Nevin Manimala

PLoS One. 2025 Jun 20;20(6):e0326040. doi: 10.1371/journal.pone.0326040. eCollection 2025.

ABSTRACT

BACKGROUND: Lymphedema is a chronic condition that significantly affects both physical function and quality of life of breast cancer patients. Although there is no definitive cure, various treatment options exist to alleviate its symptoms. Among these, Complex Decongestive Therapy (CDT) is widely regarded as a primary approach. This study seeks to evaluate the effectiveness of CDT for breast cancer patients with upper limb lymphedema and aims to assess the benefits of this treatment despite the challenges and constraints in resource-limited settings.

METHODS: This observational study was conducted among 42 female breast cancer patients with unilateral upper limb lymphedema attending the Lymphedema Clinic of the Department of Palliative Medicine at Bangladesh Medical University in Dhaka, Bangladesh. Limb volume, skin condition, and clinical signs and symptoms were assessed at baseline. All patients received the intensive phase of Complex Decongestive Therapy (CDT) for 6 weeks, with follow-up assessments conducted at the 3rd week and the 6th week.

RESULT: A significant reduction in the volume of the affected limbs was observed from baseline to the 6th week, as well as from the 3rd week to the 6th week. Although no statistically significant improvement in skin edema was recorded during this period, visible clinical improvement in skin texture was noted. After receiving CDT and proper skin care, 59.5% of patients regained normal skin on the affected limb. Additionally, there was a significant reduction in self-reported symptoms such as tightness, heaviness, and pain in the affected limb from baseline to the 6th week.

CONCLUSION: Lymphedema management using all components of Complex Decongestive Therapy (CDT) was found to be effective in reducing limb volume and alleviating the distressing symptoms of patients. Timely referral of lymphedema patients to specialized clinics and initiation of CDT can significantly reduce their ongoing suffering in Bangladesh.

PMID:40540462 | DOI:10.1371/journal.pone.0326040

Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002790. Online ahead of print.

ABSTRACT

BACKGROUND: In-situ, ante-situm, ex-situ liver resections under hypothermic perfusion (HP) are expanding tumor resectability as they could allow extensive hepatectomies and intricate vascular reconstructions. Meanwhile, hypothermic oxygenated machine perfusion (HOPE) has been well-established in liver transplantation, showing improved graft and patient outcomes. However, the quality of surgical treatment using HOPE in these non-transplant liver surgeries remains unproven.

MATERIALS AND METHODS: An exhaustive literature research and polled analysis to study the efficacy of HOPE for in-situ, ante-situm, ex-situ liver resections for hepatic malignancies were performed. Considering the sufficiency of reported data, the ante-situm liver resection under HOPE for intrahepatic cholangiocarcinoma was selected to make comparisons focusing on perioperative surgical outcome and long-term oncological outcomes. Control groups were ante-situm liver resection under conventional HP and ante-situm liver resection without conventional HP (relying on total vascular exclusion, TVE).

RESULTS: Three publications, reporting two case reports and one case series report, were identified with seven cases altogether. Generally, median hospital stay was 17 (12-30) days, 90-day severe complications occurred 14.3% (1/7) patients, no 90-day mortality was observed, median survival was 14.5 (6-34) months. Median hospital stay, 90-day severe complication and mortality rates of ante-situm approach under HOPE (n = 5) were better than conventional HP (n = 6) or TVE approaches (n = 6) [17 (12-30) vs. 26.5 (16-70) vs. 28 (20-54), 20% vs. 50% vs. 33.3%, 0% vs. 16.7% vs. 16.7%; no statistical significance]; however, 6-month recurrence rate was higher (60% vs. 0% vs. 20%), restricted mean recurrence-free survival was shorter [6.6 (95%CI: 3.6-9.2) vs. 9.1 (95%CI: 5.5-11) vs. 8.7 (95%CI: 4.8-12.7)], and restricted mean overall survival showed insignificance.

CONCLUSIONS: Although HOPE may improve perioperative outcomes of in-situ, ante-situm, ex-situ liver resections, current evidence suggests suboptimal oncological results of ante-situm approach under HOPE, highlighting the need for further refinement.

PMID:40540312 | DOI:10.1097/JS9.0000000000002790

Musculoskeletal Care. 2025 Jun;23(2):e70137. doi: 10.1002/msc.70137.

ABSTRACT

BACKGROUND: The rise of telehealth has transformed healthcare delivery, but its impact on treatment adherence compared with traditional outpatient departments (OPD) remains underexplored.

OBJECTIVE: This study aimed to assess and compare patient adherence to treatment protocols in telehealth with regular OPD settings among patients with neck pain.

METHODS: A cross-sectional study was conducted at SGT University with neck pain patients in telehealth and traditional OPD settings. Adherence was measured using a validated adherence scale and electronic health records. Data were analysed using statistical methods to identify significant differences between the two groups.

RESULTS: A total of 300 patients participated, with 150 in the telehealth group and 150 in the regular OPD group. Preliminary findings indicated adherence rates. Factors influencing adherence, such as convenience and accessibility, were also analysed.

CONCLUSION: Telehealth appears to enhance treatment adherence compared with traditional outpatient care. These findings suggest that integrating telehealth into healthcare delivery may improve patient outcomes. Future research should explore long-term adherence trends and the underlying mechanisms that drive these differences.

PMID:40540309 | DOI:10.1002/msc.70137

JAMA Health Forum. 2025 Jun 7;6(6):e251381. doi: 10.1001/jamahealthforum.2025.1381.

ABSTRACT

IMPORTANCE: Food insecurity, which is characterized by limited or uncertain access to adequate food, affects approximately 40 million individuals in the US, including many patients with cancer. Understanding the association between food insecurity and cancer mortality is crucial for improving patient outcomes and addressing health disparities.

OBJECTIVE: To investigate the association of food insecurity with cancer-specific and all-cause mortality among US adults with a diagnosis of cancer.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used nationally representative data from the 2011 to 2012 National Health Interview Survey that were linked to the National Death Index, with mortality follow-up through December 31, 2019. It included 5603 respondents to the National Health Interview Survey 40 years and older who reported receiving a diagnosis of cancer and responded to food security questions.

EXPOSURE: Food insecurity was measured using a validated 10-item National Center for Health Statistics food insecurity scale, categorized as food secure (0-2) or food insecure (3-10) based on US Department of Agriculture guidelines.

MAIN OUTCOMES AND MEASURES: The primary outcomes were cancer-specific mortality (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes: C00-C97) and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) for these outcomes, adjusting for age, sex, race and ethnicity, household income, US region, body mass index, smoking, alcohol use, comorbidities, and survey year.

RESULTS: Among the 5603 participants (mean [SD] age, 67.03 [12.03] years; 3298 female individuals [59%]; 320 Hispanic individuals [6%], 22 Native American individuals [0.4%], 136 non-Hispanic Asian individuals [2%], 529 non-Hispanic Black individuals [9%], 4519 non-Hispanic White individuals [81%], and 75 multiracial or multiethnic individuals [1%]), the prevalence of food insecurity was 10.3% among survivors of cancer. Food insecurity was associated with higher all-cause mortality (HR, 1.28; 95% CI, 1.07-1.53) but not cancer-specific mortality after full adjustment. Subgroup analyses indicated that food insecurity was associated with cancer and all-cause mortality for those individuals with household incomes 200% or greater than the federal poverty level (cancer-specific mortality: HR, 1.93; 95% CI, 1.18-3.15; all-cause mortality: HR, 1.89; 95% CI, 1.34-2.68) and those not receiving food assistance (cancer-specific mortality: HR, 1.42; 95% CI, 1.00-2.01; all-cause mortality: HR, 1.42; 95% CI, 1.14-1.76). However, there was no significant association between food insecurity and cancer-specific or all-cause mortality for people with incomes less than 100% of the federal poverty level and households participating in food assistance programs.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that food insecurity is a substantial factor associated with increased mortality among survivors of cancer. Addressing food insecurity through routine screenings and connecting patients with food assistance programs may improve survival outcomes, and further research should examine the longitudinal effects of integrating routine food insecurity screenings within cancer care settings and expanding food assistance program eligibility.

PMID:40540285 | DOI:10.1001/jamahealthforum.2025.1381

JAMA Health Forum. 2025 Jun 7;6(6):e251476. doi: 10.1001/jamahealthforum.2025.1476.

ABSTRACT

IMPORTANCE: Private equity (PE) has rapidly been acquiring physician practices in the US, but a full understanding of its association with health care prices, spending, utilization, and quality is still unknown.

OBJECTIVE: To examine changes in colonoscopy prices, spending, utilization, and quality associated with PE acquisition of gastroenterology practices.

DESIGN, SETTING, AND PARTICIPANTS: This difference-in-differences event study and economic evaluation analyzed data from US gastroenterology practices that were acquired by PE firms between 2015 and 2021. Commercial claims covering more than 50 million enrollees were used to calculate price, spending, utilization, and quality measures from 2012 to 2021. The data were analyzed between April 2024 and September 2024.

EXPOSURES: PE acquisition of gastroenterology practices.

MAIN OUTCOMES AND MEASURES: The main outcomes were price, spending per physician, number of colonoscopies per physician, number of unique patients per physician, and quality (polypectomy detection, incomplete colonoscopies, and 4 adverse event measures: cardiovascular, serious gastroenterology, nonserious gastroenterology, and any adverse event).

RESULTS: Data from more than 1.1 million patients (mean [SD] age, 47.1 [8.4] years; 47.8% male patients) undergoing 1.3 million colonoscopies were analyzed. The sample included 718 851 treated colonoscopies conducted by 1494 physicians among 590 900 patients across 1240 PE-acquired practice sites and 637 990 control colonoscopies conducted by 2550 physicians among 527 380 patients across 2657 independent practice sites. Colonoscopy prices at PE-acquired gastroenterology practices increased by 4.5% (95% CI, 2.5%-6.6%; P < .001) relative to independent gastroenterology practices. The estimated price effect increased to 6.7% (95% CI, 4.2%-9.3%; P < .001) when considering only colonoscopies performed by gastroenterologists in PE-acquired practices with market shares above the 75th percentile (24.4%) in 2021 as treated. Colonoscopy spending per physician increased by 16.0% (95% CI, 8.4%-24.0%; P < .001), while the number of colonoscopies and the number of unique patients per physician increased by 12.1% (95% CI, 5.3%-19.4%; P < .001) and 11.3% (95% CI, 4.4%-18.5%; P < .001), respectively; however, these spending and utilization measures were already increasing prior to PE acquisition. No statistically significant associations were detected for the 6 quality measures analyzed.

CONCLUSIONS AND RELEVANCE: In this economic evaluation, PE acquisition of gastroenterology practices led to higher prices and spending but had no discernible effect on quality. Policymakers may be well advised to monitor PE investment in physician practices given the increase in prices and spending without a commensurate increase in quality.

PMID:40540284 | DOI:10.1001/jamahealthforum.2025.1476

JAMA Netw Open. 2025 Jun 2;8(6):e2516468. doi: 10.1001/jamanetworkopen.2025.16468.

ABSTRACT

IMPORTANCE: Cancer-related cognitive impairment is a common concern after breast cancer treatment. However, the association between breast cancer survivorship and the risk of Alzheimer dementia (AD) remains unclear.

OBJECTIVE: To evaluate the risk of AD among breast cancer survivors compared with cancer-free controls and examine the potential association of cancer treatments with AD risk.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Korean National Health Insurance Service. A total of 70 701 patients who underwent breast cancer surgery between January 1, 2010, and December 31, 2016, were included and matched with cancer-free controls (1:3). Participants were followed up for a median (IQR) of 7.3 (5.7-9.0) years. Data analysis was performed from January 2024 to June 2024.

EXPOSURES: Breast cancer diagnosis, surgery, and subsequent treatments, including anthracycline chemotherapy and radiation therapy.

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of AD. Subdistribution hazard ratios (SHRs) and 95% CIs were calculated using competing risk regression models, adjusting for sociodemographic factors and comorbidities.

RESULTS: Among 70 701 breast cancer survivors (mean [SD] age, 53.1 [8.5] years), 1229 cases of AD were detected, with an incidence rate of 2.45 per 1000 person-years. Survivors exhibited a slightly lower risk of AD compared with cancer-free controls (SHR, 0.92; 95% CI, 0.86-0.98), especially among individuals 65 years or older (SHR, 0.92; 95% CI, 0.85-0.99). However, landmark analyses found that this lower risk did not persist beyond 5 years of survival. Cancer treatment with radiation therapy (adjusted HR, 0.77; 95% CI, 0.68-0.87) was associated with reduced risk of AD among survivors.

CONCLUSIONS AND RELEVANCE: This cohort study of breast cancer survivors found a lower risk of AD compared with cancer-free controls, despite common concerns about cognitive decline after treatment. The findings suggest certain cancer treatments potentially have benefits for lower AD risk. Further research is needed to assess the long-term risk of AD in this population.

PMID:40540273 | DOI:10.1001/jamanetworkopen.2025.16468

JAMA Netw Open. 2025 Jun 2;8(6):e2516749. doi: 10.1001/jamanetworkopen.2025.16749.

ABSTRACT

IMPORTANCE: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative.

OBJECTIVE: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023.

EXPOSURES: Percutaneous nephrolithotomy vs ureteroscopy.

MAIN OUTCOMES AND MEASURES: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery.

RESULTS: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery.

CONCLUSIONS AND RELEVANCE: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

PMID:40540269 | DOI:10.1001/jamanetworkopen.2025.16749

JAMA Netw Open. 2025 Jun 2;8(6):e2516772. doi: 10.1001/jamanetworkopen.2025.16772.

ABSTRACT

IMPORTANCE: Weight loss (WL) in older adults is associated with bone loss, increasing the risk of fracture. Because skeletal tissue is responsive to mechanical stress, replacing lost weight externally may be an innovative way to minimize WL-associated bone loss in this population.

OBJECTIVE: To examine the effect of 12 months of weighted vest use during WL on indicators of bone health compared with WL alone and WL plus resistance training (RT).

DESIGN, SETTING, AND PARTICIPANTS: This single-blind, 12-month randomized clinical trial of older adults living with obesity was conducted at an academic medical center from September 1, 2019, to April 30, 2024.

INTERVENTIONS: WL (caloric restriction targeting 10% WL with adequate calcium, vitamin D, and protein), WL plus weighted vest (WL+VEST; 8 h/d, weight replacement titrated up to 10% total WL), or WL plus progressive RT (WL+RT; supervised 3 sessions weekly).

MAIN OUTCOMES AND MEASURES: Main outcomes included 12-month change in computed tomography-acquired trabecular volumetric bone mineral density (vBMD) and dual-energy X-ray absorptiometry-acquired areal bone mineral density (aBMD) of the total hip. Secondary outcomes included change in additional computed tomography- and dual-energy X-ray absorptiometry-acquired measures of musculoskeletal health and bone turnover biomarkers.

RESULTS: A total of 150 older (mean [SD] age, 66.4 [4.6] years) adults (112 [74.7%] women) living with obesity (mean [SD] body mass index, 33.6 [3.3]) were randomized (50 to WL, 50 to WL+VEST, and 50 to WL+RT), with 133 (88.7%) completing the trial. Similar significant WL, ranging from 9.0% to 11.2%, was achieved in all groups. During 12 months, mean (SD) self-reported weighted vest wear time was 7.1 (1.5) h/d, with 78.0% (29.9%) of lost weight replaced in the vest; participants randomized to the WL+RT group attended a mean (SD) of 71.4% (19.1%) of sessions. A significant decrease in total hip trabecular vBMD was observed at 12 months in all treatment groups (ranging from -1.2% to -1.9%), with no difference between the WL+VEST and WL groups (estimated treatment difference, +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P = .13) and noninferiority of WL+VEST compared with WL+RT (estimated treatment difference, +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3). Similar effects were observed for total hip aBMD.

CONCLUSIONS AND RELEVANCE: In this 12-month randomized clinical trial, neither weighted vest use nor progressive RT was able to mitigate WL-associated bone loss at the hip in older adults living with obesity. This study highlights the need for alternative or adjunctive strategies to prevent bone loss in older adults experiencing WL because exercise may be insufficient on its own.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04076618.

PMID:40540267 | DOI:10.1001/jamanetworkopen.2025.16772

Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002789. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) and functional regurgitation (FR) have complex interactions. This study investigated the interactions between thoracoscopic surgical ablation (TSA) and FR in patients with AF, to explore whether the strategy prioritizing AF can treat FR, thus avoiding additional valve surgeries.

METHODS: A total of 152 AF patients underwent isolated TSA were included for a 12-month follow-up. Among them, the control group contains 67 patients with no valve disease, and the FR group contains 85 patients diagnosed as functional mitral regurgitation (FMR, n = 50) and/or functional tricuspid regurgitation (FTR, n = 75). The changes in the degrees of regurgitation, the recurrence rate of AF 12 months after surgery, and the occurrence of cardiac reverse remodeling were statistically analyzed. Logistic regression analyses were performed to identify variables associated with the reduction in regurgitation.

RESULTS: The difference in 12-month sinus rhythm (SR) maintenance rate between the FR group and the control group was not significant (61.18% vs. 74.62%, P = 0.08). FMR degree was reduced significantly (P < 0.05) while FTR degree was not (P = 0.66), and the reduction in FTR is related to the reduction in FMR (OR = 19.80, 95% CI 2.22-176.60, P < 0.05) among the patients with both. Significant cardiac reverse remodeling and heart function improvement were observed after TSA (e.g. preoperative vs. postoperative: LV: 47.82 ± 5.37 mm vs. 46.52 ± 5.17 mm, P < 0.05; LA: 42.73 ± 5.41 mm vs. 40.79 ± 6.57 mm, P < 0.05). Logistic regression analyses revealed that the variation in left ventricular posterior wall, the variation in pulmonary artery pressure (PAP) and SR maintenance are associated with FMR reduction (P < 0.05), while preoperative interventricular septum, the variation in PAP and preoperative FTR degree are associated with FTR reduction (P < 0.05).

CONCLUSIONS: The treatment strategy prioritizing AF is reasonable for patients with AF and FMR. The existence of mild to moderate FR cannot affect TSA results, while TSA can reduce the degree of FMR through cardiac reverse remodeling. And the reduction in FTR is secondary to the PAP decrease after FMR reduction.

PMID:40540257 | DOI:10.1097/JS9.0000000000002789

Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002517. Online ahead of print.

ABSTRACT

BACKGROUND: Neuroblastoma is a highly malignant, systemic sympathetic nerve tumor. Traditional surgical approaches often involve extensive excision, which can lead to additional tissue damage, underscoring the need for accurate and real-time tumor margin delineation. In this study, we introduce the application of Terahertz Time-Domain Spectroscopy (THz-TDS) for tumor margin assessment and rapid pathological evaluation in neuroblastoma.

METHODS: SH-SY5Y cells were employed to establish a subcutaneous tumor-bearing model in nude mice. Using a THz-TDS system, we conducted in vivo imaging of tumor-bearing mice in time domain signal and frequency domain signal, and performed transmission-mode THz detection on hematoxylin and eosin (HE) stained neuroblastoma tissue sections. In THz imaging, superparamagnetic iron oxide (SPIO) was introduced as a contrast agent to enhance the imaging performance.

RESULTS: The results revealed a strong THz reflection signal at the tumor site in the tumor-bearing mice, with the THz imaging system clearly delineating the tumor region in agreement with pathological findings. Neuroblasotuma tissues exhibited higher THz absorption coefficients compared to normal tissues. THz spectroscopy provide an excellent imaging contrast ratio in 0.5-1.0 THz, which can be further improved with SPIO nanopartical agent. Additionally, we observed a statistically significant differences of refractive index and absorption coefficient between the HE-stained tumor and healthy tissue sections (P < 0.01) within the frequency range of 0.5-1.5 THz.

CONCLUSION: This work shows that THz-based imaging technology is able to distinguish the neuroblastoma and normal tissues in time and frequency domain, which offers a great potential for in vivo applications of neuroblastoma treatment. As an advanced technique, novel THz applications could open new avenues for precise diagnosing intraoperative neuroblastoma margins.

PMID:40540248 | DOI:10.1097/JS9.0000000000002517