Nevin Manimala

Prostate. 2025 Dec 7. doi: 10.1002/pros.70106. Online ahead of print.

ABSTRACT

BACKGROUND: Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP).

METHODS: In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes.

RESULTS: At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups.

CONCLUSION: PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings.

TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.

PMID:41353629 | DOI:10.1002/pros.70106

Am J Hosp Palliat Care. 2025 Dec 7:10499091251406573. doi: 10.1177/10499091251406573. Online ahead of print.

ABSTRACT

BackgroundAlthough previous research has highlighted the protective effect of social support in caregiving contexts, further investigation is needed to understand its complex roles in modifying and explaining the impact of caregiver stressors. This cross-sectional study assessed family caregivers’ social support, digital literacy, and caregiving-related stressors, examining their relationships and impact on mental health outcomes (anxiety and depressive symptoms). Specifically, we investigated (1) whether digital literacy interacted with stressors to influence caregivers’ perceived social support and (2) whether social support mediates the relationship between caregiver stressors and mental health.MethodsData were collected from 308 caregivers of people living with dementia receiving hospice care using structured assessments, including validated measures of social support, digital literacy, anxiety, depressive symptoms, and key sociodemographic characteristics.ResultsThe direct and total effects of caregiver stressors on mental health outcomes were statistically significant, whereas the indirect effects mediated by social support were not. Although tangible support was individually associated with both outcomes, the overall mediating effect of social support was not accounted for by either emotional/informational or tangible support alone. The moderating effect of digital literacy was also not statistically significant.ConclusionsThe association between caregiver stressors and mental health appears to be more directly driven than mediated by social support. The absence of significant indirect or moderating effects highlights the complexity of these relationships and underscores the need for future research to explore additional pathways, contextual influences, and conditions under which aspects of social support or digital literacy may exert greater impact.

PMID:41353626 | DOI:10.1177/10499091251406573

Infect Dis (Lond). 2025 Dec 7:1-11. doi: 10.1080/23744235.2025.2598808. Online ahead of print.

ABSTRACT

OBJECTIVES: Evaluation of pancreatic stone protein (PSP) plasma levels has been proven effective in predicting unfavourable outcomes in patients with Ventilator-Associated Pneumonia (VAP), infection after cardiothoracic surgery and peritonitis. It is also being studied as a sepsis biomarker with promising results compared to other commonly used biomarkers. We aim to validate PSP in septic patients with community acquired infections. This will help to establish its role in point-of-care settings.

METHODS: Adult patients consecutively admitted to the Emergency Department (ED) of a tertiary medical centre, with the diagnosis of intra-abdominal infection (IAI), urinary tract infection (UTI) and lower respiratory tract infection (LRTI) who met the inclusion criteria were enrolled. PSP was measured in whole blood, within one hour since admission, by spectrophotometry using abioSCOPE device. Statistical analysis was performed, and a cut-off value for PSP to predict the composite outcome of sepsis, readmission, antibiotic treatment escalation and need for invasive treatment was estimated. Patients were followed for 28 days to document their outcomes.

RESULTS: A total of one hundred and one (n = 101) patients were included. Forty-five were male. The most common comorbidity was hypertension (33%). Fifty-three (52.5%) had LRTI, thirty-seven (36.6%) had UTI and nineteen (18.8%) had IAI. Thirteen of them had more than one type of infection. Our primary outcome met statistical significance, as PSP predicted the composite outcome of sepsis, readmission, antibiotic treatment escalation and need of invasive treatment with an Area Under Curve (AUC) =0.844 (95% CI 0.767-0.920), in the optimal cut-off of 48.5 ng/ml. PSP predicted sepsis with an AUC = 0.892 (95% CI 0.826-0.956) and was also an independent risk factor for sepsis and mortality after age adjustment. PSP was superior to the common used sepsis biomarkers, C-reactive protein (CRP), ferritin, lactate dehydrogonase (LDH)/albumin ratio, White Blood Cell count (WBC), fibrinogen and lactate both for sepsis and for the composite outcome. It was also correlated with Sequential Organ Failure Assessment (SOFA) day 1 (D1), SOFA peak and qSOFA and its prognostic value was independent of renal function, despite being inversely proportional to estimated Glomerular Filtration Rate (eGFR), reflecting the sepsis-related acute kidney injury (SAKI).

CONCLUSIONS: PSP is a valuable biomarker that can rule out patients who do not have sepsis and are not in high risk to develop sepsis the following days, giving valuable insights regarding their antimicrobial coverage and management in general. It seems to be superior to other biomarkers in sepsis prediction and adequately compatible with frequently used sepsis assessment scores, such as SOFA. In the Emergency Department setting PSP can distinguish infected patients at high risk for sepsis who have low qSOFA scores.

PMID:41353590 | DOI:10.1080/23744235.2025.2598808

J Orthop Surg (Hong Kong). 2025 Sep-Dec;33(3):10225536251407382. doi: 10.1177/10225536251407382. Epub 2025 Dec 7.

ABSTRACT

BackgroundThis study aims to compare the performance of two artificial intelligence (AI) models, ChatGPT-4.0 and DeepSeek-R1, in addressing clinical questions related to degenerative lumbar spinal stenosis (DLSS) using the North American Spine Society (NASS) guidelines as the benchmark.Methods15 clinical questions spanning five domains (diagnostic criteria, non-surgical management, surgical indications, perioperative care, and emerging controversies) were designed based on the 2013 NASS evidence-based clinical guidelines for the diagnosis and management of DLSS. Responses from both models were independently evaluated by two board-certified spine surgeons across four metrics: accuracy, completeness, supplementality, and misinformation. Inter-rater reliability was assessed using Cohen’s κ coefficient, while Mann-Whitney U and Chi-square tests were employed to analyze statistical differences between models.ResultsDeepSeek-R1 demonstrated superior performance over ChatGPT-4.0 in accuracy (median score: 3 vs 2, P = 0.009), completeness (2 vs 1, P = 0.010), and supplementality (2 vs 1, P = 0.018). Both models exhibited comparable performance in avoiding misinformation (P = 0.671). DeepSeek-R1 achieved higher inter-rater agreement in accuracy (κ = 0.727 vs 0.615), whereas ChatGPT-4.0 showed stronger consistency in ssupplementality (κ = 0.792 vs 0.762).ConclusionsWhile both AI models demonstrate potential for clinical decision support, DeepSeek-R1 aligns more closely with NASS guidelines. ChatGPT-4.0 excels in providing supplementary insights but exhibits variability in accuracy. These findings underscore the need for domain-specific optimization of AI models to enhance reliability in medical applications.

PMID:41353581 | DOI:10.1177/10225536251407382

Med Sci Monit. 2025 Dec 7;31:e949115. doi: 10.12659/MSM.949115.

ABSTRACT

BACKGROUND Peripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients. MATERIAL AND METHODS This retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient’s age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital. RESULTS Peripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12-18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001). CONCLUSIONS The overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

PMID:41353559 | DOI:10.12659/MSM.949115

Eur J Med Res. 2025 Dec 6;30(1):1215. doi: 10.1186/s40001-025-03512-4.

ABSTRACT

BACKGROUND: Age-associated memory impairment (AAMI) is a predementia state linked to endothelial dysfunction. The endothelial activation and stress index (EASIX) quantifies endothelial injury, yet its association with cognitive function remains unvalidated in population studies. This study aimed to evaluate the relationship between EASIX and cognitive performance.

METHODS: Data from adults aged ≥ 60 years in the NHANES 2011-2014 were analyzed. Multiple linear regression assessed associations between EASIX and cognitive function scores. LASSO regression selected variables, and six machine learning models (e.g., Random Forest and XGBoost) were developed. SHAP values interpreted feature importance.

RESULTS: Among 2,763 participants, EASIX showed a significant negative correlation with all cognitive scores (P < 0.05). The ElasticNet model outperformed other models. SHAP analysis identified EASIX as one of the top four influential variables, with cognitive function levels demonstrating a declining trend as EASIX score increased, particularly among older adults.

CONCLUSIONS: EASIX is significantly negatively associated with cognitive function, especially in advanced age. Although the cross-sectional design precludes causal inference, it shows promise as a blood-based biomarker for early screening and risk assessment of cognitive decline, supporting its potential clinical utility.

PMID:41353552 | DOI:10.1186/s40001-025-03512-4

J Cardiothorac Surg. 2025 Dec 6;20(1):452. doi: 10.1186/s13019-025-03718-x.

ABSTRACT

BACKGROUND: Outcomes of aortic root replacement (ARR) versus conservative root approach (CRA) in patients undergoing acute type A aortic dissection (ATAAD) repair remained controversy.

METHODS: The present study was a pooled meta-analysis of Kaplan-Meier-derived individual patient data (IPD) from comparative studies published by September 29, 2024.

RESULTS: Forty studies met our eligibility criteria, comprising 11,734 patients (4212 in the ARR group and 7522 in the CRA group). In the overall population, the overall survival was similar between the ARR and CRA groups (hazard ratio [HR], 0.95; 95% CI, 0.87-1.02; p = 0.17, log-rank test p = 0.47), while ARR was associated with lower risk of reoperation compared with CRA (HR 0.72; 95% CI, 0.59-0.87; p < 0.001, log-rank test p < 0.001). Subgroup analysis revealed that valve-sparing root replacement (VSRR) was associated with better overall survival compared with CRA (HR 0.74; 95% CI, 0.60-0.91; p = 0.004, log-rank test p = 0.003), while Bentall procedure was not (HR 1.06; 95% CI, 0.93-1.20; p = 0.37, log-rank test p = 0.39). The restricted mean survival time (RMST) was overall 12.9 months longer with VSRR compared with CRA (p = 0.009). The meta-regression analyses did not find statistically significant coefficients for the covariates of age, male sex, hypertension, diabetes, Marfan syndrome, bicuspid aortic valve, aortic root diameter and ascending aorta diameter in the CRA arm.

CONCLUSIONS: In patients underwent ATAAD repair, the overall survival was comparable between ARR and CRA, while ARR was associated with lower risk of reoperation compared with CRA. VSRR was associated with better long-term survival compared with CRA, while Bentall procedure was not.

PMID:41353548 | DOI:10.1186/s13019-025-03718-x

Eur J Med Res. 2025 Dec 6. doi: 10.1186/s40001-025-03609-w. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the correlation between paraspinal muscle atrophy, facet joint degeneration, and degenerative scoliosis (DS).

METHODS: A retrospective study included 231 chronic low back pain patients from Zhongda Hospital Affiliated to Southeast University (January 2023-January 2024). Radiographic diagnosis assigned 150 patients to DS group (subclassified into mild [n = 72], moderate [n = 56], severe [n = 22]) and 81 to non-DS control group. Using T2-weighted MRI at L3-S1 levels, ImageJ software measured multifidus (MF) and erector spinae (ES) cross-sectional area (CSA) and functional muscle ratio (LCSA/GCSA). Surgimap software quantified facet joint angle (FJA), facet overhang (FO) length, and facet joint space width (FJSW). Logistic regression analyzed risk factors with ROC curves determining diagnostic thresholds.

RESULTS: The non-DS group demonstrated a significantly higher proportion of males (P = 0.023) and greater bone mineral density (P = 0.043) compared to the DS group. Regarding paraspinal muscle parameters, the non-DS group exhibited significantly larger MF CSA, MF + ES CSA, and LCSA/GCSA at the L3/4, L4/5, and L5/S1 levels, as well as a larger ES CSA at the L3/4 level (all P < 0.05). Conversely, the ES CSA at the L5/S1 level was significantly smaller in the non-DS group. For facet joint parameters, the non-DS group showed significantly smaller FJA, FO Length at the L3/4, L4/5, and L5/S1 levels, and smaller FJSW at the L3/4 and L4/5 levels (all P < 0.05). Within the DS group, significant differences were observed between the convex and concave sides at all L3-S1 levels for LCSA/GCSA, MF CSA, ES CSA, FJA, FO Length, and FJSW (all P < 0.05). With increasing severity of DS, there was a progressive decrease in LCSA/GCSA, MF CSA, and ES CSA, and a progressive increase in FJA and FO Length across the L3-S1 levels (all P < 0.01). Post-hoc analysis revealed significant differences in the majority of muscle parameters between severe DS and mild/moderate DS (P < 0.05). Correlation analysis indicated that, except for FJSW at L5-S1 (P = 0.526), the Cobb angle was negatively correlated with MF CSA, ES CSA, LCSA/GCSA, and FJSW, and positively correlated with FJA and FO Length (all P < 0.001). In both the DS and non-DS groups, most LCSA/GCSA and other CSA measurements demonstrated no significant correlations with FJA, FO length, and FJSW. Among the few statistically significant correlations observed, all were weak (rho < 0.30). Multivariate logistic regression analysis identified the following risk-associated factors for DS: lower BMD (OR = 0.802, P = 0.032), reduced LCSA/GCSA (OR = 0.005, P = 0.003), smaller MF CSA (OR = 0.969, P = 0.027), smaller ES CSA (OR = 0.973, P = 0.014), larger FJA (OR = 1.075, P = 0.016), and greater FO length (OR = 1.067, P = 0.001). ROC analysis yielded AUCs/cut-offs: BMD (0.581/- 0.900 T-score), LCSA/GCSA (0.712/0.805), MF CSA (0.608/635 mm²), ES CSA (0.463/832 mm²), FJA (0.627/57°), FO length (0.651/6.550 mm).

CONCLUSION: DS patients demonstrate progressive paraspinal muscle atrophy, sagittal-oriented facet joints, and advanced facet degeneration correlating with scoliosis severity. Diagnostic thresholds indicating DS probability are BMD < – 0.900 T-score, LCSA/GCSA < 0.805, MF CSA < 635 mm², ES CSA < 832 mm², FJA > 57°, and FO length > 6.550 mm.

PMID:41353546 | DOI:10.1186/s40001-025-03609-w

Thromb J. 2025 Dec 6. doi: 10.1186/s12959-025-00799-5. Online ahead of print.

NO ABSTRACT

PMID:41353544 | DOI:10.1186/s12959-025-00799-5

BMC Nephrol. 2025 Dec 6. doi: 10.1186/s12882-025-04669-0. Online ahead of print.

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a prevalent and severe complication following non-cardiac surgery, often leading to poor outcomes. Despite the critical role of inflammation in AKI pathogenesis, reliable preoperative predictive models remain elusive. The pan-immune inflammation value (PIV), a novel index that integrates counts of neutrophils, platelets, lymphocytes, and monocytes, provides a comprehensive reflection of systemic inflammation. This study aimed to develop and validate a clinical prediction model for postoperative AKI (PO-AKI) in non-cardiac surgical patients.

METHODS: This retrospective study included adult patients who underwent non-cardiac surgery under general anaesthesia. The objective was to construct a model to predict PO-AKI. The statistical analysis focused on model construction and validation. LASSO regression was employed for variable selection to identify the most parsimonious set of predictors. The model’s performance was evaluated based on its discriminative ability (AUC), with calibration and decision curve analysis used to assess its clinical utility.

RESULTS: The cohort consisted of 1,164 adult patients. AKI was diagnosed in 8.4% of patients. The primary outcome, the performance of the prediction model, showed an AUC of 0.70. The model incorporated PIV and emergency surgery. The secondary outcome, the discriminative ability of PIV alone, yielded an AUC of 0.691. The model demonstrated good calibration and provided a clinical net benefit across a wide range of threshold probabilities.

CONCLUSION: We developed and validated a prediction model for PO-AKI. This model, which integrates PIV and emergency surgery, serves as an effective tool for preoperative risk stratification, facilitating the identification of high-risk patients and optimizing perioperative management.

PMID:41353543 | DOI:10.1186/s12882-025-04669-0