Tag: nevin manimala

Medicine (Baltimore). 2025 May 16;104(20):e42454. doi: 10.1097/MD.0000000000042454.

ABSTRACT

This study aimed to assess the diagnostic value of non-enhanced CT radiomics in preoperatively differentiating early-stage (T1-T2) from locally advanced (T3-T4) colon cancer, addressing the limitations of conventional empirical staging. A retrospective analysis was conducted on 170 patients with surgically confirmed primary colon cancer who underwent non-enhanced CT scans within 1 week before surgery. Three-dimensional segmentation of colonic tumors was performed on the non-enhanced images, followed by automated extraction of radiomic features. Feature selection was executed using the minimum redundancy maximum relevance (mRMR) algorithm, and key features associated with cancer stage were identified using the least absolute shrinkage and selection operator logistic regression. The performance of the radiomics model was compared with conventional T-staging by radiologists. The cohort comprised 170 patients with an average age of 61.69 ± 13.22 years, 43.3% of whom were female, and 75 (44.1%) presented with early-stage disease. Eight radiomic features from non-enhanced imaging were ultimately included. The radiomics model achieved an area under the curve (AUC) of 0.85 (95% confidence interval: 0.78-0.92) in the training set and 0.84 (95% confidence interval: 0.74-0.95) in the test set, with corresponding accuracies of 0.70 and 0.78, sensitivities of 0.87 and 0.87, and specificities of 0.69 and 0.71, respectively. Additionally, in the training set, the radiomics model (AUC = 0.85) significantly outperformed empirical T-staging by radiologists (AUC = 0.71, P < .009). A similar trend was observed in the test set, where the radiomics model (AUC = 0.85) surpassed empirical T-staging (AUC = 0.76), although this difference was not statistically significant (P = .27). Non-enhanced CT radiomics demonstrated superior performance over conventional radiologists’ T-staging in distinguishing early from advanced colon cancer stages.

PMID:40388788 | DOI:10.1097/MD.0000000000042454

Medicine (Baltimore). 2025 May 16;104(20):e42306. doi: 10.1097/MD.0000000000042306.

ABSTRACT

There is limited evidence regarding the association between myocardial function requiring extracorporeal membrane oxygenation (ECMO) and long-term survival rate in patients who reach hospital discharge. This study investigates the association between myocardial function parameters collected at different times from weaning from ECMO to long-term follow-up and the long-term mortality rate. This retrospective study investigates the effect of EF timing in the long-term. A cohort of 403 patients successfully weaned from veno-arterial ECMO (VA-ECMO) was identified from 1300 patients who underwent VA-ECMO between 2003 and 2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database (CGRD). The study revealed that a notable improvement in ejection fraction (EF) percentile between ECMO placement and successful weaning was significantly linked to reduced cumulative mortality as were higher EF values before discharge. However, no significant association was found between lower long-term mortality and EF change from discharge to mid-term follow-up, or the maximum EF at mid-term follow-up. Improvements in cardiac function following the use of VA-ECMO and better baseline cardiac function are associated with lower long-term mortality. The study showed that EF monitoring at ECMO insertion and before discharge can inform physicians regarding patients’ long-term outcomes. EF percentile improvement from insertion to weaning could be a positive indicator of successful weaning.

PMID:40388785 | DOI:10.1097/MD.0000000000042306

Medicine (Baltimore). 2025 May 16;104(20):e42385. doi: 10.1097/MD.0000000000042385.

ABSTRACT

BACKGROUND: Sugammadex sodium can antagonize aminosteroidal muscarinic drugs precisely and rapidly, so it has been widely used in fast-track anesthesia in recent years. However, it is not known whether there is an advantage of the antagonistic effect of sugammadex sodium over neostigmine at different doses and time points. In this single-center, randomized controlled study, we compared the effects of sugammadex sodium with neostigmine on postoperative myorelaxation recovery in patients undergoing suspension laryngoscopic surgery.

METHODS: A total of 90 patients scheduled for elective general anesthesia suspension laryngoscopy were selected, aged 18 to 65 years, body mass index 18 to 28 kg/m², and American Society of Anesthesiologists I-II grade. Patients were randomly divided into 3 groups: the sugammadex group (experimental groups, S1, S2), and the neostigmine group (control group, N), each comprising 30 patients. After the operation, group S1 received an intravenous injection of sugammadex sodium 2 mg/kg immediately, S2 received it when train-of-four COUNT (TOF-COUNT) > 2, and group N received intravenous injections of atropine 0.02 mg/kg + neostigmine 0.04 mg/kg when TOF-COUNT > 2. The mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index were recorded at various times: upon room entry (T1), during tracheal intubation (T2), at surgery start (T3), surgery end (T4), at extubation (T5), and upon room exit (T6). The duration of surgery, muscle relaxation recovery time from TOF-COUNT 0-2 at surgery end, and time from surgery end to extubation were recorded for each group, as well as the incidence of adverse reactions.

RESULTS: There were no statistically significant differences among the 3 groups in mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index at the 6 time points (T1, T2, T3, T4, T5, and T6). In terms of extubation timing, the S1 group showed a significantly shorter time compared with the S2 and N groups (P < .05). Compared with the S2 group, N group had significantly prolonged extubation times, showing a statistical difference. Compared with the N group, S1 and S2 groups had a significantly reduced incidence of bradycardia and increased secretions (P < .05).

CONCLUSION: The use of sugammadex sodium in otolaryngological suspension laryngoscopy surgeries offers certain advantages over neostigmine in terms of muscle relaxation recovery. Administering sugammadex sodium 2 mg/kg directly after surgery as compared with waiting until TOF-COUNT > 2 allows for earlier removal of the tracheal tube without increasing adverse reactions.

PMID:40388779 | DOI:10.1097/MD.0000000000042385

Medicine (Baltimore). 2025 May 16;104(20):e42469. doi: 10.1097/MD.0000000000042469.

ABSTRACT

This study aimed to quantify the lumbar skeletal muscle index (SMI) to predict the incidence and risk of lower back pain and to develop preventive strategies to reduce the incidence of sarcopenia and lower back pain. A total of 29 patients with low back pain in our hospital between September 2022 and March 2024 were enrolled, and lumbar computed tomography data were collected, including age, sex, and visual analog scale (VAS) score for low back pain. This study included 29 patients with an average age of (53.72 ± 18.82) years and an average height of (1.65 ± 0.43) m. The degree of lower back pain was evaluated using the visual analog scoring method, with an average score of (5.14 ± 1.382). Using AutoCAD drawing software, the total cross-sectional area of the skeletal muscles at the level of the lumbar vertebrae was calculated, with an average area of (105.63 ± 27.73) cm2. The SMI at the level of the lumbar vertebrae 3 was calculated as the ratio of the total cross-sectional area of the skeletal muscles at the level of the lumbar vertebrae to height2, (38.27 ± 8.07). Statistical analysis showed a significant negative correlation (P < .01) between SMI, age, and VAS score in patients with sarcopenia, whereas there was no significant difference in SMI between the sexes in patients with sarcopenia(P > .05). There was a significant negative correlation between SMI and age as well as VAS score, indicating that lower back pain is caused by a decrease in SMI. As people age, their muscle mass and strength gradually decreases.

PMID:40388778 | DOI:10.1097/MD.0000000000042469

Medicine (Baltimore). 2025 May 16;104(20):e42489. doi: 10.1097/MD.0000000000042489.

ABSTRACT

Medical staff hold dual roles as advocates and potential blood donors, yet systemic barriers within high-pressure clinical environments hinder their participation. Understanding their motivations and challenges is critical for strengthening blood supply systems. This cross-sectional study aimed to identify determinants of donation willingness and policy expectations among medical staff to inform evidence-based interventions. A structured questionnaire, developed via Delphi methodology with hematologists, policy experts, and psychologists, was administered to medical staff at a tertiary Grade A hospital in Chongqing, China. Stratified random sampling ensured representation across demographics. Data were collected via an encrypted online platform (SoJump.com) and analyzed using SPSS 22.0 and GraphPad Prism 6. Among 1096 participants, the observation group (non-donors, n = 460, 41.97%) exhibited statistically significant demographic divergences from the control group across gender, age, educational attainment and professional category (all P < .05). Multivariate logistic regression identified these variables as independent predictors of donation status (P < .05). Despite 83.26% of the observation group endorsing blood donation and 69.34% comprehending deferral criteria, key participation barriers included occupational workload saturation (59.13%), inadequate promotional mechanisms (49.57%), adverse physiological reactions (43.04%), and insufficient motivation (26.52%). For intervention optimization, respondents in the observation group prioritized structured promotional mechanisms (80.22%), establishing policy guidance protocols (53.26%), and systematizing regular donor recruitment activities (46.74%). Young, male, and highly educated medical staff exhibited higher donation rates. Structural reforms to alleviate occupational burdens, optimize donor recruitment paradigms, and institutionalize periodic mobilization are imperative to align clinical demand with donor supply.

PMID:40388772 | DOI:10.1097/MD.0000000000042489

Medicine (Baltimore). 2025 May 16;104(20):e42532. doi: 10.1097/MD.0000000000042532.

ABSTRACT

Although observational studies have suggested associations between personality disorders and schizophrenia, the causality of these relationships remains unclear. Determining whether personality disorders causally contribute to schizophrenia could inform early identification and preventive efforts. We performed two-sample Mendelian randomization (MR) analysis using large-scale Genome-wide Association Study data from populations of European ancestry. Because no single nucleotide polymorphism for personality disorders reached the conventional genome-wide significance threshold (P < 5 × 10-8), we sequentially relaxed the criteria (P < 5 × 10-7, P < 5 × 10-6, P < 5 × 10-5) until at least 10 instrumental variables were obtained. Ultimately, 11-95 single nucleotide polymorphism met the relaxed threshold (P < 5 × 10-5), all with F-statistics > 10, thus ensuring robust instrumental variables. The inverse variance weighted method served as our primary MR approach, supplemented by MR-Egger, weighted median, and MR Robust Adjusted Profile Score analyses, to minimize confounding, reverse causation, and weak instrument bias. Inverse variance weighted analysis revealed a significant causal association between genetically predicted personality disorders and schizophrenia (odds ratios = 1.190, 95% confidence intervals: 1.122-1.261, P = 5.51 × 10-9). Additionally, when examining a combined group of specific personality disorders, a similar causal effect was observed (odds ratios = 1.180, 95% confidence intervals: 1.033-1.345, P = .015). The sensitivity analyses showed no evidence of horizontal pleiotropy, thus supporting the robustness of these findings. Our study provides the first genetic evidence that personality disorders may have a causal influence on schizophrenia risk. These results highlight the importance of early screening and targeted interventions in individuals with personality disorders. Future research should expand to more diverse populations, employ dimensional diagnostic frameworks, and investigate the underlying biological and developmental pathways to refine the preventative and therapeutic strategies.

PMID:40388757 | DOI:10.1097/MD.0000000000042532

Medicine (Baltimore). 2025 May 16;104(20):e42526. doi: 10.1097/MD.0000000000042526.

ABSTRACT

Physical strength alone is not enough in today’s sports’ society, where athletes’ performance is geared around winning; the body’s demand for mental training is growing every day. The aim of this study is to examine the mental endurance, mental training and emotional intelligence levels of elite level individual athletes; to evaluate the relationships between these psychological variables in a multifactorial structure and to determine whether these variables show significant differences according to demographic characteristics such as gender, age, education level and duration of sportsmanship. This will offer useful strategies to maximize the performance of elite athletes. In this cross-sectional study, a quantitative research method was applied using the survey model. A total of 242 elite Turkish athletes competing in individual sports branches in the Turkish National Teams in 2023 to 2024 participated in the study. Athletes’ data was gathered and examined between January 02 and March 02, 2024. The data were collected using the Sport Mental Endurance Inventory, Sport Mental Training Inventory, and Sport Emotional Intelligence Scale. Nonparametric tests were applied for statistical analysis. The findings of this study showed that there were significant differences in mental endurance, mental training, and emotional intelligence levels according to gender, age, and sport branch variables. It was found that male athletes aged between 26 to 33 years had higher levels of mental endurance and emotional intelligence. In addition, it was determined that female athletes aged 21 years and over had higher levels of mental training and emotional intelligence. High positive correlations were found between mental endurance and emotional intelligence and between mental training and emotional intelligence. The development of mental endurance and emotional intelligence is of great importance for elite athletes to improve their success and performance. These findings suggest that mental endurance and emotional intelligence levels of athletes may differ according to demographic characteristics such as gender, age, and sport branches. These factors may have significant effects on athletes’ performances.

PMID:40388754 | DOI:10.1097/MD.0000000000042526

Medicine (Baltimore). 2025 May 16;104(20):e42510. doi: 10.1097/MD.0000000000042510.

ABSTRACT

The aim of this study was to investigate the safety and efficacy of the double mini-incision approach, and to clarify its surgical details. We retrospectively enrolled 82 patients with primary carpal tunnel syndrome. Among them, 30 patients with conventional approach were enrolled in group A, and the other 52 patients with double mini-incision approach were enrolled in group B. Objective tests were performed on patients, and basic information and subjective evaluation of patients were collected. The surgical effects and complications of the 2 approaches were compared. In addition, the surgical details of double mini-incision were further explored. The incision length of group B (26.1 ± 6.1 mm) was significantly shorter than that of group A (45.7 ± 5.9 mm, P ＜ .001). Patients in group B (93.7 ± 5.4) had significantly higher satisfaction with incision appearance than those in group A (84.3 ± 6.1, P ＜ .001). At the 12-month follow-up, no statistically significant difference in clinical outcomes were observed between the 2 groups (P > .05). However, there were 2 cases with wound pain and 1 case with pillar pain in group A, but none in group B. Two patients in group B who underwent the distal incision 1st were transferred to the conventional approach because of the epineurium and perineurium injury. The double mini-incision approach offers a sufficient range of release and surgical field, resulting in favorable surgical outcomes. The proximal incision made 1st helps to reduce the risk of nerve injury.

PMID:40388748 | DOI:10.1097/MD.0000000000042510

Medicine (Baltimore). 2025 May 16;104(20):e42473. doi: 10.1097/MD.0000000000042473.

ABSTRACT

Patients with coronary heart disease may have a higher risk of medication discrepancy during hospital-family transition period because of the complexity of their diseases, the diversity of medicines brought out of hospital and the sensitivity of medicine taking time. This study aims to analyze the influencing factors of medication discrepancy in patients with coronary heart disease during hospital-family transition period. Patients admitted to the department of cardiovascular medicine from July 1, 2023 to June 30, 2024 in a hospital in Ningbo City, Zhejiang Province, China. Electronic medical record system and patients themselves before discharge collected the baseline data of patients with coronary heart disease. Within 2 weeks after discharge, the patients were investigated by telephone follow-up with the medication discrepancy tool. Logistic regression was used to determine the influencing factors of patients’ medication discrepancy. The incidence of medication discrepancy in 107 patients within 2 weeks after discharge was 23.4%. The main discrepancy type is “medication omission.” The causes of patient-induced medication discrepancy are relatively high, and the most common reason is “forgetting to take medicine.” Logistic regression analysis showed that aspirin medication history and family APGAR index were the influencing factors of medication discrepancy. The incidence of medication discrepancy in patients with coronary heart disease in hospital-family transition period is high, among which omission is the most common. Aspirin medication history and family function are the key to identify patients’ medication discrepancy. Medical staff should pay attention to the management of medication discrepancy in patients with coronary heart disease.

PMID:40388747 | DOI:10.1097/MD.0000000000042473

Medicine (Baltimore). 2025 May 16;104(20):e42501. doi: 10.1097/MD.0000000000042501.

ABSTRACT

To clarify the patterns, reasons, and patient characteristics associated with emergency visits in the final 30 days of life for patients receiving home care in Japan. We conducted a retrospective analysis of emergency visits made by home care physicians to patients who died while receiving home care in 2018. Data on patient characteristics and emergency visits during the final 30 days of life were extracted from medical records. Poisson regression analysis was used to identify factors associated with emergency visit frequency. Among 83 end-of-life patients (median age 84 years, 49.4% male), a total of 86 emergency visits were recorded. These visits occurred most frequently in the days immediately preceding death, with 40.7% occurring within 5 days before death. Visits were more common during afternoons (37.2%) and weekends (39.6%). The primary reasons for visits included respiratory distress (20.9%), clinical assessment (14.0%), and neurological symptoms (12.8%). While some visits resulted in medication prescriptions (26.7%) or laboratory tests (22.1%), 36.1% involved observation only. Multivariable analysis revealed that longer duration of home care was associated with increased emergency visit frequency (31-365 days: relative risk [RR] 2.30, 95% confidence interval [CI]: 1.16-4.54; >365 days: RR 3.00, 95% CI: 1.56-5.78), while younger age was associated with increased visits (≤79 years: RR 2.04, 95% CI: 1.19-3.47). Emergency home visits in the terminal phase often clustered near death and frequently resulted in observation only, suggesting that some visits may be driven more by caregiver anxiety than medical urgency. Additionally, care level appeared to play a limited role during this period. These findings highlight the need for proactive symptom management, caregiver support, and scalable approaches such as telehealth to optimize end-of-life care.

PMID:40388741 | DOI:10.1097/MD.0000000000042501