Nevin Manimala

Med Sci Monit. 2025 Oct 26;31:e950416. doi: 10.12659/MSM.950416.

ABSTRACT

BACKGROUND Foot biomechanics significantly influence weightlifting performance and injury prevention. Previous studies have indicated that intensive weightlifting impacts foot structure; however, comprehensive investigations into foot characteristics among weightlifters remain scarce. This study aims to compare the foot arch index (FAI), plantar load distribution (PLD), center of pressure (CoP), and rearfoot posture in 24 elite male weightlifters (77 kg and 85 kg classes) and 32 age- and body mass index-matched healthy men. MATERIAL AND METHODS A cross-sectional study was conducted involving 24 elite male weightlifters and 32 healthy controls. The JC Mat optical plantar pressure analyzer was used to assess FAI, PLD, and CoP during static stances, while rearfoot angles were measured through postural alignment analysis. Statistical comparisons were performed using independent samples t test or the Mann-Whitney U test. RESULTS Weightlifters exhibited significantly higher FAI values (P<0.05) and greater rearfoot valgus angles (P<0.01) for both feet, compared with the controls. Their PLD was predominantly concentrated at the medial longitudinal arches (P<0.05), medial heels (P<0.01), and lateral metatarsals (P<0.05), as well as the left medial metatarsals (P<0.05). CoP distribution was symmetrical across both feet. CONCLUSIONS Elite weightlifters in this study developed low-arched pronated foot postures, characterized by medial-dominant PLD patterns and bilateral symmetrical CoP. These biomechanical adaptations may enhance stability and balance during weightlifting, whereas increased rearfoot valgus may predispose athletes to lower limb injuries. Systematic assessment of foot biomechanics is essential for optimizing performance, preventing injuries, and designing weightlifting-specific footwear.

PMID:41139217 | DOI:10.12659/MSM.950416

BMC Cancer. 2025 Oct 25;25(1):1645. doi: 10.1186/s12885-025-14809-2.

ABSTRACT

BACKGROUND: Prostate cancer is the most prevalent cancer among men within the U.S. and globally, with rising incidence, including advanced-staged disease. Risk factors for aggressive prostate cancer are not well defined. This systematic review and meta-analysis provide an overview of the relationship between cardiometabolic diseases (diabetes, dyslipidemia, obesity, and hypertension) and aggressive prostate cancer.

METHODS: Aggressive prostate cancer was defined as disease that has spread or is at high risk of spreading: high-risk or very high-risk localized (T3-T4, Grade Group 4-5), node-positive (N1), or metastatic (M1). Using PRISMA guidelines, a total of 4,830 publications revealed 25 cohort studies of over 974,000 men. Following the systematic review of these prospective studies of men with prostate cancer, R was utilized to run a random effects model, yielding hazard ratios with 95% confidence intervals and generating forest plots with measures of heterogeneity.

RESULTS: Examination of these studies revealed that a positive association exists. Diabetes was associated with a significantly increased risk of aggressive prostate cancer (HR = 1.18; 95% CI: 1.07-1.30; p = 0.0008). Obesity also showed a significant association (HR = 1.15; 95% CI: 1.06-1.24; p = 0.0006), as did hypertension, though to a lesser degree (HR = 1.07; 95% CI: 1.00-1.14; p = 0.04). Dyslipidemia was not significantly associated with aggressive prostate cancer (HR = 1.03; 95% CI: 0.98-1.03; p = 0.26).

DISCUSSION: Three of the four cardiometabolic disease components (diabetes, obesity and hypertension) were shown to have statistical significance and offered intriguing evidence on their potential associations with aggressive prostate cancer. Dyslipidemia’s association was not statistically significant, which could be attributed to variations in methods of assessment and differing mechanistic effects. High heterogeneity and limited study availability remain key limitations.

CONCLUSION: If such associations between cardiometabolic diseases and prostate cancer aggressiveness are shown to be cause and effect, such controllable and treatable conditions can allow oncologists to work alongside primary care physicians to improve patient outcomes and reduce the incidence of aggressive disease. Through the promotion of lifestyle modifications, tighter cardiometabolic control, and targeted interventions, public health efforts might improve prostate cancer outcomes.

PMID:41139205 | DOI:10.1186/s12885-025-14809-2

Ann Surg Oncol. 2025 Oct 25. doi: 10.1245/s10434-025-18513-0. Online ahead of print.

ABSTRACT

BACKGROUND: Prognostication tools offer a way to combine diverse information and inform personalized survival predictions for patients and their providers. A review of tools aimed at prognostication for patients with esophagus and gastroesophageal junction (GEJ) cancers undergoing surgery did not identify many high-quality tools that may be used.

METHODS: This study developed and externally validated a prognostic model to estimate the probability of dying within 3 years of surgery for patients with resected esophageal or GEJ cancer diagnosed between 2004 and 2016, followed to 2020. We used population-based administrative health and pathology data in Ontario (development) and Manitoba (external validation) from cancer registries, physician billing data, and hospitalization records. Predictor variables included patient (e.g., age, sex), disease (tumor stage, lymph node status), treatment (e.g., extent of surgery, receipt of radiation), and pathology factors (e.g., lymphovascular invasion). Bootstrapped calibration-in-the-large and time-varying area under the curve (AUC) statistics were estimated.

RESULTS: Model development included 2124 patients from Ontario. External model validation included 318 patients from Manitoba. Internal validation demonstrated a calibration plot slope of 1.02, intercept of – 0.01, and AUC of 0.77. In comparison, the external validation reported a calibration plot slope of 1.11, intercept of 0.005, and AUC of 0.73. These results were robust across patient characteristics (e.g., age, sex, income), disease histology, and primary tumor location.

CONCLUSION: Our model demonstrated accurate prognostic capability and may be suitable for application in real-world clinical care. Development of a web-based interface and supporting documentation for communicating risk to personalize prognosis for patients or facilitate shared decision-making is under way.

PMID:41139180 | DOI:10.1245/s10434-025-18513-0

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12091-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To develop a personalized risk stratification nomogram, integrating clinicopathological, sonographic, and mammographic features, to identify high-risk patients who may benefit from postmastectomy radiotherapy (PMRT).

MATERIALS AND METHODS: A retrospective analysis was conducted on 408 patients from Medical Center 1 (January 2011 to June 2019) and 190 patients from Medical Center 2 (January 2017 to June 2019) with pathologically staged pT1-2N1M0 breast cancer following mastectomy, with preoperative mammography (MG) and ultrasound (US) imaging. After propensity score matching (PSM), the multimodal nomogram was developed using univariate and multivariate Cox regression analyses.

RESULTS: With multivariate analysis, independent risk factors were identified, including age, pathologic T stage, positive axillary lymph nodes, lymphovascular invasion, microcalcifications, and vascularity on US, architectural distortion, and suspicious calcifications on MG (all p < 0.05). The C-index for the multimodal nomogram was 0.816 (95% CI: 0.774-0.859) in the training and 0.846 (95% CI: 0.772-0.920) in the external validation cohort, demonstrating superior prognostic accuracy, discriminative ability, and clinical applicability than clinicopathological and imaging-only models. Risk stratification using this nomogram showed that PMRT significantly improved RFS in the high-risk group (training cohort: HR = 0.392; external validation cohort: HR = 0.358, both p < 0.05), while patients in the low-risk group did not derive benefit from PMRT (training cohort: HR = 0.173; external validation cohort: HR = 0, both p > 0.05).

CONCLUSION: This multimodal nomogram served as a clinical decision-support tool for clinicians to assess the risk-benefit balance of PMRT and had potential clinical application to guide further personalized adjuvant therapy for women with pT1-2N1M0 breast cancer.

KEY POINTS: Question Can the multimodal nomogram integrating clinicopathological, ultrasonic, and mammographic parameters identify high-risk pT1-2N1M0 patients who may benefit from postmastectomy radiation therapy? Findings By effectively risk-stratifying, the nomogram identified high-risk patients who derived significant benefit from PMRT while distinguishing low-risk patients who could potentially avoid unnecessary treatment. Clinical relevance The multimodal nomogram served as a clinical decision-support tool for clinicians to optimize personalized adjuvant therapeutic approaches and improve survival outcomes for patients with pT1-2N1M0 breast cancer.

PMID:41139173 | DOI:10.1007/s00330-025-12091-1

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12084-0. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify MR imaging features of replacement histopathological growth patterns (rHGPs) of colorectal liver metastases (CRLMs) distinguishable from those of desmoplastic HGPs (dHGPs) and explore their relationships with prognosis.

MATERIALS AND METHODS: Seventy-nine patients with 104 CRLMs who underwent gadoxetic acid-enhanced MR followed by partial hepatectomy were included as a derivation cohort. The CRLMs were rHGPs or dHGPs. MR images of the CRLMs, focusing on the tumor and segmented tumor-liver interface zones (peritumoral area), were quantitatively evaluated and statistically analyzed. The statistically significant findings from the derivation cohort were validated in an independent external cohort.

RESULTS: In the derivation cohort, there were no significant differences among tumor sizes, contrast-to-noise ratios (CNRs), or enhancement ratios (ERs) of the tumors with rHGPs (n = 43) and dHGPs (n = 61) (p > 0.05). The peritumoral area was only identified during the arterial and portal phases. The thickness, CNR, and ER of the peritumoral area on the arterial and portal phase images of the rHGP group were significantly larger than those of the dHGP group (p < 0.05). The area under the ROC curve for predicting rHGP based on CNR during the arterial phase was the highest at 0.920. The peritumoral area CNR during the arterial phase was associated with a poor prognosis (p < 0.05). The usefulness of these parameters was confirmed in the validation cohort (p < 0.05).

CONCLUSION: The CRLMs with rHGPs had thicker peritumoral areas with higher CNR and ER during the arterial phase, and the CNR during the arterial phase was an independent indicator of poor prognosis.

KEY POINTS: Question Can MR imaging characteristics predict histopathological growth patterns (HGPs) of colorectal liver metastases (CRLMs), which have been established as independent predictors of prognosis? Findings CRLMs with replacement HGPs showed thicker, more enhanced peritumoral areas with higher contrast ratios than those with desmoplastic HGPs during the arterial phase. Clinical relevance Increased thickness and predominant enhancement of the peritumoral area during the arterial phase may serve as predictive markers for identifying replacement HGPs in CRLMs, which are linked to a poorer prognosis, in contrast to desmoplastic HGPs.

PMID:41139172 | DOI:10.1007/s00330-025-12084-0

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12093-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To predict active extravasation during angiography for colonic diverticular bleeding confirmed by CT angiogram (CTA) and examine the effect of procedural factors on clinical outcomes.

MATERIALS AND METHODS: Mesenteric angiograms performed at three hospitals for colonic diverticular bleeding on CTA between 2016 and 2025 were retrospectively reviewed. Data collection included CTA-to-angiogram time, extravasation and inferior vena cava size, angiogram selectivity, provocative maneuvers, and embolization techniques. Univariate and multivariate analyses were used to find associations between pre-procedural variables and active extravasation on angiography. Clinical outcomes were compared between patients who were or were not embolized.

RESULTS: One hundred seventeen patients (median age, 76 years (IQR 16), 42 women) underwent 146 angiograms. Active extravasation was found in 40% of angiograms. CTA-to-angiogram time ≤ 4 h (OR = 2.95; CI: 1.17-7.73; p = 0.02), inferior vena cava short axis ≥ 20 mm (OR = 3.63; CI: 1.24-11.6, p = 0.02) and age (OR = 1.06; CI: 1.01-1.12; p = 0.01) were independent predictors for active bleeding on angiography in a multivariate logistic model (AUC: 0.81, CI: 0.72-0.89; p < 0.01). Angiography beyond the named arterial branch revealed more bleeding than main trunk angiography (34% vs 21%). 51/58 (88%) positive and 15 negative angiograms were embolized. Patients with targeted embolization had less rebleeding (10% vs 44%, p < 0.05) and post-procedure colonoscopies (17% vs 51%, p < 0.05).

CONCLUSION: Mesenteric angiography had a 40% positivity rate for diverticular bleeding after CTA, with a higher yield if performed within 4 h, sub-selectively, and after resuscitation. Targeted embolization decreased rebleeding and post-procedure colonoscopies.

KEY POINTS: Question Colonic diverticular bleeding identified on CTA is treated with angiography and embolization, but diagnostic yield and embolization outcome are extrapolated from all-cause lower gastrointestinal bleeding. Findings Extravasation was identified in 40% of angiograms, with better yield if performed ≤ 4 h after positive CTA and sub-selectively. Targeted embolization reduced rebleeding and post-procedural colonoscopies. Clinical relevance Patients with colonic diverticular bleeding with active extravasation on CTA should be vigorously resuscitated and undergo prompt mesenteric angiography. This increases the likelihood of visualizing active extravasation and targeted embolization, leading to less rebleeding and further procedures.

PMID:41139171 | DOI:10.1007/s00330-025-12093-z

Eur Radiol. 2025 Oct 25. doi: 10.1007/s00330-025-12064-4. Online ahead of print.

ABSTRACT

OBJECTIVES: White matter hyperintensities (WMH) are abnormalities in brain imaging that contribute to cognitive decline and diseases. This study aimed to build WMH probability maps (WPMs) and normative data of WMH volume from a Chinese aging cohort, to offer valuable insights for diagnosis.

MATERIALS AND METHODS: We developed WPMs from a comprehensive dataset across six age groups (20-29, 30-39, 40-49, 50-59, 60-69, and 70-79 years), encompassing 735 participants. WMH segmentation was performed with a deep learning approach, and the resulting masks were registered to the standard space for WPM construction. We explored how WMH volume changed with age and established normative data for different age groups. Additionally, we examined whether WMH volume moderates the relationship between aging and cognitive decline. The practical utility of WPMs was then validated with a separate patient cohort with mild cognitive impairment and Alzheimer’s disease.

RESULTS: WPMs and the normative data of WMH volume were constructed for six age groups. As age increased, both the likelihood and spatial coverage of WMH grew. All types of WMH (total, periventricular, and deep white matter hyperintensities) quadratically increased with age. Deep white matter hyperintensities moderated the decline of general cognitive abilities related to aging. The two patient groups had significantly higher ratios of abnormal WMH than typical aging adults.

CONCLUSION: We successfully built WPMs and WMH normative data for Chinese adults and demonstrated their clinical diagnostic values.

KEY POINTS: Question Current diagnostic tools lack population-specific references for white matter hyperintensities (WMH)in Chinese aging adults, limiting accurate discrimination between pathological neurodegeneration and typical aging patterns. Findings These Chinese WMH probability maps show quadratic age-related growth, with deep WMH moderating cognitive decline. Mild cognitive impairment/Alzheimer’s Disease (MCI/AD) patients exhibited significantly higher WMH volumes. Clinical relevance These population-specific WMH references enable clinicians to quantitatively identify abnormal aging and early neurodegeneration in Chinese patients, addressing the critical need for ethnically tailored diagnostic tools in Alzheimer’s disease and vascular cognitive impairment.

PMID:41139170 | DOI:10.1007/s00330-025-12064-4

Eur Arch Paediatr Dent. 2025 Oct 25. doi: 10.1007/s40368-025-01126-2. Online ahead of print.

ABSTRACT

PURPOSE: This umbrella review aims to summarize the overall pooled effect sizes to statistically provide a clear and measurable conclusion about the association between passive smoking and oral health outcomes among children.

METHODS: MEDLINE/PubMed, Embase, Scopus, Science Direct, and Cochrane Database of Systematic Reviews were searched to retrieve studies. An assessment of primary study overlap was also performed. Furthermore, upon summarizing the effect sizes from included studies, a meta-analysis was also performed.

RESULTS: Out of 537 retrieved records, a total of 12 studies were included in this review. Among the primary studies reported by the systematic review (SR) and/or systematic reviews and meta-analyses (SRMAs) (n = 12), over 50% were distinct. The most common exposure to second-hand smoke was from parental or household smoke. Meta-analysis was only performed for dental caries and found that the pooled effect size was 1.53 [1.39, 1.68] at 95% CI, indicating overall statistical significance (p < 0.01).

CONCLUSION: The review concludes that there exists a significant association between passive smoking and oral health outcomes in children and emphasizes the urgent need to mitigate exposure to passive smoking and its detrimental impact on pediatric oral health.

PMID:41139162 | DOI:10.1007/s40368-025-01126-2

Ann Med. 2025 Dec;57(1):2578427. doi: 10.1080/07853890.2025.2578427. Epub 2025 Oct 25.

ABSTRACT

BACKGROUND: Age-related muscle mass decline, an important component of sarcopenia, is associated with adverse outcomes in older adults. This study aims to develop an objective method to describe muscle mass from a pathological perspective and to investigate the relationship between aging and muscle mass decline in hip fracture patients.

METHODS: This study retrospectively analysed 120 patients who sustained hip fractures between June 2021 and June 2024, including 71 females and 49 males with a mean age of 74.03 ± 16.67 years. The gluteus maximus muscle tissue was collected during surgery and subjected to histological examination. Muscle proportions were quantitatively analysed using Adobe Photoshop software. The relationship between age and muscle mass was assessed using restricted cubic splines (RCSs) with five knots at specified age percentiles to model the non-linear association.

RESULTS: A significant decline in muscle mass with increasing age, particularly after 75 years in hip fracture patients. Muscle proportions were found to decrease sharply between the ages of 75 and 79, marking a critical period for muscle loss. The study also identified 61 years as the starting point of noticeable muscle mass decline, with further accelerated loss occurring beyond 75 years. Gender differences in the rate of muscle mass decline were not statistically significant.

CONCLUSIONS: Age-related muscle mass decline is evident in hip fracture patients, with accelerated decreases occurring at specific age intervals. These findings highlight the importance of early monitoring and targeted preventive measures to mitigate adverse outcomes related to muscle loss.

PMID:41139121 | DOI:10.1080/07853890.2025.2578427

J Gynecol Obstet Hum Reprod. 2025 Oct 23:103058. doi: 10.1016/j.jogoh.2025.103058. Online ahead of print.

ABSTRACT

INTRODUCTION: To describe the effects of maternal COVID-19 on the incidence of small for gestational age (SGA) newborns and other pregnancy outcomes according to disease severity and trimester of infection.

MATERIAL AND METHODS: This was a prospective cohort study conducted at Vall d’Hebron University Hospital between March 2020 and June 2023 which included 404 consecutive single pregnancies with SARS-CoV-2 infection classified by severity and trimester of infection and a reference group of 404 consecutive single pregnancies with no suspicion of SARS-CoV-2 infection. The primary outcome was the incidence of SGA newborns. Secondary outcomes included other adverse perinatal and neonatal outcomes.

RESULTS: The rate of SGA newborns was higher in the COVID-19 group, with an adjusted relative risk of 1.60 (95% CI, 1.03-2.48). The risk was particularly elevated in severe cases and when infection occurred during the first trimester. No association was found between COVID-19 and preeclampsia or spontaneous preterm birth. COVID-19 cases showed a higher risk of iatrogenic preterm birth and maternal intensive care unit admission, particularly in severe cases during the third trimester. When analysed by severity and trimester, adverse neonatal outcomes were more frequent in severe cases and in third trimester.

DISCUSSION: Pregnancies affected by COVID-19, especially severe cases and first-trimester infections, were associated with a 60% increased risk of small for gestational age newborns and also raises the risk of iatrogenic preterm delivery, adverse neonatal outcomes, and maternal intensive care unit admission, particularly in severe cases or third-trimester infections.

CONCLUSION: Healthcare providers should remain vigilant about the risk of adverse pregnancy outcomes in severe cases of COVID19.

PMID:41139067 | DOI:10.1016/j.jogoh.2025.103058