Nevin Manimala

J Thromb Thrombolysis. 2025 Dec 17. doi: 10.1007/s11239-025-03220-0. Online ahead of print.

ABSTRACT

Amyloid microclots have been implicated in thrombotic complications across various pathological conditions such as Long COVID symptoms, yet their resistance to enzymatic fibrinolysis causes a therapeutic challenge. In this study we examine the effects of three fibrinolytic enzymes rtPA, Lumbrokinase, and Nattokinase on plasma-derived amyloid microclots, in combination with ultrasound-induced microstreaming and microbubbles. A lab-on-chip platform was used to expose the clots to ultrasound at 150, 300, and 500 kHz. Quantitative analysis revealed that ultrasound alone significantly disrupted clot structures, particularly at 150 kHz, where mean clot diameter was reduced by over 60% and large-clot count (> 30 μm) dropped by more than 80% compared to controls. The addition of fibrinolytic enzymes, however, did not produce statistically significant effects at 150-300 kHz which indicates that mechanical forces were the dominant contributors to clot disruption. At 500 kHz, where ultrasound alone was less effective, enzymatic treatment moderately enhanced the reduction in large-clot burden. These results show the potential of low-frequency ultrasound as a primary method of amyloid microclot breakdown, with enzyme co-treatment offering limited but measurable effect.

PMID:41405757 | DOI:10.1007/s11239-025-03220-0

Environ Monit Assess. 2025 Dec 17;198(1):50. doi: 10.1007/s10661-025-14806-9.

ABSTRACT

Population growth and agricultural expansion cause major changes in land use and land cover (LULC) in Ethiopia. Cultivated lands are mostly expanding without land suitability evaluation. Consequently, crop yields are not increasing as expected. This is particularly the case in the highland catchments draining toward Lake Tana, where severe consequences such as deforestation and the degradation of soil and land can be observed. In this study, the impacts of long-term LULC dynamics on the land suitability potential for selected major crops in three sub-catchments of Lake Tana, Ethiopia (Gilgelabay, Gumara and Ribb), were evaluated. Time series of Landsat images from three periods (1988, 1998, and 2017) were classified. Land suitability was analyzed via a multi criteria approach based on spatial input data such as elevation, soil, and slope maps. The overall accuracy for all LULC classifications was good to very good (89.7% to 91.6%). Five major LULC classes were distinguished: agriculture, forest, shrub/bushland, grassland, and water. In all three catchments, the results revealed that agricultural land was the dominant land cover that expanded at the expense of the other land cover types to 80%-90% in all catchments in 2017. The rate of change in agricultural land in the Gilgelabay catchment (4041.3 ha/yr) was greater than that in the Gumara (1374.5 ha/yr) and Ribb (1362.3 ha/yr) catchments. This is possibly due to the availability of other LULC classes. The natural vegetation of Gilgelabay, Gumara, and Ribb has decreased by 16.0%, 10.5%, and 1.1%, respectively, over the past three decades. However, the present LULC change trends are unsustainable, and any remaining natural vegetation should be maintained. The results from the land suitability analysis revealed that the land suitability for teff, corn, and rice is likely to change with climate change in the future. To ensure sustainable land use management, modifying land use on the basis of land suitability should be preferred over traditional practices to improve crop production. This can be achieved in close collaboration with all stakeholders, including local communities, the government, and NGOs.

PMID:41405730 | DOI:10.1007/s10661-025-14806-9

Anesth Analg. 2025 Dec 16. doi: 10.1213/ANE.0000000000007889. Online ahead of print.

NO ABSTRACT

PMID:41405726 | DOI:10.1213/ANE.0000000000007889

Anesth Analg. 2025 Dec 16. doi: 10.1213/ANE.0000000000007856. Online ahead of print.

ABSTRACT

BACKGROUND: Retrospective studies suggest that dexamethasone may provide benefits that extend beyond its antiemetic properties, including a reduction in postoperative complications. However, results from randomized controlled trials have not consistently shown there to be a reduction in composite major adverse events. This discrepancy may be due to confounding factors, measurement error, or simultaneity bias among retrospective investigations. This study used instrumental variable analysis (IVA) to help address potential sources of bias and better estimate treatment effects in patients undergoing total joint arthroplasty (TJA).

METHODS: Patients who underwent primary elective TJA between 2016 and 2021 were identified using diagnosis and procedural codes. Bivariate regression, multivariable regression, and IVA were conducted. The primary end point was a 90-day composite (any versus none) of major postoperative medical complications. Secondary outcomes were infection, readmission, and death. Two distinct instruments-the frequency of dexamethasone use by surgeon and by hospital-were used to evaluate the robustness of our IVA. Patient demographics, hospital factors, and comorbidities were reported using descriptive statistics. Instrumental variable covariates were selected using the least absolute shrinkage and selection operator with 3 regularization parameter strategies.

RESULTS: 1525,844 TJAs performed between 2015 and 2021 were identified (976,996 knees [total knee arthroplasty {TKA}]; 548,848 hips [total hip arthroplasty {THA}]). Major postoperative medical complications were observed in 31,299 (3.43%) dexamethasone-exposed patients compared to 31,266 (4.87%) unexposed patients. Surgeon-based IVA yielded results comparable to the multivariable and bivariate analysis (local average treatment effect [LATE]: TKA: -1.20% [95% confidence interval [CI], -1.33% to -1.08%]; THA: -1.14% [95% CI, -1.30% to -0.99%]). Hospital-based IVA produced similar findings (LATE: TKA: -1.23% [95% CI, -1.38% to -1.09%]; THA: -1.18% [95% CI, -1.35% to -1.00%]). Both instruments demonstrated high F-statistics and significant Hausman tests. Secondary outcomes mirrored these results, except for mortality, which did not meet endogeneity criteria across analyses.

CONCLUSIONS: The findings of this study support that dexamethasone exposure is associated with a reduction in composite major postoperative complications after TJA. The observed moderate treatment effect, in conjunction with a low baseline incidence of adverse events, may explain the inconsistent outcomes reported in previous randomized trials. Future prospective studies should incorporate composite end points and target high-risk patient populations or procedural subgroups.

PMID:41405712 | DOI:10.1213/ANE.0000000000007856

Naunyn Schmiedebergs Arch Pharmacol. 2025 Dec 17. doi: 10.1007/s00210-025-04889-z. Online ahead of print.

ABSTRACT

Changing lifestyles and the rising incidence of lifestyle diseases are causing people to increasingly turn to dietary supplements, often perceived as therapeutic measures aimed at maintaining or improving health. Although supplements cannot be marketed for the treatment or prevention of disease, many people assume they will improve health, alleviate the course of illness, or, for example, delay the aging process. Unfortunately, this is not true. Furthermore, people around the world often choose to treat illnesses with supplements instead of consulting with specialists and undergoing appropriate treatment. Information on supplement safety and some common interactions with drugs and food was gathered based on an analysis of numerous websites, databases, and publications. This analysis presents statistical data, current legal regulations, the advantages and disadvantages of supplementation, and highlights the importance of supplement control. It turns out that manufacturers are generally exempt from conducting costly and lengthy clinical trials by classifying their products as dietary supplements. This misinformation prevents consumers from making informed decisions about their use. Educating the public about the safety, benefits, and risks of dietary supplements is crucial. These topics should serve as a starting point for a broader discussion about the need for quality control and access to safe dietary supplements. Raising public awareness of healthcare in its broadest sense is crucial.

PMID:41405711 | DOI:10.1007/s00210-025-04889-z

Eur Radiol. 2025 Dec 17. doi: 10.1007/s00330-025-12201-z. Online ahead of print.

NO ABSTRACT

PMID:41405694 | DOI:10.1007/s00330-025-12201-z

Eur Radiol. 2025 Dec 17. doi: 10.1007/s00330-025-12171-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate deep-learning (DL) model accuracy in quantifying multifidus (MF) and erector spinae (ES) fat fraction (FF) compared to Dixon MRI, and to explore the indirect effect of muscle function between muscle degeneration and disability outcomes in chronic low back pain (CLBP).

MATERIALS AND METHODS: 96 CLBP and 86 healthy participants underwent 3 T MRI, muscle function assessment, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Short Form 36-Health Survey (SF-36). A DL-Otsu thresholding model quantified muscle FF and functional muscle volume from 3D T2_WI images, validated against Dixon-FF. Lin’s concordance correlation coefficient (CCC), Bland-Altman, and Passing-Bablok analyses assessed the concordance between Otsu-FF and Dixon-FF. Partial correlations and mediation analysis examined associations among muscle degeneration, muscle function, and disability outcomes.

RESULTS: Otsu-FF showed agreement with Dixon-FF (MF: CCC = 0.96, 95% CI: 0.95, 0.97; ES: CCC = 0.95, 95% CI: 0.94, 0.96; bias: MF = 0.009; ES = 0.021). Partial correlations revealed MF and ES FF correlated with disability scores (ODI/RMDQ: r = 0.25 to 0.49; SF-36: r = -0.42, -0.28, p < 0.01). Muscle endurance negatively correlated with ODI (r = -0.57, 95% CI: -0.65, -0.45) and RMDQ (r = -0.49, 95% CI: -0.61, -0.35), positively with SF-36 (r = 0.51, 95% CI: 0.38, 0.63) (p < 0.01). Muscle endurance showed indirect effects on associations between muscle FF and disability outcomes (mediation proportion: 27.12% to 100%).

CONCLUSION: DL method accurately quantified muscle FF, closely matching Dixon results. Muscle FF correlated with disability outcomes in CLBP, with muscle endurance demonstrating a statistically indirect association within this relationship.

KEY POINTS: Question What are the associations between the deep learning-derived paraspinal muscle degeneration index, muscle function, and lumbar disability outcomes among patients with chronic low back pain? Findings In chronic low back pain, deep learning-quantified higher fat fraction of paraspinal muscles correlated with worse lumbar disability outcomes, with muscle endurance demonstrating an indirect effect in this association. Clinical relevance Incorporating the fat fraction of multifidus and erector spinae muscles and muscle endurance assessment is helpful for targeting rehabilitation training in chronic low back pain, improving disability outcomes.

PMID:41405693 | DOI:10.1007/s00330-025-12171-2

Pediatr Blood Cancer. 2025 Dec 17:e70067. doi: 10.1002/1545-5017.70067. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to explore the dynamic alterations of T helper 17 (Th17) cells, regulatory T (Treg) cells and regulatory B (Breg) cells in children with persistent immune thrombocytopenia (ITP).

METHODS: A prospective cohort study was conducted involving 34 children with persistent ITP and 30 age- and sex-matched healthy controls. Peripheral blood samples were collected at baseline and 3 months post-treatment. T helper 17 and Treg cells were quantified as percentages of CD3⁺CD4⁺ T lymphocytes, and Breg cells as a percentage of CD19⁺ B lymphocytes using BD FACSDx Flex flow cytometry. All patients received standard first-line treatment with intravenous immunoglobulin and prednisone, and response was evaluated after 3 months.

RESULTS: At baseline, children diagnosed with ITP exhibited a pronounced imbalance in immune cell subsets compared with age- and sex-matched healthy controls. Specifically, Th17 cell levels and the Th17/Treg ratio were significantly elevated (7.81% ± 3.13% vs. 3.30% ± 1.51% and 1.23 ± 0.72 vs. 0.44 ± 0.23, respectively; both p < 0.001), indicating a proinflammatory immune profile. In contrast, the frequencies of immunosuppressive Treg and Breg cells were notably decreased (6.80% ± 1.75% vs. 8.03% ± 1.14%, p = 0.026; 3.10% ± 2.00% vs. 6.61% ± 1.69%, p < 0.001). After 3 months of standardised treatment, no statistically significant changes were observed in the levels of these immune cell subsets or the Th17/Treg ratio compared with pre-treatment values. Clinically, 73.5% achieved a complete response, 20.6% achieved a partial response, and 5.9% showed no response.

CONCLUSION: Both Th17/Treg cell imbalance and Breg cell deficiency contribute to the pathogenesis of persistent ITP in children. Concurrent monitoring of these immune subsets may aid in immunophenotyping, and their potential role as biomarkers for treatment outcomes warrants further investigation.

PMID:41404740 | DOI:10.1002/1545-5017.70067

Pediatr Blood Cancer. 2025 Dec 17:e70065. doi: 10.1002/1545-5017.70065. Online ahead of print.

ABSTRACT

BACKGROUND: The prevalence and clinical correlates of symptoms of anxiety and depression in pediatric patients with brain tumors are not well described. We aimed to identify clinical characteristics that are correlated with elevated symptoms of anxiety and depression following initial diagnosis.

PROCEDURE: Pediatric patients diagnosed with a brain tumor at Texas Children’s Hospital from 2012 to 2019 were enrolled. Using the parent-proxy report form of the BASC-2, patients were assessed for symptoms of anxiety and depression within 6 months of diagnosis. Correspondence analysis was applied to determine the correlation values (r) for anxiety and depression; r ≥ 0.71 was considered statistically significant as it explained at least 50% of the shared variance.

RESULTS: All patients (n = 149, mean age = 9 years [range 3-18], 56% male) underwent a tumor-directed surgery or biopsy. Overall, 24% (n = 35) of patients had elevated symptoms of anxiety, and 15% (n = 22) had elevated symptoms of depression. There was a strong correlation between elevated anxiety symptoms and surgical resection alone (r = 0.96), surgery plus chemotherapy (r = 0.86), and infratentorial tumors (r = 1.00). Elevated depression symptoms correlated with a diagnosis of low-grade glioma (r = 1.00), infratentorial tumors (r = 0.76), and low global intellectual functioning (r = 0.81).

CONCLUSIONS: Treatment type, tumor histology, tumor location, and global intellectual functioning are significantly associated with anxiety and depression symptoms in children with brain tumors close to the time of diagnosis. These findings may inform the provision of screening and supportive services to these high-risk groups.

PMID:41404737 | DOI:10.1002/1545-5017.70065

Ecol Food Nutr. 2025 Dec 17:1-22. doi: 10.1080/03670244.2025.2602593. Online ahead of print.

ABSTRACT

In this systematic review and meta-analysis, we examined how gender inequality influences undernutrition among Indian children across varying social structures. Studies on rural and urban patrilineal and matrilineal communities reporting the prevalence of undernutrition in children were included, following PRISMA 2020 guidelines. We conducted three random-effects meta-analyses to estimate the relative risk (RR) of undernutrition, with boys as the control and girls as the intervention group. In total, 58 articles (73,910 children) were analyzed and classified into three categories, i.e., urban tribal and non-tribal (n = 11), rural non-tribal (n = 13), and rural tribal (n = 34). We found that gender disparity in undernutrition is locale- and population-specific, with girls from rural tribal communities experiencing a higher risk (RR 1.062) than their rural non-tribal and urban counterparts.

PMID:41404703 | DOI:10.1080/03670244.2025.2602593