Nevin Manimala

Pediatr Transplant. 2025 Nov;29(7):e70167. doi: 10.1111/petr.70167.

ABSTRACT

BACKGROUND: Changes to the calculation of the Kidney Donor Profile Index (KDPI) have lowered the KDPI of hepatitis C (HCV+) donor kidneys; therefore, increasing the proportion of pediatric-prioritized kidneys that are HCV+. We aimed to study consent rates for HCV+ kidneys among pediatric kidney transplant candidates.

METHODS: We identified pediatric candidates waitlisted from 2019 to 2024 and excluded those who received a living donor transplant. We used logistic regression to identify candidate characteristics associated with HCV+ offer consent and Cox proportional hazards models to determine the association between HCV+ offer consent and the rate of deceased donor transplantation.

RESULTS: Among 3202 candidates included in the analysis, 124 (4%) consented to receive HCV+ deceased donor kidney offers, and 3077 (96%) did not. In adjusted logistic regression, higher candidate age (OR 1.09 per year, 95% CI 1.03-1.15, p = 0.002) and high PRA status (OR 2.76, 95% CI 1.42-5.37, p = 0.003) were associated with a higher odds of consenting to receive HCV+ donor offers, whereas Hispanic ethnicity was associated with lower odds (OR 0.44, 95% CI 0.28-0.72, p = 0.001) of consenting to receive these offers. 2773 candidates (87%) received a transplant. There was no significant association between HCV+ donor offer consent status and transplant rate after adjusting for candidate characteristics. Only 1 received a kidney from a HCV+ donor.

CONCLUSIONS: Consent to receive HCV+ donor kidney offers was rare among pediatric kidney transplant candidates. Allocation changes that increase the proportion of pediatric-prioritized kidneys that are HCV+ may decrease access to transplant for pediatric candidates.

PMID:40931645 | DOI:10.1111/petr.70167

CNS Neurosci Ther. 2025 Sep;31(9):e70504. doi: 10.1111/cns.70504.

ABSTRACT

BACKGROUND: Neurological diseases such as stroke or Parkinson’s disease are often accompanied by weakening or loss of proprioception, which seriously affects the motor control ability of the patients. However, proprioception rehabilitation is challenging due to the pain caused by impaired joints and the hard efforts that patients have to make during training. This study investigated the cross-transfer effect of short-term visuomotor training to the untrained wrist from the trained wrist, from both views of behavioral results and brain activity analyses.

METHODS: Thirty healthy volunteers aged 25.53 ± 4.95 years were recruited for this study. They were randomly assigned into two groups: the visuomotor (n = 15) group performed visuomotor training (VM group) and the conventional training (n = 15) group (CT group) performed flexion and extension training on the right wrist. Behavioral tests (movement accuracy error, MAE) were performed both before and after training, with electroencephalogram (EEG) recorded. The movement-related cortical potentials (MRCPs), event-related potentials (ERPs) and event-related spectral perturbation (ERSP) were calculated in the test session before and after training.

RESULTS: Behavioral results showed that after visuomotor training of the right wrist on the VM group, the mean MAE of both the right wrist and untrained left wrist were reduced (p < 0.05) after training. EEG topography showed reduced brain activity as the behavioral test task became familiar. ERPs showed a decrease in amplitude during the behavioral test for both trained and untrained wrist movements. MRCPs latency significantly increased at C3 and C4 while amplitude decreased at C3 and Cz for the right wrist; latency significantly increased at C3 while amplitude decreased at Cz for the left wrist. Increased power at CP3 for the right wrist and CP4 for the left wrist in α-frequency ERSP after VM was observed; reduced power in β-frequency ERSP after VM was observed for both wrists. For the CT group, the mean MAE of the trained right wrist increased (p < 0.05) after training, while the untrained left wrist showed no statistical significance. No significant energy changes corresponding to the left/right wrist were observed in EEG topography after training. There was a noticeable decrease in ERPs amplitude at the central and parietal regions for both the left and right wrists. The MRCPs latency significantly increased at C3 for the right wrist; however, the latency and amplitude did not significantly change for the left wrist. Decreased power at FC3 and CP3 for the right wrist in α-frequency ERSP after CT was observed. From the regression analysis, the behavioral improvement of VM-R was correlated with CP3; the behavioral improvement of VM-L was correlated with C3, C4, CP3, and CP4.

CONCLUSIONS: Visuomotor training on the right wrist led to proprioceptive improvements in both the trained and untrained wrists, demonstrating a cross-transfer effect. These findings suggest that visuomotor training could be used in rehabilitation protocols to improve proprioception in patients with neurological diseases, offering a less painful and more efficient method to restore motor control.

PMID:40931616 | DOI:10.1111/cns.70504

Biom J. 2025 Oct;67(5):e70072. doi: 10.1002/bimj.70072.

ABSTRACT

Phase I dose escalation trials in oncology generally aim to find the maximum tolerated dose. However, with the advent of molecular-targeted therapies and antibody drug conjugates, dose-limiting toxicities are less frequently observed, giving rise to the concept of optimal biological dose (OBD), which considers both efficacy and toxicity. The estimand framework presented in the addendum of the ICH E9(R1) guidelines strengthens the dialogue between different stakeholders by bringing in greater clarity in the clinical trial objectives and by providing alignment between the targeted estimand under consideration and the statistical analysis methods. However, there is a lack of clarity in implementing this framework in early-phase dose optimization studies. This paper aims to discuss the estimand framework for dose optimization trials in oncology, considering efficacy and toxicity through utility functions. Such trials should include pharmacokinetics data, toxicity data, and efficacy data. Based on these data, the analysis methods used to identify the optimized dose/s are also described. Focusing on optimizing the utility function to estimate the OBD, the population-level summary measure should reflect only the properties used for estimating this utility function. A detailed strategy recommendation for intercurrent events has been provided using a real-life oncology case study. Key recommendations regarding the estimand attributes include that in a seamless phase I/II dose optimization trial, the treatment attribute should start when the subject receives the first dose. We argue that such a framework brings in additional clarity to dose optimization trial objectives and strengthens the understanding of the drug under consideration, which would enable the correct dose to move to phase II of clinical development.

PMID:40931383 | DOI:10.1002/bimj.70072

Wounds. 2025 Aug;37(8):283-291.

ABSTRACT

BACKGROUND: To estimate the prevalence of biofilms in chronic wounds.

METHODS: The authors performed a systematic review of prevalence studies and meta-analysis, structured according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Articles were searched in Scopus (Elsevier), Web of Science (Clarivate), MEDLINE/PubMed (National Institutes of Health), and Embase (Elsevier) databases. Data collected included the author and year of publication, total number of lesions evaluated, number of lesions with biofilm, detected bacteria, biofilm levels, country where the research was conducted, and the methodological quality of the studies. The meta-analysis was performed using a random effects model in R software (The R Foundation for Statistical Computing).

RESULTS: A total of 281 articles were retrieved; after applying the reading and exclusion criteria, 24 studies were included. The meta-analysis incorporated 24 studies from 12 countries, evaluating 2666 lesions with a biofilm prevalence of 68% (95% CI, 58%-79%; I² = 92%). A high prevalence was observed in Asian publications (73%; 95% CI, 62%-84%; I² = 98%), with of Staphylococcus aureus (71%; 95% CI, 51%-90%; I² = 98%) and Pseudomonas aeruginosa (65%; 95% CI, 47%-82%; I² = 98%) being the most common found in all publications.

CONCLUSIONS: Despite the methodological heterogeneity of the studies included in this review, the findings indicate a high prevalence of biofilms in chronic wounds presented in the studies that made up the sample.

PMID:40931368

BMC Emerg Med. 2025 Sep 10;25(1):180. doi: 10.1186/s12873-025-01344-3.

ABSTRACT

BACKGROUND: Identifying suspected anterior circulation large-vessel occlusion (aLVO) strokes during emergency calls could enhance dispatch efficiency, particularly in rural areas. However, data on emergency medical dispatchers’ (EMDs) ability to recognize aLVO symptoms remain limited. This simulation study aimed to evaluate the feasibility of identifying side-specific arm paresis, side-specific conjugate eye deviation (CED), and aphasia during emergency calls by instructing layperson callers to perform brief, standardized examination steps. Two communication methods were compared: (1) telephone calls and (2) video calls.

METHODS: Forty-eight laypersons interacted with simulated patients presenting various stroke syndromes. Simulated EMDs conducted standardized assessments during simulated emergency calls, guiding laypersons through patient examinations.

RESULTS: In 96 telephone-assisted and 95 video-assisted calls, EMDs identified aLVO stroke symptoms with high accuracy. In telephone calls, accuracy was 0.92 for side-specific arm paresis, 0.98 for side-specific CED, and 0.88-0.99 for aphasia. In video calls, accuracy was 0.97 for side-specific arm paresis, 0.97 for side-specific CED, and 0.94-1.00 for aphasia.

CONCLUSIONS: These findings suggest that EMDs can identify stroke symptoms indicative for aLVO via both telephone and video calls using a standardized dispatch protocol to guide lay bystanders. This study provides a foundation for future real-world research on implementing aLVO detection protocols in emergency dispatch.

PMID:40931358 | DOI:10.1186/s12873-025-01344-3

Parasit Vectors. 2025 Sep 10;18(1):369. doi: 10.1186/s13071-025-07023-3.

NO ABSTRACT

PMID:40931344 | DOI:10.1186/s13071-025-07023-3

BMC Nurs. 2025 Sep 10;24(1):1167. doi: 10.1186/s12912-025-03835-x.

ABSTRACT

BACKGROUND: Organizational virtuousness and just culture, which both foster justice, honesty, and trust, have a major impact on positive work environments in the healthcare industry. Strengthening nurses’ emotional engagement and vocational commitment requires these components. With an emphasis on the mediating function of just culture, this study attempts to investigate the relationship between organizational virtuousness and nurses’ vocational commitment.

METHODS: This study used a descriptive correlational design that was informed by the STROBE checklist. A non-probability convenience sample from Alexandria Main University Hospital was chosen following accepted structural equation modeling (SEM) principles to guarantee sufficient statistical power and trustworthy parameter estimation. A sample of 400 nurses was considered adequate due to the model’s moderate complexity, the use of 61-item measurement methods, and the inclusion of several latent variables. Three validated tools-the Just Culture Survey, the Occupational Commitment Survey, and the Organizational Virtuousness Scale-were used to gather data.

RESULTS: According to linear regression analysis, nurses’ occupational commitment was significantly predicted by both organizational virtuousness and just culture, which together accounted for 15.5% of the variation. Organizational virtuousness was a significant positive predictor (B = 0.220), meaning that occupational commitment rose by 0.220 units for every unit rise in perceived virtuousness. The greatest predictor was only culture (B = 0.352, β = 0.342, t = 7.207, p < 0.001, 95% CI [0.256, 0.448]), underscoring its crucial influence on commitment. These results highlight the value of open, equitable workplace cultures and moral organizational climates in raising nurses’ levels of professional engagement. These correlations were further validated by the structural equation model, which showed good model fit (GFI = 0.961, AGFI = 0.941, RMSEA = 0.069).

CONCLUSIONS: Nurses’ commitment to their work is strengthened by an organization’s moral character and fair culture. These elements improve trust, engagement, and emotional involvement by creating a courteous, moral, and encouraging work atmosphere. In healthcare contexts, fostering such cultural values improves employee retention, productivity, and overall organizational resilience.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40931338 | DOI:10.1186/s12912-025-03835-x

Exp Appl Acarol. 2025 Sep 10;95(3):37. doi: 10.1007/s10493-025-01059-x.

ABSTRACT

The phytoseiid mite, Neoseiulus longispinosus (Evans) is considered as one of the effective biological control agents against the tetranychid mites in the Indian subcontinent. This predator can be effectively utilized to manage the two-spotted spider mite, Tetranychus urticae Koch under protected conditions. Carnation holds a significantly important position as cut flower crop in India as well as throughout the world. In this study, the biology and population growth parameters of predatory mite were studied against three different stages of T. urticae on three different cultivars of carnation viz., Kleos, Bizet and Baltico. The predator was able to complete its life cycle on all the offered stages of the prey and on all the three cultivars. The results indicated that the biology was not much affected by the different cultivars. However, the cultivar Bizet was found to be slightly better for the development of the predatory mite as the maximum fecundity (62.26 eggs/female) was recorded on this cultivar. Although numerically higher fecundity was observed on Bizet, no statistically significant superiority was found. Among the different stages of prey fed to the predator i.e., egg, protonymph and deutonymph, the predator showed better biology and population growth parameters on egg stage compared to both protonymphal and deutonymphal stages of T. urticae.

PMID:40931302 | DOI:10.1007/s10493-025-01059-x

Clin Rheumatol. 2025 Sep 10. doi: 10.1007/s10067-025-07679-3. Online ahead of print.

ABSTRACT

OBJECTIVE: Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease. Genetic factors may play a pivotal role in determining susceptibility to these disorders. HLA associations with SSc, especially HLA class II, were investigated in different populations but not in Tunisia. Our aim was to study HLA profile in South Tunisian patients with SSc.

METHODS: We conducted a case-control study on 19 SSc patients and 123 healthy controls. HLA class I (HLA-A and -B) typing was performed using a microlymphocytotoxicity complement-dependent technique followed by polymerase chain reaction sequence specific primer (PCR-SSP). HLA class II DRB1/DQB1 of all patients and controls was genotyped using the PCR-SSP technique. Statistical analysis was performed using SPSS software and R language.

RESULTS: Nineteen SSc patients and 123 healthy controls were included. The HLA-DRB1*11 was associated with the genetic susceptibility to SSc (corrected p-value (pc) = 0.005; OR = 5.56; 95% CI = [2-15.4]). The HLA-DQB1*03:01 had also increased the risk of SSc in our study (pc = 0.002; OR = 5.9; 95% CI = [2-16.8]). Concerning HLA class I typing, we found a significant association between HLA-B53 and SSc (pc = 0.01; OR = 9; 95% CI = [2.53-31.99]). The association of HLA-B53 was independent of HLA-DRB1*11 in binary logistic regression test (HLA-B53: p = 0.01; HLA-DRB1*11: p = 0.008). Concerning the haplotype study, a significant difference in the distribution of the haplotype B53-DRB1*11 was found between patients and controls (13.15% in SSc patients vs. 0.8% in controls; p = 1.33 10^-5; HaploScore = 4.35).

CONCLUSION: Our results showed that in South Tunisia SSc is associated with HLA-DRB1*11 and DQB1*03:01 alleles. A susceptibility to SSc was found in positive HLA-B53 patients. This association of HLA alleles with SSc needs further study. Key Points •HLA-DR and DQ alleles represent the most common associations reported in Systemic Sclerosis (SSc). •In this study, in addition to the known association with HLA-DRB1*11, we identified an association with HLA-B53 in a cohort of 19 South Tunisian patients.

PMID:40931287 | DOI:10.1007/s10067-025-07679-3

Obes Surg. 2025 Sep 10. doi: 10.1007/s11695-025-08244-2. Online ahead of print.

ABSTRACT

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common bariatric procedures that lead to substantial and sustained weight loss. Although both procedures induce hormonal and physiological effects, RYGB includes both a restrictive and malabsorptive component due to anatomical rerouting, whereas SG is considered primarily restrictive. This study aimed to quantify differences in energy and fat absorption between both procedures using near-infrared spectroscopy (NIRS).

METHODS: Female patients, 12-24 months post-RYGB or SG, followed a strictly controlled, tailor-made diet for 6 days. Faecal samples collected over the final 3 days were analysed using NIRS to assess energy and fat malabsorption. Physical activity and stool consistency were also evaluated.

RESULTS: Twenty-nine patients were initially included; one RYGB patient was excluded due to implausibly high reported energy intake leaving 14 RYGB and 14 SG patients. We found higher (p = 0.03) malabsorption in patients after RYGB (194.8 malabsorbed kcal, 13.2%) as compared to patients after SG (111.7 malabsorbed kcal, 7.6%). Furthermore, in the RYGB group, malabsorbed fat was higher (p = 0.01) with 9.7 g (15.4%) malabsorbed as compared to 3.9 g (6.1%) malabsorbed in SG. Even when adjusting for percentage weight loss, both differences remained statistically significant.

CONCLUSION: Fat and energy malabsorption are significantly higher following RYGB compared to SG, and NIRS proves to be a feasible method for assessing these differences. However, the differences are relatively modest and do not appear to be directly proportional to the reduction in functional intestinal length exposed to nutrients.

PMID:40931276 | DOI:10.1007/s11695-025-08244-2