Nevin Manimala

Eur Urol Open Sci. 2025 Nov 18;83:1-8. doi: 10.1016/j.euros.2025.10.019. eCollection 2026 Jan.

ABSTRACT

BACKGROUND AND OBJECTIVE: In-hospital infectious complications after cystectomy are understudied, with no reliable predictive tools. The aim of our study was to (1) comprehensively and prospectively evaluate these complications, (2) compare results between ileal conduit (IC) and ileal neobladder (NB) groups, and (3) evaluate the suitability of interleukin-6 (IL-6) and procalcitonin (PCT) levels and culture results for wound drainage fluid (WDF) as early indicators of infection.

METHODS: We monitored in-hospital complications among patients undergoing cystectomy and analyzed IL-6 and PCT levels and WDF cultures on the first postoperative day. Statistical analysis included logistic regression and Spearman correlation analysis. The trial was registered on ClinicalTrials.gov as NCT05153694.

KEY FINDINGS AND LIMITATIONS: From December 2021 to October 2024, 205 patients underwent open cystectomy in our department, of whom 186 consented to participate (66% IC, 34% NB). The median patient age was 71.6 yr and 80% were male. During their inpatient stay, 47% of patients developed fever and 44% received additional intravenous antibiotics. We found no significant differences between the IC and NB groups regarding postoperative fever, additional antibiotic use, positive blood cultures, the incidence of complications by Clavien-Dindo grade, Comprehensive Complication Index scores, or the incidence of wound infection or other infections. Microbial growth was detected in 13% of WDF samples; Escherichia coli and Enterococcus spp. were the most prevalent bacteria. We observed little to no correlations between IL-6 or PCT levels or WDF culture results and infectious complications.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Our prospective study revealed unexpectedly high incidence of in-hospital infections among cystectomy patients, with no significant differences between IC and NB groups. IL-6 and PCT levels and WDF culture results on the first postoperative day were not suitable as early indicators of infectious complications after open cystectomy.

PATIENT SUMMARY: We looked at infectious complications during their hospital stay for patients undergoing surgical removal of their bladder. We found no difference in the rate of infectious complications between two common surgical procedures that create a new pathway for urine to leave the body. We also found that levels of the markers interleukin-6 and procalcitonin, and bacterial culture results for wound drainage fluid were not helpful in predicting infectious complications for these patients.

PMID:41334533 | PMC:PMC12666572 | DOI:10.1016/j.euros.2025.10.019

Internet Interv. 2025 Nov 15;42:100890. doi: 10.1016/j.invent.2025.100890. eCollection 2025 Dec.

ABSTRACT

OBJECTIVES: This study aims to investigate the perspectives of patients, caregivers, and healthcare providers on how the Heart@Home application improves self-management following a two-week period of usage and how to improve the application for further utilization.

METHODS: This qualitative study used a case study approach. We conducted semi-structured in-depth interviews with patients, caregivers, and healthcare providers and evaluated patients’ quality of life before and after using the application. Purposeful sampling was employed, and thematic analysis was performed for qualitative data analysis.

RESULT: Nine patients, seven caregivers, and two healthcare providers were included in the analysis. The potential benefits for health behavior modification were noted through several mechanisms, including increasing self-awareness of patient’s current health status, guide for managing symptoms related to health status changes, and providing emotional assessment, reassurance and a sense of being cared for. In addition, more function in application is needed to increase engagement with application usage. Although the pre-post pilot analysis shows no statistically significant changes in participants’ quality of life, as measured by the EQ-5D questionnaire, promising trends were observed in the domains of self-management and daily activity.

CONCLUSION: The Heart@Home mobile application shows promise in promoting self-management and behavior modification among heart failure patients. Future development should focus on improving technical stability, incorporating personalized feedback, and enabling direct messaging with healthcare providers to enhance the application’s effectiveness in managing heart failure.

PMID:41334531 | PMC:PMC12666718 | DOI:10.1016/j.invent.2025.100890

JSLS. 2025 Oct-Dec;29(4):e2025.00064. doi: 10.4293/JSLS.2025.00064. Epub 2025 Nov 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Little is known about predictors of opioid use in the acute postoperative phase after hysterectomy. Inadequate pain support during this time can result in increased postoperative complications, and persistent postoperative pain. Objective is to determine predictors of increased opioid use in the acute perioperative phase (intraoperatively and 1 hour and 24 hours postoperatively).

METHODS: A prospective cohort study involving 200 participants undergoing nonurgent hysterectomy via laparoscopic, vaginal, abdominal, or robotic approaches at an academic tertiary hospital in Toronto, Canada. Data collected included demographics, preoperative validated pain questionnaire scores, pain scores at 1 and 24 hours postoperatively, and analgesic medications used. Nonparametric statistical methods and multivariate analyses were used to examine the association between clinical predictors and opioid use. Opioid use was converted into morphine equivalent dose (MED).

RESULTS: Pain sensitivity questionnaire (PSQ) score and body mass index were strongly associated with increased intraoperative MED. Twenty-four-hour postoperative opioid use was negatively correlated to age. Multivariate analysis identified PSQ total score and open hysterectomy as predictors of higher intraoperative MED. The number of preoperative pain medications, open hysterectomy, and PSQ total score were significant predictors of total MED requirements. One additional pain medication and one additional total PSQ point were associated with an increase in total MED of 10.76 and 5.17 mg, respectively.

CONCLUSIONS: This study is the first step in identifying clinical predictors of increased opioid requirements in the first 24 hours postoperatively. These predictors can inform patient-tailored management plans to ensure adequate pain support and appropriate opioid use.

PMID:41334498 | PMC:PMC12668372 | DOI:10.4293/JSLS.2025.00064

JSLS. 2025 Oct-Dec;29(4):e2025.00095. doi: 10.4293/JSLS.2025.00095. Epub 2025 Oct 31.

ABSTRACT

OBJECTIVE: Retrospective clinical report to demonstrate the use of abdominal wall elevation device with closed technique direct entry with 3-mm port.

DESIGN: An abdominal wall elevation device (LevaLap 1.0) was used during abdominal entry for laparoscopic and robotic gynecologic procedures. The primary outcomes were major vascular or visceral injury. Other events assessed included number of entry attempts, failed entry, and adverse events during entry. Descriptive statistics were used to characterize the patient population and the incidence of abdominal entry injuries or events.

SETTING: Tertiary hospital.

PATIENTS: Female patients undergoing laparoscopic gynecologic procedures with or without robotic assistance using an abdominal wall elevation device with direct entry technique from July 2023 to May 2024. Exclusion criteria were patients less than 18 years of age.

INTERVENTIONS: Use of abdominal elevation device at initial entry.

MEASUREMENTS AND MAIN RESULTS: The elevation device was used in 25 patients with a 3-mm direct trocar. Entry was achieved on the first attempt in all cases. There were no major vascular, visceral injuries, or failed entry events.

CONCLUSION: Use of a device to elevate the abdominal wall in a standardized fashion is feasible with direct entry using 3-mm port may help reduce the risk of retroperitoneal major vascular injury; however, larger comparative studies are required to confirm efficacy.

PMID:41334494 | PMC:PMC12668369 | DOI:10.4293/JSLS.2025.00095

JSLS. 2025 Oct-Dec;29(4):e2025.00089. doi: 10.4293/JSLS.2025.00089. Epub 2025 Oct 31.

ABSTRACT

BACKGROUND: With the rise in bariatric surgeries, conversions for issues like poor weight loss or reflux are becoming more common. Gastric bypass is a standard solution, but as robotic use grows, its advantage over laparoscopy remains in question.

OBJECTIVE: Compare the short and long-term outcomes of robotic versus laparoscopic sleeve conversion to Roux-en-Y gastric bypass (RYGB) surgeries.

METHODS: We conducted a retrospective analysis analyzing patients’ demographics, comorbidities, reasons for conversion, preoperative body mass index (BMI), and perioperative metrics (operative time, blood loss, hospital stay). We compared surgical outcomes, including early complications, rehospitalization, reintervention, weight loss, and resolution of comorbidities, between the robotic and laparoscopic approaches.

RESULTS: This cohort included 126 patients who underwent revisional surgery from sleeve gastrectomy to gastric bypass surgery. Out of which 27 underwent laparoscopic approaches and 99 robotic approaches. The mean age of patients was 52.5 (±11.6), and the mean pre-RYGB BMI was 36.1 (±7.1). Most patients were female (87.3%, n = 110), with 72.2% white. Robotic approach had a significantly shorter operative time than laparoscopic approach 184.1 vs 215.5 minutes, with P-value < .001, respectively. Other outcomes did not show any statistical significance between the two groups. However, the late reoperation rate revealed a significant difference, with 29.6% in the laparoscopic group required additional surgical intervention, whereas only 13.1% in the robotic group with P-value .041, suggesting advantage for the robotic approach.

CONCLUSION: Both techniques demonstrated similar complication rates. Notably, the robotic approach resulted in shorter operating times and fewer late reoperations. Further research is necessary to strengthen our findings.

PMID:41334491 | PMC:PMC12668368 | DOI:10.4293/JSLS.2025.00089

JHEP Rep. 2025 Oct 9;7(12):101603. doi: 10.1016/j.jhepr.2025.101603. eCollection 2025 Dec.

ABSTRACT

BACKGROUND & AIMS: Aging and alcohol misuse independently alter monocyte (MO) and macrophage (MØ) function, leading to impaired antimicrobial responses. However, how alcohol misuse contributes to impaired MO/MØ function during aging remains unclear.

METHODS: We compared the transcriptomes of MOs and MØs from alcohol-modulated niches (liver, brain, and bone marrow [BM]) in young (3-month-old) and old (20-24-month-old) female C57BL/6N mice (n = 4-6 per group). Statistical significance was determined using two-way ANOVA.

RESULTS: MO/MØ transcriptomes showed unique organ-specific responses to aging and alcohol. Aging elicited a common deregulation of pathogen-responsive pathways, while alcohol misuse commonly inhibited IFN signaling in the aged populations. Our studies on intercellular communication using ligand-receptor interactions revealed that BM MOs were the least communicative and liver MØs were the most communicative. Alcohol misuse specifically increased MO/MØ communication in aging. We also identified and validated specific pathways driving inter-organ MO/MØ crosstalk in alcohol misuse during aging, including APOE-TREM2 signaling from the liver to microglia and the NRXN2 and SPP1 pathways.

CONCLUSION: Our results provide a unique insight into the heterogeneity of the MO/MØ transcriptome and define the inter-organ crosstalk between BM, liver, and brain during aging and alcohol misuse.

IMPACT AND IMPLICATIONS: Aging and alcohol misuse are linked to immune dysfunction, systemic inflammation, and altered innate immune responses. Here, we examined monocyte/macrophage responses in the liver, brain, and bone marrow of young and aged mice under alcohol exposure at the transcriptomic level. We observed that aging and alcohol predominantly elicited organ-specific changes in gene expression, with minimal overlap between the monocyte/macrophage populations across different tissues. However, aging commonly upregulated pathogen response pathways while alcohol misuse inhibited interferon signaling. We also assessed cell-cell communication by analyzing ligand-receptor expression in the different monocyte/macrophage populations and identified candidate molecules (APOE, TREM2, NRXN2, SPP1) from the top pathways guiding inter-organ signaling specifically in aging and alcohol misuse. Our findings have generated a unique repository and provide novel insights on how aging and alcohol impact tissue-specific monocytes/macrophages and their crosstalk.

PMID:41334456 | PMC:PMC12666552 | DOI:10.1016/j.jhepr.2025.101603

Front Endocrinol (Lausanne). 2025 Nov 17;16:1566249. doi: 10.3389/fendo.2025.1566249. eCollection 2025.

ABSTRACT

BACKGROUND: Mitochondria and immune function play pivotal roles in the pathogenesis of gestational diabetes mellitus (GDM). However, the intricate molecular mechanisms underlying their involvement remain elusive. Therefore, this study aimed to elucidate the interaction between mitochondria-related genes (MRGs) and immune-related genes (IRGs) in GDM.

METHODS: In this study, GDM-related datasets (GSE103552, GSE154414, and GSE173193) were integrated along with MRGs and IRGs. Differential expression analysis was conducted on GSE103552 to identify differentially expressed genes (DEGs), which were then intersected with MRGs and IRGs. Correlations among the intersection genes were evaluated, and those with statistical significance and strong correlation were selected as candidate genes. Three machine learning algorithms were subsequently applied to further refine the selection of signature genes. The optimal model was determined, and genes within this model were designated as signature genes. Expression levels of these genes were then examined, and those showing significant differences and consistent trends between GDM and control groups in both GSE103552 and GSE154414 datasets were identified as hub genes. Further analyses included chromosomal and subcellular localization, enrichment, regulatory mechanism, and drug prediction analyses of hub genes. Key cell types were analyzed in GSE173193. Finally, the expression of hub genes was validated by reverse transcription quantitative polymerase chain reaction (RT-qPCR).

RESULTS: Comprehensive analysis identified MRPL15, MRPL22, and MRPS18C emerged as pivotal hub genes, each showing significantly lower expression levels in the GDM group. Chromosomal localization revealed MRPS18C on chromosome 4, MRPL22 on chromosome 5, and MRPL15 on chromosome 8. Subcellular distribution analysis indicated that MRPL15 and MRPL22 were predominantly localized in the nucleus, whereas MRPS18C was mainly cytoplasmic. Enrichment analysis showed that spliceosome, proteasome, Parkinson disease, and ribosome pathways were enriched by the hub genes. Regulatory analysis revealed that YY1 regulated MRPS18C and MRPL22, ARID3A regulated MRPS18C and MRPL15, and FOXC1 regulated MRPL22 and MRPL15. Finally, results of RT-qPCR results confirmed that MRPL15, MRPL22, and MRPS18C were significantly downregulated in the GDM group.

CONCLUSION: Our findings highlight the significance of MRPL15, MRPL22, MRPS18C, monocytes, and villous cytotrophoblast cells in GDM. These insights provide valuable implications for the diagnosis and potential therapeutic interventions targeting of GDM.

PMID:41334450 | PMC:PMC12665543 | DOI:10.3389/fendo.2025.1566249

Int J Surg Protoc. 2025 Sep 8;29(4):156-160. doi: 10.1097/SP9.0000000000000061. eCollection 2025 Dec.

ABSTRACT

INTRODUCTION: Follow-up data in breast cancer is essential and forms the basis for survival metrics and key statistical measures related to morbidity and mortality. Standard practice classifies any woman who does not engage in reviews/follow-up as “lost to follow-up (LTFU),” effectively excluding her from further analysis and disregarding her data. This study aims to evaluate patterns and predictors of LTFU among women with non-metastatic breast cancer.

DESIGN: This is a single-center prospective cohort study involving women diagnosed with non-metastatic breast cancer between 2017 and 2018. The study will follow a three-phase approach. In Phase I, 5-year follow-up data will be collected retrospectively through hospital records and electronic medical records (EMRs) up to 2024. In Phase II, patients identified as LTFU will be contacted using phone, SMS, or email to assess health status and update follow-up data. Informed consent will be obtained during outreach. In Phase III, patients who respond will be asked about reasons for missed follow-up visits, including barriers related to logistics, finance, awareness, or physician advice. Data will be analyzed using descriptive statistics, logistic regression, and thematic analysis.

OBJECTIVES: To determine the proportion of patients who are lost-to-follow-up at 5 years, identify factors associated with LTFU, and explore patient-reported barriers to follow-up in a public sector cancer care setting.

DISCUSSION: This study uses a mixed-methods approach, combining quantitative tracking with qualitative insights, with the aim of understanding patient retention and long-term oncology care. This study will provide real-world evidence on follow-up adherence and its determinants in a high-volume, resource-constrained oncology setting. The study is registered with ClinicalTrials.gov (Trial identifier: NCT06927102).

PMID:41334423 | PMC:PMC12668582 | DOI:10.1097/SP9.0000000000000061

Front Public Health. 2025 Nov 17;13:1646494. doi: 10.3389/fpubh.2025.1646494. eCollection 2025.

ABSTRACT

BACKGROUND: Prostate cancer remains a significant public health challenge, an early detection with prostate-specific antigen (PSA) testing and biparametric MRI (bpMRI) can improve outcomes. However, participation hinges on motivational, psychological, and logistical factors. This study examines the motivational profile of men in the ProstaPilot study to guide strategies to increase uptake of state-of-the-art prostate cancer screening programs.

METHODS: The ProstaPilot study enrolled 423 men who underwent both PSA testing and bpMRI of the prostate. Positive results (PSA ≥ 3 μg/L or PI-RADS 4-5 lesions) were referred for further urological examination and biopsy. Using an exploratory correlational design, 360 participants completed a detailed questionnaire. Motivational factors were extracted via Principal Component Analysis (PCA) with Oblimin rotation. Perceptions of prostate cancer risk, severity, and prevention were rated on 1-10 scales (10 = most positive).

RESULTS: PCA identified four motivational factors explaining 55.6% of variance: (1) concerns about screening (e.g., unnecessary surgery, loss of control); (2) perceived benefits of early detection; (3) social motivation (e.g., contributing to research, role modeling); and (4) barriers (e.g., logistics, embarrassment). Over half (51.1%) had not considered screening before ProstaPilot; others decided over varying timeframes. Participants showed high awareness of prostate cancer and valued early detection, rating screening effectiveness 9.55 ± 0.98 and trust in healthcare professionals 9.6 ± 1.0. Social/familial influences were moderate. Satisfaction was high: likelihood to recommend 9.45 ± 1.22; confidence in continuing participation 9.9 ± 0.39.

CONCLUSION: Highly motivated participants were marked by strong knowledge of prostate cancer screening, trust in healthcare providers, supportive social context, and high personal commitment. These findings support personalized, socially supportive, educational strategies to increase uptake of state-of-the-art screening.

CLINICAL TRIAL REGISTRATION: The study was registered on September 21, 2024, with the identifier number NCT05603351.

PMID:41334411 | PMC:PMC12665782 | DOI:10.3389/fpubh.2025.1646494

Drug Des Devel Ther. 2025 Nov 27;19:10571-10587. doi: 10.2147/DDDT.S549834. eCollection 2025.

ABSTRACT

BACKGROUND: Minimal Change Disease (MCD) / Focal Segmental Glomerulosclerosis (FSGS) are leading causes of adult nephrotic syndrome. Roughly half of patients need long-term immunosuppression for steroid dependence or relapse, but traditional drugs carry substantial adverse effects. Rituximab (RTX) depletes CD20⁺ B cells and reduces anti-podocyte antibodies; pediatric data are encouraging, yet direct adult evidence-especially between treatment-naïve and relapsed patients-remains scarce.

METHODS: This study enrolled 82 patients with MCD/FSGS diagnosed between 2020 and 2023, divided into the RTX group (24 patients, 9 treatment-naïve and 15 relapsed) and the glucocorticoid group (58 patients). The RTX group received standard-dose RTX (375 mg/m² weekly for 4 weeks), while the glucocorticoid group was treated with prednisone (1 mg/kg/day). Outcomes were compared using t-tests, χ²/Fisher, logistic regression, and Kaplan-Meier analyses.

RESULTS: The overall remission rates were 100% in the RTX group and 98.3% in the glucocorticoid group (P=0.876), but the RTX group had a significantly higher eGFR at the last follow-up (124.25 vs 109.00 mL/min/1.73 m², P=0.019). A statistically significant intergroup difference was also observed, with complete remission achieved in 89.5% of MCD patients versus 40% of FSGS patients (P< 0.05). In relapsed patients treated with RTX, prednisone dosage decreased from 34.0±15.7 mg/day to 7.7±7.8 mg/day (P< 0.001), annual relapse frequency dropped from 1.0 to 0 episodes/year (P=0.001), and 40% of patients completely discontinued glucocorticoids. The Complete Remission rate in treatment-naïve patients (88.9%) was higher than in relapsed patients (73.3%), but the difference was not statistically significant. No independent predictors of RTX efficacy were identified, and no severe infections or allergic reactions were observed.

CONCLUSION: RTX equals glucocorticoids in podocytopathy, cuts steroid use and relapse, improves long-term kidney survival, and is safe. Treatment-naïve patients may choose RTX upfront to avoid steroid side effects; relapsed patients can taper and stop steroids. However, due to the limited sample size, these results should be interpreted with caution. Larger trials must confirm its long-term efficacy and ESRD protection.

PMID:41334365 | PMC:PMC12667706 | DOI:10.2147/DDDT.S549834