Tag: nevin manimala

Aliment Pharmacol Ther. 2025 Jan 7. doi: 10.1111/apt.18459. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in the United Kingdom and the second largest cause of cancer death.

AIM: To develop and validate a model using available information at the time of faecal immunochemical testing (FIT) in primary care to improve selection of symptomatic patients for CRC investigations.

METHODS: We included all adults (≥ 18 years) referred to Nottingham University Hospitals NHS Trust between 2018 and 2022 with symptoms of suspected CRC who had a FIT. Predicted 1-year CRC diagnosis were calculated, and externally validated, using Cox proportional hazards modelling with selected multiple fractional polynomial transformations for age, faecal haemoglobin concentration (f-Hb) value, mean corpuscular volume (MCV), platelet count and sex.

RESULTS: At a CRC risk threshold of 0.6% (equivalent to f-Hb = 10 μg Hb/g (μg/g)) overall performance of the validated model across age strata using Harrell’s C index was ≥ 0.91% (overall C-statistic 93%, 95% CI 92%-95%) with acceptable calibration. Using this model yields similar numbers of detected and missed cancers, but requires ~20% fewer investigations than a f-Hb ≥ 10 μg/g strategy. For approximately 100,000 people per year with symptoms of suspected CRC, we predict it might save > 4500 colonoscopies with no evidence that more cancers would be missed if we used our model compared to using FIT f-Hb ≥ 10 μg/g.

CONCLUSIONS: Including age, sex, MCV, platelets and f-Hb in a survival analysis model to predict the risk of CRC yields greater diagnostic utility than a simple binary cut off f-Hb ≥ 10 μg/g.

PMID:39764729 | DOI:10.1111/apt.18459

J Osteopath Med. 2025 Jan 8. doi: 10.1515/jom-2024-0158. Online ahead of print.

ABSTRACT

CONTEXT: The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges.

OBJECTIVES: This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors.

METHODS: A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15-30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher’s exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different.

RESULTS: Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission.

CONCLUSIONS: Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

PMID:39764726 | DOI:10.1515/jom-2024-0158

J Osteopath Med. 2025 Jan 8. doi: 10.1515/jom-2024-0046. Online ahead of print.

ABSTRACT

CONTEXT: Point-of-care ultrasound (POCUS) has diverse applications across various clinical specialties, serving as an adjunct to clinical findings and as a tool for increasing the quality of patient care. Owing to its multifunctionality, a growing number of medical schools are increasingly incorporating POCUS training into their curriculum, some offering hands-on training during the first 2 years of didactics and others utilizing a longitudinal exposure model integrated into all 4 years of medical school education. Midwestern University Arizona College of Osteopathic Medicine (MWU-AZCOM) adopted a 4-year longitudinal approach to include POCUS education in 2017. There is a small body of published research supporting this educational model, but there is not much data regarding how this approach with ultrasound curriculum translates to real-world changes in POCUS use by graduate student clinicians having received this model of education.

OBJECTIVES: The objectives of this study are to determine the frequency of POCUS use by MWU-AZCOM graduates and to assess how a 4-year longitudinal ultrasound curriculum may enhance the abilities of MWU-AZCOM graduates to perform and interpret ultrasound imaging in specific residency programs.

METHODS: The study was approved by the MWU Institutional Review Board (#IRBAZ-5169, approval date October 3, 2022). An anonymous novel 12-question survey was conducted utilizing Research Electronic Data Capture (REDCap), a secure online platform, and distributed to MWU-AZCOM 2021 and 2022 graduates via email. Survey questions were aimed at assessing frequency of use, utilization of different imaging modalities, reasons for utilizing POCUS, barriers/enablers to utilizing POCUS, ultrasound training, and confidence in performing scans and interpreting POCUS imaging. All of the 104 surveys returned were included in the study. Statistical software R version 4.3 was utilized to conduct statistical analyses.

RESULTS: Of the 484 surveys distributed, 104 were completed (21.5 % response rate). Responses came from residents working in 14 different specialties, 50 in primary care and 54 in nonprimary care. Of all respondents, 85.6 % currently utilize POCUS in their practice on at least a monthly basis and 77.0 % believe that their POCUS training in medical school enriches their current practice in residency. The top five modalities utilized by residents were procedures (89.9 %), cardiac (88.8 %), pulmonary (82.0 %), Focused Assessment with Sonography for Trauma (FAST, 73.0 %), and vascular (71.9 %). Respondents recognized POCUS as a beneficial diagnostic tool (97.8 %) and reported enhancements in physical examination skills (58.4 %) and professional growth (61.8 %). Facilitators for POCUS adoption included cost-effectiveness (82.0 %), diagnostic differentiation (78.7 %), and safety (79.8 %). Barriers included a lack of trained faculty (27.9 %), absence of necessary equipment (26.9 %), and cost of equipment (22.1 %). Participants demonstrated high confidence levels in performing (74.0 %) and interpreting (76.0 %) POCUS, with 43.3 % believing that their POCUS training enhanced their attractiveness as residency candidates.

CONCLUSIONS: This study supports the positive impact of a 4-year longitudinal POCUS curriculum on graduates’ practice. It emphasizes the link between MWU-AZCOM’s curriculum and real-world clinical needs. Addressing identified barriers and advancing hands-on training can further enhance POCUS understanding, ensuring that future physicians are well-prepared to leverage its diagnostic potential across medical specialties.

PMID:39764717 | DOI:10.1515/jom-2024-0046

Genet Epidemiol. 2025 Jan;49(1):e22607. doi: 10.1002/gepi.22607.

ABSTRACT

Large-scale gene-environment interaction (GxE) discovery efforts often involve analytical compromises for the sake of data harmonization and statistical power. Refinement of exposures, covariates, outcomes, and population subsets may be helpful to establish often-elusive replication and evaluate potential clinical utility. Here, we used additional datasets, an expanded set of statistical models, and interrogation of lipoprotein metabolism via nuclear magnetic resonance (NMR)-based lipoprotein subfractions to refine a previously discovered GxE modifying the relationship between physical activity (PA) and HDL-cholesterol (HDL-C). We explored this GxE in the Women’s Genome Health Study (WGHS; N = 23,294; the strongest cohort-specific signal in the original meta-analysis), the UK Biobank (UKB; N = 281,380), and the Multi-Ethnic Study of Atherosclerosis (MESA; N = 4587), using self-reported PA (MET-min/wk) and genotypes at rs295849 (nearest gene: LHX1). As originally reported, minor allele carriers of rs295849 in WGHS had a stronger positive association between PA and HDL-C (p_int = 0.002). When testing available NMR metabolites to refine the HDL-C outcome, we found a stronger interaction effect on medium-sized HDL particle concentrations (M-HDL-P; p_int = 1.0 × 10^-4) than HDL-C. Meta-regression revealed a systematically larger interaction effect in cohorts from the original meta-analysis with a greater fraction of women (p = 0.018). In the UKB, GxE effects were stronger in women and using M-HDL-P as the outcome. In MESA, the primary interaction for HDL-C showed nominal significance (p_int = 0.013), but without clear sex differences and with a greater magnitude for large HDL-P. Our work provides additional insights into a known gene-PA interaction while illustrating the importance of phenotype and model refinement toward understanding and replicating GxEs.

PMID:39764704 | DOI:10.1002/gepi.22607

Eur J Orthod. 2024 Dec 4;47(1):cjae077. doi: 10.1093/ejo/cjae077.

ABSTRACT

BACKGROUND/OBJECTIVES: Evidence suggests nasal airflow resistance reduces after rapid maxillary expansion (RME). However, the medium-term effects of RME on upper airway (UA) airflow characteristics when normal craniofacial development is considered are still unclear. This retrospective cohort study used computer fluid dynamics (CFD) to evaluate the medium-term changes in the UA airflow (pressure and velocity) after RME in two distinct age-based cohorts.

MATERIALS/METHODS: The study included 48 subjects who underwent RME divided into two cohorts: a 6-9-year-old group (EEG group: early expansion group – 25 subjects) and an 11-14-year-old group (LEG group: late expansion group – 23 subjects). The nasal cavity and pharyngeal anatomy were segmented from Cone-beam computed tomography reconstructions taken before RME (T0) and 12 after RME (T1). The two UA airflow variables (pressure and velocity) were simulated using CFD. The maxillary expansion (PW) amount, two cross-sectional area measurements (CS1 = anterior cross-section and CS2 = posterior cross-section), and four UAs’ subregions (NC = nasal cavity, PAtotal = pharyngeal airway, NP = nasopharynx, VP = velopharynx, and OP = Oropharynx) were also considered. All data were statistically analyzed.

RESULTS: At the baseline, the airflow pressure, velocity, and noted obstructions were significantly higher in the EEG compared to LEG. At T1, there was a significant improvement in the median airway parameters in both groups, which was remarkably greater in the EEG. A significant negative correlation was found between pressure/velocity and both CS2 and NP. According to the CFD plots, the airflow pressure and velocity changes could be attributed to the reduction of the adenotonsillar tissues’ sizes, which were remarkably more marked in the EEG.

LIMITATIONS: The results of this study cannot be generalized since they referred to a retrospective orthodontic sample without obstructive adenotonsillar hypertrophy.

CONCLUSIONS/IMPLICATIONS: Twelve months after RME, normal craniofacial developmental changes and spontaneous adenotonsillar tissues volume regression could represent the most significant factors influencing UA airflow changes.

PMID:39764702 | DOI:10.1093/ejo/cjae077

Macromol Biosci. 2025 Jan 7:e2400429. doi: 10.1002/mabi.202400429. Online ahead of print.

ABSTRACT

Invasive fungal infections cause over 3.7 million deaths worldwide annually, underscoring the critical need for new antifungal agents. Developing selective antifungal agents is challenging due to the shared eukaryotic nature of both fungal and mammalian cells. Toward addressing this, synthetic polymers designed to mimic host defense peptides are promising new candidates for combating fungal infections. This study investigates well-defined multiblock terpolymers with specific arrangements of cationic, hydrophobic, and hydrophilic groups, as potential antifungal agents. The block sequence in these copolymers significantly impacts their minimum inhibition concentration (MIC) against Candida albicans and biocompatibility. Furthermore, compared to their statistical counterparts, these block polymers exhibit lower MIC values in certain instances. Notably, triblock terpolymers containing a central hydrophobic block present an enhanced antifungal efficacy and biocompatibility. These findings highlight the potential of block sequence-controlled polymers as a versatile platform for developing customized and targeted antifungal therapies.

PMID:39764700 | DOI:10.1002/mabi.202400429

Scand J Gastroenterol. 2025 Jan 7:1-6. doi: 10.1080/00365521.2025.2450042. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluate the clinical significance of esophagogastric junction (EGJ) morphology and esophagogastric junction contractile integral (EGJ-CI) in refractory gastroesophageal reflux disease (RGERD) patients.

METHODS: From June 2021 to June 2023, 144 RGERD patients underwent comprehensive evaluation, recording symptom scores, demographic data. GERD classification (NERD or RE, A-D) was based on endoscopic findings. Reflux was assessed through 24-hour pH-impedance monitoring, and high-resolution esophageal manometry(HREM) measured parameters including EGJ-CI.

RESULTS: HREM revealed EGJ morphologies (type I, II, III) in 80.6%, 13.9%, and 5.6% of subjects, respectively. As the separation between the lower esophageal sphincter(LES) and crural diaphragm(CD) increased, EGJ-CI decreased (p < 0.005). Subjects with EGJ morphology types II and III had significantly higher acid exposure times(AET), DeMeester scores, and impedance reflux times than type I (p < 0.05). There was no statistical difference between types II and III. Impedance reflux times in subjects with type III morphology were significantly higher than those with types I and II (p < 0.05). The optimal EGJ-CI cutoff for distinguishing pathological reflux was 24.8 mmHg·cm, with 68% sensitivity, 72.3% specificity, and an AUC of 0.693 (95% CI 0.609-0.768). Logistic regression analysis identified EGJ-CI <24.8 mmHg·cm (OR = 2.5, 95% CI 1.1-5.5, p = 0.022) and ineffective esophageal motility(IEM) (OR = 2.4, 95% CI 1.2-5.2, p = 0.027) as independent risk factors.

CONCLUSION: EGJ-CI is crucial for clinically assessing EGJ barrier function, predicting pathological reflux and selecting patients with persistent reflux symptoms for surgery.

PMID:39764668 | DOI:10.1080/00365521.2025.2450042

Hum Brain Mapp. 2025 Jan;46(1):e70130. doi: 10.1002/hbm.70130.

ABSTRACT

The brain develops most rapidly during pregnancy and early neonatal months. While prior electrophysiological studies have shown that aperiodic brain activity undergoes changes across infancy to adulthood, the role of gestational duration in aperiodic and periodic activity remains unknown. In this study, we aimed to bridge this gap by examining the associations between gestational duration and aperiodic and periodic activity in the EEG power spectrum in both neonates and toddlers. This cross-sectional study involved EEG data from 73 neonates (postnatal age 1-5 days, 40 females) and 56 toddlers (postnatal age of 2.9-3.2 years, 28 females) from the FinnBrain Birth Cohort Study. EEG power spectra were parameterized to aperiodic and periodic components using the SpecParam tool. We tested the associations between gestational duration as well as postnatal age and SpecParam parameters in neonates and toddlers while including birth weight and child sex as covariates. For neonates, multilevel models were employed, considering different data acquisitions (sleep and auditory paradigm + sleep), while in toddlers, regression models were used as only data from the auditory paradigm was available. We found that longer gestational duration was associated with a steeper power spectrum across EEG frequencies both in neonates and toddlers. Effect was especially strong in toddlers (β = 0.45, p = 0.004), while in neonates, it remained nearly statistically significant (p = 0.061). In neonates, a quadratic association between gestational duration and beta center frequency (12.5-30 Hz) was found. In toddlers, beta center frequencies were overall higher in females compared to males. Offset (calculated as the power of the aperiodic curve at 2.5 Hz) and theta center frequency had negative associations with postnatal age in neonates, but not in toddlers. Our results suggest that gestational duration may have significant and relatively long-lasting effects on brain physiology. The possible behavioral and cognitive consequences of these changes are enticing topics for future research.

PMID:39764646 | DOI:10.1002/hbm.70130

Public Health Nutr. 2025 Jan 7:1-16. doi: 10.1017/S1368980024002611. Online ahead of print.

ABSTRACT

OBJECTIVE: The public health nutrition workforce is well-placed to contribute to bold climate action, however tertiary educators are seeking practical examples of how to adequately prepare our future workforce. This study examines the responses of university students engaged in a co-designed planetary health education workshop as part of their public health nutrition training.

DESIGN: A mixed-methods approach was used to collect and interpret student responses to four interactive tasks facilitated during an in-person workshop. Data were analysed using statistical tests, frequency counting and content analysis.

SETTING: The intervention was co-designed by students (n = 5) and an educator over a 4-week period as part of a larger multi-disciplinary study at an Australian university.

PARTICIPANTS: The workshop engaged nutrition and dietetics students (n = 44) enrolled in public health nutrition coursework.

RESULTS: Students’ reported an increase in self-perceived knowledge about planetary health as a concept and how they can promote it within their future professional roles. Students’ descriptions of what planetary health means to them were focused on humans’ role in protecting and preserving the ecosystem, the responsible and sustainable use of natural resources and a need to sustain a healthy life for future generations. Students prioritised the values of ‘collaboration’ and ‘respect’ as being critical to guide personal and professional practice to promote planetary health.

CONCLUSIONS: This study demonstrated that incorporating planetary health curricula designed by, and for, university students could be a feasible and effective way to prepare the future public health nutrition workforce to address planetary health challenges.

PMID:39764641 | DOI:10.1017/S1368980024002611

Int J Surg. 2025 Jan 7. doi: 10.1097/JS9.0000000000002144. Online ahead of print.

ABSTRACT

BACKGROUND: The inclusion of clinical frailty in the assessment of patients planned for major surgery has proven to be an independent predictor of outcome. Since approximately half of all patients in the UK diagnosed with oesophagogastric (OG) cancer are over 75 years of age, assessment of frailty may be important in selection for surgery.

MATERIALS AND METHODS: This retrospective cohort study applied the Hospital Frailty Risk Score to data obtained from the NHS Secondary Uses Service electronic database for patients aged 75 years or older undergoing oesophagectomy and gastrectomy between April 2017 and March 2020. Descriptive statistics were performed to assess the effect of patient frailty on length of stay, 30-day readmission, and 30-day mortality rates. These outcomes were compared with those published by the National Oesophago-Gastric Cancer Audit.

RESULTS: Over 90% of the 1775 patients identified according to the age and resection criteria exhibited some degree of frailty. The median length of stay and 30-day readmission rate increased as patient frailty increased following both oesophagectomy and gastrectomy, as did the 30-day mortality rate following gastrectomy.

CONCLUSION: Frailty is a dynamic state and increasing age alone should not be a barrier to receiving the most appropriate treatment. Introducing standardized assessment of clinical frailty for patients with OG cancer to identify this cohort of patients earlier might enable targeted screening for frailty syndromes. This could facilitate the enhanced delivery of more holistic, frailty-attuned, approaches to person-centred care, and evidence-based treatment pathways for improved patient outcomes.

PMID:39764586 | DOI:10.1097/JS9.0000000000002144