Nevin Manimala

BMC Med. 2025 Nov 11;23(1):629. doi: 10.1186/s12916-025-04452-w.

ABSTRACT

BACKGROUND: Mosaic chromosomal alterations (mCAs) served as a novel indicator of genomic aging. We aimed to investigate the association of expanded mCAs (cell fraction ≥ 10%) with all-cause and cause-specific mortality, and to examine the joint effect of expanded mCAs and frailty index (FI), an indicator of phenotypic aging, on mortality in two large prospective cohorts.

METHODS: A total of 100,237 participants in the China Kadoorie Biobank (CKB) and 456,283 participants in the UK Biobank (UKB) were included, followed till Dec 31, 2023, and Nov 30, 2022, respectively. MoChA pipeline was used to detect expanded mCAs events and the subtypes. FIs were calculated using previously validated equations, with 28 items included in the CKB and 49 items in the UKB, and categorized participants into three groups: robust, prefrail, and frail. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to examine the associations of the expanded mCAs and joint categories of frailty-mCAs with all-cause and cause-specific mortality by using Cox proportional hazards models. The combined effect values of two cohorts were estimated using random-effects models by meta-analysis.

RESULTS: The prevalence of expanded mCAs in the CKB and UKB was 2.2% and 3.4%, respectively. After a median follow-up of 17.2 years in the CKB and 13.7 years in the UKB, expanded mCAs carriers had a higher risk of all-cause (HRs [95% CIs]: 1.20 [1.16, 1.24]) and risks of cause-specific mortality (HRs [95% CIs]: 1.27 [1.21, 1.34], 1.13 [1.02, 1.25], and 1.24 [1.12, 1.37] for death from cancers, circulatory diseases, and respiratory diseases, respectively). Such associations largely did not overlap with FI, especially for all-cause and cancer mortality. Joint analyses revealed that individuals with lower frailty level but with expanded mCAs had a comparable and even higher risk of cancer mortality compared to those with higher frailty level but without mCAs. Similar pattern was also found in terms of adjusted 10-year cancer mortality rates.

CONCLUSIONS: Our findings suggested that expanded mCAs were significantly associated with all-cause and cause-specific deaths and could serve as a complement to the FI in providing a more comprehensive perspective on mortality risk, especially for cancer mortality.

PMID:41219961 | DOI:10.1186/s12916-025-04452-w

Int J Health Geogr. 2025 Nov 11;24(1):33. doi: 10.1186/s12942-025-00417-7.

ABSTRACT

BACKGROUND: Area-level socioeconomic status is a well-established determinant of geographical disparities in life expectancy. However, limited attention has been paid to spatial spillover effects, whereby socioeconomic conditions in neighbouring regions influence health outcomes. This study aimed to estimate the direct and spatial spillover effects of socioeconomic factors on life expectancy in Japan and to explore possible mechanisms underlying the observed spillover patterns.

METHODS: Life expectancy at birth by sex at the municipal level in Japan for 2020 was the outcome variable. A spatial Durbin error model was used to estimate the direct and spatial spillover effects of ten regional socioeconomic factors, along with six control variables, on life expectancy. To ensure robustness, six spatial weight matrices were used. The results were compared with those obtained from a non-spatial linear regression model.

RESULTS: Moran’s I values for the residuals of the non-spatial model were statistically significant, indicating spatial autocorrelation. The unemployment rate and the proportion of individuals with no high school diploma showed negative direct and spillover effects, suggesting that being surrounded by regions with employment instability and low educational attainment is associated with lower life expectancy. Taxable income per capita showed no statistically significant spillover effects.

CONCLUSION: The findings indicate that socioeconomic conditions in neighbouring regions, in addition to those within a region, are associated with life expectancy. The observed spillover effects for employment and education support the role of collective resources in shaping regional health. These results indicate the need to incorporate interregional socioeconomic contexts into public health strategies to address geographical disparities in health.

PMID:41219958 | DOI:10.1186/s12942-025-00417-7

BMC Pregnancy Childbirth. 2025 Nov 11;25(1):1190. doi: 10.1186/s12884-025-08386-2.

ABSTRACT

In Southern Iraq, as in other regions, neonates and infants suffer from health problems due to different potential risk factors leading to congenital malformations, which can result in either mortality or lifelong disability. Given the limited number of studies on congenital malformations in Iraq, especially in the south, this study surveyed malformations over four years to provide a clearer picture of their incidence and causes. Retrospective data on congenital malformations in South Iraq’s governorates of Basrah, Misan, and Thi Qar from Health Directorates were derived and then analysed. The study classified malformations into six groups based on affected organ systems. Several variables were considered potential risk factors, including parental age, consanguinity, family history, place of residence, birth status, sex, and birth weight. A total of 365,106, 140,246, and 237,302 births were recorded in hospitals in Basrah, Misan, and Thi Qar, respectively, during the period from 2020 to 2023. Among them, the rate of congenital malformations per 1000 births was 2.13 in Basrah, 2.34 in Misan, and 2.91 in Thi Qar. The overall prevalence across the southern region was 2.42 per 1000. Nervous and circulatory system malformations were the most common types. The study did not identify any statistically significant temporal trends in malformations, either at the level of individual governorates or the region as a whole. Several significant associations emerged from the analysis. Malformations of the nerv [Formula: see text]. Limb and cleft lip and palate malformations were more commonly linked to parental consanguinity and a positive family history. Birth status, sex, and birth weight also showed significant associations with malformation type, while no meaningful association was found with place of residence. The low incidence of malformations reported does not necessarily reflect the actual situation in the region. Therefore, the study calls for addressing the underlying causes by improving hospital documentation systems, implementing modern recording methods, and ensuring accurate case reporting.

PMID:41219946 | DOI:10.1186/s12884-025-08386-2

BMC Sports Sci Med Rehabil. 2025 Nov 11;17(1):330. doi: 10.1186/s13102-025-01388-9.

ABSTRACT

BACKGROUND: This study aimed to examine the effect of emotional intelligence levels on decision-making among individuals interested in e-sports. The population consisted of individuals aged 18 and over who are interested in e-sports.

METHOD: The research sample included 385 participants (178 women and 207 men; Age Average = 21.41 ± 3.24). The study utilized a 20-question information form, the Melbourne Decision Making Scale, and the Schutte Emotional Intelligence Scale to collect data.

RESULTS: A statistically significant relationship was found between participants’ emotional intelligence scores and their decision-making scores. Higher emotional intelligence scores were associated with increased self-esteem in decision-making and improvements in various decision-making sub-dimensions; however, a negative relationship was found with careful decision-making. High emotional intelligence positively influenced the ability to use and evaluate emotions and maintain emotional control, which in turn positively affected decision-making.

CONCLUSION: The findings indicated that high emotional intelligence contributes positively to self-esteem and certain adaptive aspects of decision-making. However, a paradoxical pattern emerged: while emotional intelligence was positively related to maladaptive decision-making styles, it showed a negative association with careful and rational decision-making. These results suggest that emotional intelligence, although generally regarded as a protective factor, may also foster overconfidence or reliance on intuition in complex decision-making contexts. While some findings aligned with previous literature, the counterintuitive results highlight the need for further research to explore the mechanisms underlying these relationships in the specific context of e-sports.

PMID:41219941 | DOI:10.1186/s13102-025-01388-9

BMC Sports Sci Med Rehabil. 2025 Nov 11;17(1):329. doi: 10.1186/s13102-025-01382-1.

ABSTRACT

BACKGROUND: Postmenopausal women experience accelerated ageing of arterial vessels and increased cardiovascular disease risk. Exercise training, as a non-pharmacological intervention, holds great value in improving cardiovascular issues such as arterial stiffness.

OBJECTIVE: The present systematic review and meta-analysis aimed to: (1) synthesize current evidence on the efficacy of exercise in improving systemic arterial pulse wave velocity (SAPWV) in postmenopausal women; (2) clarify differential effects of exercise interventions on central versus peripheral PWV; and (3) quantify the statistical moderating effects of exercise protocol parameters and participant characteristics.

METHODS: Six electronic databases (EMBASE, EBSCOhost, Scopus, Web of Science, PubMed, Cochrane CENTRAL) were systematically searched up to August 7, 2024, and updated on April 4, 2025. Randomized controlled trials (RCTs) examining the effects of exercise training on PWV in postmenopausal women were included. A three-level meta-analysis was conducted using a random-effects model, as applied in R. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale.

RESULTS: Nine studies (27 RCTs) were included. Compared with the control group, the overall effect of exercise on SAPWV reached only marginal significance [g = -1.07; 95% confidence intervals (CI) = -2.15, 0.00, p = 0.05], with the CI including zero-indicating that the true effect could be null or even negative. Additionally, exercise had significant improvements on SAPWV sub-indicators, including carotid-femoral PWV (cfPWV; g = -2.44; 95% CI = -3.94, -0.93) and central PWV (g = -1.57; 95% CI = -2.84, -0.30). The improvement in SAPWV was more pronounced when participants aged < 65 years (g = -1.52; 95% CI = -2.80, -0.24), exercising ≥ 3 times per week (g = -1.14; 95% CI = -2.25, -0.04), and engaging in aerobic exercise (g = -1.76, 95% CI = -3.13, -0.40). PWV sub-indicators, regional PWV, and exercise type moderated the effects of exercise training on SAPWV.

CONCLUSION: The present study demonstrated that exercise training may improve arterial stiffness in postmenopausal women, with particularly pronounced effects on cfPWV and central PWV. Subgroup analysis further revealed that participants aged < 65 years, those exercising ≥ 3 times weekly, and those engaging in aerobic exercise interventions all demonstrated significant reductions in SAPWV. Although the overall effect of exercise on SAPWV reached only marginal significance, more pronounced effects were observed within specific populations and exercise modalities. Future large-sample studies are needed to validate these findings further.

PMID:41219939 | DOI:10.1186/s13102-025-01382-1

AIDS Res Ther. 2025 Nov 11;22(1):121. doi: 10.1186/s12981-025-00818-5.

ABSTRACT

BACKGROUND: Common mental disorders (CMDs) and alcohol use disorder (AUD) are significant barriers to effective antiretroviral therapy (ART) adherence among people living with HIV (PLHIV), especially in sub-Saharan Africa. Suboptimal adherence to ART contributes to increased morbidity and mortality in this population. CMD and AUD frequently co-occur, with alcohol often serving as a maladaptive coping mechanism for psychological distress, thereby compounding the negative impact on treatment outcomes. Understanding the mediating role of AUD in the relationship between CMD and ART adherence is essential for designing targeted interventions aimed at improving HIV treatment success.

METHODS: A hospital-based cross-sectional analytical study was conducted between August and October 2023 in Moshi Municipality, Kilimanjaro. A multistage systematic sampling technique was used to recruit participants. Data were collected using structured sociodemographic and interviewer-administered, validated assessment tools. Statistical analyses included one-way ANOVA for continuous variables, chi-square tests for categorical variables, and logistic regression to estimate odds ratios (ORs) with 95% confidence intervals. Mediation analysis was conducted using R version 4.4.2, with significance set at p < 0.05.

RESULTS: The study involved 532 participants, with an average age of 46.6 ± 13.3 years; 71.4% were female. The prevalence of depression, anxiety, and ART non-adherence was 14.8%, 12.4%, and 10.7%, respectively. Among men, depression and anxiety were both significantly associated with ART non-adherence in model1 and 2 respectively (depression OR = 5.38, 95% CI: 1.80-16.08; OR = 5.10, 95% CI: 1.55-16.82. Anxiety OR = 5.12, 95% CI: 1.63-16.12; OR = 5.30, 95% CI: 1.48-18.92). Among women, only depression significantly increased ART non-adherence in all models, respectively (OR = 2.50, 95% CI: 1.16-5.36; OR = 2.51, 95% CI: 1.13-5.59; OR = 3.26, 95% CI: 1.34-7.95). Alcohol use disorder significantly mediated the relationship between depression and ART non-adherence more substantially than alcohol use alone, with mediation effects up to 45.5%.

CONCLUSION: Depression is significantly associated with ART non-adherence in both genders, and AUD is a key mediator, especially among male participants. These data support the integration of mental health and substance use care into HIV services, with attention to gender-specific risk factors.

PMID:41219929 | DOI:10.1186/s12981-025-00818-5

BMC Nephrol. 2025 Nov 11;26(1):626. doi: 10.1186/s12882-025-04513-5.

ABSTRACT

Living donor (LD) kidney transplantation is the optimal treatment for elective end-stage kidney disease (ESKD) patients. However, concerns about the long-term health risks for donors, including hypertension, remain incompletely defined. We aimed to determine the incidence and predictors of hypertension after kidney donation and to assess its association with estimated glomerular filtration rate (eGFR) trajectories over time. We conducted a retrospective cohort study of 300 LD who underwent nephrectomy between 1998 and 2020, after excluding those with pre-donation hypertension. Donors were followed for a mean of 6.4 ± 4.5 years The primary outcome was the development of de novo hypertension, defined by office blood pressure measurements exceeding 140/90 mmHg or initiation of antihypertensive therapy. Predictors of post-donation hypertension were evaluated using Cox regression analysis, and the association with longitudinal changes in eGFR was assessed using linear mixed-effects models. Hypertension developed in 30% of the cohort, with an incidence of 21% at 5 years and over 50% at 15 years post-donation. Higher body mass index (BMI) (HR 1.074 per Kg/m2, P = 0.039), dyslipidemia (HR 1.959, P = 0.035), and elevated systolic (HR 1.030 per mmHg, P = 0.009) and diastolic blood pressure (HR 1.036 per mmHg, P = 0.039) were independently associated with an increased risk of hypertension post-donation. The development of hypertension was associated with a modest but statistically significant decline in eGFR over time (-0.03 vs. +0.40 ml/min/year, P = 0.026). No donor progressed to ESKD during follow-up and cardiovascular events were rare in the cohort. In conclusion, hypertension was a frequent complication post-donation in this Southern European cohort and was associated with modifiable risk factors, as higher BMI and dyslipidemia. While the associated decline in renal function over time is modest, these findings highlight the importance of long-term monitoring and proactive management of cardiovascular risk factors in living kidney donors. These results should inform pre-donation counseling, post-donation follow-up strategies, and further research into interventions that may mitigate hypertension risk while preserving donor health.

PMID:41219926 | DOI:10.1186/s12882-025-04513-5

BMC Med Educ. 2025 Nov 11;25(1):1577. doi: 10.1186/s12909-025-08181-9.

ABSTRACT

BACKGROUND: Although artificial intelligence (AI) is increasingly shaping modern healthcare, its integration into dental education remains underexplored-particularly with regard to how students’ readiness and anxiety toward AI evolve throughout their academic progression. Existing studies primarily focus on medical cohorts, leaving a critical knowledge gap in understanding how dental students across different years perceive and adapt to these technological transformations. This study aims to address this gap by assessing both cognitive readiness and emotional responses to AI among current and future dental professionals.

METHODS: A cross-sectional survey was conducted with 420 participants, including first- to fifth-year dental students and recent graduates, using purposive sampling. Two validated instruments were employed: the Medical Artificial Intelligence Readiness Scale and the Artificial Intelligence Anxiety Scale. Descriptive statistics and one-way ANOVA were used to analyze differences across academic year, gender, age, AI familiarity, and prior training experience.

RESULTS: Significant differences in AI readiness were observed based on academic year, with second-year students demonstrating the highest readiness across subdomains (Cognition, Ability, Vision), while fifth-year students scored the lowest. Participants with prior AI-related knowledge or training consistently showed higher readiness and lower anxiety levels, although the reduction in anxiety was not always statistically significant. Gender-based analysis revealed that female participants reported higher AI anxiety in specific subdomains, including Learning and Surveillance, while overall readiness scores did not significantly differ by gender or age.

CONCLUSION: Findings emphasize the need for early, continuous, and practice-oriented AI education in dental curricula. Structured exposure to AI-related concepts not only enhances competence but may also reduce anxiety. Tailoring pedagogical approaches to different stages of training could foster a more balanced integration of AI in dentistry-addressing both technological proficiency and emotional resilience.

PMID:41219925 | DOI:10.1186/s12909-025-08181-9

World J Surg Oncol. 2025 Nov 11;23(1):429. doi: 10.1186/s12957-025-04080-x.

ABSTRACT

OBJECTIVE: Retrospective analysis of the safety and efficacy of radical right hemicolectomy combined with hyperthermic intraperitoneal chemotherapy in the treatment of appendiceal mucinous tumors.

METHOD: Data were extracted from inpatient and outpatient medical records. Using R software (version 4.3.2), we collected all cases of appendiceal mucinous tumors treated with HIPEC at Jingzhou Hospital Affiliated to Yangtze University from February 2015 to February 2022 for statistical analysis and visualization. Survival analysis was performed using the ‘survival’ package, survival curves were plotted with ‘survminer’, and boxplots and percentage bar charts were generated using ‘ggplot2’.

RESULT: This study included 61 patients with appendiceal mucinous tumors, of whom 31 received postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and 30 did not. At 2 years, recurrence occurred in 12.9% of the HIPEC group versus 46.7% of the control group (P = 0.004). The hazard ratio (HR) for recurrence-free survival (RFS) was 0.21 (95% CI: 0.07-0.63; P = 0.002). Overall survival (OS) at 2 years was 93.5% with HIPEC and 80.0% without, a difference that did not reach statistical significance (P = 0.147). Postoperative complication rates and baseline characteristics were comparable between groups.

CONCLUSION: Our findings demonstrate that radical right hemicolectomy combined with HIPEC significantly reduces postoperative recurrence rates in AMN patients while showing a non-significant trend toward improved overall survival.

PMID:41219906 | DOI:10.1186/s12957-025-04080-x

BMC Cancer. 2025 Nov 11;25(1):1747. doi: 10.1186/s12885-025-15095-8.

ABSTRACT

BACKGROUND: Non-invasive prediction of pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant therapy (NAT) is crucial for adjusting surgical strategies and optimizing treatment plans. This study aims to develop a predictive model that integrates traditional radiomics and 3D deep learning features from early and peak phases of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict pCR after NAT.

METHODS: This retrospective study included 234 breast cancer patients from two hospitals who received neoadjuvant therapy. Dataset 1 (n = 204) was used for model development, and Dataset 2 (n = 30) was used for external validation. Traditional radiomics and 3D deep learning features were extracted from both the whole DCE-MRI image and the tumor region of interest (ROI). Features from different sources were integrated, followed by feature selection using independent sample t-tests and least absolute shrinkage and selection operator (LASSO) regression, and the top ten discriminative features were selected for model training. Logistic regression was used to build predictive models, and their performance was evaluated using receiver operating characteristic curves and area under curve (AUC). The DeLong test was used to assess differences between the AUC values of different models, and SHAP (SHapley Additive exPlanations) analysis was employed to examine the relationship between the features of the models and pCR.

RESULTS: For models using only traditional radiomics features, the combined model integrating early and peak phases of DCE-MRI provided the best pCR prediction. The performance of this combined model was further enhanced by adding 3D deep learning features. The optimal model (RD_EP), which integrated radiomics and deep learning features from early and peak phases of DCE-MRI, achieved AUC values of 0.892 (95% CI: 0.853-0.922) on Dataset 1 and 0.825 (95% CI: 0.713-0.886) on Dataset 2. The DeLong test showed that RD_EP had statistically significant differences compared to other prediction models (p < 0.05). SHAP analysis demonstrated that two radiomics texture features contributed the most to the model.

CONCLUSION: Integrating traditional radiomics and 3D deep learning features from different phases of DCE-MRI can accurately predict pCR to NAT in breast cancer accurately. Multi-phase imaging and diverse features are important to improve predictive accuracy and the constructed model may help guide personalized treatment strategies.

PMID:41219899 | DOI:10.1186/s12885-025-15095-8