Nevin Manimala

CJEM. 2025 Feb 11. doi: 10.1007/s43678-024-00840-y. Online ahead of print.

ABSTRACT

OBJECTIVE: The YEARS criteria combine D-dimer testing and clinical features (hemoptysis, signs of deep vein thrombosis, and pulmonary embolism as the most likely diagnosis) to risk stratify patients with symptoms of pulmonary embolism who may undergo CT pulmonary angiography in the emergency department (ED). Electronic clinical decision support can optimize CT pulmonary angiography utilization in EDs, yet its effectiveness with the YEARS criteria remains unstudied. Our goal is to increase the percentage of CT pulmonary angiograms performed with a D-dimer by 10% within six months of integrating the YEARS criteria into our electronic ordering system.

METHODS: Single centre quality improvement initiative for all ED patients > 18 years investigated for pulmonary embolism with a D-dimer and/or CT pulmonary angiogram between Jan 2022 – Jan 2023. An electronic clinical decision support algorithm was created based on the YEARS criteria and a plan-do-study-act cycle was completed. Using an SPC chart, the percentage of CT pulmonary angiograms ordered with a D-dimer was identified. Process measures included the rate of CT pulmonary angiograms ordered, the rate of imaging ordered in accordance with the YEARS criteria, and diagnostic yield of imaging based on YEARS status. Balancing measures included pulmonary embolism identified on CT pulmonary angiogram with a D-dimer < 500 ug/L FEU or within 30 days of index visit after being ruled out with the YEARS criteria.

RESULTS: Over 12 months, 2639 patients were investigated for pulmonary embolism and 906 underwent CT pulmonary angiogram. The percentage of CT pulmonary angiograms ordered with a screening D-dimer increased by 14.5% (63.8%, CI 59.5-68.1% vs 78.4%, CI 74.4-82.3%) without increasing the rate of imaging ordered (34.9%, CI 32.4-37.4% vs 33.7%, CI 31.1-36.3%). The YEARS criteria were properly applied in 60% (255/425) of patients who underwent CT pulmonary angiogram. The diagnostic yield of CT pulmonary angiogram was higher if patients were YEARS positive (13.2%, CI 9.0-17.4) compared to YEARS negative (0%, CI 0-28.3) or if not applied (8.1%, CI 3.9-12.4). There were two missed pulmonary embolisms at baseline and none post-intervention.

CONCLUSIONS: Implementation of the YEARS criteria using electronic ordering assistance increased the percentage of CT pulmonary angiograms ordered with a D-dimer without increasing imaging use in the ED.

PMID:39932659 | DOI:10.1007/s43678-024-00840-y

J Mol Neurosci. 2025 Feb 11;75(1):18. doi: 10.1007/s12031-024-02303-6.

ABSTRACT

The clinical identification of regression phenomena in ASD lacks specific biological or laboratory criteria and is often based on family history and highly subjective observations by clinicians. The present study aimed to investigate the potential role of plasma clusterin (CLU), very long-chain fatty acids (VLCFA), and carnitine as biomarkers of neurodegeneration in children with autism spectrum disorder (ASD) with and without regression. By exploring these biomarkers, we sought to provide insights into mitochondrial dysfunction, glial activation, and lipid metabolism, which may contribute to the pathophysiology of ASD and aid in the early diagnosis and intervention of regression phenomena in ASD. Ninety children aged 2-6 years were included: 30 with autism spectrum disorder (ASD), 30 with regressive ASD, and 30 healthy controls. Psychiatric assessments were conducted using DSM-5 criteria, CARS, ABC, RBS-R, and ASSQ scales. Regression in ASD was evaluated retrospectively using a modified ADI-R questionnaire. Fasting blood samples were collected, and plasma clusterin (CLU), VLCFA, and carnitine levels were measured. Statistical analyses were performed using MANOVA to assess the effect of group differences on dependent biochemical variables. Serum clusterin and carnitine levels showed no significant differences between groups. However, C22 VLCFA levels were significantly higher in both autism groups compared to controls (p = 0.04), with post hoc analysis indicating the difference between the non-regressive and control groups (p = 0.02). Serum carnitine was positively correlated with stereotypic behaviors subscale scores (r = 0.37, p = 0.004) and total scores (r = 0.35, p = 0.006) of RBS-R. Our study provides insights into the complexities of biomarker research in autism spectrum disorder (ASD), highlighting the challenges in identifying consistent biological markers for regression and non-regression phenotypes. Although no significant findings were observed, further biomarker studies are essential to distinguish possible endophenotypes, improve early diagnosis, and uncover potential therapeutic targets in ASD.

PMID:39932645 | DOI:10.1007/s12031-024-02303-6

Support Care Cancer. 2025 Feb 11;33(3):174. doi: 10.1007/s00520-025-09246-7.

ABSTRACT

PURPOSE: To explore the relationship among cognitive emotion regulation strategies, psychological flexibility, and subjective well-being, analyze the latent profiles of cognitive emotion regulation strategies, and examine the mediating role of psychological flexibility between cognitive emotion regulation strategies and subjective well-being in patients with breast cancer.

METHODS: The cross-sectional study was conducted from April to December 2023, involving 313 patients with breast cancer. The Cognitive Emotion Regulation Questionnaire-short, the Acceptance and Action Questionnaire-II, and the Index of Well-Being were utilized for data collection. Descriptive statistics, Pearson’s correlation coefficient, latent profile, Bayesian factor, and mediation effect were used for data analysis.

RESULTS: There was a small to strong correlation among the variables. Latent profile analysis revealed three potential profiles of cognitive emotion regulation strategies, named “low copers”, “high copers”, and “flexible copers”, respectively. Compared with the “flexible copers” group, psychological flexibility might potentially mediate the relationship between the “low copers” profile and subjective well-being, as well as between the “high copers” profile and subjective well-being, with relative indirect effects of -0.720 (95%CI: -1.104, -0.387) and -1.216 (95%CI: -1.732, -0.711), respectively.

CONCLUSION: The results examined the relationship among variables, identified three distinct profiles of cognitive emotion regulation strategies, and indicated that psychological flexibility might serve as a potential mediator between cognitive emotion regulation strategies and subjective well-being.

PMID:39932638 | DOI:10.1007/s00520-025-09246-7

J Community Genet. 2025 Feb 11. doi: 10.1007/s12687-025-00775-6. Online ahead of print.

ABSTRACT

Brazil is a middle-income country with approximately 210 million inhabitants, with around 2,900,000 births annually. Besides its extensive territorial area, the country is characterized by huge heterogeneity in many aspects, notably in socioeconomic status, education, access to healthcare, geographic mobility, different biomes, agricultural practices and diverse ethnic ancestry. These characteristics directly impact the frequency and distribution of genetic disorders and Congenital Anomalies (CA), which are the second leading cause of death in the first year of life. In this review, we will present the main initiatives and available information from governmental organs and scientific research in Brazil regarding the epidemiology of congenital anomalies and rare diseases, emphasizing teratogenic risk factors and population medical genetics aspects.

PMID:39932625 | DOI:10.1007/s12687-025-00775-6

Environ Monit Assess. 2025 Feb 11;197(3):268. doi: 10.1007/s10661-025-13742-y.

ABSTRACT

Drought is an extensive natural hazard influenced by human activities. Drought has a substantial impact on environmental systems and socioeconomic activities globally, posing serious challenges to water resources, agriculture, and ecosystems. Drought as a complicated natural occurrence is difficult to monitor and anticipate. However, to address the detrimental issues of drought, this study examined the innovative Trivariate Multiscalar-Standardized Drought Index (TMSDI). The climatic factors of precipitation, temperature, and Normalized Difference Vegetation Index (NDVI) are components in the development of TMSDI. To check the association of the innovative index with the another drought indices, this study evaluated correlations between the proposed index (TMSDI) and traditional drought indices, i.e., the Standardized Precipitation Index (SPI) and the Standardized Precipitation Temperature Index (SPTI) at 1-, 3-, 6-, 9-, 12-, 24-, and 48-month time scales. The outcomes demonstrate that there is a consistent relationship between the TMSDI and SPI due to higher values of correlation. The lower correlation between TMSDI and SPTI shows that there is a substantial and consistent relationship between TMSDI and SPI than TMSDI and SPTI. Moreover, the long-term behavior of different drought conditions indicates that extreme drought is more likely than extreme wet across the Markov chain’s Steady States Probabilities (SSPs). Consequently, the proposed index (TMSDI) is recommended as an effective tool to precisely and accurately monitor drought conditions over different time scales within different climate factors.

PMID:39932606 | DOI:10.1007/s10661-025-13742-y

Eur J Nutr. 2025 Feb 11;64(2):88. doi: 10.1007/s00394-025-03597-x.

ABSTRACT

PURPOSE: Nutrition, as a modifiable exposure, seems relevant to prevent depression. Several nutrients have been associated with a lower risk of depression in older adults, but longitudinal studies examining nutrient combinations are lacking. Therefore, we investigated the association between a posteriori nutrient patterns and the odds of depressive symptomatology (DS) in older adults over time.

METHODS: The sample included participants from the French Three-City cohort, a prospective population-based study focusing on adults ≥ 65 years. Nutrient intakes were assessed using a 24-hour recall in 2001 and Principal Component Analysis based on 40 nutrients, was performed to identify nutrient patterns. DS was assessed at each visit (up to eight visits until 2018) and defined by a Center for Epidemiologic Studies-Depression score ≥ 16 and/or antidepressant medication. Random effect logistic regression was performed to examine the association between nutrient patterns and DS over time controlled for potential confounding variables.

RESULTS: The study sample comprised 1,063 individuals (mean age 75.6y +/- 4.8) and 39.3% experienced DS at least once during a median follow-up of 11.5 years. Among 4 identified nutrient patterns, the first pattern characterised by high intake of magnesium, hydroxybenzaldehydes, stilbenes, dihydroflavonols, vitamin B6, lignans, tyrosols, folates, vitamins B3, B5, B1 and proanthocyanidins, was significantly associated with lower odds of DS over time (OR + 1 point = 0.85, 95% CI=[0.75;0.96]).

CONCLUSIONS: In this large sample of older adults, a mixed nutrient pattern was associated with lower odds of DS over time, offering valuable insights into nutrient potential role in mental health among older adults.

PMID:39932601 | DOI:10.1007/s00394-025-03597-x

J Neurol. 2025 Feb 11;272(3):200. doi: 10.1007/s00415-025-12928-1.

ABSTRACT

BACKGROUND: This study aims to elucidate and predict the global disease burden and trends associated with central nervous system (CNS) tumors and cancers among older patients.

METHODS: Data from the Global Burden of Disease 2021 database were used to calculate the age-standardized incidence rate (ASIR), prevalence rate (ASPR), death rate (ASDR), disability-adjusted life-years (DALYs), and the average annual percentage change (AAPC) to assess burden and trends from 1990 to 2021. A Bayesian age-period-cohort model was applied to project the global burden of CNS tumors and cancers in older patients over the next 30 years.

RESULTS: The ASIR among older adults worldwide increased by 3.59 cases per 100,000 population from 1990 to 2021, with an AAPC of 0.86%. The ASPR rose by 9.83 cases per 100,000 people, with an AAPC of 1.57%. The ASDR increased from 10.99 per 100,000 people to 13.01 per 100,000 people. DALYs also rose continuously from 234.21 per 10,000 population to 265.1, with an AAPC of 0.4%. It is anticipated that from 2021 to 2051, the ASIR, ASDR, and age-standardized DALYs will exhibit a declining pattern; however, the ASPR will initially experience a slight decrease before gradually rising again.

CONCLUSIONS: The global burden has significantly increased from 1990 to 2021. Projections indicate that over the next 30 years, the total number of patients will rise, while the age-standardized rates will show a slow downward trend.

PMID:39932600 | DOI:10.1007/s00415-025-12928-1

Arch Orthop Trauma Surg. 2025 Feb 11;145(1):160. doi: 10.1007/s00402-024-05742-3.

ABSTRACT

PURPOSE: This study aimed to evaluate whether the coronal plane alignment of the knee (CPAK) classification between three-dimensional (3D) measurement using computed tomography (CT) and two-dimensional (2D) measurement using long leg radiographs (LLR) match.

METHODS: A retrospective radiographic study compared pre-operative CT and LLR measurements in 69 patients undergoing primary total knee arthroplasty. The arithmetic hip-knee-ankle angle (aHKA), joint line obliquity (JLO), and CPAK types were calculated. A match in the CPAK classification was defined as “complete agreement” and agreement was considered partial if the CPAK was located in an adjacent column. If the discrepancy was more than one column, then it was recorded as no agreement.

RESULTS: The mean aHKA was – 0.6° ± 4.4° in 3D measurement and – 1.1° ± 4.3° in 2D measurement (p = 0.42). The mean JLO was 174.2° ± 3.5° in 3D measurement and 175.2° ± 3.6° in 2D measurement (p = 0.07). There was no statistically significant difference in either aHKA or JLO obtained by the two measurement methods, each within 1°. However, the complete agreement was confirmed in only 60.8% of cases. After incorporating even partial agreements including neighboring columns, the agreement rate was 91.2%. The disagreement was noticed in 8.8% of the cases.

CONCLUSION: The 3D measurement method enables aHKA and JLO calculations similar to those of 2D measurements. However, complete agreement with the CPAK classification in all cases was not obtained. On the other hand, 2D measurement has the advantage that JLO can be easily appreciated and remais more intuitive for surgeons.

LEVEL OF EVIDENCE: III.

PMID:39932590 | DOI:10.1007/s00402-024-05742-3

Eur J Nutr. 2025 Feb 11;64(2):85. doi: 10.1007/s00394-025-03604-1.

ABSTRACT

BACKGROUND: Increasing global pediatric respiratory diseases require understanding modifiable factors affecting lung function. We explored the association between dietary patterns, nutrients and the risk of expiratory airflow limitation (EAL) in children and adolescents.

METHODS: Dietary intake was collected using a validated food frequency questionnaire (FFQ) with 110 food items. Factor analysis was employed to determine dietary patterns. Pulmonary function was measured using a medical-grade pulmonary function analyzer. EAL was defined as the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV₁/FVC) < 0.8.

RESULTS: A total of 611 EAL cases occurred in 3,204 participants, with a prevalence of 19.07%. Four primary dietary patterns were identified (animal, healthy, sweet, and plant foods), which explained 44% of the variance in food consumption. The plant foods pattern (fourth quartile vs. first quartile intake) was associated with a reduced risk of EAL (Odds Ratio [OR] = 0.71, 95% Confidence Interval [CI]: 0.53, 0.94; P_{for trend} < 0.02). Higher fruit consumption (high vs. low) in plant foods pattern was associated with lower EAL risk (OR = 0.79, 95% CI: 0.62, 0.99, P_{for trend} = 0.04). Every standard deviation increase in foods (Chinese sauerkraut, pickled foods) and nutrients (total dietary fiber, soluble dietary fiber, and pyridoxine) in plant foods was all positively associated with FEV₁ /FVC (all P < 0.05).

CONCLUSIONS: Long-term intake of plant foods pattern enriched with dietary fiber and pyridoxine is promising for lung function protection in children and adolescents.

PMID:39932587 | DOI:10.1007/s00394-025-03604-1

Eur J Pediatr. 2025 Feb 11;184(2):186. doi: 10.1007/s00431-024-05957-x.

ABSTRACT

The escalating therapeutic use of methadone has coincided with an increase in accidental ingestions, particularly among children ≤ 5 years. This study utilized machine learning (ML) methodologies on data from the National Poison Data System (NPDS) to predict pediatric methadone poisoning outcomes to enhance clinical decision-making. We analyzed 140 medical parameters from pediatric patient records. Pre-processing steps, including synthetic oversampling, addressed the imbalanced distribution of the outcome variable. We evaluated various ML models in multiclass classification tasks. Random forest showed versatility with an accuracy of 0.96 and a strong receiver operating characteristic area under the curve (ROC AUC) (0.98). Meanwhile, the support vector machine (SVM) had the highest negative predictive value (NPV) (0.64). Shapley Additive exPlanation (SHAP) analysis identified key predictors such as coma, cyanosis, respiratory arrest, and respiratory depression for predicting serious outcomes.

CONCLUSION: This research emphasizes the utility of ML in clinical settings for early detection and intervention in methadone poisoning events in children, highlighting the synergy between data science and clinical expertise.

WHAT IS KNOWN: • The increased use of methadone for treatment has been associated with a rise in accidental ingestions, particularly in children under five years old. • Methadone poisoning in young children can lead to severe outcomes, including respiratory depression and coma, requiring urgent medical intervention.

WHAT IS NEW: • Machine learning models, particularly Random Forest and Bagging, outperform traditional methods in predicting methadone poisoning outcomes in children. • SHAP analysis provides novel insights into key predictors of severe outcomes, enabling improved clinical decision-making and risk stratification.

PMID:39932576 | DOI:10.1007/s00431-024-05957-x