Nevin Manimala

J Am Heart Assoc. 2025 May 13:e036525. doi: 10.1161/JAHA.124.036525. Online ahead of print.

ABSTRACT

BACKGROUND: Research studies of spontaneous coronary artery dissection (SCAD) have been primarily focused on European-ancestry individuals, with limited recognition and investigation in non-European-ancestry individuals. While SCAD has not been well ascertained in non-European-ancestry groups, pleiotropic associated traits identified in those of European ancestry have been assessed in individuals of other ancestries. Whether these traits are associated with the complex genetic architecture of SCAD in those of non-European ancestry has not been previously investigated.

METHODS: We investigated the associations of an established SCAD polygenic score with multiple vascular diseases in ≈900 000 ancestrally diverse participants of large-scale studies. Individual-level data from the UK Biobank and the Million Veteran Program and summary statistics of publicly available databases were analyzed.

RESULTS: A set of associations between SCAD polygenic score and related vascular diseases were replicated in non-European samples. Notable associations with the SCAD polygenic score included (1) coronary artery disease, myocardial infarction, and migraine headache in a Hispanic group (coronary artery disease: odds ratio [OR], 0.93 [95% CI, 0.90-0.95]; P=2.35×10^-7; myocardial infarction: OR, 0.88 [95% CI, 0.80-0.96]; P=5.73×10^-3; migraine headache: OR, 1.03 [95% CI, 1.01-1.06]; P=1.86×10^-2) of the Million Veteran Program; (2) headache in an African-ancestry group (OR, 1.22 [95% CI, 1.06-1.41]; P=6.94×10^-3) and a South Asian-ancestry group (OR, 1.18 [95% CI, 1.02-1.37]; P=2.43×10^-2) of the UK Biobank; and (3) coronary artery disease, myocardial infarction, and migraine headache in East Asian-ancestry cohorts (coronary artery disease: OR, 0.95 [95% CI, 0.93-0.98]; P=2.66×10^-3; myocardial infarction: OR, 0.86 [95% CI, 0.83-0.89]; P=9.51×10^-16; migraine headache: OR, 1.27 [95% CI, 1.10-1.47]; P=1.03×10^-3).

CONCLUSIONS: Pleiotropic associations of SCAD polygenic risk with related vascular diseases previously identified in European-ancestry groups showed notable, largely consistent patterns in non-European-ancestry groups.

PMID:40357661 | DOI:10.1161/JAHA.124.036525

Clin Nucl Med. 2025 May 9. doi: 10.1097/RLU.0000000000005940. Online ahead of print.

ABSTRACT

PURPOSE: Radioactive iodine therapy (RAI) ≥100 mCi (3.7 GBq) is commonly recommended for papillary thyroid cancer (PTC) patients with extranodal extension (ENE). However, no study has evaluated whether RAI ≥100 mCi is effective in reducing the recurrence of PTC with ENE.

METHODS: This retrospective cohort study enrolled 191 PTC patients with ENE who underwent total thyroidectomy and RAI. Recurrence according to RAI activity (<100 vs. ≥100 mCi) was compared before and after propensity score matching (PSM) (1:2) using Kaplan-Meier curves and Cox proportional hazards regression models. Subgroup analyses according to mass size (<4 and ≥4 cm), gender, blood vessel invasion, lymph node (LN) number (≤5 and >5), and stimulated Tg (sTg) level (<10 and ≥10 ng/mL) before and after PSM were performed.

RESULTS: During about 116 months, 5 (12.5%) and 19 (12.6%) before PSM, five (12.5%) and 3 (3.8%) after PSM recorded recurrence in <100 and ≥100 mCi groups, respectively. The impact of RAI ≥100 mCi on reducing recurrence was not significant before [log-rank P = 0.915, adjusted hazard ratio (HR) 0.49 (0.12-1.85); P = 0.294) and after PSM (log-rank P = 0.077). Subgroup analysis after PSM demonstrated the impact of RAI ≥100 mCi on lowering recurrence only in ENE patients with mass size ≥4 cm (log-rank P = 0.008), LN >5 (log-rank P = 0.007), and sTg ≥10 ng/mL (log-rank P = 0.039).

CONCLUSIONS: In PTC patients with ENE, mass size ≥4 cm, LN >5, or sTg ≥10 ng/mL had a benefit from RAI ≥100 mCi compared with RAI <100 mCi.

PMID:40357638 | DOI:10.1097/RLU.0000000000005940

Nurs Open. 2025 May;12(5):e2204. doi: 10.1002/nop2.2204.

ABSTRACT

AIM: This study aimed to determine the relationship between spiritual well-being and perceived social support (PSS) in patients with multiple sclerosis (MS).

DESIGN: This was a cross-sectional study.

PATIENT CONTRIBUTION: This study was conducted on 120 patients with MS in Isfahan in 2021. The participants were over 18 years of age and referred to the MS Clinic.

METHODS: The subjects were selected using convenience sampling. Data were collected using Cheraghi and Davari Dolatabadi’s Perceived Social Support and Paloutzian and Ellison’s Spiritual Well-Being (SWB) questionnaires and analysed using descriptive (number and percentage, mean and standard deviation) and inferential (Pearson’s test, linear regression) statistics in SPSS software.

RESULTS: Pearson correlation test indicated that there was a direct relationship between spiritual well-being and the total score of perceived social support (r = 0.415, p < 0.001) and the emotional (r = 0.328, p = 0.004) and informational (r = 0.311, p = 0.006) dimensions; this relationship was not significant in the instrumental dimension (r = 0.197, p = 0.081). Moreover, linear logistic regression analysis showed that in MS patients, the chance of spiritual well-being among MS patients will be increased by 59.2% per unit increase in emotional support. Also, the chance of spiritual well-being increases by 34.1% for each score increase in the age of MS patients.

CONCLUSIONS: It is necessary that age and perceived emotional support, as a strong predictor of spiritual health status, are considered in designing health promotion interventions for patients with MS.

PMID:40357588 | DOI:10.1002/nop2.2204

Am J Hypertens. 2025 May 13:hpaf072. doi: 10.1093/ajh/hpaf072. Online ahead of print.

ABSTRACT

BACKGROUND: Both anxiety and obesity have been implicated in hypertension development, with emerging evidence suggesting metabolic risk factors as potential mediators. Notably, obesity may partially mediate the link between anxiety and hypertension. However, the causal relationships among these factors remain unclear. To address this, we conducted a two-sample Mendelian randomization (MR) analysis to elucidate their causal relationship.

METHODS: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from European ancestry cohorts. The inverse-variance weighted (IVW) method was used as the primary analytical approach, with sensitivity analyses and heterogeneity tests conducted to ensure robustness. Additionally, a two-step MR approach was conducted to quantify the proportion of the anxiety-hypertension association mediated through obesity-related pathways.

RESULTS: The two-sample MR analysis demonstrated significant causal effects of anxiety (OR=1.025, 95% CI 1.011-1.038; P<0.001) and obesity (OR=1.010, 95% CI 1.007-1.013; P<0.001) on hypertension risk. Bidirectional analysis revealed a unidirectional causal association between anxiety and obesity (OR=1.518, 95% CI 1.044-2.206; P=0.029), with no evidence of reverse causation from obesity to anxiety (OR=1.014, 95% CI 0.990-1.039; P=0.268). Mediation analysis estimated that 17.4% (95% CI 5.3-29.5%) of anxiety’s total effect on hypertension risk was mediated through adiposity-related pathways.

CONCLUSION: The two-sample MR analysis in this study confirmed a causal relationship between anxiety and hypertension. Obesity was found to partially mediate this association. Our causal estimates support weight management interventions as an effective psychosomatic strategy for preventing hypertension in individuals with anxiety, particularly due to the modifiable nature of obesity-related risk factors.

PMID:40357578 | DOI:10.1093/ajh/hpaf072

Acta Odontol Scand. 2025 May 13;84:241-249. doi: 10.2340/aos.v84.43600.

ABSTRACT

AIM: The aim of this study is to classify accessory mandibular canals (AMC) and investigate their association with the dimensions of the mandibular canal (MC) to enhance surgical planning and prevent complications in dental treatments.

METHODS: Cone-beam computed tomography (CBCT) images were evaluated. AMC’s frequency, length, and diameter, including dental, superior, inferior, forward-open, forward-closed, and retromolar types, were determined. Additionally, the dimensions of the MC, including its length and diameter, were measured, and the relationship between the AMC and MC was statistically analyzed. Descriptive statistics, chi-square test, independent samples t-test (for normally distributed data), Kruskal-Wallis test (for non-normally distributed data), and Tamhane post hoc test were used for statistical analysis of the data.

RESULTS: AMC was identified in 82 of the 222 hemimandibles examined (36.9%). It was found that the length and diameter of AMCs varied significantly depending on the AMC type (p = 0.000). The diameter of the dental type AMCs (mean 0.40 ± 0.22 mm) was considerably smaller than that of other AMC types (mean 0.86 ± 0.37 mm). The length and diameter of the MC were measured as 69.20 ± 5.10 mm and 2.96 ± 0.57 mm, respectively. While MC length was not found to influence the presence of AMC (p = 0.785), MC diameter was significantly associated with the occurrence of AMC (p = 0.000).

CONCLUSIONS: AMC, which is critical for improving surgical planning and reducing the risk of complications in dental procedures, is not uncommon. Their presence should be carefully evaluated, particularly in cases where the MC has a larger diameter.

PMID:40357575 | DOI:10.2340/aos.v84.43600

Bioanalysis. 2025 May 13:1-12. doi: 10.1080/17576180.2025.2501934. Online ahead of print.

ABSTRACT

Assessing the performance of an immunogenicity assay before using it to support vaccine clinical trials is mandatory. Further validation of assay performance is even requested to support Phase III studies. While assay validation requires adherence to predefined acceptance criteria, there is no universal stringency level for earlier phases of assay development. Setting scientifically sound criteria for success is about finding the right balance between unavoidable assay limitations and ensuring the assay is fit-for-purpose. In this paper, we focus on the evaluation of linearity for immunogenicity assays and its use as surrogate for accuracy evaluation in the absence of reference material. We propose a simple method for evaluating assay linearity and understanding the impact of a linearity deviation on the evaluation of the response increase in clinical trial. Assessment is reliable in absence of known concentration samples, unlike methods in industry guidance, making the proposed method more versatile. Method is illustrated by two case studies, representative of the assays used in the vaccine field. Making the link between assay linearity and clinical endpoints provides a simple and clear framework to support the definition of assay validation criteria, applicable to a variety of immunogenicity assays.

PMID:40357562 | DOI:10.1080/17576180.2025.2501934

Ann Ig. 2025 May 13. doi: 10.7416/ai.2025.2708. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitals are among the most resource-intensive infrastructures, consuming significant amounts of energy, water, and materials while contributing 5.2% of global carbon dioxide emissions. Despite growing awareness and international commitments, hospitals face financial, structural, and operational barriers in implementing sustainability strategies.

STUDY DESIGN: The study assesses the maturity of healthcare stakeholders regarding environmental sustainability, exploring key drivers, barriers, and strategies for integrating sustainability into healthcare facilities.

METHODS: A national web-based survey was conducted within the Joint Research Partnership Healthcare Infrastructures between November 2022 and January 2023, gathering 30 responses from 32 partners (94% participation rate). The analysis focuses on the environmental sustainability dimension, using descriptive statistics to identify trends, challenges, and best practices.

RESULTS: Healthcare stakeholders selected the most relevant Sustainable Development Goals for hospitals. Sustainability is widely recognized as a priority, yet resource allocation emerges as marginal. The most frequently cited constraint for improving environmental sustainability was financial constraints (n=27/30). Indeed, some hospitals are implementing energy-efficient retrofitting, high-efficiency thermal power plants, and sustainability building certification. The adoption of Building Energy Management Systems and retrofit interventions to maximise energy efficiency suggests increasing interest in sustainability performance measurement.

CONCLUSIONS: Despite growing awareness, financial and regulatory support must be strengthened to facilitate hospital sustainability investments. Early integration of sustainability principles, access to public and private models and multi-stakeholder collaboration are crucial. Future research and action should foster multi-stakeholders approaches, develop sector-specific sustainability frameworks and assess the long-term impact of sustainability initiatives in healthcare.

PMID:40357533 | DOI:10.7416/ai.2025.2708

Front Psychiatry. 2025 Apr 28;16:1414273. doi: 10.3389/fpsyt.2025.1414273. eCollection 2025.

ABSTRACT

BACKGROUND: Postoperative delirium (POD) is one of the common central nervous system complications in elderly patients after non-cardiac surgery. Therefore, it is necessary to develop and validate a preoperative model for POD risk prediction.

METHODS: This study selected 663 elderly patients undergoing non-cardiac elective surgery under general anesthesia for tracheal intubation in general surgery, from September 1^st, 2020 to June 1^st, 2022. Simple random sampling method was used according to 7: 3. The occurrence of POD within 1 to 7 days after the operation (or before discharge) was followed up by the confusion assessment method (CAM). This study innovatively included the pittsburgh sleep quality index (PSQI) and the numerical pain score (NRS) for clinical work, to explore the relationship between sleep quality and postoperative pain and POD. Univariate and Multivariable Logistic regression analysis was used to analyze stepwise regression to screen independent risk factors for POD. The creation of prediction models involved the integration of outcomes through the implementation of logistic regression analysis. In addition, internal validation is employed to ensure the reproducibility of the model.

RESULTS: A total of 663 elderly patients were enrolled in this study, and 131 (19.76%) patients developed POD. The incidence of POD in each department was not statistically significant. The predictors in the POD column line graph included age, Mini Mental State Examination (MMSE) score, history of diabetes, years of education, sleep quality index, ASA classification, duration of anesthesia and NRS score. The formula Z= 8.293 + 0.102 × age – 1.214 × MMSE + 1.285 × diabetesHistory – 0.304 × yearsOfEducation + 0.602 × PSQI + 1.893 × ASA + 0.027 × anesthesiaTime + 1.297 × NRS. Conducive to the validation group to evaluate the prediction model, the validation group AUC is 0.939 (95% CI 0.894-0.969), the sensitivity is 94.44%, and the specificity is 85.09%. The calibration curves show a good fit between the clinically predicted situation and the actual situation.

CONCLUSION: The clinical prediction model constructed based on these independent risk factors has a good predictive performance, which can provide reference for the early screening and prevention of POD in clinical work.

TRIAL REGISTRATION: ChiCTR2000033639 Retrospectively registered (date of registration: 06/07/2020).

PMID:40357521 | PMC:PMC12066437 | DOI:10.3389/fpsyt.2025.1414273

Front Psychiatry. 2025 Apr 28;16:1579629. doi: 10.3389/fpsyt.2025.1579629. eCollection 2025.

ABSTRACT

INTRODUCTION: The Developmental Behavior Checklist (DBC) is a standardized tool for evaluating emotional and behavioral concerns in children and adolescents with intellectual disabilities (ID) in clinical and research settings. This study aims to validate the Turkish versions of the DBC autism screening algorithm (ASA), parent (P) and teacher (T) forms.

METHODS: Parents and teachers of 312 children and adolescents aged 4-17 with ID completed the Turkish versions of the DBC forms and the Strengths and Difficulties Questionnaire (SDQ). The presence of ASD or any other psychiatric disorder was assessed through clinical evaluation based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) guidelines. Analyses of validity and reliability were conducted to evaluate the internal consistency, sensitivity, specificity, area under the curve (AUC), convergent validity, inter-rater reliability, and test-retest reliability.

RESULTS: Among the participants, 30.6% (n=70) had a psychiatric comorbid diagnosis according to the DSM-5-TR. DBC-P exhibited a sensitivity of 64.4%, a specificity of 87.6%, and an AUC of 76%. DBC-T demonstrated a sensitivity of 89.7%, a specificity of 75.8%, and an AUC of 82.7%. Additionally, 23.1% (n=45) were diagnosed with autism spectrum disorder (ASD). The DBC-ASA showed a sensitivity of 58.1%, a specificity of 64.6%, and an AUC of 61.3%. The DBC forms displayed strong internal consistency, robust test-retest reliability, and significant correlation with the SDQ measures. Inter-rater agreement between the DBC-P and DBC-T was low to moderate. A significant difference between parent and teacher assessments highlights the need for multi-informant approaches (p <.001).

DISCUSSION: The DBC-P and DBC-T exhibit high validity and reliability, while the DBC-ASA shows moderate accuracy. This study acts as a valuable resource for clinicians, providing enhanced support for Turkish children and adolescents with ID.

PMID:40357518 | PMC:PMC12066420 | DOI:10.3389/fpsyt.2025.1579629

Clin Kidney J. 2025 Apr 25;18(5):sfaf116. doi: 10.1093/ckj/sfaf116. eCollection 2025 May.

ABSTRACT

BACKGROUND: Obesity has been associated with onset and progression of chronic kidney disease (CKD) but causal relationship remains uncertain. This study investigated how obesity causally affects estimated glomerular filtration rate.

METHODS: Cross-sectional and magnetic resonance imaging (MRI) data analyses were performed within the Prospective Investigation of Obesity, Energy, and Metabolism (POEM) study (502 participants, all aged 50 years). Additionally Mendelian randomization was performed using published summary data. Outcomes were creatinine- and cystatin C-based eGFR. Body mass index (BMI) and waist circumference (WC) were used as exposure variables in the cross-sectional and Mendelian randomization analyses. In the imaging data analyses, eGFR was regressed non-parametrically on tissue volume for each 3D voxel and visualized as a correlation “Imiomics” map.

RESULTS: Negative correlations were shown between cystatin C-based eGFR and BMI [beta = -0.190 (95% CI: -0.280 to -0.100)] and WC [beta = -0.160 (95% CI: -0.250 to -0.060)] in an adjusted model. In contrast, a positive association was found for creatinine-based eGFR [BMI beta = 1.20 (95% CI: 0.030 to 0.210) and WC beta = 0.160 (95% CI: 0.070 to 0.260)]. Similar patterns were found using MRI analysis (Imiomics map). Mendelian randomization implied a negative causal effect of obesity-related measures on cystatin C-based eGFR [BMI beta = -0.031 (95% CI: -0.037 to -0.026) and WC beta = -0.038 (95% CI: -0.045 to -0.031)], but no statistically significant effect was found for creatinine-based eGFR.

CONCLUSION: This study suggests a causal negative effect of obesity on cystatin C-based, but not creatinine-based eGFR. These findings warrant further research regarding estimations of kidney function when assessing obesity and CKD.

PMID:40357501 | PMC:PMC12067075 | DOI:10.1093/ckj/sfaf116