Nevin Manimala

Radiat Oncol. 2025 Jun 7;20(1):98. doi: 10.1186/s13014-025-02670-3.

ABSTRACT

BACKGROUND: The integration of magnetic resonance imaging with linear accelerators (Linacs) enhances adaptive radiotherapy by providing real-time imaging for improved treatment precision. However, the long-term performance of MR-Linac systems, particularly in clinical settings, remains insufficiently studied. Traditional quality assurance (QA) methods, relying on binary pass/fail criteria, may overlook critical system variations. This study applies statistical process control (SPC) techniques to evaluate the long-term performance of a 1.5T MR-Linac, focusing on optimization in beam quality, MR-to-MV alignment, MR imaging, and geometric distortion.

METHODS: A dual-phase SPC framework was applied to 1 year of daily and weekly QA data from an Elekta Unity MR-Linac. Phase I established performance benchmarks, while Phase II monitored deviations online. Evaluated parameters included beam output, symmetry, MR-to-MV alignment, signal-to-noise ratio (SNR), spatial linearity, slice profile, and geometric distortion across spherical volumes (DSVs). Stability and variability were quantified using control charts and process performance indices (Ppk).

RESULTS: Beam quality was stable overall (Ppk ≥ 1.33), though output dose and transverse symmetry showed increased variability in Phase II, with dose Ppk declining from 3.13 to 1.33. MR-to-MV alignment was consistent, but Phi rotational and Z translational offsets showed variability after system upgrades. Imaging metrics, including SNR and spatial linearity, achieved A + performance (Ppk ≥ 1.67) in Phase II, while vertical spatial resolution was lower (Ppk 1.04-1.10). Geometric distortion was well-controlled, though larger DSVs (≥ 500 mm) showed increased AP-axis distortion (2.44 mm) compared to RL (1.37 mm) and FH (0.93 mm).

CONCLUSIONS: SPC techniques dynamically identified stable parameters and areas for improvement. Key recommendations include enhanced alignment protocols for beam quality and MR-to-MV offsets, as well as targeted strategies to address geometric distortion in larger volumes and along the AP axis.

PMID:40483491 | DOI:10.1186/s13014-025-02670-3

BMC Emerg Med. 2025 Jun 7;25(1):92. doi: 10.1186/s12873-025-01252-6.

ABSTRACT

BACKGROUND: Ketamine is one of the most used drugs in trauma patients after skiing accidents. However, the environmental conditions for these patients are often rough, with numerous unpleasant sensory impressions (e.g. noise from the helicopter, cold, wind, etc.), raising concerns about the adverse psychological side effects of ketamine. Moreover, it has not yet been established whether these side effects are dose-dependent, and the supplementary administration of benzodiazepines remains controversial. We analysed the subjective perception of side effects after administration of ketamine during helicopter emergency medical service missions involving trauma patients after ski accidents.

METHODS: In this retrospective observational study, data was collected from emergency services protocols and questionnaires filled out by patients. The primary outcome was defined as the patients’ subjective perceptions of ketamine-associated side effects. The subjective intensity of twelve common classes of side effects was recorded on a five-point Likert scale. In addition, we conducted a linear regression analysis, with side effect intensity as the outcome and gender, age, type of injury, use of midazolam and fentanyl, ketamine dosage and relative pain reduction as covariates.

RESULTS: A total of 69 patients were identified who were treated with ketamine during the winter months of 2023/2024, after suffering trauma while doing alpine winter sports. Of these, 49 patients (71%) could be included. The side effects reported were mostly mild, with two-thirds of the patients describing them as “no [side effects]” or “mild”. Only 6% described them as “barely tolerable” or “unbearable”. No statistically significant association could be demonstrated between the ketamine dose and the total reported side effect score. The regression model identified the additional administration of midazolam as a significant covariate for fewer side effects. With regard to prehospital care, 85% of the patients stated that they had always felt safe, while two-thirds were satisfied with the prehospital pain therapy.

CONCLUSION: Ketamine seems to be a suitable option for pain therapy in the case of injuries during alpine winter sport activities. Side effects reported by patients in this study were rare, not dose-dependent and described by most patients as subjectively well tolerable. The supplementary administration of midazolam could potentially further reduce these side effects.

PMID:40483480 | DOI:10.1186/s12873-025-01252-6

Lipids Health Dis. 2025 Jun 7;24(1):205. doi: 10.1186/s12944-025-02632-4.

ABSTRACT

BACKGROUND: The role of high-density lipoprotein cholesterol (HDL-C) in diabetic kidney disease (DKD) remains controversial. This study aimed to delineate the subgroup-specific relationships between the two by exploring cumulative and threshold effects.

METHODS: 3,040 patients with type 2 diabetes and no baseline evidence of DKD were included. Cox proportional hazards regression models were performed to investigate the potential relationship between HDL-C level and DKD risk. To address subgroup heterogeneity, sex-stratified restricted cubic splines (RCS) were employed to model nonlinear relationships. The optimal threshold was identified through the maximum selected statistics and validated via 1,000 bootstrap iterations. Subgroup analyses stratified by sex, diabetes duration, and metabolic status were performed to evaluate heterogeneity. Survival analysis using Kaplan-Meier curves further validated these threshold effects.

RESULTS: During a median follow-up of 3.13 years, 665 subjects (21.9%) progressed to DKD. Overall, each 1 mmol/L increase in HDL-C level independently reduced DKD risk by 43%. RCS analysis demonstrated an inverse correlation between HDL-C and DKD risk (P for overall = 0.025, P for nonlinear = 0.317), with increased risk reduction at lower concentrations, plateauing at higher levels. A robust threshold of 0.93 mmol/L was identified, showing significantly stronger protection against DKD progression (hazard ratio (HR) = 0.69, P < 0.001) compared to the traditional cutoff (HR = 0.86, P = 0.109). Females showed continuous protection (HR = 0.41, P = 0.009) without threshold dependency. The male and diabetes duration < 10 years subgroups exhibited threshold effects at > 0.93 mmol/L without continuous protection. The metabolically unstable (hypertension, poorly controlled glycemia, body mass index (BMI) > 28 kg/m²) and BMI < 24 kg/m² subgroups displayed dual effects (P < 0.05). Survival analysis confirmed lower cumulative DKD incidence with HDL-C > 0.93 mmol/L (P = 0.007).

CONCLUSIONS: This study reveals sex- and metabolic context-dependent heterogeneity in HDL-C-DKD associations: males and short-duration diabetes exhibited threshold effects (0.93 mmol/L), females showed continuous protection, and subgroups with hypertension, poorly controlled glycemia, or obesity (BMI > 28 kg/m²) exhibited both continuous protection and threshold effects. These findings may inform individualized risk stratification in specific populations.

PMID:40483478 | DOI:10.1186/s12944-025-02632-4

Popul Health Metr. 2025 Jun 7;23(1):23. doi: 10.1186/s12963-025-00383-z.

ABSTRACT

BACKGROUND: The evolution of family structures in China has led to changes in the living arrangements of older adults, resulting in an increasing prevalence of individuals living alone. This shift has raised concerns about the impact on the well-being of older adults, particularly in relation to loneliness. The objective of this study is to examine the association between living alone and lonely life expectancy (LLE) among older adults, with particular attention to gender differences.

METHODS: This study analyzed data from 9664 individuals aged 65-105, drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2008, 2011, 2014, and 2018. A multistate life table approach, coupled with interpolation Markov Chain methods using IMaCh software (version 0.99r43), was employed to estimate age-specific transition probabilities, life expectancy (LE), lonely life expectancy (LLE), and the proportion of LLE to LE (LLE/LE). The analysis was stratified by gender and living arrangements, distinguishing between individuals living alone and those not living alone.

RESULTS: The study identified several key findings. First, while LE has increased among older adults in China, they continue to experience a substantial duration of LLE. Second, older adults living alone experienced both longer LLE and higher LLE/LE ratios. Specifically, the LLE/LE among individuals not living alone was 13.61% higher for males and 15.18% higher for females compared to those living alone. Third, among females living alone, the LLE/LE was the highest, reaching 39.48% at age 65, compared to just 20.96% for males not living alone.

CONCLUSIONS: Tackling persistent loneliness is essential for enhancing the quality of life among older adults, highlighting the need to integrate mental well-being into social welfare policies. As China’s population ages and family structures continue to evolve, living arrangements emerge as crucial policy indicators. Prioritizing the mental health of older adults, particularly women living alone, is critical for the development of effective social security policies.

PMID:40483472 | DOI:10.1186/s12963-025-00383-z

BMC Musculoskelet Disord. 2025 Jun 7;26(1):569. doi: 10.1186/s12891-025-08801-x.

ABSTRACT

OBJECTIVE: The present study assessed and synthesized the potential risk factors for perioperative blood transfusion in total hip arthroplasty from various studies through Meta-analysis.

METHODS: We systematically searched for relevant studies in databases including Web of Science, PubMed, Embase, and Cochrane Library from the time of database creation to 1 February 2025 and included all observational studies exploring perioperative transfusion risk factors in patients undergoing total hip arthroplasty. All included studies were assessed for quality using the Newcastle-Ottawa Scale (NOS) scale. Data were analyzed using Stata 15 software.

RESULTS: A total of 18 articles (n = 424,158) were included, meta-analysis results suggest that increased intraoperative bleeding [OR = 1.13, 95%CI (1.02, 1.24)], increased postoperative drainage [OR = 2.24, 95%CI (1.24, 4.83)], body mass index ≤ 18.5 [OR = 1.10, 95%CI (1.02, 1.20)], preoperative anemia [OR = 1.82, 95%CI (1.62, 2.03)], age ≥ 80 [OR = 1.49 95%CI(1.21, 1.83)], female [OR = 1.92, 95%CI (1.71, 2.15)], ASA class ≥ 3 [OR = 2.06, 95%CI (1.63, 2.61)] in patients with total hip arthroplasty (THA) increases the incidence of perioperative blood transfusion.

CONCLUSION: The results of the current study suggest that increased intraoperative bleeding, increased postoperative drainage, low body mass index (≤ 18.5), preoperative anemia, advanced age (≥ 80 years), female gender, and high ASA classification (≥ 3) were significantly associated with the likelihood of needing blood transfusion. These findings highlight the importance of preoperative risk assessment and perioperative management strategies to reduce the need for blood transfusion and improve patient outcomes.

PMID:40483471 | DOI:10.1186/s12891-025-08801-x

BMC Pulm Med. 2025 Jun 7;25(1):284. doi: 10.1186/s12890-025-03737-3.

ABSTRACT

BACKGROUND: Non-invasive ventilation (NIV) is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). While studies have demonstrated benefits for mortality, hospitalization rates, and health related quality of life (HRQL), evidence is particularly sparse regarding HRQL determinants in the older population.

METHODS: In a prospective, monocentric observational study, HRQL was assessed using the established Severe Respiratory Insufficiency Questionnaire (SRI). The study was prospectively registered in the German Clinical Trials Register on 17 June 2015 under the registration number DRKS00008759. Patients were categorized into two age-based groups: older patients (≥ 65 years) and younger patients (< 65 years). Multiple linear regression analyses were used to analyze factors on HRQL, including SRI scores, anemia, autonomy impairment, exacerbation history and other factors.

RESULTS: 237 Patients with COPD with CHRF receiving NIV therapy were included. The mean SRI summary score was 49.9 ± 16.8. with 23.2% (N = 55) suffering from anemia and 36.7% (N = 87) experiencing ≥ 2 exacerbations annually. Autonomy impairment was observed in 49.4% (N = 117) of patients. The updated Charlson Comorbidity Index (uCCI) was 2.2 ± 1.86. No significant differences were found in SRI Summary Scale scores between age groups (p = 0.581), but notable disparities were present in the uCCI (p = 0.014). Multiple regression analysis revealed a negative association of exacerbation history (Young group: -9.2; 95% CI = -14.8/ -3.55 vs. Older group: -6.17; 95% CI = -11.91/ -0.43) and level of autonomy impairment (e.g. Level of Care 2 Young group: -13.91; 95% CI = -21.4/ -6.43 vs. Older group: -14.94; 95% CI = -22.64/ -7.24) on SRI scores with age-related differences. Anemia only had a negative association on the SRI scores in younger patients with COPD (Young group: -7.9; 95% CI = -14.0/ -1.75 vs. Older group: -1.78; 95% CI = -9.21/ 5.65).

DISCUSSION: Frequent exacerbations and a higher level of autonomy impairment had a negative association on HRQL across all ages. However only higher levels of impairment (≥ 2) have a detrimental impact on older patients. Anemia was a negative HRQL factor in younger patients, where it was more prevalent. Overall, HRQL was found to be comparably favorable in both older and younger patients, despite age-specific differences in influencing factors.

REGISTRATION OF THE CLINICAL TRIAL: The study from which the data were analyzed was prospectively registered in the German Clinical Trials Register (DRKS00008759) on June 17, 2015.

PMID:40483464 | DOI:10.1186/s12890-025-03737-3

BMC Palliat Care. 2025 Jun 7;24(1):161. doi: 10.1186/s12904-025-01798-z.

ABSTRACT

BACKGROUND: This exploratory study investigates the emotional impact of palliative care provision among healthcare professionals in resource-limited settings, specifically in Kazakhstan. As a middle-income country with a growing burden of chronic diseases, the palliative care sector in Kazakhstan faces increasing challenges to address burnout.

METHODS: Due to limited existing knowledge, an exploratory design was adopted, employing grounded theory approach to discover professionals’ understanding of their experiences, emotional stressors, and burnout development. In-depth qualitative interviews were conducted with 60 palliative care professionals (41 nurses, 19 physicians) from 4 hospices, 2 PCUs of cancer centers, and 1 nursing department from diverse geographical locations within Kazakhstan. The data collection phase was carried out between May 2021 and July 2022. Analysis focused on identifying stressors leading to burnout and coping mechanisms used by palliative care professionals.

RESULTS: The study identifies key stressors, including emotional involvement with patients, communication challenges with relatives, witnessing patient frailty and death, lack of personal accomplishment, and emotional labor. A unique finding is the widespread denial of emotional impact among participants, expressed through normalization of work-related stress and suppression of emotions. Through analysis, four key themes were identified as central to the findings: (1) stressors contributing to burnout, (2) denial of emotional impact, (3) coping mechanisms, and (4) attitudes towards seeking psychological help.

CONCLUSIONS: The present study has revealed that the denial of emotional impact, along with the downplaying or dismissal of the impact of stress, is a recurring pattern among healthcare workers providing palliative care to terminally ill patients in Kazakhstan. The findings of this study underscore the need for tailored training to address the specific emotional needs of palliative care workers, focusing on effective communication, techniques for emotional regulation, stress management, and self-care practices to help professionals cope with the emotional demands of their work.

PMID:40483463 | DOI:10.1186/s12904-025-01798-z

BMC Oral Health. 2025 Jun 7;25(1):942. doi: 10.1186/s12903-025-06329-z.

ABSTRACT

BACKGROUND: Coeliac disease (CD) is a lifelong immune-mediated systemic disease that develops in genetically predisposed subjects who show intolerance to gluten proteins. Intestinal wall inflammation with villi atrophy results in malabsorption of nutrients and leads to several gastrointestinal and systemic symptoms. High serum levels of anti-endomysial and anti-tissue transglutaminase autoantibodies can be revealed in patients with CD. The aim of the study was to evaluate the presence of IgA, IgG, IgM, and C3 complement deposits in the oral mucosa and its condition in CD patients.

METHODS: Thirty CD patients underwent complete clinical examination followed by mycologic evaluation, of whom 10 additionally had oral mucosa biopsy. Direct immunofluorescence (DIF) was performed on the oral mucosa specimens using polyclonal rabbit IgG, IgA, IgM, and C3 antibodies. The results were statistically analyzed.

RESULTS: The most common complaints included pain due to oral ulcers, xerostomia, and gingival bleeding. Frequently observed comorbidities were anemia, allergy, and thyroid disorders. Common oral mucosal findings included white-coated tongue, linea alba, and atrophic glossitis. Candidiasis was revealed in 13 subjects (43.3%). IgA, IgG, IgM, or C3 deposits in the oral mucosa specimens were shown in none of the patients.

CONCLUSIONS: Coeliac disease may increase the frequency of white-coated tongue, linea alba, and atrophic glossitis and may promote the development of oral candidiasis. However, there are no evident markers in the CD patients’ immunopathologic examination of the oral mucosa specimens.

PMID:40483462 | DOI:10.1186/s12903-025-06329-z

BMC Public Health. 2025 Jun 7;25(1):2129. doi: 10.1186/s12889-025-23037-z.

NO ABSTRACT

PMID:40483450 | DOI:10.1186/s12889-025-23037-z

Am J Epidemiol. 2025 Jun 6:kwaf119. doi: 10.1093/aje/kwaf119. Online ahead of print.

ABSTRACT

Estimating the temporal trends in infectious disease activity is crucial for monitoring disease spread and the impact of interventions. Surveillance indicators routinely collected to monitor these trends are often a composite of multiple pathogens. For example, ‘influenza-like illness’-routinely monitored as a proxy for influenza infections-is a symptom definition that could be caused by a wide range of pathogens, including multiple subtypes of influenza, SARS-CoV-2, and RSV. Inferred trends from such composite time series may not reflect the trends of any one of the component pathogens, each of which can exhibit distinct dynamics. Although many surveillance systems routinely test a subset of individuals contributing to a surveillance indicator-providing information on the relative contribution of the component pathogens-trends may be obscured by time-varying testing rates or substantial noise in the observation process. Here we develop a general statistical framework for inferring temporal trends of multiple pathogens from routinely collected surveillance data. We demonstrate its application to three different surveillance systems covering multiple pathogens (influenza, SARS-CoV-2, dengue), locations (Australia, Singapore, USA, Taiwan, UK), scenarios (seasonal epidemics, non-seasonal epidemics, pandemic emergence), and temporal reporting resolutions (weekly, daily). This methodology is applicable to a wide range of pathogens and surveillance systems.

PMID:40481640 | DOI:10.1093/aje/kwaf119