Tag: nevin manimala

Pacing Clin Electrophysiol. 2025 Aug 25. doi: 10.1111/pace.70033. Online ahead of print.

ABSTRACT

INTRODUCTION: Premature ventricular complexes (PVC) are a common phenomenon observed in both normal and pathological heart conditions. However, they do not always behave in the same way. Different PVCs present with varying QRS morphologies, mechanisms, and origin sites. These differences may imply distinct prognoses. To date, the impact of the three-dimensional distribution of PVCs across the heart on the prognosis of ICD recipients has not been adequately investigated.

MATERIAL AND METHODS: We conducted an ambidirectional cohort study. Patients underwent two twelve-lead ambulatory ECG recordings during follow-up. The spatial distribution of PVCs was analyzed using the algorithm proposed by Kuchar et al. The impact of this spatial distribution on clinical variables was assessed using mixed generalized models.

RESULTS: Fifty-five patients were enrolled, with a mean follow-up time of 41.12 ± 13.48 months. All patients underwent two 12-lead ambulatory ECG recordings. The median PVC count was 91.5. PVCs were classified according to the algorithm proposed by Kuchar et al. PVCs arising from exit sites located in the intermediate left ventricle were associated with a higher number of therapies (odds ratio [OR]: 4.78; 95% confidence interval [CI], 1.19-19.26; p = 0.028) and prolonged QRS duration. PVCs with exit sites located in the septal region were associated with higher NYHA functional classes (OR: 2.22 [95% CI: 1.08-4.44]; p = 0.030). No statistically significant interaction was found between PVC topography and gender, number of ATP episodes, ATP success rate, or number of shock episodes.

CONCLUSION: The spatial distribution of PVCs influenced the prognosis of ICD recipients.

PMID:40853721 | DOI:10.1111/pace.70033

J Law Med. 2025 Jul;32(2):294-297.

ABSTRACT

Risk assessment is an important component of many areas of the law, including criminal law. Forensic psychologists and psychiatrists are sometimes called upon to provide evidence of the risk of future criminal activity through identifying and measuring risk factors with the aid of tools that use scales based on statistical or actuarial risk prediction. At present, there is an emphasis on “structured professional judgment” which combines the use of risk assessment tools with clinical judgment. However, the development of risk assessment tools by private companies using algorithms that are not released to the public raises both ethical and legal issues that are highlighted in this column.

PMID:40853693

JAMA Netw Open. 2025 Aug 1;8(8):e2526148. doi: 10.1001/jamanetworkopen.2025.26148.

ABSTRACT

IMPORTANCE: Transcranial direct current stimulation (tDCS) is emerging as a home-based intervention for neuropsychiatric conditions and cognitive enhancement. However, its effectiveness is limited by interindividual variability, as fixed-dose protocols have failed to account for anatomic differences influencing current delivery to targeted regions and treatment outcome. While computational modeling supports individualized dosing to improve consistency, experimental validation remains limited.

OBJECTIVE: To compare the behavioral and neurophysiologic outcomes of fixed-dose vs individualized-dose tDCS.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study using a within-participant, double-masked, crossover design was conducted from January 1, to March 31, 2024, at the National Institute of Mental Health and Neurosciences in India. Adult participants (aged 21-35 years) received 3 sessions of tDCS (fixed-dose, individualized-dose, and sham stimulation) in counterbalanced order. Individualized doses were calculated using a custom-built simulation toolbox.

MAIN OUTCOMES AND MEASURES: Behavioral performance was measured using reaction time during a rapid naming task. Neurophysiologic effects were assessed using motor-evoked potentials (MEPs) recorded before and after stimulation. Linear mixed-effects models were used for the statistical analysis.

RESULTS: Sixteen right-hand-dominant, bilingual English-Dravidian speakers (mean [SD] age, 23.1 [3.9] years; 8 female [50%]) were included. Individualized-dose tDCS associated with significantly greater reaction time improvement over sham (estimated marginal mean [SD]: before, 753.0 [41.1] ms; after, 619.0 [41.1] ms; change [Δ] = 133.6 ms; SE, 10.2 ms; z score ratio, 13.09) compared with fixed-dose tDCS (before, 694.0 [41.1] ms; after, 680.0 [41.1] ms; Δ = 14.6 ms; SE, 10.1 ms; z score ratio, 1.45). Variability was lower with individualized-dose stimulation (coefficient of variation, -1.14 vs 0.39 fixed vs individualized dose, respectively). Sex-stratified analyses showed that women had improvements with both fixed (Δ = 58.0 ms; P = .003) and individualized (Δ = 113.8 ms; P < .001) stimulation, while men had improvement only with individualized tDCS (Δ = 153.4 ms; P < .001). Seven participants (5 men and 2 women) converted from nonresponders to responders with individualized dosing. For MEPs, individualized-dose tDCS showed greater poststimulation amplitude increases over sham (β [SE], 0.91 [0.23]), although fixed-dose tDCS poststimulation amplitude was smaller, but significant (β [SE], 0.56 [0.23]; P = .02) and showed a higher percentage change (β [SE], 144.26% [55.74%]; P = .01) and reduced variability (coefficient of variation, -0.79 vs 1.12 [fixed]).

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study, dose-controlled tDCS was associated with consistent behavioral and neurophysiologic improvement, highlighting its translational importance in the treatment of neuropsychiatric disorders.

PMID:40853662 | DOI:10.1001/jamanetworkopen.2025.26148

JAMA Netw Open. 2025 Aug 1;8(8):e2526990. doi: 10.1001/jamanetworkopen.2025.26990.

ABSTRACT

IMPORTANCE: Cancer screening is a critical tool in cancer control, reducing cancer-specific mortality. However, it also has potential harms, including overdiagnosis and overtreatment. Measuring the effect of screening based on all-cause mortality is insensitive to both benefits and harms and requires substantially large sample sizes. Understanding the impact of screening on noncancer-related (off-target) mortality is essential for evaluating its overall benefit.

OBJECTIVE: To assess the association between cancer screening and off-target mortality by comparing mortality rates between screened and unscreened populations based on randomized clinical trials (RCTs).

DATA SOURCES: The analysis examined all RCTs included in a previously published (August 28, 2023) meta-analysis of cancer screening trials that included the end point of all-cause mortality in addition to targeted cancer mortality.

STUDY SELECTION: All RCTs included in the previous meta-analysis were included. The latest search in that meta analysis was conducted on October 12, 2022, with no language or publication date restrictions.

DATA EXTRACTION AND SYNTHESIS: The study followed relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two authors independently extracted data, and a third author verified those data. Off-target mortality was analyzed using rate ratios (RRs) and 95% CIs via a fixed-effects model. Heterogeneity was assessed using the I2 statistic.

MAIN OUTCOME AND MEASURES: The primary outcome was off-target mortality, defined as deaths with a cause that was not the targeted cancer.

RESULTS: A total of 17 RCTs (8 of colorectal, 3 prostate, 3 lung, 2 breast, and 1 multiple cancers) including 1 305 924 participants with 18 508 192 person-years of follow-up were included. Screening did not significantly increase off-target mortality (RR, 1.00; 95% CI, 1.00-1.01); the overall increase in off-target mortality was 0.2% (95% CI, -0.5% to 0.9%). There was no evidence of heterogeneity between trials (I2 = 0.00%; Cochran Q = 14.96, df = 18; P = .66). The trial-specific RRs ranged from 0.89 (95% CI, 0.69-1.15) to 1.09 (95% CI, 0.98-1.22), with all 95% CIs including 1. Targeted cancer deaths accounted for 2.6% to 33.1% of all deaths, depending on the cancer type.

CONCLUSIONS AND RELEVANCE: These findings show that randomization to cancer screening was not associated with more than a very small increase in noncancer-related mortality, with the 95% CI excluding an increase of greater than 1%. The findings emphasize the importance of evaluating targeted and off-target mortality separately rather than relying solely on all-cause mortality.

PMID:40853661 | DOI:10.1001/jamanetworkopen.2025.26990

JAMA Netw Open. 2025 Aug 1;8(8):e2528844. doi: 10.1001/jamanetworkopen.2025.28844.

ABSTRACT

IMPORTANCE: Diagnosis of breast and gynecologic cancers may hamper employment; little is known about who is at greater risk of resignation.

OBJECTIVE: To examine whether a breast or gynecologic cancer diagnosis is associated with resignation in working women and to identify high-risk subpopulations.

DESIGN, SETTING, AND PARTICIPANTS: This matched cohort study included women aged 15 to 58 years insured by the Japan Health Insurance Association. From April 2017 to March 2023, women newly diagnosed with breast, cervical, uterine, or ovarian cancer were identified and matched in a 1:10 ratio to working women without these cancers.

EXPOSURE: Cancer diagnosis was based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause resignation, and the secondary outcome was a composite of resignation and death, both assessed during a 2-year follow-up. Stratified Cox proportional-hazards models were applied, with multiple imputation and covariate adjustments. Subgroup analyses by prespecified covariates assessed effect size moderation and interactions between exposure and these covariates.

RESULTS: The study included 99 964 women with cancer, including 59 452 women with breast cancer (median [IQR] age, 48 [44-53] years), 14 713 women with cervical cancer (median [IQR] age, 46 [39-51] years), 16 933 women with uterine cancer (median [IQR] age, 49 [44-53 years]), and 8866 women with ovarian cancer (median age [IQR] age, 47 [40-52] years), as well as 999 640 matched controls (594 520 for the breast cancer cohort, 147 130 for the cervical cancer cohort, 169 330 for the uterine cancer cohort, and 88 660 for the ovarian cancer cohort). Most women with cancer were working in the medical, health care, or welfare sector (32 123 women [32.1%]). During follow-up, resignation rates were significantly higher for women with cancer vs controls (breast cancer: 10 820 women [18.2%] vs 97 892 women [16.5%]; hazard ratio [HR], 1.18; 95% CI, 1.16-1.20; cervical cancer: 3296 women [22.4%] vs 27 476 women [18.7%]; HR, 1.31; 95% CI, 1.26-1.36; uterine cancer: 3161 women [18.7%] vs 27 786 women [16.4%]; HR, 1.24; 95% CI, 1.19-1.29; ovarian cancer: 2004 women [22.6%] vs 15 847 women [17.9%]; HR, 1.44; 95% CI, 1.37-1.51). Regarding the composite outcome of resignation and death, there was an increased risk for all cohorts, ranging from an HR of 1.25 (95% CI, 1.22-1.27) for breast cancer to 1.81 (95% CI, 1.73-1.89) for ovarian cancer. Among all 4 cancer cohorts, resignation risk was higher among women with older age, lower income, and a history of depression.

CONCLUSIONS AND RELEVANCE: In this cohort study using a nationwide health claims database in Japan, breast and gynecologic cancers were associated with a higher resignation risk, especially among those with older age, lower income, and depression history. These findings suggest that developing targeted support interventions may benefit women at high resignation risk after a cancer diagnosis.

PMID:40853656 | DOI:10.1001/jamanetworkopen.2025.28844

Work. 2025 Aug 25:10519815251370711. doi: 10.1177/10519815251370711. Online ahead of print.

ABSTRACT

BackgroundThe burnout syndrome has been described mainly among the working population. However, it is observed that students experience burnout syndrome as well, and that physician burnout may already start during the studies od medicine. Findings also show increased problem of alcohol consumption among medical students.ObjectiveDetermine the risk of burnout in the sample of medical students, and to evaluate their alcohol consumption, as well as to determine whether there is any association between these two entities.MethodsParticipants were 290 students of Faculty of Medicine, from all six study years. Maslach Burnout Inventory – Student Survey (MBI-SS) was used to evaluate the degree of burnout. Alcohol Use Disorder Identification Test (AUDIT) was used to evaluate alcohol consumption.ResultsIn the MBI-SS subcategory of Emotional Exhaustion, 81% reported high burnout risk. Results of low burnout risk in the subcategory of Cynicism, gradually decreased during the course of studies. The highest medium burnout risk was reported in the subcategory of Academic Efficacy, at 45.20%. The number of students belonging to the minimum risk level, Zone 1, on the AUDIT test, gradually decreased as the years of study increased. There is a slightly statistically significant, positive correlation between Emotional Exhaustion and alcohol use (p ≤ 0.05), as well as between Cynicism and alcohol use (p ≤ 0.05).ConclusionHigh burnout levels and their association with alcohol use in medical students imply a further investigation of these complex and harmful issues, and raise concern for the mental well-being of the future medical practitioners.

PMID:40853638 | DOI:10.1177/10519815251370711

World J Pediatr Congenit Heart Surg. 2025 Aug 25:21501351251360692. doi: 10.1177/21501351251360692. Online ahead of print.

ABSTRACT

Background: The World Database for Pediatric and Congenital Heart Surgery (WDPCHS) was utilized to define the incidence of one-year mortality and identify associated risk factors following surgery for congenital heart disease. Methods: The WDPCHS was queried from January 2017 to September 2022 for all tier 1 surgeries submitted to the database. Out-of-hospital death was defined as a death between 30 days postoperatively and up to one year. Preoperative risk factors and other demographics were evaluated. Chi-square test was used to evaluate associations, a multivariable logistic regression model was performed and the P value for statistical significance was set at <.05. Results: Among 9764 patients alive at hospital discharge (or 30 days), overall, one-year mortality was 1.47% (n = 144). Mortality was highest in STAT 5, 22.88% (27/118) (P < .0001). Risk factors with a higher incidence of one-year mortality included: non-Trisomy 21 genetic syndromes 6.38% (18/282), more than three preoperative risk factors 12.12% (16/132), more than three postoperative complications 9.81% (37/377) all P < .0001. Highest mortality by procedure was seen with the Norwood procedure 22.88% (27/118) and truncus arteriosus repair 8.97% (7/78), both P < .0001. By multivariable analysis, the risk of one-year mortality remained significantly higher with more than three preoperative risk factors (OR 5.85, 95% CI 3.12-10.96), non-Trisomy 21 chromosomal abnormalities (OR 3.04, 95% CI 1.75-5.29), and STAT 5 cases (OR 28.4, 95% CI 15.02-53.71). Conclusions: Based on these findings, there are certain risk factors (multiple preoperative risk factors, chromosomal abnormalities, STAT 5 category) that warrant targeted increased surveillance to improve one-year outcomes.

PMID:40853632 | DOI:10.1177/21501351251360692

Work. 2025 Aug 25:10519815251370596. doi: 10.1177/10519815251370596. Online ahead of print.

ABSTRACT

BackgroundEffective workload management in education is crucial for student well-being with nature-based Virtual Reality (VR) interventions presenting a viable solution. Most publications primarily examined high-end VR devices with immersive Head-Mounted Displays (HMDs), leading to a study gap in areas with restricted access to advanced VR technology.ObjectivesThis study explores the impact of a low-cost non-immersive VR environment on students’ workload and cognitive performance in an educational context.MethodsThe participants were divided into two groups: a control group using traditional screen-based tasks and an intervention group using low-cost VR tools. Subjective workload was assessed using NASA-TLX and the participants were further categorized based on their perceived workload levels. Objective physiological data, including heart rate variability (HRV) and galvanic skin response (GSR), were recorded, and cognitive performance was measured using the Pauli Test.ResultsThe results showed no significant differences in physiological, psychological, or performance outcomes between the control and intervention groups, implying that non-immersive VR did not significantly affect stress levels. Due to the limited sensory engagement, non-immersive VR did not activate the body or engage cognition effectively.ConclusionThese findings suggest that the non-immersive VR intervention not sufficient to produce measurable cognitive impact. Future research is encouraged to investigate the potential of immersive VR environments, which might provide a greater sensory experience. In addition, longer exposure durations should be examined to enhance understanding of the effects on cognitive load, relaxation, and overall well-being in nature-based VR applications. Even though differences were not statistically significant, non-immersive VR still reduced stress and enhanced engagement.

PMID:40853605 | DOI:10.1177/10519815251370596

Eur Radiol. 2025 Aug 25. doi: 10.1007/s00330-025-11945-y. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate whether quantitative DWI and qualitative T2WI parameters can predict lymph node involvement in clinical early rectal cancer.

MATERIALS AND METHODS: This retrospective study included consecutive patients who had rectal MRI from January 1, 2010, to March 31, 2021, showing T1-T2 rectal cancer before undergoing total mesorectal excision without neoadjuvant therapy. Visible mesorectal lymph nodes on DWI were segmented by a junior reader, and ADC values were extracted. Additionally, the junior reader and a senior reader independently recorded qualitative T2WI parameters of the most suspicious lymph node per patient. Histopathology was the reference standard for malignant (pN+) and benign (pN-) lymph node status.

RESULTS: Of 69 patients (37 men and 32 women) (median age, 55 years; IQR: 48-66), 23 (33%) had pN+ status; 46 (67%) had pN- status. ADC_mean (in × 10^-3 mm²/s) of the most suspicious lymph node was not different between the two patient groups (junior reader: 1087 vs. 926, p = 0.31; senior reader: 1178 vs. 1086, p = 0.89). The Dutch criteria, based on the combination of T2WI size and morphologic parameters, showed better diagnostic performance for the senior vs. junior reader: accuracy, sensitivity, specificity, PPV, and NPV of 79.7% (95% CI: 68.3-88.4%), 56.5% (95% CI: 34.5-76.8%), 91.3% (95% CI: 79.2-97.6%), 76.5% (95% CI: 50.1-93.2%), and 80.8% (95% CI: 67.5-90.4%), vs. 69.6% (95% CI: 57.3-80.1%), 26.1% (95% CI: 12.2-48.4%), 91.3% (95% CI: 79.2-97.6%), 60% (95% CI: 26.2-97.8%), and 71.2% (95% CI: 57.9-82.2%).

CONCLUSIONS: Additional research on alternative and more objective methods for lymph node characterization is needed.

KEY POINTS: Question The performance of MRI for nodal staging in clinical early rectal cancer in particular is a knowledge gap in the literature. Findings The Dutch criteria, based on T2WI size and morphologic parameters, performed better in differentiating metastatic from benign lymph nodes than the quantitative DWI ADC parameter. Clinical relevance Accurate nodal staging in early rectal cancer is crucial for treatment decision-making. Our study highlights the need for additional research on alternative and more objective methods for lymph node characterization.

PMID:40853592 | DOI:10.1007/s00330-025-11945-y

Intern Emerg Med. 2025 Aug 25. doi: 10.1007/s11739-025-04089-w. Online ahead of print.

ABSTRACT

Intermediate-risk pulmonary embolism (IRPE) is a critical clinical entity with significant mortality risk due to normotensive shock, a condition marked by low cardiac index despite maintained blood pressure. Accurate and timely detection of hemodynamic compromise in IRPE remains a challenge. Velocity Time Integral (VTI), a Doppler echocardiographic parameter, has emerged as a potential non-invasive tool for predicting hospital outcomes, but the evidence remains fragmented. This systematic review and meta-analysis aim to evaluate the diagnostic accuracy of VTI in this context. A systematic literature search encompassing PubMed, EMBASE, and SCOPUS Databases was conducted from inception till December 2024. Studies assessing VTI’s diagnostic accuracy for predicting hospital outcomes in IRPE were included. A bivariate random-effects model was used to pool sensitivity and specificity, with heterogeneity analyzed via I² statistics and meta-regression. Literature search yielded 9 studies with 2038 patients. Pooled sensitivity and specificity of VTI for predicting hospital outcomes in IRPE were 79% (95% CI 69-86%) and 81% (95% CI 70-88%), respectively. Diagnostic odds ratio was 15.58 (95% CI: 7.42-32.69). Heterogeneity was moderate to high (I² = 66.59%), with specificity showing greater variability. Meta-regression identified study-level characteristics, including risk of bias and VTI measurement site (LVOT vs. RVOT), as sources of variability. VTI demonstrates moderate sensitivity and specificity in predicting hospital outcomes such as mortality, in-hospital mortality, resuscitated cardiac arrest, hemodynamic instability or the need for reperfusion therapy. VTI, offers a non-invasive, real-time diagnostic option. However, study heterogeneity and methodological limitations highlight the need for further research.

PMID:40853590 | DOI:10.1007/s11739-025-04089-w