Nevin Manimala

Pancreas. 2025 Feb 1;54(2):e130-e135. doi: 10.1097/MPA.0000000000002409. Epub 2024 Nov 13.

ABSTRACT

OBJECTIVES: This study aimed to identify the risk profile for postpancreatitis diabetes mellitus (PPDM) in children after a single acute pancreatitis (AP) episode and to investigate the association between episode severity and complications, length of stay (LOS), and intensive care unit (ICU) needs.

METHODS: This cross-sectional study used the Pediatric Health Information System database for patients ≤19 years old with index AP admissions (2011-2020). A query (2012-2021) was performed for diabetes mellitus (DM). Patients with prior DM or pancreatic surgery before AP or DM diagnoses were excluded.

RESULTS: Out of 12,822 patients with index AP admissions (median age, 13.4 years; 54% female), 686 (5.4%) developed PPDM, with 320 (2.5%) during and 366 (2.9%) at a later admission. The median time to PPDM was 1.9 months (interquartile range: 0-20.8 months). Patients with PPDM experienced extended LOS, heightened ICU needs, and increased complications such as sepsis, pancreatic necrosis, and cyst formation, along with higher rates of organ dysfunction and comorbidities.

CONCLUSIONS: Children face DM risks during or after AP episodes. Enhanced DM screening and close outpatient follow-up within 3 to 6 months post-discharge are recommended.

PMID:39928890 | DOI:10.1097/MPA.0000000000002409

Pancreas. 2025 Feb 1;54(2):e97-e100. doi: 10.1097/MPA.0000000000002399. Epub 2024 Aug 12.

ABSTRACT

BACKGROUND: Retrospective studies and large databases, such as the OneFlorida Clinical Research Consortium, rely on International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes to identify patients with specificity. This study aimed to determine if ICD-10 codes for CP are overutilized.

MATERIALS AND METHODS: Retrospective analysis was conducted for patients with ICD-10 codes K86.0 (alcohol-induced CP) and K86.1 (other CP) from February 2018 to February 2020. Data were extracted from the integrated electronic data repository. This study was approved by the institutional review board. The diagnosis of CP was defined as either being made by a gastroenterologist, proven by biopsy, or having characteristic findings on cross-sectional imaging with appropriate symptoms.

RESULTS: Five hundred four (37%) out of the 1360 patients had no evidence of CP. When broken down by diagnosis code, 41 of 176 charts (23.3%) with K86.0 and 461 of 1184 charts (38.6%) with K86.1 had no evidence of CP. Two hundred ninety-nine of these patients had either a single episode of acute pancreatitis, recurrent acute pancreatitis, or episode of acute necrotizing pancreatitis. Of note, 81 patients had no identifiable abdominal pathology.

CONCLUSIONS: Although the OneFlorida database makes multicenter research more accessible, it does not replace labor-intensive chart review given the propensity for overdiagnosis.

PMID:39928887 | DOI:10.1097/MPA.0000000000002399

Pancreas. 2025 Feb 1;54(2):e82-e88. doi: 10.1097/MPA.0000000000002397. Epub 2024 Aug 12.

ABSTRACT

BACKGROUND: This systematic review assessed the volume and methodological quality of randomized controlled trials (RCTs) in relation to management of acute pancreatitis (AP).

MATERIALS AND METHODS: The PubMed, MEDLINE, and CENTRAL databases were systematically searched for RCTs published across 3 time periods: <1996 (P1), 1996-2008 (P2), and >2008 (P3). RCT quality was assessed using the Cochrane Risk of Bias (RoB) 2 tool and sample size recalculation, and for spin (interpretation of nonstatistically significant results as relevant, making the study appear to be positive).

RESULTS: Overall, 263 RCTs with 23,232 patients with AP were included. The average number of RCTs per year increased from 1.4, 6.0, to 10.6 in P1, P2, and P3, respectively. The RoB assessment showed low, some, and high concerns in overall RoB in 21%, 56%, and 24% of all RCTs. Selective reporting bias improved over time. Sample size calculation reporting significantly increased through the 3 time periods (17%, 38%, and 47%; P < 0.001). Spin was identified in 68 RCTs (26% of all RCTs).

CONCLUSION: The quantity and quality of published RCTs relating AP management has increased over time, however significant shortcomings of methodological quality persist. Significant improvements in the conduct and reporting of randomized trials in AP are required to improve the evidence base in this field.

PMID:39928886 | DOI:10.1097/MPA.0000000000002397

Proc Natl Acad Sci U S A. 2025 Feb 18;122(7):e2423915122. doi: 10.1073/pnas.2423915122. Epub 2025 Feb 10.

NO ABSTRACT

PMID:39928877 | DOI:10.1073/pnas.2423915122

J Proteome Res. 2025 Feb 10. doi: 10.1021/acs.jproteome.4c00556. Online ahead of print.

ABSTRACT

ProteoArk is a web-based tool that offers a range of computational pipelines for comprehensive analysis and visualization of mass spectrometry-based proteomics data. The application comprises four primary sections designed to address various aspects of mass spectrometry data analysis in a single platform, including label-free and labeled samples (SILAC/iTRAQ/TMT), differential expression analysis, and data visualization. ProteoArk supports postprocessing of Proteome Discoverer, MaxQuant, and MSFragger search results. The tool also includes functional enrichment analyses such as gene ontology, protein-protein interactions, pathway analysis, and differential expression analysis, which incorporate various statistical tests. By streamlining workflows and developing user-friendly interfaces, we created a robust and accessible solution for users with basic bioinformatics skills in proteomic data analysis. Users can easily create manuscript-ready figures with a single click, including principal component analysis, heatmaps (K-means and hierarchical), MA plots, volcano plots, and circular bar plots. ProteoArk is developed using the Django framework and is freely available for users [https://ciods.in/proteoark/]. Users can also download and run the standalone version of ProteoArk using Docker as described in the instructions [https://ciods.in/proteoark/dockerpage]. The application code, input data, and documentation are available online at https://github.com/ArokiaRex/proteoark. A tutorial video is available on YouTube: https://www.youtube.com/watch?v=WFMKAZ9Slq4&ab_channel=RexD.A.B.

PMID:39928856 | DOI:10.1021/acs.jproteome.4c00556

Invest Ophthalmol Vis Sci. 2025 Feb 3;66(2):26. doi: 10.1167/iovs.66.2.26.

ABSTRACT

PURPOSE: Both genetic and environmental factors contribute to the development of Fuchs’ endothelial corneal dystrophy (FECD), the most common indication for corneal transplantation in the United States. Prior studies have suggested an association of height, weight, or body mass index (BMI) with FECD. We examined the association between anthropometric measures and incident FECD in the Women’s Health Initiative Observational Study (WHI-OS) of postmenopausal women (n = 22,983).

METHODS: Medicare Part B claims data from the WHI-OS baseline visit (1993-1998) to 2019 were used to identify incident cases of FECD. At baseline and follow-up year 3, weight, height, waist circumference (WC), and hip circumference were measured. At baseline, women were asked to recall their historic weight at ages 18, 35, and 50 years. At follow-up years 1 and 4 to 8, the women were asked to self-report their weight. Height and weight were used to calculate BMI at each time point. Adjusted hazard ratios (HRs), 95% confidence intervals (CI), and p for trend for incident FECD were estimated by measures of historic BMI, baseline anthropometrics measures, and anthropometric measures that incorporated more than one baseline visit (time-varying). Anthropometric measures were parameterized as continuous and categorical in analyses.

RESULTS: There were 1399 incident FECD cases with an annualized incidence rate of 5.06 per 1000 person-years (95% CI = 4.80-5.33) over 276,443 person-years of follow-up. No statistically significant associations were observed between baseline height and risk of FECD. Women with baseline BMIs ≥35 (obesity II) compared to <25 kg/m2 (normal weight or underweight) had lower risk of incident FECD (HR = 0.68, 95% CI = 0.53-0.88) with a P value = 0.0373 for an ordinal trend analysis across BMI categories. Significant inverse associations were observed for continuous measures of WC (HR = 0.97, 95% CI = 0.95-0.99 per 5 cm increase) and waist-to-hip ratio (WHR; HR = 0.92, 95% CI = 0.86-0.99 per 0.1 unit increase). No statistically significant associations were observed for time-varying BMI, but time-varying WC and WHR has statistically significant inverse associations with risk for FECD (data not shown).

CONCLUSIONS: In this cohort of postmenopausal women, BMI, WC, and WHR were inversely associated with incident FECD. These findings generally support the potential role of anthropometric measures, particularly those indicative of abdominal obesity in FECD susceptibility in women.

PMID:39928313 | DOI:10.1167/iovs.66.2.26

JAMA. 2025 Feb 10. doi: 10.1001/jama.2024.27853. Online ahead of print.

ABSTRACT

IMPORTANCE: Given the widespread use of medical imaging, evaluating the effectiveness of interventions to improve appropriateness is crucial for optimizing health care resources and patient outcomes.

OBJECTIVE: To assess the effects of implementing a clinical decision support system (CDSS), the European Society of Radiology iGuide, on the appropriateness of the medical imaging ordering behavior of physicians.

DESIGN AND SETTING: A cluster randomized clinical trial with 26 departments at 3 German university hospitals acting as clusters, incorporating a before and after discontinued design. All imaging requests originating from physicians in the participating departments over a 2.5-year period were included (between December 2021 and June 2024).

INTERVENTIONS: All departments started without a CDSS and required structured clinical indication data entry and tracking of requested imaging. After randomization, 13 clusters (departments at hospitals) received the CDSS intervention (intervention clusters) and 13 clusters did not (control clusters). The CDSS intervention provided ordering physicians with information as to whether their imaging requests were appropriate, appropriate under certain conditions, or inappropriate; in addition, alternative diagnostic tests, including the corresponding appropriateness score, were suggested by the CDSS, after which physicians could choose to modify their imaging requests.

MAIN OUTCOMES AND MEASURES: The primary outcome measure was the proportion of inappropriate imaging requests made per department. A difference-in-differences analysis was used to investigate changes in the proportion of inappropriate imaging requests between departments with vs those without the CDSS.

RESULTS: A total of 65 764 imaging requests were scored using the CDSS; 50.1% of imaging requests were for female patients and the mean patient age was 64 years (SD, 17.1 years). Prior to implementation of the CDSS, there were 21 625 imaging requests from the control clusters, 1367 (6.3%) of which were categorized as inappropriate; and there were 13 338 imaging requests from the intervention clusters, 1007 (7.6%) of which were categorized as inappropriate. After implementation of the CDSS, there were 10 055 imaging requests from the control clusters, 518 (5.2%) of which were categorized as inappropriate; and there were 7206 imaging requests from the intervention clusters, 461 (6.4%) of which were categorized as inappropriate. The intervention clusters showed a similar reduction (mean difference, -0.5% [99% CI, -2.4% to 0.4%]) in inappropriate imaging requests compared with the control clusters (mean difference, -1.8% [99% CI, -4.3% to -0.4%]) and there was a difference-in-differences value of 1.3 percentage points (99% CI, -2.0 to 1.8 percentage points; P = .69), which was not statistically significant.

CONCLUSIONS AND RELEVANCE: The CDSS did not reduce the number of inappropriate imaging requests ordered by physicians in academic hospital settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05490290.

PMID:39928308 | DOI:10.1001/jama.2024.27853

JAMA Pediatr. 2025 Feb 10. doi: 10.1001/jamapediatrics.2024.6192. Online ahead of print.

ABSTRACT

IMPORTANCE: Transition to adult care is a challenging and complex process for youth and emerging adults with chronic health and/or mental health conditions. Patient navigation has been proposed to improve care during transition, but previous studies have used single disease cohorts with a nonrandomized design.

OBJECTIVE: To compare the effectiveness of a patient navigator service to reduce emergency department (ED) use among adolescents and emerging adults with chronic health and/or mental health conditions undergoing transition to adult-oriented health care.

DESIGN, SETTING, AND PARTICIPANTS: This was a pragmatic, parallel-group, nonblinded randomized clinical trial design. Patients were followed up for a minimum 12 months and maximum 24 months after enrollment. The setting was the Canadian province of Alberta, with a population of 4.3 million inhabitants, having 3 tertiary care pediatric hospitals serving the entire population with universal health coverage. Participants included youth aged 16 to 21 years, followed up within a diverse array of chronic care clinics, expected to be transferred to adult care within 12 months, residing in Alberta, Canada.

INTERVENTIONS: A 1:1 allocation to either access to a personalized navigator, an experienced social worker within the health services environment, or usual care, for up to 24 months after randomization.

MAIN OUTCOMES AND MEASURES: All-cause ED visit rate while under observation.

RESULTS: A total of 335 participants were randomized over a period of 45 months, 164 (49.0%) to the intervention arm and 171 (51.0%) to usual care. After 1 patient withdrew, 334 participants (usual care: mean [SD] age, 17.8 [0.7] years; 99 female [57.9%]; intervention: mean [SD] age, 17.7 [0.6] years; 81 male [49.7%]) were included in the final data analysis. Among the participants, 131 (39.2%) resided in a rural location, and 126 (37.7%) had a self-reported mental health comorbidity during baseline assessment. We observed significant effect modification in the relationship between intervention and ED visits based on mental health comorbidity. Among those with a self-reported mental health condition, ED visit rates were lower in those with access to the navigator, but the association was not significant (adjusted incidence rate ratio [IRR] 0.75; 95% CI, 0.47-1.19). Among those with no mental health comorbidity, the corresponding adjusted IRR was 1.45 (95% CI, 0.95-2.20).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the navigator intervention was not associated with a significant reduction in ED visits among youth with chronic health conditions transitioning to adult care. The study did not accrue sufficient sample size to demonstrate a significant difference between groups should it exist.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03342495.

PMID:39928304 | DOI:10.1001/jamapediatrics.2024.6192

Oral Dis. 2025 Feb 10. doi: 10.1111/odi.15260. Online ahead of print.

ABSTRACT

BACKGROUND: Despite evidence suggesting a potential correlation between intestinal diseases such as inflammatory bowel diseases (IBD) and colorectal cancer (CRC) with periodontitis (PD), there is a lack of comprehensive systematic reviews and meta-analyses to consolidate these findings.

METHODS: This study investigates studies published until December 31, 2023, in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. The statistical analysis was conducted using Review Manager Version 5.4, calculating odds ratios (OR) and 95% confidence intervals (CI) based on the selected research papers, utilizing a fixed-effects model.

RESULTS: It demonstrates a significant increase in the risk of PD among patients with IBD, as indicated by an OR of 2.11 (95% CI: 1.80-2.49). Further analysis revealed elevated risks of PD for both Crohn’s disease (CD) and ulcerative colitis (UC), with respective ORs of 1.96 (95% CI: 1.69-2.26) and 2.14 (95% CI: 1.85-2.47). A direct association was observed between CRC and PD, suggesting a 20% higher risk of PD in patients with CRC (OR = 1.20, 95% CI: 1.06-1.36).

CONCLUSION: Our meta-analysis highlights the potential role of PD in managing systemic conditions like IBD and CRC.

PMID:39928298 | DOI:10.1111/odi.15260

Spine (Phila Pa 1976). 2025 Mar 1;50(5):333-338. doi: 10.1097/BRS.0000000000005121. Epub 2024 Aug 13.

ABSTRACT

STUDY DESIGN: Prospective longitudinal comparative cohort.

OBJECTIVES: To determine if the use of predictive hemodynamic monitoring (PHM) during elective multi-level posterior instrumented spine fusions decreases episodes of intraoperative hypotension (IOH) and complications.

BACKGROUND: A recent study showed an association between complications and duration of IOH in patients undergoing multi-level spine fusions. Whether the use of PHM to maintain hemodynamic stability intraoperatively decreases postoperative complications has not been evaluated.

METHODS: Adults undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring were identified and stratified into those in which predictive hemodynamic monitoring (PHM) was used and those in which it was not. Number of minutes of hypotension (MAP <65 mm Hg) and hypertension (MAP ≥100 mm Hg), volume of fluids, blood products and vasopressors administered intraoperatively and within the first 4 hours postoperatively as well as the number and type of postoperative complications were collected.

RESULTS: The 47 cases in the PHM group and 70 in the non-PHM group had similar demographic and operative characteristics. A shorter duration of IOH was seen in the PHM group (8.13 min) compared with the non-PHM group (13.28 min, P=0.029); and a shorter duration of intraoperative hypertension seen in the PHM group (0.46 min) compared with the non-PHM group (1.38 min, P=0.032). There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs. 13%, P=0.027), postoperative nausea and vomiting (0 vs. 14%, P=0.004) and postoperative cognitive dysfunction (6% vs. 19%, P=0.049) compared with the non-PHM group. There was also a statistically significant shorter length of hospitalization in the PHM (4.62 d) compared with the non-PHM group (5.99 d, P=0.017).

CONCLUSION: Predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intraoperative hypotension, a lower prevalence of complications, and a decreased hospital stay in multi-level spinal fusion surgery.

PMID:39928297 | DOI:10.1097/BRS.0000000000005121