Nevin Manimala

J Nephrol. 2025 Jul 30. doi: 10.1007/s40620-025-02364-9. Online ahead of print.

ABSTRACT

BACKGROUND: Kidney function declines faster in patients with type 2 diabetes mellitus (T2DM) than in those without, and coronary artery calcification is a risk factor for adverse kidney outcomes. Thus, we examined whether T2DM modified the relationship between coronary artery calcification and chronic kidney disease (CKD) progression.

METHODS: Among 2067 participants from the KoreaN Cohort Study for Outcome in Patients With CKD, the main exposures analyzed were T2DM and coronary artery calcification. The primary outcome was CKD progression, which was a composite of > 50% decline in estimated glomerular filtration rate (eGFR) or kidney failure requiring kidney replacement therapy. A multivariable cause-specific hazard model was used to determine the association between the main exposures and the primary outcome.

RESULTS: During 8633 person-years of follow-up, the primary outcome occurred in 565 (27.3%) participants. After adjusting for confounding factors, T2DM and coronary artery calcification score > 0 were associated with 2.03- and 1.51-fold increased risks of CKD progression, respectively. T2DM and coronary artery calcification showed a significant interaction in terms of the primary outcome. In patients with T2DM, coronary artery calcification score > 0 was associated with a significantly higher risk of CKD progression compared with coronary artery calcification score = 0. However, the significant association of coronary artery calcification score > 0 versus coronary artery calcification score = 0 was lost in patients without T2DM. The slope of eGFR decline was steeper in patients with T2DM and coronary artery calcification score > 0 than in those with T2DM or coronary artery calcification score > 0 alone.

CONCLUSIONS: Coronary artery calcification is more strongly associated with the risk of CKD progression in patients with T2DM than in those without. Therefore, the clinical implications of coronary artery calcification vary depending on the presence of T2DM.

PMID:40736786 | DOI:10.1007/s40620-025-02364-9

Int J Oral Maxillofac Implants. 2025 Jul 30;0(0):1-36. doi: 10.11607/jomi.11469. Online ahead of print.

ABSTRACT

BACKGROUND: Two-piece zirconia implants offer a metal-free alternative to titanium implants, but only limited long-term data are available. The aim of this retrospective study was to evaluate the clinical outcomes of two different, identically designed two-piece zirconia implants (NobelPearl™ and Zeramex XT) in a private dental practice.

MATERIAL AND METHODS: Between 2017 and 2024, 167 implants were placed in 106 patients and followed up to 88 months (Ø 39.1 months). In addition to the implant survival rate, marginal bone loss (MBL), clinical parameters and surface properties were examined using 3D profilometry. The statistical analysis included descriptive evaluations and a survival analysis using the life table method.

RESULTS: Three implants were lost (two fractures, one failed osseointegration), corresponding to an effective survival rate of 98.2%. The mean marginal bone loss varied between -0.14 mm and -0.58 mm. The surface roughness was minimal (Sa ~0.5 µm). No risk factor showed a significant association with implant loss in the univariate analysis.

CONCLUSION: Two-piece, screw-retained zirconia implants showed a high survival rate and stable peri-implant tissue conditions over a period of up to seven years. They represent a promising metal-free alternative to titanium implants. Further prospective long-term studies are needed to validate these results and to better understand potential risk factors.

PMID:40736783 | DOI:10.11607/jomi.11469

Int J Oral Maxillofac Implants. 2025 Jul 30;0(0):1-35. doi: 10.11607/jomi.11408. Online ahead of print.

ABSTRACT

PURPOSE: In full arches, what is the accuracy of dental implants placed by means of static computer-assisted implant surgery (s-CAIS)?

MATERIALS AND METHODS: Two independent and calibrated reviewers selected studies based on pre-defined eligibility criteria and extracted data on study-, population-, intervention- and outcome (accuracy) characteristics. Risk of bias and the quality of evidence assessments of the included articles were performed by an independent and blinded reviewer. The meta-analysis was conducted using the random- effects model at a 5% significance level.

RESULTS: Thirty (5 RCTs, 9 CCTs and 16 Case Series) studies were included. Overall, 2,056 implants distributed among arches in 416 patients (males n=161; females n=188; unclear n = 67) were assessed. Random-effects meta-analysis revealed statistically significant mean horizontal linear distortions at the implant neck and apex levels of 1.18mm (95% CI: 1.00 – 1.35) (p<0.001) and 1.46mm (95% CI: 1.22 – 1.69) (p<0.001), respectively, significant mean vertical linear distortion at implant depth level of 0.58mm (95% CI: 0.18 – 0.98) (p=0.113) and significant mean angular distortion of 3.65° (95% CI: 2.97 – 4.33) (p<0.001). Accuracy did not differ significantly between maxilla and mandible at all parameters assessed (p>0.05).

CONCLUSIONS: The accuracy of s-CAIS in full arches is within a clinically acceptable range and a 2-mm ho rizontal and 1-mm vertical safety margin should always be respected at planning.

PRACTICAL IMPLICATIONS: A safety margin of 2 mm horizontally and 1 mm vertically in the planning for implant placement can ensure better results in full arches with reabsorbed bone.

PMID:40736781 | DOI:10.11607/jomi.11408

Allergy Asthma Immunol Res. 2025 Jul;17(4):505-518. doi: 10.4168/aair.2025.17.4.505.

ABSTRACT

PURPOSE: We aimed to investigate the prevalence of atopic dermatitis (AD) and its associated risk factors in Korean children in 2022, and to compare to our findings with previous results to identify changes or trends over time.

METHODS: A nationwide, cross-sectional study of randomly selected schoolchildren aged 6-7, 9-10, and 12-13 years, respectively, was completed. Information was obtained through the International Study of Asthma and Allergies in Childhood questionnaire, and comparisons between the current and prior surveys performed in 1995, 2000, and 2010 were conducted using a trend test.

RESULTS: In the 2022 survey, the prevalence of “itchy eczema, ever” was 18.3% in 6- to 7-year-olds, 21.6% in 9- to 10-year-olds, and 18.8% in 12- to 13-year-olds. The prevalence of “AD diagnosis, ever” in 6- to 7-year-olds rose from 20.9% in 1995 to 35.4% in 2010, then dropped to 13.6% in 2022 (P < 0.001), while in 12- to 13-year-olds, it increased from 7.1% in 1995 to 23.7% in 2010, then declined to 17.5% in 2022 (P < 0.001). In 6- to 7-year-olds, the prevalence of “AD only” and “AD and asthma” decreased between 1995 and 2022 (all P < 0.001). In 12- to 13-year-olds, the prevalence of “AD only,” “AD and rhinitis,” and “AD and asthma and rhinitis” all increased during the same period (all P < 0.001).

CONCLUSIONS: The prevalence of AD decreased in Korean children aged 6-7 years and increased in those aged 12-13 years, respectively, between 1995 and 2022, with a concomitant rise in allergic comorbidities among adolescents, suggesting age-dependent trends influenced by diverse AD phenotypes.

PMID:40736778 | DOI:10.4168/aair.2025.17.4.505

Biometrics. 2025 Jul 3;81(3):ujaf086. doi: 10.1093/biomtc/ujaf086.

ABSTRACT

Easy-to-interpret effect estimands are highly desirable in survival analysis. In the competing risks framework, one good candidate is the restricted mean time lost (RMTL). It is defined as the area under the cumulative incidence function up to a prespecified time point and, thus, it summarizes the cumulative incidence function into a meaningful estimand. While existing RMTL-based tests are limited to 2-sample comparisons and mostly to 2 event types, we aim to develop general contrast tests for factorial designs and an arbitrary number of event types based on a Wald-type test statistic. Furthermore, we avoid the often-made, rather restrictive continuity assumption on the event time distribution. This allows for ties in the data, which often occur in practical applications, for example, when event times are measured in whole days. In addition, we develop more reliable tests for RMTL comparisons that are based on a permutation approach to improve the small sample performance. In a second step, multiple tests for RMTL comparisons are developed to test several null hypotheses simultaneously. Here, we incorporate the asymptotically exact dependence structure between the local test statistics to gain more power. The small sample performance of the proposed testing procedures is analyzed in simulations and finally illustrated by analyzing a real-data example about leukemia patients who underwent bone marrow transplantation.

PMID:40736766 | DOI:10.1093/biomtc/ujaf086

Biometrics. 2025 Jul 3;81(3):ujaf094. doi: 10.1093/biomtc/ujaf094.

ABSTRACT

Investigators often focus on predicting extreme random effects from mixed effects models fitted to longitudinal or clustered data, and on identifying or “flagging” outliers such as poorly performing hospitals or rapidly deteriorating patients. Our recent work with Gaussian outcomes showed that weighted prediction methods can substantially reduce mean square error of prediction for extremes and substantially increase correct flagging rates compared to previous methods, while controlling the incorrect flagging rates. This paper extends the weighted prediction methods to non-Gaussian outcomes such as binary and count data. Closed-form expressions for predicted random effects and probabilities of correct and incorrect flagging are not available for the usual non-Gaussian outcomes, and the computational challenges are substantial. Therefore, our results include the development of theory to support algorithms that tune predictors that we call “self-calibrated” (which control the incorrect flagging rate using very simple flagging rules) and innovative numerical methods to calculate weighted predictors as well as to evaluate their performance. Comprehensive numerical evaluations show that the novel weighted predictors for non-Gaussian outcomes have substantially lower mean square error of prediction at the extremes and considerably higher correct flagging rates than previously proposed methods, while controlling the incorrect flagging rates. We illustrate our new methods using data on emergency room readmissions for children with asthma.

PMID:40736765 | DOI:10.1093/biomtc/ujaf094

Tech Coloproctol. 2025 Jul 30;29(1):154. doi: 10.1007/s10151-025-03196-2.

ABSTRACT

AIM: This study aimed to assess whether early closure of loop ileostomy reduces the rate of postoperative complications related to ileostomy closure and improves patients’ quality of life, as measured by the Low Anterior Resection Syndrome (LARS) and Wexner questionnaires.

METHODS: All patients who underwent low anterior resection + ileostomy with subsequent reversal between January 2019 and May 2023 were included in the study. Patients were divided into two groups: early (< 3 months) and late closure (> 3 months). There were 46 (43%) patients in the early closure group and 61 (57%) in late closure. In this study, patients’ demographics and complication rate (categorised by severity using the Clavien-Dindo scale) were assessed.

RESULTS: We assessed and contacted 180 patients. Of these, 107 (59%) completed the LARS and Wexner questionnaires. Of the 107 patients, 51 were male (47.7%) and 56 female (52.3%). The time to ileostomy closure ranged between 0.5 and 28 months, with a median of 5. In the early and late closure groups, postoperative complications were observed in 4.3% vs. 14.8% (p = 0.08) of patients and postoperative ileus occurred in 6.5% vs. 4.9% (p = 0.72) of patients respectively. Median LARS score was 25 vs. 20 (p = 0.99) and Wexner’s 2.5 vs. 2 (p = 0.82), respectively. The previously discussed indicators (postoperative ileostomy complications, postoperative ileus rate, LARS and Wexner scores) were not statistically significantly different.

CONCLUSION: In our small retrospective study, early ileostomy closure did not affect postoperative complications related to ileostomy closure and bowel dysfunction rates compared to late closure.

TRIAL REGISTRATION: This study was a secondary analysis of the prospective trial registered at ClinicalTrials.gov no. NCT03607370, 01.07.2017.

PMID:40736758 | DOI:10.1007/s10151-025-03196-2

Environ Monit Assess. 2025 Jul 30;197(8):968. doi: 10.1007/s10661-025-14372-0.

ABSTRACT

Zichuan District is a selenium (Se)-rich area discovered in Shandong Province. This study analyzed the source of soil Se in the eastern area of Zichuan District with using multivariate statistical analysis methods and considering the contribution of exogenous input for the first time. Additionally, the environmental quality of soil was evaluated using single factor index methods and comprehensive evaluation methods. Finally, the safety of crops and the health risks of human ingestion were assessed. The results showed that: the background value of Se in the study area was 0.43 mg/kg, significantly higher than that in Shandong Province and Chinese soil (Layer A). The F1 of R-type factor analysis revealed that the black sedimentary parent material was the material basis and initial source of soil Se enrichment, while pedogenic geochemical processes and the properties of Se contribute to the continuous accumulation of soil Se, but the exogenous input was low. Cd, Hg, and Pb exhibited the most severe pollution levels in soils. Most soils in the area were none or slightly polluted, but a small portion showed moderate or intense pollution. The MPI of 45 wheat grains was all below 1, confirming the absence of heavy metal (HM) contamination. However, the Hazard Index (HI) of HMs in 3 out of the 45 wheat grains was greater than 1, indicating potential health risks from ingestion. In contrast, the Hazard Quotient (HQ) of Se in crops was all less than 1, suggesting no harm to human health.

PMID:40736754 | DOI:10.1007/s10661-025-14372-0

World J Urol. 2025 Jul 30;43(1):461. doi: 10.1007/s00345-025-05847-3.

ABSTRACT

OBJECTIVE: To discover the effectiveness of VR in improving patient understanding and enhancing the consent procedure for patients undergoing extracorporeal shockwave lithotripsy (SWL). The primary outcomes measured include patient knowledge, pain perception, and emotional well-being.

METHODS: For this prospective study (ERGO: 92019), patients with kidney stone disease (KSD) undergoing SWL were given a VR headset before their treatment. The VR glasses visually explained the SWL process (3 min) and its success and complications through an audio explanation linked to a 3D animation. The content followed the patient information leaflet (PIL) from European and British associations. Participants were provided with three questionnaires that covered pain, anxiety, and patient understanding of SWL via the VR enhanced consent (one questionnaire each).

RESULTS: 100 patients completed all three questionnaires. 68 patients reported an improved understanding of SWL with VR, and the overall improvement in patient understanding was statistically significant (p < 0.001). Participants also found the VR headset significantly more helpful and accessible and felt more confident explaining the procedure. 66 participants preferred VR to current teaching methods, and 81 firmly favoured using VR for future procedures. Findings also demonstrated a positive emotional impact, with participants reporting more positive and fewer negative emotions after VR use.

CONCLUSION: Our study showed that incorporating VR into the consent process effectively improves patient understanding and experience, with widespread approval. VR improved the psychological well-being of patients undergoing surgical procedures, highlighting the potential for VR to play a significant role in enhancing consent.

PMID:40736751 | DOI:10.1007/s00345-025-05847-3

JAMA Netw Open. 2025 Jul 1;8(7):e2523923. doi: 10.1001/jamanetworkopen.2025.23923.

ABSTRACT

IMPORTANCE: The lack of universally accepted definitions for safety net hospitals (SNHs) has made it difficult to effectively design policies to support these hospitals and the populations they serve.

OBJECTIVE: To evaluate the overlap, variation, and consistency across different definitions for SNH status.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used a hospital year-level dataset on short-term acute care US hospitals from 2014 to 2022. Hospital-level and area-level measures were used to define SNHs. Hospital characteristics under each definition, overlap across definitions, and stability of SNH samples produced by each definition from were described. Data analyses were performed from August 2024 to June 2025.

EXPOSURE: Nine hospital-level and 4 area-level SNH definitions.

MAIN OUTCOMES AND MEASURES: Hospital characteristics under each definition, overlap across definitions, and stability of SNH samples over time. Hospital-level definitions included Medicare Disproportionate Share Hospital (DSH) index, Medicare inpatient day share, dual-eligible or low-income subsidy (DLIS) inpatient day share, Medicaid inpatient day share, Medicare Safety-Net Index, teaching status, public ownership, uncompensated care share, and operating margins. Area-level measures included Area Deprivation Index, Social Vulnerability index, proportion Hispanic population, and proportion Black population. Safety net status was assigned based on quartiles defined nationally (or within a state for Medicaid-specific definitions). For a subset of measures, this quartile-based approach was compared between the absolute number of inpatient days attributed to each patient group and the relative number (or share) of inpatient days.

RESULTS: Among 4531 short-term acute care hospitals, between 992 (21.9%) and 1326 (29.3%) were SNHs in 2022, depending on definition. SNHs defined based on the absolute level of inpatient days or absolute level of DLIS populations were often large (51% [242 of 476] or 67% [537 of 801]) and were not often rural (9% [45 of 476] or 2% [17 of 801]). Meanwhile, SNHs defined based on relative level of Medicaid inpatient days or relative level of DLIS patients were more often small (63% [298 of 476] and 82% [660 of 801]) and rural (48% [228 of 476] and 69% [555 of 801]) hospitals. The largest overlap across definitions was between a hospital’s Medicaid inpatient day share and Medicare DSH index (55% overlap [808 of 1466 hospitals]), which tended to represent large, teaching hospitals. Public ownership, teaching status, and Medicare DSH index produced the most stable definitions of SNHs over time from 2014 to 2022, with 83% (862 of 1043), 74% (1000 of 1354), and 60% (809 of 1358) of similar hospitals, respectively, meeting safety net criteria. The least stable definitions were based on low operating margins, high uncompensated care share, and high DLIS day share, with only 15% (263 of 1796), 20% (362 of 1823), and 25% (436 of 1725) of similar hospitals, respectively, meeting safety net criteria in 2014, 2018, and 2022.

CONCLUSIONS AND RELEVANCE: In this cohort study of US hospitals, different SNH definitions produced different samples, and candidate measures had variable overlap and stability over time. These findings highlight the trade-offs when considering different options to define SNHs.

PMID:40736736 | DOI:10.1001/jamanetworkopen.2025.23923