Tag: nevin manimala

J Pediatr Urol. 2025 Mar 4:S1477-5131(25)00130-5. doi: 10.1016/j.jpurol.2025.02.039. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the short-term efficacy of modified plate reconstruction and tubularization urethroplasty for posterior hypospadias.

MATERIAL AND METHOD: We retrospectively collected the clinical data of posterior hypospadias patients who were newly diagnosed and underwent plate reconstruction and tubularization urethroplasty (PRTU) or modified PRTU. Surgical modifications were to reconstruct the glans segment of the urethra with a free flap, thus presenting an orthotopic urethral opening, and to preserve the Buck’s fascia at the coronal sulcus for approximately 1 cm to enhance coverage of the shaped urethra. Regular follow-up was taken in clinic or online. We compared complication rate, HOSE score and uroflowmetry testing results between these two groups.

RESULTS: A total of 107 children underwent either PRTU or modified PRTU, and 102 of them were fully followed-up (55 cases of PRTU and 47 cases of modified PRTU). All of the patients were diagnosed with posterior hypospadias. The age at operation ranged from 1 year to 1 month to 14 years old (mean age 3 years and 2 months). The postoperative follow-up period ranged from six to 63 months, with an average follow-up period of 23.2 months, and 102 patients provided comprehensive post-operative data, exhibiting a comprehensive follow-up rate of 95.3 %. There’s a statistically significant difference in the incidence of dehiscence of urethra between PRTU group (10 cases) and modified PRTU group (2 cases).

CONCLUSION: Modified PRTU is a safe, practical, and effective method for hypospadias. This procedure is appropriate for repairing posterior-type hypospadias combined with penoscrotal transposition, while reducing the risk of postoperative urethral dehiscence and achieve good appearance.

PMID:40102138 | DOI:10.1016/j.jpurol.2025.02.039

Transplant Proc. 2025 Mar 17:S0041-1345(25)00147-2. doi: 10.1016/j.transproceed.2025.01.008. Online ahead of print.

ABSTRACT

BACKGROUND: Nonadherence to immunosuppressive therapy after heart transplantation, driven by factors such as patient, caregiver, institutional, policy-related issues, and health literacy, leads to rejection and increased mortality. This study aimed to investigate the relationship between health literacy and adherence to immunosuppressive therapy in heart transplant patients.

METHODS: The sample of this cross-sectional study consisted of 57 patients who underwent heart transplantation in a university hospital in Izmir, Turkey. “Sociodemographic and Descriptive Characteristics Form”, “Data on Immunosuppressive Drug Therapy Form”, “Rapid Estimate of Adult Health Literacy in Medicine (REALM) Scale”, and “Immunosuppressive Therapy Adherence Scale (ITAS)” were used to collect the data..

RESULTS: The median score on the REALM scale was 64.00 (IQR = 3.00, min = 18.00, max = 66.00) and 80.7% of the patients scored adequately. The median score of the immunosuppressive therapy adherence scale was 11.00 (IQR= 1.00, min= 5.00, max= 12.00) and 42.1% of the patients scored full score. There was no statistically significant relationship between the median total scores of the REALM and ITAS scales in heart transplant patients (r = 0.181, P = .178).

CONCLUSIONS: In this study, the majority of heart transplant patients had adequate health literacy. It was found that less than half of these patients adhered to immunosuppressive therapy. Less than half of these patients were found to comply with immunosuppressive therapy. In this study, no relationship was found between health literacy and adherence to immunosuppressive therapy.

PMID:40102130 | DOI:10.1016/j.transproceed.2025.01.008

Transplant Proc. 2025 Mar 17:S0041-1345(25)00140-X. doi: 10.1016/j.transproceed.2025.02.051. Online ahead of print.

ABSTRACT

BACKGROUND: Liver failure constitutes a critical medical condition marked by the rapid decline in hepatic functions. Novel therapeutic approaches, including therapeutic plasma exchange (TPE) and continuous venovenous hemodiafiltration (CVVHDF), have emerged as promising modalities for mitigating the effects of this condition by facilitating detoxification and enhancing liver function. The efficacy of these interventions, whether administered individually or in combination, is a prominent area of investigation in the management of liver failure among adult populations. This study aims to evaluate the role and effectiveness of TPE, both as a standalone treatment and in conjunction with CVVHDF, in the management of liver failure in adult patients.

METHODS: This retrospective study was conducted in a Liver Transplant Intensive Care Unit (LTICU), focusing on the medical records of adult patients aged 35 to 62 years. The patient cohort consisted of individuals admitted between January 1, 2021, and June 1, 2024, due to acute liver failure or acute-on-chronic liver failure. The analysis specifically included patients who underwent therapeutic plasma exchange (TPE) or those who received continuous renal replacement therapy in conjunction with TPE. For the statistical analysis, a P-value of less than .05 was deemed indicative of statistical significance. The study encompassed a total of 47 patients with liver failure, comprising 23 males and 24 females. Among these patients, 25 (53.2%) received only TPE, while 22 (46.8%) were treated with a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF).

RESULTS: In the cohort of patients who received only therapeutic plasma exchange (TPE), the median International Normalized Ratio (INR) improved significantly, decreasing from 2 (1.6-2.6) to 1.3 (1.1-1.7). Similarly, alanine aminotransferase levels reduced from 351 (66-1482) to 166 (71-367), while aspartate aminotransferase levels decreased from 259 (132-1392) to 86 (35-160). In the group receiving a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF), notable reductions were also observed: INR decreased from 3 (2.4-4.7) to 1.5 (1.3-2.4), alanine aminotransferase levels dropped from 691 (59-2397) to 162 (70-1060), and aspartate aminotransferase levels fell from 916 (134-1828) to 69 (45-503). These changes were statistically significant, with P-values of less than .05 for each parameter in both treatment groups. Overall, 21 patients achieved survival without requiring a liver transplant, while 7 patients underwent liver transplantation, resulting in a transplant-free survival rate of 44.7%.

CONCLUSION: The findings from our study on the management of liver failure in adults demonstrate that both therapeutic plasma exchange (TPE) administered alone and in conjunction with continuous venovenous hemodiafiltration (CVVHDF) are effective treatment modalities, particularly as a bridging strategy to liver transplantation. The observed transplant-free survival rate of 44.7% underscores the significant clinical advantages of these therapies. However, to enhance the validity of these results and their applicability in broader clinical contexts, additional multicenter studies are essential for further exploration of these treatment approaches in liver failure management.

PMID:40102129 | DOI:10.1016/j.transproceed.2025.02.051

Transplant Proc. 2025 Mar 17:S0041-1345(25)00151-4. doi: 10.1016/j.transproceed.2025.02.038. Online ahead of print.

ABSTRACT

BACKGROUND: Determining effective ways to make prognostic predictions after kidney transplantation of patients is essential for the management of patients. This study examines how the PNI score affects renal outcomes after kidney transplantation. The potential impact of PNI on renal function beyond the overall nutritional status was also examined.

METHODS: In this retrospective study, 100 kidney transplant patients were divided into three groups according to PNI scores: low (<40), intermediate (40-45) and high (>45). Demographic characteristics, clinical parameters, serum creatinine levels, estimated glomerular filtration rate (eGFR) and parenchymal thickness were evaluated. Logistic regression analysis was applied for the risk of graft rejection. Patients who were followed up for at least 6 months after kidney transplantation and had complete clinical data were included in the study. The mean follow-up period was 36 months (range: 6-60 months).

RESULTS: There was no statistically significant correlation between PNI scores and renal function (P > .05). The mean creatinine level was 1.73 ± 1.11 mg/dL in the low PNI group and 1.37 ± 0.52 mg/dL in the high PNI group. Although this difference was close to the limit of statistical significance, it was not significant (P = .083). In logistic regression analysis, no significant effect of PNI score on graft rejection was observed (OR: 1.0015, 95% CI: 0.7975-1.2576, P = .9899). However, age (OR: 0.9247, P = .0347) and serum creatinine levels (OR: 2.8396, P = .0151) significantly affected the risk of graft rejection. No significant effect of PNI score on complication rates was observed.

CONCLUSIONS: This study demonstrated that PNI score alone is not a sufficient predictor of renal prognosis and graft rejection risk after kidney transplantation. Factors such as age and serum creatinine levels were found to be more predictive of the risk of graft rejection.

PMID:40102127 | DOI:10.1016/j.transproceed.2025.02.038

Ann Rheum Dis. 2025 Mar 17:S0003-4967(25)00240-7. doi: 10.1016/j.ard.2025.02.011. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess construct validity, including known-group discrimination, of the currently available disease activity instruments assessing peripheral arthritis in spondyloarthritis (SpA).

METHODS: In this analysis from the Assessment of SpondyloArthritis International Society (ASAS)-PerSpA study, patients with a diagnosis of axial SpA, peripheral SpA, or psoriatic arthritis (PsA) were included. The disease activity instruments evaluated were the Patient Global Assessment (PGA), Bath Ankylosing Spondylitis Disease Activity Index, Axial Spondyloarthritis Disease Activity Score, Disease Activity Index for PsA (DAPSA), Swollen Joint Count (SJC), Tender Joint Count, Disease Activity Score (DAS) 28, DAS44, and C-reactive protein (CRP). Construct validity was assessed through correlations with external constructs (Bath Ankylosing Spondylitis Functional Index, ASAS Health Index, and Euro Quality of Life 5 Dimensions) and known-group discrimination (active/inactive disease based on a combination of PGA [≥5/<5]), and SJC (≥1/0 and ≥2/<2) was analysed using standardised mean differences (SMDs).

RESULTS: In total, 4121 patients were included (mean age 45 [SD, 14] years, 61% males). When assessing the construct validity through correlations with external constructs, all instruments performed excellently (100% hypotheses confirmed). When assessing known-group discrimination, all disease activity measures, except CRP, presented SMDs ≥ 0.8 (good discrimination), with higher SMDs observed for DAS28 followed by DAPSA. Results were similar across disease phenotypes. Considering all combinations of PGA and SJC to discriminate between active/inactive disease, a better performance was observed for the composite scores, including joint counts.

CONCLUSIONS: In our construct validity analysis, all disease activity instruments assessing peripheral arthritis had a good performance as reflected in the correlations with external constructs and the known-group discrimination. The highest discriminatory capacity to distinguish between ‘active/inactive disease’ was observed for composite scores, including joint counts, like DAS28 and DAPSA.

PMID:40102118 | DOI:10.1016/j.ard.2025.02.011

ISA Trans. 2025 Mar 11:S0019-0578(25)00145-4. doi: 10.1016/j.isatra.2025.03.004. Online ahead of print.

ABSTRACT

Deep learning has significantly advanced bearing fault diagnosis. Traditional models rely on the assumption of independent and identically distributed, which is frequently violated due to variations in rotational speeds and loads during bearing fault diagnosis. The fault diagnosis of the bearing based on representation learning lacks the consideration of spectrum knowledge and representation diversity under multiple working conditions. Therefore, this study presents a domain-invariant representation learning strategy (DIRLs) for diagnosing bearing faults across differing working conditions. DIRLs, by leveraging envelope spectrum knowledge distillation, captures the Fourier characteristics as domain-invariant features and secures robust health state representations by aligning high-order statistics of the samples under different working conditions. Moreover, an innovative loss function, which maximizes the two-paradigm metric of the health state representation, is designed to enrich representation diversity. Experimental results demonstrate an average AUC improvement of 28.6 % on the Paderborn-bearing dataset and an overall diagnostic accuracy of 88.7 % on a private bearing dataset, validating the effectiveness of the proposed method.

PMID:40102111 | DOI:10.1016/j.isatra.2025.03.004

Z Med Phys. 2025 Mar 17:S0939-3889(25)00034-0. doi: 10.1016/j.zemedi.2025.02.004. Online ahead of print.

ABSTRACT

This work demonstrated the development of a fast, deep-learning framework (DeepSMCP) to mitigate noise in Monte Carlo dose distributions (MC-DDs) of photon treatment plans with high statistical uncertainty (SU) and its integration into the Swiss Monte Carlo Plan (SMCP). To this end, a two-channel input (MC-DD and computed tomography (CT) scan) 3D U-net was trained, validated and tested (80%/10%/10%) on high/low-SU MC-DD-pairs of 106 clinically-motivated VMAT arcs for 29 available CTs, augmented to 3074 pairs. The model was integrated into SMCP to enable a “one-click” workflow of calculating and denoising MC-DDs of high SU to obtain MC-DDs of low SU. The model accuracy was evaluated on the test set using Gamma passing rate (2% global, 2 mm, 10% threshold) comparing denoised and low-SU MC-DD. Calculation time for the whole workflow was recorded. Denoised MC-DDs match low-SU MC-DDs with average (standard deviation) Gamma passing rate of 82.9% (4.7%). Additional application of DeepSMCP to 12 unseen clinically-motivated cases of different treatment sites, including treatment sites not present during training, resulted in an average Gamma passing rate of 91.0%. Denoised DDs were obtained on average in 35.1 s, a 340-fold efficiency gain compared to low-SU MC-DD calculation. DeepSMCP presented a first seamlessly integrated promising denoising framework for MC-DDs.

PMID:40102103 | DOI:10.1016/j.zemedi.2025.02.004

Farm Hosp. 2025 Mar 17:S1130-6343(25)00018-2. doi: 10.1016/j.farma.2025.02.011. Online ahead of print.

NO ABSTRACT

PMID:40102084 | DOI:10.1016/j.farma.2025.02.011

Dent Mater. 2025 Mar 18:S0109-5641(25)00287-8. doi: 10.1016/j.dental.2025.03.004. Online ahead of print.

ABSTRACT

OBJECTIVES: To compare the impact of neutral and acidic environments on wear resistance of lithium silicate glass-ceramics (LSGCs), with and without crystallization firing after manufacturing.

MATERIALS AND METHODS: Fifty-six specimens were tested in a two-body wear simulator and divided into seven groups. Four groups consisted of commercially available LSGC materials, each opposed to steatite antagonists. A fifth group included an LSGC material tested additionally in its fired state. A sixth group involved another LSGC material opposed to zirconia antagonists. A seventh group comprised zirconia specimens, opposed to steatite antagonists. All specimens underwent a two-body wear test with 250,000 cycles, a 5 kg load, and 1 mm lateral movement, while immersed in either neutral (pH 7) or acidic (pH 3) buffer solutions. Laser scanning microscopy, optical profilometry, and scanning electron microscopy were used to quantify and/or investigate the wear. Data were analyzed using one-way ANOVA.

RESULTS: LSGC materials exhibited significantly higher wear at pH 7 compared to pH 3 (p < 0.001). The greatest volume loss was observed in an unfired LSGC material (0.138 ± 0.039 mm³ at pH 3 vs. 0.495 ± 0.092 mm³ at pH 7). Steatite antagonists also suffered significantly greater wear at pH 7, with the highest antagonist wear recorded at 1.718 ± 0.068 mm³ . The wear mechanism caused by steatite antagonists differed from zirconia antagonists.

SIGNIFICANCE: Environmental conditions play a major role in the wear performance of LSGCs. Fully crystallized LSGC materials show similar susceptibility to environmental changes compared to LSGC materials requiring crystallization firing.

PMID:40102078 | DOI:10.1016/j.dental.2025.03.004

Womens Health Issues. 2025 Mar 17:S1049-3867(25)00029-5. doi: 10.1016/j.whi.2025.02.004. Online ahead of print.

ABSTRACT

OBJECTIVES: Georgia Title X sites serve over 160,000 patients per year, providing critical contraceptive access. The U.S. Medical Eligibility Criteria and Selected Practice Recommendations for Contraceptive Use (U.S. MEC SPR) are meant to increase contraception access, but few studies have explored U.S. MEC SPR implementation. This qualitative study aimed to understand Georgia Title X providers’ experiences with and attitudes toward U.S. MEC SPR implementation.

STUDY DESIGN: From March 2023 to December 2023, we conducted semi-structured interviews with 20 Georgia Title X providers. Participants also completed a short demographic survey. Transcripts were first assessed using rapid analysis techniques in Google Sheets, then analyzed more thoroughly with a thematic analysis approach in Dedoose. We calculated demographic descriptive statistics using SAS.

RESULTS: The sample was diverse in race but not gender; all participants identified as cisgender women. Interviews revealed that most participants learned about the guidelines in medical or nursing school. Notable benefits of using the U.S. MEC SPR included facilitating patient contraceptive education and building providers’ confidence in their prescribing skills. The only reported challenges were limited user-friendliness and limited information about certain medical conditions in the U.S. MEC. Participants had mixed experiences with clinic leadership prioritizing U.S. MEC SPR use but reported similar perceived patient barriers to care.

CONCLUSIONS: This study suggests that the U.S. MEC SPR can help Title X providers serve clients seeking contraception, but barriers to widespread implementation remain. Efforts to increase guidelines use should consider providers’ needs and preferences along with factors impacting patient access to contraceptive care.

PMID:40102077 | DOI:10.1016/j.whi.2025.02.004