Nevin Manimala

Eur J Heart Fail. 2025 Apr 25. doi: 10.1002/ejhf.3664. Online ahead of print.

ABSTRACT

AIMS: Adult patients with transposition of the great arteries (TGA) and an systemic right ventricle (sRV) are at risk for heart failure (HF). In this study, we investigated risk factors for HF hospitalization and developed a novel risk stratification tool to optimize risk prediction for clinical practice.

METHODS AND RESULTS: In this international multicentre study, 522 patients with TGA and an sRV, without history of HF hospitalization, were followed retrospectively for a median of 17.9 years (interquartile range [IQR] 12.9-22.1). HF hospitalization was defined as a hospital admission for HF signs and symptoms with initiation or increase of HF medication. Predictors for HF hospitalization were established using a Cox regression analysis and were used to build a 10-year risk score. Of the 522 patients, 70% had an atrial switch operation and 30% had a congenitally corrected TGA. The median age at time of enrolment was 23.7 years (IQR 19.9-32.1) and 64% were male. During follow-up, 127 patients (24.3%) had at least one HF hospitalization. A risk stratification tool was built using the following independent predictors associated with a 10-year risk of HF hospitalization: age, New York Heart Association functional class ≥II, QRS duration >120 ms, atrial fibrillation, moderate/severe right ventricular dysfunction, with a C-statistic of 0.868 (95% confidence interval 0.823-0.913).

CONCLUSION: During follow-up, 24.3% of sRV patients had at least one HF hospitalization. Five simple, clinically-accessible variables can be used as a risk score tool to identify patients at higher risk of HF hospitalization.

PMID:40279105 | DOI:10.1002/ejhf.3664

Insect Mol Biol. 2025 Apr 25. doi: 10.1111/imb.12992. Online ahead of print.

ABSTRACT

The western flower thrips, Frankliniella occidentalis, is the principal thrips vector of Orthotospovirus tomatomaculae (order Bunyavirales, family Tospoviridae), a devastating plant-pathogenic virus commonly referred to as tomato spotted wilt virus (TSWV). The larval gut is the gateway for virus transmission by F. occidentalis adults to plants. In a previous report, gut expression at the transcriptome level was subtle but significant in response to TSWV in L1s. Since it has been well documented that the relationship between the expression of mRNA and associated protein products in eukaryotic cells is often discordant, we performed identical, replicated experiments to identify and quantify virus-responsive larval gut proteins to expand our understanding of insect host response to TSWV. While we documented statistically significant, positive correlations between the abundance of proteins (4189 identified) and their cognate mRNAs expressed in first and second instar guts, there was virtually no alignment of individual genes identified to be differentially modulated by virus infection at the transcriptome and proteome levels. Predicted protein-protein interaction networks associated with clusters of co-expressed proteins revealed wide variation in correlation strength between protein and cognate transcript abundance, which appeared to be associated with the type of cellular processes, cellular compartments and network connectivity represented by the proteins. In total, our findings indicate distinct and dynamic regulatory mechanisms of transcript and protein abundance (expression, modifications and/or turnover) in virus-infected gut tissues. This study provides molecular candidates for future functional analysis of thrips vector competence and underscores the necessity of examining complex virus-vector interactions at a systems level.

PMID:40279100 | DOI:10.1111/imb.12992

Anat Sci Int. 2025 Apr 25. doi: 10.1007/s12565-025-00843-4. Online ahead of print.

ABSTRACT

The suprascapular notch is one of the anatomical sites most commonly exposed to compressive and traction injuries of the suprascapular nerve. In this preliminary study, we aimed to evaluate the morphological and morphometric features of the notch to enhance the diagnostic accuracy and therapeutic outcomes of nerve compression. This retrospective study was conducted using computed tomography images of the scapula obtained between January 1, 2022, and August 30, 2024. A total of 852 scapulae were evaluated, of which 448 belonged to males and 404 to females. Morphometric measurements included superior transverse diameter, middle transverse diameter, and maximal depth of the notch. In addition, the notch was classified using both the Polguj and Rengachary classification systems. When the measurement parameters were compared between genders, the values were higher in males; however, only the maximal depth showed a statistically significant difference (p < 0.05). According to the Polguj classification, Type 3 was the most common (63.38%). Based on the Rengachary classification, the U-shaped form was the most frequently observed (65.02%), while the J-shaped form was the rarest (3.41%). The foramen shape was detected in 5.75% of cases. The J-shaped variant was found to be approximately four times more common in males than in females. Knowledge of the anatomical variations of the notch is likely to be beneficial for both endoscopic and open surgical interventions in the suprascapular region. In particular, three-dimensional computed tomography imaging may be useful in preoperative planning for arthroscopic resection of ossified ligament.

PMID:40279073 | DOI:10.1007/s12565-025-00843-4

Head Neck Pathol. 2025 Apr 25;19(1):50. doi: 10.1007/s12105-025-01790-2.

ABSTRACT

INTRODUCTION: Oral squamous cell carcinoma is the most prevalent of all the oral cancers. There is no definitive marker available for its early diagnosis and its effective prognosis. YAP serves as a transcriptional regulator in hippo tumor suppressor pathway thereby activating the transcription of genes taking part in cellular proliferation, alteration, migration, and invasion. On the contrary, PARK2 acts as a tumor suppressor and has been widely explored in various malignancies. However, its role in OSCC carcinogenesis is untrodden.

AIM: To evaluate the Immunohistochemical expression of YAP and PARK2 in oral epithelial dysplasia and Oral Squamous Cell Carcinoma and establish them as prognostic markers.

MATERIAL AND METHOD: The study sample consisted of 70 formalin fixed paraffin embedded tissue sections of normal oral mucosa (10), oral epithelial dysplasia (30) and oral squamous cell carcinoma (30). Immunohistochemical analysis of YAP and PARK2 was done and final scores were calculated. Further, the markers were graded as low and high expression groups. Statistical analysis was done using chi-square test, cox regression analysis and Spearman’s correlation. Kaplan Meier plot for survival analysis was also plotted.

RESULT: Immunohistochemical expression of YAP depicted a gradual incline from normal oral mucosa to oral squamous cell carcinoma while PARK2 showed a reverse trend. Significant difference of YAP and PARK2 expression between three groups was noted. Inverse moderate degree of correlation was observed between both the markers in OSCC group.

CONCLUSION: Concomitant immunoexpression of YAP and PARK2 with a moderate degree of inverse correlation from normal oral mucosa to oral squamous cell carcinoma could probably serve as diagnostic and prognostic markers as they might act through a common mechanism, probably hippo/YAP signaling, which could be further confirmed by larger sample size, including longer follow up in future studies.

PMID:40279065 | DOI:10.1007/s12105-025-01790-2

CJEM. 2025 Apr 25. doi: 10.1007/s43678-025-00913-6. Online ahead of print.

ABSTRACT

OBJECTIVES: Previous retrospective studies have demonstrated that patients with sub-optimally controlled diabetes have higher healthcare resource utilization in emergency department (ED) management of hyperglycemia compared to those with good glycemic control. This study’s objective was to prospectively describe 30-day outcomes including return visits and hospitalizations after an initial ED visit for hyperglycemia.

METHODS: We conducted a multicenter prospective cohort study of adults ≥ 18 years at four Ontario academic EDs diagnosed with hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. The primary outcome was an unplanned repeat ED visit for hyperglycemia within 30 days of index visit. We conducted telephone follow-up at 14 and 30 days to determine additional outcomes. Data were summarized using descriptive statistics.

RESULTS: There were 657 ED visits for hyperglycemia representing 594 unique patients. Mean (SD) age was 52.0 (18.2) years, 53.2% were male. Within 30 days, 96 (14.7%) had a return ED visit for hyperglycemia, 49 (7.5%) were hospitalized, and 4 (0.6%) died. We were able to contact 383 (58.3%) patients by telephone at 14 days and 275 (41.9%) at 30 days. Of these, 68.3% self-identified as Caucasian/White, while 6.3% were Indigenous. 44.9% reported an annual household income below $50,000. 29.1% of working patients took time off following their index visit.

CONCLUSION: This prospective study describes 30-day outcomes and healthcare utilization of ED patients presenting for hyperglycemia. ED clinicians should be aware of the potential for subsequent healthcare utilization and risk for readmission and intervene as appropriate to reduce adverse outcomes in patients with diabetes presenting with hyperglycemia.

PMID:40279059 | DOI:10.1007/s43678-025-00913-6

Sleep Breath. 2025 Apr 25;29(2):170. doi: 10.1007/s11325-025-03332-0.

ABSTRACT

PURPOSE: This study was conducted to determine the effect of breathing exercises on pain, sleep, and symptom management in patients undergoing hemodialysis.

METHODS: The randomized controlled study was conducted with patients undergoing hemodialysis at a private dialysis center in the northern Black Sea region. Data were collected using the Descriptive Information Form, the Visual Analog Scale (VAS), the Richards-Campbell Sleep Questionnaire (RCSQ), the Dialysis Symptom Index (DSI), and the Vital Signs Form. According to the power analysis performed in the study, a total of 70 participants, 35 in each group, needed to be included in the study in order to conduct an independent t-test with a confidence level of 95%, a test power of 95%, and an effect size of d = 0.80. The study was conducted with a total of 69 patients divided into two groups: the experimental group (n = 35) and the control group (n = 34). Patients in the experimental group performed breathing exercises (Diaphragmatic breathing, Agni Sār, Nadi Shodhana, and the 4-7-8 breathing technique) on dialysis days for eight weeks. During this period, patients in the control group continued to receive routine nursing care in the hemodialysis unit.

RESULTS: Following the application, the average pain intensity in the control group (4.06 ± 3.1) was found to be statistically significantly higher than the average in the experimental group (0.4 ± 1.19) (p < 0.001). The average sleep score in the control group (48.56 ± 22.35) was found to be statistically significantly lower than the average in the experimental group (80.21 ± 16.46) (p < 0.001). The average DSI in the control group (92 ± 22.05) was found to be statistically significantly higher than the average in the experimental group (41.37 ± 7.15) (p < 0.001).

CONCLUSION: Breathing exercises in patients undergoing hemodialysis were found to reduce pain, improve sleep quality, and have a positive impact on symptom management. In light of this, it is recommended that nurses include breathing techniques as part of the care provided to hemodialysis patients. Using complementary methods such as breathing therapy supports the physical, psychological, psychosocial, and holistic care of patients, thus increasing patient satisfaction and quality of life. Training health professionals in breathing therapy will ensure a broader use of this complementary method in a larger patient population.

PMID:40279052 | DOI:10.1007/s11325-025-03332-0

Mol Neurobiol. 2025 Apr 25. doi: 10.1007/s12035-025-04958-7. Online ahead of print.

ABSTRACT

Autoantibodies target the acetylcholine receptor (AChR) in 85% of myasthenia gravis (MG) patients. Genomic studies highlighted the association of genes encoding AChR subunits (CHRNA1 and CHRNB1) and MG in European populations. Additionally, Mendelian randomization revealed rs4151121 at the CHRNB1 locus as a potential causal variant. Here, we performed Bayesian fine-mapping of the CHRNA1 locus using GWAS summary statistics, a linkage disequilibrium matrix and functional annotations. The GWAS lead hit rs35274388 was identified as a causal variant overlapping with the promoter region (p < 0.01). Next, we performed a candidate gene study including 1038 participants from Serbia. Rs4151121 minor allele G was associated with late-onset MG (LOMG) (OR = 1.327, 95% CI = 1.084-1.625, p = 0.006, p_perm = 0.007). Carriers of the rs4151121 GG and AG genotypes had an almost 1.5-fold increased risk of developing LOMG. A borderline association of the rs35274388 minor allele A with MG was observed (OR = 1.478, 95% CI = 1.009-2.166, p = 0.044, p_perm = 0.060). Individuals with AA and GA genotypes also showed a nearly 1.5-fold higher risk of developing MG. In silico-identified causal variants at the CHRNA1 and CHRNB1 loci represent risk factors for MG in European populations, and to a greater extent for LOMG. Studies on non-European populations and functional research are needed to elucidate the role of AChR genes in the genetic architecture and development of MG.

PMID:40279038 | DOI:10.1007/s12035-025-04958-7

Jpn J Radiol. 2025 Apr 25. doi: 10.1007/s11604-025-01793-7. Online ahead of print.

NO ABSTRACT

PMID:40279030 | DOI:10.1007/s11604-025-01793-7

Adv Ther. 2025 Apr 25. doi: 10.1007/s12325-025-03199-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Clinical trials have shown that adding evolocumab to statin therapy reduces low-density lipoprotein cholesterol (LDL-C) levels by approximately 60%. Given differences in patient characteristics and standards of care between trial and real-world settings, we conducted a cohort study to evaluate the LDL-C reduction achieved with evolocumab in clinical practice of China.

METHODS: The data source was the Tianjin Regional Healthcare Database (TRHD), which includes linked electronic health records (EHR) of public hospitals serving over 15 million residents in the Tianjin metropolitan area. The study cohort included adult patients with atherosclerotic cardiovascular disease (ASCVD) who added evolocumab to their statin therapy between 2019 and 2023. Key inclusion criteria were use of the same statin intensity before and after evolocumab initiation and available LDL-C values at baseline (within 90 days before initiation) and follow-up (15-90 days after initiation). Descriptive statistics were used to analyze LDL-C change between baseline and follow-up. To provide the context for evolocumab use and for study method assessment, we included another cohort of patients with stable statin intensity (unchanged for at least 180 days)-a cohort with minimal clinical expectation of further LDL-C change over time.

RESULTS: At baseline, the median (interquartile range [IQR]) LDL-C level was 3.44 (2.73-4.15) mmol/L in the evolocumab cohort (n = 395) and 2.20 (1.72-2.92) mmol/L in the stable statin cohort (n = 4160). At follow-up, the mean (95% confidence interval [CI]) percentage reduction in LDL-C levels was 63.0% (60.5-65.5%) in the evolocumab cohort and 2.5% (0.3-4.7%) in the stable statin cohort.

CONCLUSIONS: LDL-C reductions in patients who added evolocumab to statin therapy in real-world clinical practice in China align with reductions observed in clinical trials.

PMID:40279014 | DOI:10.1007/s12325-025-03199-3

Neurocrit Care. 2025 Apr 25. doi: 10.1007/s12028-025-02247-8. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency department length of stay (EDLOS) directly impacts outcomes of critically ill patients, with the risk of in-hospital mortality increasing by nearly 40% when an intensive care unit (ICU) bed is delayed beyond 4 h. Patients with intracerebral hemorrhage (ICH) suffer from worse functional outcomes and higher mortality when EDLOS exceeds 5 h, even for EDLOS exceeding just 1 h. Our goal was to implement an expedited triage pathway to reduce EDLOS of patients with ICH to less than 3 h and evaluate for downstream reduced morbidity and mortality.

METHODS: We conducted a retrospective analysis of patients with ICH evaluated in the emergency department (ED) at an academic comprehensive stroke center between January 1, 2022, and June 30, 2023. Univariate and multivariate logistic regression analyses were conducted to investigate the association between the NeuroICU FastTrack intervention with EDLOS less than 3 h and the rate of in-hospital mortality.

RESULTS: A total of 234 patients with ICH arrived to the ED and were admitted to the neuro-ICU. Post implementation, there was a statistically significant decrease in EDLOS from an average of 6.6 h to 4 h (p < 0.001) and a significant decrease in patient mortality (p = 0.006). There was also a reduction in mortality to 9.3% (p = 0.006) compared to a preintervention mortality rate of 22.9%. Additionally, the morbidity outcome (mRS of 0-2) remained relatively constant in both groups preintervention (23%) to post intervention (28%).

CONCLUSIONS: Consistent with prior published evidence and National Institute of Neurological Disorders and Stroke recommendations, a shorter EDLOS significantly decreased mortality, but there was no difference in morbidity in our population. The NeuroICU FastTrack process expedited critically ill ICH patient throughput from the ED to the ICU, enhanced bed availability through streamlined procedures, and improved patient outcomes.

PMID:40279011 | DOI:10.1007/s12028-025-02247-8