Nevin Manimala

Alzheimers Dement. 2024 Dec;20 Suppl 6:e084076. doi: 10.1002/alz.084076.

ABSTRACT

BACKGROUND: Recent preclinical studies have revealed a significant reduction in amyloid-β plaques and pro-inflammatory cytokines in Alzheimer’s disease (AD) mouse models following low-dose radiation therapy (LDRT). This phase II, multicenter, prospective, single-blinded, randomized controlled trial (NCT05635968, funding from Korea Hydro & Nuclear Power: Grant No. A21IP11) aims to investigate the efficacy and safety of whole-brain LDRT in patients with AD.

METHOD: Probable AD dementia patients (MMSE 13-24 & CDR 0.5-1) with evidence of amyloid pathology (confirmed by a positive 18F-flutemetamol PET scan) were randomly assigned to one of three groups. They received a total of six fractions of LDRT: Group A with total 0 cGy (sham irradiation), Group B with 24 cGy, and Group C with 300 cGy. The effectiveness of LDRT was assessed through 18F-flutemetamol PET, brain MRI and neurocognitive function tests at baseline, and at 6 and 12 months post-LDRT. The primary endpoint was the change in the ADAS-K-cog score. The secondary endpoints included the changes in 18F-flutemetamol PET, brain MRI, and scores of K-MMSE, CDR, CGA-NPI and K-iADL.

RESULT: A total of 15 patients (5 in each group) who completed 6 months post-LDRT follow-up were analyzed in this interim analysis. Baseline ADAS-K-cog (mean values in the order of group A, B, and C: 40.8 vs. 30.2 vs. 37.4, p = 0.111), CDR (1.0 vs 0.7 vs. 0.8, p = 0.141), K-MMSE (19.6 vs. 22.4 vs. 19.2, p = 0.125) scores were not statistically different across the three groups. After 6 months, mean differences in cognitive test scores compared to baseline were 3.4 vs. 0.2 vs 0.4 (ADAS-K-cog, p = 0.369), 0.6 vs 0.0 vs 0.0 (CDR, p = 0.089), and -1.8 vs. 0.8 vs. 1.2 (K-MMSE, p = 0.081). Compared to Group A, more subjects in experimental groups (B+C) showed improvement in K-iADL (0/5 in Group A vs. 4/10 in Group B+C) and CGA-NPI (0/5 in Group A vs. 5/10 in Group B+C). LDRT was well-tolerated in all patients without any adverse events.

CONCLUSION: Whole-brain LDRT for patients with AD was tolerable and demonstrated potential benefits in neurocognitive function tests. Quantitative imaging analysis will follow, and final results with the planned follow-up are awaited.

PMID:39782493 | DOI:10.1002/alz.084076

Alzheimers Dement. 2024 Dec;20 Suppl 6:e093562. doi: 10.1002/alz.093562.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) clinical trials led to the recent successes with monoclonal antibodies targeting amyloid, which opens up many new directions for research into treatment for AD in the future. Gaining greater understanding from these successes and failures will help researchers to focus their efforts on avenues that have the highest potential benefit.

METHOD: We performed a meta-analysis of over a hundred studies of 70+ AD treatments. A global statistical test (GST) combining ADAS-cog, ADCS-ADL and CDR-sb was used to assess the overall efficacy in these studies, in a fair way across multiple outcomes. Disease modifying treatment effects and symptomatic effects impacting all disease symptoms will perform better on this GST than treatments impacting only one symptom. In addition, a false positive effect is less likely to occur on all 3 outcomes simultaneously, making the GST a more reliable outcome for detecting true treatment effects. Composite scores, ADCOMS and iADRS, were used to target true disease progression in the lecanemab and donanemab phase 2 studies, respectively, and have similar advantages to a GST. A similar approach would have possibly averted much of the controversy surrounding the aducanumab approval.

RESULT: Some studies that were previously determined to be failures show some indication of positive effects. And conversely, some studies previously thought to be promising are shown to be more clearly failures. Meta-analyses combining similar treatments across programs illuminate overlooked mechanisms as well as more conclusive failures.

CONCLUSION: The success and failure of Alzheimer’s treatments is partly hidden by including 3 different domains of clinical efficacy: cognition, function and global. True treatment efficacy and true lack of efficacy are much easier to detect with multiple, combined outcomes.

PMID:39782484 | DOI:10.1002/alz.093562

J Cardiothorac Surg. 2025 Jan 8;20(1):46. doi: 10.1186/s13019-024-03227-3.

ABSTRACT

OBJECTIVES: Despite the advances in medicine, aortic dissection remains a cardiac surgery emergency with high mortality and morbidity rates. This study examined the effects of the Glue + Felt technique, which uses biological glue and felt to repair the proximal anastomotic site, on the outcomes of patients with acute type A aortic dissection.

METHODS: A total of 108 patients who underwent surgery for acute type A aortic dissection at our clinic between 2007 and 2020 were included in the study. The patients were divided into two groups: the “Glue + Felt Technique” and the “Bentall-De Bono” groups, based on the surgical technique used for the aortic root. The effects of these two techniques on the development of intraoperative and postoperative complications and survival rates were statistically analyzed.

RESULTS: The Glue + Felt technique was used for 76 patients, while the Bentall-De Bono technique was used for 32 patients. The Kaplan-Meier analysis revealed significant differences in survival rates between the two groups over the entire follow-up period, both with and without propensity score matching (p < 0.001 and p = 0.02, respectively). However, no significant differences were observed in comparisons beyond the first 30 days of follow-up, either with or without propensity score matching (p = 0.573 and p = 0.561, respectively). The main factors contributing to this difference were the duration of cardiopulmonary bypass and aortic cross-clamp time (p < 0.05). During the average follow-up period of 46.2 ± 31.6 months, no re-intervention was required in patients from the Glue-Felt technique group.

CONCLUSIONS: The mortality rate in aortic dissection surgery is higher with more extensive surgical intervention as the duration of cardiopulmonary bypass and aortic cross-clamp time increases. Repairing the lumen and reducing operation time in suitable patients using the Glue-Felt technique for the proximal anastomotic site positively impacts postoperative complications and improves in-hospital and 30-day survival rates, without increasing long-term re-intervention rates.

PMID:39780221 | DOI:10.1186/s13019-024-03227-3

J Orthop Surg Res. 2025 Jan 9;20(1):23. doi: 10.1186/s13018-025-05454-3.

ABSTRACT

BACKGROUND: Osteoporosis, a skeletal disorder affecting nearly 20% of the global population, poses a significant health concern, with osteoporotic vertebral body fractures (VBF) representing a common clinical manifestation. The impact of osteoporotic sintering fractures in the thoracolumbar spine on the sagittal lumbar profile is incompletely understood and may lead to the onset of clinical symptoms in previously asymptomatic patients.

METHODS: This retrospective single-center study analyzed data from patients presenting with osteoporotic spine fractures between 2017 and 2022. Patient selection involved stringent inclusion and exclusion criteria, focusing on radiologically documented osteoporotic sintering fractures in the thoracolumbar junction (TH11-L2). Clinical parameters were recorded and analyzed, alongside lateral-view radiographic assessments utilizing the IDS 7-PACS^®-System (Sectra, Linköping, Sweden). Measurements included total lumbar lordosis, lordosis caudal to the fracture, kyphosis of the fractured vertebra, and sacral slope. Statistical analysis was conducted using SPSS 27 (IBM, Armonk, USA).

RESULTS: Thirty patients (73.3% female, 26.7% male) met the inclusion criteria, with an average age of 82.4 years. Analysis revealed a significant increase in kyphosis of the fractured vertebra in the thoracolumbar spine (p < 0.0001) following further sintering of osteoporotic VBF with increased lordosis caudal to the fracture (p < 0.0001). Total lumbar lordosis remained unchanged, alongside sacral slope measurements (p = 0.612 and p = 0.863, respectively).

CONCLUSION: Progressive sintering of osteoporotic fractures in the thoracolumbar junction accentuates lordosis in underlying segments, potentially exacerbating degenerative changes and symptomatic manifestations. Thus, prioritizing interventions aimed at preventing progressive sintering and restoring sagittal balance is paramount in optimizing treatment outcomes for affected individuals.

PMID:39780214 | DOI:10.1186/s13018-025-05454-3

BMC Med Educ. 2025 Jan 8;25(1):33. doi: 10.1186/s12909-025-06642-9.

ABSTRACT

BACKGROUND: Visual Thinking Strategies (VTS) is an evidence-based pedagogical approach that uses art analysis and structured inquiry to enhance observation, critical thinking, and teamwork, especially in medical training for clinical skills development. This study aimed to compare the short-term and delayed follow-up effects of integrating Visual Thinking Strategies and Visual Thinking Activity (VTA) tasks based on the PRISM Model with Observation Exercises (OE) on medical students’ observation skills, including the number of observations, number of words used, and time spent describing observations.

METHOD: This pre- and post-test experimental study with a control group was conducted among first-year medical students at Gonabad University of Medical Sciences during the 2023-2024 academic year. Forty-four students participated in the intervention group, receiving VTS and VTA tasks, while 45 students formed the control group, engaging in OE alone. Observation skills were assessed using standardized art images (short-term) and real-world clinical exposure (delayed follow-up) through measures of total observations, number of words used, and time spent describing observations. Descriptive statistics, analysis of one-way ANOVA/ANCOVA, and independent t-tests were employed for data analysis.

RESULTS: In the short-term evaluation, the intervention group demonstrated significantly higher performance in the total number of observations (p = 0.001, Adjusted Partial Eta2 = 0.12), number of words used to describe art images (p = 0.001, Adjusted Partial Eta2 = 0.21), and time spent analyzing images (p < 0.001, Adjusted Partial Eta2 = 0.17) compared to the control group. However, after one month in a clinical exposure, no significant differences were found between the groups in the total number of observations (p = 0.62) and number of words used (p = 0.64). Nevertheless, the intervention group spent significantly more time describing their clinical observations (p = 0.04, Effect Size = 0.44).

CONCLUSION: The findings highlight the significant role of VTS in enhancing medical students’ observation skills. While both interventions were equally effective in the delayed follow-up and real-world settings regarding the total number of observations and words used, the VTS and VTA approach led to a notable increase in the time spent on observation descriptions. This conclusion warrants further investigation in future studies.

PMID:39780206 | DOI:10.1186/s12909-025-06642-9

BMC Rheumatol. 2025 Jan 8;9(1):3. doi: 10.1186/s41927-024-00428-0.

ABSTRACT

BACKGROUND: Fibromyalgia Syndrome (FMS) is a chronic disabling musculoskeletal condition of unknown aetiology characterized by generalized musculoskeletal pain, extreme fatigue, mood disturbance, impaired cognition, and lack of refreshing sleep. Middle East pain syndrome (MEPS) is a newly described pollution-induced syndrome of hyperparathyroidism and fibromyalgia mimicking rheumatoid arthritis, characterized by the radiological presence of spur-like excrescences in terminal phalanges. This study aimed to explore the inflammatory nature of Middle East pain and Fibromyalgia syndromes.

METHODS: Eighty primary fibromyalgia patients were included in this study. They were divided into two groups, group [1] 1 of 40 FMS patients with low vitamin D levels and secondary hyperparathyroidism, which were diagnosed as MEPS, and group [2] of 40 primary FMS patients. They were subjected to full medical history taking, clinical examination and laboratory assessment including serum IL-17 by enzyme-linked immunosorbent assay technique, as well as assessment of Madrid Sonographic Enthesitis Index (MASEI) using musculoskeletal ultrasound and nailfold capillaroscopic pattern assessment. Plain X-ray films for hands were done on all patients.

RESULTS: There was a statistically significant elevation of serum IL17 in the MEPS group (median = 58.3 ng/L) compared to the FMS group (median = 45.7 ng/L) as the p-value is < 0.05. Capillaroscopic examination revealed a statistically significant difference between MEPS and FMS groups regarding angiogenesis as the p-value is < 0.05. The ultrasonographic examination also showed a statistically significant difference between MEPS and FMS groups as regards MASEI score as the p-value is < 0.05. Hands X-rays evidenced the exclusive existence of tuft spur-like excrescences in MEPS patients only.

CONCLUSION: Elevated IL-17 levels, non-scleroderma pattern capillaroscopic and enthesopathy findings in both MEPS and FMS patients are strongly supportive that inflammatory mechanisms participate in the pathogenesis of both diseases. The significant increase of these findings in MEPS than FMS patients as well as the presence of hand tufts spur-like excrescences, confirm that the newly discovered MEPS is a different disease although it involves fibromyalgia symptoms and signs.

PMID:39780200 | DOI:10.1186/s41927-024-00428-0

BMC Health Serv Res. 2025 Jan 8;25(1):44. doi: 10.1186/s12913-024-11845-9.

ABSTRACT

BACKGROUND: This study aimed to determine the mediating role of social intelligence in the effect of nurses’ work-related strain on trait anger and anger expressions. The challenging working conditions for nurses often result in increased strain and anger. Social intelligence could help to manage anger.

METHODS: This cross-sectional, descriptive study was conducted with 446 nurses at a public hospital in Türkiye between April and May, 2021. The questionnaire consisted of socio demographics, Trait Anger and Anger Expression Inventory, Tromso Social Intelligent Scale, and Work-Related Strain Inventory. The data was collected face to face. Descriptive statistics and Pearson’s correlation coefficient were conducted using SPSS (v.26) and mediation analysis was conducted using PROCESS macro (Hayes, model 4).

FINDINGS: Social intelligence played a mediating role in the effect of work-related strain on trait anger, anger-in, anger-out, and anger-control (β = 0.105, β = 0.100, β = 0.131, β=-0.136, respectively). Social intelligence reduced the effect of work-related strain on trait anger and anger in/out expressions, while increasing anger control.

CONCLUSION: The findings of this study show that social intelligence could be used to manage anger of nurses. Nurse managers could implement initiatives aimed at managing nurses’ anger and anger expressions through the decreasing of work-related strain and increasing of nurses’ social intelligence.

PMID:39780189 | DOI:10.1186/s12913-024-11845-9

Cardiovasc Diabetol. 2025 Jan 8;24(1):11. doi: 10.1186/s12933-024-02571-x.

ABSTRACT

BACKGROUND: Among hypertensive cohorts across different nations, the relationship between the triglyceride-glucose index (TyG) and its conjunction with obesity metrics in relation to cardiovascular disease (CVD) incidence and mortality remains to be elucidated.

METHODS: This study enrolled 9,283, 164,357, and 5,334 hypertensives from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKBB), and Shanghai Pudong cohort. The related outcomes for CVD were defined by multivariate Cox proportional hazards models, Generalized Additive Models and Mendelian randomization analysis. Mediation analysis explored the mediating role of inflammatory markers in the above relationships.

RESULTS: Five measures of insulin resistance were linked to CVD and related death in a U-shaped pattern, with the highest group having different risk increases. Higher glucose triglyceride-waist height ratio (TyG-WHTR) was linked to higher all-cause mortality (UKBB: HR 1.21, 95%CI 1.16-1.26, NHANES: HR 1.17, 95%CI 1.00-1.36), CVD mortality (UKBB: HR 1.36, 95%CI 1.23-1.49, NHANES: HR 1.32, 95%CI 1.00-1.72) risks. In the China Pudong cohort, higher triglyceride/high-density lipoprotein-cholesterol (TG/HDL_C) ratio was associated with higher risks of CVD and stroke (HR 1.31, 95%CI 1.00-1.73 and 1.67, 1.06-2.63). Inflammation markers like systemic inflammatory response index (SIRI) and C-reactive protein (CRP) partially explained these links, with CRP having a stronger effect. Genetically predicted TyG was also linked to stroke (OR 1.26, 95%CI 1.10-1.45) risk.

CONCLUSIONS: An elevated TyG index and its related indices are significantly correlated with an increased risk of CVD and related mortality across three national cohorts. These indices are anticipated to serve as valid predictors of incident CVD and mortality in individuals with hypertension.

PMID:39780176 | DOI:10.1186/s12933-024-02571-x

BMC Public Health. 2025 Jan 8;25(1):84. doi: 10.1186/s12889-024-21274-2.

ABSTRACT

BACKGROUND: Despite advancements in Human Immunodeficiency Virus (HIV) treatment and care, undernutrition remains a significant concern, accelerating disease progression and risk of Acquired Immune Deficiency Syndrome (AIDS)-related deaths. The nutritional status of second-line antiretroviral treatment (SLART) users in Ethiopia has not been thoroughly investigated. So, this study aimed to assess the nutritional status of HIV/AIDS patients who were on SLART and its associated factors in Northern Ethiopia.

METHODS: A retrospective cross-sectional study was conducted on 366 HIV-infected adults who had been on SLART for at least six months in northern Ethiopia. Clients who had documented Weight and height at six months of therapy were included. Data was entered and cleaned by using EpiDATA version 4.6.0.2 and statistical analysis was done by STATA version 17. Multiple imputation method was applied to manage variables having up to 25% missing values by using R-Version 3.6.2 software. Binary logistic regression was used with P < 0.05 as a significant predictor in the final analysis. Data was collected from February 01 to April 30, 2021.

RESULTS: The magnitude of undernutrition among adults who were on SLART in the study area was 38.52% (95%CI: 33.65-43.64). Those populations also had a baseline undernutrition status of 39.1% (95%CI: 34.11-44.15) during their transition to SLART. The risk of being malnourished at six months of SLART initiation was fifteen times higher among those who were undernourished at SLART start (AOR:15.099, 95%CI: 8.532, 26.720) reflecting the high burden of the problem in the advanced courses of HIV/AIDS treatment and care.

CONCLUSIONS: The proportion of undernutrition among SLART users in Northern Ethiopia is high. During HIV therapy, a client’s overall nutritional health is predicted by their prior undernutrition condition. This highlights the need for comprehensive nutritional assessment, counseling, and monitoring of the nutritional status of SLART users in the area with emphasis on an early identification of possible barriers to the improvement of such conditions. Promoting the consumption of nutrient-dense local foods and appropriate food preparation methods in addition to nutritional support are vital in this setting.

PMID:39780169 | DOI:10.1186/s12889-024-21274-2

J Cardiothorac Surg. 2025 Jan 9;20(1):49. doi: 10.1186/s13019-024-03215-7.

ABSTRACT

OBJECTIVE: To explore the safety and efficacy of low-intensity anticoagulation in patients after On-X mechanical aortic valve replacement.

METHODS: A total of 104 patients undergoing aortic valve replacement in Cardiac Surgery Department of Sichuan Provincial People’s Hospital from December 2018 to December 2021 were randomly divided into low-intensity anticoagulant (INR:1.5-2.0) and high-intensity anticoagulant (INR:2.0-2.5) to compare the incidence of adverse events related to postoperative anticoagulation between the two groups.

RESULTS: Fifty-three patients were included in the low-intensity anticoagulation group (INR 1.5-2.0), and 51 patients were included in the high-intensity group (2.0-2.5). There was no significant difference in baseline data and surgical index between the two groups (P > 0.05); there were statistically significant differences in PT, INR and bleeding events (P < 0.05), but no significant difference in embolic events (P > 0.05).

CONCLUSION: For patients requiring On-X mechanical aortic valve replacement who have no risk factors for thromboembolism, it is appropriate to control the INR in the target range 1.5-2.0, which can reduce the incidence of bleeding adverse events and significantly improve the quality of life, without increasing the risk of thromboembolic adverse events.

PMID:39780165 | DOI:10.1186/s13019-024-03215-7