Nevin Manimala

Colorectal Dis. 2025 Aug;27(8):e70192. doi: 10.1111/codi.70192.

ABSTRACT

BACKGROUND: Extremes of body weight may be associated with poorer outcomes after colorectal surgery (CRS). We aimed to compare perioperative results and healthcare costs across the full range of body mass index (BMI) categories in an Asian cohort following CRS.

MATERIALS AND METHODS: This retrospective study was conducted using the American College of Surgeons – National Surgical Quality Improvement Programme (ACS-NSQIP) Participant Use Data File to identify patients ≥18 years old who underwent major elective CRS between January 2018 and December 2023. Both malignant and benign surgical indications were included. Emergency surgery was excluded. BMI was classified according to WHO Asian categories.

RESULTS: Over 72 months, 3169 patients (53.3% male), with a median age of 68.4 years, underwent elective CRS (83.4% for colorectal cancer). The median overall BMI was 23.2 (IQR 20.5-26.3) kg/m² with 351 (11.1%) underweight, 1168 (36.8%) normal weight, 566 (17.9%) overweight, 819 (25.8%) obesity class I and 265 (8.4%) obesity class II. Underweight BMI was independently associated with increased 30-day mortality (OR 2.54, 95% CI 1.01-6.41) and pneumonia (OR 1.89, 95% CI 1.03-3.40), while overweight BMI was independently associated with increased deep incisional surgical site infection (OR 3.31, 95% CI 1.18-9.97). The underweight group incurred the highest mean total cost per patient at $28,557.35, which was $4624.17 higher compared to the overall mean (p = 0.001).

CONCLUSION: Underweight BMI is independently associated with increased risks of early mortality and pneumonia following CRS in an Asian population, with greater healthcare costs incurred compared to patients in higher BMI categories.

PMID:40751348 | DOI:10.1111/codi.70192

HGG Adv. 2025 Jul 31:100487. doi: 10.1016/j.xhgg.2025.100487. Online ahead of print.

ABSTRACT

We developed an imputation panel for Alzheimer’s disease (AD) and related dementias (ADRD) using 15,958 whole-genome sequencing (WGS) samples from the Alzheimer’s Disease Sequencing Project (ADSP). Recognizing the importance of associations between structural variants (SVs) and AD, and their underrepresentation in existing public reference panels, our panel uniquely integrates single nucleotide variants (SNVs), short insertions and deletions (indels), and SVs. This panel enhances the imputation of rare variants underlying disease susceptibility onto genotype array data, offering a cost-effective alternative to whole-genome sequencing while significantly augmenting statistical power. Notably, we discovered 10 rare indels nominal significant related to AD that are absent in the TOPMed-r2 panel and identified one genome-wide significant (P < 5 x 10^-08) and three suggestive significant (P < 1 × 10^-05) AD-associated SVs. These findings provide the other insights into AD genetics and underscore the critical role of imputation panels in advancing our understanding of complex diseases like ADRD.

PMID:40751311 | DOI:10.1016/j.xhgg.2025.100487

J Clin Anesth. 2025 Jul 31;106:111946. doi: 10.1016/j.jclinane.2025.111946. Online ahead of print.

ABSTRACT

BACKGROUND: Annual professional practice evaluations (i.e., peer review) are mandatory for anesthesiologists in many practice settings. The de Oliveira Filho clinical anesthesia supervision instrument is a valid and psychometrically reliable tool suitable for these high-stakes assessments. We studied item-specific feedback to anesthesiologists to increase their scores.

METHODS: The retrospective cohort study used all 11 academic years for which the studied department used the supervision instrument, July 2013 through June 2024. There were 55,195 evaluations of 715 combinations of anesthesiologist and year by 242 rating trainees (e.g., anesthesia residents), each evaluation with 9-items scored 4=always, 3=frequently, 2=rarely, or 1=never.

RESULTS: The 9-item supervision instrument had Cronbach alpha 0.96 and functioned as a binary (4 vs ≤3) multivariate array. Consequently, the 87% (47,859/55,195) of evaluations with all 9 items 4=always, or all 9 items ≤3, provided information about the quality of performance of the anesthesiologists, but no potentially useful item-specific information for feedback to anesthesiologists. Cochran Q tests were performed for each of the 715 combinations of anesthesiologist and year using the remaining 7336 evaluations. There were 17% (124/715) of the combinations of anesthesiologist and year with adjusted P < 0.05, showing one or more of the items’ scores differed significantly from the other items’ scores. The 17% of combinations represented 6.0% (3311/55,195) of evaluations. For each of those 124 combinations of anesthesiologist and year, 36 McNemar tests were performed, comparing the 1st item to the 2nd, …, 8th item to 9th. Among those pairwise comparisons that were statistically significant, the directions of odds ratios were examined. The items about teaching quality accounted for 19% and 26% of the odds ratios <1 (i.e., low scores), respectively, while the other seven items each accounted for ≤5%.

CONCLUSIONS: Earlier it was known that anesthesiologists’ annual professional practice evaluations can be provided along with education regarding good teaching attributes associated with high quality intraoperative supervision and greater supervision scores. Our results show that also providing analyses of individual item scores could benefit, at most, <20% of the faculty anesthesiologists.

PMID:40749386 | DOI:10.1016/j.jclinane.2025.111946

Pediatr Neurol. 2025 Jul 9;171:21-27. doi: 10.1016/j.pediatrneurol.2025.07.003. Online ahead of print.

ABSTRACT

BACKGROUND: Tuberous sclerosis complex (TSC) is a genetic disorder that can cause multiorgan hamartomas. The brain is often affected by cortical tubers, subependymal nodules, and subependymal giant cell astrocytoma (SEGA). Consensus guidelines recommend frequent brain magnetic resonance imaging (MRI), in the pediatric population, to monitor for SEGA. This study compares the effectiveness of fast-sequence nonsedated limited MRI with standard MRI.

METHODS: Fifty-one patients with TSC had both MRIs. Two attending pediatric neuroradiologists measured subependymal lesions, lateral ventricle diameter, and changes in measurements compared with the most recent prior MRI.

RESULTS: Sixty-five percent of patients required sedation for standard MRI. The mean age was 8.7 years. There was no significant difference between radiologists in identifying SEGA or measuring lateral ventricle size, regardless of imaging type. However, Radiologist A measured subependymal lesions smaller than Radiologist B. There was a statistically significant difference in lesion measurement on the anteroposterior (AP) view, with an average 0.6 mm smaller (P = 0.028) on limited MRI compared with standard MRI. There was no significant difference in the transverse view measurement (P = 0.77) or lateral ventricle size (P = 0.57). Additionally, there was no significant difference in the percent change of subependymal lesions over time between the two imaging types (transverse view P = 0.95, AP view P = 0.52).

CONCLUSIONS: Limited MRI reduces health care costs, repetitive sedation, and MRI scanner time, overall requiring less hospital resources. Limited MRI is clinically similar in accuracy to standard MRI. Limited MRI should be incorporated in the assessment of SEGA in pediatric TSC.

PMID:40749383 | DOI:10.1016/j.pediatrneurol.2025.07.003

Eur J Radiol. 2025 Jul 28;191:112342. doi: 10.1016/j.ejrad.2025.112342. Online ahead of print.

ABSTRACT

PURPOSE: Computed tomography angiography (CTA) is a widely used diagnostic tool, but concerns about radiation exposure necessitate accurate dose estimation. This study investigates the correlation between Effective Dose (ED) and Size-Specific Dose Estimate (SSDE) estimated from the patient’s body mass index (BMI) in CTA to evaluate the utility of SSDE-BMI as a patient-specific dosimetry parameter.

METHODS: A retrospective analysis of 422 adult patients (226 males and 196 females) with an average age of 51.28 years undergoing Coronary Computed Tomography Angiography (CCTA) was conducted. Two values of ED were derived (ED103 and ED_DLP derived using the dose-length product (DLP) and ICRP conversion factors), while the two values of SSDE_BMI were calculated from the volume-computed tomography dose index (CTDIvol) and the patient’s BMI.

RESULTS: Overall, statistical analysis revealed a strong positive correlation between ED103 and SSDE_BMIs, significantly stronger than correlations between traditional metrics ED_DLP and SSDE_BMI. A highly significant correlation between these two dose indices was observed across various patients’ BMI and gender. The highest correlation was reported for Obese Class II female patients, which is attributed to proportional dose adjustments made to compensate for increased X-ray attenuation.

CONCLUSIONS: These findings underscore SSDEs’ importance in personalized radiation risk assessment and protocol optimization. This supports the use of SSDE_BMI as a reliable, patient-specific dose metric in radiation protection strategies for CCTA.

PMID:40749323 | DOI:10.1016/j.ejrad.2025.112342

Res Vet Sci. 2025 Jul 25;194:105814. doi: 10.1016/j.rvsc.2025.105814. Online ahead of print.

ABSTRACT

Equine endometritis is the primary reproductive pathology that causes significant economic losses due to subfertility, and Staphylococcus aureus (S. aureus) is one of the main infectious agents. Oxygen-ozone is a gas with high oxidative potential that promotes the destruction of bacterial cells, modulates inflammation, and induces a regenerative response, making it an adequate alternative treatment for endometritis. This study aimed to evaluate the antimicrobial and antibiofilm effects of the oxygen-ozone gas on microbial cultures of S. aureus. Closed ozonated systems were used in three experiments. The S. aureus cultures were then treated with the oxygen-ozone mixture by either bubbling the gas through the Tryptic Soy Broth with the bacteria or directly exposing the plates to the gas while testing different amounts and lengths of the exposure. In the first experiment, it was observed that the bactericidal effect on the planktonic state increased after 10 min, and showed a better result at 60 min. In experiment two a bactericidal effect with exposure for 10 min to concentrations of 19 and 41 μg/mL was observed. After exposure for 20 min, a concentration of 10 μg/mL was effective in killing the strain in the planktonic state. Antibiofilm effects were observed at concentrations of 19, 41, and 70 μg/mL. Therefore, it can be concluded that S. aureus showed sensitivity to oxygen-ozone gas, which also promoted an antibiofilm effect on the studied strain.

PMID:40749316 | DOI:10.1016/j.rvsc.2025.105814

J Environ Radioact. 2025 Jul 31;289:107769. doi: 10.1016/j.jenvrad.2025.107769. Online ahead of print.

ABSTRACT

The existing data gaps in the sorption and desorption parameters of naturally occurring radionuclides (e.g., radium (Ra)) challenge the use of radioecological risk assessment models. We present two alternatives for deriving Ra distribution coefficients (K_d (Ra)) in soils when the physicochemical information on the solid and liquid phases involved is too scarce to apply parametric prediction models: the deduction of sorption parameters from those of chemical analogues (such as Ba and Sr) and the proposal of best estimate K_d (Ra) values deduced from probabilistic distribution functions of data grouped according to relevant factors affecting K_d (Ra) variability. Regarding the use of chemical analogues, partial least squares regression analysis and univariate linear correlations revealed that Ba and Ra sorption in soils was governed by the same soil properties (K_d (Ca + Mg) and Mn_am), related to exchangeable sites on the soil surface. The derivation of K_d (Ra) values from K_d (Ba) and also K_d (Sr) is feasible by applying suitable correction factors. Furthermore, several K_d (Ra) best estimates were derived from the distribution functions of K_d (Ra) datasets obtained from own and literature data. Statistical differences were noticed for the sorption and desorption datasets (the latter significantly affected by data from native Ra), leading to the proposal of distinct K_d (Ra) values (870 and 2760 L kg^-1, respectively) for uptake and remobilisation scenarios. Regarding the desorption data, diverse K_d (Ra) best estimates were suggested for acidic (1540 L kg^-1) and alkaline (6440 L kg^-1) soils. For the sorption data, statistically different K_d (Ra) best estimates were suggested according to pH (100 and 1240 L kg^-1 for pH < 4.5 and pH ≥ 7, respectively) and water-soluble Ca + Mg content, allowing for the selection of the most appropriate best estimate values for use in risk assessment models depending on the available information.

PMID:40749306 | DOI:10.1016/j.jenvrad.2025.107769

Med Image Anal. 2025 Jul 25;105:103741. doi: 10.1016/j.media.2025.103741. Online ahead of print.

ABSTRACT

The performance of a well-trained segmentation model is often trapped by domain shift caused by acquisition variance. Existing efforts are devoted to expanding the diversity of single-source samples, as well as learning domain-invariant representations. Essentially, they are still modeling the statistical dependence between sample-label pairs to achieve a superficial portrayal of reality. On the contrary, we propose a Spectrum Intervention based Invariant Causal Representation Learning (SI²CRL) framework, to unify the data generation and representation learning from causal view. Specifically, for the data generation, the unknown object elements can be reified in frequency domain as phase variables, then we propose an amplitude-based intervention module to generate low-frequency perturbations via random-weighted multilayer convolutional network. For the causal representations, a two-stage causal synergy modeling process is proposed to derive unobservable causal factors. In the first stage, the style-sensitive non-causal factors lying in the shallow layer of encoder are filtered out by contrastive-based causal decoupling mechanism. In the second stage, the hierarchical features in decoder are first factorized with cross-covariance regularization to ensure channel-wise independence; Subsequently, we introduce an adversarial-based causal purification module, which encourages the decoder to iteratively update causally sufficient information and make domain-robust predictions. We evaluate our SI²CRL against the state-of-the-art methods on cross-site prostate MRI segmentation, cross-modality (CT-MRI) abdominal multi-organ segmentation, and cross-sequence (MRI) cardiac segmentation. Our approach achieves consistent performance gains compared to these peer methods.

PMID:40749275 | DOI:10.1016/j.media.2025.103741

Accid Anal Prev. 2025 Jul 30;220:108172. doi: 10.1016/j.aap.2025.108172. Online ahead of print.

ABSTRACT

OBJECTIVES: Higher age is often seen as a key factor in the decline of driving skills. Moreover, there is some evidence that overestimation is related to both higher age and poorer on-road performance in older drivers. However, it is unknown how the extent of overestimation or underestimation affects on-road driving performance beyond age.

METHODS: 112 older drivers with and without mild cognitive impairment participated in this prospective on-road study. All participants underwent a standardized on-road driving assessment, neuropsychological testing, collection of driving-related data and different self-assessments. Statistical analyses included a hierarchical regression analysis to predict on-road driving performance by adding age and sex in the first step and the validity of self-assessment (VSA) in the second step. Correlation analyses focused on the association between VSA and cognitive and driving-related behavioral factors.

RESULTS: Results revealed that the combination of age and sex significantly predicted on-road driving skills (R²_adjusted = 0.320). The inclusion of VSA led to a significant increase of explained variance in the criterion (R²_adjusted = 0.639). Moreover, the degree of overestimation correlated with higher age, lower cognitive performance and more risky driving behavior.

DISCUSSION: Our results highlight the importance of the VSA for on-road driving performance beyond the effects of age and sex. Moreover, the VSA appears to decrease towards overestimation with increasing age and decreasing cognition and should thus be a focus of safety research.

PMID:40749272 | DOI:10.1016/j.aap.2025.108172

ESMO Open. 2025 Jul 31;10(8):105516. doi: 10.1016/j.esmoop.2025.105516. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies showed that in mismatch repair-deficient (dMMR)/microsatellite instability (MSI) nonmetastatic colon cancer (CC), neoadjuvant immune checkpoint inhibitors (ICIs) were associated with exceptional rates of pathological major response (pMR) and complete response (pCR). Patients included in these trials, however, were highly selected, and real-life data are now needed to better evaluate the efficacy and tolerability of neoadjuvant ICIs in routine clinical practice.

PATIENTS AND METHODS: This retrospective observational study aimed to describe the clinical practices regarding ICIs in the neoadjuvant setting for patients with dMMR/MSI nonmetastatic CC, and to evaluate their efficacy and safety in real-world conditions. Patients receiving ICIs as part of a therapeutic trial were excluded.

RESULTS: Between 2019 and 2024, 32 patients were included across six French centers [median age 70 years (range 51-76 years), Lynch syndrome 31%]. Twenty-four patients had right-sided CC (85%), including three (9%) with two primary tumor locations. Ten patients (31%) received ipilimumab + nivolumab (NICHE regimen), while 22 (69%) were treated with pembrolizumab monotherapy. Grade ≥3 toxicities were observed in six patients (19%), including one toxic death and three toxicities (9%) leading to treatment discontinuation (one rheumatoid polyarthritis-like syndrome and two tumor fistulizations). Three patients developed bowel obstruction while receiving ICIs, two of whom underwent surgery showing pCR and pMR. Thirty patients were resected and 33 tumors were analyzed histologically with pMR in 21 cases (64%) including pCR in 14 cases (42%). The presence of an independent-cells contingent was statistically associated with poor pathological response.

CONCLUSIONS: This retrospective real-world study confirms the excellent results of neoadjuvant ICIs in dMMR/MSI nonmetastatic CC patients. pMR and pCR rates were, however, lower than those published in previous studies (64% and 42%, respectively), with higher rates of grade ≥3 toxicity, including one potential toxic death and three treatment discontinuations.

PMID:40749247 | DOI:10.1016/j.esmoop.2025.105516