Nevin Manimala

Int Urol Nephrol. 2025 Dec 23. doi: 10.1007/s11255-025-04913-4. Online ahead of print.

ABSTRACT

PURPOSE: We examined the relationship between psychiatric comorbidities-namely depression, anxiety, and combined depression-anxiety-and hospitalization outcomes among patients diagnosed with neurogenic bladder. Using a large, nationally representative database, the study sought to generate evidence for refining clinical guidelines and improving patient management.

METHODS: A retrospective study was performed using National Inpatient Sample (NIS) records from 2010-2019, identifying 676,826 adults with neurogenic bladder. Mental health comorbidities were classified through ICD-9/ICD-10 coding for depression (n = 125,654), anxiety (n = 77,730), and depression with anxiety (n = 34,330). Outcomes assessed included hospital length of stay, total charges, in-hospital mortality, and specific urological complications. Descriptive statistics and logistic regression analyses were applied, with adjustments for demographic and hospital-related variables.

RESULTS: Depression, anxiety, and depression-anxiety were found in 13.5%, 6.4%, and 5.1% of cases, respectively, with higher rates among older adults and women. Anxiety was associated with elevated risks of hydronephrosis (OR 1.420), urinary tract infections (OR 1.050), urinary stones (OR 1.511), and acute renal failure (OR 1.246), whereas the odds of cystitis were reduced (OR 0.636). Patients with both depression and anxiety exhibited comparable complication patterns, while depression alone showed no significant associations. Surprisingly, individuals with any of these psychiatric conditions had shorter median hospital stays (5 vs 6 days) and lower mortality (1.8-2.4% vs 3.7%).

CONCLUSION: Mental health comorbidities in patients with neurogenic bladder are linked to a nuanced spectrum of outcomes. Anxiety increases the risk of several urological complications yet may confer protective effects regarding mortality. These results underscore the importance of systematic psychological assessment and integrated multidisciplinary management in neurogenic bladder care.

PMID:41430520 | DOI:10.1007/s11255-025-04913-4

Int Ophthalmol. 2025 Dec 23;46(1):46. doi: 10.1007/s10792-025-03927-2.

ABSTRACT

PURPOSE: To evaluate the effects of upper eyelid blepharoplasty on corneal topography and higher-order optical aberrations (HOAs).

METHODS: Seventy-seven patients (154 eyes) who underwent upper eyelid blepharoplasty for dermatochalasis and had complete preoperative and 3-month postoperative corneal topography and aberrometry data were included. All measurements were obtained using the Sirius topography system. Aberrometric parameters-including total RMS, HOA RMS, coma, trefoil, and spherical aberration-as well as advanced topographic indices such as EIf, EIb, TSI, and TImax were analyzed. As this was a retrospective observational study, trial registration was not applicable.

RESULTS: No statistically significant change was observed in total RMS values. At a 6 mm pupil diameter, HOA RMS decreased from 0.53 ± 0.25 to 0.49 ± 0.17 (p = 0.014), and coma decreased from 0.31 ± 0.20 to 0.27 ± 0.14 (p = 0.002). Spherical aberration also showed a postoperative reduction (0.23 ± 0.10 to 0.21 ± 0.10; p = 0.008). Significant improvements were detected in trefoil (p < 0.001), TImax (p < 0.001), EIf (p < 0.001), EIb (p = 0.008), and TSI (p = 0.005). No significant postoperative differences were observed in keratometric values or secondary astigmatism (p > 0.05).

CONCLUSION: Upper eyelid blepharoplasty appears to produce beneficial changes in corneal surface morphology and optical aberrations. Given its potential to enhance visual quality and patient satisfaction, the functional implications of blepharoplasty should be considered alongside its aesthetic goals during surgical planning.

PMID:41430516 | DOI:10.1007/s10792-025-03927-2

J Math Biol. 2025 Dec 22;92(1):16. doi: 10.1007/s00285-025-02331-9.

ABSTRACT

Starvation driven diffusion (SDD) describes a cognitive strategy that starvation of a species leads to its stronger movement. In this paper, to better understand the effects of SDD, we propose and analyze a type of predator-prey systems with predator and prey both obeying SDD. By analyzing the linearized eigenvalue problem, we investigate the stability and instability of a semi-trivial steady state, which depends on the conversion efficiency of prey to predator as well as on the predator’s minimum motility rate when conversion efficiency is properly large. Predator and prey coexist if the unique semi-trivial steady state is unstable. Utilizing Crandall-Rabinowitz bifurcation theorem, we investigate the local existence, stability, and structure of a bifurcating nontrivial steady state. There exists only one critical conversion efficiency guaranteeing the occurrence of steady-state bifurcation at the unique semi-trivial steady state. The global existence and structure of a bifurcating nontrivial steady state are proven by the global bifurcation theorem. One nontrivial steady state always exists for sufficiently large conversion efficiency. As examples, we apply theoretical results to predator-prey models with Holling type II/IV functional response involving SDD, and verify them via numerical simulations. We numerically observe spatially inhomogeneous periodic solutions, which should arise from nontrivial steady states via Hopf bifurcation, or even via homoclinic bifurcation in the case of Holling type IV functional response. Notably, these solutions consistently mirror resource distribution patterns, aligning conceptually with the ideal free distribution.

PMID:41430494 | DOI:10.1007/s00285-025-02331-9

World J Mens Health. 2026 Jan;44(1):194-202. doi: 10.5534/wjmh.250093.

ABSTRACT

PURPOSE: While the association between defect of DNA damage repair (DDR) genes and prostate cancer (PCa) risk is well-established, there has been a lack of data in East Asian population. This study reports contemporary prevalence of DDR genes mutations in Korean PCa patients.

MATERIALS AND METHODS: We analysed samples from 1,316 patients with PCa in Korea. Whole genome sequencing and targeted cancer panel sequencing were employed for genetic analysis. A total of 26 DDR genes were analysed based on the previous literature.

RESULTS: Germline mutation profiling was conducted in 1,026 patients, identifying 66 mutations (6.4%) at 14 genes. Somatic mutation profiling in 550 patients revealed 105 mutations (19.1%) at 15 genes. While BRCA2 was most frequent (3.4%) among germline mutations, CDK12 was most frequent (6.5%) among somatic mutations in our study. Patients with metastatic disease showed significantly higher mutation frequency than patient with localized disease in both germline and somatic mutation (both p-value<0.05). There were statistically positive correlation between increase of grade group and higher frequency in both germline and somatic DDR gene mutations (p<0.001). The patients with higher stage showed significantly higher rate of DDR gene mutation in germline analysis (p<0.001) but not in somatic analysis (p=0.888).

CONCLUSIONS: BRCA2 was the most prevalent in germline mutations but CDK12 was out-numbered BRCA2 in somatic mutations in the present study. The higher frequency of DDR gene mutation was associated with advanced cancer stage and higher cellular grade group.

PMID:41430472 | DOI:10.5534/wjmh.250093

Surg Endosc. 2025 Dec 22. doi: 10.1007/s00464-025-12496-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Liver resection is technically challenging due to the liver’s anatomical complexity. Augmented reality (AR), especially when combined with indocyanine green (ICG) fluorescence, has been adopted to enhance resection precision, reduce intraoperative complications, and improve outcomes. This systematic review and meta-analysis aimed to evaluate whether AR-guided liver surgery is associated with reduced intraoperative bleeding and improved clinical outcomes compared to conventional techniques.

METHODS: A comprehensive search was conducted in Embase, PubMed, and the Cochrane Library, following PRISMA 2020 guidelines. Studies comparing AR-guided liver resections were included. Outcomes analyzed included blood loss, transfusion rates, Clavien-Dindo classification, operative time, liver failure, surgical site infection (SSI), resection-related complications, hospital stay length, and tumor recurrence. Statistical analysis was performed using Review Manager 5.4 and R Studio 4.5, applying a random-effects model when heterogeneity was high.

RESULTS: Of 284 identified studies, 5 met inclusion criteria, totaling 410 patients (AR group n = 141), with 56% male and a mean age of 57 years. AR use was significantly associated with reduced blood loss (MD: -75.9 mL; 95% CI -103.4 to -48.3; p < 0.001), lower transfusion rates (RR: 0.47; 95% CI 0.26 to 0.85; p = 0.01), and fewer resection-related complications (RR: 0.64; 95% CI 0.46 to 0.90; p = 0.009). Subgroup analysis in patients with liver tumors confirmed these benefits, including a lower recurrence rate (RR: 0.52; 95% CI 0.34 to 0.79; p = 0.002). No significant differences were found for Clavien-Dindo classification, operative time, liver failure, SSI, or hospital stay duration.

CONCLUSION: AR-guided liver surgery demonstrated significant clinical benefits, notably reducing intraoperative bleeding, transfusion needs, resection-related complications, and tumor recurrence. Despite limitations in study number and methodological variability, this meta-analysis supports AR as a safe and effective tool in liver surgery, warranting further research to standardize its application.

PMID:41430466 | DOI:10.1007/s00464-025-12496-5

Surg Endosc. 2025 Dec 22. doi: 10.1007/s00464-025-12479-6. Online ahead of print.

ABSTRACT

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is an important surgical treatment for choledocholithiasis; however, the choice between indwelling T-tube placement and primary suture remains controversial. This study aimed to evaluate the safety and feasibility of LCBDE coupled with primary suture using a prospective cohort design, as well as to summarize the key techniques of primary suturing.

METHODS: Patients with choledocholithiasis who met the inclusion criteria between January 2019 and March 2023 were enrolled. The primary suture group comprised patients who underwent LCBDE with primary closure, while the T-tube drainage group consisted of those who received LCBDE with T-tube drainage. Perioperative data and follow-up outcomes were collected and statistically analyzed for both groups.

RESULTS: Operative time (120.00 [100.00-139.50] vs. 99.00 [85.00-118.50] min; P = 0.000) and postoperative hospital stay (7.00 [5.00-9.00] vs. 5.00 [4.00-6.00] days; P = 0.000) differed significantly between groups. No significant differences were observed in estimated blood loss (40.7 ± 24.1 vs. 41.4 ± 23.7 mL; P = 0.537), conversion rate to laparotomy (2.38% vs. 2.27%; P = 0.918), time to gastrointestinal function recovery (2.1 ± 0.7 vs. 2.0 ± 0.6 days; P = 0.317), or postoperative complication rate (2.92% vs. 3.18%; P = 0.959). During follow-up, one case of common bile duct (CBD) stenosis and one case of extrahepatic cholangiocarcinoma occurred in the T-tube group; no such complications were observed in the primary suture group. The rates of residual stones (1.75% vs. 0.45%; P = 0.225) and recurrent stones (1.75% vs. 1.81%; P = 0.980) were without statistical significance.

CONCLUSION: In our grouping situation, LCBDE and primary suture is safer and more feasible than T-tube drainage in operative time and postoperative hospital stay. This conclusion has certain reference value for clinicians to choose the surgical method in laparoscopic surgery for choledocholithiasis.

PMID:41430465 | DOI:10.1007/s00464-025-12479-6

Eur Arch Otorhinolaryngol. 2025 Dec 22. doi: 10.1007/s00405-025-09932-6. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to evaluate and compare the diagnostic accuracy of two multimodal large language models-ChatGPT-5.0 Plus and Gemini 2.5-in interpreting pure tone audiograms. The primary hypothesis was that ChatGPT-5.0 Plus would outperform Gemini 2.5 in identifying auditory thresholds, determining type and degree of hearing loss, detecting masking, and providing treatment recommendations based on standardized visual inputs.

DESIGN: A diagnostic simulation study was conducted using 80 software-generated audiograms representing common hearing loss profiles, including normal, conductive, sensorineural, and mixed types. Each audiogram was interpreted by both models using a structured seven-question diagnostic prompt aligned with professional audiological guidelines. Two independent evaluators-an audiologist and an otolaryngologist with audiology expertise-rated each model’s response using a five-point Likert scale. Inter-rater agreement and comparative analyses were performed using non-parametric statistical tests.

RESULTS: ChatGPT-5.0 Plus outperformed Gemini on six of seven diagnostic items and in the overall score. Inter-rater agreement for ChatGPT was almost perfect overall (κ = 0.951), with moderate concordance on Q1 (κ = 0.490) and very high agreement across the remaining items (κ = 0.912-0.981). Gemini also showed strong but lower consistency (overall κ = 0.823; item-level 0.833-0.949), with the weakest agreement on treatment recommendation (Q7). Comparative analyses revealed statistically significant advantages for ChatGPT in air and bone conduction threshold identification, classification of hearing loss type and degree, and diagnostic accuracy. Differences in masking evaluation (Q5) were not significant. Median score differences of 1-2 points on the 5-point scale underscored the clinical relevance of ChatGPT’s superior performance.

CONCLUSIONS: ChatGPT-5.0 Plus demonstrated superior accuracy and consistency in interpreting pure tone audiograms compared to Gemini 2.5. While not suitable as standalone diagnostic tools, large language models may serve as useful adjuncts in primary care and telehealth environments for preliminary audiological assessment. Further validation in real-world clinical settings is necessary before broader implementation.

PMID:41430450 | DOI:10.1007/s00405-025-09932-6

Eur Arch Otorhinolaryngol. 2025 Dec 22. doi: 10.1007/s00405-025-09904-w. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the prognostic value of hematological inflammatory biomarkers in predicting hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with combined systemic and intratympanic corticosteroids.

METHODS: This retrospective study included 125 patients diagnosed with ISSNHL between 2012 and 2021 who received both oral prednisone and intratympanic methylprednisolone. Clinical data and pre-treatment blood samples were collected. Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated. Hearing outcomes were classified as complete, partial, or no recovery based on pure tone average (PTA) thresholds. Univariate and multivariable logistic regression analyses were performed to identify predictors of recovery.

RESULTS: Of the 125 patients, 33 (26.4%) had no recovery, 50 (40.0%) partial recovery, and 42 (33.6%) complete recovery. Dizziness, current smoking, delayed treatment initiation (> 7 days), elevated triglycerides (≥ 98 mg/dL), and high PLR (≥ 142) were independently associated with a lower probability of hearing recovery. A higher LMR (≥ 3.0) showed a positive trend but did not reach statistical significance in adjusted models.

CONCLUSIONS: In patients with ISSNHL treated with dual-route corticosteroids, several clinical and hematologic factors, particularly elevated PLR and delayed treatment, are independently associated with reduced odds of hearing recovery. Inflammatory blood markers may serve as accessible prognostic tools to support early risk stratification.

PMID:41430443 | DOI:10.1007/s00405-025-09904-w

Sci Rep. 2025 Dec 22. doi: 10.1038/s41598-025-33179-0. Online ahead of print.

ABSTRACT

Accurate prenatal diagnosis of high-risk placenta accreta spectrum (PAS) is vital for maternal safety and can mitigate severe complications. We aimed to investigate the diagnostic value of a novel MRI sign, “increased intra-myometrial vascularity (IIMV),” and to evaluate its contribution to an optimal MRI sign combination for differentiating high-risk placenta accreta spectrum (PAS), specifically placenta increta (PI) and percreta (PP), from placenta accreta (PA) or normal placenta. This retrospective study reviewed 166 high-risk pregnant women who underwent MRI. Two radiologists independently assessed the presence of the seven established risk signs from the SAR-ESUR consensus and the novel IIMV sign. The IIMV sign was defined as continuous tubular or tortuous flow-void structures confined within the myometrium, associated with architectural distortion. Univariate logistic regression and interobserver agreement (kappa statistics) were used to select significant signs, which were then incorporated into a multivariate model to construct diagnostic combinations. AUCs were compared between combinations (with and without IIMV sign) in differentiating PI + PP group from PA + Normal groups. The novel IIMV sign demonstrated the highest specificity (0.91) and was independently associated with the differentiation between the PI + PP and Normal + PA groups. The optimal sign combination, which included IIMV, placental bulge, myometrial thinning, and bladder wall interruption, achieved an area under the curve (AUC) of 0.84. In contrast, the combination without IIMV showed a decreased AUC of 0.79 (p = 0.1203). The “increased intra-myometrial vascularity” sign is a highly specific marker for high-risk PAS. Its inclusion in an MRI-based diagnostic model improves the performance for identifying invasive placental disorders compared to combinations that do not utilize this novel sign.

PMID:41430431 | DOI:10.1038/s41598-025-33179-0

Sci Rep. 2025 Dec 23. doi: 10.1038/s41598-025-32913-y. Online ahead of print.

ABSTRACT

Carbohydrate antigen 125 (CA125) is increasingly recognized as a biomarker in heart failure (HF). However, its response to sodium-glucose co-transporter 2 inhibitors (SGLT2i) after acute myocardial infarction (AMI) remains insufficiently explored. In this study, CA125 levels were measured from plasma samples collected in the EMMY trial, and robust linear mixed-effects models (R-LMEMs) were applied to assess the effects of empagliflozin on CA125 levels, their changes over a 26-week period, and their associations with established HF biomarkers. Our analysis showed that empagliflozin had no statistically significant effect on log-transformed CA125 levels. CA125 exhibited minor fluctuations at 6 weeks before declining at 26 weeks to a level below baseline, which had been measured shortly after AMI. Log-transformed CA125 was significantly associated with log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) and multiple echocardiographic parameters, including left ventricular ejection fraction (LVEF), end-diastolic and end-systolic dimensions, and volumes (LVEDD, LVEDV, LVESD, LVESV), and the ratio of early diastolic transmitral inflow velocity to early diastolic mitral annular velocity (E/e’). Notably, CA125’s associations with NT-proBNP and E/e’ were modified by empagliflozin. In conclusion, although CA125 showed significant associations with established HF biomarkers, it did not exhibit a parallel response to empagliflozin after AMI.

PMID:41430429 | DOI:10.1038/s41598-025-32913-y