Nevin Manimala

Eur J Surg Oncol. 2025 Apr 12;51(8):110023. doi: 10.1016/j.ejso.2025.110023. Online ahead of print.

ABSTRACT

Axillary surgery for breast cancer has seen significant de-escalation in the past three decades. The ACOSOG Z0011 trial suggested that completion axillary clearance was not necessary in women with low disease burden after sentinel node biopsy (SLNB). Flaws in the design of the trial undermined confidence in its findings which delayed widespread adoption and caused practice heterogeneity globally. This systematic review evaluated the impact of Z0011 (and similar trials) on the rate and extent of axillary conservation in women with node-positive, low-risk early breast cancer. A search was conducted on the Ovid MEDLINE, Scopus, Web of Science and COCHRANE databases. Screening of titles and abstracts was undertaken according to eligibility criteria. Data were quality assessed using the ROBINS-1 and Robvis tools. The review retrieved 1362 papers, of which 30 papers were included, representing data from 290,754 women across nine countries. All articles were retrospective cohort studies. Included studies showed a statistically significant downward temporal trend in rates of ALND following the publication of the Z0011 trial but the extent of change ranged from a 5.6 %-73.4 % reduction in axillary clearance rates. This review demonstrated the Z0011 trial has been practice-changing. However, it also identified that few patients are eligible for de-escalation due to tight inclusion criteria. Finally, most articles were from Western countries, from research-focused hospitals, which limits generalizability. Further research across a wider range of settings is needed to understand the extent to which Z0011 has been implemented globally.

PMID:40367641 | DOI:10.1016/j.ejso.2025.110023

Child Abuse Negl. 2025 May 13;165:107492. doi: 10.1016/j.chiabu.2025.107492. Online ahead of print.

ABSTRACT

BACKGROUND: International evidence-based best practice for police interviewers of vulnerable groups, such as Indigenous populations, recommends encouraging interviewees to give a full uninterrupted account, followed by open-ended questions, to optimise memory and avoid contaminating information. However, most research examining the applicability of interview strategies on information gain has been conducted in western cultures.

OBJECTIVE: There is currently little extant quantitative research on questioning in police interviews with Indigenous complainants. The primary objective of this research was to examine whether international standards for interviewing vulnerable groups for legal purposes are transferable to an Indigenous population.

PARTICIPANTS AND SETTING: Police interviews with complainants reporting historical childhood sexual abuse [HCSA] as adults in a northern Canadian territory with an Indigenous population (N = 45 interviews) were examined.

METHODS: Interviews were coded for types of questions, answers, and investigation-relevant details reported. Frequency distributions were calculated for each dependent variable, and further inferential statistics were conducted using t-test, chi square, and one-way ANOVA analyses, to examine the possible effect of question types on the elicitation of certain answer and detail types.

RESULTS: Results showed a statistically significant difference in the mean number of overall details elicited (d = 0.29), with questions classed as productive eliciting more details compared to unproductive questions. Specifically, open-ended questions elicited the most details, including both overall details and abuse relevant details.

CONCLUSIONS: Although these results should be considered exploratory, the international guidance on interviewing vulnerable groups was found to be applicable to this Indigenous population.

PMID:40367620 | DOI:10.1016/j.chiabu.2025.107492

Ecotoxicol Environ Saf. 2025 May 13;298:118272. doi: 10.1016/j.ecoenv.2025.118272. Online ahead of print.

ABSTRACT

OBJECTIVE: Endocrine-disrupting chemicals (EDCs) can interfere with endocrine function and lead to neurological damage. Neurofilament light chain (NfL) is a protein released into the blood after neuroaxonal damage, and it has become a dependable biomarker for neurological conditions. The study aimed to investigate the associations between single or combined EDCs exposure and serum NfL levels in adults.

METHODS: The 1372 participants included in the study were from the 2013-2014 National Health and Nutrition Examination Survey. Due to the difference in types of EDCs, participants were divided into two populations. Multiple linear regression models were used to assess the association between 32 EDCs and NfL. The least absolute shrinkage and selection operator regression model was used for EDCs selection and the weighted quantile sum (WQS) regression was used for examining the association of EDCs mixture with NfL and identify the predominant exposure.

RESULTS: Levels of urinary bisphenol S, mono(2-ethylhexyl) phthalate, dibutyl phosphate, glyphosate, and 3,5,6-trichloropyridinol were positively associated with serum NfL levels, while benzophenone-3, methylparaben, and propylparaben showed negative associations. In the WQS regression model, the changes of NfL were 0.154 (95 % CI: 0.014-0.294) and 0.164 (95 % CI: 0.033-0.296) for each quartile increase in WQS index of EDCs mixture in the two populations, respectively. Analysis of the subgroup with gender stratification suggested that the association between EDCs mixture and NfL was only significant in men. The positive mixture β was 0.219 (95 % CI: 0.056-0.380) and 0.257 (95 % CI: 0.082-0.433) in the two population, respectively.

CONCLUSION: The study suggested a potential association between single or combined exposure to EDCs and NfL levels. High-level EDCs exposure might be associated with more severe neurological damage, particularly in men.

PMID:40367613 | DOI:10.1016/j.ecoenv.2025.118272

J Pharm Biomed Anal. 2025 May 8;264:116954. doi: 10.1016/j.jpba.2025.116954. Online ahead of print.

ABSTRACT

Gastrodiae Rhizoma (Tianma, GR), the dried tuber of Gastrodia elata Bl., is a valuable herb for medicinal and dietary applications. Current markets feature three key cultivars: G. elata f. glauca (WTM), G. elata f. elata (HTM), and their hybrid (WHTM), with significant price variations yet lacking defined chemical authentication markers. Here, we implemented a pseudotargeted LC-MS/MS metabolomics strategy employing 534 optimized MRM transitions. This strategy was coupled with multivariate analysis – unsupervised principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) – of 40 authenticated batches, to decipher cultivar-specific chemical fingerprints. The approach identified 88 statistically validated markers, with 14 pivotal discriminators-primarily 4-Hydroxybenzyl alcohol derivatives-exhibiting distinct cultivar distribution patterns. This chemical blueprint serves as a tool for authentication in quality control and supports regulatory standard establishment for GR products.

PMID:40367578 | DOI:10.1016/j.jpba.2025.116954

Clinics (Sao Paulo). 2025 May 13;80:100683. doi: 10.1016/j.clinsp.2025.100683. Online ahead of print.

ABSTRACT

BACKGROUND: Existing systematic reviews provide evidence that art therapy is an effective intervention for reducing symptoms of depression in children and adolescents. This study aims to systematically review and quantify the impact of art-based interventions on depressive symptoms in this demographic through meta-analysis.

METHOD: A systematic search of databases and journals identified eligible studies for inclusion in a meta-analysis examining the efficacy of art therapy interventions on depressive symptom reduction. A random-effects meta-analysis was conducted using the Standardized Mean Difference (SMD).

RESULTS: The meta-analysis of twelve (randomized) controlled trials revealed a significant effect (SMD = -0.72; 95 % CI [-1.28, -0.16], p = 0.01), indicating that children and adolescents (n = 333) who received art therapy experienced a more significant reduction in depressive symptoms compared to those (n = 344) in the control groups.

LIMITATIONS: The existing evidence is limited to studies with low statistical power and methodological quality. Furthermore, the included studies were highly heterogeneous in terms of the intervention type, measurement tools, participant samples, and study designs.

CONCLUSIONS: The findings suggest that art-based interventions can be effective in reducing depressive symptoms in children and adolescents. However, future research requires more methodologically rigorous and well-controlled studies to strengthen the evidence base.

PMID:40367574 | DOI:10.1016/j.clinsp.2025.100683

Poult Sci. 2025 May 7;104(8):105275. doi: 10.1016/j.psj.2025.105275. Online ahead of print.

ABSTRACT

Fledgling broiler ducks vary in body weight and growth rate. The aim of this study was to investigate the relationship between serum metabolites and the intestinal microbiota in Cherry Valley broiler ducks with different finishing weights and to reveal differences in their metabolic regulation and microbial composition. Serum and cecum content samples were collected from Cherry Valley broiler ducks of different finishing weights. Metabolites were identified and compared using untargeted metabolomics, 16S rRNA gene sequencing, multivariate statistics and bioinformatics. Six key findings emerged. First, serum biochemical parameters showed that AST and ALT levels were significantly lower in the high weight group (Group H) than in the low weight group (Group L), and serum immunoglobulin IgG levels were significantly higher in group H. Second, the chorionic height to crypt depth ratio of the duodenum was significantly higher in group H than in group L. Third, the gut microbial community diversity or abundance was lower in broiler ducks in group L. Fourth, LEfSe analysis showed that the biomarker for group L was Streptococcus, whereas for group H it was Faecalibacterium. Fifth, a total of 127 differential metabolites were identified (49 up-regulated and 78 down-regulated). Finally, Spearman’s correlation analysis showed that Spearman’s correlation analyses showed that the Lipid-related serum metabolites were higher in low-body recombinant broiler ducks, mainly Lathosterol, Cholesterol, Cynaratriol and Leukotriene B4. In addition to lipid-associated serum metabolites in high-body recombination, The water-soluble vitamin-like metabolite Pantothenate and the antibiotic-like metabolite Tylosin were high. The cecum microbiota is strongly associated with metabolites, especially Faecalibacterium, unclassified Tannerellaceae, Subdoligranulum, Alistipes, and [Ruminococcus] torques_group, with which it exhibits strong Correlation. Broiler ducks with higher body weights have a better intestinal villous structure, enhanced digestion and absorption, higher levels of immunoglobulin secretion and superior growth performance. Broiler ducks with different body weights differed in plasma metabolites and cecum flora. Spearman’s correlation analyses showed that the Correlation between differential metabolites and differential gut microbial genera.

PMID:40367572 | DOI:10.1016/j.psj.2025.105275

Eur J Radiol. 2025 May 7;188:112131. doi: 10.1016/j.ejrad.2025.112131. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective study aimed to compare the effects of unilateral and bilateral percutaneous transhepatic biliary drainage (PTBD) procedures on inflammatory markers and clinical outcomes in patients with malignant hilar biliary obstruction (MHBO).

METHODS: The study included 102 patients with MHBO who underwent PTBD at our institution. Patients were divided into unilateral (n = 46) and bilateral (n = 56) groups based on the drainage method. Demographic information and laboratory parameters were collected, and inflammatory markers were measured at baseline and follow-up intervals (24 h, 1 week, and 1 month). Statistical analyses were conducted to compare clinical and laboratory outcomes between the two groups.

RESULTS: In both groups all types of bilirubin levels showed significant decreaese after succesful cathetarization of at least one biliary duct and obervation of biliary drainage in all patients. Both unilateral and bilateral PTBD groups showed significant improvements in hepatic and cholestatic enzymes (ALT, AST, ALP, GGT), coagulation parameters (INR, APTT), and CRP levels over time (p < 0.05). However, most inflammatory markers, including CRP and procalcitonin, showed no significant differences between the two groups. Notably, only unilateral group exhibited significant improvements in platelet and lymphocyte counts from baseline to 1 month (p = 0.05 and p = 0.028, respectively). Correlation analysis revealed a strong negative association between CRP and albumin in the unilateral group (r = -0.713, p < 0.001), whereas the bilateral group showed a positive correlation between CRP and procalcitonin (r = 0.783, p < 0.001).

CONCLUSION: Our study demonstrates that there were no significant differences between unilateral and bilateral PTBD in recovery of hyperbilirubinemia. However, some inflammatory markers were adversely affected in the bilateral group. Based on these findings, unilateral PTBD may suffice as a first-line approach in patients with MHBO due to its less invasive nature and lower cost. Bilateral drainage should be reserved for cases where sufficient bilirubin reduction cannot be achieved.

PMID:40367561 | DOI:10.1016/j.ejrad.2025.112131

Eur J Radiol. 2025 Apr 27;188:112137. doi: 10.1016/j.ejrad.2025.112137. Online ahead of print.

ABSTRACT

Accurate segmentation of cerebral arteries on computed tomography angiography (CTA) images is essential for the diagnosis and management of cerebrovascular diseases, including ischemic stroke. This study implemented a deep learning-based U-Net++ model for cerebral artery segmentation in CTA images, focusing on optimizing pruning levels by analyzing the trade-off between segmentation performance and computational cost. Dual-energy CTA and direct subtraction CTA datasets were utilized to segment the internal carotid and vertebral arteries in close proximity to the bone. We implemented four pruning levels (L1-L4) in the U-Net++ model and evaluated the segmentation performance using accuracy, intersection over union, F1-score, boundary F1-score, and Hausdorff distance. Statistical analyses were conducted to assess the significance of segmentation performance differences across pruning levels. In addition, we measured training and inference times to evaluate the trade-off between segmentation performance and computational efficiency. Applying deep supervision improved segmentation performance across all factors. While the L4 pruning level achieved the highest segmentation performance, L3 significantly reduced training and inference times (by an average of 51.56 % and 22.62 %, respectively), while incurring only a small decrease in segmentation performance (7.08 %) compared to L4. These results suggest that L3 achieves an optimal balance between performance and computational cost. This study demonstrates that pruning levels in U-Net++ models can be optimized to reduce computational cost while maintaining effective segmentation performance. By simplifying deep learning models, this approach can improve the efficiency of cerebrovascular segmentation, contributing to faster and more accurate diagnoses in clinical settings.

PMID:40367559 | DOI:10.1016/j.ejrad.2025.112137

Patient Educ Couns. 2025 May 13;137:108821. doi: 10.1016/j.pec.2025.108821. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the relationships between acceptance of illness, psychological resilience, and patient activation (PA) in young and middle-aged patients with lung cancer in China.

METHODS: A cross-sectional study was conducted between January and April 2024. Patients with lung cancer completed a survey that included the Patient Activation Measure (PAM), the Acceptance of Illness Scale (AIS), and the Summary of the Psychological Resilience Scale brief version (CD-RISC10). Descriptive statistics, independent sample t-test, one-way analysis of variance (ANOVA), and multivariate regression analysis were used to identify factors influencing PA.

RESULTS: A total of 292 patients participated in the study. The mean PAM score was 66.77 (SD=13.25). Higher levels of PA were positively associated with acceptance of illness (β=0.475, 95 % CI: 1.073-1.437, P < 0.001) and psychological resilience (β=0.503, 95 % CI: 1.073-1.426, P < 0.001), collectively explaining 78.4 % of the variance after controlling for age, education, and duration of discharge in the multiple linear regression analysis.

CONCLUSION: Age, education, duration of discharge, acceptance of illness, and psychological resilience each influenced PA distinctly, with acceptance of illness and psychological resilience emerging as the most significant predictors.

PRACTICE IMPLICATIONS: Professionals should implement targeted interventions for young and middle-aged lung cancer patients, focusing on enhancing illness acceptance and psychological resilience to improve self-care capabilities and promote long-term self-management.

PMID:40367550 | DOI:10.1016/j.pec.2025.108821

Waste Manag. 2025 May 13;203:114879. doi: 10.1016/j.wasman.2025.114879. Online ahead of print.

ABSTRACT

The air classification efficiency of landfilled Municipal Solid Waste (MSW) is critical for resource recovery but remains challenged by the heterogeneity and non-spherical morphology of waste. In this study, a probabilistic framework that integrates spheroid modeling with the Monte Carlo procedure to predict and optimize the separation efficiency was developed, and the results were compared using orthogonal experiments. The morphological distributions (elongation, flatness, and size) of 381 landfill samples and the density distributions of 184 landfill samples were statistically characterized. For the numerical model, spheroidal particles were generated by randomly sampling from each parameter’s distribution. Then, a numerical model that incorporates non-spherical drag coefficients was developed. The model achieved a Root Mean Square Error (RMSE) of < 0.13 in predicting separation indicators, compared to the experimental results. The experimental results demonstrated that, under the same airflow velocity conditions, the recovery of light substances (R_L) in landfilled MSW was lower than that of fresh MSW, partially due to the increase in density resulting from the degradation of organic matter. The numerical model revealed that the separation efficiency (E) exhibited velocity-dependent unimodal trends. The model further identified the optimal performance of the effective separation interval for an airflow direction of 15° under 21.40 m/s (50 Hz), and the interval length was 21 % and 15 % longer compared to 0° and 30°, respectively, under equivalent velocities. The results of this work provide a reference for optimizing the air classification apparatus of landfilled MSW, and a basic method for use in more thorough simulation studies.

PMID:40367546 | DOI:10.1016/j.wasman.2025.114879