Nevin Manimala

BMC Surg. 2025 Aug 26;25(1):394. doi: 10.1186/s12893-025-02973-y.

ABSTRACT

OBJECTIVE: This study aims to explore the effects of prehabilitation strategies on the psychological state and glucose metabolism markers in patients undergoing laparoscopic sleeve gastrectomy (LSG).

METHODS: A total of 120 eligible patients undergoing elective LSG between January 2024 and December 2024 were enrolled in the study. They were randomly assigned to either the control group or the observation group, with 60 patients in each group. The control group received routine care interventions, while the observation group received prehabilitation strategies. The outcomes were compared between the two groups, including body mass index (BMI), body fat percentage (PBF), visceral fat area (VFA), waist-to-hip ratio (WHR), basal metabolic rate (BMR), glucose metabolism markers, psychological state, and incidence of postoperative complications, measured both one day before and six months after the intervention.

RESULTS: One day before the intervention, there were no significant differences between the two groups in BMI, PBF, VFA, WHR, and BMR (P > 0.05). However, six months after the intervention, the observation group showed significantly lower BMI, PBF, VFA, WHR, and BMR compared to the control group (P < 0.05). Furthermore, at six months post-surgery, the observation group had significantly lower HbA1c levels compared to the control group (P < 0.05), while the difference in fasting blood glucose (FBG) was not statistically significant (P > 0.05). Regarding psychological state, the observation group showed significantly lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) six months after the intervention (P < 0.05). Additionally, the incidence of postoperative minor complications was significantly lower in the observation group compared to the control group (P < 0.05).

CONCLUSION: Prehabilitation strategies can effectively improve the psychological state, reduce glycated hemoglobin levels, promote weight loss, and reduce the incidence of minor postoperative minor complications in patients undergoing laparoscopic sleeve gastrectomy. These strategies appear to be safe and effective, and could be considered for wider clinical adoption.

CLINICAL REGISTRATION NUMBER: Not applicable.

PMID:40859236 | DOI:10.1186/s12893-025-02973-y

BMC Gastroenterol. 2025 Aug 26;25(1):619. doi: 10.1186/s12876-025-04199-x.

ABSTRACT

BACKGROUND: Over the past few decades, the global incidence of cholangiocarcinoma has risen overall. In particular, the incidence of intrahepatic cholangiocarcinoma increased by 109% over a ten-year period, rising from 0.67 per 100,000 in 2007 to 1.40 per 100,000 in 2016¹. Epidemiological studies have suggested that cholecystitis may increase the risk of hepatobiliary cancers. However, whether this association indicates an independent causal relationship remains unclear. Given that observational studies are prone to residual confounding and bias, limiting the strength of causal inference. Our study aimed to evaluate whether cholecystitis is an independent risk factor for cholangiocarcinoma.

METHODS: Instrumental variables were identified as independent single nucleotide polymorphisms highly associated with cholecystitis (n = 25). The entire dataset from the Integrative Epidemiology Unit (IEU) publicly available genome-wide association studies (GWAS) was utilized to obtain cholangiocarcinoma outcome data (n = 25). In this study, five MR statistical techniques (Inverse Variance Weighted, MR Egger, Weighted Median, Simple Mode, and Weighted mode) were used. The MR Egger intercept test, leave-one-out analysis, and the funnel plot were all utilized in sensitivity analyses.

RESULTS: Results of the Inverse Variance Weighted (IVW) method genetically predicted cholecystitis was associated with higher risk of cholangiocarcinoma, with an odds ratio of 2.915 (95% CI = 1.122-7.575, P = 0.038). Weighted Median Method also demonstrated consistent direction of effect (P = 0.016). However, MR-Egger, Simple Mode, and Weighted Mode all showed no statistical significance (P > 0.05). Both funnel plots and MR Egger intercepts indicated the absence of any directional pleiotropic effects between cholecystitis and cholangiocarcinoma.

CONCLUSION: We found evidence supporting a causal effect between cholecystitis and cholangiocarcinoma, indicating an increased likelihood of cholangiocarcinoma in patients with cholecystitis through MR analysis.These findings may help inform clinical strategies for the management of cholecystitis, with the aim of potentially reducing the risk of cholangiocarcinoma.

PMID:40859233 | DOI:10.1186/s12876-025-04199-x

BMC Public Health. 2025 Aug 26;25(1):2920. doi: 10.1186/s12889-025-22909-8.

ABSTRACT

BACKGROUND: Healthcare accessibility remains a critical challenge in many low-and middle-income countries, where disparities between rural and urban areas persist. This study, conducted in Dodoma region, Tanzania, models the determinants of healthcare accessibility, aiming to generate evidence that informs policy interventions for equitable healthcare service delivery in underserved populations.

METHODS: A cross-sectional survey design was adopted. Data were collected from 1,009 households (urban 556; rural 453) across four selected districts withing Dodoma region, Tanzania, using a structured questionnaire digitized and implemented through KoboToolbox. The bivariate analysis and binary logistics regression were used to assess the determinants of healthcare accessibility. Fairlie decomposition was also used to assess and explain the healthcare accessibility disparity between urban and rural areas.

RESULTS: Among the 1,009 households surveyed, 45% had access to healthcare services, with urban households having higher access compared to rural households. Significant determinants of healthcare accessibility included healthcare insurance cover [(AOR = 72.006 p < 0.001), CI:19.573 – 264.895], household size [(AOR = 0.713, p < 0.05), CI: 0.536 – 0.947], age of the head of household [(AOR = 0.830 p < 0.001), CI:0.785 – 0.878], and Out-of-pocket costs used for the last illness episodes [(AOR = 0.404 p < 0.01), CI:0.139 -1.167]. Additionally, decision-making authority within households, payment methods, and the presence of chronic illness showed significant or partial influence on accessibility. Fairlie’s decomposition revealed that health insurance and the age of the head of household account for the largest (93.4%) share of the disparity in healthcare accessibility between urban and rural households. These findings underscore the complexity of healthcare access, providing actionable insights for policy interventions to address rural-urban disparities.

CONCLUSION: The study highlights the importance of health insurance coverage in improving healthcare access, emphasizing the need for targeted policy interventions to address rural-urban disparities and improve health outcomes, considering unique rural household needs.

PMID:40859226 | DOI:10.1186/s12889-025-22909-8

Eur J Heart Fail. 2025 Aug 26. doi: 10.1002/ejhf.3799. Online ahead of print.

ABSTRACT

AIMS: End-stage cancer may resemble a heart failure (HF)-like phenotype marked by cardiac wasting, dysfunction, and symptoms such as dyspnoea, congestion, and impaired physical function. The EMPATICC (EMPower the heArt of patients with TermInal Cancer using Cardiac medicines) trial evaluates the safety and efficacy of optimized HF therapy in patients with advanced cancer to improve self-care ability.

METHODS: EMPATICC is a multicentre, investigator-initiated, randomized, double-blind, controlled, proof-of-concept trial employing a joint cardio-oncology care approach. Patients were randomized 1:1 to optimized HF therapy (sacubitril/valsartan, empagliflozin, ivabradine, ferric carboxymaltose) plus usual care, or usual care alone, for 30 days, followed by a 30-day open-label extension. Eligible patients had stage IV solid tumours (per Union for International Cancer Control), were receiving palliative care, had a 1-6 month life expectancy, and were on optimized analgesia. At baseline, first patients had to meet ≥2 criteria of the following indicating cardiovascular risk: heart rate ≥70 bpm, N-terminal pro-B-type natriuretic peptide ≥600 pg/ml, elevated high-sensitivity troponin, left ventricular ejection fraction <55%, left ventricular mass loss >15%, transferrin saturation <20%, or moderate/high likelihood of HF with preserved ejection fraction (based on the HFA-PEFF score); and they had to meet at least one criterion of the following indicating functional limitation: ≥6 s to walk 4 m, inability to wash ≥3 days of the last 7 days, or symptoms of dyspnoea at rest. Enrolment ended 30 January 2025; 93 patients completed randomization. The primary endpoint is a hierarchical composite (analysed by win ratio): (1) days alive and able to wash, (2) 4 m walking ability, and (3) patient global assessment of well-being.

CONCLUSIONS: EMPATICC evaluates whether HF therapy can improve function and well-being in advanced cancer, potentially reshaping care in this population.

PMID:40857084 | DOI:10.1002/ejhf.3799

J Acquir Immune Defic Syndr. 2025 Aug 26. doi: 10.1097/QAI.0000000000003752. Online ahead of print.

ABSTRACT

BACKGROUND: The Veterans Aging Cohort Study (VACS) Index 2.0 accurately predicts mortality using age and clinical biomarkers, but adding behavioral and psychosocial factors that are common among sexual minority men (SMM) may improve its predictive accuracy. We examined whether adding these factors would improve mortality prediction among SMM living with HIV.

METHODS: We included 1,438 SMM in the Multicenter AIDS Cohort Study (MACS) who initiated highly active antiretroviral therapy (HAART) for at least one year between January 1996 and September 2022. We divided the sample into development (70%) and validation (30%) sets. We used Cox proportional hazards models to develop new indices in the development set by adding binary behavioral and psychosocial factors (depression, cigarette smoking, heavy alcohol use, polydrug use) or the total number of these factors in the VACS Index 2.0 and estimated mortality using Weibull survival models. We compared accuracy using C-statistics and calibration curves in the validation set and within subgroups (age, race, CD4 count, and viral suppression).

RESULTS: Among the 1,438 SMM, 83 (5.8%) died within 5 years of follow-up. Depression significantly predicted 5-year mortality after adjusting for the VACS Index 2.0 and resulted in a 70% increased risk of death (aHR=1.70, 95% CI=1.10-2.63) compared to men without depression. The addition of depression improved C-statistics from 0.818 to 0.851 in the development set. Results were robust in all subgroups.

CONCLUSIONS: Including depression improved the VACS Index 2.0 in predicting mortality. Screening and treating depression could improve health and reduce mortality among SMM living with HIV.

PMID:40857055 | DOI:10.1097/QAI.0000000000003752

Ann Plast Surg. 2025 Sep 1;95(3):268-272. doi: 10.1097/SAP.0000000000004477.

ABSTRACT

PURPOSE: To analyze the aesthetic and functional results of a dual-flap reconstruction protocol for nail expansion by recessing the nail fold to increase the exposed nail matrix after repair of finger pulp defect.

METHODS: A total of 18 patients who underwent a dual-flap reconstruction protocol were retrospectively reviewed. We increased nail bed exposure by recessing a Y-V flap of eponychium and reconstructed the pulp with volar V-Y advancement flaps or homodigital island flaps depending on the injury geometry. A controllable 0.3- to 0.45-cm-wide recession of eponychium was feasible. The eponychial Y-V recession flap was separated from the nail matrix and slid proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed.

RESULTS: The flaps survived in all patients. The exposed nail beds were lengthened 0.3 to 0.45 cm. The fingertips had smooth and natural nail plates with inconspicuous scars on both the eponychium and pulp and no deformities. The mobility of injured and uninjured contralateral fingers did not differ statistically. All patients and observers were satisfied with the appearance and function of the reconstructed fingertips.

CONCLUSIONS: The eponychial Y-V recession flap combined with volar soft tissue reconstruction provided for the aesthetic and functional restoration of the fingertip defects with partial nail bed defect.

PMID:40857042 | DOI:10.1097/SAP.0000000000004477

Int J Cancer. 2025 Aug 26. doi: 10.1002/ijc.70090. Online ahead of print.

ABSTRACT

Human fatty acid binding protein-4 (FABP-4), a protein elevated in obesity that promotes colon cancer cell invasiveness and metastasis, may be associated with higher mortality in individuals with colorectal cancer (CRC) and may serve as a mediator of the obesity-mortality association in these individuals. We used a causal diagram to inform covariate selection and applied Cox proportional hazards models to estimate hazard ratios (HRs) for CRC-specific, non-CRC-specific, and all-cause mortality by FABP-4 levels measured in baseline blood samples from 1371 incident CRC cases from the European Prospective Investigation into Cancer and Nutrition cohort. Competing risk analyses were adapted for CRC and non-CRC deaths. Mediation analyses were conducted to estimate total effects (TEs), direct effects (DEs), and mediation proportions (MPs) by FABP-4 of pre-diagnostic body mass index (BMI) on mortality. In the fully adjusted model including BMI, higher circulating FABP-4 concentrations were associated with higher CRC mortality (HR_Q4vsQ1 = 1.49; 95% CI: 1.11-2.00) and all-cause mortality (HR_Q4vsQ1 = 1.49; 95% CI: 1.15-1.93), but not statistically associated with non-CRC mortality (HR_Q4vsQ1 = 1.51; 95% CI: 0.82-2.76). The TE and DE per 5 kg/m² of BMI on all-cause mortality were 1.21; 95% CI: 1.10-1.34, and 1.13; 95% CI: 1.02-1.26, respectively, with a MP of 34.5% (p = .002) by FABP-4. For CRC-specific and non-CRC-specific mortality, MPs by FABP-4 were 33.7% (p = .03) and 36.1% (p = .02), respectively. In conclusion, higher concentrations of FABP-4 were associated with higher CRC-specific and all-cause mortality in individuals with CRC. FABP-4 was a significant partial mediator of the adiposity-mortality relationship in individuals with CRC.

PMID:40857027 | DOI:10.1002/ijc.70090

Head Neck. 2025 Aug 26. doi: 10.1002/hed.70018. Online ahead of print.

ABSTRACT

BACKGROUND: Podoplanin is a mucin-like transmembrane glycoprotein expressed in oral epithelium with a documented role in cell motility, tumorigenesis, tumor invasion, and metastasis. Podoplanin is a potentially valuable biomarker for determining malignant transformation of oral premalignant disease (OPMD).

METHODS: A systematic search was done in accordance with PRISMA guidelines for articles reporting podoplanin expression in OPMD. The outcomes compared were the presence of podoplanin expression, the grade of podoplanin expression, and the incidence of malignant transformation. Statistical analysis of these outcomes included proportions (%), sensitivity, negative predictive value, and hazard ratio (HR) with 95% confidence intervals (CI).

RESULTS: There were 14 included studies (N = 971) with 78.7% OPMD, 13.9% OSCC, and 7.4% healthy controls. Positive expression of podoplanin had a sensitivity and negative predictive value for malignant transformation of 78.9% [95% CI: 69.7%-86.2%] and 88.8% [84.4%-92.1%], respectively. The hazard ratio was 4.4 for the malignant transformation of podoplanin expressing OPMDs [95% CI: 2.6-7.4].

CONCLUSIONS: Podoplanin expression levels increased in a gradient from normal tissue to OPMD to OSCC, respectively. Furthermore, OPMD with podoplanin expression has higher rates of malignant transformation than OPMDs not expressing podoplanin.

PMID:40857023 | DOI:10.1002/hed.70018

Stat Med. 2025 Aug;44(18-19):e70168. doi: 10.1002/sim.70168.

ABSTRACT

The incorporation of real-world data to supplement the analysis of trials and improve decision-making has spurred the development of statistical techniques to account for introduced confounding. Recently, “hybrid” methods have been developed through which measured confounding is first attenuated via propensity scores and unmeasured confounding is addressed through (Bayesian) dynamic borrowing. Most efforts to date have focused on augmenting control arms with historical controls. Here we consider augmenting treatment arms through “expanded access”, which is a pathway of nontrial access to investigational medicine for patients with seriously debilitating or life-threatening illnesses. Motivated by a case study on expanded access, we developed a novel method (the ProPP) that provides a conceptually simple and easy-to-use combination of propensity score weighting and the modified power prior. Our weighting scheme is based on the estimation of the average treatment effect of the patients in the trial, with the constraint that external patients cannot receive higher weights than trial patients. The causal implications of the weighting scheme and propensity-score integrated approaches in general are discussed. In a simulation study, our method compares favorably with existing (hybrid) borrowing methods in terms of precision and type I error rate. We illustrate our method by jointly analyzing individual patient data from the trial and expanded access program for vemurafenib to treat metastatic melanoma. Our method provides a double safeguard against prior-data conflict and forms a straightforward addition to evidence synthesis methods of trial and real-world (expanded access) data.

PMID:40857021 | DOI:10.1002/sim.70168

Oral Health Prev Dent. 2025 Aug 26;23:499-506. doi: 10.3290/j.ohpd.c_2226.

ABSTRACT

PURPOSE: This study aimed to assess factors that impact midazolam dose for intravenous sedation (IVS) in dental patients with anxiety.

MATERIALS AND METHODS: This was a retrospective, observational study for adult, anxious patients (moderate to severe dental anxiety) who had different types of dental procedures under IVS with midazolam and local anaesthesia. A logbook of dental patients who had dental procedures was used to collect data on an Excel sheet (Microsoft Excel Workbook 2024).

RESULTS: Data of 233 patients were recorded. The average dose of IVS with midazolam delivered was 6.62 mg (SD = 3.24). Multivariable logistic regression found that two variables were statistically significant predictors for the IVS with midazolam dose, which are age (B = 1.30, S.E = 0.47, Exp(B) = 3.68, 95% CI = 1.45-9.33, P = 0.006) and non-surgical periodontal therapy with root planing (B = 0.85, SE = 0.39, Exp(B) = 2.35, 95% CI = 1.08-5.12, P = 0.031).

CONCLUSIONS: Younger patients and non-surgical periodontal therapy with root planing appear to be predictors for higher doses of IVS with midazolam. Other variables that were not predictors to affect IVS with midazolam dose, such as medical history, American Society of Anesthesiologists (ASA) classification, medications, and others, are crucial, and they should not be neglected when designing the treatment plan to deliver dental treatment under IVS with midazolam.

PMID:40857015 | DOI:10.3290/j.ohpd.c_2226