Tag: nevin manimala

Eur J Orthop Surg Traumatol. 2025 May 18;35(1):201. doi: 10.1007/s00590-025-04324-2.

ABSTRACT

PURPOSE: The aim of this study was to determine if a delay to surgery of more than 48 h was associated with poorer functional outcomes and increased 1-year mortality rates for elderly hip fractures.

METHODS: A retrospective review of surgically treated elderly (≥ 60 years old) hip fracture patients in a single institution was conducted. Patients were divided into 2 groups depending on hours from admission to surgery: Group 1 ( ≤ 48 h) and Group 2 (> 48 h); these groups were 1:1 matched for the initial Modified Barthel’s Index (MBI) and Charlson Comorbidity Index (CCI).

RESULTS: 2562 patients were eligible for the study. The cut-point value in a receiver operating curve analysis for 12-month MBI against time to surgery was not robust enough to determine an optimal time for surgery. Group 1 (n = 888) had significantly better MBI scores at 6-months [mean 78.7 (± 19.9) vs. mean 75.5 (± 20.6)] and 1-year [mean 80.4 (± 20.1) vs. mean 76.9 (± 22.3)] (p < 0.001). This difference in MBI scores between the groups did not meet the minimal clinically important difference of 10 points. There was no significant difference in 1-year mortality (3.7% vs. 4.4%) (p = 0.427). Delayed surgery past 48 h significantly increased the risk of post-operative complications. (Urinary tract infection, acute retention of urine and pneumonia) (p < 0.001).

CONCLUSION: Delayed surgery for elderly hip fractures after 48 h increases the risk of acute post-operative complications. There is no increase in 1-year mortality and no clinically important deterioration of MBI if operated on after 48 h.

LEVEL OF EVIDENCE: III.

PMID:40382761 | DOI:10.1007/s00590-025-04324-2

Discov Oncol. 2025 May 18;16(1):801. doi: 10.1007/s12672-025-02654-5.

ABSTRACT

BACKGROUND: Previous studies have investigated the potential role of immune factors in chondrosarcoma (CHS). However, the causal relationship is unknown.

METHODS: A two-sample Mendelian randomization (MR) was used to explore potential correlations between 731 immunocyte phenotypes, 91 inflammatory proteins, and CHS. The data were derived from published summary statistics of genome-wide association studies. Inverse-variance weighted was employed as the primary method. Furthermore, a range of analytical methods, including MR-Egger, weighted mode, and weighted median was used to enhance the robustness of the results. A two-step MR was used to assess the mediating effects of inflammatory proteins. Subsequently, sensitivity and MR Steiger directionality tests were performed.

RESULTS: MR analyses showed that 12 immunocyte phenotypes were positively correlated with CHS (P < 0.05, OR > 1), and 11 immunocyte phenotypes were negatively correlated with CHS (P < 0.05, OR < 1). Five inflammatory proteins were positively associated with CHS (P < 0.05, OR > 1). No heterogeneous or horizontal pleiotropy was found. The MR Steiger analysis found no statistically significant evidence of reverse causation. Mediation analysis did not identify any potential mediating effects.

CONCLUSION: Our study underscores the pivotal role of immune factors in CHS and offers insights that can inform future research.

PMID:40382743 | DOI:10.1007/s12672-025-02654-5

Pediatr Surg Int. 2025 May 18;41(1):138. doi: 10.1007/s00383-025-06042-6.

ABSTRACT

BACKGROUND: A well accepted approach to the management of gastroschisis is gradual reduction of the herniated viscera using preformed silos followed by surgical closure of the abdominal wall defect. However, if the abdominal wall closure is delayed for a longer duration than necessary, it may increase morbidities. We sought to compare the outcomes of infants undergoing silo reduction whose abdominal wall defect was closed ≤ 5 days versus > 5 days after birth.

METHODS: Retrospective cohort study (January-2010 to December-2020).

RESULTS: One-hundred-and-nine infants who were managed using primary silo with staged reduction were included. Median gestation was 36.2 (interquartile range, IQR: 35.2, 37) weeks. Ten infants had complex gastroschisis. Thirty-four infants underwent early-closure of abdominal wall defect and 75 had delayed closure. Mortality rate was 2.7% (3/109; one in early and two in delayed closure). The median age at full feeds was 24.5 days (IQR 17.5, 30) in the delayed-closure group vs 15 (12.5, 22.5) in the early-closure group. The median hospital stay was 32 days (IQR 23, 43) vs 19 (15, 30) days. On multivariable analysis, delayed closure (Exponentiated regression coefficient ERC 1.40, 95% confidence interval CI: 1.05, 1.86, P = 0.020) and complex gastroschisis (ERC 2.03; 95% CI: 1.11, 3.72, P = 0.021) were associated with longer time to reach full feeds. Same factors were associated with longer duration of hospital stay.

CONCLUSIONS: Gradual reduction using silos achieved excellent outcomes in neonates with gastroschisis. Completing the silo reduction and closing the abdominal wall within five days could further improve their outcomes.

PMID:40382741 | DOI:10.1007/s00383-025-06042-6

CNS Drugs. 2025 May 18. doi: 10.1007/s40263-025-01190-8. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Chronic sleeplessness is a primary clinical symptom of vascular depression (VaDep). We investigated the efficacy and safety of escitalopram plus tandospirone citrate for patients with VaDep and chronic insomnia and the potential correlation of insomnia severity with neurotransmitter indexes, including serotonin (5-HT), serotonin 2C receptor (5-HT_2CR), serotonin 7 receptor (5-HT₇R) in platelets, and plasma 5-HT.

METHODS: This double-blind, randomized controlled study randomized patients with VaDep and chronic insomnia [Hamilton depression rating scale (HAMD) > 17 points] into a monotherapy group [escitalopram (10 mg once daily) plus placebo] or combined group [escitalopram (10 mg once daily) plus tandospirone citrate (10 mg three times daily)] by using a 1:1 assignment algorithm generated by SPSS 25.0 software. The primary endpoint was the change in sleep quality from baseline to week 12, evaluated by the Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), Epworth Sleepiness Scale, and Asen Self-Rating Insomnia Scale (AIS). Secondary outcomes were the changes in depression and anxiety assessment and the levels of peripheral blood neurotransmitters from baseline to week 12, including HAMD, the Hamilton anxiety scale (HAMA), 5-HT, 5-HT_2CR, 5-HT₇R in platelets, and plasma 5-HT. The levels of 5-HT, 5-HT_2CR, and 5-HT₇R were detected with the enzyme-linked immunosorbent assay kits. The safety assessment included the Treatment-Emergent Symptom Scale and clinical and laboratory variables. The therapeutic improvement was analyzed by a generalized estimation equation.

RESULTS: A total of 123 subjects (30.89% male) were included, with a mean age of 70.56 ± 6.37 (mean ± standard deviation, SD) years. In the monotherapy group, the baseline HAMD and PSQI scores (n = 61 for both) were 28.84 ± 2.49 and 14.16 ± 1.86, respectively. In the combined group, the baseline HAMD and PSQI scores (n = 62 for both) were 28.81 ± 2.51 and 14.21 ± 1.87, respectively. The HAMA and HAMD scores in both groups were significantly lower at weeks 4, 8, and 12 after treatment than before treatment (P < 0.001). Compared with the monotherapy counterpart, the combined group displayed significantly lower PSQI and AIS scores at weeks 4, 8, and 12 and improved PSG sleep macrostructure at week 12, including total sleep time (TST), sleep latency, sleep efficiency, sleep maintenance rate (SMT), wake time after sleep onset, and percentage of sleep in each phase. Platelet 5-HT, plasma 5-HT, and platelet 5-HT₇R decreased in both groups at the end of weeks 4, 8, and 12 of treatment. Platelet 5-HT₇R was moderately negatively correlated with the percentage of nonrapid eye movement 3 sleep time (N3). Plasma 5-HT was moderately positively correlated with PSQI and AIS and negatively with TST, SMT, nonrapid eye movement 2 sleep time (N2), and percentage of N2 sleep time. No statistical difference in the total incidence of adverse events was found between the two groups (P = 0.842).

CONCLUSIONS: The statistically significant changes in PSG, PSQI, and AIS may indicate that the combination of escitalopram and tandospirone may improve, with a reasonable safety profile, the sleep quality of patients with VaDe. The clinical results observed were associated with changes in measures of plasma 5-HT and platelet 5HT₇R; these findings suggest that a possible role of central serotonergic function in the mechanism of action of the drug combination in this trial could be a relevant subject of future studies.

CLINICAL TRIAL REGISTRY NUMBER: ChiCTR2300075407.

PMID:40382735 | DOI:10.1007/s40263-025-01190-8

Eur Radiol. 2025 May 18. doi: 10.1007/s00330-025-11684-0. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to develop and validate a predictive model for preoperative extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) using MRI features.

METHODS: We retrospectively analyzed 140 confirmed PTC cases, divided into training (n = 84) and validation (n = 56) groups. MRI features such as T2-weighted imaging, multiphase contrast-enhanced MRI, and diffusion-weighted imaging were evaluated along with clinical data. Univariate and multivariate logistic regression identified independent predictors of ETE and developed a predictive nomogram. We evaluated the nomogram’s discrimination, calibration, and clinical utility, and performed subgroup analyses to explore the relationships between risk factors and baseline data. Predictive performance was assessed using ROC curves and DeLong tests.

RESULTS: Age, protrusion value, and apparent diffusion coefficient_Brightest_rate (ADC_Best_rate) were independent predictors of ETE. The nomogram effectively differentiated ETE from no-ETE, showing strong discrimination, clinical utility, and calibration in both the training (AUC = 0.826, Hosmer-Lemeshow p = 0.882) and validation cohorts (AUC = 0.805, Hosmer-Lemeshow p = 0.585). The model performed consistently across different MRI systems (1.5 T and 3.0 T) and gender subgroups. Notably, ADC_Best_rate (AUC = 0.742) outperformed ADC_mean_rate and ADC_minimum_rate. A significant interaction between ADC_Best_rate and gender (p = 0.02) showed that ADC_Best_rate predicted ETE in PTC more accurately in males (AUC = 0.897) compared to females (AUC = 0.644).

CONCLUSION: Our nomogram model, incorporating age, protrusion value, and ADC_Best_rate, effectively predicted preoperative ETE in PTC patients, aiding surgeons in optimizing therapeutic decision-making. ADC_Best_rate may be a promising potential indicator in MRI functional imaging.

KEY POINTS: Question This study addresses the challenge of accurately predicting extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) to improve surgical decision-making. Findings A predictive nomogram incorporating age, protrusion value, and ADC_Best_rate effectively differentiates ETE from no-ETE, showing strong performance in both training and validation cohorts. Clinical relevance This nomogram aids surgeons in identifying patients at risk for ETE, enhancing therapeutic decision-making and potentially improving patient outcomes in PTC management.

PMID:40382730 | DOI:10.1007/s00330-025-11684-0

ACS Sens. 2025 May 18. doi: 10.1021/acssensors.4c03397. Online ahead of print.

ABSTRACT

Surface-enhanced Raman spectroscopy (SERS) is a transformative tool for infectious disease diagnostics, offering rapid and sensitive species identification. However, background spectra in biological samples complicate analyte peak detection, increase the limit of detection, and hinder data augmentation. To address these challenges, we developed a deep learning framework utilizing dual neural networks to extract true virus SERS spectra and estimate concentration coefficients in water for 12 different respiratory viruses. The extracted spectra showed a high similarity to those obtained at the highest viral concentration, validating their accuracy. Using these spectra and the derived concentration coefficients, we augmented spectral data sets across varying virus concentrations in water. XGBoost models trained on these augmented data sets achieved overall classification and concentration prediction accuracy of 92.3% with a coefficient of determination (R²) > 0.95. Additionally, the extracted spectra and coefficients were used to augment data sets in saliva backgrounds. When tested against real virus-in-saliva spectra, the augmented spectra-trained XGBoost models achieved 91.9% accuracy in classification and concentration prediction with R² > 0.9, demonstrating the robustness of the approach. By delivering clean and uncontaminated spectra, this methodology can significantly improve species identification, differentiation, and quantification and advance SERS-based detection and diagnostics.

PMID:40382719 | DOI:10.1021/acssensors.4c03397

JMIR Res Protoc. 2025 May 15. doi: 10.2196/72528. Online ahead of print.

ABSTRACT

BACKGROUND: The aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in elderly individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “Promoting Oral Health in Nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.

OBJECTIVE: To assess the acceptability of the expert standard among nursing staff providing care for elderly individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, Care Rationed or Missed (CROM), and the standard’s acceptability.

METHODS: This quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic TFA (Theoretical Framework of Acceptability), a questionnaire to measure acceptability of interventions across seven domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile (OHLP) and competence in mouth care using the questionnaire developed by the German Network for Quality Development in Nursing (DNQP). Barriers to implementation will be evaluated according to the Acute Care Nurses’ Questionnaire on Oral Hygiene and CROM using the oral care related question from Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of firstly calculating mean acceptability with 95% confidence interval for each recommended intervention of the expert standard. Secondly, repeated measures ANOVA are used to examine mean differences of acceptability between these interventions. Thirdly, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi square tests of independence are used to compare CROM with already published rates in German speaking countries.

RESULTS: Results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025.

CONCLUSIONS: This study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in the elderly. By focusing on acceptability as a prerequisite for implementation, the study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.

PMID:40382708 | DOI:10.2196/72528

Schizophr Bull. 2025 May 18:sbaf065. doi: 10.1093/schbul/sbaf065. Online ahead of print.

ABSTRACT

BACKGROUND: Foundational models of the psychoses included course as a core element differentiating patients. Current models, ICD-11 and DSM-5, only require symptom criteria to be met to make a diagnosis. We explore the proposition that making course designation essential, again, would improve the categorization of patients with psychotic disorders.

STUDY DESIGN: We briefly discuss the history by which symptoms, alone, became the primary elements required for diagnosis. We review past and recent evidence on the best models for differentiating among psychoses.

STUDY RESULTS: The use of course designations, along with symptoms, produces the best fit to the way in which psychotic disorders present and progress. It also matches how clinicians assess patients and choose therapeutic interventions. A model including course as a factor is more accurate and complete than models using symptoms alone. And it produces groups of patients that are likely to be more homogeneous than purely symptom-based models. The degree of heterogeneity among patients classified together within current International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) categories can lead to false findings in research and a lack of clarity on the best treatment in individual cases. Increasing homogeneity in diagnostic groups, by including course designations, could advantage clinical care, clinical trials, and research on underlying pathogenic mechanisms.

CONCLUSIONS: Adding a course as a diagnostic element is practical. Clinicians already consider it. Specifying courses can be required in making a diagnosis. Doing so is evidence based and enhances the accuracy and value of diagnoses. We recommend restoring the course as a core element of any new diagnostic system.

PMID:40382705 | DOI:10.1093/schbul/sbaf065

Arch Iran Med. 2025 Apr 1;28(4):207-216. doi: 10.34172/aim.31947. Epub 2025 Apr 1.

ABSTRACT

BACKGROUND: The increasing demand for healthcare services and some associated factors including lack of physicians, lack of trust in physicians, ineffectiveness of treatments and high costs may be have led to a rise in non-physician-provided services. This study aims to assess health services delivery by non-physicians and its associated factors in Iran.

METHODS: This study was a cross-sectional study conducted using a convenience sampling method in the Iranian community in 2023. A standard questionnaire with 45 questions was developed based on focus group discussions and a validation process to assess the status of receiving services in six medical areas including traditional medicine, abortion, traditional dentistry, obesity and slimming diets, bone setting, and addiction treatment. Data collection was carried out using online questionnaires on Iranian and non-Iranian social media platforms. Descriptive and analytical statistics were used to analyze the data, with logistic regression adjusting for various demographic factors.

RESULTS: Out of 1713 participants, 53.9% (95% CI: 51.5%-56.3%) were women, and the majority were in the 30-40 age group. Traditional Islamic medicine was the most commonly sought service, with 56% (95% CI: 51.2%-60.8%) of users receiving it from non-physicians. Satisfaction with non-physician services varied, with 32.1% (95% CI: 25.8%-38.4%) reporting high satisfaction for traditional medicine, but only 49.4% (95% CI: 40.5%-58.3%) for experimental dentistry. Key reasons for choosing non-physician providers included the effectiveness of traditional treatments and fear of modern medicine’s side effects.

CONCLUSION: The result showed that the use of non-physician services can be considerable and that necessary interventions should be designed to standardize treatments and deal with substandard providers who may be harmful to the health of the community.

PMID:40382692 | DOI:10.34172/aim.31947

Arch Iran Med. 2025 Apr 1;28(4):189-197. doi: 10.34172/aim.31306. Epub 2025 Apr 1.

ABSTRACT

BACKGROUND: Comparing the trends of mortality rates provides valuable insight for policy discussions and promotes awareness of health issues. This study aimed to investigate the changes in mortality rate and life expectancy from 2011 to 2021 and the effect of COVID-19 period on these indices.

METHODS: We investigated the data of all-cause deaths between 2011 and 2021 by age group, sex and year using Excel spreadsheets from the National Organization for Civil Registration (NOCR), via collected the census method. Joinpoint regression was used to calculate the trend of mortality rate during the study period.

RESULTS: During the study period, there were 262,708 deaths, of which 148,919 were men (56.68%). The trend of mortality rate in both sexes has been increasing. Life expectancy in men and women decreased from 76.71 and 80.82 in 2011 to 74.43 and 77.53 in 2021, respectively. From 2018 to 2021, there was a significant increase in standardized mortality rate in men (APC=14.74; 95% CI=5.73; 28.65) and women (APC=14.29; 95% CI=4.67; 28.97). However, from 2011 to 2018, we observed a yearly 2.65% decreasing trend in men which was statistically significant (APC=-2.95, 95% CI=-7.67, -0.84). In women, no significant trend was seen.

CONCLUSION: With the emergence of the COVID-19 epidemic in 2019, the trend of mortality rate and life expectancy changed completely, with additional deaths and decreasing life expectancy. Therefore, prevention, control and treatment of epidemic diseases should be a serious concern of policy makers.

PMID:40382690 | DOI:10.34172/aim.31306