Nevin Manimala

J Surg Res. 2025 Nov 22;316:53-58. doi: 10.1016/j.jss.2025.10.031. Online ahead of print.

ABSTRACT

INTRODUCTION: Standardized letters of recommendation (SLORs) have been adopted in colon and rectal surgery to reduce bias and improve consistency in applicant evaluation. Despite their widespread use, concerns remain about their limited ability to distinguish between applicants and their susceptibility to inflated ratings and narrative bias. This study aims to identify program directors’ perspectives on the current SLOR and guide the development of an improved tool to improve utility, fairness, and meaningful assessment in the selection process.

METHODS: A needs assessment survey was distributed to all Accreditation Council for Graduate Medical Education-accredited colon and rectal surgery residency program directors via the American Program Directors in Colon and Rectal Surgery listserv in Spring 2025. It included 7 Likert-style questions (including a 26-item rating matrix) and 5 free-text questions designed to assess satisfaction and perspectives on what should be included in a revised SLOR. Descriptive statistics were used to analyze quantitative responses; qualitative responses were thematically coded. Results were presented for comment at the American Program Directors in Colon and Rectal Surgery annual meeting and feedback was collected. A new SLOR form was created.

RESULTS: Fifty-two program directors responded (70% participation rate). While 62% found the current SLOR somewhat useful, only 27% rated it as very useful. Primary concerns included lack of discrimination due to inflated ratings, superlative narrative comments, and inconsistent use across institutions. Clinical judgment (98%), professionalism (93%), and interpersonal skills (91%) were identified as the most valued domains. Respondents reported mixed views on the value of narrative comments and identified the current “weakness” field as unhelpful or harmful. Suggestions for improvement included a more meaningful rating scale, structured free-text prompts with character limits, and clearer anchors for competency assessment. A revised SLOR incorporating these features was pilot-tested and refined.

CONCLUSIONS: Colorectal surgery program directors express limited satisfaction with the current SLOR due to poor discriminatory capacity and inconsistent narrative content. An updated form-developed through user feedback and best practices in evaluation-was created to enhance clarity, fairness, and utility in the application process. Its effectiveness will be assessed after implementation in the 2025 match cycle. These findings may guide SLOR redesigns in other specialties seeking to enhance holistic and equitable applicant assessment.

PMID:41275532 | DOI:10.1016/j.jss.2025.10.031

J Pediatr Endocrinol Metab. 2025 Nov 25. doi: 10.1515/jpem-2025-0540. Online ahead of print.

ABSTRACT

OBJECTIVES: Nutrition education is important for managing type 2 diabetes (T2D), and how much knowledge is retained after nutrition education for new onset diabetes is challenging to assess. We hypothesize that deployment of a nutrition assessment will reinforce nutrition knowledge in newly diagnosed youth with T2D.

METHODS: An exploratory quality improvement project was conducted to evaluate nutrition knowledge retained following new diagnosis of T2D. We implemented an 18-item nutrition assessment (at the first or second outpatient visit) evaluating nutrition label reading, hypoglycemia/hyperglycemia management, insulin management, and physical activity. Data was collected from the medical record, and descriptive and summary statistics were performed.

RESULTS: Quizzes were administered to 19 patients and their caregivers, mean patient age 14.9 ± 2.1 years, 68 % female, 68 % NH Black, 79 % publicly insured, with mean HbA1c 11.3 % at diagnosis, and 8.2 % at time of assessment. Mean overall nutrition assessment score was 14/18 (76 %). Patients scored well on questions about insulin (87 % correct) and physical activity (90 % correct) but needed additional reinforcement on questions about general nutrition (61 % correct) and acute and chronic complications of diabetes (64 % correct). Patients who had a lower HbA1c at follow-up scored higher on the quiz (p=0.037). Dietitians commented that the assessments allowed them to gain “quick insight” into patients’ baseline knowledge, which enabled more tailored nutrition education with each patient.

CONCLUSIONS: Implementation of nutrition assessments during comprehensive diabetes visits is feasible and facilitates nutrition education with the patient and/or caregiver in an engaging manner. Reinforcement of nutrition education is critical for type 2 diabetes management and outcomes.

PMID:41275517 | DOI:10.1515/jpem-2025-0540

Nutr Rev. 2025 Nov 23:nuaf222. doi: 10.1093/nutrit/nuaf222. Online ahead of print.

ABSTRACT

CONTEXT: Excessive salt intake is a well-established, modifiable risk factor for hypertension and cardiovascular disease. Although reducing salt consumption lowers blood pressure (BP), the quantitative association across intake levels, subgroup differences, and the influence of salt-intake assessment methods remain uncertain.

OBJECTIVE: To evaluate the association between salt-intake levels and BP across randomized controlled trials using predefined intake categories and to explore study-level continuous trends.

DATA SOURCES: The PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China Knowledge Network, Wanfang, China Science and Technology Journal Database (VIP), and Sinomed databases were searched from inception to December 2024, without language restrictions.

DATA EXTRACTION: Two reviewers independently screened records using prespecified PICOS criteria, extracted study characteristics and outcomes (systolic and diastolic BPs), and assessed risk of bias with the RoB2 tool. Discrepancies were resolved by discussion or third-reviewer adjudication. Salt was used as the primary exposure metric (measured in grams per day; conversion: 1 g sodium = 2.54 g salt).

DATA ANALYSIS: Random-effects meta-analyses compared standardized intake categories (high >15 g d-1; moderate 5-15 g d-1; low <5 g d-1). Prespecified study-level meta-regression was conducted as an exploratory assessment of continuous trends. Subgroup and sensitivity analyses considered salt sensitivity, age, intervention duration, comorbid conditions, geographic region, publication year, and potassium handling. Publication bias diagnostics were performed where applicable.

CONCLUSIONS: Across 43 randomized controlled trials (1983-2024), higher amounts of salt intake were associated with higher BP, whereas lower intake was associated with larger BP reductions, demonstrating a graded association across intake categories. Exploratory study-level continuous trends were not statistically significant, consistent with residual heterogeneity, exposure measurement error, and adherence variation. These findings support individualized salt-reduction strategies and robust public-health measures, including food reformulation and national salt-reduction programs, to reduce the burden of hypertension and cardiovascular disease.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration No. CRD42024617388.

PMID:41275512 | DOI:10.1093/nutrit/nuaf222

Lab Med. 2025 Nov 23:lmaf072. doi: 10.1093/labmed/lmaf072. Online ahead of print.

ABSTRACT

INTRODUCTION: Cell-derived microparticles that promote coagulation can lead to transfusion-related complications. Although age-dependent changes in hemostasis are known, the impact of donor age on microparticle concentration variability remains largely unexplored. We sought to determine microparticle concentrations and investigate their relationship with donor age.

METHODS: Whole-blood samples were collected from volunteers aged 17 to 60 years using K3EDTA as an anticoagulant. Donors were allocated to 1 of 5 age groups. Flow cytometric analysis and counting beads were used to determine microparticle concentrations and their origins.

RESULTS: A cross-sectional study of 394 blood donors revealed a mean (SD) total microparticle count of 25 693 (1578), 26 956 (976), 26 979 (989), 24 886 (987), and 271 331 (1355) particles/µL in blood donors aged 17 to 20, 21 to 30, 31 to 40, 41 to 50, and 51 to 60 years, respectively. Similarly, there were no statistically significant differences in the concentrations of red blood cell (RBC)-derived microparticles, platelet-derived microparticles, or leukocyte-derived microparticles among the donor age groups. Linear regression analysis revealed that the r2 values between the total microparticle, RBC-derived microparticle, platelet-derived microparticle, and leukocyte-derived microparticle concentrations in whole blood and donor age were less than 0.01.

DISCUSSION: Our assessment of microparticle concentration across different blood donor age groups revealed age-independent variability in microparticle levels. These findings enhance our understanding of how donor factors influence microparticle values.

PMID:41275511 | DOI:10.1093/labmed/lmaf072

Psychol Health Med. 2025 Nov 23:1-18. doi: 10.1080/13548506.2025.2587970. Online ahead of print.

ABSTRACT

OBJECTIVES: The consequences such as the destruction of this study was conducted in order to examine the impact of concerns for sustainable food and future on state-trait anxiety levels of individuals living in the earthquake zone.

METHODS: Being a descriptive study, it was conducted with 554 individuals who experienced the earthquake in February 2023. Socio-demographic ınformation questionnaire and statefulness-continuity anxiety ınventory were used for data collection. In the study, independent samples t-test, ANOVA and multiple-regression analysis were used.

RESULTS: The mean age of the participants was found to be 34.49 ± 13.63. There was a statistical significance between state and trait anxiety levels and the anxiety about the future, access to food, food safety, food storage, food hygiene, food processing and sheltering.

CONCLUSION: It was found that 20.2% of the change in the level of state anxiety of the participants was about the future, about having access to enough food for themselves and thier families, and about sheltering. Additionally, 10.8% of the variance in trait anxiety levels was attributed to concerns about the safety of accessible food, access to sufficient food for themselves and their families, and future housing.

PMID:41275506 | DOI:10.1080/13548506.2025.2587970

Neurol Res. 2025 Nov 23:1-14. doi: 10.1080/01616412.2025.2592857. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the efficacy and safety of adjunctive middle meningeal artery embolization (MMAE) versus standard care alone in symptomatic, non-emergent chronic subdural hematoma (CSDH) based on randomized trials data.

METHODS: A systematic search (inception – Nov 2024) identified eligible RCTs. Quality was assessed with the Cochrane Risk of Bias tool. Pooled analysis compared recurrence, progression, or surgical rescue at 90 or 180 days between adjunctive MMAE and control. MMAE-related serious adverse events (SAEs) were pooled as logit-transformed proportions with Clopper-Pearson intervals and mRS changes were pooled using binomial variance in R (v4.1.2).

RESULTS: 3 RCTs (EMBOLISE, STEM, MAGIC-MT) with 1432 patients (MMAE :706 [49.30%], Control :726 [50.70%]) met our inclusion criteria. Mean age was 72.50 ± 10.90 years , and 1104 patients (82.70%) were male . Common symptoms included headache (61.10%) . Antithrombotic use was 23.0% and 50.80% of hematomas were left-sided. Mean hematoma volume was 156.23 mm³ and thickness was 21.3 mm . The risk of recurrence, progression, or surgical rescue was lower with MMAE (RR = 0.50, 95% CI: 0.37-0.69). No difference was seen in all-cause mortality (RR = 1.01, 95% CI: 0.09-10.95) or stroke (RR = 1.07, 95% CI: 0.28-4.13). SAEs related to MMAE were 3% (95% CI:0.00-0.31). Baseline mRS (0-2) was similar between groups (MMAE:0.97, 95% CI:0.08-1.00; Control:0.97, 95% CI:0.06-1.00) and remained comparable at 90 days (MMAE:0.83, 95% CI:0.61-0.94; Control:0.82, 95% CI:0.68-0.91).

CONCLUSIONS: Adjunctive MMAE reduces the risk of recurrence, hematoma progression, or the need for surgical rescue compared to standard care, without increasing all-cause mortality or stroke, while achieving comparable functional outcomes (mRS 0-2) at 90 days.

PMID:41275487 | DOI:10.1080/01616412.2025.2592857

Orv Hetil. 2025 Nov 23;166(47):1869-1876. doi: 10.1556/650.2025.33426. Print 2025 Nov 23.

ABSTRACT

INTRODUCTION: Newborn hearing screening plays a crucial role in the early detection and treatment of hearing loss.

OBJECTIVE: This study presents a database developed by Hungarian software engineers, designed for the collection and analysis of data on hearing screening and subsequent care. The National Newborn Hearing Screening Registry has been collecting data since September 1, 2019, on mandatory objective hearing screening conducted in neonatal units and neonatal intensive care centres, along with confirmations from five designated verification centres. The aim of the study is to describe the structure of the database and to analyze the data collected.

METHOD: The registry aggregates data from screening devices performing brainstem-evoked response audiometry (BERA) via machine-to-machine communication. Indicators were defined and analyzed using registry data collected over a five-year period (2020-2024) and evaluated annually.

RESULTS: During the study period, hearing screening data for a total of 345,945 newborns were recorded in the database. According to the registry data, screening coverage was 80.16%. Among screened newborns, 6.14% were referred due to suspected hearing loss. Only 16.81% of those who had a positive screening result underwent audiological evaluation at a verification centre, according to the transferred data.

DISCUSSION: Data reported to the registry indicate that newborn hearing screening is not yet comprehensive. The high rate of suspected cases places an increased burden on the health care system and affected families. There is a low rate of data transfer to verification centres, raising concerns regarding access to adequate audiological diagnostics and treatment for screened children.

CONCLUSION: These findings underscore the importance of standardized data collection for effective hearing rehabilitation. The results provide insight into care pathways and highlight critical deficiencies in the system that require improvement. Data collection alone is insufficient; continuous data and patient follow-up are essential. Enhancing the involvement and awareness of health visitors and pediatricians is also key, which constitutes one of the main objectives of this study. Orv Hetil. 2025; 166(47): 1869-1876.

PMID:41275470 | DOI:10.1556/650.2025.33426

Surg Endosc. 2025 Nov 23. doi: 10.1007/s00464-025-12392-y. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive liver resection and ablation depend on surgical planning and image guidance. Surgical planning is normally based on preoperative imaging. The position, shape, and volume of the abdominal organs change during laparoscopy, which challenges image registration and reduces surgical precision. This study aims to analyze the morphological changes of the liver and spleen from pre- to intraoperative (with pneumoperitoneum) computed tomography (CT) images.

METHODS: We used portal venous phase pre- and intraoperative CT images from 15 patients who underwent laparoscopic liver ablation in general anesthesia under 12 mmHg pneumoperitoneum at Rikshospitalet, Oslo University Hospital, Oslo, Norway. A rigid registration, based on spinal landmarks, was used to register intraoperative to preoperative CT images. Morphological features were extracted and statistically analyzed for the liver and spleen.

RESULTS: The liver volume decreased by 12% from the preoperative to the intraoperative CT scan. The mean cranial movement of the liver was 45 mm between pre- and intraoperative CT images. A few morphological radiomic features changed significantly for both liver and spleen.

CONCLUSION: To the best of our knowledge, this is the first published study in humans to analyze the morphological changes of the liver and spleen during pneumoperitoneum. The results show a significant reduction in liver volume and change in shape and position of the liver during such laparoscopy. This deformation from preoperative to intraoperative imaging poses significant challenges for image registration, which is crucial for surgical navigation. These findings highlight the need for updated intraoperative navigation using imaging and registration to ensure accurate surgical planning.

PMID:41275463 | DOI:10.1007/s00464-025-12392-y

Anal Bioanal Chem. 2025 Nov 23. doi: 10.1007/s00216-025-06214-2. Online ahead of print.

ABSTRACT

Nitrosamines are classified as carcinogenic chemicals and are a growing public health concern. They have been widely documented in food, which is the main route of human exposure. However, there is little research on their appearance in biological samples, such as feces. This study presents a methodology for determining the concentration of 14 nitrosamines in cooked hams and fecal samples obtained from animals fed with them, allowing changes in the nitrosamine concentration during digestion to be identified. The novelty of this research lies in the fact that it is the first to evaluate whether incorporating polyphenols into cooked ham influences the levels of NAs in feces using an animal model. The proposed analytical method based on ultrasound-assisted extraction of the nitrosamine high-performance liquid chromatography and mass spectrometry using a triple quadrupole achieved low limits of quantification (in the 0.44-47 ng g^-1 range), good precision (coefficient of variation of less than 12.4%), and trueness for both matrices. A total of 68 samples were analyzed, with five nitrosamines detected in the cooked ham samples and seven in the fecal samples. Statistical analysis revealed that the nitrosamine profile mainly depended on the biological matrix. While the preservative did not significantly affect the nitrosamine profile in cooked ham, it did modulate the nitrosamine concentration in feces. Specifically, diets containing polyphenols significantly reduced fecal nitrosamine levels compared to diets containing nitrites, suggesting a possible protective role against the formation of these compounds in the gut.

PMID:41275462 | DOI:10.1007/s00216-025-06214-2

Environ Sci Pollut Res Int. 2025 Nov 23. doi: 10.1007/s11356-025-37240-3. Online ahead of print.

ABSTRACT

Diatom-based monitoring offers a cost-effective and reliable tool for assessing water quality in developing countries. As natural bio-indicators, diatoms respond sensitively to environmental changes, making them ideal for long-term ecological monitoring. The current paper aims to examine the potential use of a diatom-based tool at the genus level (generic diatom index (GDI)), when flora at the species level is poorly known, for water quality assessment in the Cambodian river systems. Nineteen monitoring sites within the Sangker River catchment have been chosen for the study, while eleven physicochemical parameters and trophic diatom index (TDI) values have been used to predict the response of GDI values. Basic statistical tests and linear regression (LM) were used to describe the spatio-temporal variation of water quality based on GDI classification. A total of 78 diatom genera were recorded, dominated by biraphid taxa (67%), and 13 genera accounted for ~ 90% of total abundance. GDI classification indicated that 10% of sites were of good quality, 53% moderate, and 37% poor, with water quality declining downstream and in areas influenced by urban and agricultural activities. The linear model revealed that GDI was significantly associated with nutrient- and oxygen-related parameters (orthophosphate, dissolved oxygen, and chloride) and correlated strongly with TDI (adjusted R² = 0.96). Seasonal variation was also significant, highlighting the importance of temporal dynamics in tropical rivers. The current findings provided clear evidence of potential uses of diatom indices to assess the water quality in the Sangker River and other Cambodian river networks even at the genus level of determination. More importantly, diatom indices could be potential tools for long-term biomonitoring in developing countries like Cambodia, where the data and resources are limited. Consequently, the study suggested further investigation on the ecological sensitivity of diatom flora to localize their values, improving GDI classification performance within the tropical environment.

PMID:41275459 | DOI:10.1007/s11356-025-37240-3