Tag: nevin manimala

Med Princ Pract. 2025 Oct 11:1-23. doi: 10.1159/000548894. Online ahead of print.

ABSTRACT

OBJECTIVE: Autoimmune hepatitis (AIH) is a chronic immune-mediated liver disease that usually responds to corticosteroids ± azathioprine (AZA). However, some patients are intolerant or refractory to first-line therapy and require second-line immunosuppression. Mycophenolate mofetil (MMF) and tacrolimus (TAC) are commonly used alternatives, although comparative evidence is limited. This systematic review and meta-analysis evaluated the efficacy and safety of MMF and TAC in adult AIH patients who failed first-line therapy.

METHODS: A systematic search of six databases identified 16 eligible studies (n = 705), including retrospective cohorts and one case series. Study quality was assessed using the Newcastle-Ottawa Scale and the MMS (methodological quality and synthesis of case series and case reports) tool.

RESULTS: Biochemical remission was achieved in 56% of MMF-treated patients, rising to 66% with ≥6 months follow-up. TAC showed a pooled remission rate of 66%, increasing to 67% when defined by transaminase normalization. MMF was particularly effective in azathioprine-intolerant patients, while TAC showed better outcomes in steroid-refractory patients. Adverse events differed: MMF was most often associated with gastrointestinal intolerance, whereas TAC was linked to tremor, hypertension, diabetes, and renal impairment. However, statistical analysis showed wide confidence intervals, and there was considerable heterogeneity across studies.

CONCLUSION: Both MMF and TAC are effective second-line therapies for AIH. MMF appears safer and better tolerated in azathioprine-intolerant patients, while tacrolimus showed a modest advantage in efficacy over mycophenolate in steroid-refractory cases. Given the limitations of current evidence, including small sample sizes, heterogeneity, and lack of randomized controlled trials, treatment choice should be individualized until higher-quality data are available.

PMID:41078044 | DOI:10.1159/000548894

Am J Nephrol. 2025 Oct 10:1-13. doi: 10.1159/000548738. Online ahead of print.

ABSTRACT

INTRODUCTION: Parathyroid hormone (PTH) induces browning of adipose tissue, leading to increased resting energy expenditure and loss of adipose and muscle tissues in animal models of kidney failure. However, its clinical significance in humans remains unclear. This study aimed to investigate whether PTH-lowering therapy with upacicalcet, a novel injectable calcimimetic, affects serum albumin levels as a surrogate marker of protein-energy wasting in patients on hemodialysis with secondary hyperparathyroidism (SHPT).

METHODS: This was a post-hoc analysis of a phase 3, double-blind, placebo-controlled study of upacicalcet for the treatment of SHPT in patients on hemodialysis. Participants were randomized in a 2:1 ratio to receive either upacicalcet or placebo after each hemodialysis session for 24 weeks. Longitudinal changes in serum albumin levels were compared between groups using mixed-effects models for repeated measures. The rate of change (slope) in serum albumin over time was also estimated using a linear mixed-effects model.

RESULTS: A total of 99 patients in the upacicalcet group and 46 patients in the placebo group were included in the analysis. While serum albumin levels tended to decline in the placebo group, they remained relatively stable in the upacicalcet group, with a significant treatment-by-time interaction. In the linear mixed-effects model, the slope was less steep in the upacicalcet group than in the placebo group, although the between-group difference (0.09 g/dL per year; 95% CI, -0.04 to 0.23) did not reach statistical significance.

CONCLUSION: These findings raise the hypothesis that PTH suppression with upacicalcet mitigates the gradual decline in serum albumin levels over time. Further studies are warranted to investigate the long-term impact of PTH control on protein-energy wasting and related clinical outcomes.

PMID:41078042 | DOI:10.1159/000548738

Acta Cytol. 2025 Oct 9:1-18. doi: 10.1159/000548613. Online ahead of print.

ABSTRACT

INTRODUCTION: Hyperthyroidism-related epithelial hyperplasia is seldomly listed as a pitfall in thyroid cytology. Therefore, we focused on the cytomorphological characteristics of epithelial hyperplasia and compared these features with papillary thyroid carcinoma (PTC).

METHODS: Study group consisted of 76 patients (133 FNA specimens) histologically diagnosed with hyperthyroidism-related epithelial hyperplasia without a concomitant malignancy. The control group contained 21 histologically verified FNAs of PTCs. A total of 48 cytomorphological features were quantitatively evaluated.

RESULTS: Statistically significant differences between the study groups were discovered on the architectural, cellular, and nuclear levels. Nuclear features varied most: nuclear elongation, grooves, irregular nuclear membrane, pseudoinclusions, the presence of nucleoli or small eccentric nucleoli were clearly more common in PTC group.

CONCLUSION: Fine-needle aspiration referrals with clinical data and thyroid function test results can facilitate the interpretation of cytomorphological features and reduce the use of undetermined categories in cases of hyperthyroidism-related epithelial hyperplasia.

PMID:41078039 | DOI:10.1159/000548613

Conserv Biol. 2025 Oct 12:e70158. doi: 10.1111/cobi.70158. Online ahead of print.

ABSTRACT

The Natura 2000 (N2K) network of protected areas is one of the main tools for area-based conservation in the European Union (EU), yet its role in preserving plant biodiversity requires better understanding. We examined data kept in the European Vegetation Archive from over 1.2 million vegetation plots and obtained over 14.2 million plant species occurrences. To test the N2K network’s representativeness of plant species gamma diversity, we compared the number and percentage of native and conservation priority species in- and outside the N2K network throughout the EU and for individual countries, biogeographical regions, and combinations thereof. We then determined whether N2K sites hosted more species than sites outside the network with the species-area relationship. Overall, almost 90% of the native vascular plant species occurred at least once in the N2K network. Yet, significant variation exists across countries and biogeographical regions-from 0% of species in the Boreal region of Lithuania, to 98% in the Alpine region of Croatia-indicating that local N2K sites are not equally representative of the regional gamma diversity. Nonetheless, the N2K network contains more species than land outside the network when area is taken into account. The planned expansion of the N2K network, as mandated by the European Biodiversity Strategy for 2030, should prioritize areas with currently underrepresented elements of the EU vascular flora.

PMID:41077638 | DOI:10.1111/cobi.70158

Pharmacoepidemiol Drug Saf. 2025 Oct;34(10):e70235. doi: 10.1002/pds.70235.

ABSTRACT

PURPOSE: Observational comparative studies can be analyzed using intention-to-treat (ITT) (i.e., initial-treatment) or as-treated (AT) (i.e., per-protocol) approaches to estimate distinct treatment effects. Unfortunately, AT analyses have an increased vulnerability to selection bias from informative censoring. While methods for informative censoring adjustment are well established, the nuances of their implementation are less well documented.

METHODS: We compared marginal hazard ratios for all-cause mortality from ITT and AT analyses comparing new users of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the clinical practice research datalink from 2019 to 2022 using inverse probability of treatment weights. We created inverse probability of censoring weights (IPCW) using (A) non-lagged and (B) lagged models to adjust for informative censoring in the AT analyses. We replicated analyses comparing acetylcholinesterase inhibitor and angiotensin receptor blocker initiators to assess the impact of IPCW in a different context.

RESULTS: We identified 335 469 SSRI initiators and 24 318 SNRI initiators. While AT estimates (HR: 1.50, 95% CI: 1.30-1.74) were further from the null than ITT estimates (HR: 1.22, 95% CI: 1.12-1.32), applying IPCW attenuated AT estimates using both lagged and non-lagged models (lagged HR: 1.24, 95% CI: 1.08-1.44; non-lagged HR: 1.16, 95% CI: 1.00-1.33). In the 337 981 antihypertensive initiators, however, IPCW did not influence AT estimates.

CONCLUSIONS: Younger patients were more likely to discontinue SSRIs than SNRIs, resulting in biased AT estimates closer to estimates in older patients. IPCW attenuated this bias, highlighting the utility of weighting when censoring is linked to patient characteristics.

PMID:41077625 | DOI:10.1002/pds.70235

Int Urol Nephrol. 2025 Oct 12. doi: 10.1007/s11255-025-04847-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Cognitive and psychological disorders are among the most important outcomes of the end stage of renal disease. Treatments have neither definitely prevented the disorders’ progression nor cured them. This study aims at evaluating the effect of solving a Sudoku puzzle on memory and anxiety in hemodialysis (HD) patients.

MATERIALS AND METHODS: This randomized controlled clinical trial study was conducted on 64 HD patients. The samples were randomly assigned either to the control group (n = 32) or Sudoku (intervention) group (n = 32). The study lasted for four weeks. The anxiety and memory of the participants were measured by the Spielberger State Trait Anxiety Inventory (STAI-S) and Wechsler Memory Scale (WMS) at the beginning and end of the study. The intervention group solved the Sudoku puzzle within 20 min for four weeks, three times per week (12 times), 15 min after the HD onset, the control group received no intervention. To evaluate the effect of the Sudoku puzzle on momentary anxiety, the state anxiety of all samples was measured and recorded in the first session of the study, 40 min after the onset of the first HD session. The data were analyzed with SPSS software version 25.

RESULTS: The mean and standard deviation of the anxiety score were 82.71 ± 5.1 and 70.93 ± 18.0 in the Sudoku group (p = 0.001) and 82.43 ± 5.77 and 82.06 ± 4.55 in the control group at the beginning and the end of the study, respectively (p = 0.778). Moreover, the mean and standard deviation of the state anxiety score in the first session were 41.37 ± 3.29 and 38.5 ± 2.9 in the intervention group (p = 0.001) and 39.5 ± 2.9 and 42.15 ± 2.73 in the control group (p = 0.001) before the HD onset and 40 min after the HD onset, respectively. There was no statistically significant difference in memory scores in the Sudoku group before and after the intervention. However, the covariance test showed that at the end of the study, there was a statistically significant difference between memory scores in the control and intervention groups(p = 0.048). The results showed that there is a statistically significant difference in the post tests between the two groups in terms of anxiety, state anxiety and memory (p ≤ 0.05).

CONCLUSION: Sudoku solving seems to play an effective role in reducing anxiety and state anxiety in HD patients, but it has little effect in improving memory. Therefore, it is recommended to use it as an adjunctive treatment to control anxiety and improve memory in hemodialysis patients.

PMID:41077610 | DOI:10.1007/s11255-025-04847-x

J Egypt Natl Canc Inst. 2025 Oct 13;37(1):68. doi: 10.1186/s43046-025-00326-7.

ABSTRACT

BACKGROUND: Computed tomography imaging, a non-invasive tool, is used around the globe by medical professionals to identify and diagnose lung cancer; a lethal disease with high rates of occurrence and mortality globally. Radiomics extracted from medical images, including computed tomography, in tandem with machine learning frameworks has received considerable focus and research for lung nodule identification.This investigation can help out clinicians to reach radiomics-based better and quicker decision support system for treatments and early diagnosis. However, it is still foggy and unclear which radiomics feature(s) to use for the prediction of pulmonary nodule. Consequently, this work is offered with an endeavor to efficiently apply machine learning techniques and radiomics to classify CT pulmonary nodules.

METHODS: Lung Image Data Consortium (LIDC), containing 1018 CT cancer cases, is put to use. The Wavelet Packet Transform is used in conjunction with geometrical features, gray level run length matrix, gray level co-occurrence method and gray level difference method techniques to extract radiomics. Two techniques, boosted and bagged ensemble classification trees, are employed to choose an apposite set of features. The categorization of nodules as malignant or benign is assessed by the utilization of cutting-edge machine learning models: Support Vector Machines, Boosted Classification Ensemble Tree, Decision Trees, Bagged Classification Ensemble Tree, RUSBoosted Ensemble Trees, Subspace Discriminant Ensemble and Subspace KNN Ensemble.

RESULTS: The findings reveal that the Ensemble Subspace KNN gives best AUROC (93.4%), accuracy (88.3%) and F1-score (85.2%) using BACET feature selection method. The best sensitivity is produced by FGSVM (97.1%). RUSBOCET gives best precision and specificity of 93.4% and 83.1% respectively.

CONCLUSION: Lung Cancer remains the most common and deadly type of cancer. Early detection of lung lesions and nodules is crucial in the fight against lung cancer. The purpose of this study was to investigate radiomics based on geometrical, texture, and Daubechies WPT texture features for quantitative CT image analysis. The LIDC database was used in this study. Geometrical features, texture features based on three statistical methodologies (GLCM, GLDM GLRLM) and Daubechies WPT texture features are retrieved from the nodules. Using the ensemble EFS, BOCET and BACET, pertinent features were identified. Lastly, various cutting-edge ML classifiers were used to classify LC as malignant or benign. The out-turn shows that, using BACET EFS, Ensemble Subspace KNN gives best AUROC (93.4%), accuracy (88.3%) and F1-score (85.2%). FGSVM yields the best sensitivity of 97.1%. RUSBOCET gives best precision and best specificity of 93.4% and 83.1% respectively. Therefore, the methodology can be applied with efficacy to the CT based PN classification. Thus, the result can assist medical professionals in making better decisions and interventions.

PMID:41077595 | DOI:10.1186/s43046-025-00326-7

Environ Monit Assess. 2025 Oct 13;197(11):1199. doi: 10.1007/s10661-025-14646-7.

ABSTRACT

Surface sediments collected from Apapa-Badagry creeks (west of Lagos Lagoon) were investigated for the presence of organochlorine pesticides (OCPs) and polycyclic aromatic hydrocarbons (PAHs). The total OCP concentrations (∑OCPs) ranged from 231.72 to 1324.57 ng/g, while ∑PAHs ranged from 15.17 to 30.92 ng/g. Drins were the most prevalent pesticides detected across all sample stations. All low molecular weight (LMW) PAHs were below the detection limits, except for acenaphthylene. Urban runoff and nearby industrial and domestic discharges could be responsible for the high levels of OCPs and PAHs at station L_P2. Isomeric ratio analysis of DDT compounds indicated no recent inputs of technical DDT, whereas hexachlorocyclohexane (HCHs) suggested a lindane source. Diagnostic PAH ratios suggested mixed sources of pollution, which were pyrolytic and petrogenic. Principal component analysis of the OCPs and PAHs dataset extracted three principal factors, each representing distinct pollutant origins within the creek sediments. The sources of OCPs were mainly agricultural and industrial run-off, whereas PAHs were primarily attributed to industrial emissions, biomass and wood burning, and vehicular combustion. Ecological risk assessment indicated that adverse effects from p,p’-DDT would rarely occur, whereas those from p,p’-DDD would occur regularly in benthic organisms in Apapa-Badagry Creek.

PMID:41077593 | DOI:10.1007/s10661-025-14646-7

BMC Pediatr. 2025 Oct 13;25(1):807. doi: 10.1186/s12887-025-06038-0.

ABSTRACT

BACKGROUND: Pediatric drug clinical trials are essential for ensuring the accessibility and safety of medications intended for children. In recent years, the Chinese government has implemented various measures to foster the development of pediatric drug clinical trials, and these efforts have yielded noticeable results. This study analyzed pediatric drug trial data from ClinicalTrials.gov and the Drug Clinical Trial Registration and Information Publication Platform. Its primary purpose was to discuss the issues and challenges faced by pediatric drug clinical trials in China and propose potential solutions.

METHODS: This study conducted a cross-sectional analysis of concluded pediatric drug clinical trials (completed or discontinued) in mainland China from 2003 to 2023. Descriptive statistics were performed on the included data, and both univariate subgroup analysis and binary logistic regression were utilized to analyze the factors influencing completion duration and trial discontinuation.

RESULTS: A total of 722 concluded pediatric drug clinical trials were extracted, with the overall number increasing annually at an average annual growth rate of 21.5%. We found that there existed imbalance in various aspects such as drug type, diseases, age, and the types and distribution of trial institutions. The analysis of trial durations indicated a progressive reduction in the completion cycles of pediatric drug clinical trials conducted in China, with notable variations across different subgroups. Four variables-trial size, the establishment of Data Monitoring Committees (DMCs), control type, and disease-exerted significant influence on the discontinuation of pediatric drug clinical trials. The primary reasons for trial discontinuation are issues related to safety or efficacy as reflected in trial outcomes (27.2%), as well as adjustments in commercial strategies or trial plans (24.6%).

CONCLUSIONS: Despite the ongoing increase in the number of pediatric drug clinical trials in China, significant challenges and imbalances persist across various dimensions. To enhance the quality and efficiency of these trials and collectively advance pediatric drug research and development, it is imperative to refine the existing legal and regulatory frameworks, promote the professionalization and standardization of pediatric drug clinical trials, bolster the application of emerging methods and technologies, such as seamless design and artificial intelligence.

PMID:41077578 | DOI:10.1186/s12887-025-06038-0

Orthop Surg. 2025 Oct 12. doi: 10.1111/os.70184. Online ahead of print.

ABSTRACT

OBJECTIVE: Conversion to hip arthroplasty (cHA) is a widely utilized and effective surgical intervention for addressing the failure of internal fixation in intertrochanteric femoral fractures (FIF-INF). Although previous studies have confirmed that the failure rate of internal fixation is higher in unstable intertrochanteric femoral fractures, but whether the efficacy and complications of cHA after failure differ from those in stable fractures remains unclear. This study aimed to evaluate and compare the clinical and radiological outcomes, as well as the incidence of complications associated with hip arthroplasty over a minimum follow-up period of 3 years after the failure of internal fixation in both stable and unstable intertrochanteric femoral fractures.

METHODS: This multicenter study retrospectively analyzed patients who underwent hip arthroplasty subsequent to the failure of FIF-INF from December 2012 to December 2020 at various participating research centers. Cases demonstrating excellent and acceptable quality fracture reduction, as defined by the criteria established by Chang et al., were included. According to AO/OTA classification criteria of intertrochanteric fractures, the fractures were classified into stable fractures (31-A1) and unstable fractures (31-A2, A3). There were 47 patients with stable fractures and 56 patients with unstable fractures. Clinical and radiological evaluations were conducted for all patients. This study employed independent samples t-tests, χ² tests or Fisher’s exact test, and both univariate and multivariate logistic regression analyses.

RESULTS: A total of 103 patients were analyzed. The HHS in the stable group improved from a preoperative mean of 47.08 ± 5.50 to 89.13 ± 4.75 at the final follow-up, whereas that in the unstable group increased from 45.43 ± 6.36 to 83.87 ± 4.67. The improvement scores for the stable and unstable groups were 42.05 ± 4.69 and 38.81 ± 3.06, respectively, with a statistically significant difference (p < 0.0001). VAS scores decreased from the preoperative levels of 7.13 ± 0.92 and 7.61 ± 0.82 to 2.36 ± 0.87 and 2.91 ± 0.79, respectively, indicating a significant reduction in pain in both groups; however, the unstable group reported more severe postoperative pain (p = 0.001). The incidence of postoperative complications following cHA was significantly greater in the unstable group (28.57%) than in the stable group (10.64%) (p = 0.047).

CONCLUSION: cHA is an effective treatment modality for the failure of internal fixation in intertrochanteric femoral fractures. Compared with stable fractures, patients with initial unstable fractures that have failed experience a greater incidence of postoperative complications, relatively poorer joint function, and more pronounced pain following cHA.

PMID:41077565 | DOI:10.1111/os.70184