Nevin Manimala

Biotechnol Biofuels Bioprod. 2025 Jun 7;18(1):60. doi: 10.1186/s13068-025-02662-1.

ABSTRACT

BACKGROUND: 2,3-butanediol (2,3-BDO) is an economically important platform chemical that can be produced by the fermentation of sugars using an engineered strain of Zymomonas mobilis. These fermentations require continuous monitoring and modification of fermentation conditions to maximize 2,3-BDO yields and minimize the production of the undesired coproducts glycerol and acetoin. Because of the time required for sampling and off-line chromatographic measurement of fermentation samples, the ability of fermentation scientists to modify fermentation conditions in a timely manner is limited. The goal of this study was to test if near-infrared spectroscopy (NIRS) along with multivariate statistics could reduce the time needed for this analysis and enable real-time monitoring and control of the fermentation.

RESULTS: In this work we developed partial least squares (PLS) calibration models to predict the concentrations of glucose, xylose, 2,3-BDO, acetoin, and glycerol in fermentations via NIRS using two different spectrometers and two different spectroscopy modalities. We first evaluated the feasibility of rapid NIRS monitoring through experiments where we measured the signals from each analyte of interest and built NIRS-based PLS models using spectra from synthetic samples containing uncorrelated concentrations of these analytes. All analytes showed unique spectral signatures, and this initial modeling showed that all analytes could be detected simultaneously. We then began work with samples from laboratory fermentation experiments and tested the feasibility of regression model development across two spectral collection modalities (at-line and on-line) and two instruments: a laboratory-grade instrument and a low-cost instrument with a more limited spectral range. All modalities showed promise in the ability to monitor Z. mobilis fermentations of glucose and xylose to 2,3-BDO. The low-cost instrument displayed a lower signal-to-noise ratio than the laboratory-grade instrument, which led to comparatively lower performance overall, but still provided sufficient accuracy to monitor fermentation trends. While the ease of use of on-line monitoring systems was favored as compared to at-line systems due to the lack of sampling required and potential for automated process control, we observed some decrease in performance due to the additional complexity of the sample matrix.

CONCLUSION: We have demonstrated that NIRS combined with multivariate analysis can be used for at-line and on-line monitoring of the concentrations of glucose, xylose, 2,3-BDO, acetoin, and glycerol during Z. mobilis fermentations. The decrease in signal-to-noise ratio when using a low-cost spectrometer led to greater prediction error than the laboratory-grade spectrometer for at-line monitoring. The on-line monitoring modality showed great promise for real time process control via NIRS.

PMID:40483497 | DOI:10.1186/s13068-025-02662-1

BMC Pregnancy Childbirth. 2025 Jun 7;25(1):664. doi: 10.1186/s12884-025-07792-w.

ABSTRACT

BACKGROUND: Health literacy during pregnancy is essential for maintaining and improving a healthy life. This study aims to examine the effect of health literacy on pregnancy-related anxiety and risk perception during pregnancy.

METHODS: This was a cross-sectional study. 204 pregnant women (24-37 weeks of gestation) were included in the study. The study data were collected using the descriptive information form, Maternal Health Literacy in Pregnancy Scale, Risk Perception in Pregnancy Scale, and Pregnancy-Related Anxiety Scale. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, version 26.0. Armonk, NY: IBM Corp.) software and SPSS Amos.

RESULTS: The average age of the participants was 28.2; the average age at marriage was 22.76; and the average gestational week was 25.93. 38.7% of the participants were high school graduates. According to the study results, there were significant positive relationships between health literacy and pregnancy anxiety during pregnancy (r =.340, p <.01) and negative relationships between risk perception (r = -.212, p <.05). These findings indicate that while increased health literacy is associated with lower risk perception, it may paradoxically be linked to higher pregnancy-related anxiety.

CONCLUSIONS: This study has shown that health literacy can reduce risk perception while increasing pregnancy anxiety. This situation suggests that increasing knowledge should be considered together with anxiety management.

PMID:40483496 | DOI:10.1186/s12884-025-07792-w

Cardiovasc Diabetol. 2025 Jun 7;24(1):242. doi: 10.1186/s12933-025-02795-5.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) frequently coexists with diabetes mellitus (DM), leading to a worse prognosis if both are present. Steatotic liver disease (SLD) may also predispose to DM, but its impact among AF patients is unclear. We aimed to determine whether metabolic dysfunction-associated SLD (MASLD), MASLD with increased alcohol intake (MetALD), or alcohol-related liver disease (ALD) elevates DM risk in AF.

METHODS: Non-diabetic individuals who developed AF between 2010 and 2018 from the Korean National Health Insurance Service database were included. Patients with a fatty liver index (FLI) < 30 were classified as non-SLD, whereas those with FLI ≥ 30 and at least one cardiometabolic risk factors were categorized as MASLD, MetALD, or ALD based on daily alcohol intake. Incident DM hazard ratios (HRs) were estimated with Cox regression models.

RESULTS: Among 195,195 patients (mean age 64.4 ± 13.0 years, 57.5% male); 108,918 (55.8%) in non-SLD, 71,795 (36.8%) in MASLD, 7644 (3.9%) in MetALD, and 6838 (3.5%) in ALD, respectively. Over a mean follow-up of 6.0 ± 2.9 years, 25,632 (13.0%) developed DM. Compared with non-SLD, the adjusted HRs with 95% confidence intervals (CIs) for incident DM were 1.930 (1.879-1.983), 1.789 (1.682-1.904), and 1.932 (1.817-2.054) for MASLD, MetALD, and ALD, respectively. In the age 20-39 years group, adjusted HRs with 95% CIs were 5.844 (4.501-7.587), 5.354 (3.681-7.787), and 7.033 (4.660-10.615), respectively.

CONCLUSION: SLD confers an increased risk of new-onset DM in AF patients, especially in younger adults. Implementing management strategies to prevent DM in AF patients with SLD might mitigate the risk of DM and its potential impact on AF-related outcomes.

PMID:40483494 | DOI:10.1186/s12933-025-02795-5

BMC Complement Med Ther. 2025 Jun 7;25(1):207. doi: 10.1186/s12906-025-04914-x.

ABSTRACT

BACKGROUND: Understanding liver diseases is important worldwide due to their prevalence. Apart from liver disease arising from hepatitis C viral infection, most chronic liver diseases currently have no cure. Several therapeutic alternatives, including some natural products, have been proposed to treat liver diseases. The natural product Jatropha dioica has been reported to possess antioxidant activity and, by extension, could have hepatoprotective activity. Accordingly, our aim was to test the hypothesis that an extract of J. dioica is protective against liver damage induced by valproic acid (VPA).

METHODS: Twelve male and twelve female Wistar rats were sorted into four groups: control, non-toxicity, valproic acid control (VPA-C), and J. dioica + VPA (JdVPA). J. dioica (300 mg/kg, given orally) was used as treatment, followed by a concomitant injection of VPA (500 mg/kg, i.p.) for the first 4 days to induce liver injury. To evaluate the severity of the injury, liver function tests were performed. In addition, oxidative stress biomarkers were quantified, as well as measures of the expression of the genes Actb, Il6, and Nfkb1.

RESULTS: The VPA-C group showed a significant increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and malondialdehyde (MDA), a decrease in superoxide dismutase (SOD), and a reduction in glutathione (GSH) vs the control group. The JdVPA group showed a significant decrease in ALT, AST, and MDA and an increase in GSH and SOD vs the VPA-C group. Gene expression of Il6 and Nfkb1 did not show any statistically significant differences between study groups. Histologically, VPA presented an inflammatory infiltrate, which decreased in the JdVPA group.

CONCLUSION: The extract of J. dioica at the administered dose did not display toxicity and was capable of ameliorating the liver injury generated by VPA in biochemical and oxidative stress biomarkers, which suggests its potential hepatoprotective activity.

PMID:40483492 | DOI:10.1186/s12906-025-04914-x

Radiat Oncol. 2025 Jun 7;20(1):98. doi: 10.1186/s13014-025-02670-3.

ABSTRACT

BACKGROUND: The integration of magnetic resonance imaging with linear accelerators (Linacs) enhances adaptive radiotherapy by providing real-time imaging for improved treatment precision. However, the long-term performance of MR-Linac systems, particularly in clinical settings, remains insufficiently studied. Traditional quality assurance (QA) methods, relying on binary pass/fail criteria, may overlook critical system variations. This study applies statistical process control (SPC) techniques to evaluate the long-term performance of a 1.5T MR-Linac, focusing on optimization in beam quality, MR-to-MV alignment, MR imaging, and geometric distortion.

METHODS: A dual-phase SPC framework was applied to 1 year of daily and weekly QA data from an Elekta Unity MR-Linac. Phase I established performance benchmarks, while Phase II monitored deviations online. Evaluated parameters included beam output, symmetry, MR-to-MV alignment, signal-to-noise ratio (SNR), spatial linearity, slice profile, and geometric distortion across spherical volumes (DSVs). Stability and variability were quantified using control charts and process performance indices (Ppk).

RESULTS: Beam quality was stable overall (Ppk ≥ 1.33), though output dose and transverse symmetry showed increased variability in Phase II, with dose Ppk declining from 3.13 to 1.33. MR-to-MV alignment was consistent, but Phi rotational and Z translational offsets showed variability after system upgrades. Imaging metrics, including SNR and spatial linearity, achieved A + performance (Ppk ≥ 1.67) in Phase II, while vertical spatial resolution was lower (Ppk 1.04-1.10). Geometric distortion was well-controlled, though larger DSVs (≥ 500 mm) showed increased AP-axis distortion (2.44 mm) compared to RL (1.37 mm) and FH (0.93 mm).

CONCLUSIONS: SPC techniques dynamically identified stable parameters and areas for improvement. Key recommendations include enhanced alignment protocols for beam quality and MR-to-MV offsets, as well as targeted strategies to address geometric distortion in larger volumes and along the AP axis.

PMID:40483491 | DOI:10.1186/s13014-025-02670-3

BMC Emerg Med. 2025 Jun 7;25(1):92. doi: 10.1186/s12873-025-01252-6.

ABSTRACT

BACKGROUND: Ketamine is one of the most used drugs in trauma patients after skiing accidents. However, the environmental conditions for these patients are often rough, with numerous unpleasant sensory impressions (e.g. noise from the helicopter, cold, wind, etc.), raising concerns about the adverse psychological side effects of ketamine. Moreover, it has not yet been established whether these side effects are dose-dependent, and the supplementary administration of benzodiazepines remains controversial. We analysed the subjective perception of side effects after administration of ketamine during helicopter emergency medical service missions involving trauma patients after ski accidents.

METHODS: In this retrospective observational study, data was collected from emergency services protocols and questionnaires filled out by patients. The primary outcome was defined as the patients’ subjective perceptions of ketamine-associated side effects. The subjective intensity of twelve common classes of side effects was recorded on a five-point Likert scale. In addition, we conducted a linear regression analysis, with side effect intensity as the outcome and gender, age, type of injury, use of midazolam and fentanyl, ketamine dosage and relative pain reduction as covariates.

RESULTS: A total of 69 patients were identified who were treated with ketamine during the winter months of 2023/2024, after suffering trauma while doing alpine winter sports. Of these, 49 patients (71%) could be included. The side effects reported were mostly mild, with two-thirds of the patients describing them as “no [side effects]” or “mild”. Only 6% described them as “barely tolerable” or “unbearable”. No statistically significant association could be demonstrated between the ketamine dose and the total reported side effect score. The regression model identified the additional administration of midazolam as a significant covariate for fewer side effects. With regard to prehospital care, 85% of the patients stated that they had always felt safe, while two-thirds were satisfied with the prehospital pain therapy.

CONCLUSION: Ketamine seems to be a suitable option for pain therapy in the case of injuries during alpine winter sport activities. Side effects reported by patients in this study were rare, not dose-dependent and described by most patients as subjectively well tolerable. The supplementary administration of midazolam could potentially further reduce these side effects.

PMID:40483480 | DOI:10.1186/s12873-025-01252-6

Lipids Health Dis. 2025 Jun 7;24(1):205. doi: 10.1186/s12944-025-02632-4.

ABSTRACT

BACKGROUND: The role of high-density lipoprotein cholesterol (HDL-C) in diabetic kidney disease (DKD) remains controversial. This study aimed to delineate the subgroup-specific relationships between the two by exploring cumulative and threshold effects.

METHODS: 3,040 patients with type 2 diabetes and no baseline evidence of DKD were included. Cox proportional hazards regression models were performed to investigate the potential relationship between HDL-C level and DKD risk. To address subgroup heterogeneity, sex-stratified restricted cubic splines (RCS) were employed to model nonlinear relationships. The optimal threshold was identified through the maximum selected statistics and validated via 1,000 bootstrap iterations. Subgroup analyses stratified by sex, diabetes duration, and metabolic status were performed to evaluate heterogeneity. Survival analysis using Kaplan-Meier curves further validated these threshold effects.

RESULTS: During a median follow-up of 3.13 years, 665 subjects (21.9%) progressed to DKD. Overall, each 1 mmol/L increase in HDL-C level independently reduced DKD risk by 43%. RCS analysis demonstrated an inverse correlation between HDL-C and DKD risk (P for overall = 0.025, P for nonlinear = 0.317), with increased risk reduction at lower concentrations, plateauing at higher levels. A robust threshold of 0.93 mmol/L was identified, showing significantly stronger protection against DKD progression (hazard ratio (HR) = 0.69, P < 0.001) compared to the traditional cutoff (HR = 0.86, P = 0.109). Females showed continuous protection (HR = 0.41, P = 0.009) without threshold dependency. The male and diabetes duration < 10 years subgroups exhibited threshold effects at > 0.93 mmol/L without continuous protection. The metabolically unstable (hypertension, poorly controlled glycemia, body mass index (BMI) > 28 kg/m²) and BMI < 24 kg/m² subgroups displayed dual effects (P < 0.05). Survival analysis confirmed lower cumulative DKD incidence with HDL-C > 0.93 mmol/L (P = 0.007).

CONCLUSIONS: This study reveals sex- and metabolic context-dependent heterogeneity in HDL-C-DKD associations: males and short-duration diabetes exhibited threshold effects (0.93 mmol/L), females showed continuous protection, and subgroups with hypertension, poorly controlled glycemia, or obesity (BMI > 28 kg/m²) exhibited both continuous protection and threshold effects. These findings may inform individualized risk stratification in specific populations.

PMID:40483478 | DOI:10.1186/s12944-025-02632-4

Popul Health Metr. 2025 Jun 7;23(1):23. doi: 10.1186/s12963-025-00383-z.

ABSTRACT

BACKGROUND: The evolution of family structures in China has led to changes in the living arrangements of older adults, resulting in an increasing prevalence of individuals living alone. This shift has raised concerns about the impact on the well-being of older adults, particularly in relation to loneliness. The objective of this study is to examine the association between living alone and lonely life expectancy (LLE) among older adults, with particular attention to gender differences.

METHODS: This study analyzed data from 9664 individuals aged 65-105, drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2008, 2011, 2014, and 2018. A multistate life table approach, coupled with interpolation Markov Chain methods using IMaCh software (version 0.99r43), was employed to estimate age-specific transition probabilities, life expectancy (LE), lonely life expectancy (LLE), and the proportion of LLE to LE (LLE/LE). The analysis was stratified by gender and living arrangements, distinguishing between individuals living alone and those not living alone.

RESULTS: The study identified several key findings. First, while LE has increased among older adults in China, they continue to experience a substantial duration of LLE. Second, older adults living alone experienced both longer LLE and higher LLE/LE ratios. Specifically, the LLE/LE among individuals not living alone was 13.61% higher for males and 15.18% higher for females compared to those living alone. Third, among females living alone, the LLE/LE was the highest, reaching 39.48% at age 65, compared to just 20.96% for males not living alone.

CONCLUSIONS: Tackling persistent loneliness is essential for enhancing the quality of life among older adults, highlighting the need to integrate mental well-being into social welfare policies. As China’s population ages and family structures continue to evolve, living arrangements emerge as crucial policy indicators. Prioritizing the mental health of older adults, particularly women living alone, is critical for the development of effective social security policies.

PMID:40483472 | DOI:10.1186/s12963-025-00383-z

BMC Musculoskelet Disord. 2025 Jun 7;26(1):569. doi: 10.1186/s12891-025-08801-x.

ABSTRACT

OBJECTIVE: The present study assessed and synthesized the potential risk factors for perioperative blood transfusion in total hip arthroplasty from various studies through Meta-analysis.

METHODS: We systematically searched for relevant studies in databases including Web of Science, PubMed, Embase, and Cochrane Library from the time of database creation to 1 February 2025 and included all observational studies exploring perioperative transfusion risk factors in patients undergoing total hip arthroplasty. All included studies were assessed for quality using the Newcastle-Ottawa Scale (NOS) scale. Data were analyzed using Stata 15 software.

RESULTS: A total of 18 articles (n = 424,158) were included, meta-analysis results suggest that increased intraoperative bleeding [OR = 1.13, 95%CI (1.02, 1.24)], increased postoperative drainage [OR = 2.24, 95%CI (1.24, 4.83)], body mass index ≤ 18.5 [OR = 1.10, 95%CI (1.02, 1.20)], preoperative anemia [OR = 1.82, 95%CI (1.62, 2.03)], age ≥ 80 [OR = 1.49 95%CI(1.21, 1.83)], female [OR = 1.92, 95%CI (1.71, 2.15)], ASA class ≥ 3 [OR = 2.06, 95%CI (1.63, 2.61)] in patients with total hip arthroplasty (THA) increases the incidence of perioperative blood transfusion.

CONCLUSION: The results of the current study suggest that increased intraoperative bleeding, increased postoperative drainage, low body mass index (≤ 18.5), preoperative anemia, advanced age (≥ 80 years), female gender, and high ASA classification (≥ 3) were significantly associated with the likelihood of needing blood transfusion. These findings highlight the importance of preoperative risk assessment and perioperative management strategies to reduce the need for blood transfusion and improve patient outcomes.

PMID:40483471 | DOI:10.1186/s12891-025-08801-x

BMC Pulm Med. 2025 Jun 7;25(1):284. doi: 10.1186/s12890-025-03737-3.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). While studies have demonstrated benefits for mortality, hospitalization rates, and health related quality of life (HRQL), evidence is particularly sparse regarding HRQL determinants in the older population.

METHODS: In a prospective, monocentric observational study, HRQL was assessed using the established Severe Respiratory Insufficiency Questionnaire (SRI). The study was prospectively registered in the German Clinical Trials Register on 17 June 2015 under the registration number DRKS00008759. Patients were categorized into two age-based groups: older patients (≥ 65 years) and younger patients (< 65 years). Multiple linear regression analyses were used to analyze factors on HRQL, including SRI scores, anemia, autonomy impairment, exacerbation history and other factors.

RESULTS: 237 Patients with COPD with CHRF receiving NIV therapy were included. The mean SRI summary score was 49.9 ± 16.8. with 23.2% (N = 55) suffering from anemia and 36.7% (N = 87) experiencing ≥ 2 exacerbations annually. Autonomy impairment was observed in 49.4% (N = 117) of patients. The updated Charlson Comorbidity Index (uCCI) was 2.2 ± 1.86. No significant differences were found in SRI Summary Scale scores between age groups (p = 0.581), but notable disparities were present in the uCCI (p = 0.014). Multiple regression analysis revealed a negative association of exacerbation history (Young group: -9.2; 95% CI = -14.8/ -3.55 vs. Older group: -6.17; 95% CI = -11.91/ -0.43) and level of autonomy impairment (e.g. Level of Care 2 Young group: -13.91; 95% CI = -21.4/ -6.43 vs. Older group: -14.94; 95% CI = -22.64/ -7.24) on SRI scores with age-related differences. Anemia only had a negative association on the SRI scores in younger patients with COPD (Young group: -7.9; 95% CI = -14.0/ -1.75 vs. Older group: -1.78; 95% CI = -9.21/ 5.65).

DISCUSSION: Frequent exacerbations and a higher level of autonomy impairment had a negative association on HRQL across all ages. However only higher levels of impairment (≥ 2) have a detrimental impact on older patients. Anemia was a negative HRQL factor in younger patients, where it was more prevalent. Overall, HRQL was found to be comparably favorable in both older and younger patients, despite age-specific differences in influencing factors.

REGISTRATION OF THE CLINICAL TRIAL: The study from which the data were analyzed was prospectively registered in the German Clinical Trials Register (DRKS00008759) on June 17, 2015.

PMID:40483464 | DOI:10.1186/s12890-025-03737-3