Nevin Manimala

Diabetes Technol Ther. 2025 Apr 21. doi: 10.1089/dia.2025.0064. Online ahead of print.

ABSTRACT

Background: Potatoes are a staple food, especially in pediatric populations, but they pose distinct challenges for individuals with type 1 diabetes (T1D). This study evaluated glycemic responses in youth with T1D using a second-generation automated insulin delivery system after consuming potatoes prepared by two methods: fried and boiled. Methods: The study was conducted during a 5-day school camp for unaccompanied youth with T1D, aged 11-17 years, who had been using the Tandem t:slim X2™ Control-IQ insulin pump for at least 6 months. On two separate days, participants consumed a standardized meal containing 240 g of either fried or boiled potatoes, considered as 38 g of carbohydrates. Continuous glucose monitoring (CGM) data were collected and analyzed for all participants. Results: Our study population consisted of 31 children and adolescents (mean age 14.2 ± 1.7 years). Time in range was slightly higher after consuming boiled potatoes compared with fried potatoes, though the difference was not statistically significant (73.7% vs. 67.8%; P = 0.225). Mean glucose changes from pre-meal to 3-h post-meal were comparable between groups (-34.3 vs. -25.4 mg/dL; P = 0.517). Similarly, no significant differences were observed in the area under the curve of glucose levels. However, the percentage of bolus insulin within the 3-h post-meal period tended to be higher after fried potato consumption (20.7% vs. 11.9%; P = 0.075). Conclusions: Despite differences in glycemic index and fat content, the Tandem t:slim X2 Control-IQ system effectively maintained satisfactory glucose control within the 3-h post-meal period for both fried and boiled potatoes.

PMID:40256802 | DOI:10.1089/dia.2025.0064

Dent Traumatol. 2025 Apr 21. doi: 10.1111/edt.13067. Online ahead of print.

ABSTRACT

This in vitro study aimed to evaluate the effect of isotonic sports drinks (Gatorade) on color variation and thickness of ethylene-vinyl acetate (EVA). White thermoformed EVA blocks (n = 60) were prepared and randomly allocated into five groups (n = 12): reverse osmosis water (G1-control, transparent/colorless), isotonic passion fruit flavor (G2-yellow drink), isotonic citrus flavor (G3-orange drink), isotonic strawberry with passion fruit flavor (G4-red drink), and isotonic grape flavor (G5-purple drink). The specimens were submerged in their respective liquids/drinks for each group and incubated at 37°C for 28 consecutive days. The liquids/drinks were replaced every 24 h. Color variation (ΔE_ab) and thickness (mm) were evaluated using a digital spectrophotometer and a digital micrometer, respectively, at baseline and after 7, 14, 21, and 28 days. ΔE_ab was calculated using the CIEL*a*b* system. Statistical analysis for both independent and dependent data was performed (α = 5%). Regarding color variation, G2 and G5 showed significant changes in ΔE_ab values after 21 and 28 days (p < 0.05), respectively. After 21 days, G2 became less clear and more pigmented towards the blue and red coordinates, with a reduction in L* (p < 0.001) and b* (p < 0.001), and an increase in a* (p < 0.001). After 28 days, G5 became pigmented towards the red and blue coordinates, with no significant change in L* (p > 0.05), but a reduction in b* (p = 0.021) and an increase in a* (p < 0.001). The thickness did not vary in relation to time or isotonic flavor/drink (p > 0.05). Isotonic drinks may cause changes in the color of EVA depending on the exposure time and the color of the isotonic drink consumed.

PMID:40256793 | DOI:10.1111/edt.13067

Breastfeed Med. 2025 Apr 21. doi: 10.1089/bfm.2024.0368. Online ahead of print.

ABSTRACT

Introduction: Breastfeeding provides substantial health benefits for both children and mothers; yet the U.S. rates remain suboptimal, with disparities shaped by structural, social, and policy factors. This study examines how the U.S. hospital maternity care practices influence breastfeeding initiation, with particular attention to their impact across different population groups. Methods: We analyzed cross-sectional county-level variations in hospital maternity care quality and breastfeeding initiation from 2017 to 2022 using data from the National Vital Statistics System and the Maternity Practices in Infant Nutrition and Care (mPINC) surveys. We employed a linear probability model to assess these relationships. Results: Higher county mPINC scores are significantly associated with increased breastfeeding initiation, with each additional point linked to a 0.10 percentage point (pp) increase (p < 0.001). This association varies by race/ethnicity. Each additional mPINC point corresponds to a 0.25 pp increase for non-Hispanic Black mothers (p < 0.001) and a 0.14 pp increase for non-Hispanic American Indian/Alaska Native mothers (p < 0.001), approximately three and two times higher, respectively, than the increase for non-Hispanic White mothers. The effect of better maternity practices also differs by county type, with a 0.08 pp increase in metro areas (p < 0.001) and a 0.17 pp increase in nonmetro areas (p < 0.001). Conclusions: Higher quality hospital maternity care practices are associated with increased breastfeeding initiation, particularly among population groups with historically lower breastfeeding rates. Enhancing maternity care policies and practices may help reduce long-standing breastfeeding disparities.

PMID:40256784 | DOI:10.1089/bfm.2024.0368

Front Bioeng Biotechnol. 2025 Apr 4;13:1491775. doi: 10.3389/fbioe.2025.1491775. eCollection 2025.

ABSTRACT

OBJECTIVE: To compare the clinical efficacy and screw placement accuracy of robot artificial intelligence (AI)-assisted percutaneous screw fixation and conventional C-arm-assisted percutaneous screw fixation (manual placement) in the treatment of thoracolumbar single-segment fractures without neurological symptoms.

METHODS: This study is a single-center retrospective analysis involving patients with thoracolumbar single-segment fractures without neurological symptoms. Patients were divided into Group A (robotic AI-assisted placement) and Group B (manual placement). Clinical outcomes such as operative time, intraoperative fluoroscopy frequency, screw placement accuracy, postoperative complications, length of hospital stay, and postoperative pain were compared between the two groups.

RESULTS: Group A showed significantly better screw placement accuracy, fewer intraoperative fluoroscopy attempts, shorter fluoroscopy time, and fewer guidewire adjustments compared to Group B (P < 0.05). Additionally, Group A had shorter hospital stays, a lower incidence of postoperative complications, and short-term greater improvement in Visual Analog Scale (VAS) scores (P < 0.05). However, after 1 year of follow-up, there was no statistically significant difference between the two groups in the improvement of VAS scores.

CONCLUSION: Robotic AI-assisted placement improves pedicle screw placement accuracy, reduces intraoperative fluoroscopy frequency and time, alleviates postoperative pain, and accelerates patient recovery. This approach aligns with the principles of enhanced recovery in orthopedic surgery and holds promise for wider clinical application in the treatment of thoracolumbar fractures.

PMID:40256780 | PMC:PMC12006081 | DOI:10.3389/fbioe.2025.1491775

Front Bioeng Biotechnol. 2025 Apr 4;13:1510642. doi: 10.3389/fbioe.2025.1510642. eCollection 2025.

ABSTRACT

BACKGROUND: Clinically relevant postoperative pancreatic fistula (CR-POPF) represents a significant complication after pancreaticoduodenectomy (PD). Therefore, the early prediction of CR-POPF is of paramount importance. Based on above, this study sought to develop a CR-POPF prediction model that amalgamates radiomics and clinical features to predict CR-POPF, utilizing Shapley Additive explanations (SHAP) for visualization.

METHODS: Extensive radiomics features were extracted from preoperative enhanced Computed Tomography (CT) images of patients scheduled for PD. Subsequently, feature selection was performed using Least Absolute Shrinkage and Selection Operator (Lasso) regression and random forest (RF) algorithm to select pertinent radiomics and clinical features. Last, 15 CR-POPF prediction models were developed using five distinct machine learning (ML) predictors, based on selected radiomics features, selected clinical features, and a combination of both. Model performance was compared using DeLong’s test for the area under the receiver operating characteristic curve (AUC) differences.

RESULTS: The CR-POPF prediction model based on the XGBoost predictor with the combination of the radiomics and clinical features selected by Lasso regression and RF exhibited superior performance among these 15 CR-POPF prediction models, achieving an accuracy of 0.85, an AUC of 0.93. DeLong’s test showed statistically significant differences (P < 0.05) when compared to the radiomics-only and clinical-only models, with recall of 0.63, precision of 0.65, and F1 score of 0.64.

CONCLUSION: The proposed CR-POPF prediction model based on the XGBoost predictor with the combination of the radiomics and clinical features selected by Lasso regression and RF can effectively predicting the CR-POPF and may provide strong support for early clinical management of CR-POPF.

PMID:40256777 | PMC:PMC12006764 | DOI:10.3389/fbioe.2025.1510642

EClinicalMedicine. 2025 Apr 10;83:103195. doi: 10.1016/j.eclinm.2025.103195. eCollection 2025 May.

ABSTRACT

BACKGROUND: The BALANCE trial demonstrated non-inferiority of 7 (vs 14) day antibiotic durations in patients with uncomplicated non-S. aureus/lugdunensis bacterial bloodstream infections (BSI). However, there may be patient subgroups who benefit from longer durations. We aimed to evaluate if bedside clinical decision rules could identify these subgroups.

METHODS: In this post-hoc analysis of the multicentre, randomised BALANCE trial (October 17, 2014-May 5, 2023), we applied three clinical decision rules to investigate heterogeneity of treatment effect in 7-day vs 14-day antibiotic durations on 90-day all-cause mortality. We used the rules to categorize patients in BALANCE into different risk groups and calculated the unadjusted absolute risk difference (RD) for 90-day mortality in patients receiving 7- vs 14-day antibiotics within each risk group. Statistical significance was tested using an interaction test. The BALANCE trial is registered with ClinicalTrials.gov (NCT03005145).

FINDINGS: 3581 patients were included. All three rules predicted mortality risk, but none identified statistically significant effect modification: (a) static rule (low-risk: RD -0.58, 95% CI -8.91 to 7.73; moderate-risk: RD -.01, 95% CI -3.86 to 1.83; high-risk: RD -2.65, 95% CI -7.12 to 1.81; p = 0.74); (b) dynamic rule (met rule on day 7: RD -2.18, 95% CI -4.81 to 0.45; did not meet rule: RD 1.75, 95% CI -3.89 to 7.40; p = 0.16); and (c) early clinical failure criteria (score<2: RD -2.38, 95% CI -5.0 to 0.23; score ≥2: RD -0.65, 95% CI -5.06 to 3.77; p = 0.24). Results were consistent across sensitivity analyses including imputation for missing data and restricting analyses to gram-negative BSI.

INTERPRETATION: The decision rules included in our analyses did not identify a subgroup of patients within BALANCE that would benefit from 14 (vs 7) days of treatment. 7-day treatment duration is sufficient for most patients with uncomplicated non-S. aureus/lugdunensis BSI. Future research could explore data-driven machine-learning approaches to identify comprehensive combinations of patient characteristics that may guide individualised duration of antibiotic therapy.

FUNDING: The BALANCE trial was funded by the Canadian Institutes of Health Research, Health Research Council of New Zealand, Australian National Medical Research Council, Physicians Services Incorporated Ontario and Ontario Ministry of Health and Long-term Care Innovation Fund. SWXO conducted this study as part of his PhD studies, with funding from: the Emerging & Pandemic Infections Consortium (University of Toronto, Canada); Connaught International Scholarship (University of Toronto, Canada); the Queen Elizabeth II Graduate Scholarship in Science and Technology (QEII-GSST; Government of Ontario, Canada); and the Melbourne Research Scholarship (University of Melbourne, Australia). VML is supported by Clinical Research Scholar-Junior 2 program (FRQ-S).

PMID:40256773 | PMC:PMC12008128 | DOI:10.1016/j.eclinm.2025.103195

EClinicalMedicine. 2025 Apr 9;83:103193. doi: 10.1016/j.eclinm.2025.103193. eCollection 2025 May.

ABSTRACT

BACKGROUND: Haematologic malignancies accounted for 6.6% of total cancer cases and 7.2% of total cancer-related deaths worldwide in 2022. We implemented a novel approach to estimate the lifetime risk of developing and dying from various types of haematologic malignancies at the global, regional and country-specific perspectives in 2022.

METHODS: We retrieved incidence and mortality rates for Hodgkin lymphoma (HL), Non-Hodgkin lymphoma (NHL), multiple myeloma (MM) and leukaemia from GLOBOCAN 2022 of 185 countries, along with the national population statistics and all-cause mortality data sourced from the United Nations. For trend analysis, we obtained consecutive cancer registry data spanning from 2003 to 2017 from the Cancer Incidence in Five Continents (CI5) Plus database. After quality control, datasets from 30 countries were included. We used the “adjusted for multiple primaries (AMP)” method to calculate the lifetime risk of incidence (LRI) and mortality (LRM) by cancer type, selected age interval, sex, country and geographic region.

FINDINGS: In 2022, the global lifetime risk of incidence (LRI) and mortality (LRM) for all haematologic malignancies was 1.67% and 0.98%, respectively. LRI was highest for NHL, whereas the LRM was highest for leukaemia. On a general level, males exhibited higher LRI and LRM compared to females. Both LRI and LRM increased with higher Human Development Index (HDI) levels. The LRI and LRM for haematologic malignancies were notably high in regions such as Australia/New Zealand, Northen America, as well as Northen, Western and Southern Europe, whereas they were comparatively low in Middle, Western and Eastern Africa. We observed about 5-fold regional disparity in the LRI/LRM ratio for HL, ranging from 1.50 in Middle Africa to 7.67 in Western Europe. Individuals aged 60 and above still faced 71.26% and 78.57% remaining risks for developing and dying from all haematologic malignancies. Among the 185 countries studied, NHL was the haematologic malignancy with the highest LRI in 68.65% of the countries. However, leukaemia had the highest LRM in 58.92% of these countries. MM exhibited the highest LRI and LRM particularly in islands surrounding the Caribbean Sea. Out of 30 countries with eligible consecutive cancer surveillance data, 24 exhibited significant upward trends in LRI of all haematologic malignancies, with AAPCs ranging from 0.5% in USA to 4.3% in Latvia. 25 countries showed significant upward trends in LRM, with AAPCs ranging from 1.0% in USA to 5.5% in Republic of Korea.

INTERPRETATION: The global lifetime risks of haematologic malignancies exhibit considerable variations across different world regions, necessitating country-specific and targeted decision-making strategies. In contrast to traditional indicators, the compositive lifetime risks provide intuitive measures with profound public health implications, offering fresh insights into the development of regional disease prevention and control strategies.

FUNDING: CAMS Innovation Funds for Medical Sciences (No. 2021-I2M-1-061, No. 2021-I2M-1-011).

PMID:40256772 | PMC:PMC12008131 | DOI:10.1016/j.eclinm.2025.103193

Cancer Manag Res. 2025 Apr 16;17:815-825. doi: 10.2147/CMAR.S503171. eCollection 2025.

ABSTRACT

BACKGROUND: Immunotherapy has demonstrated potential in the treatment of esophageal cancer (EC); however, the overall response rate (ORR) remains below 30% among EC patients. Herein, the use of peripheral blood lymphocyte subsets as biomarkers was explored to evaluate the efficacy of immunotherapy in this patient population.

METHODS: Sixty-three patients were enrolled. The patients were diagnosed with EC and treated with immune checkpoint inhibitors (ICIs) at The Fourth Hospital of Hebei Medical University from December 2019 to June 2023. Kaplan-Meier (KM) survival curves were used to reflect differences in survival benefit. The prognostic factors of survival were investigated using the Cox proportional hazards regression model for both univariate and multivariate analyses. Two-tailed P values were reported and statistical significance was defined as P < 0.05.

RESULTS: The results of univariate and multifactorial Cox regression analysis for progression-free survival (PFS) revealed that only CD8+ T lymphocytes demonstrated a significant association with PFS (P = 0.034, P = 0.020). Additionally, the multifactorial Cox regression analysis results for overall survival (OS) revealed a significant association between natural killer (NK) cells and OS (P=0.049). Further, a systematic analysis was conducted on the CD8+ T cell biomarker. The KM survival curves indicated that the group with low CD8+ T cell levels experienced a significantly greater PFS benefit compared to the high CD8+ T cell group (P = 0.030).

CONCLUSION: The present study reveals that the reduction of both CD8+ T lymphocytes and NK cells in peripheral blood lymphocyte subsets after immunotherapy can serve as superior predictors for the effectiveness of ICIs in patients diagnosed with EC.

PMID:40256769 | PMC:PMC12009565 | DOI:10.2147/CMAR.S503171

PeerJ. 2025 Apr 15;13:e19223. doi: 10.7717/peerj.19223. eCollection 2025.

ABSTRACT

BACKGROUND: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with poorly understood mechanisms. Variations in gut microbiota composition are observed in different IBS subtypes. Ginsenosides have shown potential in alleviating IBS symptoms, but their interactions with gut microbiota in different IBS subtypes are not well studied.

METHODS: In this study, we investigated the effects of ginsenosides on the gut microbiota of both healthy participants and participants suffering from IBS characterized by diarrhea (IBS-D) or constipation (IBS-C), using in vitro fermentation alongside 16S rRNA sequencing and bioinformatics analyses.

RESULTS: The analysis demonstrated that there were no statistically significant alterations in α- or β-diversity between the ginsenosides-treated and control groups across all models. However, the microbial composition assessment revealed the presence of 51 shared genera, with notable variations in composition and a significant enrichment of specific taxa. Specifically, the LEfSe analysis revealed that, following ginsenosides treatment, the healthy model groups exhibited significant enrichment of Stenotrophomonas and Achromobacter, while the IBS-D model groups demonstrated significant enrichment of Pseudomonas and Stenotrophomonas.

CONCLUSIONS: The results elucidate the distinctive microbial signatures associated with ginsenosides treatment across both healthy and IBS-D groups, underscoring the potential therapeutic efficacy of ginsenosides in modulating gut microbiota. This study highlights the necessity for further investigation into targeted microbiome therapies for IBS, which may facilitate the development of more personalized and efficacious treatment strategies for gastrointestinal health.

PMID:40256741 | PMC:PMC12007494 | DOI:10.7717/peerj.19223

PeerJ. 2025 Apr 17;13:e19280. doi: 10.7717/peerj.19280. eCollection 2025.

ABSTRACT

PURPOSE: This study aimed to assess the quality, reliability, content, and usefulness of YouTube videos related to anesthesia in geriatric and elderly patients.

METHODS: Using Google Trends, the most popular search terms in the past five years, “geriatric anesthesia” and “anesthesia in the elderly,” were identified. A search on YouTube using these terms initially yielded 200 of the most viewed videos for each term. After applying exclusion criteria, 87 videos were included for detailed analysis. Major themes and topics related to anesthesia in geriatric and elderly patients were identified using a pre-determined qualitative thematic analysis method. The usefulness of the videos was assessed using the specially developed Geriatric and Elderly Anesthesia Usefulness Score (GAEUS). The overall quality and reliability of the videos were evaluated using the Global Quality Scale (GQS) and the Modified DISCERN Scale (M-DISCERN), respectively. The average of the quality, reliability, and usefulness scores calculated by the researchers was used for consistency analysis.

RESULTS: In our study, 48.3% (42) of the videos on geriatric and elderly patients concerning anesthesia on YouTube were created by personal blogs. The quality of the videos was measured using the GQS, with a mean score of 3.34 and a median of 3 (range: 1-5), showing no significant difference according to the video source (p = 0.166). Reliability was assessed using the M-DISCERN scale, with a mean score of 3.37 and a median of 3.50 (range: 1-5), again showing no significant difference according to the video source (p = 0.097). Usefulness was measured using the GAEUS score, with a mean score of 15.30 and a median of 12.5 (range: 2-63), which showed a significant difference according to the video source (p = 0.000). The average duration of videos with low usefulness was 31.59 minutes (range: 5-44), while the average duration of moderately and highly useful videos was 59.37 minutes (range: 19.44-119.05). This duration difference was statistically significant (u = 2.569, p = 0.010).

CONCLUSION: In our study, we examined YouTube videos covering anesthesia topics for geriatric and elderly patients. The highest usefulness scores were obtained from personal blogs; however, all sources generally showed low usefulness. The quality of the videos was assessed using the GQS, and their reliability was evaluated with the M-DISCERN. On both scales, the videos showed moderate performance across all sources. These findings indicate a need for more comprehensive and informative content on YouTube, especially for the education of healthcare professionals and patients. To better address the needs of elderly patients, the richness of content and educational value of these videos should be enhanced.

PMID:40256732 | PMC:PMC12009561 | DOI:10.7717/peerj.19280