Tag: nevin manimala

JAMA Oncol. 2026 Jan 8. doi: 10.1001/jamaoncol.2025.5869. Online ahead of print.

ABSTRACT

IMPORTANCE: While preliminary evidence suggests that sodium-glucose cotransporter 2 (SGLT2) inhibitors for diabetes may have antitumorigenic effects, their potential benefits in prostate cancer remain unexplored. Understanding their association with outcomes among patients undergoing hormone therapy could inform future adjunct treatment strategies.

OBJECTIVE: To evaluate whether the use of SGLT2 inhibitors is associated with clinical outcomes in patients with prostate cancer receiving hormone therapy.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, sequential target trial emulation of monthly cohorts used territory-wide electronic health records (January 1, 1993, to April 30, 2025) from the Hong Kong Hospital Authority, covering a population of approximately 7.5 million. Adult men diagnosed with prostate cancer who initiated androgen deprivation therapy (ADT) were included. Follow-up extended through April 2025, and data were analyzed from June to October 2025.

EXPOSURES: Use of SGLT2 inhibitors (primarily dapagliflozin and empagliflozin) initiated during hormone therapy and maintained for at least 1 month. Comparator groups included nonusers of SGLT2 inhibitors.

MAIN OUTCOMES AND MEASURES: The primary outcome was time to ADT failure. Secondary outcomes include time to next-generation hormonal agent failure, disease-specific survival, and overall survival. Both intention-to-treat and per-protocol analyses were conducted using complementary log-log model regression to provide the hazard ratio (HR) estimate.

RESULTS: Among 14 223 eligible patients (median [IQR] age at enrollment, 74 [68-80] years) with a median follow-up of 66 months (95% CI, 65-67 months), intention-to-treat SGLT2 inhibitor use was associated with reduced risk of ADT failure (HR, 0.63; 95% CI, 0.41-0.95; P = .03) and next-generation hormonal agent failure (HR, 0.44; 95% CI, 0.20-0.97; P = .04). Sensitivity analyses confirmed robustness of these findings across different comparator subgroups. Metformin monotherapy was not associated with disease progression but was associated with improved overall survival (HR, 0.59; 95% CI, 0.42-0.83; P = .002). No statistically significant outcome differences were observed between dapagliflozin and empagliflozin.

CONCLUSIONS AND RELEVANCE: In this cohort study with a target trial emulation design, SGLT2 inhibitor use was associated with delayed hormone therapy failure in patients with prostate cancer, suggesting a potential oncologic benefit beyond glucose lowering. These findings support the potential of SGLT2 inhibitors in treatment for prostate cancer.

PMID:41505116 | DOI:10.1001/jamaoncol.2025.5869

J Osteopath Med. 2026 Jan 9. doi: 10.1515/jom-2025-0145. Online ahead of print.

ABSTRACT

CONTEXT: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-sustaining therapy for severe refractory cardiogenic shock. Although VA-ECMO provides various degrees of cardiopulmonary support, mortality rates remain high. Serum biomarkers have potential to identify the rising risk of mortality in patients receiving ECMO, but evidence supporting their prognostic value is inconsistent.

OBJECTIVES: This study aims to systematically investigate existing evidence on the relationship between biomarkers and mortality in adult patients with refractory cardiogenic shock undergoing VA-ECMO support.

METHODS: A systematic review was conducted conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Analogous search strings were developed to complete a comprehensive literature search across multiple databases that included Embase, Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search limits include studies published in the last 5 years (>2018) and in the English language. The inclusion criteria were: all genders aged 18 and older being treated for cardiogenic shock with VA-ECMO and intra-ECMO biomarker data with corresponding mortality data. Biomarkers included in the criteria were: lactate, creatinine, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), troponin, C-reactive protein (CRP), and white blood cell (WBC) count. Identified articles were included within the main findings after unanimous approval by all authors. The quality of the evidence was assessed systematically utilizing a standardized and validated checklist.

RESULTS: Our search yielded 1,033 studies, with 650 studies remaining after the removal of duplicates, leaving 538 studies to be screened for title and abstract study relevance. Subsequently, 112 studies remained for full-text review. Reasons for exclusion during full-text review include conference abstract, no mention of specific biomarkers, and wrong comparison of treatment modalities. Five studies remained for data extraction. Data gathered from five retrospective cohort studies reported a total of 589 patients supported by VA-ECMO following a diagnosis of cardiogenic shock, with the most common inciting factor being postcardiac surgery. Most patients were male. The age range for all participants was between 45 and 77 years. Common comorbidities include diabetes mellitus, hypertension, and vascular disease. Overall mortality was 59.9 % (353/589) based on survival to 30-day post-ECMO initiation or hospital discharge. In three of the studies, the patients in the survivor cohort had statistically significant lower intra-ECMO lactate levels compared to the non-survivors (p<0.01). One of the studies found statistically significant differences between survivors and non-survivors in the intra-ECMO values for serum lactate (p<0.001), creatinine (p<0.023), bilirubin (p<0.001), AST (p<0.05), and ALT (p<0.05). Another study reported statistically significant differences in nadir lactate levels through 24 and 48 h of ECMO initiation in survivors vs. non-survivors (p=0.001 and p=0.001 respectively).

CONCLUSIONS: Serum lactate was the biomarker most utilized to assess the risk of mortality. Serum creatinine (Scr), bilirubin, AST, and ALT also demonstrated significance in predicting mortality, although not as widely studied as serum lactate. Future research is needed to further investigate the usage of Scr, bilirubin, AST, and ALT to better assess their significance, regarding VA-ECMO mortality in patients diagnosed with cardiogenic shock. Further research is also warranted to investigate the minimal concentration of these biomarkers and their association with mortality to allow clinicians a better predictor of a patient’s mortality risk while receiving VA-ECMO.

PMID:41505108 | DOI:10.1515/jom-2025-0145

Curr Med Sci. 2026 Jan 8. doi: 10.1007/s11596-025-00160-x. Online ahead of print.

ABSTRACT

OBJECTIVE: The benefits of caffeine to human health have been widely reported, but the association between caffeine intake and mortality among patients with chronic kidney disease (CKD) has been rarely reported in large epidemiologic studies. This study aimed to investigate the association between caffeine intake and mortality among CKD patients.

METHODS: Our study was conducted among non-dialysis CKD patients in the 2003-2016 National Health and Nutrition Examination Survey (NHANES). Weighted COX regression analysis was used to explore the linear relationship between caffeine intake and mortality among CKD patients (including all-cause mortality, as well as mortality due to cardiovascular disease, cancer, cerebrovascular disease, nephropathy, and influenza or pneumonia). Restricted cubic spline analysis was performed to explore the nonlinear relationship. Finally, threshold effects were analyzed through fitting a two-piecewise linear regression model.

RESULTS: In a fully adjusted model, no significant linear association was found between caffeine intake and mortality. However, there was a U-shaped association between caffeine intake and all-cause mortality (inflection point: 277 mg). Moreover, there was a J-shaped association between caffeine intake and cardiovascular mortality (inflection point: 252 mg) and cancer mortality (inflection point: 79 mg).

CONCLUSION: All-cause mortality was reduced in CKD patients when caffeine intake was less than 277 mg (about 1.85 cups of Americano). However, excessive caffeine intake was associated with increased all-cause mortality, cardiovascular mortality and cancer mortality in this population.

PMID:41505074 | DOI:10.1007/s11596-025-00160-x

Radiol Med. 2026 Jan 8. doi: 10.1007/s11547-025-02170-0. Online ahead of print.

ABSTRACT

PURPOSE: This meta-analysis evaluates the diagnostic performance of computed tomography (CT)-based artificial intelligence (AI) models versus radiologists for preoperative microvascular invasion (MVI) detection in hepatocellular carcinoma (HCC).

METHODS: A systematic literature search was conducted in PubMed, Embase, and Web of Science to identify studies published up to February 2025 focusing on the diagnostic accuracy of CT-based AI models for the preoperative detection of MVI in HCC, compared with the diagnostic performance of radiologists. A bivariate random-effects model was employed to calculate the pooled sensitivity, specificity, and area under the curve (AUC), all presented with 95% confidence intervals (CIs). Heterogeneity among studies was assessed using the I² statistic. The methodological quality of included studies was evaluated using a modified version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.

RESULTS: Of 918 identified studies, 32 studies with 3,709 cases were included. For the internal validation set, the pooled sensitivity, specificity, and AUC for detecting MVI in HCC were 0.83 (95% CI 0.79-0.87), 0.81 (95% CI 0.76-0.86), and 0.89 (95% CI 0.86-0.92), respectively. Radiologists achieved a sensitivity of 0.82 (95% CI 0.63-0.93), specificity of 0.65 (95% CI 0.45-0.81), and AUC of 0.80 (95% CI 0.77-0.84).

CONCLUSIONS: CT-based AI may have the potential to outperform radiologists in predicting MVI in HCC. However, existing evidence is limited by study heterogeneity and limited number of the direct comparison between AI and radiologists. Prospective multicenter studies are needed to validate its clinical utility.

PMID:41505041 | DOI:10.1007/s11547-025-02170-0

Eur Phys J E Soft Matter. 2026 Jan 8;49(1-2):1. doi: 10.1140/epje/s10189-025-00544-w.

ABSTRACT

This work investigates chiral particles, which break mirror symmetry, in turbulent Taylor-Couette flow. These particles generally display a translation-rotation coupling moving through a quiescent fluid. Here, we performed experiments using large chiral particles (typical size 5mm) in turbulent Taylor-Couette flow, for Reynolds numbers $9·{10}^3\le \text{Re}\le 1.5·{10}^5$ . The density-matched chiral particles are studied in a dilute regime $(\varphi =1.7·{10}^{–4})$ , where their location and orientation are tracked over time to investigate the particle-fluid coupling. We investigate whether the translation-rotation coupling observed at low Reynolds numbers is still observable over the measured high Reynolds numbers, using the tracked location and orientation. Similarly, we verify whether the chiral particles display a preferred location or orientation, and whether the left-handed and right-handed particles show different rotation statistics. The location data show that the chiral particles closely follow the structure of Taylor vortices. Hence, the orientation data and rotation data of the chiral particles are split between the Taylor vortices and particle chiralities. The results show no difference in rotation and orientation dynamics between chiralities. Rather, the particle dynamics are flow-dominated, where the flow vorticity determines the specific particle dynamics.

PMID:41505007 | DOI:10.1140/epje/s10189-025-00544-w

Arch Osteoporos. 2026 Jan 8;21(1):20. doi: 10.1007/s11657-025-01635-z.

ABSTRACT

In the U.S’s largest integrated health system, during a 24-year period (1999-2022), bisphosphonate treatment initiation for fracture prevention in men shifted towards higher-risk populations, including older men and those with prior fracture and frailty.

PURPOSE: To evaluate 24-year trends in bisphosphonate (BP) initiation among older U.S. male Veterans and shifts in demographic and clinical characteristics of BP-treated men over time.

METHODS: U.S. national Veterans Health Administration (VHA) data (1999-2022) were queried to identify men aged ≥ 50 years with a first prescription for an FDA-approved BP for fracture prevention. Age, race, ethnicity, BP drug and route, prior fracture, and, in those aged ≥ 65 years, Veterans Affairs Frailty Index (VA-FI), were examined across five time periods. Temporal trends were analyzed using chi-square and nonparametric trend tests.

RESULTS: A total of 298,340 men initiated a BP during 1999-2022, of whom 233,857 (78.4%) were aged ≥ 65 years. BP initiation rose sharply after FDA approval of BPs for men in 2000, peaked in 2004-2005, then declined by about 50% between 2006 and 2012, and then plateaued. Over time, the proportion of BP initiators aged < 65 years declined from a peak of 28.2% during the middle time period (2008-2012) to a nadir of 13.3% during the final years (2018-2022, p < 0.001 for trend). Among the subset of men age 65 and older who initiated BP, the proportion with prior fracture increased from 8.3% in 1999-2002 to 24.5% in 2018-2022 (p < 0.001). Notably, over half of the men who initiated BP during 1999-2002 were classified as non-frail, whereas in the most recent time period (2018-2022), over half of BP initiators were frail (mildly, moderately, or severely) and only 14.8% of them were non-frail (p < 0.001).

CONCLUSION: In the VHA, BP initiating patterns shifted over time towards treating older men, with much larger proportions of men who had a prior fracture and were classified as frail.

PMID:41504976 | DOI:10.1007/s11657-025-01635-z

Arch Womens Ment Health. 2026 Jan 8;29(1):14. doi: 10.1007/s00737-025-01658-y.

ABSTRACT

PURPOSE: Maternal depression is a significant public health concern that can adversely affect both mothers and their children. Although various psychotherapeutic interventions have been proposed, their relative comparative efficacy remains unclear. This network meta-analysis (NMA) aimed to evaluate and compare the efficacy of different psychotherapeutic interventions in reducing maternal depressive symptoms.

METHODS: A systematic search was conducted in the Web of Science Core Collection (Science Citation Index Expanded and Social Sciences Citation Index) to identify randomized controlled trials (RCTs) published between 1 February 2021 and 1 February 2025. Eligible studies included mothers aged ≥ 18 years who were assessed for maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and received any form of psychotherapy. Data were extracted using a predefined format (PROSPERO ID: CRD420251010916). Random-effects models were used to perform the NMA in R, reporting mean differences (MD) with 95% confidence intervals (CIs) and P-scores.

RESULTS: A total of 8 RCTs involving 2,919 participants were included. Cognitive behavioral therapy (CBT) was the only intervention that showed a statistically significant reduction in depressive symptoms compared to treatment as usual (TAU) (MD = -3.22, 95%CI: -5.91 to -0.54; p = 0.019; P-score = 0.92). Other interventions showed trends toward improvement, but these were not statistically significant (p > 0.05).

CONCLUSION: CBT emerged as the most efficacious psychotherapeutic approach in both direct and indirect comparisons, supported by statistical evidence from the NMA.

PMID:41504974 | DOI:10.1007/s00737-025-01658-y

J Gastrointest Cancer. 2026 Jan 8;57(1):5. doi: 10.1007/s12029-025-01391-w.

ABSTRACT

PURPOSE: Secondary malignant neoplasms of the liver are more common than primary liver cancers but remain understudied. This study provides the first nationwide analysis of liver metastases-related mortality trends and disparities in the US.

METHODS: This study analyzed CDC WONDER mortality data (1999-2023) and US Cancer Statistics incidence data for adults ≥ 45 years. Liver metastases-related (ICD-10: C78.7) mortality was stratified by demographics, geographic regions, and primary site of malignancy. Age-adjusted mortality and incidence rates (AAMRs, AAIRs) and crude mortality rates (CMRs) were reported per 100,000 population. Temporal trends were analyzed using Joinpoint regression to calculate annual and average annual percentage changes (APC, AAPC).

RESULTS: Liver metastases-related AAMR rose from 23.8 (1999) to 25.1 (2023) (AAPC = 0.22%*, 95% CI: 0.14-0.29). Males accounted for 51.3% of the 597,332 deaths and had higher AAMRs than females throughout. Lung (25.6%) and colon (24.6%) cancers were the leading primary sites causing deaths related to liver metastases. AAIRs and AAMRs (irrespective of metastasis) declined for most primary cancers. CMRs had an increasing trend, with nearly a 10-fold difference between ages 45-54 and 85+. Non-Hispanic (NH) Blacks had the highest AAMR with a declining trend (AAPC=-0.66%*), while NH Whites saw a significant increase (AAPC = 0.49%*). The West showed the biggest regional increase (AAPC = 1.24%*). AAMR rose the most in Vermont (AAPC = 5.30%*). Rural areas consistently had higher AAMRs (1999-2020).

CONCLUSION: Mortality from liver metastases has risen among older US adults, with notable demographic and geographic disparities. Improved survival among patients with primary cancers means more individuals are living long enough to experience recurrence and develop late liver metastases, underscoring the need for enhanced detection, surveillance, and management.

PMID:41504955 | DOI:10.1007/s12029-025-01391-w

Oecologia. 2026 Jan 8;208(2):21. doi: 10.1007/s00442-025-05855-5.

ABSTRACT

Apex carnivores are known to regulate ecosystem structure and function, including via interactions with syntopic, competitively inferior carnivores. These effects may be dependent on relative carnivore density and resource availability or productivity. We investigated the functional effect of African lions as an apex carnivore on the presence of co-occurring large carnivore species across two adjoining National Parks that contrast in relative densities of carnivores and prey. We employed two-species occupancy models from track data to test statistical interactions between lions and the other syntopic large carnivore species, while accounting for each species’ habitat selection. We further investigated the influence of anthropogenic and natural variables on these co-occurrence dynamics. Our models revealed that the occurrence of each carnivore species was best predicted by access to their own key resources. We also found significant statistical interactions between lions and cheetahs, lions and leopards, and lions and spotted hyenas in resource-rich landscapes. Finally, we found limited support for the competition exclusion hypothesis between most species, with the exception of lion-African wild dog co-occurrence patterns. Species’ co-occurrence dynamics were all influenced by resource availability, with lion-leopard and lion-cheetah co-occurrence decreasing strongly with increasing resource availability. Most species co-occurrence declined with increasing occurrence of lions. The patterns revealed by this study improves predictions of how changes in resource availability and carnivore occurrence could impact carnivore community dynamics and the functional role of apex carnivores.

PMID:41504937 | DOI:10.1007/s00442-025-05855-5

Pediatr Nephrol. 2026 Jan 8. doi: 10.1007/s00467-025-07076-7. Online ahead of print.

ABSTRACT

BACKGROUND: Early detection of ophthalmological and kidney complications of hypertension in children and adolescents may play a significant role in prophylaxis and prevent irreversible organ damage. This study aimed to assess standard kidney injury markers (creatinine, urea, uric acid, cystatin C, 24-h microalbuminuria), as well as potential ophthalmological changes using optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) in the early course of newly diagnosed hypertension in children and adolescents.

METHODS: The study group consisted of 56 children and adolescents with newly diagnosed hypertension who had not received antihypertensive treatment prior to the study. Fifteen individuals served as controls. The ECHO, abdominal ultrasound, ophthalmological examination, urine and blood tests were performed.

RESULTS: The concentration of cystatin C was increased in patients with hypertension. Children and adolescents with hypertension had decreased values of GFR (90.31 ± 13.00 ml/min/1.73 m²), estimated by the Filler equation, compared to subjects with optimal values of blood pressure (99.00 ± 9.27 ml/min/1.73 m²). The data revealed statistically significant differences in the retinal vessel density analyzed by OCT-A, which was decreased in the control group compared with the study group.

CONCLUSIONS: Pediatric patients with newly diagnosed hypertension have increased concentrations of cystatin C and hypofiltration estimated by the Filler equation. OCT-A might be considered a diagnostic tool for better understanding the early process of microvascular changes and the influence of concomitant comorbidities in newly diagnosed systemic hypertension.

PMID:41504898 | DOI:10.1007/s00467-025-07076-7