Nevin Manimala

BMC Emerg Med. 2025 Oct 10;25(1):204. doi: 10.1186/s12873-025-01364-z.

ABSTRACT

BACKGROUND: The Saitama Tone Health and Medical Care Region Medical Collaboration Promotion Council has established a regional medical network system (Patient-Centered Digital Health Records, Tonetto) that shares medical information among healthcare facilities and provides medical services to Tonetto users. This system has facilitated the sharing of medical information between core hospitals, general hospitals, and clinics, thereby contributing to improved medical care. Furthermore, Tonetto has facilitated the availability of patient information for emergency transport. This study aimed to evaluate the impact of Tonetto on emergency transportation times for older patients.

METHODS: The study population consisted of 1,820 older patients (aged 65 and over) among 2,542 emergency patients transported to East Saitama General Hospital between January and December 2023. Based on their registration status in the Tonetto system, the patients were divided into two groups: a Tonetto-registered group (n = 319) and a Tonetto-nonregistered group (n = 1,501). Statistical analysis was performed using a general linear model that included main effects and interaction terms for the three categories of transport distance (< 5, 5-10, and ≥ 10 km) and two categories of Tonetto registration status. The difference in transport time was estimated based on Tonetto registration status for each transport distance category. To control for confounding variables, the model included severity, age, sex, and transport distance as covariates.

RESULTS: The difference in transport time (minutes) between the Tonetto-nonregistered group and the Tonetto-registered group (95% confidence interval) was – 0.3 (- 3.0, 2.4), – 3.5 (- 8.9, 1.9), – 24.3 (- 38.3, – 10.2), respectively. A reduction of 24 min in transport time was observed in the Tonetto-registered group for distances of 10 km or more (p = 0.001).

CONCLUSIONS: Tonetto registration was associated with a substantial reduction in emergency transport time for older patients over long distances. These findings demonstrate the potential of regional medical information networks to improve the efficiency of emergency care and support the development of a nationwide emergency medical information system in Japan.

PMID:41073895 | DOI:10.1186/s12873-025-01364-z

BMC Cardiovasc Disord. 2025 Oct 10;25(1):734. doi: 10.1186/s12872-025-05133-5.

ABSTRACT

BACKGROUND: The appropriate periprocedural management of oral anticoagulation in transcatheter aortic valve implantation (TAVI) patients who require long-term anticoagulation remains controversial.

PURPOSE: This systematic review and meta-analysis compare the efficacy and safety of periprocedural continuation versus interruption of anticoagulation in patients undergoing TAVI with an indication for long-term anticoagulation.

METHODS: We searched PubMed, Embase, and Cochrane Central databases to identify relevant articles. We included both observational and randomized controlled trials. Data were analysed using random-effects model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). A p < .05 was considered statistically significant.

RESULTS: Four studies comprising 3,144 patients, with anticoagulation continued in 1,500 (47.7%) patients were included. There were no difference between periprocedural continuation and interruption of anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI: 0.64-1.10; p = .19), major bleeding (OR: 0.98; 95% CI: 0.57-1.68; p = .95), major vascular complications (OR: 0.93; 95% CI: 0.72-1.20; p = .60), and myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20-1.77; p = .36). However, the incidence of stroke was significantly lower in the continuation group (OR: 0.61; 95% CI: 0.39-0.94; p = .03). The incidence of blood transfusion was not significantly different between the continuation and interruption groups (OR: 0.86; 95% CI: 0.42-1.77; p = .68).

CONCLUSIONS: In this meta-analysis comparing periprocedural continuation of anticoagulation to interruption of therapy in patients undergoing TAVI with concomitant indications for long-term anticoagulation, continuation of anticoagulation was associated with a lower incidence of stroke without increasing the risk of bleeding. These findings suggest a potentially favourable safety profile in favour of continuation of anticoagulant therapy, they should be interpreted with caution and validated in larger and well-designed randomised trials. The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42024607149).

PMID:41073885 | DOI:10.1186/s12872-025-05133-5

J Appl Clin Med Phys. 2025 Oct;26(10):e70279. doi: 10.1002/acm2.70279.

ABSTRACT

PURPOSE: Improved accuracy in 4DCT imaging and precise targeting of tumors contribute to more effective and targeted radiation therapy. This study focuses on evaluating the accuracy of utilizing the GateCT (VisionRT Ltd, London, United Kingdom) in comparison with a pressure sensor system (ANZAI Medical Co., Ltd., Shinagawa, Tokyo) to provide 4DCT with respiratory information.

METHODS: A dynamic breathing phantom enclosing three spheres (A, P, and R) of different densities was enrolled to produce breathing patterns tracked by the two systems. Image sets for three breathing phases obtained based on GateCT and ANZAI systems were analyzed using deformable registration by deforming the three-phase image sets with the static image sets. Our deformable registration approach revealed how far different phase image sets were from the quantified by various metrics, such as dice similarity coefficient (DSC), mean surface distance (MSD), absolute volume estimation, mean Jacobian, and Warp.

RESULTS: Results indicated DSC values greater than 0.90 across all phases and spheres for both respiratory systems, with mean DSC values for spheres A, P, and R of 0.980 versus 0.977, 0.977 versus 0.976, and 0.977 versus 0.976 for GateCT and ANZAI systems, respectively. MSDs for both systems were consistently less than 2 mm across all spheres and phases. Furthermore, the mean volume estimation error for both systems, relative to the static, exhibited statistical insignificance (p > 0.05). Friedman test revealed significant differences in median Jacobian, and median Warping between the two systems (p < 0.05).

CONCLUSIONS: In addition to the effectiveness of deformable image registration in the quantification of respiratory system performance, both systems exhibited comparable performance in providing 4DCT with respiratory information.

PMID:41073878 | DOI:10.1002/acm2.70279

J Appl Clin Med Phys. 2025 Oct;26(10):e70306. doi: 10.1002/acm2.70306.

ABSTRACT

PURPOSE: Lattice radiotherapy (LRT), a form of spatially fractionated radiation therapy (SFRT), has emerged as a promising approach for treating massive tumors. By delivering high-dose regions within the tumor while sparing surrounding healthy tissue, LRT offers distinct advantages over conventional radiotherapy. Recent advancements in treatment planning systems (TPS), particularly the integration of intelligent optimization engines (IOEs) with automated planning capabilities, have the potential to further refine and expand the clinical utility of LRT. This study aimed to comparatively evaluate the planning quality and clinical feasibility of lattice SFRT treatment plans generated using the Ethos planning system, equipped with an IOE and O-ring linear accelerator, versus the Eclipse planning system paired with a conventional C-arm TrueBeam linac, in patients with stage III non-small cell lung cancer (NSCLC).

METHODS: Twenty retrospective stage III NSCLC cases (GTV > 200 cc) with available PET-CT imaging were selected. A total of 40 plans (20 Eclipse, 20 Ethos) were compared, incorporating lattice spheres (1 cm diameter, 2 cm spacing between spheres) placed in the tumor, FDG-PET/CT-informed intratumoral heterogeneity, prioritizing viable perinecrotic subregions while avoiding critical OARs. Plans aimed to deliver 15 Gy to lattice spheres, limit Valley (PTV minus spheres) doses to 2 Gy, and restrict doses to organs at risk (OARs) to ≤ 3 Gy. Dose conformity, OAR sparing, dose gradient parameters (PEDR, PVDR), planning time, and deliverability, which was evaluated using ArcCheck, EPID gamma analysis, and MLC log-file verification.

RESULTS: Ethos demonstrated statistically significant improvements compared to Eclipse in lattice sphere mean dose (17.2 Gy vs. 15.83 Gy, p < 0.001), V15 Gy coverage (98.2 % vs. 91.74 %, p < 0.001), and dose gradient metrics (PEDR: 6.42 vs. 5.80; PVDR: 3.70 vs. 3.29; both p < 0.001, and VPDR: 0.131 vs. 0.135; PVDR_DVH: 7.62 vs. 7.41). For the valley target, Ethos plans demonstrated a lower mean dose (Dmean: 4.72 Gy vs. 4.91 Gy, p = 0.064), although not statistically significant, and achieved significantly improved dose gradient at V7.5 Gy (14.5% vs. 16.35%, p = 0.019), V5Gy (30.77% vs. 34.84%, p = 0.006), and V2Gy (99.77% vs. 97.79%, p < 0.001) compared to Eclipse. Ethos achieved significantly better OAR sparing, particularly for the bronchial tree, heart, spinal cord, esophagus, and great vessels (all p < 0.01). Furthermore, Ethos substantially reduced planning time (36.55 vs. 95.96 min, p < 0.001). Both planning systems achieved high gamma passing rates (> 95%), confirming the accuracy and deliverability of the treatment plans.

CONCLUSION: The Ethos automated treatment planning demonstrated superior lattice dose conformity, enhanced OAR sparing, and significantly faster optimization compared to Eclipse. This automated optimization capability highlights the potential of Ethos for efficient and effective lattice radiotherapy in managing massive NSCLC tumors.

PMID:41073872 | DOI:10.1002/acm2.70306

Eur J Orthop Surg Traumatol. 2025 Oct 10;35(1):430. doi: 10.1007/s00590-025-04558-0.

ABSTRACT

PURPOSE: Tibial plateau fractures can result in significant morbidity, and complications following surgical fixation may negatively impact recovery. We aimed to evaluate whether such complications influence patient-reported outcomes at 6 months postoperatively.

METHODS: We conducted a retrospective cohort study at a single level I trauma center from 2022 to 2024. Adult patients who sustained a tibial plateau fracture (AO/OTA 41) treated with open reduction internal fixation (ORIF) were eligible for inclusion if they had completed Patient-Reported Outcomes Measurement Information System (PROMIS) surveys at 6 months postoperatively and had clinical follow-up confirming radiographic healing. Patients were excluded if they were under 18 years of age, lacked adequate medical record documentation, were managed non-operatively or with closed reduction percutaneous fixation, or did not complete PROMIS surveys at the 6-month time point. The primary outcomes were PROMIS scores assessing physical function (PF), pain interference (PI), global physical health (GPH), global mental health (GMH), anxiety, and depression. Secondary outcomes included percent of normal function and Brief Resilience Scale (BRS) scores. These outcomes were compared between patients who experienced complications and those who did not.

RESULTS: A total of 106 patients were included (mean age 50.4 years; mean follow-up 261.5 days). Complications occurred in 25.5% of patients, including fracture-related infection (FRI, 10.4%), DVT/PE (7.5%), and reoperation within 6 months (11.3%). Patients with FRI had significantly lower PROMIS-PF scores at 6 months compared to those without FRI (31.5 vs. 37.4, p = 0.015), exceeding the MCID. Other PROMIS domains were not significantly different. Patients undergoing early reoperation prior to 6 months, or reoperation to promote bone healing at any timepoint, demonstrated lower PF scores, though these differences were not statistically significant.

CONCLUSION: In this cohort of patients with tibial plateau fractures, FRI was associated with significantly worse physical function at 6-months as measured by the PROMIS-PF score. This difference was also clinically significant, exceeding the MCID.

PMID:41073836 | DOI:10.1007/s00590-025-04558-0

Geroscience. 2025 Oct 10. doi: 10.1007/s11357-025-01889-y. Online ahead of print.

ABSTRACT

Sarcopenia is a major contributor to frailty and functional decline among older adults. Combining exercise with nutritional strategies such as creatine monohydrate (CRE) and β-hydroxy-β-methylbutyrate (HMB) supplementation may help to preserve strength and independence. To evaluate the effects of 6-week CRE + HMB supplementation combined with an integral physical conditioning (IPC) program on functional strength and body composition in physically active older adults. In a randomized, double-blind, placebo-controlled crossover trial, 30 older adults (20 men, 10 women; ≥ 60 years) completed two 6-week intervention periods (CRE + HMB or placebo) separated by a 3-week washout. The IPC program performed in both conditions consisted of four supervised weekly sessions combining strength, power, multicomponent circuits, high-intensity interval and moderate intensity continuous training), performed at 40-100% training heart rate (THR) and 20-90% one-repetition maximum (1RM) and structured as warm-up, main part and cooldown. Functional strength and body composition (bioelectrical impedance analysis) were assessed pre- and post-intervention, respectively. Significant time × group interactions were observed for fat mass, fat-free mass, total muscle mass, skeletal muscle mass, appendicular skeletal muscle mass, muscle mass index, skeletal muscle index and ALM/BMI (all p < 0.05). The CRE + HMB group showed reductions in fat mass and body fat percentage, with slight numerical increases in muscle parameters, whereas the placebo group exhibited opposite trends. However, within-group changes were not statistically significant. In contrast, CRE + HMB significantly improved multiple functional strength outcomes, including leg/back strength, arm flexion strength, upper-body endurance (dumbbell flexion, push-ups, isometric hold) and core endurance (crunches). Regression analyses suggested that these improvements were largely independent of changes in muscle mass, supporting a potential neuromuscular mechanism. Six weeks of CRE + HMB supplementation combined with IPC enhanced functional strength and endurance in active older adults, largely independent of changes in muscle mass. This combined approach represents a promising strategy for preserving functional capacity and promoting healthy ageing.

PMID:41073834 | DOI:10.1007/s11357-025-01889-y

Support Care Cancer. 2025 Oct 11;33(11):930. doi: 10.1007/s00520-025-09917-5.

ABSTRACT

PURPOSE: The clinical management of patients with cancer by oncologists and nurses needs to differentiate between maladaptive emotions that do require professional mental health care and adaptive emotions that do not require such care. Previous qualitative research identified six symptoms as potential indicators of maladaptive emotions. These included lingering, increasing or extreme emotions, emotions that interfere with daily life or with treatment, and unexplained somatic symptoms. The present study tested the validity of these symptoms as indicators of maladaptive emotions in patients with cancer.

METHODS: Patients with a solid malignancy were assessed 3 to 7 months after the start of chemo- or immunotherapy. Patients were categorized as experiencing either adaptive or maladaptive emotions, using two reference standards: (a) a psychiatric diagnostic assessment or (b) patient’s subjective need for professional mental health care. Oncologists and nurses assessed the presence of the six symptoms, using a checklist. A total count was made of the number of symptoms that were rated as present.

RESULTS: As hypothesized, the total symptom count was statistically significantly greater in patients with maladaptive emotions than in patients with adaptive emotions. This was consistently observed for the ratings by oncologists as well as nurses, and for both reference standards.

CONCLUSION: The current study confirmed six symptoms assessed by oncologists and nurses as valid indicators of maladaptive emotions in patients with cancer. We recommend assessing these symptoms in the broader context of managing emotional well-being of patients with cancer.

PMID:41073816 | DOI:10.1007/s00520-025-09917-5

Support Care Cancer. 2025 Oct 10;33(11):927. doi: 10.1007/s00520-025-10012-y.

ABSTRACT

PURPOSE: To investigate the current status of CRF and identify its influencing factors in patients undergoing chemotherapy for gastric cancer.

METHODS: A total of 525 patients receiving chemotherapy for gastric cancer were recruited from a tertiary general hospital in China. Data were collected using a set of standardized questionnaires. Stepwise multiple linear regression was applied to determine the impact of variables that were statistically significant (P < 0.05) in independent sample t tests, one-way ANOVA, and correlation analyses on fatigue levels. All statistical tests were two-sided, with a significance level set at α = 0.05.

RESULTS: The median (interquartile range) scores for total CRF, physical fatigue, emotional fatigue, and cognitive fatigue were 21.00 (15.00-27.00), 8.00 (4.00-12.00), 9.00 (7.00-11.00), and 4.00 (1.00-6.00), respectively. Overall, 57.2% of patients experienced moderate to severe fatigue. Multivariate analysis showed that female gender, nutritional risk status, poor sleep status, depression, and pain were significantly associated with higher CRF in patients undergoing chemotherapy for gastric cancer, together explaining 31.6% of the total variance.

CONCLUSION: CRF is highly prevalent among patients with gastric cancer and is influenced by multiple factors. These findings provide scientific evidence for the early identification of high-risk groups and the development of personalized intervention programs.

PMID:41073814 | DOI:10.1007/s00520-025-10012-y

Eye (Lond). 2025 Oct 10. doi: 10.1038/s41433-025-04035-2. Online ahead of print.

ABSTRACT

OBJECTIVE: The clinical evidence linking medications to retinal detachment (RD) remains limited. This study utilises real-world data from the U.S. FDA Adverse Event Reporting System (FAERS) to identify drugs associated with RD and characterise their classifications.

METHODS: A disproportionality analysis was performed on over 17 million FAERS reports. Drugs with statistically significant disproportionate RD reporting were identified and categorised by therapeutic class, signal strength, latency period, subgroup factors (e.g., off-label use, age, gender, subtypes, regions), and sensitivity analysis.

RESULTS: Thirty drugs showed significant associations with RD, including ophthalmic agents, anticancer therapies, corticosteroids, and erectile dysfunction medications. Signal strength varied: pilocarpine, encorafenib, and ocriplasmin exhibited the highest signal strength, while prednisolone and bevacizumab showed lower strength. Latency periods differed significantly: erectile dysfunction drugs had the longest median latency (365 days), whereas anticancer drugs had the shortest (14 days). Subgroup analyses revealed elevated RD signal strength with off-label use and distinct susceptibility patterns: younger adults (<65) and males had higher signal strength for specific drug classes (e.g., ophthalmic agents), while older adults (>65) were more susceptible to RD with corticosteroids. Subtype analysis highlighted drug-specific associations with exudative, tractional, and rhegmatogenous RD. Sensitivity analysis restricted to healthcare professional reports further confirmed the robustness of the findings.

CONCLUSIONS: This study provides a stratified list of medications with disproportionate reporting signals for RD. Further high-quality epidemiological and mechanistic studies are warranted to validate the potential causality associations between these medications and RD. Assessment of drug-related retinal detachment using real-world large-scale data.

PMID:41073807 | DOI:10.1038/s41433-025-04035-2

Neuropsychopharmacology. 2025 Oct 10. doi: 10.1038/s41386-025-02257-2. Online ahead of print.

ABSTRACT

There is active scientific debate about the nature of addiction as a mental disorder, but with comparatively little discussion of nosology itself. To contribute to the ongoing dialogue, this review provides a concise history of the formal medical diagnoses used to define addiction clinically and vanguard contemporary perspectives. The history of addiction as a medical diagnosis starts at the beginning of the 20th century in the first International Classification of Diseases (ICD) and was present in 1953 in the first edition of the Diagnostic and Statistical Manual (DSM). Across iterations of both systems, the evolving nosology can be broadly divided into three epochs, an early primeval period (1900-1948), reflecting coarse definitions subsumed within personality disorder; a phenomenological period (1948-1980), reflecting descriptive definitions; and an empirically-informed period (1980 to the present), comprising operational definitions of polythetic syndromes, increasingly informed by empirical findings. Contemporary priorities suggest an emerging fourth epoch, prioritizing a diagnostic nomological network of objective etiologically-informed tests via, for example, the Research Domain Criteria (RDoC) and Addictions Neuroclinical Assessment (ANA) frameworks. Both RDoC and ANA focus on using objective mechanistic indicators to decrease subjectivity in diagnosis and increase alignment between etiology and diagnosis. Next-generation diagnostic approaches are anticipated to enhance incisiveness in psychiatric diagnosis and in turn improve clinical outcomes. Tracing the vicissitudes of addiction nosology over the past century reveals an evolution that is both more humane and scientific, from moral weakness and personality defect toward diagnostic definitions and practices that are grounded in empirical evidence.

PMID:41073802 | DOI:10.1038/s41386-025-02257-2