf104