Nevin Manimala

Crit Care. 2025 Mar 8;29(1):106. doi: 10.1186/s13054-025-05323-9.

ABSTRACT

INTRODUCTION: Albumin kinetics in septic shock have been extensively studied, but clinical recommendations remain weak. An increased transcapillary escape rate (TER) of albumin has been demonstrated, though TER does not account for lymphatic return. Mass balance calculations, considering lymphatic return, have been used to assess net albumin leakage (NAL) in major surgery but not in sepsis.

OBJECTIVES: This study aimed to evaluate NAL in ten ICU patients with suspected sepsis, hypothesizing a net positive leakage. Secondary aims included investigating associations between NAL and fluid overload, glycocalyx shedding products, and cytokines, as well as identifying factors associated with it.

METHODS: This prospective, observational study included ten patients within twelve hours of ICU admission for suspected sepsis at Karolinska University Hospital Huddinge. Albumin, hematocrit, and hemoglobin levels were sampled at 0, 1, 2, 4, 8, and 24 h. NAL was estimated using mass balance calculations, comparing proportional changes in albumin and hemoglobin concentrations over time, adjusted for albumin and hemoglobin infusions and losses. A proportionally greater decrease or smaller increase in albumin compared to hemoglobin indicated NAL, representing the net leakage from the circulation to the interstitium minus lymphatic return.

RESULTS: Over 24 h, patients exhibited a net positive albumin leakage to the interstitium of 8 ± 10 g (p = 0.029). NAL showed no correlation with glycocalyx shedding products or fluid overload but had a weak correlation with interleukin-6 and interleukin-8 in the first 4 h. Albumin infusions appeared to increase net leakage.

CONCLUSION: This study demonstrated a net positive albumin leakage of 8 ± 10 g over 24 h in ICU patients with suspected sepsis, with a weak early correlation to pro-inflammatory cytokines but no significant link to fluid balance or glycocalyx shedding. Notably, albumin infusions were associated with increased net leakage.

PMID:40057738 | DOI:10.1186/s13054-025-05323-9

BMC Public Health. 2025 Mar 8;25(1):926. doi: 10.1186/s12889-025-22090-y.

ABSTRACT

BACKGROUND: People living with HIV (PLHIV) in the southern United States (US) are at high risk for poor outcomes across the HIV care continuum leading to low rates of viral suppression. Understanding structural barriers to care-including transportation vulnerability-is critical to improve HIV outcomes. This study investigated relationships between travel time to HIV care, transportation vulnerability, and HIV care disruptions to inform future transportation interventions for PLHIV residing in South Carolina and other southern US states.

METHODS: A total of 160 PLHIV (N = 160) were recruited from a large immunology center in South Carolina. Participants reported on transportation experiences, transportation vulnerabilities, and residence. Differences in sociodemographic characteristics, transportation vulnerabilities, and HIV care disruptions were compared across travel time groups (< 15, 15-30, and > 30 min from residential location to the HIV clinic) using Mantel-Haenszel Chi-Square tests. Multivariable logistic regression tested our a priori hypothesis that travel time would predict HIV care disruptions.

RESULTS: A majority of participants were aged 45-64 years old (54.4%), single (77.0%), male (63.8%), and Black (77.5%). Nearly 20% of participants lived < 15 min from their HIV clinic, 59.1% lived 15-30 min, and 21.4% lived > 30 min away. PLHIV who had to travel > 30 min to HIV care were more likely than those living < 15 min away to report transportation vulnerability (73.5% vs. 51.6%, p = 0.048), missed HIV care appointments (64.7% vs. 41.9%, p = 0.049), and transportation challenges that prevented them from seeing HIV care providers (67.7% vs. 39.4%; p = 0.014). Adjusted odds ratios (AOR) show that PLHIV who had to travel > 30 min were more likely to experience transportation-related disruptions to HIV care, including being late to appointments (AOR 5.25, 95% CI:1.06-25.92), missing appointments (AOR 3.85, 95% CI:1.04-15.89), and being unable to see HIV providers (AOR 7.06, 95% CI:0.59-14.89).

CONCLUSIONS: In South Carolina-a rural southern state with a disproportionate burden of HIV-long travel time (> 30 min) to HIV care is associated with care disruptions, including more missed visits. Transportation interventions, as well as other efforts to expand rural access to HIV care, are urgently needed to ensure that all PLHIV are able to engage in consistent HIV care in order to reach and maintain viral suppression.

PMID:40057737 | DOI:10.1186/s12889-025-22090-y

Microb Cell Fact. 2025 Mar 8;24(1):58. doi: 10.1186/s12934-025-02671-7.

ABSTRACT

CONTEXT AND GOAL: This study aimed to isolate and optimize a high-yield lipase-producing Pseudomonas aeruginosa strain from biological samples, enhance enzyme production through random mutagenesis, and evaluate its potential anticancer activity. Fifty-one biological samples (blood, urine, sputum, wound pus) were screened, and three isolates demonstrated significant lipase activity. The isolate with the highest activity, identified as P. aeruginosa (GenBank accession number PP436388), was subjected to ethidium bromide-induced mutagenesis, resulting in a two-fold increase in lipase activity (312 U/ml). Lipase production was optimized using submerged fermentation, with critical factors identified statistically as Tween 80, peptone, and substrate concentration. The enzyme was purified via ammonium sulfate precipitation and Sephadex G-100 chromatography, and its molecular weight (53 kDa) was confirmed by SDS-PAGE.

FINDINGS: Optimal conditions for enzyme production included a pH of 9, temperature of 20 °C, and a 24-h incubation period. The partially purified enzyme exhibited high stability at pH values up to 10 and storage temperatures of 4 °C. Anticancer activity was evaluated using the MTT assay, revealing an IC₅₀ of 78.21 U/ml against human hepatocellular carcinoma using HepG-2 cells, with no cytotoxicity observed against Vero cells. Flow cytometry confirmed that the enzyme’s anticancer potential was mediated through apoptosis and necrosis. QRT-PCR data revealed that the expression of the Bcl-2 gene was significantly downregulated by 62% (P < 0.05) following the treatment of HepG-2 cells with the lipase enzyme. These findings suggest that lipase from P. aeruginosa holds promise as a novel therapeutic agent for hepatocellular carcinoma, addressing the limitations of current treatments.

PMID:40057735 | DOI:10.1186/s12934-025-02671-7

Lipids Health Dis. 2025 Mar 8;24(1):88. doi: 10.1186/s12944-025-02500-1.

ABSTRACT

BACKGROUND AND AIM: The MoKaRi study aims to evaluate the impact of two nutritional concepts on cardiometabolic risk factors.

METHODS: For our 20-week intervention study, 65 participants with moderate elevated low-density lipoprotein cholesterol (LDL-C; ≥ 3 mmol/l) and without lipid-lowering therapy were recruited. The intervention to improve nutritional behavior was based on individualized menu plans which were characterized by defined energy and nutrient intake. To improve compliance, individual nutritional counselling sessions were held every two weeks. In addition to motivation, cooking skills were strengthened and nutritional knowledge was imparted. Follow-up visits were carried out after 10 and 20 weeks.

RESULTS: The MoKaRi diet lowered the concentrations of total cholesterol (menu plan group (MP): -15%; menu plan plus fish oil group (MP-FO): -11%), LDL-C (MP: -14%; MP-FO: -16%) and non-high-density lipoprotein cholesterol (MP: -16%; MP-FO: -13%) (p < 0.001). Body weight (MP: -5%; MP-FO: -8%; p < 0.05), waist circumference (MP: -6%; MP-FO: -9%) as well as diastolic blood pressure (MP: -8%; MP-FO: -8%), apolipoprotein A1 (MP: -15%; MP-FO: -20%), apolipoprotein B (MP: -15%; MP-FO: -6%) and glycated hemoglobin A_1c (HbA1c) (MP: -1.8%; MP-FO: -3.6%) were also reduced in both groups after 20 weeks (p < 0.05). In both intervention groups, a maximum reduction in LDL-c of approx. 26% was achieved within the 20 weeks of intervention. Individual participants achieved a reduction of 45-49%. The supplementation of fish oil on top of the menu plans resulted in more substantial effects on body weight (MP: -5% vs. MP-FO: -8%), body fat (MP: -11% vs. MP-FO: -20%), triglycerides (MP: -14% vs. MP-FO: -28%), high-sensitivity C-reactive protein (MP: -19% vs. MP-FO: -43%) and HbA1c (MP: -1.8% vs. MP-FO:-3.6%; p < 0.05).

CONCLUSIONS: The MoKaRi diet resulted in a significant reduction of cardiometabolic risk factors. Our data highlights the additional benefit of the combination between menu plans and fish oil supplementation, which resulted in more substantial effects on body weight, BMI, TG, HbA1c and hs-CRP.

GOV IDENTIFIER: NCT02637778.

PMID:40057729 | DOI:10.1186/s12944-025-02500-1

BMC Pregnancy Childbirth. 2025 Mar 8;25(1):257. doi: 10.1186/s12884-025-07367-9.

ABSTRACT

BACKGROUND: To comprehensively evaluate the risk factors for recurrent gestational diabetes mellitus (GDM) in women with a history of GDM during re-pregnancy.

METHODS: Articles about risk factors for recurrent GDM were searched in China National Knowledge Infrastructure, Wanfang Data, VIP Database for Chinese Technical Periodicals, PubMed, EMBASE, the Cochrane Library, and Web of Science from the date of establishment to January 2023. Meta-analysis of risk factors for recurrent GDM was performed using STATA/SE 15.1 software.

RESULTS: A total of 19 studies were included in the meta-analysis, comprising 15 case-control studies and 4 cohort studies, involving 11,385 patients. Among them, 2,462 patients experienced recurrent GDM, while 2,909 did not. The analysis of case-control studies revealed a GDM recurrence rate of 48%. Meta-analysis identified several significant risk factors for GDM recurrence: advanced maternal age at subsequent pregnancy [ES = 3.02, 95% CI (1.24,2.79), P = 0.003], increased BMI prior to the subsequent pregnancy [ES = 2.23, 95% CI (1.04,1.72), P = 0.026], elevated 1-hour plasma glucose levels in oral glucose tolerance test (OGTT) during previous pregnancy [ES = 2.79, 95% CI (1.11,1.78), P = 0.005], increased 2-hour OGTT glucose levels in previous pregnancy [ES = 2.75, 95% CI (1.11,1.91), P = 0.006], and previous delivery of macrosomia [ES = 3.48, 95% CI (1.38,3.18), P = 0.001]. All these factors showed statistically significant differences between the recurrence and non-recurrence groups. Pregnant women with a history of GDM can reduce the risk of recurrence by adopting a reasonable pregnancy plan, such as avoiding advanced maternal age, managing body weight, controlling blood glucose levels during pregnancy, and losing weight before conception.

CONCLUSION: Advanced maternal age, elevated BMI before subsequent pregnancy, increased OGTT levels during the previous pregnancy, and the delivery of macrosomia are significant risk factors for recurrent GDM.

PMID:40057727 | DOI:10.1186/s12884-025-07367-9

BMC Nurs. 2025 Mar 8;24(1):261. doi: 10.1186/s12912-025-02868-6.

ABSTRACT

BACKGROUND: Critical care nurses face complex ethical dilemmas and high-pressure situations that require quick ethical decision-making. Personality traits have been recognized as influencing individuals’ ethical decision-making processes and attitudes toward safety in healthcare. Moral sensitivity helps nurses recognize ethical issues and respond appropriately to these challenges. So, this study aimed to assess the mediation role of moral sensitivity on safety attitudes and personality traits among critical care nurses.

METHOD: This study used a convenience sample method and a descriptive correlational research design to conduct it on 232 critical care nurses who worked at intensive care units and emergency departments of nine Sohag Governmental Hospitals. Three tools were used to collect data: the Moral Sensitivity Questionnaire (MSQ), the Big Five Factors of Personality Inventory sheet, and the Safety Attitudes Questionnaire (SAQ). The data were analyzed using descriptive statistics and inferential tests (multivariate linear regression using the backward method).

RESULT: The study revealed the personality profiles of the participants, with a total personality traits mean score (150.012 ± 9.628) and higher mean scores in conscientiousness and openness. The highest mean in moral sensitivity was interpersonal orientation, 22.76 ± 3.339, and moral meaning, 26.97 ± 4.279. Participants had low average mean scores regarding safety attitude 73.254 ± 11.368. There was a positive correlation between personality traits, moral sensitivity, and safety attitude. Finally, moral sensitivity acted as a mediating factor between personality traits and safety attitude.

CONCLUSION: The results of the present study suggest that personality assessment and moral sensitivity training be incorporated into nursing education and professional development programs. By enhancing nurses’ self-awareness and sensitivity to ethical dilemmas, institutions can potentially improve safety attitudes and, consequently, patient care outcomes.

PMID:40057726 | DOI:10.1186/s12912-025-02868-6

BMC Womens Health. 2025 Mar 8;25(1):107. doi: 10.1186/s12905-025-03636-z.

ABSTRACT

BACKGROUND: Nigeria faces a dual challenge of high fertility rates and limited female education. Studies suggest that education can contribute to fertility reduction. This study aimed to show the differences and quantify the disparity in fertility rates between educated and uneducated women in Nigeria.

METHODS: A repeated cross-sectional analysis was conducted using secondary data from the Nigeria Demographic and Health Surveys (2003, 2008, 2013, 2018; Total = 121,774). Fertility differentials for women aged 15-49 were measured using Oaxaca-Blinder decomposition (α = 0.05).

RESULTS: The proportion of women without education remained high throughout the study period (41.6% in 2003, 35.8% in 2008, 37.8% in 2013 and 34.9% in 2018). Uneducated women consistently exhibited higher fertility rates than educated women across all survey years and regions. The risk difference of high fertility was greatest in the SouthEast region (34.0) and lowest in the North East (22.19). Factors contributing to the disparity included maternal age, age at first marriage, wealth index, and age at first birth.

CONCLUSION: Marked fertility inequalities exist between educated and uneducated women across Nigerian regions. These findings highlight the crucial role of female education in fertility reduction efforts.

PMID:40057721 | DOI:10.1186/s12905-025-03636-z

Eur J Radiol. 2025 Feb 27;185:112017. doi: 10.1016/j.ejrad.2025.112017. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: CT-Guided Microwave Ablation Combined with Percutaneous Vertebroplasty for Spinal Metastases is an emerging minimally invasive therapeutic option. This study aimed to compare the clinical efficacy and risk factors for bone cement leakage in CT-guided percutaneous vertebroplasty (PVP) with or without microwave ablation (MWA) in the treatment of spinal metastases.

MATERIALS AND METHODS: A retrospective analysis was conducted on 69 patients with 104 vertebral metastases treated between January 2019 and December 2022, divided into two groups: PVP group(n = 23, 37 vertebrae) underwent PVP alone, and MWA + PVP group(n = 46, 67 vertebrae) underwent MWA combined with PVP. Postoperative pain, daily living capabilities, and other parameters were compared, and CT and MRI were used to assess bone cement leakage and tumor control. Logistic regression analysis was used to evaluate the risk factors for leakage.

RESULTS: The technical success rate was 100 % for both groups.The Visual Analog Scale（VAS), Daily Morphine Consumption(DMC), Oswestry Disability Index(ODI), and Activity of Daily Living Scale(ADL) scores at various postoperative time points in both the PVP and MWA + PVP groups showed significant improvements compared to preoperative levels (P < 0.05). However, there were no significant differences between the two groups within 12 weeks (P > 0.05), but at the 24-week follow-up, the MWA + PVP group exhibited superior scores (P < 0.05).At the 24-week postoperative follow-up, the local tumor control rates for patients and lesions in the PVP group were 78.26 % (18/23) and 78.38 % (29/37), respectively, while those in the MWA + PVP group were 91.30 % (42/46) and 91.04 % (61/67), respectively. PVP group had mild bone cement leakage in 64.80 % of vertebrae, compared to 22.30 % in MWA + PVP group. Multifactorial logistic analysis revealed that microwave ablation is an independent protective factor against bone cement leakage, cortical bone cement leakage, and vascular bone cement leakage, with an approximately consistent odds ratio (OR) of 0.2 for its protective effect, and these associations were statistically significant (P-values of 0.008, 0.005, and 0.007, respectively).Conversely, Pathological fractures (OR = 29.6,P < 0.001)and posterior vertebral wall ruptures（OR = 17.3,P = 0.01） were two independent risk factors for bone cement leakage, and the volume of bone cement injected was an independent risk factor for spinal canal bone cement leakage （OR = 1.7, P = 0.01）.

CONCLUSION: Compared with PVP alone, MWA combined with PVP in the treatment of spinal metastases not only demonstrates more pronounced tumor control efficacy but also effectively reduces the risk of bone cement leakage. This finding offers a novel perspective for the minimally invasive treatment of spinal metastases and provides robust clinical evidence for optimizing treatment regimens and enhancing patients’ quality of life. It holds promise as one of the significant options in the therapeutic arsenal against spinal metastases.

PMID:40054036 | DOI:10.1016/j.ejrad.2025.112017

Neural Netw. 2025 Feb 26;187:107297. doi: 10.1016/j.neunet.2025.107297. Online ahead of print.

ABSTRACT

In feed-forward neural networks, dataset-free weight-initialization methods such as LeCun, Xavier (or Glorot), and He initializations have been developed. These methods randomly determine the initial values of weight parameters based on specific distributions (e.g., Gaussian or uniform distributions) without using training datasets. To the best of the authors’ knowledge, such a dataset-free weight-initialization method is yet to be developed for restricted Boltzmann machines (RBMs), which are probabilistic neural networks consisting of two layers. In this study, we derive a dataset-free weight-initialization method for Bernoulli-Bernoulli RBMs based on statistical mechanical analysis. In the proposed weight-initialization method, the weight parameters are drawn from a Gaussian distribution with zero mean. The standard deviation of the Gaussian distribution is optimized based on our hypothesis that a standard deviation providing a larger layer correlation (LC) between the two layers improves the learning efficiency. The expression of the LC is derived based on a statistical mechanical analysis. The optimal value of the standard deviation corresponds to the maximum point of the LC. The proposed weight-initialization method is identical to Xavier initialization in a specific case (i.e., when the sizes of the two layers are the same, the random variables of the layers are {-1,1}-binary, and all bias parameters are zero). The validity of the proposed weight-initialization method is demonstrated in numerical experiments using a toy dataset and real-world datasets.

PMID:40054026 | DOI:10.1016/j.neunet.2025.107297

Sleep Med Rev. 2025 Jan 15;80:102048. doi: 10.1016/j.smrv.2025.102048. Online ahead of print.

ABSTRACT

Major depressive disorder (MDD) and Insomnia disorder (ID) are characterized by sleep alterations. To define their polysomnographic profiles, we conducted a Network Meta-Analysis comparing MDD and ID patients versus healthy controls (HCs). The literature search, conducted from 2008 up to January 2023 and following PRISMA guidelines, covered PubMed, Web of Science, Scopus, and Embase databases. We addressed publication bias using funnel plot asymmetry inspection and Egger’s test, evaluated statistical heterogeneity with I², and local and global inconsistencies with the separate indirect from direct evidence method and Q between designs, respectively. Pairwise meta-analyses employed a fixed-effects model, while network analysis utilized a random-effect approach. We evaluated 86 ID and 17 MDD studies, comparing sleep parameters for 636 MDDs versus 491 HCs, and 3661 IDs versus 2792 HCs. The network meta-analysis reported that patients with MDD have greater rapid eye movement (REM) sleep duration and REMs density, and lower REM sleep latency compared to IDs. ID patients instead exhibited lower total sleep time and time in bed, and greater wake after sleep onset and non-REM sleep stage 3 than MDD patients. This work emphasized sleep depth and continuity alterations in both MDD and ID, with major involvement of REM sleep in MDD.

PMID:40054014 | DOI:10.1016/j.smrv.2025.102048