Nevin Manimala

Europace. 2025 Mar 6:euaf045. doi: 10.1093/europace/euaf045. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Current guidelines for the optimal ablation strategy for persistent atrial fibrillation(PerAF) remain unclear. While our previous RCT confirmed the favorable prognosis of aggressive ablation, real-world evidence is still lacking.

METHODS: Among 4,833 PerAF patients undergoing catheter ablation at 10 centers, two groups were defined: Regular Ablation(PVI-only or PVI plus anatomical ablation) and Aggressive Ablation(anatomical plus electrogram-guided ablation), with 1,560 patients each after propensity score(PS) matching. The primary endpoint was 12-month AF/atrial tachycardia(AT) recurrence-free survival off anti-arrhythmic drugs after a single procedure. Additional PS matching was performed within the regular group between PVI-only and anatomical ablation(n=455 each). Furthermore, anatomical ablation from the regular group was independently matched with aggressive ablation (n=1,362 each).

RESULTS: At 12 months, the Aggressive Group showed superior AF/AT-free survival(66.2% vs. 59.3%, p<0.001; HR 0.745), similar AT recurrence(12.0% vs. 11.3%, p=0.539), and significantly higher procedural AF termination(67.0% vs. 21.0%, p<0.001) than Regular Group. Moreover, patients with AF termination had improved AF/AT-free survival(72.3% vs. 55.2%, p<0.001). Safety endpoints did not differ significantly between the two groups. Both the ablation outcomes and AF termination rate showed increasing trends with the extent of ablation aggressiveness but declined with extremely aggressive ablation. After additional PS matching, within the regular group, no statistical differences were observed though AF/AT-free survival in the anatomical group was slightly higher than the PVI-only group (60.7% vs. 55.6%, p=0.122); while aggressive ablation showed improved AF/AT-free survival compared to anatomical ablation alone from regular group (67.5% vs. 59.9%, p<0.001).

CONCLUSION: Aggressive ablation achieved more favorable outcomes than regular ablation, and moderately aggressive ablation may be associated with better clinical outcomes. AF termination is a reliable ablation endpoint.

PMID:40048703 | DOI:10.1093/europace/euaf045

J Breast Imaging. 2025 Mar 6:wbaf007. doi: 10.1093/jbi/wbaf007. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze recent trends in U.S. breast cancer mortality rates by age group and race and ethnicity.

METHODS: This retrospective analysis of female breast cancer mortality rates used National Center for Health Statistics data from 1990 to 2022 for all women, by age group, and by race or ethnicity. Joinpoint analysis assessed trends in breast cancer mortality rates.

RESULTS: Breast cancer mortality rates for women 20 to 39 years old decreased 2.8% per year from 1999 to 2010 but showed no decline from 2010 to 2022 (annual percentage change [APC], -0.01; P = .98). For women of ages 40 to 74 years, breast cancer mortality rates decreased 1.7% to 3.9% per year from 1990 to 2022 (P <.001); a decline was found for all cohorts in this age group except Asian women. For women ≥75 years of age, breast cancer mortality rates declined significantly from 1993 to 2013 (APC, -1.26; P = .01) but showed no evidence of decline from 2013 to 2022 (APC, -0.2; P = .24). Across all ages, breast cancer mortality rates declined for White and Black women but not for Asian, Hispanic, and Native American women. Asian women ≥75 years of age had significantly increasing mortality rates (APC, 0.73; P <.001). For 2004 to 2022, breast cancer mortality rates were 39% higher in Black women than White women and varied strongly by age group: 104% for ages 20 to 39 years, 51% for ages 40 to 74 years, and 13% for ages ≥75 years.

CONCLUSION: Female breast cancer mortality rates have stopped declining in women <40 years of age and >74 years of age. The higher mortality rates in Black women compared with White women are age dependent and substantially higher in younger women.

PMID:40048690 | DOI:10.1093/jbi/wbaf007

Mod Rheumatol. 2025 Mar 6:roaf015. doi: 10.1093/mr/roaf015. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance imaging (MRI), utilizing fat-saturated T2-weighted and STIR sequences, is essential for the early diagnosis and monitoring of axial spondyloarthritis (axSpA). Recently, the European Society of Musculoskeletal Radiology proposed recommendations for the standardization of MRI findings for axSpA. However, the predictive value of specific MRI findings for spinal ankylosis progression remains unclear. This study investigates whether baseline MRI findings correlate with the progression of spinal ankylosis observed on radiographs over a two-year period.

METHODS: Twenty-six axSpA patients who met ASAS criteria and underwent baseline and two-year follow-up imaging were included. MRI assessments of the lumbar spine and SIJ evaluated inflammatory and structural lesions, including Romanus and Anderson lesions. Radiographic progression was defined as a ≥2-point increase in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses compared clinical and imaging parameters between progression (n=9) and non-progression (n=17) groups.

RESULTS: Patients in the progression group had significantly higher baseline mSASSS (P=0.04) and mHAQ scores (P=0.04). Positive MRI findings of anterior and posterior corner inflammatory lesions and Anderson-central lesions were significantly associated with progression (P<0.05). Romanus lesions, indicative of early structural changes, were more frequent in the progression group (P=0.02). However, fat lesions and SIJ inflammation showed no significant predictive value.

CONCLUSION: Baseline MRI findings, particularly inflammatory and Romanus lesions, are strong predictors of spinal ankylosis progression in axSpA. These results highlight the importance of incorporating MRI into personalized treatment strategies to mitigate disease progression. Further studies are needed to validate these findings in larger cohorts.

PMID:40048664 | DOI:10.1093/mr/roaf015

Eur Heart J. 2025 Mar 6:ehaf080. doi: 10.1093/eurheartj/ehaf080. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: In the Surgical Treatment for Ischaemic Heart Failure Trial Extension Study (STICHES), coronary artery bypass grafting (CABG) improved outcomes of patients with ischaemic left ventricular dysfunction receiving medical therapy, whereas in the Revascularization for Ischaemia Ventricular Dysfunction trial (REVIVED-BCIS2), percutaneous coronary intervention (PCI) did not. The aim of this study was to explore differences in outcomes of participants treated with medical therapy alone in STICHES vs. REVIVED-BCIS2 and to assess the incremental benefit of CABG or PCI.

METHODS: Pooled analysis of adjusted individual participant data from two multicentre randomized trials. All patients had left ventricular ejection fraction ≤35% and coronary artery disease and received medical therapy. Participants were randomized 1:1 to CABG (STICHES) or PCI (REVIVED-BCIS2). The primary outcome was the composite of all-cause death and hospitalization for heart failure over all available follow-up.

RESULTS: A total of 1912 participants (88% male, 76% white ethnicity) were included with 98.3% completeness of follow-up for the primary outcome. The median follow-up was 118 months in STICHES and 41 months in REVIVED-BCIS2. Those receiving medical therapy alone in REVIVED-BCIS2 had fewer primary outcome events than those receiving medical therapy alone in STICHES (adjusted hazard ratio 0.60, 95% confidence interval 0.48-0.74, P < .001). Patients receiving PCI in REVIVED-BCIS2 were less likely to experience a primary outcome event than those receiving CABG in STICHES. Adjusted outcomes of patients treated with CABG in STICHES were worse than those receiving medical therapy alone in REVIVED-BCIS2.

CONCLUSIONS: Patients with ischaemic cardiomyopathy receiving medical therapy in REVIVED-BCIS2 had better outcomes than those in STICHES, with or without CABG surgery. Further trials comparing CABG, PCI, and medical therapy in this population are warranted.

PMID:40048661 | DOI:10.1093/eurheartj/ehaf080

J Antimicrob Chemother. 2025 Mar 6:dkae467. doi: 10.1093/jac/dkae467. Online ahead of print.

ABSTRACT

BACKGROUND: Helicobacter pylori eradication in penicillin-allergic patients presents challenges. Options of effective regimens are lacking in areas where tetracycline is unavailable.

OBJECTIVES: To evaluate the efficacy of replacing the proton pump inhibitor (PPI) with a potassium-competitive acid blocker (P-CAB, vonoprazan) in standard bismuth quadruple therapy containing doxycycline and metronidazole as a first-line treatment for H. pylori.

METHODS: This prospective randomized clinical trial enrolled 332 naive patients with H. pylori infection and penicillin allergy. Participants were randomly assigned in a 1:1 ratio to either the 14 day P-CAB/BDM group (vonoprazan 20 mg twice daily, colloidal bismuth 200 mg twice daily, doxycycline 100 mg twice daily and metronidazole 400 mg three times daily) or the 14 day PPI/BDM group (rabeprazole 10 mg twice daily, and the same dose of the three other drugs as in the 14 day P-CAB/BDM group).

RESULTS: Eradication rates in the P-CAB/BDM and PPI/BDM groups were 90.4% and 71.1% (P value for superiority was 0.013), respectively, by ITT analysis. The efficacy of P-CAB/BDM remained non-inferior and even superior to PPI/BDM therapy in all ITT, modified ITT and PP analyses. The overall frequency of adverse events (39.8% and 40.4%; P = 0.911) and compliance (88.0% and 91.0%; P = 0.372) were similar between P-CAB and PPI regimens. Patients with higher body surface area were significantly associated with eradication failure in both groups (P < 0.05).

CONCLUSIONS: The 14 day P-CAB/BDM therapy provided a satisfactory eradication rate of >90% (ITT analysis) and had a good safety profile as first-line H. pylori therapy, providing an alternative option for penicillin-allergic patients.

PMID:40048654 | DOI:10.1093/jac/dkae467

Psychol Health Med. 2025 Mar 6:1-19. doi: 10.1080/13548506.2025.2470878. Online ahead of print.

ABSTRACT

In contemporary society, where vegetarian diets are gaining popularity, it is imperative to develop a profound understanding of these individuals’ dietary choices and their health implications. Specifically, it is crucial to examine how the prevalence of fat phobia affects their dietary preferences, in order to promote a balanced nutritional approach. The aim of the study is to evaluate the carbohydrate quality and nutrition knowledge level of vegan and vegetarian individuals in Istanbul, Turkey, and to examine their relationship with fatphobia. A questionnaire consisting of questions about sociodemographic characteristics, eating habits, the Nutrition Knowledge Level Scale for Adults, Fat Phobia Scale, and a 24-hour Food Consumption Record Form was administered face-to-face to 500 vegetarian individuals aged 18-65 living in Istanbul. Individuals in this study are 26.4% vegan, 10.4% lacto-vegetarian, 25.4% lacto-ovo-vegetarian, 12% pollo-vegetarian, 10.4% pesco-vegetarian and 15.4% semi-vegetarian. The group that has the highest Basic Nutrition Information (47.51 ± 7.95), Food Preference Information (24.27 ± 6.04), Evaluation of Daily Food Preferences as Correct (6.89 ± 1, 33) are vegans. The group with the highest Evaluating the Importance Degree of the Relationship Between Nutrition and Health (9.27 ± 0.89) and Carbohydrate Quality Index value (11.08 ± 2.14) are pesco-vegetarians. The group with the highest Fat Phobia Scale (3.23 ± 0.28) are pollo-vegetarians. There was no statistically significant difference between the Carbohydrate Quality Index values and ‘Fat Phobia Scale Total’ scores of the different vegetarian dietary types (p > 0.05). It has been found that pesco-vegetarians have the highest carbohydrate quality index. Pollo-vegetarians, on the other hand, are noted for having the highest fat phobia.

PMID:40048647 | DOI:10.1080/13548506.2025.2470878

J Neurosci Nurs. 2025 Mar 6. doi: 10.1097/JNN.0000000000000826. Online ahead of print.

ABSTRACT

BACKGROUND: Thrombolytic therapy is an effective intervention for acute ischemic stroke. However, the timely administration of this treatment can be hindered by delayed decision-making on the part of family members. Little is known about the reasons for their delay in making decisions. METHODS: This qualitative interview study used face-to-face, individual, semistructured interviews with 16 participants from 2 tertiary hospital neurology wards in Guangdong, China. The interviews were analyzed using inductive content analysis, and descriptive statistics were used to summarize participants’ characteristics. RESULTS: Three main themes emerged: a large family communication network, struggling with bleeding risk, and seeking distance treatment advice. CONCLUSION: In China, family members make decisions on behalf of patients and are affected by various factors in the decision-making process, resulting in delayed decision-making. They may experience psychological conflicts when deciding whether to permit thrombolysis, and they tend to seek information from external sources without understanding thrombolysis. Healthcare professionals caring for stroke patients eligible for thrombolytic therapy should provide decision-making support programs tailored to the specific needs of these family members to reduce delayed decision-making.

PMID:40048642 | DOI:10.1097/JNN.0000000000000826

JMIR Hum Factors. 2025 Mar 6;12:e65785. doi: 10.2196/65785.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) chatbots have been customized to deliver on-demand support for people with mental health problems. However, the effectiveness of AI chatbots in tackling mental health problems among the general public in Hong Kong remains unclear.

OBJECTIVE: This study aimed to develop a local AI chatbot and compare the effectiveness of the AI chatbot with a conventional nurse hotline in reducing the level of anxiety and depression among individuals in Hong Kong.

METHODS: This study was a pilot randomized controlled trial conducted from October 2022 to March 2023, involving 124 participants allocated randomly (1:1 ratio) into the AI chatbot and nurse hotline groups. Among these, 62 participants in the AI chatbot group and 41 in the nurse hotline group completed both the pre- and postquestionnaires, including the GAD-7 (Generalized Anxiety Disorder Scale-7), PHQ-9 (Patient Health Questionnaire-9), and satisfaction questionnaire. Comparisons were conducted using independent and paired sample t tests (2-tailed) and the χ2 test to analyze changes in anxiety and depression levels.

RESULTS: Compared to the mean baseline score of 5.13 (SD 4.623), the mean postdepression score in the chatbot group was 3.68 (SD 4.397), which was significantly lower (P=.008). Similarly, a reduced anxiety score was also observed after the chatbot test (pre vs post: mean 4.74, SD 4.742 vs mean 3.4, SD 3.748; P=.005), respectively. No significant differences were found in the pre-post scores for either depression (P=.38) or anxiety (P=.19). No statistically significant difference was observed in service satisfaction between the two platforms (P=.32).

CONCLUSIONS: The AI chatbot was comparable to the traditional nurse hotline in alleviating participants’ anxiety and depression after responding to inquiries. Moreover, the AI chatbot has shown potential in alleviating short-term anxiety and depression compared to the nurse hotline. While the AI chatbot presents a promising solution for offering accessible strategies to the public, more extensive randomized controlled studies are necessary to further validate its effectiveness.

PMID:40048637 | DOI:10.2196/65785

J Magn Reson Imaging. 2025 Mar 6. doi: 10.1002/jmri.29749. Online ahead of print.

ABSTRACT

BACKGROUND: MR-generated acoustic noise may be particularly concerning at 7-Tesla (T) systems. Noise levels can be reduced by altering gradient output using software optimization. However, such alterations might influence image quality or prolong scan times, and these optimizations have not been well characterized.

PURPOSE: To evaluate image quality, sound pressure levels (SPLs), and perceived noise levels when using the acoustic noise reduction technique SofTone for T₂-weighted fast spin echo (T₂W FSE) and three-dimensional T₁-weighted turbo field echo (3D T₁W TFE), and to compare with conventional imaging during 7-T brain MRI.

STUDY TYPE: Prospective.

SUBJECTS: Twenty-eight volunteers underwent brain MRI, with n = 26 for image quality evaluations.

FIELD STRENGTH/SEQUENCE: Conventional and SofTone versions of T₂W FSE and 3D T₁W TFE at 7 T.

ASSESSMENT: Peak SPLs (A-weighted decibels, dBA), participant-perceived noise levels (Borg CR10-scale), qualitative image assessments by three neuroradiologists (four-graded ordinal scales), interrater reliability, and percentage agreement.

STATISTICAL TEST: Paired t-test, Wilcoxon’s Signed-Rank Test, and Krippendorff’s alpha; p < 0.05 were considered statistically significant.

RESULTS: SofTone significantly reduced peak SPLs: from 116.3 to 97.0 dBA on T₂W FSE, and from 123.7 to 101.5 dBA on 3D T₁W TFE. SofTone was perceived as significantly quieter than conventional scanning. T₂W FSE showed no significant differences in image quality assessments (p = 0.21-1.00), except one radiologist noting significantly less artifact interference with SofTone. General image quality remained acceptable for 3D T₁W TFE, though one radiologist scored it significantly lower with SofTone (mean scores: 3.08 vs. 3.65), and two radiologists observed significantly worse white and gray matter differentiation with SofTone (mean scores: 3.19 vs. 3.54; 2.27 vs. 2.81).

DATA CONCLUSION: SofTone can significantly reduce sound intensity and perceived noise levels while maintaining acceptable image quality with T₂W FSE and 3D T₁W TFE in brain MRI. It appears to be an effective tool for providing a safer, quieter 7-T scan environment.

EVIDENCE LEVEL: 4 Technical Efficacy: Stage 5.

PMID:40048635 | DOI:10.1002/jmri.29749

Transplantation. 2025 Mar 6. doi: 10.1097/TP.0000000000005355. Online ahead of print.

ABSTRACT

BACKGROUND: Deciphering the impact of invasive percutaneous core needle biopsy of the kidney allograft on diagnostic biomarkers may help guide their clinical usage.

METHODS: We prospectively enrolled 39 adult kidney allograft recipients (patients) who underwent 41 clinically indicated, ultrasound-guided, percutaneous core needle biopsies. Pre- and post-biopsy urines were analyzed for urinary cell 3-gene signature score (UroMap), and the bloods for peripheral blood gene expression score (AlloMap Kidney) and plasma donor-derived cell-free DNA percentage (dd-cfDNA). We performed statistical analyses to compare pre- and post-biopsy values.

RESULTS: Median A260/A280 ratios of RNA from pre- and post-biopsy urines were 1.99 and 2.01, respectively; RNA yield, 0.78 versus 0.76 micrograms; and transcript copies of 18S rRNA, TGFβ1, CD3ε, CXCL10, and UroMap score were similar (all P > 0.05, Wilcoxon matched-pairs signed-rank test). The pre- and post-scores were very strongly correlated (Spearman’s correlation coefficient [rs]: 0.83, P < 0.0001). AlloMap Kidney scores in pre- and post-biopsy peripheral blood were similar (P > 0.05) and strongly correlated (rs = 0.70, P < 0.0001). dd-cfDNA in post-biopsy plasma was higher than in pre-biopsy plasma (0.61% versus 0.26%, P = 0.004). The higher post-biopsy percentage was replicated in an independent cohort of 119 post-biopsy plasma collected from 105 patients with no rejection biopsies. To normalize the biopsy-associated increase, a correction factor of -0.36% was derived by subtracting the pre-biopsy dd-cfDNA percent from the post-biopsy percent.

CONCLUSIONS: UroMap and AlloMap Kidney scores are not affected by the biopsy procedure. However, dd-cfDNA increases following the biopsy procedure and could be normalized using the correction factor identified in this study.

PMID:40048628 | DOI:10.1097/TP.0000000000005355