Nevin Manimala

JAMA Netw Open. 2025 Jun 2;8(6):e2516749. doi: 10.1001/jamanetworkopen.2025.16749.

ABSTRACT

IMPORTANCE: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative.

OBJECTIVE: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023.

EXPOSURES: Percutaneous nephrolithotomy vs ureteroscopy.

MAIN OUTCOMES AND MEASURES: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery.

RESULTS: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery.

CONCLUSIONS AND RELEVANCE: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

PMID:40540269 | DOI:10.1001/jamanetworkopen.2025.16749

JAMA Netw Open. 2025 Jun 2;8(6):e2516772. doi: 10.1001/jamanetworkopen.2025.16772.

ABSTRACT

IMPORTANCE: Weight loss (WL) in older adults is associated with bone loss, increasing the risk of fracture. Because skeletal tissue is responsive to mechanical stress, replacing lost weight externally may be an innovative way to minimize WL-associated bone loss in this population.

OBJECTIVE: To examine the effect of 12 months of weighted vest use during WL on indicators of bone health compared with WL alone and WL plus resistance training (RT).

DESIGN, SETTING, AND PARTICIPANTS: This single-blind, 12-month randomized clinical trial of older adults living with obesity was conducted at an academic medical center from September 1, 2019, to April 30, 2024.

INTERVENTIONS: WL (caloric restriction targeting 10% WL with adequate calcium, vitamin D, and protein), WL plus weighted vest (WL+VEST; 8 h/d, weight replacement titrated up to 10% total WL), or WL plus progressive RT (WL+RT; supervised 3 sessions weekly).

MAIN OUTCOMES AND MEASURES: Main outcomes included 12-month change in computed tomography-acquired trabecular volumetric bone mineral density (vBMD) and dual-energy X-ray absorptiometry-acquired areal bone mineral density (aBMD) of the total hip. Secondary outcomes included change in additional computed tomography- and dual-energy X-ray absorptiometry-acquired measures of musculoskeletal health and bone turnover biomarkers.

RESULTS: A total of 150 older (mean [SD] age, 66.4 [4.6] years) adults (112 [74.7%] women) living with obesity (mean [SD] body mass index, 33.6 [3.3]) were randomized (50 to WL, 50 to WL+VEST, and 50 to WL+RT), with 133 (88.7%) completing the trial. Similar significant WL, ranging from 9.0% to 11.2%, was achieved in all groups. During 12 months, mean (SD) self-reported weighted vest wear time was 7.1 (1.5) h/d, with 78.0% (29.9%) of lost weight replaced in the vest; participants randomized to the WL+RT group attended a mean (SD) of 71.4% (19.1%) of sessions. A significant decrease in total hip trabecular vBMD was observed at 12 months in all treatment groups (ranging from -1.2% to -1.9%), with no difference between the WL+VEST and WL groups (estimated treatment difference, +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P = .13) and noninferiority of WL+VEST compared with WL+RT (estimated treatment difference, +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3). Similar effects were observed for total hip aBMD.

CONCLUSIONS AND RELEVANCE: In this 12-month randomized clinical trial, neither weighted vest use nor progressive RT was able to mitigate WL-associated bone loss at the hip in older adults living with obesity. This study highlights the need for alternative or adjunctive strategies to prevent bone loss in older adults experiencing WL because exercise may be insufficient on its own.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04076618.

PMID:40540267 | DOI:10.1001/jamanetworkopen.2025.16772

Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002789. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (AF) and functional regurgitation (FR) have complex interactions. This study investigated the interactions between thoracoscopic surgical ablation (TSA) and FR in patients with AF, to explore whether the strategy prioritizing AF can treat FR, thus avoiding additional valve surgeries.

METHODS: A total of 152 AF patients underwent isolated TSA were included for a 12-month follow-up. Among them, the control group contains 67 patients with no valve disease, and the FR group contains 85 patients diagnosed as functional mitral regurgitation (FMR, n = 50) and/or functional tricuspid regurgitation (FTR, n = 75). The changes in the degrees of regurgitation, the recurrence rate of AF 12 months after surgery, and the occurrence of cardiac reverse remodeling were statistically analyzed. Logistic regression analyses were performed to identify variables associated with the reduction in regurgitation.

RESULTS: The difference in 12-month sinus rhythm (SR) maintenance rate between the FR group and the control group was not significant (61.18% vs. 74.62%, P = 0.08). FMR degree was reduced significantly (P < 0.05) while FTR degree was not (P = 0.66), and the reduction in FTR is related to the reduction in FMR (OR = 19.80, 95% CI 2.22-176.60, P < 0.05) among the patients with both. Significant cardiac reverse remodeling and heart function improvement were observed after TSA (e.g. preoperative vs. postoperative: LV: 47.82 ± 5.37 mm vs. 46.52 ± 5.17 mm, P < 0.05; LA: 42.73 ± 5.41 mm vs. 40.79 ± 6.57 mm, P < 0.05). Logistic regression analyses revealed that the variation in left ventricular posterior wall, the variation in pulmonary artery pressure (PAP) and SR maintenance are associated with FMR reduction (P < 0.05), while preoperative interventricular septum, the variation in PAP and preoperative FTR degree are associated with FTR reduction (P < 0.05).

CONCLUSIONS: The treatment strategy prioritizing AF is reasonable for patients with AF and FMR. The existence of mild to moderate FR cannot affect TSA results, while TSA can reduce the degree of FMR through cardiac reverse remodeling. And the reduction in FTR is secondary to the PAP decrease after FMR reduction.

PMID:40540257 | DOI:10.1097/JS9.0000000000002789

Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002517. Online ahead of print.

ABSTRACT

BACKGROUND: Neuroblastoma is a highly malignant, systemic sympathetic nerve tumor. Traditional surgical approaches often involve extensive excision, which can lead to additional tissue damage, underscoring the need for accurate and real-time tumor margin delineation. In this study, we introduce the application of Terahertz Time-Domain Spectroscopy (THz-TDS) for tumor margin assessment and rapid pathological evaluation in neuroblastoma.

METHODS: SH-SY5Y cells were employed to establish a subcutaneous tumor-bearing model in nude mice. Using a THz-TDS system, we conducted in vivo imaging of tumor-bearing mice in time domain signal and frequency domain signal, and performed transmission-mode THz detection on hematoxylin and eosin (HE) stained neuroblastoma tissue sections. In THz imaging, superparamagnetic iron oxide (SPIO) was introduced as a contrast agent to enhance the imaging performance.

RESULTS: The results revealed a strong THz reflection signal at the tumor site in the tumor-bearing mice, with the THz imaging system clearly delineating the tumor region in agreement with pathological findings. Neuroblasotuma tissues exhibited higher THz absorption coefficients compared to normal tissues. THz spectroscopy provide an excellent imaging contrast ratio in 0.5-1.0 THz, which can be further improved with SPIO nanopartical agent. Additionally, we observed a statistically significant differences of refractive index and absorption coefficient between the HE-stained tumor and healthy tissue sections (P < 0.01) within the frequency range of 0.5-1.5 THz.

CONCLUSION: This work shows that THz-based imaging technology is able to distinguish the neuroblastoma and normal tissues in time and frequency domain, which offers a great potential for in vivo applications of neuroblastoma treatment. As an advanced technique, novel THz applications could open new avenues for precise diagnosing intraoperative neuroblastoma margins.

PMID:40540248 | DOI:10.1097/JS9.0000000000002517

Biol Trace Elem Res. 2025 Jun 20. doi: 10.1007/s12011-025-04713-y. Online ahead of print.

ABSTRACT

This study aimed to evaluate the phytochemical composition, antioxidant activity, elemental content, and chemometric classification of 21 coffee samples sourced from various retail outlets in Jazan, Saudi Arabia. The samples represent a range of geographical origins and roasting levels. Each sample was ground independently and freshly prepared prior to the analysis. Total phenolic content(TPC) was determined using the Folin-Ciocalteu method, while antioxidant activity was assessed using the DPPH radical scavenging assay. Elemental analysis was conducted using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and volatile compound profiling was performed using gas chromatography-mass spectrometry (GC-MS). Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) are classified as chemometric techniques and are used to evaluate multidimensional datasets. The caffeine content ranged from 18.48% to 62.48%. TPC values were between 52.0 and 69.0 mg GAE/mL, and DPPH antioxidant activity ranged from 39.0% to 75.5%. Among the elements detected, manganese (Mn) had the highest average concentration (1769.43 ± 683.41 ppb), followed by copper (Cu: 806.38 ± 257.93 ppb) and zinc (Zn: 523.71 ± 340.80 ppb). Toxic elements such as arsenic (As), beryllium (Be), chromium (Cr), and antimony (Sb) were not detected. PCA and HCA successfully classified the samples based on their elemental and phytochemical profiles. GC-MS identified volatile compounds including fatty acid esters, aromatic hydrocarbons, and steroid derivatives unique to specific samples. Notably, strong correlations among Cu, Zn, Cd, and Pb suggested co-accumulation patterns. This study provides an integrated assessment of the chemical composition of commercial coffee products, complemented by nutritional and health evaluations, and illustrates the strategic use of chemometric techniques for distinguishing or classifying coffee samples.

PMID:40540238 | DOI:10.1007/s12011-025-04713-y

J Comput Neurosci. 2025 Jun 20. doi: 10.1007/s10827-025-00909-2. Online ahead of print.

ABSTRACT

According to current anatomical models, motor cortical areas, the basal ganglia, and the ventral motor thalamus form partially closed (re-entrant) loop structures. The normal patterning of neuronal activity within this network regulates aspects of movement planning and execution, while abnormal firing patterns can contribute to movement impairments, such as those seen in Parkinson’s disease. Most previous research on such firing pattern abnormalities has focused on parkinsonism-associated changes in the basal ganglia, demonstrating, among other abnormalities, prominent changes in firing rates, as well as the emergence of synchronized beta-band oscillatory burst patterns. In contrast, abnormalities of neuronal activity in the thalamus and cortex are less explored. However, recent studies have shown both changes in thalamocortical connectivity and anatomical changes in corticothalamic terminals in Parkinson’s disease. To explore these changes, we created a computational framework to model the effects of changes in thalamocortical connections as they may occur when an individual transitions from the healthy to the parkinsonian state. A 5-dimensional average neuronal firing rate model was fitted to replicate neuronal firing rate information recorded in healthy and parkinsonian primates. The study focused on the effects of (1) changes in synaptic weights of the reciprocal projections between cortical neurons and thalamic principal neurons, and (2) changes in synaptic weights of the cortical projection to thalamic interneurons. We found that it is possible to force the system to change from a healthy to a parkinsonian state, including the emergent oscillatory activity, by only adjusting these two sets of synaptic weights. Thus, this study demonstrates that small changes in the afferent and efferent connections of thalamic neurons could contribute to the emergence of network-wide firing patterns that are characteristic for the parkinsonian state.

PMID:40540231 | DOI:10.1007/s10827-025-00909-2

Ann Surg Oncol. 2025 Jun 20. doi: 10.1245/s10434-025-17617-x. Online ahead of print.

ABSTRACT

BACKGROUND: Robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) are becoming increasingly prevalent. However, whether the two surgical procedures share the same oncologic outcomes remains controversial.

PATIENTS AND METHODS: A multicenter, retrospective study was conducted. Patients who underwent radical cystectomy for histologically confirmed bladder cancer at ten centers between 2012 and 2019 were enrolled. Data on baseline conditions, perioperative details, pathological results, and survival outcomes were collected. The primary outcome measures were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Propensity score matching was conducted to reduce the effects of bias and confounding variables, while multiple imputation was applied to address missing variables.

RESULTS: A total of 2766 patients were enrolled, including 1291 LRC patients and 1475 RARC patients. After propensity score matching, a total of 753 pairs of patients were obtained. In the RARC group, organ-confined diseases were detected in 482 patients (64.0%). Lymph node metastasis was observed in 120 (15.9%) patients. In the LRC group, organ-confined diseases were detected in 521 (69.2%) patients, and 101 (13.4%) patients had lymph node metastasis. The median follow-up time was 47.6 months (33.4-63.4 months) for the RARC group and 45.6 months (23.1-70.8 months) for the LRC group. Survival analysis showed no statistically significant differences in OS (HR: 0.89, 95% CI: 0.72-1.10, p = 0.269), RFS (HR: 0.84, 95% CI: 0.69-1.01, p = 0.069), and CSS (HR: 0.86, 95% CI: 0.68-1.08, p = 0.196) between the two groups. Recurrent bladder cancer, T stage, and lymph node metastasis were identified as significant risk factors.

CONCLUSIONS: There were no statistically significant differences in oncologic outcomes between RARC and LRC.

PMID:40540221 | DOI:10.1245/s10434-025-17617-x

Acta Diabetol. 2025 Jun 20. doi: 10.1007/s00592-025-02544-w. Online ahead of print.

ABSTRACT

AIMS: This study evaluates the contribution of common variants in Maturity-Onset Diabetes of the Young (MODY) genes on type 1 diabetes (T1D), using a polygenic score (PGS) approach.

METHODS: 485 children and youth diagnosed with T1D from at least 1 year and 271 healthy controls (HC) were recruited. Personal information (i.e. age, sex, height, weight) were collected for each participant, and clinical information (i.e. age at diagnosis, disease duration, presence of autoantibodies and ketoacidosis at onset (DKA)) were also obtained for T1D subjects. Participants were genotyped using Illumina Infinium Global Screening Array. PGS based on Single Nucleotide Polymorphisms (SNPs) in 16 MODY genes were developed. The association of this PGS with T1D susceptibility and clinical disease characteristics was assessed by regression analysis.

RESULTS: A PGS including 335 SNPs in MODY genes discriminates T1D from HC (AUC = 60.1%, AIC = 787.6). This PGS was significantly higher in T1D compared to HC (p-value = 0.0004, pseudo-R2 = 2.85%). Moreover, regression analysis between PGS and T1D clinical characteristics showed higher PGS values in T1D subjects with zinc transporter 8 autoantibodies (ZnT8A) compared with T1D subjects without ZnT8A (p-value = 0.04). A similar trend was also observed for antibodies directed against glutamic acid decarboxylase (GADA), although the association did not reach statistical significance (p-value = 0.06).

CONCLUSIONS: Our study suggests that a polygenic approach based on MODY genes may discriminate T1D from HC and may contribute to patient stratification, helping to better understand T1D heterogeneity.

PMID:40540212 | DOI:10.1007/s00592-025-02544-w

Int Ophthalmol. 2025 Jun 20;45(1):252. doi: 10.1007/s10792-025-03631-1.

ABSTRACT

PURPOSE: This study aimed to evaluate the short-term effects of topical latanoprostene bunod on corneal and anterior segment parameters in patients with primary open-angle glaucoma (POAG).

METHODS: A prospective, cross-sectional study was conducted on 30 eyes of 30 patients with POAG. All participants received topical latanoprostene bunod monotherapy. Corneal and anterior segment parameters, including keratometry, corneal thickness, endothelial cell characteristics, and corneal densitometry, were measured before and approximately after one month of treatment using the Pentacam HR and non-contact specular microscopy. Statistical analysis was performed to compare pre- and post-treatment measurements.

RESULTS: No significant changes were observed in corneal keratometry, endothelial cell density, hexagonality, or anterior chamber parameters including anterior chamber angle, depth, and volume following treatment (p > 0.05 for all). Although reductions in central corneal thickness and thinnest corneal thickness were noted, these changes were not statistically significant (p > 0.05 for both). A significant decrease in densitometric parameters was observed in most corneal zones after treatment, including anterior, central, posterior, and total thickness measurements (p < 0.05 for all). In contrast, no significant change was found in the peripheral 10-12 mm zones (p > 0.05 for all).

CONCLUSION: Short-term use of latanoprostene bunod reduced corneal densitometry values, suggesting improved corneal transparency without significantly affecting corneal thickness, endothelial cell characteristics, or anterior segment parameters. Further long-term studies with larger sample sizes are needed to evaluate its prolonged effects on corneal health.

PMID:40540210 | DOI:10.1007/s10792-025-03631-1

Brain Imaging Behav. 2025 Jun 20. doi: 10.1007/s11682-025-01029-2. Online ahead of print.

ABSTRACT

The aim of this study is to investigate the disparities in volumes of hippocampal subfields and alterations in whole-brain functional connectivity among individuals diagnosed with diabetic retinopathy (DR). This study comprised a total of 32 diabetic patients with retinopathy (DR group, n = 32) and 38 healthy adults (HC group, n = 38), who underwent psychological cognitive testing along with structural and functional magnetic resonance imaging. The FreeSurfer software was utilized for the extraction and computation of hippocampal subfield volumes, as well as the overall volumes of the left and right hippocampus. The volumetric comparisons were conducted by employing independent sample t-tests in SPSS 26.0. The functional connectivity comparisons were subjected to statistical analysis using the Matlab software. Age, education level and grnder were used as control variables, and partial correlation analysis was performed to investigate the relationship between differences in volume and functional connectivity values with psychological cognitive test results and clinical indicators. The volume of the left hippocampal tail and fissure, as well as the right hippocampal C3, C4 and fissure regions in the DR patient group, exhibited significant differences compared to the HC group (P < 0.05, FDR < 0.05). Regions of interest were identified based on the segmented volume differences, and compared to the HC group, enhanced connectivity was observed between the left hippocampal tail and the left caudate nucleus (MNI: x,y, z=-6, 12, 9) and the right caudate nucleus (MNI: x,y, z = 9, 12, 12) in DR patients. Additionally, reduced connectivity was observed between the left hippocampal fissure and the right precentral gyrus (MNI: x, y, z = 57, 0, 45) and the right supplementary motor area (MNI: x, y, z = 9, 3, 60). Partial correlation analysis, with age, education level, and gender as covariates, showed no significant associations between the imaging changes and clinical indicators or cognitive scores. The alterations in hippocampal volume and function observed in patients with DR may potentially underlie their cognitive impairment and sensorimotor deficits, thus suggesting a plausible neuropathological mechanism.

PMID:40540191 | DOI:10.1007/s11682-025-01029-2