Nevin Manimala

BJS Open. 2025 Dec 29;10(1):zraf155. doi: 10.1093/bjsopen/zraf155.

ABSTRACT

BACKGROUND: The Swedish National Board of Health and Welfare centralized the surgical care of patients with anorectal malformations from four to two centres in 2018. This retrospective review compares short-term complications after anorectal reconstruction before and after centralization.

METHODS: Hospital records of all infants in Sweden who underwent reconstruction of an anorectal malformation between 1 July 2013 and 30 June 2023 were reviewed and divided in two 5-year periods: before and after centralization. The main outcomes were unplanned readmissions and surgical procedures requiring general anaesthesia up to 90 days after reconstruction, as well as early complications classified according to the Clavien-Madadi system up to 30 days after the procedure.

RESULTS: Before centralization, 173 infants underwent anorectal reconstruction, compared with 176 infants after centralization. Patient groups were comparable with respect to associated malformations and type of anorectal malformation. Before centralization, 80 infants (46.2%) had a colostomy before the anorectal reconstruction, compared with 89 infants (50.6%) after centralization (P = 0.454). Anorectal reconstruction was performed at a median age of 61 and 47 days of age before and after centralization, respectively (P = 0.794). Unplanned readmissions up to 90 days after anorectal reconstruction were needed in 12 infants (6.9%) before centralization, compared with 22 infants (12.5%) after centralization (P = 0.104). Unplanned surgical procedures under general anaesthesia were required in 20 (11.6%) and 22 (12.5%) infants before and after centralization, respectively (P = 0.870). Complications (Clavien-Madadi grade III-V) within 30 days after anorectal reconstruction were seen in 16 (9.2%) and 12 (6.8%) infants before and after centralization, respectively (P = 0.436).

CONCLUSION: Centralization of the surgical care of patients with anorectal malformations in Sweden did not seem to have an impact on short-term complications.

PMID:41557458 | DOI:10.1093/bjsopen/zraf155

Adicciones. 2025 Dec 23;37(4):383-394. doi: 10.20882/adicciones.2464.

ABSTRACT

Wernicke’s encephalopathy (WE) is caused by thiamine deficiency (TD) whose main risk factor is alcohol use disorder. Pathogenic mechanisms associated with WE include mitochondrial dysfunction, oxidative stress and neuroinflammation. This study aims to explore the gene expression signature of certain candidate genes related to neuroinflammation, mitochondrial dysfunction and thiamine metabolism in the hippocampus from animals exposed to chronic alcohol consumption, thiamine deficiency or the combination of both. Male Wistar rats (n=42) were randomly assigned to 4 experimental groups: control (C) receiving tap water or tap water plus thiamine (0.2 g/L), chronic alcohol (CA) forced ingestion for 36 weeks, TD diet and pyrithiamine for 12 days (TDD) and CA combined with TDD. The relative gene expression of neurotrophic factors (Ptn, Mdk, Ptprz), proinflammatory molecules (Tlr4, Ccl2 and Hmgb1), mitochondrial homeostatic factors (Mfn1 and Mfn2) and thiamine metabolism (Tpk1) was analyzed in RNA isolated from the hippocampus across all experimental groups. Differences in gene expression were assessed using non-parametric tests (Kruskal-Wallis). Ptprz mRNA levels tended to be downregulated in the TDD group compared to controls (p=0.06, non-significant) and levels were significantly decreased related to the CA+TDD group (p<0.05). TDD group showed the lowest expression levels of Ptn across all experimental groups, and this decrease was statistically significant compared to the control and CA groups (p<0.05). Our findings indicate a differential gene expression profile of the PTN-MDK-PTPRZ axis in the hippocampus of rats receiving a TD diet but not in the rest of the WE models analyzed (CA and CA+TDD).

PMID:41557452 | DOI:10.20882/adicciones.2464

Adicciones. 2025 Dec 23;37(4):311-322. doi: 10.20882/adicciones.2428.

ABSTRACT

Soybeans contain different isoflavones (mainly daidzein) which work as reversible inhibitors of aldehyde-dehydrogenase-2 enzyme (ALDH2). This activity has been related in animal experiments with a reduction of cocaine use. Our aim was to carry out an open-label pilot study to evaluate the possible efficacy of soy isoflavones as natural inhibitor of ALDH2 in cocaine use disorder. Nine subjects with severe cocaine use disorder participated in a single-center, open, non-controlled trial during 12 weeks of treatment and 4 of follow-up. The Substance Use Report (SUR) showed that three subjects (33.3%) reported a cocaine consumption of less than 20% (80% non-use days) from 10 to 12 weeks of the treatment period, from two (22.2%) at baseline, although non-significant. A finding that could not be confirmed by the detection of urine metabolites of cocaine. Seven participants (77.8%) completed the study at 16 weeks and one (1.11%) at 12 weeks. Urine concentrations of isoflavones, demonstrated that eight participants (88.9%) followed the treatment along the study. The Severity Dependence Scale (SDS) score showed a significant decrease between baseline to 12 weeks, baseline to 16 weeks and 12 to 16 weeks; the Brief Substance Craving Scale (BSCS) and Cocaine Selective Severity Assessment (CSSA) decreased their values but not significantly. Significant improvements in different areas of the SF-36 scale were observed: body pain scores decreased from baseline to 16 weeks statistically significant; social function improved its scores from baseline to 12 weeks and from baseline to 16 weeks significantly; the rest of areas increased their scores but not significantly. These findings show lower ratios of cocaine use days, and high retention and adherence to treatment although the acquisition of complete abstinence was not observed. Soy isoflavones could be considered a potential treatment in future research, to be confirmed by placebo-controlled studies with adequate sample size.

PMID:41557447 | DOI:10.20882/adicciones.2428

Otol Neurotol. 2026 Jan 20. doi: 10.1097/MAO.0000000000004830. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze demographic disparities in the prevalence of cochleovestibular symptoms including hearing loss, tinnitus, and dizziness.

METHODS: The National Health and Nutrition Examination Survey (NHANES) database was queried for the prevalence of cochleovestibular symptoms among random samples of US survey participants between 1999 and 2018. Welch t test, mean difference, and χ2 analyses were performed to compare demographic differences between healthy and symptomatic patients. Multivariate logistic regression was also performed for each symptom.

RESULTS: Participants who reported having hearing loss (OR=3.93, P<0.001) or tinnitus (OR=2.04, P<0.001) were significantly older than healthy individuals. However, older age was not a risk factor for having dizziness (P=0.281). Similarly, BMI was significantly higher among participants with hearing loss (OR=1.33, P<0.001) and tinnitus (OR=1.27, P<0.001), although this was not true of dizziness (P=0.992). Men had a higher likelihood of developing hearing loss (OR=1.75, P<0.001), whereas women had a higher likelihood of developing dizziness (OR=1.73, P<0.001). No significant gender difference was evident for tinnitus (P=0.304). Black, Hispanic, and multi-racial participants were less likely than White subjects to develop hearing loss or tinnitus (all P<0.001). In contrast, the odds of developing dizziness were greater among all ethnicities other than White; however, this greater odd was only statistically significant in Hispanics (P=0.033).

CONCLUSIONS: Cochleovestibular symptoms’ prevalence varies across US demographics and racial/ethnical groups. Knowledge of these disparities, whether the result of biological or societal effects, can help identify at-risk populations. These insights can further inform health care policy decisions and improve care delivery for patients affected by these disorders.

PMID:41557436 | DOI:10.1097/MAO.0000000000004830

Phys Rev Lett. 2025 Dec 31;135(26):261901. doi: 10.1103/3pcs-dxtn.

ABSTRACT

A search for the charmless baryonic decay B^{+}→Λ[over ¯]pp[over ¯]p is performed using proton-proton collision data recorded by the LHCb experiment, corresponding to an integrated luminosity of 5.4 fb^{-1}. The branching fraction for this decay is measured for the first time relative to that of the topologically similar decay B^{+}→J/ψK^{+}, with J/ψ→Λ[over ¯]pK^{-}. The branching fraction is measured to be B(B^{+}→Λ[over ¯]pp[over ¯]p)=(2.15±0.35±0.12±0.28)×10^{-7}, where the first uncertainty is statistical, the second is systematic, and the third arises from the uncertainty in the normalization channel branching fraction. The CP asymmetry is measured to be A_{CP}=(5.4±15.6±2.4)%, where the uncertainties are statistical and systematic. The background-subtracted invariant-mass distributions of Λ[over ¯]p and p[over ¯]p pairs exhibit pronounced enhancements at both kinematic thresholds, in contrast to a uniform phase-space distribution.

PMID:41557403 | DOI:10.1103/3pcs-dxtn

JAMA Neurol. 2026 Jan 20. doi: 10.1001/jamaneurol.2025.5329. Online ahead of print.

NO ABSTRACT

PMID:41557361 | DOI:10.1001/jamaneurol.2025.5329

JAMA Netw Open. 2026 Jan 2;9(1):e2552944. doi: 10.1001/jamanetworkopen.2025.52944.

ABSTRACT

IMPORTANCE: General mammography screening guidelines target women at average risk within a specified age range (age based) and do not consider absolute risk of individual women at a given age (risk based).

OBJECTIVE: To compare outcomes of mammography screening strategies that vary by 5-year risk of invasive breast cancer vs age-based strategies.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used 2 established Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer models and simulated US women born in 1980 who were aged 40 years or older without a prior history of breast cancer. Modeling analyses were conducted from April 2023 to April 2025.

INTERVENTION: Digital breast tomosynthesis delivered via 50 screening strategies (3 age based and 47 risk based) vs a no-screening scenario. Five-year absolute invasive breast cancer risk was based on the validated Breast Cancer Surveillance Consortium, version 3 calculator. Women’s 5-year breast cancer risk was categorized as low, average, intermediate, or high.

MAIN OUTCOMES AND MEASURES: Primary outcomes included lifetime number of breast cancer deaths averted and false-positive screening recalls. Lifetime outcomes were averaged across models and expressed per 1000 women screened.

RESULTS: Nine risk-based screening strategies were associated with a comparable or greater number of deaths averted than biennial age-based screening from ages 40 to 74 years (B40-74) (range across strategies for mean model estimates, 6.8-7.5 per 1000 women vs 6.8 per 1000 women) as well as reduced false-positive recalls by 8% to 23% (1050-1257 per 1000 women for risk-based screening strategies vs 1365 per 1000 women for B40-74). For example, a risk-based approach using a combination of biennial screening (for women at low risk aged 55-74 years, at average risk aged 50-59 years, at intermediate risk aged 45-54 years, and at high risk aged 40-49 years) and annual screening (for women at average risk aged 60-74 years, at intermediate risk aged 55-74 years, and at high risk aged 50-74 years) would be associated with 6% more breast cancer deaths averted than B40-74 (7.2 vs 6.8 per 1000 women) and 13% fewer false-positive recalls (1190 vs 1365 per 1000 women). Results were consistent across the 2 CISNET models, and the relative difference in breast cancer deaths averted between B40-74 and risk-based screening strategies was more pronounced than for life-years gained.

CONCLUSIONS AND RELEVANCE: In this decision analytical modeling study of breast cancer screening, population risk-based screening using 5-year invasive breast cancer risk was associated with similar or greater benefits than age-based screening as well as reduced false-positive recalls. As personalized medicine advances, risk-based screening is poised to become a cornerstone of breast cancer prevention, offering a more nuanced and tailored approach to patient care.

PMID:41557352 | DOI:10.1001/jamanetworkopen.2025.52944

JAMA Netw Open. 2026 Jan 2;9(1):e2554686. doi: 10.1001/jamanetworkopen.2025.54686.

ABSTRACT

IMPORTANCE: Community water fluoridation (CWF) is a widely implemented public health intervention aimed at preventing dental caries. However, concerns have emerged about potential unintended birth outcomes of fluoride exposure, particularly birth weight, which is a widely accepted summary measure of infant health and has been found to be associated with later-life health and human capital.

OBJECTIVE: To evaluate the association between prenatal exposure to CWF and birth outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted using an event-study analysis with a difference-in-differences (DID) approach that exploited the staggered rollout of CWF across US counties from January 1968 to December 1988. The study included birth outcomes from singleton births obtained from the National Vital Statistics System’s Natality Detail Files. The analysis compared within-county changes in birth outcomes before and after the introduction of CWF, using counties that never fluoridated or had not yet fluoridated as the control. Data were analyzed between February 4 and October 28, 2025.

EXPOSURE: County-level CWF.

MAIN OUTCOMES AND MEASURES: The primary outcome was change in mean birth weight, and secondary outcomes were incidence of low birth weight (<2500 g), gestational length (weeks), and incidence of prematurity (gestational age <37 weeks). Community water fluoridation exposure was measured as the population-weighted share of county residents served by fluoridated water based on Centers for Disease Control and Prevention Fluoridation Census data.

RESULTS: The study sample included 11 479 922 singleton births (mean [SD] gestational age, 39.5 [0.8] weeks; 51.2% boys; mean [SD] birth weight, 3337.4 [172.8] g; highest mean [SD] maternal age proportions, 0.36 [0.13] aged 20-24 years and 0.27 [0.12] aged 25-29 years) across 677 counties (408 CWF treated [60.3%] and 269 [39.7%] never treated) over the 21-year period, aggregated to the county-month level. No evidence of an association of CWF with birth weight or other birth outcomes was found (DID estimate, -0.53; 95% CI, -4.75 to 3.70). Event-study estimates showed no discernible pretreatment trends and no significant changes following CWF adoption, with estimates small in magnitude across all posttreatment periods, ranging from -8.44 g (95% CI, -20.41 to 3.53 g) to 7.20 g (95% CI, -5.45 to 19.85 g). Findings were supported by sensitivity analyses incorporating state-specific time trends, alternative exposure thresholds, and tests for compositional changes in births.

CONCLUSIONS AND RELEVANCE: This cohort study of more than 11 million births found no association of CWF with adverse birth outcomes. These findings provide reassurance about the safety of CWF during pregnancy and underscore the value of rigorous causal designs in evaluating potential adverse effects of public health interventions.

PMID:41557351 | DOI:10.1001/jamanetworkopen.2025.54686

JAMA Netw Open. 2026 Jan 2;9(1):e2554797. doi: 10.1001/jamanetworkopen.2025.54797.

ABSTRACT

IMPORTANCE: Socioeconomic disparities in hospice care access are well recognized, but their structural drivers remain underexplored. Low-income patients with cancer often face compounded informational, psychosocial, and financial barriers at the end of life.

OBJECTIVE: To examine how limited cultural capital, disease-related stigma, and class-based disadvantage may be jointly associated with hospice care access among low-income patients with cancer in China.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive qualitative study was conducted at a tertiary hospital in southwestern China from July 2024 to July 2025. Adult patients with advanced cancer receiving government social assistance were purposively sampled.

MAIN OUTCOME AND MEASURES: Semistructured in-depth interviews were conducted, transcribed verbatim, and thematically analyzed using a 6-phase approach. Two researchers independently coded transcripts, with analytic consensus achieved through iterative discussion. NVivo 12 software was used for data management. Analysis occurred from August to October 2025.

RESULTS: Among 16 adults with advanced cancer (median [range] age, 55 years [late 30s to early 70s]; 9 men [56.2%]), 4 themes emerged: (1) Limited cultural capital was associated with cognitive and communicative barriers, including low health literacy, reliance on informal sources, and poor digital navigation. (2) Stigma surrounding cancer and death was associated with moral dilemmas and inhibition of open discussion of hospice. (3) Economic deprivation was associated with restricted care options, reinforced curative treatment priorities, and weakened access to social support. (4) Patients and families used resilience strategies, including peer networks, communication tactics, and value redefinition. These domains interacted synergistically; poverty was associated with reduced access to education and digital literacy, with exacerbated stigma internalization and discouraged care-seeking.

CONCLUSIONS AND RELEVANCE: This study found that cultural capital deficits, stigma, and socioeconomic hardship were jointly associated with a self-reinforcing cycle of hospice exclusion. These outcomes suggest that interventions must address these factors simultaneously by improving health literacy, reducing stigma, and expanding financial and systemic support.

PMID:41557349 | DOI:10.1001/jamanetworkopen.2025.54797

JAMA Pediatr. 2026 Jan 20. doi: 10.1001/jamapediatrics.2025.5866. Online ahead of print.

ABSTRACT

IMPORTANCE: Children born very preterm or with very low birth weight are at higher risk for executive function deficits, affecting attention, self-regulation, and problem-solving. Early developmental interventions have shown potential benefits, but their long-term effect on executive functioning remains uncertain.

OBJECTIVE: To evaluate whether an enhanced developmental intervention (EDI) initiated in the neonatal intensive care unit (NICU) and continued at home through the first 2 years improves executive function at school age in very preterm children.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis assessed school-aged outcomes from a randomized clinical trial of infants born with fewer than 32 weeks of gestation or with birth weight less than 1500 g from January 2016 to February 2019. Follow-up assessments were conducted from July 7, 2023, to August 16, 2024, at a single center in Porto Alegre, Brazil. Data analyses were completed from August to December 2024.

INTERVENTION: EDI compared with usual care.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the scaled scores of Developmental Neuropsychological Assessment, Second Edition, subtests, which measures auditory attention, inhibition, design fluency, and motor persistence. The examiner was masked to group allocation. Medical records identified children with neurodevelopmental conditions that precluded formal assessment. The effect size for the Mann-Whitney U test comparisons was calculated using the rank-biserial correlation. Binary logistic regression was used to compare performance in the primary outcomes. Sensitivity analyses were used for those lost to follow-up.

RESULTS: Of the original randomized clinical trial, 80 children (96% of those eligible) were assessed at a mean (SD) age of 7 (1) years; 34 children (43%) were female. Baseline characteristics were similar between groups. In the primary analysis of median scaled scores, children who received EDI demonstrated significantly better performance across all 4 executive function domains compared to usual care (median scores, 12-14 vs 2-9; r = 0.44-0.77; all P < .001). All results remained significant after Bonferroni correction (P < .0125), indicating medium to large effect sizes. In the secondary analysis of performance classification, EDI was associated with higher odds of expected performance in design fluency (odds ratio, 11.3; 95% CI, 4.08-31.7; P < .001). No statistically significant differences were observed for the remaining 3 domains.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial, early EDI, beginning in the NICU and extending through the first 2 years, contributed to sustained improvements in executive function in very preterm children. These findings support the long-term neurodevelopmental benefits of early intervention, with potential implications for academic and socioemotional outcomes in children from low- and middle-income settings.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02835612.

PMID:41557341 | DOI:10.1001/jamapediatrics.2025.5866