Nevin Manimala

Gynecol Oncol Rep. 2025 Mar 17;58:101725. doi: 10.1016/j.gore.2025.101725. eCollection 2025 Apr.

ABSTRACT

OBJECTIVE: The incidence and mortality of endometrial cancer is increasing. After surgical staging, patients with high-risk disease often undergo adjuvant treatment, which may include systemic therapy, radiation therapy, or combined modalities. Patients in rural Appalachia have limited access to subspecialty care needed for optimal disease management. This study aims to compare adjuvant treatment regimens and outcomes among patients with high-risk endometrial cancer living in Appalachian and non-Appalachian regions.

METHODS: We retrospectively identified 179 patients with high-risk endometrial carcinoma who underwent surgical staging at a single academic medical center and received adjuvant therapy between 2012 and 2019. Patients were identified as Appalachian (n = 119) and non-Appalachian (n = 60) residents based on home ZIP code. Adjuvant therapy regimen, recurrence rate, recurrence location, progression free survival (PFS), and overall survival (OS) were compared. Statistical comparisons were performed using multinomial and ordinal logistic regression models, Kaplan-Meier curves, Log Rank test, two-sample t-tests, Fisher’s exact, and chi-square tests.

RESULTS: There was no significant difference in adjuvant therapy regimen between groups. Overall recurrence rates were similar, though rate of vaginal recurrence was higher among non-Appalachian patients compared to Appalachian patients (42 % vs. 14 %, p = 0.05). There were no differences in rate of pelvic or distant recurrences, PFS, or OS.

CONCLUSION: Despite lower densities of subspecialists in rural Appalachia, Appalachian and non-Appalachian patients with high-risk endometrial cancer received similar adjuvant therapy regimens and had similar disease outcomes. Further efforts should work to optimize treatment and surveillance for patients with endometrial carcinoma with barriers to subspecialty care.

PMID:40213528 | PMC:PMC11985054 | DOI:10.1016/j.gore.2025.101725

J Clin Orthop Trauma. 2025 Mar 17;65:102977. doi: 10.1016/j.jcot.2025.102977. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) is increasingly used to minimize blood loss associated with total hip replacement (THR), yet its comparative efficacy in inflammatory versus degenerative arthritis during THR remains underexplored in Indian patients. The objective of this study was to evaluate and compare the estimated intraoperative blood loss in patients undergoing THR with and without TXA administration, stratified by underlying degenerative and inflammatory joint conditions.

METHODS: This retrospective cohort study analyzed medical records of patients undergoing THR at a single center from October 2020 to October 2023. Patients were stratified by TXA usage and the type of arthritis (inflammatory and degenerative). The primary outcome was intraoperative blood loss, while secondary outcomes included operative time and time to full weight-bearing.

RESULTS: The study enrolled 126 patients, including 21 with inflammatory arthritis and 105 with degenerative arthritis, of whom 106 received TXA (n = 19, inflammatory arthritis; n = 87, degenerative arthritis).The primary outcome of mean intraoperative blood loss was lower in the TXA group (350.57 ± 162.36 mL) compared to the non-TXA group (380.00 ± 192.22 mL), although this difference did not reach statistical significance (p = 0.472).Secondary outcome, operative time was significantly shorter in patients receiving TXA (88.53 ± 24.38 min) compared to those who did not receive TXA (102.58 ± 45.27 min, p = 0.046). While the time to full weight-bearing was comparable between the TXA users and non-users (p = 0.341).Subgroup analysis suggested a more pronounced reduction in blood loss with TXA use among patients with degenerative arthritis than those with inflammatory arthritis, though the difference was not statistically significant.

CONCLUSION: TXA administration in THR significantly reduced operative time but showed no significant difference in blood loss or postoperative recovery. The results suggest a potential for more pronounced benefits in patients with degenerative arthritis.

PMID:40213505 | PMC:PMC11979939 | DOI:10.1016/j.jcot.2025.102977

Lancet Reg Health Eur. 2025 Feb 10;51:101231. doi: 10.1016/j.lanepe.2025.101231. eCollection 2025 Apr.

ABSTRACT

BACKGROUND: Local transmission of dengue, chikungunya, and Zika infection is an emerging public health threat in Europe. Monitoring the epidemiological trends can help define the intervention strategy. The aim of this work was to analyse epidemiological characteristics of autochthonous transmission of Aedes-borne arboviruses in Europe.

METHODS: A systematic review of the literature published from January 1, 2007, to January 31, 2024, reporting autochthonous cases of dengue, chikungunya, and Zika detected in Europe was performed. We searched MEDLINE, EMBASE, and the ECDC reports. Descriptive statistics and a secondary analysis were used to summarize the epidemiological characteristics of local transmission events (LTEs), explore potential temporal trends and identify relevant associations between epidemiological variables. Time intervals between key events were analysed to identify potential delays in LTE identification and intervention.

FINDINGS: A total of 59 studies were included, describing 56 LTEs. The frequency of LTEs increased over time, with an average of 1.25 (95% CI: 1.17-1.35) times increment every year. While the highest number of dengue LTEs was reported in France (N = 37), Italy faced the largest number of cases detected in an LTE (N = 41). Considering all the arboviral LTEs, the median time between the symptom onset of the primary case and the diagnosis of the index case (“outbreak detection”) was 35.5 days (range 23.0-76.0). Only for chikungunya, higher delays correlated with higher cumulative number of cases detected per LTE, though this may be biased due to the low sample size.

INTERPRETATION: We have observed a gradual increase of Aedes-borne arboviral LTEs in Europe over time, and a considerable delay in outbreak detection. Improving the timeliness of LTE identification is essential.

FUNDING: This work was partly funded by the Italian Ministry of Health (Ricerca corrente) and by the European Union (Next Generation EU, Missione 4 Componente 1 CUP H93C22000640007).

PMID:40213502 | PMC:PMC11984593 | DOI:10.1016/j.lanepe.2025.101231

Psychol Med. 2025 Apr 11;55:e111. doi: 10.1017/S0033291725000753.

ABSTRACT

BACKGROUND: Emerging evidence indicates that gene-environment interactions (GEIs) are important underlying mechanisms for the development of schizophrenia (SZ). We investigated the associations of polygenic risk score for SZ (PRS-SZ), environmental measures, and their interactions with case-control status and clinical phenotypes among patients with schizophrenia spectrum disorders (SSDs).

METHODS: The PRS-SZ for 717 SSD patients and 356 healthy controls (HCs) were calculated using the LDpred model. The Korea-Polyenvironmental Risk Score-I (K-PERS-I) and Early Trauma Inventory-Self Report (ETI-SR) were utilized as environmental measures. Logistic and linear regression analyses were performed to identify the associations of PRS-SZ and two environmental measures with case-control status and clinical phenotypes.

RESULTS: The PRS-SZ explained 8.7% of SZ risk. We found greater associations of PRS-SZ and total scores of the K-PERS-I with case-control status compared to the ETI-SR total score. A significant additive interaction was found between PRS-SZ and K-PERS-I. With the subdomains of the K-PERS-I and ETI-SR, we identified significant multiplicative or additive interactions of PRS-SZ and parental socioeconomic status (pSES), childhood adversity, and recent life events in association with case-control status. For clinical phenotypes, significant interactions were observed between PRS-SZ and the ETI-SR total score for negative-self and between PRS-SZ and obstetric complications within the K-PERS-I for negative-others.

CONCLUSIONS: Our findings suggest that the use of aggregate scores for genetic and environmental measures, PRS-SZ and K-PERS-I, can more accurately predict case-control status, and specific environmental measures may be more suitable for the exploration of GEIs.

PMID:40211091 | DOI:10.1017/S0033291725000753

Bone Marrow Transplant. 2025 Apr 10. doi: 10.1038/s41409-025-02569-3. Online ahead of print.

ABSTRACT

The impact of center volume on outcomes in pediatric hematopoietic cell transplantation (HCT) is not well established. We retrospectively analyzed data from a nationwide registry, including 6966 pediatric patients who underwent their first allogeneic HCT at 123 centers in Japan between 2001 and 2020. Centers were categorized by transplant volume as low volume centers (C1, the smallest number of transplantation), medium-low volume centers (C2), medium-high volume centers (C3), and high volume centers (C4, the greatest number of transplantation), and outcomes were compared across these categories. The analysis revealed no statistically significant differences in HCT outcomes among center categories. The 5-year OS by center category was 66.8% (95% CI 64.4-69.0%) for C1, 66.8% (95% CI 64.5-69.0%) for C2, 67.9% (95% CI 65.6-70.2%) for C3, and 68.3% (95% CI 65.9-70.6%) for C4. These results were consistent even when analysis was restricted to malignant and nonmalignant diseases. Our findings suggest that, unlike in adult HCT, outcomes for pediatric HCT are not significantly affected by center volume. These results indicate the consistent quality of care across centers, supporting the accessibility of HCT at various institutions for pediatric patients.

PMID:40211066 | DOI:10.1038/s41409-025-02569-3

Sci Rep. 2025 Apr 10;15(1):12218. doi: 10.1038/s41598-025-97112-1.

ABSTRACT

The relationship between Klotho and epilepsy is poorly understood. This study aimed to investigate the association between serum Klotho levels and epilepsy. A total of 99,966 individuals who participated in the NHANES from the 2013 to 2016 were initially included. After excluding participants with missing data on serum Klotho concentration (57,286), epilepsy (6) and relevant covariates (6,096), the final sample consisted of 36,578 participants, with a mean age of 59 years. Weighted multivariable logistic regression analyses showed that high serum Klotho levels were negatively associated with the prevalence of epilepsy, with an odds ratio (OR) of 0.74 (95% confidence interval [CI]: 0.64 to 0.86; P < 0.001. The Restricted Cubic Spline analyses (RCS) model showed a non-linear relationship between the serum Klotho levels and epilepsy. Subgroup analysis showed that serum Klotho levels were negatively correlated with epilepsy prevalence in individuals under 65 years of age and in males. Our study suggests that serum Klotho levels were associated with the prevalence of epilepsy. Further large-scale prospective studies and randomized trials are warranted to confirm our findings.

PMID:40211052 | DOI:10.1038/s41598-025-97112-1

Evid Based Dent. 2025 Apr 10. doi: 10.1038/s41432-025-01135-6. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the influence of scanning speed and distance on the precision and quality of digital intraoral scans.

DATA: The PICO strategy was employed to delineate the inclusion and exclusion criteria. The acquired records underwent filtration according to eligibility criteria, with essential information subsequently extracted. The meta-analysis, facilitated by Review Manager 5.4, utilized chi-square and the inconsistency index, along with forest plots. The standardized mean difference (SMD) was employed for the comparative analysis of study groups. Additionally, the study encompassed assessments of publication bias and the quality of included studies.

SOURCES: The search was conducted using three Internet databases: PubMed, ScienceDirect, and the Cochrane Library.

RESULTS: Among the evaluated scanners (Trios 3, Trios 4, iTero, Primescan, Medit i500), only TRIOS 3 exhibited a statistically significant sensitivity to scanning parameters (SMD = -4.03; 95% CI: -7.26 to -0.80; P = 0.01). Increased scanning distances and faster speeds markedly reduced its accuracy, likely due to its older optical technology lacking real-time error correction features present in newer models like TRIOS 4 and Primescan. No significant effects were observed for TRIOS 4, Primescan, or Medit i500 (P > 0.05), suggesting their advanced hardware/software mitigates parameter variability.

CONCLUSIONS: Clinicians using TRIOS 3 should prioritize shorter scanning distances (5-10 mm) and slower speeds to optimize accuracy, as its performance is highly dependent on operator-controlled parameters. In contrast, newer scanners (e.g., TRIOS 4, Primescan) demonstrate greater resilience to distance/speed variations, enabling flexible clinical workflows. These findings underscore the importance of device-specific protocols to enhance digital impression reliability in restorative and prosthetic dentistry.

PMID:40211050 | DOI:10.1038/s41432-025-01135-6

Sci Rep. 2025 Apr 10;15(1):12221. doi: 10.1038/s41598-025-97578-z.

ABSTRACT

Patients with diabetes had significant vascular resistance, which was explained by vascular remodeling and an increase in fluid volume as a result of hyperglycemia. Insulin resistance in type 2 diabetes impairs lipid catabolism, and obesity raises the risk of isolated systolic hypertension. However, in Ethiopia minimal study has been conducted to address the specific relationship between isolated systolic hypertension and type 2 diabetes. Therefore, this study aims to determine the magnitude and determinants of isolated systolic hypertension among type 2 diabetes patients in selected referral hospitals of Amhara region, Ethiopia. A multicenter institution-based cross-sectional study was conducted from September 1 and December 30, 2023. Referral hospitals were chosen using simple random sampling. Additionally, participants in the study were chosen from the designated referral hospitals using systematic sampling approaches. To collect clinical and sociodemographic data, an interviewer-administered questionnaire was utilized. Epi-data version-4.6 and Stata-14 were used for data entry and statistical analysis, respectively. The descriptive statistics were presented with tables and graphs. A binary logistic regression model was fitted to identify associated factors of isolated systolic hypertension. In the final model, statistical significance was decided at p ≤ 0.05, and the strength of association was indicated using an adjusted odds ratio with 95% CI. The analysis included 258 participants, and the prevalence of isolated systolic hypertension was found to be 21.3% (95% CI 18-27.1%). Older age (AOR = 4.64, 95%CI 1.31,16.36), fasting blood sugar of ≥ 130 mg/dl (AOR = 2.32, 95% CI; 1.04, 5.19), and BMI > 25 Kg/m² (AOR = 2.75, 95% CI (1.33, 5.68)) were statistically significant factors of isolated systolic hypertension. The prevalence of isolated systolic hypertension (ISH) in this study was high, affecting large population of Type 2 Diabetes Mellitus (T2DM) patients. Older age, high body mass index (BMI), and elevated fasting blood sugar levels were identified as key determinants of ISH. The study emphasizes the need for regular monitoring and management of blood pressure in T2DM patients, particularly those who are older, and have higher BMI.

PMID:40211033 | DOI:10.1038/s41598-025-97578-z

Sci Rep. 2025 Apr 10;15(1):12352. doi: 10.1038/s41598-025-87663-8.

ABSTRACT

This study investigates the impact of lithium-ion battery (LIB) design characteristics on recycling efficiency through a comprehensive mixed-methods research approach. The study employs structural equation modeling (SEM) and analytic hierarchy process (AHP) methodologies, analyzing data collected through systematic expert interviews with 15 industry professionals and structured surveys of 150 battery manufacturing and recycling facilities. Through rigorous qualitative and quantitative analysis, this research examines the relationships between design complexity, material diversity, connection methods, and recycling process efficiency and overall recycling performance. The research methodology combines in-depth interviews, expert consultations, and statistical analysis to ensure robust findings. Data sources include primary data from industry surveys, expert interviews, and secondary data from technical documentation and recycling facility reports, providing a comprehensive foundation for the analysis. The research compares recycling efficiency across different battery types, including traditional designs, cell-to-pack (CTP), and cell-to-body (CTB), utilizing multi-group analysis. Through life cycle cost analysis and environmental impact assessment, the study quantifies the potential economic and ecological benefits of optimized designs. Results indicate that while optimized LIB designs may increase initial production costs, they significantly enhance recycling efficiency, reduce total lifecycle costs, and minimize environmental impacts. SEM analysis reveals that design characteristics indirectly influence overall recycling performance by affecting recycling process efficiency. Multi-group analysis demonstrates the superior recyclability of CTP and CTB designs compared to traditional configurations. The study also evaluates the improvement potential for recycling efficiency across various materials, providing a basis for optimizing recycling strategies. This research offers valuable insights for battery design, recycling technology innovation, and policy formulation, emphasizing the importance of incorporating recyclability considerations in LIB development. It contributes significantly to advancing the energy storage industry towards a circular economy model.

PMID:40211024 | DOI:10.1038/s41598-025-87663-8

Sci Rep. 2025 Apr 10;15(1):12251. doi: 10.1038/s41598-025-91469-z.

ABSTRACT

Viral codon fitness (VCF) of the host and the VCF shifting has seldom been studied under quantitative measurements, although they could be concepts vital to understand pathogen epidemiology. This study demonstrates that the relative synonymous codon usage (RSCU) of virus genomes together with other genomic properties are predictive of virus host codon fitness through tree-based machine learning. Statistical analysis on the RSCU data matrix also revealed that the wobble position of the virus codons is critically important for the host codon fitness distinction. As the trained models can well characterise the host codon fitness of the viruses, the frequency and other details stored at the leaf nodes of these models can be reliably translated into human virus codon fitness score (HVCF score) as a readout of codon fitness of any virus infecting human. Specifically, we evaluated and compared HVCF of virus genome sequences from human sources and others and evaluated HVCF of SARS-CoV-2 genome sequences from NCBI virus database, where we found no obvious shifting trend in host codon fitness towards human-non-infectious. We also developed a bioinformatics tool to simulate codon-based virus fitness shifting using codon compositions of the viruses, and we found that Tylonycteris bat coronavirus HKU4 related viruses may have close relationship with SARS-CoV-2 in terms of human codon fitness. The finding of abundant synonymous mutations in the predicted codon fitness shifting path also provides new insights for evolution research and virus monitoring in environmental surveillance.

PMID:40211017 | DOI:10.1038/s41598-025-91469-z