Nevin Manimala

Environ Res. 2025 Oct 23:123188. doi: 10.1016/j.envres.2025.123188. Online ahead of print.

ABSTRACT

Although environmental pollutants are known to affect the immune system, the impact of chemical mixtures on adolescent immune function remains understudied. Adolescence is a critical period for immune maturation, and disruptions during this stage may have implications for long-term health. Leukocytes, key components of the immune system, serve as indicators of immune status, with altered levels reflecting potential inflammation or immunosuppression. The present study examined the associations of 14 chemical exposure biomarkers measured in blood with counts of total leukocytes and leukocyte subtypes in 980 adolescents (13-16 years old) from the Flemish Environment and Health Studies 2012-2020 (FLEHS III and IV). The exposure biomarkers included 5 metals, 3 chlorinated pesticides, and 6 polychlorinated biphenyls (PCBs). We used four different statistical approaches: multiple linear regression, elastic net, Bayesian model averaging, and Bayesian kernel machine regression. Total leukocyte and neutrophil counts were negatively associated with PCBs and manganese (Mn), and positively associated with copper (Cu), whereas lymphocyte count was negatively associated with thallium (Tl). The neutrophil-lymphocyte ratio (NLR) was also negatively associated with Mn. An analysis excluding smokers additionally showed that higher cadmium (Cd) concentrations were associated with lower leukocyte count. Our study suggests immunosuppressive effects of PCBs, non-essentials metals Tl and Cd, and the essential metal Mn. Due to the cross-sectional design, we cannot rule out the possibility of reverse causation. The current study provides epidemiological evidence that exposure to metals and PCBs may have adverse effects on the immune system at concentrations detected in a general population of adolescents.

PMID:41139052 | DOI:10.1016/j.envres.2025.123188

J Pain Symptom Manage. 2025 Oct 23:S0885-3924(25)00897-8. doi: 10.1016/j.jpainsymman.2025.10.007. Online ahead of print.

ABSTRACT

CONTEXT: Peaceful acceptance of illness is associated with lower psychological distress and increased engagement in advance care planning among adults with advanced cancer. Limited data exist on factors influencing illness acceptance in older adults.

OBJECTIVES: To examine patient, caregiver, and oncologist characteristics associated with peaceful acceptance of illness in older adults with advanced cancer.

METHODS: A secondary analysis of a cluster-randomized trial evaluating the impact of geriatric assessment (GA) on cancer care in community oncology practices (NCT02107443). Participants included 333 patient-caregiver dyads. Patients were aged ≥70 years, had incurable stage III/IV solid tumors or lymphoma, and ≥1 GA impairment. Peaceful acceptance of illness was measured using the 5-item PEACE scale (range 5-20; higher scores indicate greater acceptance). Multivariable linear regression examined associations between PEACE scores and patient (e.g., GA impairments), caregiver (e.g., education), and oncologist factors (e.g., confidence).

RESULTS: The mean (standard deviation, SD) age was 76.8 (5.4) years for patients and 66.6 (12.1) years for caregivers. Common cancers included lung (27%), gastrointestinal (26%), and genitourinary (16%). Mean (SD) PEACE score was 17.4 (2.5), indicating high illness acceptance. Lower acceptance was associated with psychological impairment (b=-0.92; 95% CI, -1.56 to -0.29), shorter patient-estimated life expectancy (b=-1.06; 95% CI, -2.06 to -0.06), and caregiver education ≤high school (b=0.90; 95% CI, 0.32 to 1.49). No oncologist factors were significantly associated.

CONCLUSION: Patient psychological health, perceived prognosis, and caregiver education were linked to PEACE. Triadic interventions addressing these factors may enhance end-of-life care for older adults with advanced cancer.

PMID:41139045 | DOI:10.1016/j.jpainsymman.2025.10.007

Can J Cardiol. 2025 Oct 23:S0828-282X(25)01275-9. doi: 10.1016/j.cjca.2025.10.018. Online ahead of print.

ABSTRACT

BACKGROUND: Ablation procedures for atrial fibrillation (AF), including catheter (CA) and surgical ablation, are effective rhythm control therapies. The current study is a Bayesian network meta-analysis evaluating randomized evidence on the invasive treatment of AF, focusing on freedom from atrial tachyarrhythmias (ATA), while evaluating the potential trade-off in morbidity and mortality.

METHODS: This study was registered in PROSPERO (CRD42025632171). Randomized controlled trials (RCTs) were included comparing any of the four treatments; CA, isolated thoracoscopic, hybrid thoracoscopic ablation, and the Convergent procedure. Primary outcome was freedom from ATA at 12-months. Secondary outcomes were mortality, stroke, and bleeding. A Bayesian network meta-analysis was performed. The combined effects of the primary and secondary outcomes were studied in a bivariate analysis. Treatments were ranked and their effects were summarized using surface under the cumulative ranking curves (SUCRAs).

RESULTS: Ten RCTs were included in the analysis (n=877 patients, predominantly persistent AF). Using CA as a reference, the pooled network ORs for freedom from ATA for hybrid thoracoscopic, isolated thoracoscopic, and Convergent were 4.95 (95%CrI 2.16-13.46), 2.23 (95%CrI 1.23-4.48), and 2.23 (95%CrI 0.90-6.69), with SUCRAs for hybrid thoracoscopic, isolated thoracoscopic, Convergent, and CA of 95.5%, 50.8%, 52.1%, and 1.5%, respectively. No increase in periprocedural morbidity or mortality was observed. Results were robust across various sensitivity analyses.

CONCLUSION: In this Bayesian network meta-analysis, consisting exclusively of randomized data, surgical ablation in general, but hybrid ablation in particular, provides superior outcome in terms one-year-freedom from ATA. Both CA and surgical procedures are characterized by a favorable safety profile.

PMID:41139022 | DOI:10.1016/j.cjca.2025.10.018

J Shoulder Elbow Surg. 2025 Oct 23:S1058-2746(25)00753-0. doi: 10.1016/j.jse.2025.09.008. Online ahead of print.

ABSTRACT

INTRODUCTION: We aimed to determine whether Computed Tomography Hounsfield Units (CTHU) are an independent predictor of proximal humerus fracture fixation failure following open reduction and internal fixation (ORIF). We hypothesize that CTHU of the glenoid vault <160 Hounsfield Units (HU) would be associated with a higher rate of failure of ORIF and need for subsequent revision to arthroplasty.

MATERIALS AND METHODS: A retrospective cohort study was performed at a single academic center, including patients who sustained a displaced proximal humerus fracture treated with ORIF using locking plates over a twenty-year period. A minimum follow-up of 6 months was required. Exclusion criteria included concomitant glenoid fractures, humeral shaft fractures, primary bone malignancies, metastatic disease, or lack of preoperative CT scan. CTHU were measured at four distinct regions with the glenoid vault to assess bone density. Patients were categorized into those requiring subsequent revision to arthroplasty and those who did not. Statistical analyses were performed using standard tests for categorical and continuous variables, with significance set at p<0.05.

RESULTS: 135 patients were identified with 95 patients who successfully underwent ORIF and 40 patients who required revision to arthroplasty. Patients who required revision to arthroplasty had lower mean CTHU compared to those without revision (110.9±42.6 vs. 170.5±45.9, p<0.001). Patients with 2-part (166.9±44.9 vs 113.9±43.3, p<0.0001) and 3-part (175.7+47.3 vs 118.4+ 54.0) proximal humerus fractures who underwent revision arthroplasty had significantly decreased mean CTHU compared to patients who did not undergo revision. CTHU of the glenoid vault <160 HU significantly increased the risk of revision to arthroplasty after ORIF (p<0.001, RR = 3.00, 95% CI [1.28, 7.02]). Within the failed cohort who required revision to arthroplasty, there was no difference in CTHU between those who failed within 6 months or after 6 months from ORIF (92.9±37.7 vs. 134.3±50.9, p=0.057); there was a significant difference in revision rates of 2-part proximal humerus fractures with CTHU <160 compared to those with CTHU > 160 (p=0.004). CTHU of the glenoid vault were found to be positively correlated to the deltoid tuberosity index (R=0.72, p<0.001) and combined cortical thickness of the humerus (R=0.21, p=0.02).

DISCUSSION: CTHU of the glenoid vault <160 HU is an independent risk factor for ORIF failure in patients with displaced proximal humerus fractures, leading to a higher likelihood of requiring revision to arthroplasty. This opportunistic measurement CTHU can assist surgeons in informed decision-making between ORIF and primary arthroplasty in the management of these fractures.

LEVEL OF EVIDENCED: Level III; Retrospective Cohort Comparison; Prognosis Study.

PMID:41139006 | DOI:10.1016/j.jse.2025.09.008

J Inj Violence Res. 2025 Mar 16;17(1). Online ahead of print.

ABSTRACT

BACKGROUND: Fireworks are widely used worldwide for their visual and auditory appeal. However, they pose significant safety risks, particularly to children and young adults, many of whom sustain serious injuries from exposure to these pyrotechnic devices. Given the preventable nature of such incidents and their associated challenges, this study aims to examine the epidemiological impact of injuries caused by fireworks during the Chaharshanbeh Soori ceremony in Fars Province.

METHODS: This cross-sectional study included all individuals who experienced injuries between March 6, 2022, and April 4, 2022. Data were collected by emergency technicians affiliated with Shiraz University of Medical Sciences. Statistical analyses included descriptive statistics (mean ± standard deviation [SD] and frequency [%]) and analytical methods, specifically the chi-square test.

RESULTS: A total of 79 individuals were injured, with a mean age of 19.4 ± 11.5 years. The majority of the injured were male (73, 92.4%). Most injuries (66, 83.5%) occurred unintentionally, and 9 patients (11.4%) reported headache as a symptom, while 7 patients (8.9%) experienced visual disorders. Among those who received treatment, eye injuries were the most common (17, 26.2%). A significant difference was observed in recovery based on the injured body part; hand injuries had the highest recovery rate (6, 42.9%), compared to other injuries (p less than 0.029).

CONCLUSIONS: The findings indicate that fireworks-related accidents during the Chaharshanbeh Soori ceremony predominantly affect teenagers and young adults, often occurring unintentionally. Given the significant physical, financial, and long-term consequences of these injuries, this study’s results can inform policymakers in implementing preventive measures. Additionally, it highlights the need to raise awareness among the public and relevant authorities to ensure safer conduct of such ceremonies in the future.

PMID:41111445

High Alt Med Biol. 2025 Oct 17. doi: 10.1177/15578682251385415. Online ahead of print.

ABSTRACT

Wu, Tianzhun, Ruofan Li, Song, Li Xu, Chaofan Shi, Juanjuan Liu, Xing Gao, Shilin Huang, Shizhou Li, Dandan Zeng, Wenfeng Luo, Yan Lin, Jiazhou Ye, Minggen Hu, and Rong Liang. Using Mendelian randomization to dissect the relationship between high-altitude adaptation and liver diseases/traits. High Alt Med Biol. 00:00-00, 2025. Background: It has been reported that high-altitude adaptation (HAA) and susceptibility to multiple liver diseases/traits differ between individuals at higher altitudes compared to those at lower altitudes. To investigate this association, we conducted a Mendelian randomization study. Methods: To investigate the association between HAA and liver diseases/traits, we utilized genome-wide association studies focusing on East Asian ancestry. Our study included six liver disease-related phenotypes: autoimmune hepatitis, chronic hepatitis B, chronic hepatitis C, acute hepatitis by hepatitis A virus, hepatic cancer, and hepatic bile duct cancer, as well as five liver traits: alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase (GGT), and total bilirubin. A Bonferroni-corrected significance was set at p < 4.55 × 10^-3. Results: Our study identified a significant genetically predicted causal impact of HAA on GGT (odds ratio [OR] = 1.601; 95% confidence interval [CI] = 1.204-2.129; p = 0.0012). Interestingly, the association remained statistically significant even when the causal direction was reversed, with GGT predicting HAA (OR = 1.01; 95% CI = 1.003-1.011; p = 0.0013). Both findings surpassed the Bonferroni-corrected threshold. Conclusion: In conclusion, our study provides suggestive evidence for a potentially causal bidirectional association between HAA and GGT. These novel insights may inform the development of targeted preventive measures and therapeutic interventions for liver diseases and high-altitude adaptation.

PMID:41111436 | DOI:10.1177/15578682251385415

J Inj Violence Res. 2025 Apr 19;17(1). Online ahead of print.

ABSTRACT

BACKGROUND: There has been minimal research on drive-by shootings since the 1990s. It was the purpose of this study to investigate the demographics and injury patterns of drive-by shootings across the entire US using a national database.

METHODS: The Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2020 (ICPSR 38574) data for 1993 through 2020 was analyzed using statistical analyses accounting for the stratified and weighted nature of the data.

RESULTS: There were an estimated 63,882 emergency department visits due to drive-by shootings. The drive-by group was younger compared to the no-drive-by group (average age 24.5 years vs. 28.7 years – p less than 10-4). Patients injured in drive-by shootings were more prevalent in medium and large size hospitals. There was a lower percentage of White (17.9% vs. 42.3%) and a higher percentage of Hispanic (30.1% vs. 13.1%) peoples in the drive-by group compared to the no-drive-by group (p = 0.0009). The head/neck (14.3% vs. 3.5%) and lower extremity (35.5% vs. 25.5%) were more commonly injured in the drive-by group compared to the no-drive by group (p = 0.0008). While those in the drive-by group were admitted to the hospital more often (43.9% vs. 32.7%), there was no difference in the percentage of fatalities between the two groups (4.4% drive-by, 4.9% no-drive-by).

CONCLUSIONS: This study encompasses both rural and urban areas, all races, and both sexes. These national estimates give health care providers and health facility administrators important demographic information. While both drive-by and no-drive-by shootings increased from 2014 onward, the average annual increase was much greater for the drive-by group (22.7%) compared to the non-drive-by group (8.6%). This data provides helpful information that could be useful when analyzing prevention strategies and firearm legislation and their impact on drive-by shootings.

PMID:41111410

Phys Chem Chem Phys. 2025 Oct 20. doi: 10.1039/d5cp02594j. Online ahead of print.

ABSTRACT

Detailed information on the chemical and physical properties of the precursors of incipient carbon nanoparticles (CNPs) in flame combustion provides clues on the reaction pathways for CNP formation and growth. Therefore, this data is needed by the modeling community who seeks to understand inception at a fundamental level. However, identifying and isolating the precursors in a reactive environment at high temperature remains a challenging task. The present work reports a multi-diagnostic approach to identify the molecular species involved in the inception of CNPs based on the comparative analysis of surface morphology (scanning electron microscopy), chemical composition (time of flight secondary ions mass spectrometry), chemical state (X-ray photoelectron spectroscopy), and structure (Raman spectroscopy) of samples extracted from a nitrogen-diluted ethylene laminar diffusion flame stabilized on a Yale burner. Statistical analysis enables the reduction of the pool of species to be considered by showing, for instance, that large polyaromatic molecules are not required for the CNP inception to occur. Several low m/z species are identified as likely candidates that are consistent with polycyclic aromatic hydrocarbons (PAHs) and their derivatives. Among them, this work stresses the importance of species slightly above the curve representing the maximally condensed aromatics and of non-benzenoid PAHs (containing 5-member aromatic rings for instance). This new experimental evidence reveals trends consistent with the “combined physical and chemical inception” group of hypotheses, according to which small clusters (typically dimers) of PAHs initially bound by physical forces are rapidly stabilized by the formation of C-C covalent bonds according to various postulated mechanisms (extended HACA, spin localization).

PMID:41111402 | DOI:10.1039/d5cp02594j

Folia Morphol (Warsz). 2025;84(3):625-634. doi: 10.5603/fm.55110.

ABSTRACT

BACKGROUND: Radiological examination of bones such as the clavicle have been developed to estimate the age of an individual without valid identification or when suspected of providing inaccurate age. However, there is a paucity of information on the influence of sex and laterality on age in the estimation process. Therefore, the aim of this study was to evaluate the impact of sex and laterality in the ossification process of the medial clavicular epiphysis within the South African and Kenyan population.

MATERIALS AND METHODS: A retrospective study of 1605 digital radiographs selected from the South African and Kenyan population aged between 14 and 30 years was performed. The ossification process of the medial clavicular epiphysis was scored in accordance with Schmeling’s (2004) staging system. The difference between the chronological age and estimated age for each sex was recorded in a Bland-Altman chart. A log linear regression test was used to test for bilateral asymmetry in the ossification status of the medial epiphyses RESULTS: While statistically significant differences between males and females were observed in stages 1, 2, 3, and 4 of the ossification process, a paired sample t-test did not report any statistically significant difference in the asymmetry of the medial epiphysis (p = 0.89).

CONCLUSIONS: The present study concurs that the maturation of the clavicle starts earlier in the female population. However, no significant differences were recorded in the timeframe of maturation between the right and left clavicles.

PMID:41111394 | DOI:10.5603/fm.55110

J Laparoendosc Adv Surg Tech A. 2025 Oct 17. doi: 10.1177/10926429251389908. Online ahead of print.

ABSTRACT

Introduction: Few studies have compared conventional Roux-en-Y (RNY) reconstruction with oncometabolic surgical techniques for postoperative glycemic control in patients with gastric cancer and type 2 diabetes. This study evaluates the impact of long-limb (oncometabolic) RNY reconstruction on type 2 diabetes remission and glycemic control compared with the conventional method in patients undergoing laparoscopic radical gastrectomy. Materials and Methods: Between 2020 and 2024, 44 patients with gastric cancer and type 2 diabetes were enrolled at our institution. Of these, 19 patients underwent laparoscopic radical gastrectomy with oncometabolic RNY reconstruction, and 25 patients received conventional RNY reconstruction. Demographic data (age, gender, and BMI), preoperative glycemic parameters (fasting blood sugar and HbA1c), and tumor characteristics were recorded. Comparative analysis assessed diabetes treatment outcomes in the first postoperative year, including antidiabetic medication use, insulin requirements, and diabetes remission rates. Results: Diabetes remission occurred in 52.6% of the oncometabolic surgery group compared with 20% in the conventional RNY group (P = .024). Multivariate logistic regression showed that oncometabolic surgery increased remission likelihood by 5.75 times (OR = 5.75; 95% CI: 1.17 to 28.21; P = .03). Antidiabetic medication use decreased by 78.9% in the oncometabolic group versus 24% in the conventional group (P = .001). Insulin requirements dropped from 36.8% to 5.3% in the oncometabolic group (P = .031). Conclusions: Oncometabolic surgery provides significant advantages in gastric cancer patients not only from an oncological perspective but also from a metabolic perspective.

PMID:41111390 | DOI:10.1177/10926429251389908