Nevin Manimala

Obes Surg. 2025 Sep 8. doi: 10.1007/s11695-025-08228-2. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic bariatric surgery (MBS) is the most effective obesity treatment. The increasing number of MBS among young patients has led to more post-bariatric pregnancies. Our study investigates how breastfeeding duration impacts postpartum weight retention and health outcomes for mothers and babies after MBS.

METHODS: MOMBARIS (Maternal Outcomes of Bariatric Surgery and Pregnancy Study) is a multicentre study. The population is derived from MOMBARIS 2, which focused on obstetric outcomes. It included patients who became pregnant following MBS, analysing pre-operative metrics, type of surgery, pregnancy details, and breastfeeding duration. Data analysis was conducted using Julius.ai.

RESULTS: We analysed 156 patients post-MBS, with 148 pregnancies leading to childbirth. Among them, 131 had laparoscopic sleeve gastrectomy (LSG), 12 underwent Roux-en-Y gastric bypass (RYGB), and 5 had one anastomosis gastric bypass (OAGB). The mean age was 31.7 ± 5.45 years (range 19-48) with a pre-operative BMI of 43.9 kg/m² ± 5.8 kg/m² (range 31.9-68.8). The mean %EWL was 72% (± 28.6). Seventeen patients had multiple children. Breastfeeding results indicated that 116 patients (78.4%) initiated breastfeeding, with 40.5% continuing beyond 6 months. No significant differences were found in BMI metrics across breastfeeding groups.

CONCLUSIONS: Bariatric outcomes (%EWL, %TWL) show no statistical difference based on breastfeeding patterns, nor does breastfeeding significantly affect weight loss maintenance post-surgery. Additionally, delaying pregnancy after surgery does not guarantee more significant weight loss.

PMID:40921955 | DOI:10.1007/s11695-025-08228-2

Int J Clin Oncol. 2025 Sep 8. doi: 10.1007/s10147-025-02875-2. Online ahead of print.

ABSTRACT

BACKGROUND: To evaluate the effects of cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT), individually and in combination, on alleviating anxiety and depression, and improving quality of life (QoL) in breast cancer patients.

METHODS: We searched PubMed and EMBASE for articles published up to April 6, 2025, using the keywords “randomized controlled trials (RCTs)”, “cognitive-behavioral therapy”, “mindfulness-based therapy”, and “breast cancer”. Pooled effects were expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs).

RESULTS: Fifty-one RCTs were included. Compared with controls (usual care, wait-list control, etc.), CBT and MBT (analyzed separately or in combination) demonstrated significant benefits. The SMDs (95% CIs) were as follows: anxiety [CBT ( – 0.33, – 0.52 to – 0.14); MBT ( – 0.80, – 1.16 to – 0.45); combined ( – 0.55, – 0.74 to – 0.37)], depression [CBT ( – 0.31, – 0.49 to – 0.14); MBT ( – 0.80, – 1.12 to – 0.48); combined ( – 0.55, – 0.73 to – 0.37)] and QoL [CBT (0.38, 0.15 to 0.62); MBT (0.33, 0.11 to 0.55); combined (0.37, 0.20 to 0.53)]. MBT showed significantly greater efficacy than CBT for anxiety (p = 0.020) and depression (p = 0.009). Pooled effects of CBT and MBT were stronger for group-based and longer duration interventions (all outcomes), with effects on depression and QoL being especially strong in Asians. Face-to-face CBT outperformed internet-delivered CBT across all outcomes.

CONCLUSION: CBT and MBT, individually and combined, are effective for anxiety, depression, and QoL in breast cancer patients, with MBT demonstrating superior efficacy for anxiety and depression. The selection of psychological treatments for breast cancer patients should consider intervention method, ethnicity, intervention duration, and delivery format.

PMID:40921953 | DOI:10.1007/s10147-025-02875-2

Invest New Drugs. 2025 Sep 9. doi: 10.1007/s10637-025-01584-x. Online ahead of print.

ABSTRACT

In China, many solid tumor drugs have been approved via the accelerated approval (AA) pathway. We extracted data regarding indications for solid tumor-treating drugs approved by the National Medical Products Administration (NMPA) between 2015 and 2023, along with their corresponding Chinese Society of Clinical Oncology (CSCO) guideline recommendation levels and inclusion data. Descriptive statistics, Fisher’s exact tests, and t-tests were used to examine associations between NMPA approval pathways and CSCO guideline recommendation levels. The study included 92 solid tumor drugs comprising 191 indications. Sixty-three indications were approved via the regular approval (RA), and 128 were approved via the AA. One hundred fifty-seven indications obtained CSCO guideline recommendation level I, 28 obtained level II, and 6 obtained level III. No significant difference in the recommendation level was observed between the approval pathways. The average time for the indications approved via the RA to obtain the recommendation level was 2.03 months before NMPA approval. The average time for the indications approved via the AA to obtain the level was 6.66 months after NMPA approval. Compared with initial levels, 57 indications had their recommendation levels upgraded. Most indications obtain the CSCO guideline recommendation level I, with similar likelihoods across obtaining different approval pathways. Indications approved via the RA tended to obtain the CSCO guideline recommendation earlier than those via the AA. Given the limitations in data completeness and CSCO guideline coverage, these findings should be interpreted with caution. Clearer criteria for evaluating recommendation levels and standardizing rating procedures will enable CSCO guidelines to better support clinicians and patients.

PMID:40921945 | DOI:10.1007/s10637-025-01584-x

Acad Psychiatry. 2025 Sep 8. doi: 10.1007/s40596-025-02211-w. Online ahead of print.

ABSTRACT

OBJECTIVE: A deep understanding of patients in psychiatry requires an ability to appreciate and describe the biopsychosocial determinants of health. Great works of theatre portray a nuanced observation of the human condition, but these have not been formally evaluated in psychiatric literature as teaching tools. The purpose of this study was to explore Shakespeare’s King Lear as an educational intervention in supporting formulation skills training in geriatric psychiatry residency.

METHODS: Seven residents attended a half-day educational session where they interacted with four professional actors of diverse backgrounds in creating five scenes from King Lear, with faculty debriefing. Residents completed pre-and post-surveys measuring confidence on topics related to the workshop learning objectives. Three-month follow-up surveys and semi-structured interviews were conducted with all participants.

RESULTS: A non-parametric Friedman test among repeated measures indicated statistically significant improvements in confidence in formulating a biopsychosocial understanding (chi-square 9.30, p = 0.01), in communicating an understanding of social and cultural determinants of health (7.60, p = 0.02), and in describing the role of ageism and stigma associated with mental disorders in older adulthood (8.09, p = 0.02). Key themes from the semi-structured interviews included the importance of contextualizing and taking a holistic approach to formulation. This experience was deemed helpful and recommended for inclusion in the residency program.

CONCLUSIONS: The study demonstrates the potential benefits of using live performance of ancient text on residents’ confidence in formulation, communicating determinants of health, and in describing ageism in geriatric psychiatry.

PMID:40921913 | DOI:10.1007/s40596-025-02211-w

Ann Surg Oncol. 2025 Sep 8. doi: 10.1245/s10434-025-18261-1. Online ahead of print.

ABSTRACT

BACKGROUND: Right-sided hepatectomy (RH) is the standard surgical approach for perihilar cholangiocarcinoma (PHC) due to anatomical considerations but is associated with a high risk of post-hepatectomy liver failure (PHLF). Left-sided hepatectomy (LH) and central hepatectomy (CH) have been proposed as alternative strategies to preserve liver function, but the feasibility and outcomes of CH have not been sufficiently investigated. CH allows for greater preservation of liver parenchyma, potentially reducing the risk of PHLF.

METHODS: This retrospective study analyzed 63 patients with PHC who underwent major hepatectomy at the Juntendo University Hospital between January 2019 and March 2024. Patients were categorized into the LH (n = 18), RH (n = 28), and CH (n = 17) groups. Preoperative future liver remnant volume, perioperative outcomes, pathological findings, and long-term outcomes were compared. Statistical significance was set at p < 0.05.

RESULTS: The CH group had a significantly higher future liver remnant volume compared with the RH group (62.7% vs. 45.5%; p < 0.001). The incidence of PHLF was lower in CH (11.8%) than RH (39.3%), although not statistically significant. CH was associated with a longer median operative time (691 min) and a higher incidence of bile leakage (47.1%). R0 resection rates and long-term outcomes were comparable among the three groups.

CONCLUSIONS: CH is a feasible alternative in selected PHC, offering comparable oncological outcomes while preserving functional liver volume despite its technical complexity.

PMID:40921895 | DOI:10.1245/s10434-025-18261-1

Environ Monit Assess. 2025 Sep 8;197(10):1090. doi: 10.1007/s10661-025-14554-w.

ABSTRACT

To a large extent, the food security and ecological balance of a region, particularly in agriculturally dominated areas, largely depend on the sustainable use and management of groundwater resources. However, in recent times, both natural and human-driven factors have heavily impacted the lowering of groundwater resources. Therefore, the present study has been carried out in a drought-prone region of Birbhum district, part of the red-lateritic agro-climatic zone of West Bengal, Eastern India, to delineate groundwater potential zones (GWPZs). In this regard, 12 hydrological and environmental factors were selected after a multicollinearity test, i.e., elevation, slope, curvature, geomorphology, geology, lineament density, distance from river, topographic wetness index (TWI), groundwater level, rainfall, land use land cover, and soil types for modeling groundwater potentiality. To fulfill the objective, standard machine learning (ML) algorithms like “random forest (RF),” “support vector regression (SVR),” “maximum-entropy (Max-Ent),” and the ensemble approach of RF-Max-Ent have been applied. To validate the obtained result, five statistical techniques, i.e., area under curve (AUC), sensitivity, specificity, F-score, and Kappa coefficient, have been selected. The ranking and relative importance of all factors revealed that elevation, rainfall, TWI, and soil type are the most influential factors for groundwater potentiality in this study. The result of the evaluation metric indicates that the ensemble of RF-Max-Ent is the most suitable model to delineate GWPZ in this study site, as AUC is 0.893 in validation, followed by RF, Max-Ent, and SVR. Additionally, the rank value in the Friedman rank test and chi-squared test for RF-Max-Ent is 3.824 and 32.121, respectively. Overall, the findings revealed that a sizeable section of the study area has moderate to very good groundwater potential. The findings of this study can significantly support achieving sustainable development goals and help to improve groundwater levels in this region through appropriate groundwater policy planning.

PMID:40921891 | DOI:10.1007/s10661-025-14554-w

Environ Monit Assess. 2025 Sep 8;197(10):1093. doi: 10.1007/s10661-025-14534-0.

ABSTRACT

Understanding seagrass dynamics is crucial for the effective management and conservation of seagrass meadows. However, such information remains limited for many regions worldwide, including Kuta Mandalika on Lombok Island, Indonesia. This rapidly developing coastal area, which is home to both tourism infrastructure and an international race circuit, hosts extensive seagrass meadows whose condition and dynamics require careful assessment. Establishing a baseline is essential for long-term monitoring, especially in light of ongoing coastal development. In this study, we integrated time-series Sentinel-2 imagery with a robust seagrass aboveground carbon stock (AGC) mapping model to monitor changes in seagrass AGC from 2019 to 2023. Our analysis shows that seagrass AGC exhibits a clear seasonal pattern, with peak biomass typically occurring in May and June each year. Additionally, results from Seasonal-Trend Decomposition using Loess (STL) and a Generalized Additive Mixed Model (GAMM) with an AR(1) error structure indicate a statistically significant decline in seagrass AGC associated with the construction of the Kuta Mandalika Circuit. These findings provide a critical baseline for distinguishing between natural seasonal variability and long-term anthropogenic impacts, offering valuable insights to inform future monitoring, management, and conservation strategies for these vital coastal ecosystems.

PMID:40921888 | DOI:10.1007/s10661-025-14534-0

Crit Rev Immunol. 2025;45(5):67-78. doi: 10.1615/CritRevImmunol.2025060503.

ABSTRACT

Galectin-10(Gal-10)/CLC(Charcot-Leyden crystal) has been discovered to be related to ECRSwNP characterized by high eosinophilic infiltration. We aimed to investigate the effects of Gal-10 on ECRSwNP. A total of 36 tissue samples were collected, including 11 ECRSwNP samples, 15 non-ECRSwNP samples, and 10 Control samples. Human eosinophils were divided into 3 groups: Control, siRNA-NC, and Gal-10 interference groups. Immunohistochemistry (IHC), Western blotting and quantitative real-time PCR (qRT-PCR) detected the expression of Gal-10 in the tissues samples and expression of p-p38 and p-p65 in human eosinophils. Enzyme-Linked Immunosorbent Assay (ELISA) was adopted to measure the expression levels of IL-4, IL-5, IL-8, MBP, ECP, and TNF-α in the human eosinophils. We found the expression of Gal-10 was significantly higher in ECRSwNP group (P < 0.05). The expression levels of IL-4, IL-5, IL-8, MBP and TNF-α in the Gal-10 interference group were lower (P < 0.05), but ECP had no statistical difference in human eosinophils. There showed the expression levels of p-p38 and p-p65 proteins in the Gal-10 interference group were lower (P < 0.05). The deletion of Gal-10 in eosinophils down-regulates the expression of cytokines and granule cationic proteins in ECRSwNP which may be caused by the p38MAPK/ NF-κB pathway.

PMID:40921147 | DOI:10.1615/CritRevImmunol.2025060503

Eur J Oncol Nurs. 2025 Aug 26;78:102969. doi: 10.1016/j.ejon.2025.102969. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the effectiveness of a mobile chemotherapy drug guide application, ChemoNurse, developed for cancer nurses, in improving their knowledge and attitudes toward chemotherapy practices.

METHODS: A randomized controlled trial with a repeated-measures design was conducted with 59 nurses (29 intervention, 30 control) who participated. Nurses in the intervention group used the ChemoNurse mobile application for six months, while the control group received no additional intervention. Data was collected using the Chemotherapy Practice Knowledge Scale and the Attitude Scale for Chemotherapy Practices at baseline, 3rd month, and 6th month. Statistical analyses included repeated measures ANOVA to examine group, time, and interaction effects.

RESULTS: Significant improvements were observed in the intervention group compared to the control group in total knowledge scores (p < 0.001). Subscale analyses revealed significant time effects in domains such as Creating a Safe Environment (p < 0.001), and Procurement and Administration of Chemotherapy Drugs (p < 0.001). The Treatment Planning and Patient Education subscale showed significant group (p < 0.001) and interaction effects (p < 0.001). In terms of attitudes, the intervention group demonstrated a significant decrease in negative attitudes (p < 0.001) and a significant increase in positive attitudes (p < 0.001).

CONCLUSION: The ChemoNurse mobile application significantly improved cancer nurses’ knowledge and professional attitudes regarding chemotherapy administration. These findings highlight the potential of mobile technologies as effective, scalable tools for enhancing clinical competence and supporting safe, evidence-based cancer nursing practice.

PMID:40921109 | DOI:10.1016/j.ejon.2025.102969

JMIR Cancer. 2025 Sep 8;11:e73843. doi: 10.2196/73843.

ABSTRACT

BACKGROUND: Disparities in cancer burden between transgender and cisgender individuals remain an underexplored area of research.

OBJECTIVE: This study aimed to examine the cumulative incidence and associated risk factors for cancer and precancerous conditions among transgender individuals compared with matched cisgender individuals.

METHODS: We conducted a retrospective cohort study using patient-level electronic health record (EHR) data from the University of Florida Health Integrated Data Repository between 2012 and 2023. Transgender individuals were identified using a validated, computable phenotype algorithm that used structured data and clinical notes. They matched 1:10:10 by age and calendar year of index date with cisgender women and cisgender men. The index date was the first transgender-related record for transgender individuals and a matched diagnosis date for cisgender controls. Primary outcomes included new-onset cancers associated with human papillomavirus, human immunodeficiency virus, tobacco, alcohol, lung, breast, and colorectal sites. Secondary outcomes were precancerous conditions related to the same cancer types. We calculated cumulative incidence rates and conducted time-to-event analyses using the Fine-Gray method, treating all-cause death as a competing risk, to assess associations between gender identity and the presence of cancer or precancer, adjusting for demographic and clinical covariates. Interaction analyses evaluated if associations between cancer risk factors and precancer differed by gender identity.

RESULTS: We identified 2745 transgender individuals (mean age at index date 25.1, SD 14.0 years) and matched them with 27,450 cisgender women and 27,450 cisgender men from the same health care system. The cumulative incidence of cancer did not differ significantly between transgender and cisgender cohorts (transgender n=28, 1.0% vs cisgender women, n=358, 1.3%; P=.13 and cisgender men, n=314, 1.1%; P=.64). However, transgender individuals exhibited significantly higher risks for precancerous conditions compared to cisgender women (subdistribution hazard ratios [sHRs] 1.1, 95% CI 1.0-1.3) and cisgender men (sHR 1.3; 95% CI 1.2-1.5). Specifically, transgender individuals were more likely to develop colorectal precancer (sHR 1.2; 95% CI 1.1-1.4) compared to cisgender women, as well as human papillomavirus-related precancer (sHR 1.8; 95% CI 1.4-2.3) and colorectal precancer (sHR 1.4; 95% CI 1.2-1.6) compared to cisgender men. Subgroup analyses showed similar patterns in both female-to-male and male-to-female individuals compared with their matched cisgender counterparts. Interaction analyses revealed stronger protective effects of private insurance or Medicare against precancers in transgender individuals than in cisgender peers, while being non-Hispanic Black or having substantial comorbidities were stronger risk factors among transgender individuals.

CONCLUSIONS: Transgender individuals showed a similar cancer incidence yet significantly higher precancer incidence compared with cisgender individuals, suggesting underdiagnosis or delayed detection. These findings highlight the need for tailored preventive care strategies, including targeted screenings and risk reduction interventions, to address cancer disparities in the transgender population.

PMID:40921087 | DOI:10.2196/73843