Tag: nevin manimala

Braz J Cardiovasc Surg. 2025 Mar 18;40(2):e20230469. doi: 10.21470/1678-9741-2023-0469.

ABSTRACT

OBJECTIVE: To assess the technical feasibility and functional, metabolic, and structural myocardial integrity of the donor heart after four hours of direct coronary oxygen persufflation (COP).

METHODS: This research was carried out on three-month-old minipig siblings weighing 23-36 kg. Cardiac arrest was achieved by administrating two liters of Bretschneider’s cardioplegic solution (histidine-tryptophan-ketoglutarate [HTK]) (Custodiol®, Germany) into the aortic root. Orthotopic heart transplantation was performed after three hours of cardiac arrest.

RESULTS: A statistically significant decrease in cardiac output was observed in both groups (from 3.36 ± 0.36 l/min and 3.72 ± 0.52 l/min in the HTK group and modified HTK + COP to 2.35 ± 0.52 l/min and 2.15 ± 0.34 l/min, respectively) (Р<0.05). Differences between both groups were insignificant (P>0.05). Cardiac output was 2.99 ± 0.45 l/min and 2.48 ± 0.58 l/min (Р>0.05) in both groups after 120 min of cardiac recovery. Lactate dehydrogenase, creatine phosphokinase-MB, and troponin I changes in coronary sinus blood were significantly higher in the early reperfusion period. Statistical insignificance was observed between both groups (P>0.05). Myocardial oxygen consumption was 8.2 [7.35; 9.35] ml-О2/min/100 g and 7.7 [6.75; 10.12] ml-О2/min/100g in both groups (P>0.05). Histological examinations demonstrate no significant myocardial ischemic injury in the persufflation group.

CONCLUSION: The study demonstrated technical feasibility and safety of direct coronary persufflation for four hours during ex vivo donor heart conditioning. However, no significant advantages of direct COP were observed over the standard cold preservation protocol.

PMID:40101187 | DOI:10.21470/1678-9741-2023-0469

Urol Pract. 2025 Mar 18:101097UPJ0000000000000814. doi: 10.1097/UPJ.0000000000000814. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to characterize payments by drug and medical device manufacturers to current program directors (PD) of the Society of Urologic Oncology (SUO)-accredited fellowship programs in the United States (US).

METHODS: PDs were identified from SUO fellowship websites as of February 2024. Demographic data, educational background, and scholarly metrics were collected via an online search. Industry payments SUO PDs from 2014 to 2023 were extracted from the Open Payments database. Descriptive statistics were used to summarize PD characteristics and industry payment details. Univariable linear regression was used to assess the association of PD characteristics or scholarly metrics with payments.

RESULTS: Fifty-one PDs from 37 SUO fellowship programs were identified. PDs were predominantly men (94%) and mid-career. In aggregate, over the study period, PDs received $USD 18,963,555 in industry payments over ten years. Most payments were for associated research funding ($15,490,525, 81.6%; median [IQR] per PD recipient, $126,584 [$36,565-$706,516]; 1,262 payments). General payments accounted for a total of $3,473,030 (18.3%) (median [IQR] per PD, $10,345 [$2,196-$49,180]). SUO PDs received $120,763 (0.6%) for education fees. No association was found between PD characteristics or research metrics and industry payments.

CONCLUSIONS: PDs of SUO fellowships receive significant industry payments, surpassing those received by the average urologist. Most of these payments are allocated to research, with smaller proportions directed to general support and educational initiatives.

PMID:40101162 | DOI:10.1097/UPJ.0000000000000814

Med Sci Sports Exerc. 2025 Mar 18. doi: 10.1249/MSS.0000000000003706. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the physiological effects of a moderate-intensity interval training (MIT) microcycle followed by an active recovery period (collectively termed MITblock) with a time-matched regular training period (REG) during the general preparation phase in well-trained cyclists.

METHODS: Using a randomized crossover design, 30 well-trained male cyclists (maximal oxygen consumption (VO2max), 70.5 (4.6) mL·min-1·kg-1) completed both MITblock and REG. The MIT microcycle involved six interval sessions over seven days with 5-7 × 10-14 min work intervals at a perceived exertion (RPE) of 14-15 on the Borg 6-20 scale. A six-day active recovery period followed before physiological testing. During REG, cyclists performed their regular preparatory-phase training routine, which primarily involved low-intensity exercise. Specific guidelines included completing either two MIT sessions or one MIT session and one high-intensity interval session per week. Endurance performance indicators assessed included changes in 15 min maximal average power output (PO15min), power output at 4 mmol·L-1 [blood lactate] (PO4mmol), 1 min peak power output during incremental testing (POVO2max), and VO2max.

RESULTS: Although the Training Impulse (TRIMP) score was not different between MITblock and REG (1944 (436) vs. 1800 (232), respectively; p = 0.27), MITblock resulted in significantly greater improvements than REG in PO4mmol (4.0 (4.4)% vs. -1.3 (3.7)%, p < 0.01), POVO2max (2.5 (4.5)% vs. -0.7 (3.9)%, p < 0.01) and VO2max (2.0 (3.9)% vs. 0.0 (3.5)%, p = 0.05). Changes in PO15min were not statistically different between MITblock and REG (3.9 (8.3)% vs. 0.2 (6.8)%, p = 0.14). During MIT intervals, RPE was 14.4 (0.3), corresponding to 66 (5)% of POVO2max, 85 (3)% of maximal heart rate, and 2.8 (1.1) mmol·L-1 [blood lactate].

CONCLUSIONS: Six moderate-intensity interval sessions over seven days, followed by a six-day active recovery period, induce improvements in endurance performance indicators compared to a time-matched regular training period in well-trained cyclists.

PMID:40101160 | DOI:10.1249/MSS.0000000000003706

JMIR Form Res. 2025 Mar 18;9:e64973. doi: 10.2196/64973.

ABSTRACT

BACKGROUND: The Interactive Care Coordination and Navigation (iCAN) mobile health intervention aims to improve care coordination and reduce hospital and emergency department visits among people experiencing homelessness.

OBJECTIVE: This study aimed to conduct a three-part economic evaluation of iCAN, including a (1) cost analysis, (2) exploratory financial cost-benefit analysis, and (3) budget impact analysis (BIA).

METHODS: We collected cost and expenditure data from a randomized controlled trial of iCAN to conduct a cost analysis and exploratory financial cost-benefit analysis. Costs were classified as startup and recurring costs for participants and the program. Startup costs included participant supplies for each participant and SMS implementation costs. Recurring costs included the cost of recurring services, SMS text messaging platform maintenance, health information access fees, and personnel salaries. Using the per participant per year (PPPY) costs of iCAN, the minimum savings reduction in the average health care costs among people experiencing homelessness that would lead to a benefit-cost ratio >1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0% (no savings) to 50%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US $.

RESULTS: The total cost of iCAN was US $2865 PPPY, which was made up of US $265 in startup (9%) and US $2600 (91%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8%. This means that if average health care costs (US $36,917) among people experiencing homelessness were reduced by more than 7.8% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25% ($9229/$36,917; equal to 56% [$9229/$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US $2.22 in health care savings per US $1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US $28.7 million, which could be reduced to US $2.2 million if at least 8% ($2880/$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention.

CONCLUSIONS: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8% ($2880/$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio.

PMID:40101159 | DOI:10.2196/64973

Transplantation. 2024 Nov 8. doi: 10.1097/TP.0000000000005259. Online ahead of print.

ABSTRACT

BACKGROUND: Ex vivo lung perfusion (EVLP) can increase the donor pool by allowing high-risk lungs to be further evaluated for transplant. Several EVLP platforms are currently in use. This study examines whether different EVLP platforms have any association with post-transplant outcomes.

METHODS: The United Network for Organ Sharing registry was queried from February 28, 2018, to March 31, 2024, for adult double lung transplant recipients with EVLP data. EVLP platform was categorized as hospital EVLP, EVLP facility, mobile EVLP, or No EVLP. Recipients of EVLP lungs were statistically matched to recipients of No EVLP lungs on donor characteristics.

RESULTS: After matching, the final cohort included 1542 in the No EVLP group and 771 who received EVLP. Lungs placed on EVLP had significantly longer ischemic time than No EVLP (P < 0.001). Patients who received EVLP lungs had significantly longer post-transplant length of stay (≥25 d versus 21 d No EVLP, P < 0.001). Ischemic time (OR = 1.04, P = 0.008) and being in the ICU at the time of transplant (OR = 2.22, P < 0.001) were associated with higher rates of primary graft dysfunction (PGD3). After adjusting for hospital status and ischemic time, there was no association between the EVLP modality and PGD3. Subgroup analysis showed that DCD recipients did not have worse short- or long-term outcomes.

CONCLUSIONS: There is no relationship between EVLP modality, PGD3, and post-transplant survival after matching donor quality and adjusting for ischemic time. Work should continue to focus on reducing ischemic times so EVLP can continue to increase the donor pool while limiting adverse effects.

PMID:40101107 | DOI:10.1097/TP.0000000000005259

J Clin Hypertens (Greenwich). 2025 Mar;27(3):e70030. doi: 10.1111/jch.70030.

ABSTRACT

We aimed to study trends in achieving blood pressure (BP) goals, antihypertensive prescribing, and whether clinician behavior changed in temporal relationship to the JNC-8 (October 1, 2014), SPRINT results (November 9, 2015), and the 2017 hypertension guideline (November 13, 2017). We used the National Cardiovascular Data Registry (NCDR) Practice INNovation and CLinical Excellence (PINNACLE) registry and studied patients with hypertension aged >65 years (n = 3 678 774). We found a statistically significant, albeit small and minimally relevant, increase from 2013 to 2018 in achieving office-based SBP.

PMID:40101103 | DOI:10.1111/jch.70030

Medicine (Baltimore). 2025 Mar 14;104(11):e41746. doi: 10.1097/MD.0000000000041746.

ABSTRACT

Although studies have indicated causality between brisk walking and various diseases, the relationships between walking pace and respiratory diseases lack thorough investigation. The underlying relationships between walking pace and various respiratory diseases were examined through univariable Mendelian randomization (MR) analyses. Furthermore, we performed multivariable MR analyses to observe whether relationships between walking pace and respiratory diseases change after adjustment of body mass index (BMI). The genome-wide association study data of self-reported walking pace, BMI, and 42 respiratory diseases were retrieved from publicly available datasets. We employed the inverse-variance weighted, weighted median, and MR-Egger methods for MR analysis. Using the inverse-variance weighted method in univariable MR, we identified statistically significant negative causal associations between self-reported walking pace and 4 respiratory traits, including chronic lower respiratory diseases (odds ratio [OR], 0.27 [95% confidence interval [CI], 0.18-0.41]), asthma (OR, 0.23 [95% CI, 0.14-0.38]), chronic obstructive pulmonary disease (OR, 0.15 [95% CI, 0.08-0.30]), and diseases of the respiratory system (OR, 0.54 [95% CI, 0.41-0.70]). Similar results were observed with the MR-Egger and weighted median methods. These associations remained significant, though slightly attenuated, after adjusting for BMI. A brisk walking pace may significantly benefit respiratory health and aid in disease prevention and risk stratification.

PMID:40101097 | DOI:10.1097/MD.0000000000041746

Medicine (Baltimore). 2025 Mar 14;104(11):e41821. doi: 10.1097/MD.0000000000041821.

ABSTRACT

The COVID-19 pandemic has significantly impacted the mental health of healthcare workers globally. Given the critical role these professionals play, understanding the prevalence and predictors of post-traumatic stress disorder (PTSD) among healthcare workers is crucial for developing targeted interventions. Comprehensive data on the predictors of PTSD symptoms within this population remain limited. This cross-sectional study surveyed 852 healthcare workers across 4 Polish regions between 2021 and 2022. Data were collected using the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), which was culturally adapted and validated for Polish respondents. To identify key predictors of PTSD symptoms, researchers employed various statistical methods: Descriptive Statistics summarized key variables (e.g. age, job tenure) to provide an overview of data distribution and sample characteristics. Pearson Correlations examined linear relationships among variables like age, work experience, and PTSD severity, ensuring no multicollinearity through variance inflation factor checks. t-Tests and Mann-Whitney U tests compared PTSD symptom severity across demographic and professional subgroups, accounting for normality using the Kolmogorov-Smirnov test. And Hierarchical Regression Analysis identified significant predictors, incorporating demographic factors first and work-related variables (e.g. fear for personal health) in a second step. A total of 88.1% of participants were female, and 82.6% were nurses. The overall prevalence of PTSD symptoms was high, with a mean total PTSD score of 37.87. Gender differences were significant, with women reporting higher scores across the PTSD subscales, including avoidance and hyperarousal. Nurses had significantly higher intrusion symptoms compared to other professionals. Fear for personal health was the strongest predictor of PTSD symptoms (β = 0.15, P < .001), explaining 11% of the variance in the final regression model (R2 = 0.11, P < .001). The findings underscore the urgent need for targeted mental health interventions, particularly for women and nurses, who are disproportionately affected by PTSD during the pandemic. Predictive models should guide the development of support programs to mitigate the long-term psychological impact of COVID-19 and ensure better preparedness for future pandemics. The significant influence of fear for personal health on PTSD outcomes highlights the importance of protective measures and psychological support for frontline healthcare workers.

PMID:40101094 | DOI:10.1097/MD.0000000000041821

Medicine (Baltimore). 2025 Mar 14;104(11):e41880. doi: 10.1097/MD.0000000000041880.

ABSTRACT

Endolymphatic hydrops (EH) has been visualized on magnetic resonance imaging (MRI) in patients with various inner ear diseases. The purpose of this study was to evaluate the prevalence and risk factors of significant EH on inner ear MRI in patients with 1 or more audiovestibular symptoms and to predict the incidence of significant EH using multivariate analysis and multilayer perceptron artificial neural network modeling. This retrospective study included a total of 135 patients with 1 or more audiovestibular symptoms who do not meet the diagnostic criteria for MD and underwent inner ear MRI at our institution from July 2021 to January 2024. The EH grade of each patient was evaluated, and “significant EH” was considered grade II or III. Of 135 patients with 1 or more audiovestibular symptoms, 48 patients (35.6%) presented with significant EH and 87 patients (64.4%) without significant EH on inner ear MRI. The prevalence of significant EH was higher in males, which was statistically significant (P = .007). The prevalence of significant EH was higher in the right ear, and the mean age of patients with significant EH was 1.94 years higher, but no statistical significance was observed (P = .660 and .456, retrospectively). The odds ratio for significant EH development was 2.696 (95% confidence interval: 1.296-5.607) times higher in men, which was statistically significant. Predicting the incidence of significant EH development using multivariate analysis, sex was the only variable that was statistically significant (P = .008). Based on a predictive model using multilayer perceptron (MLP), the classification accuracy of the model was 79.5%. In our study, the male gender could be related to the risk of developing significant EH in patients with audiovestibular symptoms. The accuracy of our suggested MLP model for predicting the incidence of significant EH was 79.5%, with sex being the highest predictor importance. In the future, inner ear MRI and MLP neural network modeling can be combined as a noninvasive and precise support system in the diagnosis of EH.

PMID:40101092 | DOI:10.1097/MD.0000000000041880

Medicine (Baltimore). 2025 Mar 14;104(11):e41646. doi: 10.1097/MD.0000000000041646.

ABSTRACT

To analyze the effects of drug treatments and types of drugs on pregnancy outcomes in pregnant women at different gestational ages. The records of 526 pregnant women from our hospital from September 2018 to January 2024 were analyzed retrospectively. Women were categorized into 3 groups: normal delivery, artificial abortion, and spontaneous abortion. Data on maternal age, gestational age, smoking, drinking, radiation, medication timing, and types were collected and compared. Pearson correlation analysis assessed relationships between pregnancy outcomes, gestational age at medication, and medication types. After comparing multiple potential influencing factors, it was found that smoking history, timing of medication, and the use of antitussive and phlegm-reducing medications differed significantly among the different pregnancy outcome groups (P < .05). Multiple regression analysis showed that the gestational age at which pregnant women took medication was a significant positive influencing factor for adverse pregnancy outcomes, specifically artificial abortion (Coefficient = 0.210, P = .002). In addition, the use of antitussive and phlegm-reducing medications had a positive directional influence on adverse pregnancy outcomes, specifically spontaneous abortion (Coefficient = 0.294, P = .016). Further analysis showed that as the gestational age at the time of medication increased, the normal delivery rate initially increased and then decreased. The rate of artificial abortion first increased and then stabilized, while the spontaneous abortion rate showed minimal fluctuation. The use of medications by pregnant women and the duration of pregnancy significantly impact induced abortion rates. Cough and mucus-reducing medications can lead to miscarriage, while other drugs in early pregnancy generally do not affect outcomes. Antitussive and mucus-reducing drugs specifically increase the risk of spontaneous abortion. Raising awareness about proper medication use and conducting research on this topic is crucial for enhancing prenatal and postnatal care, reducing induced abortions, and promoting population growth.

PMID:40101089 | DOI:10.1097/MD.0000000000041646