Clin Imaging. 2025 May 3;123:110489. doi: 10.1016/j.clinimag.2025.110489. Online ahead of print.
NO ABSTRACT
PMID:40334343 | DOI:10.1016/j.clinimag.2025.110489
Tag: nevin manimala
Oral Oncol. 2025 May 6;165:107341. doi: 10.1016/j.oraloncology.2025.107341. Online ahead of print.
ABSTRACT
BACKGROUND: Recently, a molecular characterization of adenoid cystic carcinoma (ACC) has been proposed, based on upregulation of c-Myc, a proto-oncogene involved in carcinogenesis, and p63, a transcription factor of the p53 gene family. The aim of this study was to evaluate c-Myc and p63 expression and classify patients with ACC into the proposed molecular groups.
METHODS: We included in the analysis 50 patients with ACC of the head and neck region diagnosed treated between 2000 and 2021 in four tertiary referral centers in Greece. Patient demographics and disease characteristics were retrieved from patients’ medical records. C-Myc and p63 expression were evaluated by immunohistochemistry.
RESULTS: Forty-seven patients were eligible for classification. The majority of patients had primary non-metastatic tumors. P63 protein was found to be overexpressed in 39 patients (78 %), who were classified as ACC type II (ACC-II). Eight patients with no p63 overexpression were classified as ACC type I (ACC-I). Among ACC-II patients, 31 had negative expression of c-Myc and 8 patients had low c-Myc expression. We found a statistically significant difference in the primary tumor location between the two groups (p = 0.0470). Notably, patients that belonged to the ACC-II subgroup had more favorable prognosis (50 months for ACC-I vs. 135 months for ACC-II, p = 0.0066).
CONCLUSIONS: We confirmed the recently published data regarding the c-myc/p63 prognostic classification for ACC. Evaluation of c-Myc and p63 should be routinely performed in ACC tumors to allow for accurate stratification and implementation of ACC subtyping for clinical trials.
PMID:40334310 | DOI:10.1016/j.oraloncology.2025.107341
J Healthc Qual Res. 2025 May 6;40(5):101132. doi: 10.1016/j.jhqr.2025.101132. Online ahead of print.
ABSTRACT
OBJECTIVES: Patient satisfaction is a key indicator of healthcare quality and essential for improving hospital services. This study aimed to assess patient satisfaction and to identify areas for improvement in gynecological care across inpatient, outpatient, and emergency settings.
MATERIAL AND METHODS: We conducted a descriptive, cross-sectional study among 587 gynecological patients at a tertiary care teaching hospital in Karachi, Pakistan. We assessed multiple dimensions of patient care, such as doctor satisfaction, nursing care, housekeeping services, and value for money using simple random sampling. We used a standard questionnaire to gauge patient satisfaction with care and analyzed the data using Statistical Package for the Social Sciences (SPSS) version 21. We considered a p-value of less than 95% to be statistically significant.
RESULTS: The analysis revealed high satisfaction rates across all service areas. Doctor satisfaction scored the highest at 95.4% (95% CI: 0.929-0.978, p<0.0001), followed by value for money at 90.4% (95% CI: 0.870-0.939, p<0.0001). Housekeeping and nursing care were rated 86.2% (95% CI: 0.821-0.902, p<0.0001) and 83.3% (95% CI: 0.790-0.877, p<0.0001), respectively. The hospital achieved a 98.9% recommendation rate, with 54.3% rating their experience as “Excellent,” 36.9% as “Good,” 7.8% as “Average,” and only 1.1% as “Bad.”
CONCLUSIONS: This study highlights high patient satisfaction in gynecological services, reflected in strong recommendations and positive feedback. While physician care is well-rated, improvements in nursing and housekeeping through enhanced communication are needed. These findings support quality enhancement efforts, fostering a blame-free culture and setting a benchmark for similar institutions in Pakistan.
PMID:40334301 | DOI:10.1016/j.jhqr.2025.101132
Value Health Reg Issues. 2025 May 6;49:101123. doi: 10.1016/j.vhri.2025.101123. Online ahead of print.
ABSTRACT
OBJECTIVES: Cardiovascular diseases (CVDs) are responsible for nearly one-third of the deaths in Brazil. Time-series studies help evaluate the effectiveness of prevention strategies and assist in health planning. Therefore, the aim of this study was to conduct a retrospective temporal analysis, considering sex and comorbidities, of hospitalizations and deaths due to acute myocardial infarction (AMI) and heart failure (HF) among adults over 20 years of age in Minas Gerais from 2016 to 2022.
METHODS: The data were obtained from the Hospital Information System of the Unified Health System. Seasonal Autoregressive Integrated Moving Average with Exogenous variables models were created to evaluate seasonal components and/or interventions in the time series of deaths.
RESULTS: We recorded a total of 90 670 hospitalizations due to AMI, with a case fatality rate of 0.085, and 178 477 hospitalizations due to HF, with a case fatality rate of 0.100. Men predominantly experienced AMI, whereas women predominantly experienced HF. We found that winter periods correlated with an increase in hospitalizations due to AMI and HF. We observed that hospitalizations due to respiratory diseases were associated with a higher risk of CVD. During the pandemic, we observed a reduction in hospitalizations due to CVDs. In September 2020, we observed a significant increase in male deaths due to AMI. Among women, we found an inverse relationship between hospitalizations for AIDS and deaths from HF. Hospitalizations due to HF decreased over time, whereas those for AMI increased.
CONCLUSIONS: Respiratory diseases were associated with an increased risk of CVD. Winter periods showed an increase in hospitalizations for AMI and HF.
PMID:40334300 | DOI:10.1016/j.vhri.2025.101123
G Ital Nefrol. 2025 Apr 29;42(2):2025-vol2. doi: 10.69097/42-02-2025-08.
ABSTRACT
Background. This study evaluated the causes of and risk factors for mortality among patients on chronic HD hospitalised with SARS-CoV-2; in particular, it evaluated whether the cause of death was directly related to coronavirus disease 2019 (Covid-19) or another pathology. The European Renal Association registry showed a 20% mortality rate after 28 days for these patients. Methods. The clinical data of chronic HD patients hospitalised because of SARS-CoV-2 at the Fondazione Policlinico Universitario Agostino Gemelli from 15 March 2020 to 28 February 2022 were analysed. Univariate and multivariate regression analyses were performed to identify risk factors for mortality. The causes of mortality were obtained from the hospital discharge forms. Results. One hundred fifty-two patients on maintenance haemodialysis with positive SARS-CoV-2 test results were hospitalised during the study period. There were 100 male (65.8%) and 52 female (34.2%) patients (mean age, 69 years; standard deviation [SD], 14.14 years). The mean Charlson comorbidity index (CCI) was 6.44 (SD, 2.64), and the average hospitalisation length was 23.57 days (SD, 24.55 days). Forty-two (27.6%) patients died, but only 22 deaths (59%) were directly caused by Covid-19. Conclusions. Only 59% of the deaths of patients with positive Covid-19 test results were directly caused by Covid-19. The survival of patients on chronic HD is independently related to specific patient characteristics (age, CCI, presence of peripheral vascular disease, and intensive care unit admission), but not to Covid-19.
PMID:40332976 | DOI:10.69097/42-02-2025-08
JAMA Netw Open. 2025 May 1;8(5):e258903. doi: 10.1001/jamanetworkopen.2025.8903.
ABSTRACT
IMPORTANCE: Scarce population-based data exist on whether APOE4 modifies associations of blood-based neurodegenerative biomarkers with cognitive decline, particularly in a diverse, biracial population of community-dwelling older adults without dementia.
OBJECTIVE: To assess whether APOE4 carrier status is associated with an accelerated rate of cognitive decline in older adults without dementia and with elevated neurodegenerative burden.
DESIGN, SETTING, AND PARTICIPANTS: This 20-year prospective cohort study started in 1993 and was conducted through 2012 on the South Side of Chicago among community-dwelling older adults without dementia from the longitudinal biracial Chicago Health and Aging Project. The interaction of APOE4 carrier status with prospective associations of serum neurodegenerative biomarkers with global cognitive decline was examined using a mixed-effects regression model, adjusting for demographics and chronic health conditions. Statistical analyses were conducted from June 2024 to January 2025.
EXPOSURE: APOE4 carrier status and serum biomarker levels for total tau (t-tau), neurofilament light (NfL) chain, and glial fibrillary acidic protein (GFAP) measured with a Quanterix Neuroplex kit at baseline.
MAIN OUTCOMES AND MEASURES: Cognitive decline calculated from composite global cognition scores across study waves.
RESULTS: Among 1038 community-dwelling older adults (mean [SD] age, 77.1 [5.9] years; 615 Black [59.2%] and 423 White [40.8%]; 651 female [62.7%]), there was a mean (SD) of 12.8 (3.4) years of education and 343 individuals (33.0%) were APOE4 carriers. Higher levels of blood-based neurodegenerative biomarkers (ie, t-tau, NfL, and GFAP) were associated with a faster rate of cognitive decline among APOE4 carriers than noncarriers. Specifically, compared with noncarriers, APOE4 carriers had annual rates of cognitive decline per 1-log10 unit higher levels in t-tau and GFAP that were accelerated by a β (SD) of -0.03 (0.02) (P = .046) and -0.07 (0.03) (P = .02), respectively. Similarly, compared with noncarriers and participants in the lower NfL tertile, APOE4 carriers with middle and upper tertiles of NfL levels experienced accelerated cognitive decline, with a β (SD) of -0.04 (0.02) (P = .006) and -0.03 (0.02) (P = .07), respectively, although the difference was not significant for upper tertiles.
CONCLUSIONS AND RELEVANCE: This study found that higher levels of neurodegeneration (t-tau), axonal injury (NfL), and reactive astrocytes and neuroinflammation (GFAP) biomarkers were associated with accelerated cognitive decline in genetically susceptible APOE4 carriers. These findings highlight the association of APOE4 with exacerbation of neurodegenerative processes, with not only significant implications for understanding and tracking the progression of neurodegenerative diseases, but also a call for inclusivity of APOE4 status in scientific investigations and clinical trials.
PMID:40332937 | DOI:10.1001/jamanetworkopen.2025.8903
JAMA Netw Open. 2025 May 1;8(5):e258927. doi: 10.1001/jamanetworkopen.2025.8927.
ABSTRACT
IMPORTANCE: Agitation events are increasing in emergency departments (EDs), exacerbating safety risks for patients and clinicians. A wide range of clinical etiologies and behavioral patterns in the emergency setting make agitation prediction difficult in this setting.
OBJECTIVE: To develop, train, and validate an agitation-specific prediction model based on a large, diverse set of past ED visit data.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included electronic health record data collected from 9 ED sites within a large, urban health system in the Northeast US. All ED visits featuring patients aged 18 years or older from January 1, 2015, to December 31, 2022, were included in the analysis and modeling. Data analysis occurred between May 2023 and September 2024.
EXPOSURES: Variables that served as potential exposures of interest, encompassing demographic information, patient history, initial vital signs, visit information, mode of arrival, and health services utilization.
MAIN OUTCOMES AND MEASURES: The primary outcome of agitation was defined as the presence of an intramuscular chemical sedation and/or violent physical restraint order during an ED visit. A clinical model was developed to identify risk factors that predict agitation development during an ED visit prior to symptom onset. Model performance was measured using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (PR-AUC).
RESULTS: The final cohort comprised 3 048 780 visits. The cohort had a mean (SD) age of 50.2 (20.4) years, with 54.7% visits among female patients. The final artificial intelligence model used 50 predictors for the primary outcome of predicting agitation events. The model achieved an AUROC of 0.94 (95% CI, 0.93-0.94) and a PR-AUC of 0.41 (95% CI, 0.40-0.42) in cross-validation, indicating good discriminative ability. Calibration of the model was evaluated and demonstrated robustness across the range of predicted probabilities. The top predictors in the final model included factors such as number of past ED visits, initial vital signs, medical history, chief concern, and number of previous sedation and restraint events.
CONCLUSIONS AND RELEVANCE: Using a cross-sectional cohort of ED visits across 9 hospitals, the prediction model included factors for detecting risk of agitation that demonstrated high accuracy and applicability across diverse patient populations. These results suggest that clinical application of the model may enhance patient-centered care through preemptive deescalation and prevention of agitation.
PMID:40332935 | DOI:10.1001/jamanetworkopen.2025.8927
JAMA Netw Open. 2025 May 1;8(5):e258942. doi: 10.1001/jamanetworkopen.2025.8942.
ABSTRACT
IMPORTANCE: Motor vehicle crashes are the leading cause of death for US teens. Newer vehicles and driver assistance technologies show promise in reducing crashes and injury severities; however, research on the age and technologies of vehicles driven by teens involved in fatal crashes is limited.
OBJECTIVE: To examine the differences in vehicle age and driver assistance technologies between vehicles driven by teen and middle-aged drivers involved in fatal crashes and to investigate the associations among vehicle age, driver assistance technologies, and driver death in these crashes.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used fatal crash data (2016-2021) obtained from the Fatality Analysis Reporting System. Data analysis was restricted to passenger vehicles. Participants included teen drivers (15-18 years old) and middle-aged drivers (31-55 years old). All analyses were performed between December 1, 2023, and July 25, 2024.
EXPOSURES: Exposures include the vehicle age (≤5, 6-15, or >15 years) and the number of driver assistance technologies installed (0 to 4).
MAIN OUTCOMES AND MEASURES: The main outcome was whether the driver died in fatal crashes. Multivariable logistic regressions examined the associations between vehicle age (or driver assistance technologies installed) and driver death in fatal crashes, adjusting for driver sex, restraint use, and crash year.
RESULTS: Among 81 145 drivers (49 838 male [61.4%]) involved in fatal crashes, there were 9809 teen drivers (mean [SD] age, 17.2 [0.9] years) and 71 336 middle-aged drivers (mean [SD] age, 41.7 [7.3] years). A higher proportion of teen drivers were operating vehicles older than 15 years compared with middle-aged drivers (2706 drivers [27.6%] vs 16 239 drivers [22.8%]). Driving vehicles aged 6 to 15 years (adjusted risk ratio [aRR], 1.19; 95% CI, 1.17-1.22) or older than 15 years (aRR, 1.31; 95% CI, 1.28-1.34) was associated with significantly higher odds of driver death in fatal crashes compared with driving vehicles 5 years old or newer, independently of driver age. Additionally, each installed driver assistance technology was associated with a 6% reduction (aRR, 0.94; 95% CI, 0.90-0.98) in the risk of driver death in fatal crashes.
CONCLUSIONS AND RELEVANCE: These findings suggest that older vehicles and those with fewer driver assistance technologies are associated with increased risk of driver death in fatal crashes; thus, teens should drive the safest vehicles available, not older family cars. The findings underscore the urgent need to ensure teens drive safer vehicles to protect their lives.
PMID:40332934 | DOI:10.1001/jamanetworkopen.2025.8942
JAMA Netw Open. 2025 May 1;8(5):e259043. doi: 10.1001/jamanetworkopen.2025.9043.
ABSTRACT
IMPORTANCE: In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. Little is known about unintended outcomes of this guideline on analgesic prescribing for older adults with cancer, who commonly require opioids as first-line pain treatment.
OBJECTIVE: To determine whether the 2016 CDC guideline was associated with altered analgesic prescribing among older adults with cancer.
DESIGN, SETTING, AND PARTICIPANTS: Interrupted time series analysis of a longitudinal cohort using Medicare Current Beneficiary Survey (MCBS) dataset (2010-2020), a nationally representative longitudinal survey of Medicare beneficiaries linked to Medicare claims. MCBS participants older than 65 years who reported a non-skin cancer diagnosis were followed up for up to 4 years. Subgroup analysis conducted for those with poor prognosis cancer or a cancer-related pain encounter (advanced cancer/cancer pain). Data were analyzed from January 2023 to February 2025.
EXPOSURE: CDC Guideline for Prescribing Opioids for Chronic Pain publication in March 2016.
MAIN OUTCOMES AND MEASURES: Quarterly prescribing rates of opioids (typical opioids, tramadol, and buprenorphine) and gabapentinoids (gabapentin and pregabalin). For each time series analysis outcome, a level change estimated immediate change and trend (ie, slope) change estimated ongoing change following the guideline.
RESULTS: The cohort included 11 903 older adults with cancer (mean [IQR] age, 79.4 [73-85] years, 6504 [54.6%] women), including 1283 with advanced cancer or cancer pain. Compared with preguideline trends, we observed the following changes after the guideline release: the slope of opioid prescribing decreased (typical opioids: -0.47; 95% CI, -0.63 to -0.30 percentage points [pp]/quarter; tramadol: -0.27; 95% CI, -0.36 to -0.17 pp/quarter; buprenorphine: -0.01; 95% CI, -0.02 to -0.01 pp/quarter), though tramadol prescribing rose by 11.5% overall; and gabapentinoid prescribing increased by 24.9% (slope change, -0.03; 95% CI, -0.09 to 0.02 pp/quarter).
CONCLUSIONS AND RELEVANCE: In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in opioid prescribing that was less pronounced for tramadol compared with typical opioids and was followed by a 25% increase in gabapentinoid prescribing. This may reflect a shift in cancer pain management from first-line opioids to tramadol, which is less safe, and gabapentinoids, which have been shown to be less effective for cancer pain treatment.
PMID:40332933 | DOI:10.1001/jamanetworkopen.2025.9043
JAMA Surg. 2025 May 7. doi: 10.1001/jamasurg.2025.1072. Online ahead of print.
ABSTRACT
IMPORTANCE: Use of modern neoadjuvant chemotherapy (NAC) regimens has markedly increased rates of pathologic complete response (pCR) in breast cancer, raising the question of whether surgical removal of the primary tumor is required for patients with pCR. For surgery to be omitted, one must be able to accurately predict pCR before surgery.
OBJECTIVE: To investigate if adding post-NAC core needle biopsy of the tumor bed to trimodality imaging in patients who have clinical complete response (cCR) will predict pCR (resolution of both invasive disease and ductal carcinoma in situ) in 90% or more cases.
DESIGN, SETTING, AND PARTICIPANTS: This was a phase 2, prospective, nonrandomized clinical trial. Patients were enrolled from August 2017 to June 2019. This is the final analysis, which was completed in December 2023. The setting included academic and community hospital center members of NRG (ie, the National Surgical Adjuvant Breast and Bowel Project, the Radiation Therapy Oncology Group, and the Gynecologic Oncology Group) in the US and Canada. Patients with operable (T1-T3, stage I-III) invasive ductal carcinoma who completed NAC and achieved cCR and radiological complete response (rCR) or near rCR by mammography (mass ≤1 cm and no malignant microcalcifications), ultrasound (mass ≤2 cm), and magnetic resonance imaging (no mass with rapid rise or washout kinetics).
INTERVENTIONS: Patients underwent marker-directed stereotactic multiple-core needle biopsy of the tumor bed with marker placement before breast-conservation surgery.
MAIN OUTCOMES AND MEASURES: End points were negative predictive value (NPV) and sensitivity of the biopsy.
RESULTS: A total of 105 patients were enrolled with 101 evaluable (mean [SD] age, 52.8 [10.5] years); 77 patients (76.2%) were younger than 60 years, and all breast cancer subtypes were represented with 32 (31.7%) triple-negative breast cancer, 21 (20.8%) hormone receptor-positive/epidermal growth factor receptor 2 (ERBB2; formerly HER2)-negative (ERBB2-) breast cancer, and 46 (45.5%) ERBB2-positive (ERBB2+) breast cancer. In 101 evaluable patients, 36 had residual disease at surgery (pCR = 64%). With imaging criteria, NPV of the biopsy was 78.3% (95% CI, 67.9%-86.6%), and the sensitivity of the biopsy was 50% (95% CI, 32.9%-67.1%). In an exploratory subset analysis, the NPV in patients with ERBB2+ breast cancer was 90% (95% CI, 76.3%-97.2%). On retrospective central review, 62 of 101 enrolled patients met imaging eligibility criteria. In this exploratory post hoc analysis, NPV in these patients was 86.8% (95% CI, 74.7%-94.5%).
CONCLUSIONS AND RELEVANCE: These findings do not support breast conservation treatment without surgery based on the study criteria for cCR and rCR/near rCR by trimodality imaging and negative tumor-bed biopsy. Strict adherence to imaging criteria may be required to achieve acceptable predictive values.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03188393.
PMID:40332918 | DOI:10.1001/jamasurg.2025.1072