Nevin Manimala

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12093-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To predict active extravasation during angiography for colonic diverticular bleeding confirmed by CT angiogram (CTA) and examine the effect of procedural factors on clinical outcomes.

MATERIALS AND METHODS: Mesenteric angiograms performed at three hospitals for colonic diverticular bleeding on CTA between 2016 and 2025 were retrospectively reviewed. Data collection included CTA-to-angiogram time, extravasation and inferior vena cava size, angiogram selectivity, provocative maneuvers, and embolization techniques. Univariate and multivariate analyses were used to find associations between pre-procedural variables and active extravasation on angiography. Clinical outcomes were compared between patients who were or were not embolized.

RESULTS: One hundred seventeen patients (median age, 76 years (IQR 16), 42 women) underwent 146 angiograms. Active extravasation was found in 40% of angiograms. CTA-to-angiogram time ≤ 4 h (OR = 2.95; CI: 1.17-7.73; p = 0.02), inferior vena cava short axis ≥ 20 mm (OR = 3.63; CI: 1.24-11.6, p = 0.02) and age (OR = 1.06; CI: 1.01-1.12; p = 0.01) were independent predictors for active bleeding on angiography in a multivariate logistic model (AUC: 0.81, CI: 0.72-0.89; p < 0.01). Angiography beyond the named arterial branch revealed more bleeding than main trunk angiography (34% vs 21%). 51/58 (88%) positive and 15 negative angiograms were embolized. Patients with targeted embolization had less rebleeding (10% vs 44%, p < 0.05) and post-procedure colonoscopies (17% vs 51%, p < 0.05).

CONCLUSION: Mesenteric angiography had a 40% positivity rate for diverticular bleeding after CTA, with a higher yield if performed within 4 h, sub-selectively, and after resuscitation. Targeted embolization decreased rebleeding and post-procedure colonoscopies.

KEY POINTS: Question Colonic diverticular bleeding identified on CTA is treated with angiography and embolization, but diagnostic yield and embolization outcome are extrapolated from all-cause lower gastrointestinal bleeding. Findings Extravasation was identified in 40% of angiograms, with better yield if performed ≤ 4 h after positive CTA and sub-selectively. Targeted embolization reduced rebleeding and post-procedural colonoscopies. Clinical relevance Patients with colonic diverticular bleeding with active extravasation on CTA should be vigorously resuscitated and undergo prompt mesenteric angiography. This increases the likelihood of visualizing active extravasation and targeted embolization, leading to less rebleeding and further procedures.

PMID:41139171 | DOI:10.1007/s00330-025-12093-z

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12064-4. Online ahead of print.

ABSTRACT

OBJECTIVES: White matter hyperintensities (WMH) are abnormalities in brain imaging that contribute to cognitive decline and diseases. This study aimed to build WMH probability maps (WPMs) and normative data of WMH volume from a Chinese aging cohort, to offer valuable insights for diagnosis.

MATERIALS AND METHODS: We developed WPMs from a comprehensive dataset across six age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years), encompassing 735 participants. WMH segmentation was performed with a deep learning approach, and the resulting masks were registered to the standard space for WPM construction. We explored how WMH volume changed with age and established normative data for different age groups. Additionally, we examined whether WMH volume moderates the relationship between aging and cognitive decline. The practical utility of WPMs was then validated with a separate patient cohort with mild cognitive impairment and Alzheimer’s disease.

RESULTS: WPMs and the normative data of WMH volume were constructed for six age groups. As age increased, both the likelihood and spatial coverage of WMH grew. All types of WMH (total, periventricular, and deep white matter hyperintensities) quadratically increased with age. Deep white matter hyperintensities moderated the decline of general cognitive abilities related to aging. The two patient groups had significantly higher ratios of abnormal WMH than typical aging adults.

CONCLUSION: We successfully built WPMs and WMH normative data for Chinese adults and demonstrated their clinical diagnostic values.

KEY POINTS: Question Current diagnostic tools lack population-specific references for white matter hyperintensities (WMH)in Chinese aging adults, limiting accurate discrimination between pathological neurodegeneration and typical aging patterns. Findings These Chinese WMH probability maps show quadratic age-related growth, with deep WMH moderating cognitive decline. Mild cognitive impairment/Alzheimer’s Disease (MCI/AD) patients exhibited significantly higher WMH volumes. Clinical relevance These population-specific WMH references enable clinicians to quantitatively identify abnormal aging and early neurodegeneration in Chinese patients, addressing the critical need for ethnically tailored diagnostic tools in Alzheimer’s disease and vascular cognitive impairment.

PMID:41139170 | DOI:10.1007/s00330-025-12064-4

Eur Arch Paediatr Dent. 2025 Oct 25. doi: 10.1007/s40368-025-01126-2. Online ahead of print.

ABSTRACT

PURPOSE: This umbrella review aims to summarize the overall pooled effect sizes to statistically provide a clear and measurable conclusion about the association between passive smoking and oral health outcomes among children.

METHODS: MEDLINE/PubMed, Embase, Scopus, Science Direct, and Cochrane Database of Systematic Reviews were searched to retrieve studies. An assessment of primary study overlap was also performed. Furthermore, upon summarizing the effect sizes from included studies, a meta-analysis was also performed.

RESULTS: Out of 537 retrieved records, a total of 12 studies were included in this review. Among the primary studies reported by the systematic review (SR) and/or systematic reviews and meta-analyses (SRMAs) (n = 12), over 50% were distinct. The most common exposure to second-hand smoke was from parental or household smoke. Meta-analysis was only performed for dental caries and found that the pooled effect size was 1.53 [1.39, 1.68] at 95% CI, indicating overall statistical significance (p < 0.01).

CONCLUSION: The review concludes that there exists a significant association between passive smoking and oral health outcomes in children and emphasizes the urgent need to mitigate exposure to passive smoking and its detrimental impact on pediatric oral health.

PMID:41139162 | DOI:10.1007/s40368-025-01126-2

Ann Med. 2025 Dec;57(1):2578427. doi: 10.1080/07853890.2025.2578427. Epub 2025 Oct 25.

ABSTRACT

BACKGROUND: Age-related muscle mass decline, an important component of sarcopenia, is associated with adverse outcomes in older adults. This study aims to develop an objective method to describe muscle mass from a pathological perspective and to investigate the relationship between aging and muscle mass decline in hip fracture patients.

METHODS: This study retrospectively analysed 120 patients who sustained hip fractures between June 2021 and June 2024, including 71 females and 49 males with a mean age of 74.03 ± 16.67 years. The gluteus maximus muscle tissue was collected during surgery and subjected to histological examination. Muscle proportions were quantitatively analysed using Adobe Photoshop software. The relationship between age and muscle mass was assessed using restricted cubic splines (RCSs) with five knots at specified age percentiles to model the non-linear association.

RESULTS: A significant decline in muscle mass with increasing age, particularly after 75 years in hip fracture patients. Muscle proportions were found to decrease sharply between the ages of 75 and 79, marking a critical period for muscle loss. The study also identified 61 years as the starting point of noticeable muscle mass decline, with further accelerated loss occurring beyond 75 years. Gender differences in the rate of muscle mass decline were not statistically significant.

CONCLUSIONS: Age-related muscle mass decline is evident in hip fracture patients, with accelerated decreases occurring at specific age intervals. These findings highlight the importance of early monitoring and targeted preventive measures to mitigate adverse outcomes related to muscle loss.

PMID:41139121 | DOI:10.1080/07853890.2025.2578427

J Gynecol Obstet Hum Reprod. 2025 Oct 23:103058. doi: 10.1016/j.jogoh.2025.103058. Online ahead of print.

ABSTRACT

INTRODUCTION: To describe the effects of maternal COVID-19 on the incidence of small for gestational age (SGA) newborns and other pregnancy outcomes according to disease severity and trimester of infection.

MATERIAL AND METHODS: This was a prospective cohort study conducted at Vall d’Hebron University Hospital between March 2020 and June 2023 which included 404 consecutive single pregnancies with SARS-CoV-2 infection classified by severity and trimester of infection and a reference group of 404 consecutive single pregnancies with no suspicion of SARS-CoV-2 infection. The primary outcome was the incidence of SGA newborns. Secondary outcomes included other adverse perinatal and neonatal outcomes.

RESULTS: The rate of SGA newborns was higher in the COVID-19 group, with an adjusted relative risk of 1.60 (95% CI, 1.03-2.48). The risk was particularly elevated in severe cases and when infection occurred during the first trimester. No association was found between COVID-19 and preeclampsia or spontaneous preterm birth. COVID-19 cases showed a higher risk of iatrogenic preterm birth and maternal intensive care unit admission, particularly in severe cases during the third trimester. When analysed by severity and trimester, adverse neonatal outcomes were more frequent in severe cases and in third trimester.

DISCUSSION: Pregnancies affected by COVID-19, especially severe cases and first-trimester infections, were associated with a 60% increased risk of small for gestational age newborns and also raises the risk of iatrogenic preterm delivery, adverse neonatal outcomes, and maternal intensive care unit admission, particularly in severe cases or third-trimester infections.

CONCLUSION: Healthcare providers should remain vigilant about the risk of adverse pregnancy outcomes in severe cases of COVID19.

PMID:41139067 | DOI:10.1016/j.jogoh.2025.103058

Environ Res. 2025 Oct 23:123188. doi: 10.1016/j.envres.2025.123188. Online ahead of print.

ABSTRACT

Although environmental pollutants are known to affect the immune system, the impact of chemical mixtures on adolescent immune function remains understudied. Adolescence is a critical period for immune maturation, and disruptions during this stage may have implications for long-term health. Leukocytes, key components of the immune system, serve as indicators of immune status, with altered levels reflecting potential inflammation or immunosuppression. The present study examined the associations of 14 chemical exposure biomarkers measured in blood with counts of total leukocytes and leukocyte subtypes in 980 adolescents (13-16 years old) from the Flemish Environment and Health Studies 2012-2020 (FLEHS III and IV). The exposure biomarkers included 5 metals, 3 chlorinated pesticides, and 6 polychlorinated biphenyls (PCBs). We used four different statistical approaches: multiple linear regression, elastic net, Bayesian model averaging, and Bayesian kernel machine regression. Total leukocyte and neutrophil counts were negatively associated with PCBs and manganese (Mn), and positively associated with copper (Cu), whereas lymphocyte count was negatively associated with thallium (Tl). The neutrophil-lymphocyte ratio (NLR) was also negatively associated with Mn. An analysis excluding smokers additionally showed that higher cadmium (Cd) concentrations were associated with lower leukocyte count. Our study suggests immunosuppressive effects of PCBs, non-essentials metals Tl and Cd, and the essential metal Mn. Due to the cross-sectional design, we cannot rule out the possibility of reverse causation. The current study provides epidemiological evidence that exposure to metals and PCBs may have adverse effects on the immune system at concentrations detected in a general population of adolescents.

PMID:41139052 | DOI:10.1016/j.envres.2025.123188

J Pain Symptom Manage. 2025 Oct 23:S0885-3924(25)00897-8. doi: 10.1016/j.jpainsymman.2025.10.007. Online ahead of print.

ABSTRACT

CONTEXT: Peaceful acceptance of illness is associated with lower psychological distress and increased engagement in advance care planning among adults with advanced cancer. Limited data exist on factors influencing illness acceptance in older adults.

OBJECTIVES: To examine patient, caregiver, and oncologist characteristics associated with peaceful acceptance of illness in older adults with advanced cancer.

METHODS: A secondary analysis of a cluster-randomized trial evaluating the impact of geriatric assessment (GA) on cancer care in community oncology practices (NCT02107443). Participants included 333 patient-caregiver dyads. Patients were aged ≥70 years, had incurable stage III/IV solid tumors or lymphoma, and ≥1 GA impairment. Peaceful acceptance of illness was measured using the 5-item PEACE scale (range 5-20; higher scores indicate greater acceptance). Multivariable linear regression examined associations between PEACE scores and patient (e.g., GA impairments), caregiver (e.g., education), and oncologist factors (e.g., confidence).

RESULTS: The mean (standard deviation, SD) age was 76.8 (5.4) years for patients and 66.6 (12.1) years for caregivers. Common cancers included lung (27%), gastrointestinal (26%), and genitourinary (16%). Mean (SD) PEACE score was 17.4 (2.5), indicating high illness acceptance. Lower acceptance was associated with psychological impairment (b=-0.92; 95% CI, -1.56 to -0.29), shorter patient-estimated life expectancy (b=-1.06; 95% CI, -2.06 to -0.06), and caregiver education ≤high school (b=0.90; 95% CI, 0.32 to 1.49). No oncologist factors were significantly associated.

CONCLUSION: Patient psychological health, perceived prognosis, and caregiver education were linked to PEACE. Triadic interventions addressing these factors may enhance end-of-life care for older adults with advanced cancer.

PMID:41139045 | DOI:10.1016/j.jpainsymman.2025.10.007

Can J Cardiol. 2025 Oct 23:S0828-282X(25)01275-9. doi: 10.1016/j.cjca.2025.10.018. Online ahead of print.

ABSTRACT

BACKGROUND: Ablation procedures for atrial fibrillation (AF), including catheter (CA) and surgical ablation, are effective rhythm control therapies. The current study is a Bayesian network meta-analysis evaluating randomized evidence on the invasive treatment of AF, focusing on freedom from atrial tachyarrhythmias (ATA), while evaluating the potential trade-off in morbidity and mortality.

METHODS: This study was registered in PROSPERO (CRD42025632171). Randomized controlled trials (RCTs) were included comparing any of the four treatments; CA, isolated thoracoscopic, hybrid thoracoscopic ablation, and the Convergent procedure. Primary outcome was freedom from ATA at 12-months. Secondary outcomes were mortality, stroke, and bleeding. A Bayesian network meta-analysis was performed. The combined effects of the primary and secondary outcomes were studied in a bivariate analysis. Treatments were ranked and their effects were summarized using surface under the cumulative ranking curves (SUCRAs).

RESULTS: Ten RCTs were included in the analysis (n=877 patients, predominantly persistent AF). Using CA as a reference, the pooled network ORs for freedom from ATA for hybrid thoracoscopic, isolated thoracoscopic, and Convergent were 4.95 (95%CrI 2.16-13.46), 2.23 (95%CrI 1.23-4.48), and 2.23 (95%CrI 0.90-6.69), with SUCRAs for hybrid thoracoscopic, isolated thoracoscopic, Convergent, and CA of 95.5%, 50.8%, 52.1%, and 1.5%, respectively. No increase in periprocedural morbidity or mortality was observed. Results were robust across various sensitivity analyses.

CONCLUSION: In this Bayesian network meta-analysis, consisting exclusively of randomized data, surgical ablation in general, but hybrid ablation in particular, provides superior outcome in terms one-year-freedom from ATA. Both CA and surgical procedures are characterized by a favorable safety profile.

PMID:41139022 | DOI:10.1016/j.cjca.2025.10.018

J Shoulder Elbow Surg. 2025 Oct 23:S1058-2746(25)00753-0. doi: 10.1016/j.jse.2025.09.008. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to determine whether Computed Tomography Hounsfield Units (CTHU) are an independent predictor of proximal humerus fracture fixation failure following open reduction and internal fixation (ORIF). We hypothesize that CTHU of the glenoid vault <160 Hounsfield Units (HU) would be associated with a higher rate of failure of ORIF and need for subsequent revision to arthroplasty.

MATERIALS AND METHODS: A retrospective cohort study was performed at a single academic center, including patients who sustained a displaced proximal humerus fracture treated with ORIF using locking plates over a twenty-year period. A minimum follow-up of 6 months was required. Exclusion criteria included concomitant glenoid fractures, humeral shaft fractures, primary bone malignancies, metastatic disease, or lack of preoperative CT scan. CTHU were measured at four distinct regions with the glenoid vault to assess bone density. Patients were categorized into those requiring subsequent revision to arthroplasty and those who did not. Statistical analyses were performed using standard tests for categorical and continuous variables, with significance set at p<0.05.

RESULTS: 135 patients were identified with 95 patients who successfully underwent ORIF and 40 patients who required revision to arthroplasty. Patients who required revision to arthroplasty had lower mean CTHU compared to those without revision (110.9±42.6 vs. 170.5±45.9, p<0.001). Patients with 2-part (166.9±44.9 vs 113.9±43.3, p<0.0001) and 3-part (175.7+47.3 vs 118.4+ 54.0) proximal humerus fractures who underwent revision arthroplasty had significantly decreased mean CTHU compared to patients who did not undergo revision. CTHU of the glenoid vault <160 HU significantly increased the risk of revision to arthroplasty after ORIF (p<0.001, RR = 3.00, 95% CI [1.28, 7.02]). Within the failed cohort who required revision to arthroplasty, there was no difference in CTHU between those who failed within 6 months or after 6 months from ORIF (92.9±37.7 vs. 134.3±50.9, p=0.057); there was a significant difference in revision rates of 2-part proximal humerus fractures with CTHU <160 compared to those with CTHU > 160 (p=0.004). CTHU of the glenoid vault were found to be positively correlated to the deltoid tuberosity index (R=0.72, p<0.001) and combined cortical thickness of the humerus (R=0.21, p=0.02).

DISCUSSION: CTHU of the glenoid vault <160 HU is an independent risk factor for ORIF failure in patients with displaced proximal humerus fractures, leading to a higher likelihood of requiring revision to arthroplasty. This opportunistic measurement CTHU can assist surgeons in informed decision-making between ORIF and primary arthroplasty in the management of these fractures.

LEVEL OF EVIDENCED: Level III; Retrospective Cohort Comparison; Prognosis Study.

PMID:41139006 | DOI:10.1016/j.jse.2025.09.008

J Inj Violence Res. 2025 Mar 16;17(1). Online ahead of print.

ABSTRACT

BACKGROUND: Fireworks are widely used worldwide for their visual and auditory appeal. However, they pose significant safety risks, particularly to children and young adults, many of whom sustain serious injuries from exposure to these pyrotechnic devices. Given the preventable nature of such incidents and their associated challenges, this study aims to examine the epidemiological impact of injuries caused by fireworks during the Chaharshanbeh Soori ceremony in Fars Province.

METHODS: This cross-sectional study included all individuals who experienced injuries between March 6, 2022, and April 4, 2022. Data were collected by emergency technicians affiliated with Shiraz University of Medical Sciences. Statistical analyses included descriptive statistics (mean ± standard deviation [SD] and frequency [%]) and analytical methods, specifically the chi-square test.

RESULTS: A total of 79 individuals were injured, with a mean age of 19.4 ± 11.5 years. The majority of the injured were male (73, 92.4%). Most injuries (66, 83.5%) occurred unintentionally, and 9 patients (11.4%) reported headache as a symptom, while 7 patients (8.9%) experienced visual disorders. Among those who received treatment, eye injuries were the most common (17, 26.2%). A significant difference was observed in recovery based on the injured body part; hand injuries had the highest recovery rate (6, 42.9%), compared to other injuries (p less than 0.029).

CONCLUSIONS: The findings indicate that fireworks-related accidents during the Chaharshanbeh Soori ceremony predominantly affect teenagers and young adults, often occurring unintentionally. Given the significant physical, financial, and long-term consequences of these injuries, this study’s results can inform policymakers in implementing preventive measures. Additionally, it highlights the need to raise awareness among the public and relevant authorities to ensure safer conduct of such ceremonies in the future.

PMID:41111445