Tag: nevin manimala

Vet Ital. 2025 Dec 9;61(4). doi: 10.12834/VetIt.3739.35888.2.

ABSTRACT

Urban pigeon populations pose significant challenges in cities worldwide, contributing to structural damage, health concerns, and environmental imbalances. Since 2005, the Municipality of Genoa has implemented a targeted pigeon control programme utilising Nicarbazin, a sterilising agent that inhibits egg fertilisation. This study assesses the effectiveness of the sterilisation strategy in the Circonvallazione a Monte district from 2010 to 2017, analysing population trends and behavioural responses across various feeding points. Using a combination of statistical methods, including Duncan’s test, ANOVA, and time series analysis, we identify significant declines in pigeon numbers and the emergence of distinct population dynamic patterns. Results indicate that while pharmacological sterilisation effectively reduces populations, its success varies depending on local environmental factors, nesting availability, and unauthorised feeding. The study suggests that an integrated approach, combining reproductive control with habitat modification and public awareness initiatives, is essential for long-term pigeon population management. Our findings contribute to the growing body of research on humane and sustainable urban wildlife control.

PMID:41364501 | DOI:10.12834/VetIt.3739.35888.2

Stat Methods Med Res. 2025 Dec 9:9622802251399913. doi: 10.1177/09622802251399913. Online ahead of print.

ABSTRACT

The expectation-maximization (EM) algorithm is a popular tool for maximum likelihood estimation, but its use in high-dimensional regularization problems in linear mixed-effects models has been limited. In this article, we introduce the EMLMLasso algorithm, which combines the EM algorithm with the popular and efficient R package glmnet for Lasso variable selection of fixed effects in linear mixed-effects models and allows for automatic selection of the tuning parameter. A comprehensive performance evaluation is conducted, comparing the proposed EMLMLasso algorithm against two existing algorithms implemented in the R packages glmmLasso and splmm. In both simulated and real-world applications analyzed, our algorithm showed robustness and effectiveness in variable selection, including cases where the number of predictors $\left(p\right)$ is greater than the number of independent observations $\left(n\right)$. In most evaluated scenarios, the EMLMLasso algorithm consistently outperformed both glmmLasso and splmm. The proposed method is quite general and simple to implement, allowing for extensions based on ridge and elastic net penalties in linear mixed-effects models.

PMID:41364493 | DOI:10.1177/09622802251399913

JAMA Netw Open. 2025 Dec 1;8(12):e2547111. doi: 10.1001/jamanetworkopen.2025.47111.

ABSTRACT

IMPORTANCE: Aortic stenosis (AS) and obstructive coronary artery disease (CAD) often coexist, yet the impact of obstructive CAD on clinical and patient-reported outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) remains a subject of ongoing debate.

OBJECTIVES: To investigate the association of obstructive CAD with clinical outcomes and health status among patients with symptomatic severe AS undergoing TAVR.

DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis of the investigator-initiated, multicenter SCOPE I (Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis for Transcatheter Aortic Valve Implantation by Transfemoral Approach) randomized clinical trial was conducted at 20 tertiary heart centers in Europe from February 8, 2017, to February 2, 2019, with follow-up through 3 years. Data were analyzed from February 17 through August 13, 2025.

EXPOSURE: Presence vs absence of obstructive CAD, defined as greater than 50% stenosis in at least 1 major epicardial coronary vessel.

MAIN OUTCOMES AND MEASURES: Parameters of interest included vital and patient-reported disease-specific health status (Kansas City Cardiomyopathy Questionnaire [KCCQ] scores, ranging from 0 to 100, with higher numbers indicating better health status), and clinical efficacy according to Valve Academic Research Consortium (VARC)-3 definitions. Analyses were conducted using the as treated population.

RESULTS: Of 732 patients with symptomatic severe AS undergoing TAVR (mean [SD] age, 82 [4] years; 416 [56.8%] female), obstructive CAD was identified in 373 (51.0%), 144 (38.6%) of whom underwent elective percutaneous coronary intervention (PCI) during the periprocedural period. At 3 years after TAVR, there were no statistically significant differences in patient-reported health status (eg, median [IQR] baseline overall KCCQ scores with CAD, 54.2 [40.3-69.8] vs without CAD, 55.2 [38.5-72.9] and at 3-year follow-up with CAD, 79.7 [64.4-90.6] vs without CAD, 82.3 [68.2-91.7]), mortality (all-cause death: 88 of 373 [24.7%] vs 76 of 359 [22.3%], adjusted hazard ratio, [HR], 0.97 [95% CI, 0.66-1.43]; cardiovascular death: 59 of 373 [17.6%] vs 51 of 359 [15.5%], adjusted HR, 0.87 [95% CI, 0.54-1.42]), and clinical efficacy of TAVR (163 of 313 [52.1%] vs 159 of 298 [53.4%]; adjusted risk ratio, 1.10 [95% CI, 0.92-1.32]) between patients with vs without obstructive CAD. Having (vs not having) obstructive CAD was associated with a numerically albeit not statistically significantly higher risk of myocardial infarction (18 of 372 [5.5%] vs 3 of 359 [1.1%]; adjusted HR, 3.83 [95% CI, 0.96-15.31]). Periprocedural PCI among patients with obstructive CAD did not improve clinical outcomes, patient-reported health status, nor the integrated end points of clinical outcomes and quality of life measures.

CONCLUSIONS AND RELEVANCE: In this post hoc analysis of SCOPE I, patients with obstructive CAD who underwent TAVR had no statistically significant differences in survival, patient-reported health status, or VARC-3 clinical efficacy compared with patients without CAD through 3 years of follow-up. Findings suggest that a tailored approach may be essential in the treatment of TAVR candidates with severe AS and CAD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03011346.

PMID:41364435 | DOI:10.1001/jamanetworkopen.2025.47111

JAMA Netw Open. 2025 Dec 1;8(12):e2547831. doi: 10.1001/jamanetworkopen.2025.47831.

ABSTRACT

IMPORTANCE: Second primary cancers are an important cause of morbidity, mortality, and resource use among lung cancer survivors, yet their risk relative to recurrence and their determinants have been incompletely defined.

OBJECTIVES: To quantify the competing risks of recurrence, intrathoracic new cancer (locoregional or distant recurrences confined to the thorax and/or second primary lung cancers), and non-lung secondary cancers (NLSCs) after curative-intent local therapy for non-small cell lung cancer (NSCLC) and to identify clinical factors associated with NLSC.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included consecutive stage I to III NSCLC survivors treated with definitive local therapy and evaluated in a dedicated survivorship clinic at a single high-volume academic cancer center from January to May 2019. Follow-up was measured from completion of local therapy; eligible participants were disease-free 12 months or longer following curative-intent surgery or radiotherapy. Data were analyzed in October 2025.

EXPOSURES: Definitive local therapy (surgery or radiotherapy) for NSCLC followed by survivorship care.

MAIN OUTCOMES AND MEASURES: The outcomes were incidence and timing of recurrence, NLSC, intrathoracic new cancer, extrathoracic cancer, or death measured using nonparametric cumulative incidence functions (CIFs), with death as a competing event, and multivariable Fine-Gray and cause-specific Cox models for NLSC. Overall survival (OS) was estimated using the Kaplan-Meier method.

RESULTS: Among 496 survivors (58.5% female [290]; median [IQR] age, 69.1 [62.8-74.3] years), the median (IQR) follow-up was 71.6 (57.7-84.8) months. Of these patients, 367 (74.0%) were former smokers; the index cancer was adenocarcinoma in 372 (75.0%); 337 (67.9%) had stage I disease, 72 (14.5%) had stage II, and 87 (17.5%) had stage III. Recurrence occurred in 67 of 496 patients (13.5%). Secondary cancers developed in 116 of 496 patients (23.4%), including a new primary lung cancer in 77 of 496 patients (15.5%) and NLSC in 39 of 496 patients (7.9%). Median (IQR) time to diagnosis of an NLSC was 52.3 (35.9-65.6) months, and CIFs (competing risks) at 5 years (death and other first events treated as competing risks) were 11.5% for recurrence, 5.6% for NLSC, 16.8% for intrathoracic new cancer, and 10.4% for extrathoracic cancer. In Fine-Gray models, a hereditary syndrome and/or pathogenic germline variant was associated with higher risk for NLSC (subdistribution hazard ratio [SHR], 10.76; 95% CI, 4.62-25.06; P < .001), whereas pack-years (per 10) were not associated with higher risk (SHR, 1.00; 95% CI, 0.97-1.03; P = .85). Cause-specific Cox results were concordant (HR, 8.32; 95% CI, 3.14-22.02; P < .001).

CONCLUSIONS AND RELEVANCE: In this cohort study of NSCLC survivors, the risk of NLSC was clinically meaningful and distinct from intrathoracic new cancers. Genetic predisposition correlated with NLSC risk and should inform survivorship care pathways.

PMID:41364434 | DOI:10.1001/jamanetworkopen.2025.47831

JAMA Netw Open. 2025 Dec 1;8(12):e2547924. doi: 10.1001/jamanetworkopen.2025.47924.

ABSTRACT

IMPORTANCE: Older adults with metastatic solid cancers experience substantial treatment burdens. Advances in cancer therapeutics and evolutions in care over the years have changed the experience of cancer diagnosis and treatment, but it is unknown how health care contact days have evolved over time.

OBJECTIVE: To assess the burden of and trends in health care contact days among older adults diagnosed with 4 common metastatic cancers.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Surveillance, Epidemiology, and End Results-Medicare linked database to identify traditional Medicare beneficiaries 66 years and older who were diagnosed with metastatic breast, colorectal, lung, and prostate cancers from January 2008 to February 2019. Analyses were conducted from February 2024 to January 2025.

EXPOSURES: Cancer type and year of diagnosis.

MAIN OUTCOMES AND MEASURES: Health care contact days (sum of ambulatory [days with a clinician visit, test, imaging, procedure, or treatment] and institutional [days in a hospital, emergency department, skilled nursing facility, or inpatient hospice] days) in the year after diagnosis were assessed. Changes in contact days over time were examined using multivariable negative binomial regression models.

RESULTS: A total of 55 806 beneficiaries (14 827 [26.6%] diagnosed at 71-75 years of age; 29 347 [52.6%] male) with metastatic cancer (6495 breast, 10 232 colorectal, 27 340 lung, and 11 739 prostate) who survived 1 year or more after diagnosis were studied. In the year after diagnosis, beneficiaries with colorectal cancer had the highest mean (SD) contact days (62.9 [48.1]), followed by those with lung (60.2 [47.0]), breast (48.7 [47.9]), and prostate (40.1 [42.4]) cancers. Across all cancer types, mean contact days increased from 2008 to 2019 with a prominent increase in ambulatory days from 2016 onward; the largest increase in contact days was observed for breast cancer (44.9 [95% CI, 38.7-52.2] to 57.6 [95% CI, 46.9-70.8]).

CONCLUSIONS AND RELEVANCE: This cohort study of older traditional Medicare beneficiaries who were diagnosed with common metastatic cancers found a mean of 40.1 to 62.9 health care contact days in the year after diagnosis. Health care contact days increased from 2008 to 2019, suggesting that treatment advancements and/or care inefficiencies may have imposed additional burdens on beneficiaries.

PMID:41364432 | DOI:10.1001/jamanetworkopen.2025.47924

Plast Reconstr Surg. 2025 Dec 9. doi: 10.1097/PRS.0000000000012703. Online ahead of print.

ABSTRACT

PURPOSE: GLP-1 agonists have gained FDA approval for managing type 2 diabetes. However, they have been increasingly utilized for their weight loss side effect profile. Although of low incidence rate, surgical site wound complications have been observed in patients using these medications. Given the paucity of literature on weight loss medications and its implications in plastic surgery, this study aims to evaluate the impact of weight loss medication on postoperative surgical site outcomes in patients undergoing common plastic and reconstructive procedures.

METHODS: The TriNetX National Health Research database was queried to identify patients undergoing panniculectomy, abdominoplasty, and breast reduction. Patients with diabetes, peripheral vascular diseases, nutritional/metabolic/endocrine diseases, history of cancer, and smokers were excluded. Propensity matching analysis was performed to balance the cohorts. Postoperative outcomes, specifically surgical wound infections, breakdown, or dehiscence within 30 days post-procedure were assessed based on patients’ GLP-1 agonist use status.

RESULTS: The risk of surgical site wound healing complications in patients taking GLP-1 agonists compared to those not on these medications was statistically significantly higher before cohort matching as well as after matching. Matched cohorts: 4.7% vs. 2.7% for panniculectomy (p = 0.05), 9.8% vs. 3.6% for abdominoplasty (p=0.001), and 2.6 % vs. 1.3% for breast reduction (p=.035), respectively.

CONCLUSIONS: Patients using GLP-1 agonists were associated with higher rates of surgical site complications across all evaluated procedures. This underscores the necessity of patient counseling regarding the implications of these weight loss medications prior to surgery, along with the potential need for a strategic perioperative management plan to enhance surgical outcomes.

PMID:41364427 | DOI:10.1097/PRS.0000000000012703

Obes Surg. 2025 Dec 9. doi: 10.1007/s11695-025-08278-6. Online ahead of print.

ABSTRACT

Obesity is a chronic, systemic disease that alters the function of tissues, organs, and overall health, requiring prompt recognition and treatment by qualified professionals. IFSO recognizes the need to provide a new methodology for developing IFSO position statements. All new official position statements should be developed using a GRADE-based methodology, systematically reviewing all available evidence relevant to Metabolic and Bariatric Surgery (MBS). The present Position Statement was developed using results coming from a systematic review and meta-analysis, reported herein, following the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fourteen Randomized controlled trials (RCTs) were included in this meta-analysis, 13 and 1 of them assessing outcomes of OAGB in primary and revisional setting respectively, with a total of 1288 patients. In the short term, OAGB exhibited a significantly higher excess weight loss percentage (EWL%) compared to RYGB. Regarding weight loss and metabolic outcomes, OAGB was not reported to be inferior in terms of weight loss and T2DM resolution when compared to RYGB. Further RCTs comparing OAGB to other MBS procedures are needed to reach a definitive recommendation regarding OAGB in revisional surgery setting. Regarding safety profile, no statistically significant differences between OAGB and other MBS were reported. This position statement was issued by the IFSO OAGB task force and approved by IFSO Scientific Committee aims to provide evidence on the effectiveness of One Anastomosis Gastric Bypass in both primary and revisional settings.

PMID:41364417 | DOI:10.1007/s11695-025-08278-6

J Robot Surg. 2025 Dec 9;20(1):71. doi: 10.1007/s11701-025-03037-2.

ABSTRACT

To evaluate trifecta achievement and identify predictors of successful outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN) for stage I renal cell carcinoma (RCC) using the Medtronic Hugo™ robotic-assisted surgery (RAS) system, and to compare findings with contemporary literature using the da Vinci and other robotic platforms. This prospective observational study enrolled 77 patients with clinically staged T1 RCC undergoing RAPN using the Hugo™ RAS system at a single tertiary institution between August 2023 and March 2025. The primary endpoint was attainment of trifecta outcome. The trifecta outcome was defined as negative surgical margins, warm ischaemia time (WIT) ≤25 min, and absence of complications (Clavien-Dindo grade ≥ III) within 3 months. Patient demographics, tumour characteristics (including R.E.N.A.L. nephrometry score (RNS)), intraoperative variables, and perioperative outcomes were systematically recorded. Univariate and multivariate logistic regression analyses identified independent predictors of trifecta success using the new robotic system. Contemporary literature was reviewed for comparative analysis. Trifecta was achieved in 62 of 77 patients (80.5%; 95% CI: 69.9-88.1%). Mean patient age was 52.2 ± 13.5 years (81% male); mean tumor size was 3.6 ± 1.3 cm. The majority of tumors were T1a (67.5%) with intermediate complexity (50.6%). Median WIT was 22 (range 12-35) minutes; median R.E.N.A.L. nephrometry score (RNS) was 7 (4-10). All 36 patients with low RNS complexity achieved trifecta, whereas none of the 2 patients with high complexity did (p < 0.001). RNS was the only independent predictor of trifecta achievement on multivariate analysis (OR: 0.35; 95% CI: 0.18-0.68; p = 0.002). No positive surgical margins were identified. Two patients experienced Clavien-Dindo grade III complications (hematuria with clot retention), both managed endoscopically. No intraoperative conversions or perioperative deaths occurred. Postoperative creatinine changes were significantly lower in trifecta-achieved patients (0.12 ± 0.22 mg/dL, 14.1% increase) compared to non-trifecta patients (0.38 ± 0.39 mg/dL, 40.5% increase; p = 0.018), demonstrating enhanced renal functional preservation with successful trifecta achievement. The 80.5% trifecta rate with Hugo™ RAS compares favorably to published da Vinci RAPN series (60-70%) and approaches the 92.6% rate reported in the initial Hugo™ LPN vs. RAPN comparative study. RNS and complexity stratification emerged as the only significant independent predictor, consistent with findings from da Vinci series (Sharma et al.: 60.9%; Furukawa et al.: 62.1%; Kim et al.: 65% in T1a subset) but superior to some published cohorts. RAPN using the Hugo™ RAS system demonstrates high trifecta achievement rates (80.5%) in stage I RCC, with tumor complexity as assessed by R.E.N.A.L. nephrometry score emerging as the critical independent predictor of surgical success. These outcomes compare favorably with, or exceed, published da Vinci series and support the feasibility and safety of the Hugo™ RAS system in the Indian surgical setting. The consistency of RNS as a predictor across multiple robotic platforms suggests that preoperative anatomical assessment should guide patient selection and surgical planning. Multi-institutional studies with extended follow-up and direct head-to-head comparisons are warranted.

PMID:41364415 | DOI:10.1007/s11701-025-03037-2

Ir J Med Sci. 2025 Dec 9. doi: 10.1007/s11845-025-04193-y. Online ahead of print.

ABSTRACT

PURPOSE: Thirst is common and distressing symptom among critically ill patients, yet its risk factors remain unclear. This review evaluates associations between clinical factors-including age, opioid use, ASA classification, diuretic use, oral rehydration practices, and NPO status-and thirst in critically ill and surgical patients.

METHODS: We systematically searched PubMed, EMBASE, Scopus, Web of Science, CNKI, and the Cochrane Library from inception to March 2025. Studies assessing risk factors for thirst using validated scales were included. Data extraction was performed independently by two reviewers. Pooled estimates were calculated using random-effects models with DerSimonian-Laird estimation, and heterogeneity was evaluated via Cochran’s Q and I² statistics. Publication bias was assessed using Doi plots.

RESULTS: Fifteen studies were included. Meta-analysis of 10 studies comparing age (N = 5644) yielded a weighted mean difference (WMD) of 1.080 years (95%CI: -0.673 to 2.833; p = 0.227; I² = 83%). Analysis of 5 studies on opioid use (N = 1636) showed a pooled odds ratio (OR) of 1.84 (95%CI: 0.95-3.56; p = 0.071; I² = 63%). For ASA classification (5 studies), the pooled OR was 1.196 (95%CI: 0.910-1.482; p < 0.001). Similarly, pooled ORs for diuretic use (1.286; 95%CI: 0.676-2.447), oral rehydration (0.815; 95%CI: 0.362-1.835), and NPO status (0.757; 95%CI: 0.195-2.948) were non-significant.

CONCLUSIONS: Although trends suggest that factors such as opioid use and higher ASA classification may increase odds of thirst, no single risk factor consistently predicts thirst among critically ill patients. Substantial heterogeneity across studies and potential publication bias underscore the need for further well-designed research to clarify these associations.

PMID:41364408 | DOI:10.1007/s11845-025-04193-y

Menopause. 2025 Dec 9. doi: 10.1097/GME.0000000000002708. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the relationship of anxiety and depression with menopausal symptoms in postmenopausal women.

METHODS: This descriptive, cross-sectional study was conducted with 236 postmenopausal women aged 45-65 years. Data were collected using the Personal Information Form, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Menopause Symptom Assessment Scale. Descriptive statistics, Pearson correlation analysis, and multivariable-adjusted linear analysis were employed for the statistical evaluation of the data. The models were adjusted for the following covariates: age, educational status, income status, marital status, number of living children, presence of chronic disease, body mass index, duration of menopause, and perception of the menopausal period.

RESULTS: A statistically significant positive correlation was found between anxiety and menopausal symptoms (r=0.623, P<0.001). Multivariable-adjusted linear regression analysis indicated that a one-unit increase in anxiety was associated with a 0.424-unit increase in menopausal symptom scores (B=0.424, P<0.001). Similarly, a statistically significant positive correlation was observed between depression and menopausal symptoms (r=0.442, P<0.001). A one-unit increase in depression was associated with a 0.416-unit increase in menopausal symptom scores (B=0.416, P<0.001).

CONCLUSIONS: In conclusion, a significant relationship was found between anxiety and depression and menopausal symptoms. This finding highlights the importance of not overlooking psychological factors such as anxiety and depression when evaluating menopausal symptoms in postmenopausal women.

PMID:41364387 | DOI:10.1097/GME.0000000000002708