Nevin Manimala

Nutr Clin Pract. 2025 Sep 7. doi: 10.1002/ncp.70022. Online ahead of print.

ABSTRACT

BACKGROUND: Esophagectomy causes anatomical changes that can lead to rapid food transit and reactive hypoglycemia (RH). Patients are advised on eating patterns postesophagectomy to prevent RH, but its true incidence and the impact of dietary recommendations remain under-researched.

MATERIALS AND METHODS: Individuals >12 months postesophagectomy were recruited from the National Centre for Oesophageal and Gastric Cancer at St James’s Hospital in Dublin, Ireland. Over 7 days, continuous glucose monitoring (CGM) captured glucose readings, with food and symptom diaries documenting dietary intake and symptoms. The nutrition composition of meals was calculated, and food diaries were coded for the following eating patterns: leaving >3 h between meals, simple sugars with meals, fluid with meals, and alcohol with meals. Data analysis compared eating patterns preceding asymptomatic and symptomatic RH events. In all cases, P < 0.05 was considered statistically significant.

RESULTS: Thirty-two participants completed the study, with 21,504 glucose readings and 1276 meals analyzed. CGM identified 226 meals (17.7%) followed by RH events, 19 of which were symptomatic. Meals associated with RH events were higher in carbohydrate (35.3 g vs 31.7 g; P = 0.036), fiber (4.11 g vs 3.15 g; P = 0.020), and sugar (12.65 g vs 10.96 g; P = 0.048). Leaving >3 h between meals and consuming alcohol with meals also increased RH risk. Nutrient composition and eating patterns did not differentiate symptomatic from asymptomatic RH events.

CONCLUSIONS: Total carbohydrate content and specific eating patterns appeared to significantly influence RH incidence, with most RH events being asymptomatic. CGM may serve as a useful adjunct to dietary interventions in the management of RH in patients postesophagectomy.

PMID:40914827 | DOI:10.1002/ncp.70022

Mol Nutr Food Res. 2025 Sep 7:e70252. doi: 10.1002/mnfr.70252. Online ahead of print.

ABSTRACT

The relationship between dietary biotin intake and cognitive function remains unclear. This study explores the association between biotin and dementia, and the mediating role of inflammation indicators. Dietary biotin intake was assessed via the 24-h recall questionnaire. Dementia outcomes were identified through “algorithmically defined outcomes,” identified through an algorithm integrating self-reports, hospital admissions, and death certificate records. Participants aged 40-69 with complete biotin and baseline data were included. During a 11.25-year median follow-up, 1256 incident dementia cases occurred among 122 959 participants. Cox proportional hazards models showed that compared to the lowest biotin intake (Q1), biotin reduced the risk of all-cause dementia (HR: 0.75[0.64,0.88] p < 0.001 for Q2; HR: 0.68[0.58,0.81] p < 0.001 for Q3; HR: 0.67[0.56,0.81] p < 0.001 for Q4) and Alzheimer’s disease (AD) (HR: 0.74[0.58,0.96] p = 0.026 for Q2; HR: 0.65[0.49,0.85] p = 0.002 for Q3). Restricted cubic splines (RCSs) revealed an “L-shaped” nonlinear relationship between biotin and all-cause dementia (p nonlinear < 0.001) and Alzheimer’s dementia (p nonlinear = 0.004) and exhibited the saturation effect. Multicategorical mediation analysis suggested that systemic immune-inflammation index (SII), a composite inflammatory marker calculated from platelet, neutrophil, and lymphocyte counts, mediated the association partially. Subgroup and sensitivity analyses confirmed stable results. Higher dietary biotin intake may reduce the risk of dementia.

PMID:40914826 | DOI:10.1002/mnfr.70252

JPEN J Parenter Enteral Nutr. 2025 Sep 7. doi: 10.1002/jpen.70010. Online ahead of print.

ABSTRACT

BACKGROUND: Intravenous lipid emulsions are a key component of parenteral nutrition, and their fatty acid compositions may influence immune responses and clinical outcomes.

METHODS: This retrospective cohort study conducted from January 2020 to December 2022 compared clinical outcomes of hospitalized non-critical care patients receiving parenteral nutrition with either mixed oil or soybean oil lipid emulsions for at least 48 h. The primary outcome was a composite of the presence of pneumonia, urinary tract infection, or an intra-abdominal collection diagnosed within 14 days of initiating parenteral nutrition. Secondary outcomes included catheter-related bloodstream infection, length of hospital stay, duration of antibiotic therapy, in-hospital mortality, and changes in the aspartate transaminase (AST)/alanine transaminase (ALT) ratio over time.

RESULTS: Among 266 patients (mixed oil lipid emulsion: n = 130; soybean oil lipid emulsion: n = 136) there was no statistically significant difference in all-cause infections (P = 0.21). In patients receiving lipid emulsions for >7 days, the use of mixed oil lipid emulsions was associated with a shorter median antibiotic duration (4 days: interquartile range [IQR] 1-8.5 vs 7 days: IQR 5-10; P = 0.04). Additionally, patients who received mixed oil emulsions for >7 days had a significantly greater change in the AST/alkaline phosphatase ratio after 14 days compared with the soybean oil group (β = -0.51; P = 0.02).

CONCLUSION: Although there was no difference in all-cause infections between types of lipid emulsions, mixed oil lipid emulsions were associated with shorter antibiotic use and lower AST/ALT ratio in hospitalized, non-critical care patients receiving parenteral nutrition for >7 days.

PMID:40914815 | DOI:10.1002/jpen.70010

World J Surg Oncol. 2025 Sep 6;23(1):334. doi: 10.1186/s12957-025-03981-1.

ABSTRACT

BACKGROUND: Inflammation impacts the prognosis of numerous types of tumors. Inflammatory indicators such as the neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and neutrophil-to-eosinophil ratio (NER) have emerged as potential prognostic markers and are closely correlated with the outcomes of cancer patients. However, the connection between NER and cancer prognosis remains incompletely understood. Therefore, we conducted a meta-analysis to investigate the potential of the inflammatory marker NER as a prognostic indicator in cancer patients.

METHODS: A thorough search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library, with a cutoff date of August 2024. Relevant data were extracted, and hazard ratios (HRs) and relative risks (RRs), along with their corresponding 95% confidence intervals (CIs), were calculated to assess the prognostic impact of the NER on overall survival (OS), progression-free survival (PFS), and the objective response rate (ORR). Stata version 18 statistical software was utilized for the meta-analysis of the literature that met the inclusion criteria.

RESULTS: Seven cohort studies encompassing a total of 1,336 cancer patients were included in this meta-analysis. These findings indicate that lower NER is associated with improved PFS in cancer patients. Additionally, in cancer patients undergoing immunotherapy, lower NER levels are linked to a better ORR. A lower NER is correlated with improved OS and ORR in patients with metastatic renal cancer who are receiving immunotherapy.

CONCLUSION: In cancer patients, elevated NER is associated with poorer PFS and ORR. Similarly, high NER levels in patients with metastatic renal cell carcinoma undergoing immunotherapy are linked to worse OS and ORR. The inflammatory marker NER, which serves as an efficacious prognostic indicator for cancer patients, offers profound insights into related cancers in the context of immunotherapy. In the future, high-quality prospective studies are warranted to corroborate these findings.

PMID:40914797 | DOI:10.1186/s12957-025-03981-1

J Cancer Educ. 2025 Sep 6. doi: 10.1007/s13187-025-02725-9. Online ahead of print.

ABSTRACT

Cholangiocarcinoma (CCA) remains a major public health concern in Thailand, particularly in areas endemic for Opisthorchis viverrini infection. During the period of 2020-2022, there was a rapid shift in public communication behaviors that created new opportunities to promote health education through diverse media channels. This study aimed to assess public awareness of CCA prevention and explore the feasibility of applying social marketing strategies during a time of health crisis. A cross-sectional survey of 150 participants was conducted in high-risk communities of Sisaket Province using multi-stage sampling. Data were collected using a validated questionnaire evaluating awareness of CCA prevention after exposure to five media types: broadcast, print, signage, personal (village health volunteers), and online media. Feasibility was assessed using a 16-item scale based on the 4P’s marketing mix framework: product, price, place, and promotion. Descriptive statistics were conducted. Participants demonstrated high awareness across all media types, especially through online media (Facebook, Line), print media, and public signage. The feasibility of implementing social marketing strategies for education was rated high overall (mean = 4.26, SD = 0.14), with strong agreement in knowledge transfer and community participation. These findings underscore the potential of using multi-channel media and marketing principles to enhance public education and promote preventive behaviors for CCA. Importantly, the results provide insight into how such strategies may be adapted for other emerging diseases, where rapid and widespread public engagement is critical. Social marketing represents a promising tool for cancer education of the public, particularly in low-resource settings and during times of public health disruption.

PMID:40914774 | DOI:10.1007/s13187-025-02725-9

Eur J Orthop Surg Traumatol. 2025 Sep 6;35(1):383. doi: 10.1007/s00590-025-04475-2.

ABSTRACT

INTRODUCTION: Accurate diagnosis of subscapularis tears remains challenging due to the limitations of physical examinations and imaging techniques. Therefore, specific radiological parameters have been proposed as predictors of atraumatic subscapularis tears to improve diagnostic sensitivity and accuracy. These parameters include coracohumeral distance (CHD), coracoglenoid angle (CGA), coracoid angle (CA), coracoid overlap (CO), and coracohumeral angle (CHA). However, well-accepted cutoff values are still lacking, and there is no consensus on its clinical usefulness.

MATERIALS AND METHODS: The PubMed, Scopus, and Cochrane Library databases were queried in July 2024. Inclusion criteria focused on studies that reported MRI-based radiological measurements of the coracoid process in patients with subscapularis tears versus controls. A meta-analysis was performed to evaluate outcomes, with data reported as raw mean difference (MD) and 95% confidence interval (CI).

RESULTS: Fourteen studies involving 1,692 patients with subscapularis tears and 1,648 controls were included. Significant findings include a smaller axial CHD in the subscapularis tear group compared to controls (MD, – 1.67; 95% CI, – 2.61 to – 0.72; P = 0.002). The sagittal CHD was also reduced in the tear group (MD, – 1.43; 95% CI, – 1.89 to – 0.98; P < 0.0001). The CGA was (MD, – 1.15; 95% CI, – 2.20 to – 0.10; P = 0.032), and the CA was also reduced (MD, – 18.63; 95% CI, – 35.60 to – 1.66; P = 0.042). The CO showed no significant difference between the tear and control groups (MD, 1.68; 95% CI, – 1.27 to 4.62; P = 0.21). In contrast, the CHA was increased in the tear group (MD, 3.71; 95% CI, 2.32-5.11; P < 0.01).

CONCLUSION: Several radiological parameters, including CA, CHA, CGA, and axial and sagittal CHD, demonstrated statistically significant differences between patients with and without atraumatic subscapularis tears. Among them, CHA appears to be the most promising due to its consistent association and low heterogeneity. However, substantial variability across studies and limited data for certain parameters underscore the need for further prospective research to validate their diagnostic value and establish standardized imaging protocols.

STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, III.

PMID:40914771 | DOI:10.1007/s00590-025-04475-2

Eur Radiol. 2025 Sep 6. doi: 10.1007/s00330-025-11643-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Establishing paediatric DRLs is challenging due to sparse data availability. The objective was to assess paediatric fluoroscopic dose levels in Dutch clinical practice, as current diagnostic reference levels (DRLs) need updating following the European Guidelines on DRLs for Paediatric Imaging (PiDRL).

MATERIAL AND METHODS: Air Kerma-area Product (KAP) values were retrospectively collected from paediatric patients (0-18 years) who underwent fluoroscopic procedures in nine Dutch hospitals between 01-01-2017 and 01-06-2021. The protocols included were: micturating cystourethrography (MCU), upper gastrointestinal (Upper GI) and lower gastrointestinal with contrast enema (Lower GI). In accordance with the PiDRL recommendations for sparse data, the 75th percentiles of the median KAP values per age group from each hospital were fitted using an exponential dose-age curve, resulting in an age-dependent DRL curve. DRL values were compared to Dutch, other European national and European DRLs.

RESULTS: A total of 971 examinations were included. For MCU, the proposed DRL curve was lower than the Dutch DRLs. The proposed DRL curve for Upper GI was also lower than the UK DRLs. No DRL curve could be established for Lower GI due to limited data.

CONCLUSIONS: Paediatric fluoroscopic dose levels in this study are substantially lower than the current Dutch DRLs, indicating the need for new national Dutch DRLs for MCU. This study proposes using a DRL dose-age curve to update Dutch paediatric DRLs. Using the proposed curve method, more DRLs could be established than with the conventional method. The proposed DRL curves might serve as input for updating Dutch paediatric DRLs.

KEY POINTS: Question Current Dutch diagnostic reference levels for paediatric fluoroscopy need updating, which is challenging due to sparse data availability. Findings Observed dose levels in this retrospective study indicate a potential decrease in Dutch diagnostic reference levels for paediatric fluoroscopy, using a dose-age curve method. Clinical relevance Updating Dutch paediatric fluoroscopic DRLs using a dose-age curve method allows for the establishment of DRLs in case of sparse data availability. This allows for further optimisation of radiation doses in the paediatric population.

PMID:40914762 | DOI:10.1007/s00330-025-11643-9

J Robot Surg. 2025 Sep 6;19(1):570. doi: 10.1007/s11701-025-02755-x.

ABSTRACT

A major cause of cancer death, colorectal cancer is becoming more common in younger people. The comparative effectiveness of robotic versus laparoscopic total mesorectal excision (TME) as surgical interventions for mid-low rectal cancer following neoadjuvant chemoradiotherapy (nCRT) remains uncertain. To systematically evaluate oncological, perioperative, and survival outcomes of robotic versus laparoscopic surgery for mid-low rectal cancer following nCRT. A PRISMA-compliant systematic review and meta-analysis included 20 non-randomized studies (13,212 patients) from Web of Science, PubMed, and Embase up to July 2025. Outcomes encompassed pathological completeness (circumferential resection margin, TME quality), perioperative metrics (operative duration, conversion rates), complications, and survival (5-year OS/DFS). Risk of bias was assessed via ROBINS-I; statistical synthesis utilized RevMan5.4 and hazard ratios derived from Kaplan-Meier curves. This meta-analysis of 20 non-randomized studies (13,212 patients) found no significant differences in 5-year overall survival (HR: 1.07, 95% CI 0.20-5.66, p = 0.94, I² = 98%) or disease-free survival (HR: 1.16, 95% CI 0.72-1.89, p = 0.54, I² = 0%) between robotic and laparoscopic TME after nCRT. Robotic surgery demonstrated superior technical outcomes, including higher rates of complete TME (OR: 1.97, p = 0.02) and reduced conversion to open surgery (OR: 0.46, p < 0.001), but required significantly longer operative time (WMD: + 42.09 min, p < 0.001). Perioperative metrics showed equivalence in intraoperative blood loss (p = 0.20), hospitalization duration (p = 0.78), and postoperative complications, including anastomotic leakage (5.4% vs. 6.5%, p = 0.28) and Clavien-Dindo III-IV events (OR: 1.11, p = 0.54). Pathological outcomes were comparable, with no differences in circumferential resection margin positivity (OR: 1.0, p = 1), distal margin length (p = 0.92), or lymph-node yield (p = 0.55). Local (OR: 0.85, p = 0.34) and distant recurrence rates (p = 0.99) were statistically indistinguishable. Risk-of-bias assessment revealed confounding risks in non-randomized designs, underscoring the need for RCT validation. Robotic and laparoscopic TME achieve equivalent long-term survival and oncological control after nCRT, with robotic advantages in technical precision counterbalanced by prolonged operative duration. The equivalence underscores nCRT’s dominant role in tumor control, while procedural differences highlight context-dependent surgical feasibility. High heterogeneity in survival data and reliance on non-randomized evidence necessitate validation through rigorously designed RCTs incorporating standardized protocols and patient-reported functional outcomes.

PMID:40914745 | DOI:10.1007/s11701-025-02755-x

Musculoskelet Surg. 2025 Sep 6. doi: 10.1007/s12306-025-00919-4. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2).

METHODS: This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis.

RESULTS: Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion.

CONCLUSION: Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.

PMID:40914742 | DOI:10.1007/s12306-025-00919-4

Mol Diagn Ther. 2025 Sep 6. doi: 10.1007/s40291-025-00814-5. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Sacituzumab govitecan, an anti-trophoblast cell surface antigen 2 (TROP2) antibody-drug conjugate, has been approved by both the US Food and Drug Administration and European Medicines Agency for patients with metastatic triple-negative breast cancer who have received two or more prior systemic therapies, including at least one of them for advanced disease. Although TROP2 evaluation is not required for patient selection, survival data from the ASCENT trial show improved response rates in patients with high TROP2 expression by immunohistochemistry. However, there is no standardized testing assay for these patients. This study evaluated the consistency of TROP2 expression analysis across different immunohistochemistry assays.

METHODS: Twenty-six triple-negative breast cancer samples were analyzed using three different immunohistochemistry assays on a Dako Omnis platform, according to manufacturer protocols. Specifically, ENZO-ABS380-0100 (assay A, used in ASCENT), Abcam SP295 (assay B, used in TROPiCS-02), and Santa Cruz B9-sc-376746 (assay C, used in cross-sectional studies). TROP2 expression on tumor cell membranes was quantified using the H-score, categorized as low (≤ 100), intermediate (> 101 to ≤ 200), and high (> 200). Assay agreement was evaluated using Cohen’s κ and Gwet’s AC2 statistics.

RESULTS: Assay A showed a broader range of TROP2 expression, with 57.7% of samples (n = 15) classified as low, 34.6% (n = 9) as intermediate, and 7.7% (n = 2) as high expressors. Assay B identified only n = 5 (19.2%) low expressors, n = 11 (42.3%) intermediate, and n = 10 (38.4%) high. While assay C identified n = 4 (15.4%) low expressors, n = 12 (46.2%) intermediate, and n = 10 (38.4%) high. Not surprisingly, assays B and C exhibited substantial agreement, with 80.8% of cases showing consistent results (κ = 0.81; p < 0.0001), indicating similar staining outcomes for TROP2 expression. The overall concordance between Assay A, B, and C was fair to moderate (AC2 = 0.35, p = 0.0067).

CONCLUSIONS: Our hypothesis-generating study highlights significant variability among TROP2 assays, suggesting differences in sensitivity and specificity for triple-negative breast cancer. We demonstrate that TROP2 expression is both heterogeneous and dynamic across samples and assays, highlighting the need for methodological improvements in testing. Future research integrating computational pathology with standardized immunohistochemistry protocols and quantitative scoring systems may enhance the clinical utility of TROP2 as a biomarker in triple-negative breast cancer.

PMID:40914741 | DOI:10.1007/s40291-025-00814-5