Nevin Manimala

Support Care Cancer. 2025 Aug 20;33(9):800. doi: 10.1007/s00520-025-09825-8.

ABSTRACT

OBJECTIVE: To assess functioning and health-related quality of life (HRQoL) in patients referred to a cancer diagnostic pathway for non-specific serious symptoms, and to explore whether changes over 3 months differ among patients diagnosed with cancer, another serious diagnosis, or no serious diagnosis.

METHODS: A prospective cohort study was conducted at a hospital-based cancer diagnostic clinic. Functioning and HRQoL were assessed at baseline and after 3 months using the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and the EuroQol 5-Domain 5-Level (EQ-5D-5L), respectively.

RESULTS: A total of 347 patients were included, with 242 completing follow-up. At baseline, patients with another serious diagnosis reported the highest functioning difficulties (median WHODAS: 25) and lowest HRQoL (median EQ-5D-5L: 0.705). Functioning scores improved modestly across all groups at 3 months, with no statistically significant differences between them. However, HRQoL improved significantly only in patients with another serious diagnosis, compared to those with cancer or no serious diagnosis (p = 0.04).

CONCLUSION: Patients referred to a cancer diagnostic pathway for non-specific serious symptoms experience considerable functioning difficulties and reduced HRQoL at referral. While functioning improved modestly across all groups, only patients with another serious diagnosis showed a significant improvement in HRQoL. These findings highlight the need for early assessment and support for all patients in this pathway, irrespective of the final diagnosis, to ensure equitable care and timely rehabilitation when needed.

PMID:40833621 | DOI:10.1007/s00520-025-09825-8

Psychol Res. 2025 Aug 20;89(5):134. doi: 10.1007/s00426-025-02166-5.

ABSTRACT

The human visual system employs two complementary mechanisms-feature contrast enhancement and continuity maintenance-to effectively process extensive visual input. However, how these mechanisms interact to shape visual perception remains poorly understood. In this study, participants were asked to estimate the orientations of a serial of Gabor patches. Our results revealed two key perceptual biases: a cardinal bias, characterized by systematic deviations away from cardinal orientations (e.g., 0°), and serial dependence, where current estimates were attracted toward previously presented orientations. Notably, we found that the cumulative influence of cardinal bias across trials produced a repulsive history effect. When this effect was statistically removed from the estimation errors, the strength of serial dependence significantly increased. This suggests that while feature contrast enhancement and continuity maintenance generate opposing behavioral effects, they may share overlapping computational or neural processes. These mechanisms likely interact dynamically to refine and optimize visual perception. Moreover, our findings offer a robust methodological framework for isolating serial dependence effects, enabling future studies to more accurately quantify their role in perceptual decision-making. By disentangling these interacting biases, this work advances our understanding of how the visual system balances sensitivity to feature differences with the integration of perceptual history.

PMID:40833616 | DOI:10.1007/s00426-025-02166-5

Nervenarzt. 2025 Aug 20. doi: 10.1007/s00115-025-01874-y. Online ahead of print.

ABSTRACT

With the introduction of the 11th revision of the World Health Organization (WHO) “International Statistical Classification of Diseases and Related Health Problems” (ICD-11), structural and content-related adjustments were made to the diagnostic guidelines for affective disorders, which are presented in this review article. The update has resulted in some changes to the diagnostic classification of affective disorders, based on the American Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). The ICD-11 assigns depressive symptoms to so-called clusters, the main symptoms of depressed mood and joylessness can be accompanied by cognitive, behavioral or neurovegetative symptoms. In the case of remission of depressive episodes, the ICD-11 distinguishes between partial and complete remission. A persistent depressive disorder is present if the depressive episode lasts continuously for more than 2 years. In future, bipolar disorder will be divided into type I and type II. Manic episodes can still only be coded in the context of bipolar disorders and cannot be diagnosed as an independent, separate disorder. The concept of persistent affective disorders in the ICD-10 is abandoned, dysthymia is categorized as a depressive disorder and cyclothymia as a bipolar disorder.

PMID:40833614 | DOI:10.1007/s00115-025-01874-y

Arch Gynecol Obstet. 2025 Aug 20. doi: 10.1007/s00404-025-08151-y. Online ahead of print.

ABSTRACT

OBJECTIVE: This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery.

DATA SOURCES: MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024.

STUDY ELIGIBILITY CRITERIA: We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery.

STUDY APPRAISAL AND SYNTHESIS METHODS: Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months.

RESULTS: A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = – 0.02 (- 0.06, 0.02); I² = 81%, p < 0.01), and six months (RD = – 0.11, CI – 0.15, – 0.07, I² = 91%, p < 0.01).

CONCLUSIONS: Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO, Unique identifier: CRD42024552495.

PMID:40833607 | DOI:10.1007/s00404-025-08151-y

Am J Biol Anthropol. 2025 Aug;187(4):e70112. doi: 10.1002/ajpa.70112.

ABSTRACT

OBJECTIVES: In the San Francisco Bay Area, Late Holocene resource intensification models predict an increase in diet breadth and a reduction in foraging efficiency associated with an increase in population, sedentism, and territoriality among fisher-hunter-gatherer populations. Here we compare bone stable carbon (δ¹³C) and nitrogen (δ¹⁵N) isotope values of sites along the eastern bay shore to interpret how ecogeographical partitioning of resources by latitude and distance from the bay reflects differential access and control of resources.

MATERIALS AND METHODS: With the support of, and in collaboration with, the Muwekma Ohlone Tribe of the San Francisco Bay Area, we analyzed bone collagen and bioapatite from 154 burials from Mánni Muwékma Kúksú Hóowok Yatiš Túnnešte-tka (CA-ALA-329) (2500-180 cal B.P.) to examine temporal changes in diet. Further, we examined the ecogeographical partitioning of resources in relation to published data from four contemporaneous sites.

RESULTS: For collagen (n = 146), δ¹³C values average -18.2‰±0.7‰ (1SD) and δ¹⁵N values average 9.8‰±1.5‰ (1SD). For bioapatite (n = 144), δ¹³C values average -13.8‰±1.0‰ (1SD). Adult males had statistically significantly higher isotope values compared to adult females, but differences were minimal (< 1.1‰). No meaningful temporal changes in diet were identified. Regional dietary differences occurred along a latitudinal gradient of the eastern bay shore.

DISCUSSION: Foraging efficiency was localized, suggesting that the exploitation of different microhabitats was critical to each tribal group. Stable isotope data complement zooarchaeological and paleobotanical data; although they reveal different aspects of subsistence practices and diet.

PMID:40832742 | DOI:10.1002/ajpa.70112

BJOG. 2025 Aug 20. doi: 10.1111/1471-0528.18333. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare long-term clinical and cost-effectiveness of pessary self-management (SM) with clinic-based care (CBC) for pelvic floor-specific quality of life (QoL).

DESIGN: Four-year questionnaire follow-up of trial participants.

SETTING: UK pessary clinics.

SAMPLE: Responders at 4 years aged ≥ 18 years at recruitment, using a pessary (except Shelf, Gellhorn or Cube) which had been retained ≥ 2 weeks.

EXCLUSIONS: limited manual dexterity; cognitive deficit; pregnancy; requiring non-English SM teaching.

METHODS: SM group received a 30-min teaching session; information leaflet; 2-week follow-up call; and telephone support. CBC group received routine appointments. Allocation was by remote web-based application, minimised on age, user type (new/existing) and centre with no blinding. Participants were invited to opt into a 4-year follow-up. The primary analysis was intention to treat.

OUTCOME MEASURES: The primary outcomes were pelvic floor-specific QoL (PFIQ-7) and incremental net monetary benefit (INB) 4 years post-randomisation. Secondary outcomes included complications and prolapse symptoms.

RESULTS: Of 340 women randomised, 186 (55%) responded at 4 years (86/169 [51%] SM, 100/171 [58%] CBC). There was no statistically significant group difference in PFIQ-7 at 4 years (mean SM 32.9 vs. CBC 31.4, adjusted mean difference [AMD] SM-CBC 4.86, 95% CI -6.41 to 16.12). There was a statistically non-significant lower percentage of pessary complications for SM (SM 17.7% vs. CBC 22.0%, AMD 3.01 CI -0.58 to 6.61). At 4-years, SM was cost-effective (INB £2240). There was one potentially related serious adverse event (SM group).

CONCLUSIONS: Pessary self-management is an effective and cost-effective long-term option for women with prolapse.

TRIAL REGISTRATION: ISRCTN number: 62510577 (https://doi.org/10.1186/ISRCTN62510577).

PMID:40832737 | DOI:10.1111/1471-0528.18333

Alzheimers Dement. 2025 Aug;21(8):e70428. doi: 10.1002/alz.70428.

ABSTRACT

INTRODUCTION: Many health life exposure factors (LEFs) influence cognitive decline and dementia incidence, but their relative importance to episodic memory (an early indicator of cognitive decline) among diverse older adults is unclear. We used machine learning to rank LEFs for memory performance in a large and diverse US cohort.

METHODS: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) and Study of Healthy Aging in African Americans (STAR), participants underwent neuropsychological testing and answered questionnaires about multiple LEFs. XGBoost and Shapley Additive exPlanation values ranked the importance of factors influencing cross-sectional episodic memory in the full sample and by sex and ethnic group.

RESULTS: Among 2245 adults (mean age: 74 years; range 54-90), age, sex, education, volunteering, income, vision, hearing, sleep, and exercise contributed to memory performance regardless of group stratification.

DISCUSSION: This innovative methodology can help identify risk factors important for memory performance and guide future dementia risk reduction interventions among older adults.

HIGHLIGHTS: This work uses a regression tree machine learning model (XGBoost) with highly interpretable Shapley Additive exPlanation values to analyze impacts of 12 life exposure factors plus age, sex and ethnoracial identity on episodic memory outcome. This approach has valuable properties, including the ability to implicitly account for variable interactions, non-linear relations with outcome, and missing values. Age, sex, education, income, volunteering, exercise, hearing and vision, and sleep (quality and duration) have important impacts on memory outcome in a combined model and in stratified models regardless of ethnoracial identity. We also demonstrate individualized models for subgroups of participants, showing how life exposure factors vary in importance between divergent populations and suggesting an approach to personalized interventions. This approach can be valuable for both policy decisions and individualized interventions to support healthy cognitive aging.

PMID:40832727 | DOI:10.1002/alz.70428

J Magn Reson Imaging. 2025 Aug 20. doi: 10.1002/jmri.70080. Online ahead of print.

ABSTRACT

BACKGROUND: Atypical glioblastoma (GBM) (minimal or no necrosis on MRI) and primary central nervous system lymphoma (PCNSL) are difficult to distinguish on MRI; whether tumor habitat can more accurately distinguish atypical GBM from PCNSL remains uncertain.

PURPOSE: To evaluate the diagnostic performance with tumor habitats, apparent diffusion coefficient (ADC), and edema index (EI) to distinguish atypical GBM from PCNSL.

STUDY TYPE: Retrospective.

POPULATION: One hundred twenty-five patients (63 male and 62 female) diagnosed with atypical GBM or PCNSL were included.

FIELD STRENGTH/SEQUENCE: 1.5 T and 3.0 T, Axial ADC and T1 contrast-enhanced spin-echo inversion recovery sequence (T1-CE).

ASSESSMENT: The tumor habitat was derived using T1-CE and ADC sequences. Based on this tumor habitat, EI and relative ADC (rADC), we constructed a model.

STATISTICAL TESTS: Logistic regression; Akaike Information Criterion; Receiver operating characteristic (ROC) curves, calibration curves, and Decision Curve Analysis.

RESULTS: Three tumor habitats were identified: high-enhancement cellular habitat (Habitat 1), low-enhancement cellular habitat (Habitat 2), and nonviable tissue habitat (Habitat 3). The voxel fraction of the three tumor habitats in atypical GBM and PCNSL groups shows statistically significant differences. The EI of patients in the PCNSL group was significantly higher than that of the patients in atypical GBM. A model was established incorporating the parameters Habitat 2, Habitat 3, EI, and rADCmean. The model exhibits excellent discriminative ability in the training set (AUC = 0.851, 95% CI: 0.781-0.921) and validation set (AUC = 0.807, 95% CI: 0.724-0.889). Histopathological evaluation showed that vasculogenic mimicry (VM) levels were significantly higher in the PCNSL group. Multiple linear regression analysis showed a significant correlation between habitat voxel fraction and VM levels.

DATA CONCLUSION: A model built based on tumor habitat, EI, and rADCmean can differentiate atypical GBM from PCNSL preoperatively. The differences in VM levels are one of the pathological mechanisms underlying the variations in tumor habitats between atypical GBM and PCNSL.

TECHNICAL EFFICACY STAGE: 3.

PMID:40832718 | DOI:10.1002/jmri.70080

J Cosmet Dermatol. 2025 Aug;24(8):e70412. doi: 10.1111/jocd.70412.

ABSTRACT

BACKGROUND: Laser resurfacing treatments have revolutionized dermatological procedures by improving skin texture, tone, and quality. Effective periprocedural care remains essential to reduce side effects, support healing, and optimize aesthetic outcomes. Hypochlorous acid (HOCl), a naturally occurring oxidant with anti-inflammatory and antimicrobial properties, has demonstrated efficacy in promoting wound healing and minimizing scarring.

AIM: To evaluate the use of stabilized HOCl mist in the periprocedural care of patients undergoing laser resurfacing.

METHODS: Ten patients underwent treatment with UltraClear, CO2RE, and/or GentleMax Pro laser devices. Stabilized HOCl mist was applied before and after the procedure, with continued application twice daily for 1 week posttreatment. Follow-up assessments at 1-3 weeks and 1-3 months post-procedure included clinical photography, tolerability evaluation, and aesthetic outcome assessment. Outcomes measured included Clinician Erythema Assessment (CEA), 4-point Edema Scale, Investigator Global Assessment of Pigmentation Scale (IPA), and Global Aesthetic Improvement Scale (GAIS). Statistical analysis was performed using the Friedman and Wilcoxon signed-rank tests.

RESULTS: HOCl mist was associated with accelerated recovery, including a noticeable reduction in erythema and pigmentation. Statistically significant improvements were observed in CEA (p = 0.007) and IPA (p = 0.012) scores, indicating reduced clinical severity and pigment alteration. Edema and GAIS scores showed no statistically significant change.

CONCLUSION: Stabilized HOCl mist is well-tolerated and may significantly aid post-procedural recovery by minimizing side effects and reducing discomfort. Results support the potential role of stabilized HOCl mist as a beneficial adjunct in post-laser skincare, contributing to faster healing, reduced inflammation, and enhanced cosmetic results.

PMID:40832716 | DOI:10.1111/jocd.70412

Stroke. 2025 Aug 20. doi: 10.1161/STROKEAHA.124.049955. Online ahead of print.

ABSTRACT

BACKGROUND: This individual participant data meta-analysis aimed to determine whether time to treatment influences the effect of intraarterial thrombolysis (IAT), intravenous thrombolysis, and conservative standard therapy on visual outcomes in nonarteritic central retinal artery occlusion.

METHODS: We searched MEDLINE, CENTRAL, and Embase up to June 2023 for studies reporting treatment modality and peri-treatment best-corrected visual acuity (BCVA) for ≥5 participants, excluding patients with nonsevere vision loss (BCVA <1.0 logarithm of the minimum angle of resolution [logMAR]) or treated after 24 hours of symptom onset. The primary outcome was recovery from severe vision loss (final BCVA <1.0 logMAR). We used mixed-effect models and local polynomial regression to investigate nonlinear relationships between time to treatment and recovery from severe vision loss.

RESULTS: Of 4074 screened studies, individual participant data were sought from 52, with 35 contributing individual participant data for 1038 participants. In total, 783 patients met inclusion criteria (age, 64.8±13.3 years; 35.5% female; baseline BCVA, 2.3±0.5 logMAR). For every hour decrease in time to treatment, thrombolysis was associated with greater improvement in BCVA (intraarterial, 0.02 logMAR [95% CI, 0-0.04]; intravenous, 0.04 logMAR [95% CI, 0.00-0.07]) than conservative standard therapy (0.01 logMAR [95% CI, 0-0.02]). A nonlinear relationship was detected for intraarterial thrombolysis with a changepoint at 8 hours (95% CI, 6.7-9.4). Thrombolysis was associated with increased recovery from severe vision loss compared with conservative standard therapy (intraarterial within 6 hours: odds ratio, 2.72 [95% CI, 1.02-7.28], 27.2% versus 12.0%; intravenous within 4.5 hours: odds ratio, 3.32 [95% CI, 1.24-8.92], 28.8% versus 11.1%). Findings were consistent in subgroup analysis restricted to patients receiving recombinant tissue-type plasminogen activator. Monte-Carlo simulations showed that a randomized controlled trial would require 95 participants per group to achieve 80% power to detect an odds ratio of 3.0 for recovery from severe vision loss.

CONCLUSIONS: Early intervention in nonarteritic central retinal artery occlusion is associated with improvement in visual recovery, with intraarterial thrombolysis and intravenous thrombolysis outperforming nonthrombolytic treatments. These findings warrant confirmation in sufficiently powered randomized controlled trials.

PMID:40832714 | DOI:10.1161/STROKEAHA.124.049955