Nevin Manimala

Stroke Vasc Interv Neurol. 2025 Nov 14;5(6):e001702. doi: 10.1161/SVIN.124.001702. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Mechanical thrombectomy is a critical intervention for patients with acute ischemic stroke with large vessel occlusion. However, significant barriers remain in its widespread implementation, particularly in low- to middle-income countries, including a shortage of trained physicians and limited access to advanced medical technologies. This systematic review and meta-analysis aimed to comprehensively evaluate current mechanical thrombectomy training methodologies and assess their effectiveness in improving procedural skills among neurointerventional teams.

METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, searching PubMed, Scopus, and Web of Science. Eight studies were included, with 3 studies eligible for meta-analysis. We assessed training approaches, participant demographics, and procedural outcomes using the Risk of Bias in Non-randomized Studies of Interventions tool and performed statistical analysis using OpenMetaAnalyst software.

RESULTS: Various training modalities, including virtual reality simulations and hands-on workshops, consistently demonstrated positive effects on procedural skills and professional confidence, demonstrating significant improvements across multiple metrics. Our systematic review and meta-analysis revealed statistically significant reductions in total procedure time (average decrease of 17.84 minutes, 95% CI: [-22.19 to -13.48]), number of handling errors (decreased by 6.34 errors, 95% CI: [-13.16 to 0.48]), contrast volume (decreased by 27.35 mL, 95% CI: [-45.11 to -9.60]), and fluoroscopy time (reduced by 8.07 minutes, 95% CI: [-10.71 to -5.44]). Participants showed increased procedural steps completed, with an average increase of 6.52 steps (95% CI: [3.99-9.05]).

CONCLUSION: Structured, simulation-based mechanical thrombectomy training programs can significantly enhance procedural skills, clinical decision-making, and professional confidence among neurointerventional teams, potentially improving stroke care.

PMID:41608732 | PMC:PMC12697599 | DOI:10.1161/SVIN.124.001702

Stroke Vasc Interv Neurol. 2025 Sep 16;5(6):e001933. doi: 10.1161/SVIN.125.001933. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are commonly prescribed for the management of type 2 diabetes, and recent studies have highlighted their neuroprotective and anti-inflammatory properties. However, their influence on clinical outcomes in patients undergoing endovascular treatment for unruptured intracranial aneurysms remains largely unexplored.

METHODS: This retrospective cohort study utilized the TriNetX database to identify patients with type 2 diabetes (International Classification of Diseases, Tenth Revision [ICD-10]: E11) and unruptured intracranial aneurysms (ICD-10: I67.1). Patients were categorized based on the use of GLP-1RAs. The outcomes included overall survival, poor functional outcome, new subarachnoid hemorrhage, and hydrocephalus. The propensity score matching method was applied.

RESULTS: A total of 6824 patients met the inclusion criteria, with 447 patients in each group following propensity score matching. No statistically significant differences were observed in short- and mid-term mortality between GLP-1RAs users and non-users. However, long-term mortality was significantly lower in the GLP-1 group (odds ratio 0.58, 95% CI 0.36-0.94). Furthermore, GLP-1RAs users demonstrated significantly reduced risks of poor functional outcomes (odds ratio 0.37, 95% CI 0.21-0.66), new subarachnoid hemorrhage (odds ratio 0.39, 95% CI 0.27-0.56), and hydrocephalus (odds ratio 0.57, 95% CI 0.33-0.97) at 3 months, with similar trends persisting in mid- and long-term follow-up.

CONCLUSION: Use of GLP-1RAs in patients with unruptured intracranial aneurysms treated via endovascular intervention is associated with improved long-term survival and reduced risks of subarachnoid hemorrhage, hydrocephalus, and poor functional outcomes. These findings suggest a potential therapeutic benefit beyond glycemic control. Prospective studies are needed to validate these results and explore their implications for clinical decision-making in aneurysm treatment.

PMID:41608727 | PMC:PMC12697656 | DOI:10.1161/SVIN.125.001933

Stroke Vasc Interv Neurol. 2025 Sep 24;5(6):e001818. doi: 10.1161/SVIN.125.001818. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: The Alberta Stroke Program Early Computed Tomography Score and core volume on preoperative imaging are key predictors of clinical outcomes following endovascular therapy in patients with a large ischemic core. Although the corticospinal tract is essential for motor function, its prognostic impact in patients with a large ischemic core remains unclear.

METHODS: This multicenter retrospective study analyzed preoperative imaging data from patients with Alberta Stroke Program Early Computed Tomography Score ≤5 who underwent endovascular therapy. The presence of lesions in the posterior corona radiata and lesions in the primary motor cortex was assessed. A good outcome was defined as a modified Rankin Scale score ≤3 at 90 days. The association between lesions in the posterior corona radiata, lesions in the primary motor cortex, and good outcome was analyzed using univariable and stepwise multivariable logistic regression, with variable selection based on Akaike information criterion corrected for small sample size.

RESULTS: Among 107 patients, 37 (34.6%) achieved a good outcome. In univariable analysis, neither lesions in the posterior corona radiata nor core volume was significantly associated with a good outcome. In stepwise multivariable logistic regression, modified Rankin Scale score before onset (odds ratio, 0.30 [95% CI, 0.10-0.73]), cardioembolism (odds ratio, 0.25 [95% CI, 0.08-0.76]), absence of lesions in the primary motor cortex involvement (odds ratio, 13.49 [95% CI, 3.75-63.45]), and shorter onset-to-reperfusion time (odds ratio, 0.996 [95% CI, 0.992-0.998]) were independent predictors. Alberta Stroke Program Early Computed Tomography Score and the absence of multiple artery occlusion were retained in the final model but were not statistically significant.

CONCLUSION: Absence of lesions in the primary motor cortex involvement was independently associated with good outcome after endovascular therapy in patients with large ischemic core, suggesting its potential utility as a complementary imaging marker in this population.

PMID:41608725 | PMC:PMC12697621 | DOI:10.1161/SVIN.125.001818

Stroke Vasc Interv Neurol. 2025 Oct 23;5(6):e001789. doi: 10.1161/SVIN.125.001789. eCollection 2025 Nov.

ABSTRACT

BACKGROUND: There is limited information on systemic blood pressure goals and variability before and during mechanical thrombectomy and how it affects outcomes in large vessel ischemic stroke.

METHODS: A longitudinal cohort study of patients with acute ischemic stroke and large vessel occlusion who underwent thrombectomy at a comprehensive stroke center in southwestern Colombia (January 2017-January 2023). Two groups were defined: group H (hypotension before thrombectomy, defined as >30 mmHg systolic blood pressure drop between arrival and anesthesia induction) and no hypotension (NH) group. Primary outcomes included functional status (modified Rankin Scale score, 0-2 favorable; 3-6 unfavorable) and mortality (modified Rankin scale score = 6) at discharge and 90-day follow-up. Inverse probability weighting was used to reduce confounding.

RESULTS: A total of 167 patients (44.3% female), median age 66 (interquartile range, 53-76), underwent thrombectomy. Admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score were similar (16.5 versus 16; Alberta Stroke Program Early Computed Tomography Score 9 in both). Thrombolysis was used in 45.4% (H: 23.3% versus NH: 22.1%). Door-to-needle time: 56 minutes versus 47 minutes; door-to-groin: 138 minutes versus 129.5 minutes. Procedure duration was longer in H (100 minutes versus 85 minutes). Successful reperfusion was not significantly different (modified Thrombolysis in Cerebral Infarction≥2b) 73.05% (H: 76.6%, NH: 70%, P = 0.29). Unfavorable modified Rankin scale score at discharge: H: 70.1%, NH: 68.9% (P = 0.86). Mortality at discharge: H: 32.5%, NH: 16.7% (P = 0.2); at 90 days: H: 37.7%, NH: 18.9% (P = 0.02) with inverse probability weighting analysis showing higher mortality in H both at discharge (odds ratio [OR] = 2.16, 95% CI: 0.93-5.04, P = 0.07) and 90 days (OR = 2.93, 95% CI: 1.25-6.86, P = 0.01) only the latter with statistical significance.

CONCLUSION: Hypotension before thrombectomy in large vessel occlusion stroke was associated with increased 90-day mortality. Worse functional outcomes were also observed, though not statistically significant. Early blood pressure control during anesthetic induction may improve prognosis.

PMID:41608719 | PMC:PMC12697584 | DOI:10.1161/SVIN.125.001789

Front Microbiol. 2026 Jan 13;16:1735665. doi: 10.3389/fmicb.2025.1735665. eCollection 2025.

ABSTRACT

INTRODUCTION: Understanding the dynamics of soil organic carbon (SOC) in sloping farmlands is critical, as they play a vital role in the global carbon cycle and soil health. Although prior research has focused on physical carbon loss due to erosion, the biological mechanisms by which slope gradients affect microbial carbon cycling remain poorly understood.

METHODS: Soil samples were collected from maize fields with three slope gradients (30°, 45°, and 60°) across different growth stages. Key indicators were determined as follows: SOC by potassium dichromate oxidation (external heating method); DOC by ultrapure water extraction (1:5 ratio) and organic carbon analyzer; POC by sodium hexametaphosphate dispersion, 53-μm sieving, and chromic acid oxidation; soil Ca²⁺, Mg²⁺, and Cl^– by EDTA complexometric titration and silver nitrate titration, respectively; invertase (SUC) by 3,5-dinitrosalicylic acid colorimetry; polyphenol oxidase (SPPO) and peroxidase (SPOD) by commercial kits with L-dopa as substrate. Statistical analyses were performed using IBM SPSS 26 (One-way ANOVA with LSD post-hoc test, Pearson correlation analysis) and Origin 2024 (Principal Component Analysis, PCA). Normality of data was verified prior to analysis, and significance was set at P < 0.05.

RESULTS: Results showed that SOC levels decreased with increasing slope steepness, while DOC peaked at 45°. SPPO and SPOD activities (involved in recalcitrant carbon decomposition) were significantly elevated at 60°. SUC activity was positively correlated with DOC, while oxidase activities were positively associated with POC and negatively with Mg²⁺.

DISCUSSION: This study identifies a critical slope threshold (30°-45°) for DOC loss: DOC availability on steeper slopes stimulates microbial synthesis of SPPO and SPOD, enhancing recalcitrant carbon degradation and potentially intensifying long-term SOC depletion. The identification of this threshold provides insights for designing microbiome-informed strategies to mitigate soil degradation and safeguard ecological security.

PMID:41608696 | PMC:PMC12835812 | DOI:10.3389/fmicb.2025.1735665

Mediterr J Rheumatol. 2026 Jan 8;37(Suppl 1):92-99. doi: 10.31138/mjr.030125.epr. eCollection 2026 Mar.

ABSTRACT

OBJECTIVES: The onset, progression and recurrence of psoriasis is believed to be related to mood and psychological disorders, such as depression. Psoriasis affects the personal, social and sexual life of patients resulting in psychological stress.

AIM: The purpose of the research is the psychometric evaluation of patients with psoriasis.

METHODS: Seventy one patients with psoriasis were enrolled in the study. The measurement of the severity of psoriasis in the patients was implemented through specific indicators, the Psoriasis Area and Severity Index (PASI). Beck’s Depression Inventory (BDI) was used to measure the intensity of depressive symptoms. In addition, the Eysenck Personality Questionnaire (EPQ), the self-completed scale Brief Symptom Inventory SCL – 90, and the HDHQ questionnaire (Psychometric Hostility and Direction of Hostility Questionnaire) were given. The validity and reliability of questionnaires rely on input from experts and potential responders who may suggest pertinent revisions to prepare forms with attractive designs, easily understandable questions, and correctly ordered points that appeal to target respondents.

RESULTS: Females with psoriasis have on average significantly higher scores in the BDI depression scale (13.5±10.0 vs. 7.9±8.3, p=0.009) compared to men, as well as in the SCL90 depression scale (13.64±10.18 vs. 7.00±5.45, p=0.003). The extroversion scale of the EPQ is statistically significantly related with the patients’ psychiatric history and stable income. Patients receiving medication for psoriasis are 2 times more likely to answer the lie questions positively than patients not receiving medication (OR=2.01, p=0.028).

CONCLUSION: Psoriasis exerts a direct influence on the social daily life of the individual, at a functional and behavioural level. It is essential to emphasise the importance of addressing the psychological effects of psoriasis along with its physical aspects for better outcomes.

PMID:41608670 | PMC:PMC12835929 | DOI:10.31138/mjr.030125.epr

iScience. 2026 Jan 2;29(2):114623. doi: 10.1016/j.isci.2025.114623. eCollection 2026 Feb 20.

ABSTRACT

Risk stratification guides management in acute pulmonary embolism (APE), yet current models have limitations. We investigated the Prognostic Nutritional Index (PNI) as a potential biomarker to refine risk assessment. Analyzing 1,163 discovery, 208 internal-validation, and 212 external-validation APE patients, we found that a higher PNI was independently associated with lower 30-day and in-hospital mortality after multivariable adjustment. Incorporating PNI into the European Society of Cardiology (ESC) risk model improved its predictive performance for 30-day mortality. Crucially, a PNI ≤42.5 effectively stratified intermediate-risk patients, identifying subgroups with 4.7- and 6-fold higher 30-day mortality in the intermediate-low- and intermediate-high-risk categories, respectively. These findings position PNI as a simple, valuable tool for enhancing precision in APE risk stratification.

PMID:41608662 | PMC:PMC12834838 | DOI:10.1016/j.isci.2025.114623

World J Stem Cells. 2026 Jan 26;18(1):114114. doi: 10.4252/wjsc.v18.i1.114114.

ABSTRACT

A recent preclinical study reported that Wumei Pills (WMP) and Lactobacillus reuteri (L. reuteri) mitigate 5-fluorouracil-induced intestinal mucositis by promoting intestinal stem cell (ISC)-mediated repair via Wnt/β-catenin signaling. The mechanistic interpretation rests largely on systemic inflammation readouts, correlative microbiota changes, and immunohistochemistry of pathway markers. From a clinical standpoint, chemotherapy-induced mucositis remains a common and burdensome toxicity that leads to dose reductions, treatment delays, and infection risk; current care is largely supportive and does not directly restore ISC-mediated repair. This unmet need motivates rigorous appraisal of the proposed “WMP → L. reuteri → ISC/Wnt” axis. To highlight key methodological considerations that may affect causal inference and analytical rigor in the proposed “WMP → L. reuteri → ISC/Wnt” pathway. This letter critically appraises the study’s design, endpoints, and analyses against current best practices in mucositis biology, microbiome causality testing, Wnt/β-catenin pathway validation, and preclinical statistics, and synthesizes concrete, literature-grounded remedies. Six issues with potential impact on interpretation were identified: (1) Reliance on serum cytokines/lipopolysaccharide to infer local mucosal inflammation, with limited tissue-level indices (e.g., myeloperoxidase, interleukin-1β, immune-cell infiltration); (2) Absence of necessity/sufficiency tests to verify microbiota mediation (e.g., L. reuteri depletion, WMP-donor fecal microbiota transplantation, probiotic add-back); (3) Pathway evidence tiering – Wnt/β-catenin activation not confirmed by β-catenin nuclear translocation or downstream targets (Axin2, c-Myc, cyclin D1), and Lgr5 quantification/specificity insufficient; (4) Statistical design under-specified (power justification, blinded assessment, control of multiple comparisons) and potential cage effects unmodeled; (5) Limited dose-response and safety profiling for WMP/L. reuteri; and (6) Constrained generalizability (single sex/strain/age, lack of ABX-only controls, single time-point). The reported benefits of WMP and L. reuteri in chemotherapy-induced mucositis are promising, but stronger causal and analytical foundations are needed. Incorporating tissue-level inflammation readouts, microbiota loss-/gain-of-function designs, definitive Wnt/β-catenin activation assays, rigorous statistical practices (including mixed-effects models for cage clustering and multiplicity control), dose-response/safety evaluation, and broader experimental scope (sex/age/strain, ABX-only controls, time-course) will yield more robust and translationally relevant conclusions.

PMID:41608653 | PMC:PMC12836234 | DOI:10.4252/wjsc.v18.i1.114114

Tob Prev Cessat. 2026 Jan 27;12. doi: 10.18332/tpc/214782. eCollection 2026.

ABSTRACT

INTRODUCTION: This study examined the association between smoking cessation and different usage combinations of three tobacco products (combustible cigarette [CC], electronic cigarette [EC], heated tobacco product [HTP]) in Korean adults.

METHODS: We analyzed repeated data from the Korea Health Panel Survey (KHPS), which consisted of nationally representative samples. A total of 1380 Korean adults participated in the study. The outcome of interest was whether the participant succeeded in quitting smoking all types of tobacco products. Participants were classified according to whether they smoked any of the three tobacco products (CCs and/or ECs and/or HTPs) based on their self-reported responses.

RESULTS: A total of 211 participants had quit smoking during the follow-up period. After adjusting for potential confounding factors, the adjusted odds ratio (AOR) for smoking cessation was 3.15 (95% CI: 1.66-5.95), and 1.81 (95% CI: 0.63-5.21) for participants who currently smoke only HTPs (HTP-only user) and participants who currently vape only ECs (EC-only user), respectively, compared with participants who currently smoke only CCs (CC-only user). There was no significant association between dual or triple smoking and smoking cessation.

CONCLUSIONS: HTP-only users had a statistically significant association with smoking cessation, with higher odds of quitting smoking within two years compared to CC-only users. Further studies with a large sample are required to validate our results considering a small number of participants in the comparison groups in this study.

PMID:41608649 | PMC:PMC12838446 | DOI:10.18332/tpc/214782

Front Sports Act Living. 2026 Jan 13;7:1680250. doi: 10.3389/fspor.2025.1680250. eCollection 2025.

ABSTRACT

BACKGROUND: Water-based exercise augments exercise-induced increases in brain blood flow, optimizing a proposed key mechanistic pathway for improved brain health. Aquatic treadmill exercise has been shown to aid gait re-education of stroke survivors, however its potential to enhance cerebrovascular function in this clinical population has not been tested. This pilot study aimed to examine the feasibility and preliminary efficacy of a 4-week aquatic treadmill (ATM) training intervention on cerebrovascular responsiveness and gait function in stroke survivors.

METHODS: Six community-dwelling stroke survivors (58 ± 11 years, 8 ± 11 years post stroke) completed a 4-week ATM intervention, consisting of 20-30 min sessions, 3 times/week. Pre- and post-intervention measures were taken of cerebrovascular reactivity (CVR), indexed via changes in middle cerebral artery blood velocity (MCAv) to a hypercapnic (5% CO₂ in air) stimulus. Changes in mobility were assessed via 10-metre walk, Timed-Up-And-Go, and 6-minute walk (6MW) tests.

RESULTS: Adherence to the intervention was excellent, with 70 of the 72 (97%) available training sessions completed by participants. CVR increased on average by 44% (95% CI: ±58%; 2.8%-4.0%ΔMCAv/mm Hg ΔPETCO₂) in the stroke-affected hemisphere and 48% (95% CI: ±41%; 3.0%-4.5%ΔMCAv/mm Hg ΔPETCO₂) in the unaffected hemisphere post intervention, although changes did not reach statistical significance (p = 0.218; Friedman’s test). Within-group gait improvements were seen in speed and distance, with some changes above clinically meaningful thresholds; although this was not uniformly evident.

CONCLUSION: This pilot study established ATM training as a feasible option for some patients in stroke rehabilitation. Despite the limited sample size, the study demonstrated promising enhancements in cerebrovascular function, with preliminary evidence suggesting concurrent improvements in gait performance. Well-designed, larger studies are warranted.

PMID:41608538 | PMC:PMC12835293 | DOI:10.3389/fspor.2025.1680250