Nevin Manimala

Pulmonology. 2025 Dec 31;31(1):2591498. doi: 10.1080/25310429.2025.2591498. Epub 2025 Nov 24.

ABSTRACT

BACKGROUND: The clinical impact of bronchiectasis (BE) in acute exacerbations of COPD (AECOPD) remains controversial, with unclear phenotypic heterogeneity.

RESEARCH QUESTION: Does BE independently influence clinical outcomes and phenotypic heterogeneity in AECOPD patients?

STUDY DESIGN AND METHODS: This prospective multicenter cohort study analysed 11 759 hospitalised AECOPD patients from 10 Chinese medical centres. Propensity score matching (1:3) balanced baseline characteristics, and unsupervised cluster analysis identified phenotypic subgroups. Primary endpoints included mortality and exacerbation frequency, with secondary endpoints assessing mechanical ventilation, ICU admission, and length of stay (LOS).

RESULTS: AECOPD-BE patients had higher rates of non-invasive ventilation (23.5% vs 20.1%, p = 0.002), ICU admission (9.8% vs 6.5%, p < 0.001), and prolonged LOS (median 10 vs 9 days, p < 0.001). Mortality rates were similar (in-hospital: 1.1% vs 1.3%, p = 0.477; 3-year: 17.8% vs 21.6%, p = 0.652), but BE patients had more exacerbations (2.92 ± 4.30 vs 2.18 ± 2.72 events, p = 0.004). Cluster analysis revealed two phenotypes: a Systemic Inflammatory-High Risk (SI-HR) subgroup with severe inflammation and poorer outcomes, and a Stable Compensated (SC) subgroup with milder manifestations.

CONCLUSION: BE independently predicts increased acute healthcare utilisation and exacerbation risk in AECOPD without affecting mortality. The SI-HR phenotype identification supports targeted management strategies for this heterogeneous population.Clinical Trial Registration: Chinese Clinical Trail Registry NO.: ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.

PMID:41277420 | DOI:10.1080/25310429.2025.2591498

Psychol Health Med. 2025 Nov 24:1-18. doi: 10.1080/13548506.2025.2591856. Online ahead of print.

ABSTRACT

This study aimed to assess the long-term risk for depression in individuals with epilepsy, identify time-specific risk patterns, and evaluate high-risk subgroups in a nationwide cohort from South Korea. This nationwide retrospective matched cohort study analyzed data from 2,267 patients with epilepsy and 22 670 age- and sex-matched controls retrieved from the Korean National Health Insurance Service cohort (2002-2013) were analyzed. KCD-8 codes (F32 and F33) were used as depression markers and time-stratified Cox proportional hazards models were employed to calculate the adjusted hazard ratios (aHRs) for depression over 10 years, adjusting for demographic and clinical covariates. The incidence rate (IR) of depression was 43.23 per 1,000 person-years in the epilepsy group compared to 14.30 in the controls (IRR = 3.02). Depression risk was highest in the first 0-2 years post-diagnosis (aHR = 3.32) and increased again at 8-10 years (aHR = 2.82). Men (IRR = 3.52) and individuals aged <60 years (IRR = 3.66) also demonstrated elevated IRRs. Smoking, low BMI, and high income were significant additional risk factors. Epilepsy substantially increases the long-term risk of depression, particularly during the early and late post-diagnosis periods and our findings underscore the need for systematic mental health screenings.

PMID:41277411 | DOI:10.1080/13548506.2025.2591856

Thorac Cancer. 2025 Nov;16(22):e70190. doi: 10.1111/1759-7714.70190.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the short-term clinical outcomes of subxiphoid approach thoracoscopic surgery (SATS) versus lateral intercostal approach thoracoscopic surgery (LIATS) for anterior mediastinal tumors.

METHODS: Clinical data from patients who underwent video-assisted thoracoscopic surgery for anterior mediastinal tumors between April 1, 2020 and December 31, 2023 were analyzed. Patients were stratified into two cohorts according to the surgical approach used: the SATS group (n = 679) and the LIATS group (n = 461). Intraoperative and postoperative outcomes were compared between the two groups.

RESULTS: A total of 1140 patients were included in the statistical analysis after screening and assessment. After propensity score matching, a total of 417 SATS patients were matched with 417 LIATS patients. In the analysis of the outcomes, the LIATS group had a shorter operation time than the SATS group (p < 0.001). There were no statistical differences in Numeric Rating Scale (NRS) pain scores on Postoperative Day 1 (p = 0.113), Day 2 (p = 0.189), or Day 3 (p = 0.462). Postoperative atelectasis was more common in the SATS group than in the LIATS group (p = 0.025). There were no perioperative deaths.

CONCLUSIONS: The SATS did not demonstrate significant improvements in postoperative pain compared with the LIATS. However, the LIATS was associated with shorter operative time in the overall cohort.

PMID:41277410 | DOI:10.1111/1759-7714.70190

Paediatr Perinat Epidemiol. 2025 Nov 24. doi: 10.1111/ppe.70099. Online ahead of print.

ABSTRACT

BACKGROUND: Surveillance of congenital anomaly prevalence over time can identify new teratogens. Anomalies with a genetic cause are excluded from the monitoring.

OBJECTIVES: We examined temporal changes in the proportion of genetic diagnoses among cases with a congenital anomaly.

METHODS: Data was used from twenty EUROCAT congenital anomaly registries over the birth years 2013 and 2022. All pregnancy outcomes were included. Multilevel binomial regression models were fitted to estimate the annual change in the proportion of genetic diagnoses of all anomalies by registry. Results were additionally reported, excluding cases with trisomy 13, 18, or 21.

RESULTS: Overall, 20% of the 100,099 cases in the study had a genetic diagnosis, and this proportion increased annually by 1.4% (95% CI, 0.8%-1.9%); an absolute increase of approximately 3% from 2013 to 2022. After excluding the trisomies, the overall proportion was 10% with an annual increase of 1.2% (95% CI 0.4%-2.0%). There was considerable variation in the proportion of genetic cases per registry. An increasing proportion of genetic diagnoses was found for five congenital anomaly groups, after excluding the trisomies. We hypothesise that the increase in genetic diagnoses is due to increased access to clinical genetic services, more extensive genetic testing, and the identification of new genes as causes of congenital anomalies.

CONCLUSIONS: The modest increase in genetic diagnoses among cases with a congenital anomaly is not expected to have a large impact on the surveillance of the non-genetic anomalies in the EUROCAT network. EUROCAT will continue to monitor the proportion of genetic diagnoses every five years.

PMID:41277385 | DOI:10.1111/ppe.70099

Basic Clin Pharmacol Toxicol. 2025 Dec;137(6):e70145. doi: 10.1111/bcpt.70145.

ABSTRACT

Poisoning from organophosphorus compounds (OPCs) poses a significant health issue, especially in countries without proper testing facilities, including cholinesterase (ChE) levels. This study aimed to evaluate the effectiveness of a three-element score called PGI, incorporating pH, the Glasgow Coma Scale (GCS) and impaired systolic blood pressure, in predicting mortality and the need for mechanical ventilation (MV) in acute OPC poisoning. A retrospective cross-sectional study was conducted using medical records of 202 patients admitted for acute OPC poisoning over 3 years. The findings indicated an 11.4% mortality rate and a 25.7% underwent MV. A strong negative correlation was observed between the PGI score and serum ChE level (r = -0.6430, p < 0.0001). The PGI scores of 2 and above were a strong predictor for mortality and MV need. Among PGI components, blood pH < 7.23 was the best mortality predictor, while a GCS < 12 effectively predicted the need for MV (AUC = 0.920). Although the PGI score outperformed PSS in predicting adverse outcomes, it did not show a statistically significant difference compared to serum ChE. The PGI score is a reliable prognostic tool that could replace PSS and serum ChE in predicting the severity of OPC poisoning, as well as the risk of mortality and MV need.

PMID:41277382 | DOI:10.1111/bcpt.70145

J Rural Health. 2025 Sep;41(4):e70095. doi: 10.1111/jrh.70095.

ABSTRACT

PURPOSE: The purposes of this study were to (1) identify predictors of sedentary time and (2) determine whether sociodemographic risk factors associated with sedentary time are mediated by sleep disturbances in younger (<60) and older (≥60) depressed rural patients with CVD.

METHODS: Depressed rural patients with CVD completed surveys and wore ActiGraph GT9X Link monitors to measure sedentary time and sleep parameters (total sleep time and wake-after-sleep-onset [WASO]). Hierarchical regression analysis was conducted to identify factors associated with sedentary time, followed by a multi-group path analysis to examine how significant factors identified in the regression were associated with sedentary time, comparing the two age groups, and whether this association was mediated by parameters reflecting sleep disturbances.

FINDINGS: Participants (n = 222) were predominantly White with an average age of 58 years and 52% were unemployed due to illness. Age, employment status, and WASO were significantly associated with sedentary time. Path analysis showed a significant mediating effect of age on sedentary time through WASO in the younger group (n = 115). However, the mediating effect of WASO on the relationship between age and sedentary time was not significant in the older group (n = 107).

CONCLUSIONS: The findings highlight the critical roles of age and sleep disturbances in promoting physical inactivity, with sleep disturbances being particularly influential in younger patients. Tailoring interventions by age groups may enhance strategies to mitigate CVD risk associated with inactivity.

PMID:41277370 | DOI:10.1111/jrh.70095

Am Surg. 2025 Nov 24:31348251399200. doi: 10.1177/00031348251399200. Online ahead of print.

ABSTRACT

BackgroundRecent studies suggest that general surgery (GS) residents perform more operations related to their future specialty compared with their peers. In this multi-institutional study, we examined the process of early specialization among GS residents pursuing a career in vascular surgery (VS).MethodsData from the US Resident OPerative Experience (ROPE) Consortium, comprising 20 Accreditation Council for Graduate Medical Education (ACGME)-accredited GS residency programs across the United States, were queried. Case volume and type were compared between GS residents pursuing vs fellowship and all other residents. Effect size was evaluated using Cohen’s d statistic. Effect size was considered large if d > 0.8, moderate if 0.5 ≤ d < 0.8, small if 0.2 ≤ d < 0.5, and inconsequential if d < 0.2.ResultsA total of 1343 GS residents graduated from 2010-2020 across all programs participating in ROPE, of which 135 (10.1%) pursued vs fellowship. Total major vascular case volume was significantly greater among residents pursuing vs fellowship (138 [100-207] vs 100 [80-139], P < 0.0001) with a large effect size (d = 1.81). Vascular cases reported in a surgeon chief role (27 [9-53] vs 10 [2-29], P < 0.0001, d = 0.76, moderate effect) and surgeon junior role (107 [79-154] vs 88 [62-118], P < 0.0001, d = 1.00, large effect) were also greater among GS residents pursing a vs specialty. Nearly all vascular operative categories demonstrated similar trends (P < 0.01 each).ConclusionsGS residents pursuing a vs fellowship perform more vascular cases compared with their peers. Given the differences in both surgeon chief and surgeon junior roles, career focus may begin as early as the junior resident years.

PMID:41277369 | DOI:10.1177/00031348251399200

Turk Kardiyol Dern Ars. 2025 Nov 24. doi: 10.5543/tkda.2025.47364. Online ahead of print.

ABSTRACT

Adjunctive vein of Marshall ethanol infusion (EIVOM) during atrial fibrillation (AF) ablation has emerged as a promising technique with the potential to significantly improve procedural outcomes. Despite the existing body of evidence, a comprehensive evaluation focusing on mitral isthmus block, AF recurrence, and procedural duration has not yet been conducted. This meta-analysis aims to rigorously assess the benefits of EIVOM combined with radiofrequency ablation (EIVOM-RF) compared with radiofrequency ablation alone (RF-only) in patients undergoing catheter ablation for AF or related arrhythmias. We systematically reviewed both randomized controlled trials and observational studies that compared EIVOM-RF with RF-only approaches, encompassing a total of 1,406 patients in the EIVOM-RF group and 1,849 in the RF-only group. The primary outcomes assessed included the rate of successful mitral isthmus ablation, recurrence of atrial arrhythmias, and overall procedure time. Patients treated with EIVOM-RF demonstrated a significantly lower likelihood of atrial arrhythmia recurrence compared to those receiving RF-only treatment. Furthermore, EIVOM-RF was associated with an impressive increase in the success rate of achieving mitral isthmus block. While total procedure time tended to be longer with EIVOM-RF, this difference was statistically significant and showed considerable variability. These findings compellingly indicate that EIVOM enhances procedural efficacy, albeit at the cost of increased procedural duration. In conclusion, EIVOM combined with RF ablation represents a transformative approach that markedly improves procedural success rates and significantly reduces arrhythmia recurrence in patients undergoing ablation for AF.

PMID:41277368 | DOI:10.5543/tkda.2025.47364

Food Funct. 2025 Nov 24. doi: 10.1039/d5fo03652f. Online ahead of print.

ABSTRACT

Aging is accompanied by a gradual decline in immune function. Previously, we demonstrated that daily intake of 4 g plant stanols, provided as fatty-acid esters, increased antibody titre responses following different vaccinations. Effects of lower intakes, however, are unknown. We therefore evaluated whether daily consumption of 2, 3 or 4 g of plant stanols, provided as fatty-acid esters, improved immune responses following influenza vaccination in older adults. A double-blind, randomized, placebo-controlled parallel trial was performed. Older participants (59-87 years) consumed products with added plant stanols (2, 3 or 4 g d^-1 provided as fatty-acid esters) or control products for approximately 14 days prior to vaccination until 4 weeks post-vaccination. Antibody titres, serum metabolic risk markers, and haematological and immunological parameters were measured and statistically evaluated using linear mixed models. Data of 128 participants were analysed. Changes in IgM and IgG concentrations did not differ significantly between the control and plant stanol groups. Also, changes in Hemagglutination Inhibition (HI) antibody titres were not significantly different between the groups for either the Phuket or Victoria strains. Serum LDL-cholesterol concentrations decreased significantly in the 4 g d^-1 and 3 g d^-1 groups compared with control. Serum LDL-cholesterol concentrations in the 2 g d^-1 group were also lowered, but did not reach statistical significance. No between-group differences in haematological and immunological parameters were observed. Daily consumption of 2, 3 or 4 g of plant stanols provided as fatty-acid esters, did not improve vaccination responses following annual influenza vaccination in men and women aged 60 years or older.

PMID:41277360 | DOI:10.1039/d5fo03652f

Neurourol Urodyn. 2025 Nov 24. doi: 10.1002/nau.70191. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the correlation between clinical characteristics, ultrasound measurements, and the severity of stress urinary incontinence (SUI) in women, aiming to identify key transperineal ultrasound measurements that can guide clinical management of SUI.

METHODS: The study was conducted with 519 women diagnosed with urinary incontinence from three hospitals in Fujian Province, China, who underwent clinical assessment and transperineal ultrasound examination from November 2019 and May 2024. Ultrasound measurements, including temporal and morphological metrics, were analyzed in relation to SUI severity, categorized as slight, moderate, or severe. Statistical analyses included Spearman’s rank correlation and logistic regression.

RESULTS: Among the 314 women with SUI, significant correlations were found between ultrasound measurements and SUI severity. The duration of maximum contraction showed the strongest correlation with severity, followed by twitch count during sustained contraction. Logistic regression revealed that age (OR = 1.052, p = 0.018) and larger differences in LHA between Valsalva and rest (OR = 1.227, p = 0.035) were risk factors for moderate-to-severe SUI, while longer the duration of maximum contraction reduced the risk (OR = 0.924, p < 0.001).

CONCLUSION: Transperineal ultrasound was proved to be a noninvasive, objective method for the evaluation and management of SUI. Key findings underscored the potential of ultrasound in advancing pelvic floor health and guiding personalized pelvic floor muscle training. Further research is needed to standardize these measurements and validate their clinical utlity.

PMID:41277356 | DOI:10.1002/nau.70191