Nevin Manimala

J Nephrol. 2025 Jul 5. doi: 10.1007/s40620-025-02336-z. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney donation after circulatory death is a valid alternative to donation after brain death. However, ischemia-reperfusion injury can damage the graft and make it non-viable. The Karpinski score, currently used to evaluate kidney quality, does not account for this type of damage and is, therefore, insufficient for predicting expected functional recovery.

METHODS: Sixty-seven kidney biopsies from donors after circulatory death and seventy-two kidney biopsies from donors after brain death were analyzed histologically. A Karpinski score was assigned to all samples. Additionally, biopsies obtained from donation after circulatory death were reviewed for the presence of ischemia-reperfusion injury defined as brush border loss within the tubular epithelium as well as acute tubular injury. Clinical data were also retrieved and analysed, in an attempt to find a statistically significant correlation between histological/clinical findings and graft function.

RESULTS: The mean Karpinski scores of samples obtained on the occasion of donation after circulatory death and after brain death showed no significant difference. Ischemia-reperfusion injuries were two times more frequent in samples obtained after donation after circulatory death compared to donation after brain death. Statistical analysis revealed that a cutoff of 15% in brush border loss and 0.9 mg/dL in serum creatinine before death allowed to predict functional recovery, especially delayed functional recovery. A composite predictive score summing these two parameters was therefore created.

CONCLUSIONS: Donation after circulatory death is associated with unique patological characteristics compared to donation after brain death and requires different considerations. This study proposes a simple and clinically applicable tool for predicting the delayed functional recovery in the case of kidneys donated after circulatory death; the novelty lies in combining morphological (brush border loss) and biochemical (serum creatinine before death) into a new predictive score that may provide support for pre-implantation decision-making and potentially improve transplant outcomes.

PMID:40616769 | DOI:10.1007/s40620-025-02336-z

Updates Surg. 2025 Jul 5. doi: 10.1007/s13304-025-02317-8. Online ahead of print.

ABSTRACT

Fecal incontinence (FI) is a debilitating condition that commonly affects postmenopausal women, particularly those with a history of obstetric trauma. To date, there are few studies directly comparing SP and SNM, which present many discrepancies in the inclusion criteria, such as age, etiology, and elapsed time from the onset of the condition. This retrospective study aims to compare the clinical outcomes of the two procedures most widely performed in the management of FI: sphincteroplasty and sacral neuromodulation (SNM). The inclusion criteria were established to ensure a representative sample of a well-defined patient population affected by fecal incontinence: postmenopausal women with late onset of FI after previous obstetric trauma. A cohort of 58 women aged 65 and older treated consecutively at the Humanitas San Pio X Hospital between January 2016 and December 2022 was analysed. Thirty-five women underwent sphincteroplasty, while 23 received SNM. Outcomes were evaluated based on the functional outcomes and the incidence of adverse events. Statistical Analysis did not show any statistically significant differences between the two groups (SP and SNM) in terms of baseline characteristics and 2-year functional outcomes. Both techniques were effective in the treatment of FI according to the Cleveland Clinic Incontinence Score registrations over the 2-year follow-up. No differences were found between the two techniques in terms of both early and late complication rates. Therefore, SP and SNM proved to be safe and effective treatments for late-onset FI in postmenopausal women with a history of obstetric trauma, yielding favourable outcomes at 24 months.

PMID:40616746 | DOI:10.1007/s13304-025-02317-8

Drugs Aging. 2025 Jul 5. doi: 10.1007/s40266-025-01226-0. Online ahead of print.

NO ABSTRACT

PMID:40616740 | DOI:10.1007/s40266-025-01226-0

Eat Weight Disord. 2025 Jul 5;30(1):50. doi: 10.1007/s40519-025-01762-z.

ABSTRACT

BACKGROUND: Psoriasis is a chronic skin disease affecting millions of people, with obesity being a common comorbidity. Many studies suggest that obesity may influence the onset and treatment efficacy of psoriasis. Currently, increasing evidence indicates that abdominal obesity is associated with various metabolic diseases, but research on the relationship between abdominal obesity and psoriasis remains limited. This study uses advanced obesity indicators such as the conicity index and body roundness index to explore the association between abdominal obesity and psoriasis.

METHODS: This study is a cross-sectional analysis that uses univariate regression analysis and weighted multivariable logistic regression to investigate the relationship between conicity index, android percent fat, body roundness index, and psoriasis. Additionally, restricted cubic spline analysis was performed to explore the nonlinear association between these indicators and psoriasis. Subgroup analysis and interaction tests were also conducted.

RESULTS: A total of 4873 participants were included in this study. After adjusting for confounding variables, the results showed a positive correlation between conicity index, android percent fat, body roundness index, and the risk of psoriasis. When conicity index, android percent fat, and body roundness index were converted into quartiles (Q1-Q4), the risk of psoriasis in the Q4 group was significantly higher compared to the Q1 group (conicity index: p = 0.032, android percent fat: p = 0.020, body roundness index: p = 0.003). In the subgroup analysis and interaction tests, no significant interaction between the conicity index, body roundness index, and the association with psoriasis was found (p > 0.05). The results only suggest that the poverty income ratio (PIR), marital status, and alcohol consumption may influence the relationship between android percent fat and psoriasis. In addition, subgroup analysis based on age shows that the association between abdominal obesity and psoriasis is more significant in the population over 40 years old.

CONCLUSIONS: After adjusting for covariates, the study found that three abdominal obesity indicators-conicity index, android percentage fat, and body roundness index-are positively correlated with psoriasis risk, suggesting that the association between abdominal obesity and psoriasis as a comorbidity is more likely to occur, emphasizing the clinical significance of this link.

LEVEL OF EVIDENCE: Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

PMID:40616714 | DOI:10.1007/s40519-025-01762-z

Graefes Arch Clin Exp Ophthalmol. 2025 Jul 5. doi: 10.1007/s00417-025-06898-3. Online ahead of print.

ABSTRACT

PURPOSE: Strabismus, including esotropia and exotropia, significantly affects binocular vision and presents challenges in clinical management and surgical correction. Although previous studies have explored the anatomical characteristics of horizontal rectus extraocular muscles (EOMs) in strabismus, large-scale analyses of insertional anatomy remain limited. This study investigates anatomical variations in the insertions of horizontal rectus EOMs in patients with esotropia and exotropia, aiming to understand their impact on strabismus management.

METHODS: A retrospective case-control study was conducted using clinical records from 4781 patients diagnosed with strabismus who underwent surgery at the Zhongshan Ophthalmic Center, Sun Yat-sen University, from June 2014 to August 2020. Anatomical measurements of horizontal rectus EOM insertions were taken using a Castroviejo caliper. Statistical analyses, including regression analysis, were performed to examine the relationship between EOM characteristics and clinical outcomes.

RESULTS: Significant anatomical differences were observed among esotropia, exotropia, and control groups. Esotropia patients exhibited shorter medial rectus (MR) insertion distances (mean: 4.81 mm) than both exotropia (5.09 mm) and controls (5.08 mm, p < 0.001), with moderate effect sizes. Exotropia subtypes showed wider MR and lateral rectus (LR) insertions, particularly in constant and pattern types (MR width p = 0.001, LR width p = 0.002). Regression analysis indicated that shorter MR insertion distance was significantly associated with greater esodeviation at both near (β = -13.60, p < 0.001) and distance (β = -12.76, p < 0.001), though with small effect sizes. Refractive error (SE) and age were also significant predictors of deviation magnitude and AC/A ratio.

CONCLUSION: Anatomical variations in the horizontal rectus EOMs are significantly associated with esotropia and exotropia. These findings enhance our understanding of strabismus pathophysiology and may help guide surgical strategies for severe cases, though further research is needed to refine clinical applications.

PMID:40616711 | DOI:10.1007/s00417-025-06898-3

Cancer Immunol Immunother. 2025 Jul 5;74(8):260. doi: 10.1007/s00262-025-04115-y.

ABSTRACT

BACKGROUND: Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide. While early-stage lesions can be definitively treated with local therapies, advanced stage cutaneous squamous cell carcinoma (cSCC) often requires systemic treatments such as PD-1 inhibitors. These treatments may be administered for prolonged durations; this practice may lead to an unnecessary physical and financial toxicity. The purpose of this study was to evaluate the patterns of disease progression after anti-PD-1 therapy discontinuation in this group of patients.

METHODS: This retrospective cohort study included patients diagnosed with advanced cSCC and treated with either cemiplimab or pembrolizumab from 2019 to 2024 at a single university-affiliated tertiary medical center.

RESULTS: The cohort included 131 patients, with a 73% overall response rate. Among the 86 patients with either partial or complete response as the best response included in the final analysis, 40 (47%) patients had a treatment break for at least 3 months, and 46 (53%) continued without discontinuation to a maximal duration of 2 years. After a median follow-up of 29.9 months, 24 (60%) patients in the break group remained progression-free, systemic treatment-free, and alive throughout the follow-up. Four patients (10%) experienced disease progression. Among these, the best overall response was PR in three patients and CR in one patient. Nine (22.5%) patients died due to non-oncological reasons, two (5%) patients died from an unknown cause, and one (2.5%) due to treatment toxicity. The percentage of patients achieving CR was statistically significantly higher in the break group compared to the no-break group.

CONCLUSIONS: Our findings advocate for a more tailored approach to the duration of PD-1 inhibitor therapy in cSCC, potentially reducing burdens of overtreatment. Future studies regarding establishing robust predictors for safe treatment discontinuation are required to enhance decision-making in clinical practice.

PMID:40616706 | DOI:10.1007/s00262-025-04115-y

Pediatr Surg Int. 2025 Jul 5;41(1):202. doi: 10.1007/s00383-025-06100-z.

ABSTRACT

BACKGROUND: Intestinal atresia is a congenital anomaly characterized by a complete obstruction of the intestinal lumen. This study aims to identify factors influencing outcomes in affected infants to inform targeted interventions and improve their care.

METHODS: This study employed a hybrid cohort design combining retrospective chart review with prospective data collection of patients surgically managed with intestinal atresia at a tertiary center over 5 years. Statistical analysis was performed using SPSS version 25.0, and p value of < 0.05 was considered statistically significant.

RESULTS: 82 patients with intestinal atresia were included; females comprised 61% (F:M ratio 1.56:1). The mean birth weight was 2499 ± 705 g, and the mean gestational age was 36.5 ± 2.5 weeks. Prenatal diagnosis was made in 23.2%, while 43.6% had associated anomalies. Intraoperatively, findings revealed obstruction in the duodenum (37.8%), jejunum (29.3%), ileum (29.3%), and colon (3.6%). Duodenal atresia was primarily managed with diamond-shaped duodenoduodenostomy (90.3%), while jejunal, ileal, and colonic atresia were managed with resection and anastomosis. Mortality was 42.7%, and sepsis (28.6%) and respiratory insufficiency (26%) were the leading causes of death. Prematurity was significantly associated as an independent risk factor for mortality.

CONCLUSION: Neonatal survival in our country remains poor compared to developed nations, with mortality influenced by premature deliveries, inefficient perioperative care, and postoperative complications.

PMID:40616700 | DOI:10.1007/s00383-025-06100-z

Hernia. 2025 Jul 5;29(1):221. doi: 10.1007/s10029-025-03418-4.

ABSTRACT

TITLE: Cessation vs No Cessation of Acetylsalicylic acid Preoperatively in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair (CAPTAIN): Final Report from a Multi-Center, Single-Blinded, Randomized-Controlled Trial. The CAPTAIN trial is a prospective multi-center randomized-controlled trial evaluating the safety of continuing acetylsalicylic acid preoperatively in patients undergoing elective laparoscopic inguinal hernia mesh repair (LIHR).

METHODS: Patients undergoing LIHR were eligible for inclusion. Patients unfit for general anesthesia, patients who had obstructed hernias or patients who underwent open operation were excluded. Participants were randomized by the trial coordinator using allocation concealment to either acetylsalicylic acid-cessation or continuation group, without the surgeon knowing.

OUTCOME: Primary outcome was the incidence of bleeding complications evidenced by the presence of postoperative hematomas before the patient was discharged from hospital. Secondary outcomes include incidence of major cardiovascular events, post-operative thromboembolic events, seroma formation and length of hospital stay.

RESULTS: 100 patients were recruited between April 2016 and June 2024. 5 patients were excluded because they 3 underwent open operation, 1 withdrew consent and 1 had their operation cancelled, leaving 45 patients in the acetylsalicylic acid-continuation group and 50 patients in the cessation group.

OUTCOMES: We found that significantly more patients who continued acetylsalicylic acid had hematomas in the index admission (11 vs 5, p = 0.018). There was no difference in the amount of intraoperative blood loss between the two groups, 12.9 vs 9.3ml (p = 0.130). Both groups of patients had short postoperative stay-an average of less than a day. There were no postoperative thromboembolic events or major adverse cardiac events in either group. The rates of postoperative seroma were similar between both groups, 28.9% vs 26% (p = 0.755). At 30 days post operation, there were no hernia recurrence or readmissions in either group.

CONCLUSION: The increase in the rate of postoperative hematomas formation in the acetylsalicylic acid-continuation group though statistically significant; was not clinically significant as no blood transfusion was required and all hematomas resolved with conservative management by 90-days clinic review despite no cessation of acetylsalicylic acid. Thus, this randomized-controlled trial concludes that it is safe to continue acetylsalicylic acid perioperatively in selected patients undergoing LIHR. Larger scale randomized-controlled trials would be helpful to corroborate these findings.

TRIAL REGISTRATION: Ethics approval was obtained from our healthcare cluster’s Domain Specific Review Board (reference number 2015/00512). The study protocol was registered on ClinicalTrials.gov (registration number NCT02604732).

PMID:40616699 | DOI:10.1007/s10029-025-03418-4

Environ Monit Assess. 2025 Jul 5;197(8):866. doi: 10.1007/s10661-025-14324-8.

ABSTRACT

Droughts are one of the most severe natural hazards, and its occurrences are increasingly exacerbated due to climate change. While numerous studies have analyzed drought occurrences using multi-model ensembles (MME) developed considering uniform weights to general circulation models (GCMs), biases inherent in these models impeded the attainment of reliable predictions. Also, studies conducted were region specific and were limited to considering a specific socio-economic pathway (SSP). The inconsistency in findings drawn across different SSPs limits the applicability of these results to implement best management practices to combat drought effectively. In this study, Drought Prone Index (DPI) built on the mathematical framework of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) has been proposed. This index represents the frequency and severity of the possible drought events considering near future (2024-2060) and far future (2061-2100). Further, to overcome the limitation of bias, a multi-criteria decision-making (MCDM) framework integrating CRiteria Importance Through Intercriteria Correlation (CRITIC) and analytical hierarchy process (AHP) methods has been proposed to create differential weighted multi-model ensemble. The proposed framework is demonstrated considering India as study area. Findings of our study indicate a significant increase in rainfall and temperature ranging between 100-440 mm, and 0.75-3.5 °C across different SSP scenarios. Alongside a decline in rainfall in certain regions of Northeast India and the Western Ghats is observed from the derived spatial maps created using the data of developed MME. Spatial variation of DPI computed at a district level indicates that though the frequency of drought occurrences in the near and far future periods does not substantially increase, the severity of droughts is found to be intense. Findings highlight that it is imperative to consider the influence of climate change while assessing the droughts. These findings can assist policymakers and stakeholders in prioritizing resource allocation and implementing targeted mitigation strategies.

PMID:40616693 | DOI:10.1007/s10661-025-14324-8

Clin Oral Investig. 2025 Jul 5;29(7):372. doi: 10.1007/s00784-025-06450-x.

ABSTRACT

OBJECTIVES: This study aimed to compare the clinical efficacy of a novel apical barrier technique (N-ABT) and a traditional apical barrier technique (T-ABT).

MATERIALS AND METHODS: A randomized controlled clinical trial was conducted. Forty-seven patients with 50 teeth meeting the inclusion criteria of large root canals and incompletely developed apical foramina were enrolled. Teeth were randomly assigned to either the N-ABT or T-ABT group in a 1:1 ratio and were followed for 24 months. N-ABT employed 3D printing technology to design personalized pluggers and to calculate the precise volume of barrier material, while T-ABT used a standard commercial plugger without volume control. Randomization was performed using a computer-generated sequence, and the study was conducted in a single-blind manner.

RESULTS: A total of 45 teeth completed the 24-month follow-up (22 in the N-ABT group and 23 in the T-ABT group), with no significant adverse events reported. All cases were considered clinically successful, defined by the absence of symptoms and a reduction in apical radiolucency. Success was further classified as healed (complete disappearance of apical radiolucency) or healing (reduction in apical radiolucency). At the 12-month follow-up, the N-ABT group showed a slightly higher healed rate (22.7% vs. 17.4% in the T-ABT group), and at the 24-month follow-up, a trend toward a higher healed rate was observed (68.2% vs. 47.8% in the T-ABT group), although the differences were not statistically significant. However, N-ABT significantly improved filling efficiency by reducing the number of obturation attempts from 1.41 ± 0.50 to 1 and the filling time from 99.31 ± 25.08 s to 38.78 ± 15.56 s. Additionally, N-ABT significantly increased the no overfilling rate from 8.7 to 40.9%.

CONCLUSIONS: N-ABT clinically improve clinical outcomes (> 20%) during the observation period, it also demonstrated enhanced filling quality and efficiency and reduced technical sensitivity.

CLINICAL RELEVANCE: The novel apical barrier technique demonstrated superior filling quality and efficiency compared to the traditional apical barrier technique, reduced technical sensitivity, and showed potential for future automated filling procedures, enhancing clinical applicability.

CLINICAL TRIAL REGISTRATION: This study was registered on www.chictr.org.cn (Identifier: ChiCTR2200058635;Trial title: Personalized Root Canal Barrier Technique Using 3D Printing Technology).

PMID:40616689 | DOI:10.1007/s00784-025-06450-x