Nevin Manimala

Aust N Z J Obstet Gynaecol. 2025 Jan 26. doi: 10.1111/ajo.13940. Online ahead of print.

ABSTRACT

BACKGROUND: Modern assisted reproductive technology (ART), including pre-implantation genetic testing for aneuploidy (PGT-A), has opened new avenues in understanding early embryonic events and has simultaneously raised questions about the impact of ART itself on sex ratios.

AIMS: The primary aim was to investigate whether patient demographic characteristics, ovarian stimulation protocols or laboratory characteristics in ART influence sex ratios. The secondary aim was to relate the blastocyst sex ratio (BSR) to the corresponding secondary sex ratio (SSR) in our patient cohort.

MATERIALS AND METHODS: We conducted a retrospective single-centre cohort study on consecutive PGT-A cycles from January 2019 to February 2022. We analysed demographic data, stimulation protocols, laboratory characteristics and pregnancy outcomes.

RESULTS: The euploidy rate was 45.1% (2608/5777), BSR 1.07 and euploid BSR 1.03. There was no statistical difference in the ploidy status of XX and XY blastocysts and on multivariate logistic regression analysis, there was no association between euploidy and BSR or any other variables examined, including female age and stimulation protocol. The SSR was 1.02 (1294 embryo transfers) with no statistical difference in biochemical pregnancy (p = 0.41), clinical pregnancy (p = 0.56), miscarriage (p = 0.65) or live birth rates (p = 0.40) based on embryo sex.

CONCLUSIONS: Our study indicates that the euploid BSR is not skewed by sex, and there is no relationship between BSR and euploidy, patient characteristics or stimulation protocols. Pregnancy outcomes did not vary by sex, and the SSR was consistent with the SSR of the general Australian population at birth.

PMID:39865443 | DOI:10.1111/ajo.13940

Cancer. 2025 Feb 1;131(3):e35734. doi: 10.1002/cncr.35734.

ABSTRACT

BACKGROUND: Breast cancer screening (BCS) inequities are evident at national and local levels, and many health systems want to address these inequities, but may lack data about contributing factors. The objective of this study was to inform health system interventions through an exploratory analysis of potential multilevel contributors to BCS inequities using health system data.

METHODS: The authors conducted a cross-sectional analysis within a large academic health system including 19,774 individuals who identified as Black (n = 1445) or White (n = 18,329) race and were eligible for BCS. They evaluated individual-level, provider-level, and clinic-level factors. They conducted logistic regression and Blinder-Oaxaca (BO) decomposition analyses to quantitatively estimate the contribution of factors to the mean difference in BCS outcomes between the two racialized groups. They calculated average marginal effects (AME) for the logistic regression models representing the estimated additive probability of receiving BCS in the Black versus White group.

RESULTS: BCS was completed in 63.7% of Black and 71.7% of White individuals (AME, -0.08; 95% confidence interval (CI), -0.10 to -0.04; p < .001). In the BO decomposition, observed factors explained 13.3% difference in BCS. Lower patient portal use among Black versus White patients had the greatest estimated contribution to the BCS inequity (4.6 percentage points; 95% CI, 3.0-6.2).

CONCLUSION: Racialized group differences in patient portal use had the greatest estimated contribution to the explained difference in BCS between Black and White individuals. Patient portal use promotion could be considered as a part of multifaceted health system efforts to address BCS inequities.

PMID:39865423 | DOI:10.1002/cncr.35734

Pharmacol Res Perspect. 2025 Feb;13(1):e70066. doi: 10.1002/prp2.70066.

ABSTRACT

Doxorubicin (DOXO) has long been used clinically and remains a key drug in cancer therapy. DOXO-induced cardiomyopathy (DICM) is a chronic and fatal complication that severely limits the use of DOXO. However, there are very few therapeutic agents for DICM, and there is an urgent need to identify those that can be used for a larger number of patients. The most likely pathogenic mechanism of DICM is the involvement of reactive oxygen species (ROS) and promotion of cell death. In this study, we investigated the efficacy and mechanism of action of edaravone (EDA), a known radical scavenger in DICM. Two methods of EDA administration were employed: daily and weekly. Our results showed that the daily administration group had prolonged survival periods and preserved the left ventricular ejection fraction in DICM mice. In contrast, in the weekly treatment group, slight improvements were observed in these indicators compared with those in DICM mice; however, none of them were statistically significant. These results show that the daily administration group had a higher efficacy than the weekly administration group. Gene-expression results showed that Nrf2 and its related genes were upregulated in the daily group but not in the weekly group. Based on these results, we hypothesized that the Sirt1/Nrf2/HO-1 and ABCB4 pathways were involved in EDA. However, there is limited evidence that EDA is effective against DICM. The findings obtained herein bolster the evidence in DICM by demonstrating prolonged survival and continued preservation of cardiac function and proposing a possible mechanism.

PMID:39865410 | DOI:10.1002/prp2.70066

J Ren Care. 2025 Mar;51(1):e70003. doi: 10.1111/jorc.70003.

ABSTRACT

BACKGROUND: Uremic pruritus is a quite common condition among patients with chronic kidney disease. Symptom severity and patterns are variable.

AIM: To assess how nurses in the field of nephrology perceive the issue of uremic pruritus in dialysis patients and the relevance of this condition.

DESIGN: A qualitative survey-based study.

PARTICIPANTS: Nurses working in the field of nephrology.

METHODS: Nurses were administered an online survey with a 10-item survey (5 on socio-demographics, 5 specific to nephrology). Responses were reported in descriptive form and response rates.

RESULTS: The study involved 185 nurses working in the field of nephrology, most of which were over the age of 40, and 39% had over 20 years of experience. Most perceived that uremic pruritus has decreased over the years thanks to better dialysis methods and that it is currently independent of the type of dialysis. Fifty-two percent estimate pruritus affects half or more of patients, and 47.6% that it affects only a minority. 75% estimate moderate-to-severe uremic pruritus involves between 1 and 3 cases every 10 patients (40.5% estimating ≤3/10 patients and 34.6% ≤1/10 patients), and 25% it affects at least half of patients. 41% estimate that more than half the patients do not find relief from PU to prevent it from impairing their quality of life.

CONCLUSIONS: The results highlight a large divergence in the perception of uremic pruritus among nurses. While this evidence the need for greater awareness on uremic pruritus, this also suggests a privileged role for nurses in detecting uremic pruritus occurrence and properly referring patients to nephrologist.

PMID:39865403 | DOI:10.1111/jorc.70003

Cancer Med. 2025 Feb;14(3):e70582. doi: 10.1002/cam4.70582.

ABSTRACT

INTRODUCTION: Immune checkpoint inhibitors (ICI) have improved the therapeutic arsenal in outpatient oncology care; however, data on necessity of hospitalizations associated with immune-related adverse events (irAEs) are scarce. Here, we characterized hospitalizations of patients undergoing ICI, from the prospective cohort study of the immune cooperative oncology group (ICOG) Hannover.

METHODS: Between 12/2019 and 06/2022, 237 patients were included. Clinical data and characteristics of ICI were collected during a 6-month observation period after the initiation of therapy. Descriptive statistics and Kaplan-Meier statistics were administered.

RESULTS: During the observation period, 30/237 patients were hospitalized (HA(+)). Most common underlying tumor entities were malignant melanoma (59.5%), renal cell carcinoma (13.1%), and nonsmall-cell lung carcinoma (12.7%). HA(+) patients exhibited an increased rate of pulmonary and cerebral metastases. We observed a significantly higher hospitalization rate during dual ICI with Nivolumab and Ipilimumab (p = 0.001). The predominant irAEs for hospitalization were colitis (26.7%), followed by hypophysitis (13.3%), leading to a median hospitalization of 7 (1-34) days. Interdisciplinary consultations were frequent, especially to gastroenterology (46.7%) and neurology (26.7%). Although a trend toward a prolonged overall survival in the HA(+) subgroup was identified, no statistically significant differences were found.

DISCUSSION: The hospitalization rate of 12.6% is comparable to rates reported in previous studies. There was a disproportionate admission of patients with immune-related colitis and hypophysitis compared to the prevalence described under ICI. We observed a high need for interdisciplinary consultations in line with the heterogeneity of immune-mediated side effects. Compared to non-hospitalized patients, there was no survival disadvantage in the HA(+) cohort.

CONCLUSION: With a relatively low hospitalization rate, short length of stay, and good clinical outcome, our data support the outpatient nature of ICI. The findings underscore the importance of interdisciplinary collaboration and vigilant monitoring of irAEs to ensure timely recognition and management.

PMID:39865401 | DOI:10.1002/cam4.70582

Orthod Craniofac Res. 2025 Jan 25. doi: 10.1111/ocr.12901. Online ahead of print.

ABSTRACT

OBJECTIVE: Primary aim was to analyse dentoalveolar and skeletal effects induced by an anterior open bite (AOB) treatment protocol for intrusion of maxillary buccal segment. Secondary aim was to investigate whether a subsequent change occurred in hyoid position.

MATERIALS AND METHODS: Study group included 28 non-growing subjects treated in academic setting for correction of AOB. All patients received same appliance that included bilateral acrylic bite-blocks covering posterior dentition. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants. Lateral cephalograms taken at pre-treatment (T0) and after intrusion (T1) were analysed using NemoCeph software. Eight skeletal, 9 dental, 6 soft tissue and 5 hyoid parameters were measured and evaluated statistically.

RESULTS: Mean open bite was -3.2 ± 2.1 mm at T0. T1-T0 duration was 9.6 ± 1.9 months. Increase in SNB (1.1° ± 2.1°) and the decrease in ANB (-1.1° ± 1.3°), Y-axis (-0.5° ± 3.5°), SN-GoGn (-2.0° ± -2.5°) and lower facial height (-1.4 ± 2.1 mm) were significant, indicating mandibular counter-clockwise rotation. Overjet and open bite decreased significantly (-1.8 ± 2.3 mm and 4.2 ± 2.1 mm, respectively). Maxillary molars intruded (U6-PP: -3.1 ± 1.3 mm) and distalised (ΔU6-TVL: -1.5 ± 2.7 mm) significantly. Mean change in L6-MP was significant (0.9 ± 1.4 mm) showing mandibular molar eruption. Lower lip-true vertical line (TVL) showed significant forward movement of lower lip (-1.8 ± 2.3 mm). Mean changes in hyoid parameters were not significant.

CONCLUSION: Significant maxillary buccal segment intrusion was achieved in a relatively short period. AOB was corrected while facial profile and smile aesthetics were improved. Distalisation of maxillary molar suggests that intrusive force vector can be modified to achieve simultaneous intrusion and distalisation.

PMID:39865400 | DOI:10.1111/ocr.12901

J Ren Care. 2025 Mar;51(1):e70002. doi: 10.1111/jorc.70002.

ABSTRACT

BACKGROUND: Many people with kidney failure start and remain on in-centre haemodialysis treatment despite evidence of improved outcomes with home dialysis. To make an informed modality decision patients must receive frequent, high-quality modality education. This education is inconsistent in the in-centre haemodialysis setting, where patients spend the most time with nurses while receiving haemodialysis treatments.

OBJECTIVES: The aim of this study was to examine in-centre haemodialysis nurses’ perceptions around modality education for patients receiving in-centre haemodialysis using the COM-B model of behaviour change.

DESIGN: We used framework analysis as a research method, applying the COM-B model as a theoretical framework to understand nurses’ perceptions of modality education.

PARTICIPANTS: We interviewed 13 in-centre haemodialysis nurses in a single province in Canada.

APPROACH: We completed semi-structured interviews via Zoom, which ranged from 30 to 60 min.

FINDINGS: Participants reported knowledge deficits, lack of experience or exposure to other dialysis modalities, and lack of resources to support modality education practices. In-centre haemodialysis nurses reported some factors that enhanced modality education, including strong nurse-patient therapeutic relationships and previous experience in other dialysis modalities.

CONCLUSIONS: Nurses could have a role in modality education but had different views on what this role should be. Nurses faced barriers in modality education such as knowledge deficits, a lack of experience with home modalities, and limited patient teaching resources. Factors that favoured modality education were strong nurse-patient relationships and previous experience with other modalities.

PMID:39865379 | DOI:10.1111/jorc.70002

Clin Oral Implants Res. 2025 Jan 25. doi: 10.1111/clr.14405. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the treatment of peri-implant mucositis (PM) using a nonsurgical submarginal peri-implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.

METHODS: Fifty-six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6-month follow-up and to identify significant predictors of implant-site BOP through mixed generalized linear regression.

RESULTS: After 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4-42.3] vs. 48.7 [95% CI 46.5-51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant-sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).

CONCLUSIONS: NSPI + CHX showed better results compared to placebo in implant-sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM-treated patients.

PMID:39865359 | DOI:10.1111/clr.14405

Liver Int. 2025 Feb;45(2):e16240. doi: 10.1111/liv.16240.

ABSTRACT

BACKGROUND AND AIMS: The performance of non-invasive liver tests (NITs) is known to vary across settings and subgroups. We systematically evaluated whether the performance of three NITs in detecting advanced fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) varies with age, sex, body mass index (BMI), type 2 diabetes mellitus (T2DM) status or liver enzymes.

METHODS: Data from 586 adult LITMUS Metacohort participants with histologically characterised MASLD were included. The diagnostic performance of the Fibrosis-4 Index (FIB-4), enhanced liver fibrosis (ELF) and vibration-controlled transient elastography liver stiffness measurement (VCTE LSM) was evaluated. Performance was expressed as the area under the receiver operating characteristics curve (AUC). Thresholds for detecting advanced fibrosis (≥F3) were calculated for each NIT for fixed (high) sensitivity, specificity and predictive values.

RESULTS: Differences in AUC between all subgroups were small and statistically not significant, indicating comparable performance in detecting ≥F3, irrespective of these clinical factors. However, different thresholds were needed to achieve the same level of accuracy with each test. For example, for a fixed sensitivity and specificity, the thresholds for all three NITs were higher in patients with T2DM. Effects for sex, age and liver enzymes were less pronounced.

CONCLUSIONS: Performance of the selected NITs in detecting advanced liver fibrosis does not vary substantially with clinical characteristics. However, different thresholds have to be selected to achieve the same sensitivity, specificity and predictive values in the respective subgroups. Large prospective studies are called for to study NIT accuracy considering multiple patient characteristics.

PMID:39865358 | DOI:10.1111/liv.16240

Head Neck. 2025 Jan 24. doi: 10.1002/hed.28083. Online ahead of print.

ABSTRACT

BACKGROUND: To correlate between immunohistochemical expression of tumor-infiltrating lymphocytes (TILs), tumor-associated macrophages (TAMs), and natural killer (NK) cells with the AJCC 8th edition TNM staging system and other disease-modifying clinico-pathological variables.

METHODS: The representative histology sections of tumor invasive margin (IM) and tumor core (TC) were selected according to the International Immuno-Oncology Biomarker Working Group and were subjected to immunohistochemistry with antibodies for TILs (CD3, CD8, FOXP3), NK Cells (CD57), TAMs (CD68, CD163) and pan-leukocyte marker (CD45). Histo-immuno-density-intensity (HIDI) scoring was calculated as a product of the proportion and intensity of staining. Ordinal-ordinal and continuous-ordinal variables were correlated using Kendall’s tau-b (τb), and binary-ordinal variables were correlated using Rank-Biserial (r_rb) statistics.

RESULTS: A total of 111 patients were included in the study. None of the clinical and pathological parameters showed a strong correlation with any of the immune infiltrates including TNM staging.

CONCLUSION: We hypothesize an independent activity of tumor immunology in the disease prognosis.

TRIAL REGISTRATION: CTRI/2020/07/026335.

PMID:39865357 | DOI:10.1002/hed.28083