Nevin Manimala

Stroke. 2025 Aug 20. doi: 10.1161/STROKEAHA.124.049955. Online ahead of print.

ABSTRACT

BACKGROUND: This individual participant data meta-analysis aimed to determine whether time to treatment influences the effect of intraarterial thrombolysis (IAT), intravenous thrombolysis, and conservative standard therapy on visual outcomes in nonarteritic central retinal artery occlusion.

METHODS: We searched MEDLINE, CENTRAL, and Embase up to June 2023 for studies reporting treatment modality and peri-treatment best-corrected visual acuity (BCVA) for ≥5 participants, excluding patients with nonsevere vision loss (BCVA <1.0 logarithm of the minimum angle of resolution [logMAR]) or treated after 24 hours of symptom onset. The primary outcome was recovery from severe vision loss (final BCVA <1.0 logMAR). We used mixed-effect models and local polynomial regression to investigate nonlinear relationships between time to treatment and recovery from severe vision loss.

RESULTS: Of 4074 screened studies, individual participant data were sought from 52, with 35 contributing individual participant data for 1038 participants. In total, 783 patients met inclusion criteria (age, 64.8±13.3 years; 35.5% female; baseline BCVA, 2.3±0.5 logMAR). For every hour decrease in time to treatment, thrombolysis was associated with greater improvement in BCVA (intraarterial, 0.02 logMAR [95% CI, 0-0.04]; intravenous, 0.04 logMAR [95% CI, 0.00-0.07]) than conservative standard therapy (0.01 logMAR [95% CI, 0-0.02]). A nonlinear relationship was detected for intraarterial thrombolysis with a changepoint at 8 hours (95% CI, 6.7-9.4). Thrombolysis was associated with increased recovery from severe vision loss compared with conservative standard therapy (intraarterial within 6 hours: odds ratio, 2.72 [95% CI, 1.02-7.28], 27.2% versus 12.0%; intravenous within 4.5 hours: odds ratio, 3.32 [95% CI, 1.24-8.92], 28.8% versus 11.1%). Findings were consistent in subgroup analysis restricted to patients receiving recombinant tissue-type plasminogen activator. Monte-Carlo simulations showed that a randomized controlled trial would require 95 participants per group to achieve 80% power to detect an odds ratio of 3.0 for recovery from severe vision loss.

CONCLUSIONS: Early intervention in nonarteritic central retinal artery occlusion is associated with improvement in visual recovery, with intraarterial thrombolysis and intravenous thrombolysis outperforming nonthrombolytic treatments. These findings warrant confirmation in sufficiently powered randomized controlled trials.

PMID:40832714 | DOI:10.1161/STROKEAHA.124.049955

Stroke. 2025 Aug 20. doi: 10.1161/STROKEAHA.124.050446. Online ahead of print.

ABSTRACT

BACKGROUND: Racial disparities have been reported in stroke care, but understanding if there is regional variability is critical to focusing policies and resources. Here, we sought to study racial and ethnic inequity in the administration of thrombolysis and thrombectomy at the national and state levels.

METHODS: We conducted a retrospective cohort study using Get With The Guidelines-Stroke Program registry data from 2003 to 2022 to evaluate racial disparities in the administration of acute stroke treatments in US patients. We used mixed-effects modeling to analyze national and state-level disparities, adjusting for relevant demographic, clinical, and hospital-level characteristics.

RESULTS: 660 369 patients were eligible for thrombolysis and 105 184 patients for thrombectomy. The mean age was 70.21±14.48 years, and 50.18% were female. The race/ethnic distribution was 69.06% of non-Hispanic White, 16.88% of non-Hispanic Black, 7.02% of Hispanic, 2.84% of Asian, and 4.20% of American Indian/Alaska Native/Hawaiian/Pacific Islander patients. Eligible non-Hispanic Black patients had statistically higher thrombolytic rates compared with non-Hispanic White patients (adjusted odds ratio [aOR], 1.04 [95% CI, 1.03-1.06]), indicating no racial disparities in thrombolytic treatment at the national level. Similarly, equal or higher rates of thrombolytic administration were noted in other race/ethnic groups at the national level (Asian: aOR, 1.12 [95% CI, 1.09-1.16]; Hispanic: aOR, 1.14 [95% CI, 1.12-1.17]; and other: aOR, 1.10 [95% CI, 1.07-1.13]; P<0.0001). However, when non-Hispanic Black patients were compared with non-Hispanic White patients at the individual state level, there were disparities in many of the stroke-belt states. Racial disparities remained significant at the national level between non-Hispanic Black and non-Hispanic White patients and eligible thrombectomy patients after adjusting for patient- and hospital-level covariates (aOR, 0.85 [95% CI, 0.82-0.89]; P<0.0001).

CONCLUSIONS: These data suggest that racial/ethnic disparities in stroke care vary depending on the intervention and geographic location. Equitable utilization of thrombolysis nationally may underscore the benefits of quality improvement initiatives though state-level inequities persist. Endovascular thrombectomy utilization demonstrated race-based disparities in use, and further efforts are needed to ensure equitable care of patients with stroke in the United States.

PMID:40832710 | DOI:10.1161/STROKEAHA.124.050446

Circ Genom Precis Med. 2025 Aug 20:e005336. doi: 10.1161/CIRCGEN.125.005336. Online ahead of print.

NO ABSTRACT

PMID:40832708 | DOI:10.1161/CIRCGEN.125.005336

J Magn Reson Imaging. 2025 Aug 20. doi: 10.1002/jmri.70086. Online ahead of print.

ABSTRACT

BACKGROUND: Myocardial contraction fraction (MCF) is a promising volumetric index of myocardial function.

PURPOSE: To evaluate the association of MRI-derived MCF with demographic characteristics, clinical data, MRI findings, and the history of heart failure in patients with transfusion-dependent thalassemia (TDT).

STUDY TYPE: Retrospective.

SUBJECTS: 1154 TDT patients (52.9% female, 37.46 ± 10.67 years) enrolled in the Extension-Myocardial Iron Overload in Thalassemia project and 167 healthy subjects (54.5% female, 36.33 ± 15.78 years).

FIELD STRENGTH/SEQUENCE: 1.5 T/cine imaging for assessment of left ventricular (LV) function parameters, gradient-echo T2* technique for myocardial iron overload (MIO) assessment, late gadolinium enhancement (LGE) imaging for detection of replacement myocardial fibrosis.

ASSESSMENT: MCF was calculated as LV stroke volume divided by LV myocardial volume.

STATISTICAL TESTS: Independent-samples t-test, Wilcoxon signed-rank test, and chi-squared test for comparison between groups; analysis of covariance; Pearson’s or Spearman’s correlations; univariable and stepwise multivariable linear regression analyses; receiver operating characteristic curve analysis for assessment of diagnostic efficiency and DeLong’s test for area under the curves (AUCs) comparison. Statistical significance was defined as p < 0.05.

RESULTS: Healthy subjects and TDT patients showed comparable MCF values (99.5% ± 15.0% vs. 102.7% ± 29.7%, p = 0.820). In TDT, MCF was significantly lower in males compared to females (98.4% ± 27.1% vs. 106.6% ± 31.3%) and in patients with diabetes (96.8% ± 29.7% vs. 103.7% ± 29.1%). MCF significantly decreased with age (R = -0.066). MCF was significantly correlated with global heart T2* values (R = 0.075), and patients with MIO (T2* < 20 ms) had a significantly lower MCF compared to those without (96.3% ± 22.0% vs. 103.3% ± 30.2%). MCF had a significant inverse correlation with the number of LGE-positive segments (R = -0.314). MCF demonstrated a diagnostic performance comparable to that of global heart T2* values in distinguishing between TDT patients with and without a history of heart failure (AUC 0.63 vs. 0.58, p = 0.401 for the difference). The LV ejection fraction did not significantly differentiate patients based on heart failure history (AUC = 0.55, p = 0.223).

DATA CONCLUSION: In patients with TDT, MCF was significantly correlated with MIO and LGE extent. Additionally, patients with a history of heart failure had significantly impaired MCF.

EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: Stage 2.

PMID:40832696 | DOI:10.1002/jmri.70086

J Cosmet Dermatol. 2025 Aug;24(8):e70407. doi: 10.1111/jocd.70407.

ABSTRACT

BACKGROUND: Although both radiofrequency (RF) and focused ultrasound (FU) are commonly used non-invasive skin-tightening methods, comparative studies between the two methods are lacking.

OBJECTIVE: To study and compare the efficacy and safety of RF and FU in facial rejuvenation.

METHODS: We recruited 36 patients to receive a single treatment: the RF group (n = 21) and the FU group (n = 15). Every participant was evaluated on baseline (T0), 1-month follow-up (T1) and 3-month follow-up (T3). Three blinded dermatologists used the FLR scale, Modified Fitzpatrick Wrinkle Scale (MFWS), and Allergan Skin Roughness Scale to assess facial wrinkles. Safety profiles were recorded, and subjects completed questionnaires to provide subjective evaluations.

RESULTS: Intergroup comparison indicated that the ultrasound group showed superior efficacy over the RF group in the mid-face (Z = 2.915, p = 0.004) and lower face (Z = 2.142, p = 0.046) on T1. Intragroup comparison observed a statistically significant reduction in FLR and MFWS scores with both treatments. Subjective satisfaction aligned with objective results, and no severe adverse reactions were observed.

CONCLUSION: Both RF and FU are effective in facial rejuvenation, though their efficacy differs. They are comparably safe and yield high patient satisfaction.

TRIAL REGISTRATION: ChiCTR number: ChiCTR2500097849.

PMID:40832682 | DOI:10.1111/jocd.70407

Front Artif Intell. 2025 Aug 4;8:1620019. doi: 10.3389/frai.2025.1620019. eCollection 2025.

ABSTRACT

The study addresses the problem of nonlinear characteristics of common air pollutants by proposing a deep learning time-series model based on the long short-term memory (LSTM) integrated with a generalized additive model (GAM). LSTM model captures both nonlinear relationships and temporal long-term dependencies in time-series data, and GAM provides insight into the statistical relationship between selected features and the target pollutant. The post-hoc eXplainable artificial intelligence (xAI) technique, local interpretable model-agnostic explanation (LIME), further explains the nonlinearity. Finally, causal inference was determined on the impact of the air pollutants relationship, thereby offering further interpretability in which deep learning models are deficient. Meteorological and air pollutant statistical records were leveraged from a Hantam (Karoo) air monitoring station in South Africa, and through a random sampling approach, synthetic data were generated for the city of Kimberley. The model was evaluated with the mean squared error (MSE), root mean squared error (RMSE) and mean absolute error (MAE) for different time-steps. The proposed referred to as long short-term memory generalized additive model based post-hoc eXplainable Artificial Intelligence (LSTM-GAM_xAI) model with a 10-day time-step and 5-day time-step for multiple pollutants prediction guaranteed least MSE. Though the causal effect analysis show no p-values (>0.88) for variables, the experiment results show that LSTM-GAM-xAI guaranteed the lowest MSE values across different time-steps.

PMID:40832676 | PMC:PMC12358413 | DOI:10.3389/frai.2025.1620019

Indian J Psychol Med. 2025 Aug 15:02537176251359425. doi: 10.1177/02537176251359425. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol Dependence Syndrome (ADS) is a prevalent condition marked by difficulty controlling alcohol use, with significant global health impacts. Despite the effectiveness of anti-craving medications like Naltrexone, Acamprosate, Baclofen, Ondansetron, and Topiramate, these medications remain underutilized by healthcare providers. This study aims to assess the relationship between craving and relapse rates among individuals prescribed anti-craving medications and to explore the correlation between medication dosage and craving severity.

METHODS: This was a prospective observational cohort study in which individuals prescribed anti-craving medications were monitored over three months. The study utilized the Penn Alcohol Craving Scale (PACS) to measure craving intensity and the Medication Adherence Rating Scale (MARS) to assess medication adherence. Alcohol use patterns were categorized into relapse, lapse, abstinence, and active use based on predefined operational definitions.

RESULTS: Participants were between 30 and 50 years old and predominantly male. Severe dependence was observed in the majority of cases, and baclofen was prescribed to most participants. Pearson’s correlation between Severity of Alcohol Dependence Questionnaire (SADQ-C) and PACS scores was r = 0.304 (p = .017), and MARS scores significantly predicted PACS scores (R = 0.757, R ² = 0.573, p < .001). Most participants were in the action phase, with a significant proportion maintaining abstinence. However, relapse rates increased as the study progressed. Overall, adherence to anti-craving medications reduced cravings and facilitated abstinence.

CONCLUSIONS: The research noted a significant reduction in craving in individuals receiving anti-craving medications. Nevertheless, no statistically significant correlation was identified between the dosage of Baclofen and PACS scores.

PMID:40832651 | PMC:PMC12357832 | DOI:10.1177/02537176251359425

BMJ Public Health. 2025 Aug 17;3(2):e002176. doi: 10.1136/bmjph-2024-002176. eCollection 2025.

ABSTRACT

BACKGROUND: The first 1000 days of life are a crucial foundational period during which many different factors can impact development. It is unknown to what extent different factors cluster and how this affects later-life outcomes.

METHODS: In this population-based cohort study, we used registry data of all children born in the Netherlands in 2006. We used latent class analysis to investigate clustering of circumstances in the first 1000 days of life, including socioeconomic indicators (household income, parental education), prenatal and perinatal biomedical factors (maternal age, late-start antenatal care, preterm birth/born small for gestational age/poor start in life), and adverse childhood experiences in the first 1000 days (parental death, separation, mental health problems and detention) and associated clusters with school performance (ie, highest secondary school level advice at age 12).

RESULTS: In the study population of 181 575 children, we identified five clusters. We labelled cluster 1 (39%) and cluster 2 (27%) as ‘resource-richest’, clusters 3 (15%) and 4 (15%) as ‘intermediate’, and cluster 5 (5%) as ‘resource-poorest’, with the latter having the highest probabilities of low socioeconomic resources, adverse prenatal and perinatal biomedical factors and adverse childhood experiences in the first 1000 days. Compared with those in the resource-richest cluster (cluster 2), children in the resource-poorest cluster (cluster 5) had poorer school performance (OR 0.13, 95% CI 0.11 to 0.14), also after adjustment for parental education and household income (OR 0.20, 95% CI 0.18 to 0.24).

CONCLUSIONS: Clustering of risk factors across different domains during the first 1000 days of life was associated with poorer school performance at age 12, suggesting that children growing up in resource-limited environments during this critical developmental window may face challenges in reaching their full developmental and educational potential. If we find similar associations with health-related outcomes, this would further underscore the importance of policies that strengthen resources across multiple domains early in life to support long-term human potential.

PMID:40832646 | PMC:PMC12359527 | DOI:10.1136/bmjph-2024-002176

BMJ Public Health. 2025 Aug 17;3(2):e001607. doi: 10.1136/bmjph-2024-001607. eCollection 2025.

ABSTRACT

BACKGROUND: Poor knowledge of sexual and reproductive health and rights (SRHR) among university students has been constantly reported in low-income and middle-income countries. This study aimed to assess University of Rwanda (UR) students’ knowledge on SRHR.

METHODS: This cross-sectional study involved an online survey of 441 students across UR. Data were collected using a validated 50-item SRHR knowledge questionnaire via Moodle. Data were cleaned and analysed using STATA. Descriptive and inferential statistics, such as a bivariate logistic regression model and multivariate logistic regression with backward elimination, were used for the final model. A P-value of 0.05 with 95% CI limits was considered. The association between explanatory variables and the outcome (SRHR knowledge) was evaluated. A mean cut-off was employed, categorising experiences into a binary outcome (poor and good SRHR knowledge scores). Stepwise backward elimination logistic regression analysis was conducted to identify predictors of good SRHR knowledge.

RESULTS: The majority of the participants (56%) had poor SRHR knowledge. In the bivariate analysis, statistically significant variables included prior exposure to the SRHR course by using YouTube (OR 2.36 (1.12 to 4.97) and radio (OR 3.08 (1.20 to 7.88)), prior learning SRHR courses online (OR 1.92 (1.10 to 3.38)) and participant age group 21-24 years (OR 0.50 (0.27 to 0.93). In the multivariate analysis, prior exposure to the SRHR course through YouTube (adjusted OR (aOR) 5.48 (1.29 to 23.22)) and SRHR prior exposure through radio (aOR 5.56 (1.37 to 23.04)) were associated with SRHR knowledge.

CONCLUSION AND RECOMMENDATIONS: UR students do not have sufficient knowledge of SRHR. Every UR student can benefit from SRHR training from reliable sources so that they can make effective choices regarding their reproductive health.

PMID:40832645 | PMC:PMC12359537 | DOI:10.1136/bmjph-2024-001607

J Orthop. 2025 Aug 9;69:305-310. doi: 10.1016/j.jor.2025.08.008. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Deep vein thrombosis (DVT) is a prevalent complication of KA following knee arthroplasty (KA), leading to the development of post-thrombotic syndrome (PTS). PTS is associated with declining quality of life (QoL) and increased treatment costs. This study aims to investigate the correlation between fibrinogen to albumin ratio (FAR) and lower extremity DVT and evaluate the predictive value of FAR in diagnosing DVT post-KA.

METHODS: A total of 331 patients undergoing KA at the Department of Joint Surgery between August 2020 and August 2022 were included in this study. Among them,38 patients with DVT identified through post-operative routine color Doppler flow imaging (CDFI) comprised the study group, while 278 patients without DVT formed the control group. Pre-operative FAR ratios were analyzed to investigate the association between pre-operative FAR and lower extremity DVT following KA.

RESULTS: No significant differences were observed in the basic characteristics between the two groups. Additionally, there were no statistically significant differences in the laboratory values, including white blood cells, neutrophils, hemoglobin, fibrinogen, albumin, and platelets before and after surgery. However, the pre-operative FAR in patients with DVT was significantly higher than that in the control group (0.077 ± 0.007 vs. 0.067 ± 0.012, P < 0.001). ROC curve analysis of FAR for predicting lower extremity DVT revealed a cut-off value of 0.070 (AUC = 0.732, P < 0.001), with a sensitivity of 94.7 % and specificity of 51.1 %. Multivariate logistic regression analysis showed pre-operative FAR was the only independent predictor of DVT post-KA (OR = 1.12, 95 %CI: 1.06-1.17, P < 0.001).

CONCLUSIONS: Pre-operative FAR has a good predictive capability for lower extremity DVT post-KA.Its detection may be a simple and useful method for the prediction of DVT in patients undergoing KA.

PMID:40832625 | PMC:PMC12359187 | DOI:10.1016/j.jor.2025.08.008