Tag: nevin manimala

JAMA Netw Open. 2025 Dec 1;8(12):e2550044. doi: 10.1001/jamanetworkopen.2025.50044.

ABSTRACT

IMPORTANCE: Little is known about food insecurity (FI) among graduate medical education (GME) trainees or how FI might relate to well-being outcomes in this population.

OBJECTIVES: To assess the prevalence of and factors associated with FI among GME trainees and to investigate the associations of FI with well-being outcomes such as burnout and social isolation in this population.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, a survey was distributed among 3408 resident and fellow physicians at 4 geographically distinct sites within 2 US academic institutions from May 2 to June 21, 2023. All resident and fellow physicians appointed at both institutions were eligible and were invited by email to participate.

MAIN OUTCOMES AND MEASURES: The primary outcome was prevalence of FI. Measurement instruments included a 2-item FI screening tool, a 2-item measure of burnout, items addressing intent to stay at one’s institution, social isolation, and demographic characteristics. Univariable analysis and multivariable Poisson and linear regression were used to characterize prevalence and factors associated with FI and associations with well-being outcomes and intent to stay at the institution.

RESULTS: Of those eligible, 1656 residents and fellows participated in the survey (a response rate of 48.6%). Of these respondents, 735 of 1458 (50.4%) who indicated their gender identified as men and 365 of 1402 (26.0%) who indicated their parental status reported having children. Of the 1551 respondents who reported their age, 519 (33.5%) were younger than 30 years, 770 (49.6%) were aged 31 to 35 years, 169 (10.9%) were aged 36 to 40 years, and 53 (3.4%) were older than 40 years. Among 1457 respondents indicating their race and ethnicity, the majority were Asian (310 [21.3%]) or White (654 [44.9%]). The overall prevalence of FI was 13.7%. FI proportions differed across training sites, with higher levels in large metropolitan locations (15.6%, 17.0%, and 21.3% for the 3 sites in large metropolitan areas vs 4.5% for the site in a small metropolitan area; P < .001). There were also differences by postgraduate year (16.9% for postgraduate year 1 vs 10.1% for postgraduate year ≥5; P = .003) and race and ethnicity (22.4% for Black or African American trainees compared with 8.4% for White trainees; P = .04). Those with FI were more likely to experience burnout (adjusted relative risk, 1.37 [95% CI, 1.18-1.60]; P < .001), were less likely to consider remaining at their institution after training (adjusted relative risk, 0.81 [95% CI, 0.68-0.98]; P = .02), and had higher social isolation scores (T-score parameter estimate 2.37 [95% CI, 0.89-3.86]; P = .002).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, nearly 1 in 7 GME trainees screened positive for FI. FI was associated with important well-being outcomes including burnout. These findings suggest that academic medical institutions should pursue systemic solutions to address FI among resident and fellow physicians as a means of supporting their well-being.

PMID:41405884 | DOI:10.1001/jamanetworkopen.2025.50044

JAMA Netw Open. 2025 Dec 1;8(12):e2550195. doi: 10.1001/jamanetworkopen.2025.50195.

ABSTRACT

IMPORTANCE: Standard preoperative radiotherapy (RT) for high-risk soft tissue sarcoma (STS) is delivered over 5 weeks, which can be a logistical challenge for patients.

OBJECTIVE: To evaluate the long-term toxic effects and clinical outcomes associated with a shorter 5-day, dose-equivalent preoperative RT regimen.

DESIGN, SETTING, AND PARTICIPANTS: Phase 2, single-group nonrandomized trial with an initial cohort (April 2016 to May 2018) and expansion cohort (October 2018 to May 2023) at a single academic center in the US. Participants were patients with histologically confirmed extremity or trunk STS recommended to undergo standard preoperative RT and surgery. Patients with planned neoadjuvant systemic therapy who were enrolled in the expansion group were excluded from this analysis. Analysis was conducted September 2024 to August 2025.

INTERVENTION: A total of 30 Gy in 5 fractions were delivered preoperatively.

MAIN OUTCOMES AND MEASURES: The primary end point was 2-year grade 2 or higher radiation toxic effects. Secondary end points included major wound complications (MWC), local failure, distant progression, and overall survival.

RESULTS: A total of 110 patients were treated with preoperative RT and surgery (42 patients [38%] were aged 65-79 years; 64 [58%] were male; 75 had tumors of the lower extremity [68%], and 64 patients [58%] had high-grade disease). The initial cohort accrued 50 patients who underwent surgery. The expansion cohort accrued 83 patients; 60 of 83 were treated without neoadjuvant chemotherapy and were included. Median (IQR) follow-up was 37.3 (20.1-60.6) months, including 64.2 (36.3-74.1) months for the initial cohort and 30.0 (13.5-40.2) months for the expansion cohort. At 2 years, 14 of 74 evaluable patients (18.9%) developed grade 2 or higher toxic effects (10 patients [25.0%] for the initial cohort and 4 patients [11.8%] for the expansion cohort). MWCs occurred in 33 of 110 patients (30.0%); (17 [34.0%] for the initial cohort and 16 [26.7%] for the expansion cohort). Time to wound closure exceeded 6 months for 15 patients (13.6%), including 12 of 29 patients (41.4%) who underwent local tissue advancement flaps. Two-year local control adjusting for competing risk of death was 92.4% (95% CI, 86.3%-96.5%). There were 3 (2.7%) bone fractures and 5 (4.5%) amputations.

CONCLUSIONS AND RELEVANCE: This nonrandomized clinical trial of ultrahypofractionated preoperative RT identified durable local control with MWC and favorable late grade 2 or higher toxic effects rates. Randomized data are necessary to differentiate the safety profiles of various fractionation regimens, especially duration of wound healing.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02701153.

PMID:41405883 | DOI:10.1001/jamanetworkopen.2025.50195

Health Rep. 2025 Dec 17;36(12):18-29. doi: 10.25318/82-003-x202501200002-eng.

ABSTRACT

BACKGROUND: An increasing number of Canadians are living with mental health problems, including mood disorders. However, few studies have examined the prevalence of, and factors associated with, mood disorders among older Canadians (65 years or older).

DATA AND METHODS: A pooled sample of 172,524 community-dwelling older Canadians from nine cycles of the annual Canadian Community Health Survey – 2015 to 2023 – was used to examine mood disorders and associated correlates. Multivariable logistic regression, stratified by sex, was implemented to identify factors associated with mood disorders.

RESULTS: From 2015 to 2023, on average, 7.0% of older Canadians reported a diagnosis of a mood disorder, with females (8.3%) more likely than males (5.5%) to do so. In a multivariable analysis that adjusted for demographic, socioeconomic, geographic, and health-related factors, Indigenous people (males and females) had higher odds of having a mood disorder than non-Indigenous, non-racialized populations. South Asian and Chinese males, as well as females belonging to Black and Other racialized groups, had significantly lower odds compared with their non-Indigenous, non-racialized counterparts. Living alone, being a male immigrant, and having lower household income were associated with a higher likelihood of experiencing mood disorders among older Canadians.

INTERPRETATION: The results of this study highlight the importance of considering racialized population groups, as well as socioeconomic, geographic, and health-related factors – separately for males and females – when examining mood disorders among older Canadians to inform screening and intervention programs.

PMID:41405853 | DOI:10.25318/82-003-x202501200002-eng

Health Rep. 2025 Dec 17;36(12):3-17. doi: 10.25318/82-003-x202501200001-eng.

ABSTRACT

BACKGROUND: The prevalence of household food insecurity in the 10 provinces rose from 16.8% in 2019 to 18.4% in 2022 and 22.9% in 2023. This study examines whether and how the sociodemographic and economic patterning of households’ vulnerability to food insecurity changed across these years.

DATA AND METHODS: Using data from the master files for households in the 10 provinces from the 2018, 2021, and 2022 cycles of the Canadian Income Survey, year-specific logistic regression models were conducted to estimate the predicted probability of household food insecurity by sociodemographic and economic characteristics. The predicted probability of food insecurity was also charted in relation to household income from the prior tax year, expressed in 2022 constant dollars and adjusted for household size, for each survey year.

RESULTS: The probability of food insecurity increased significantly for most households, irrespective of the sociodemographic or economic characteristics considered. In 2019 and 2022, households receiving 50% or more of their income from employment or self-employment had a lower probability of food insecurity than those with a smaller proportion of their income from employment, but there was no difference between these groups in 2023. The probability of food insecurity was significantly higher in 2022 than 2019 at all household income levels above $20,000 and higher along the entire household income continuum in 2023 than 2022.

INTERPRETATION: The probability of food insecurity is highest for low-income households, but food insecurity is becoming more prevalent among moderate- and higher-income households, and reliance on employment income is no longer protective against food insecurity.

PMID:41405852 | DOI:10.25318/82-003-x202501200001-eng

Adv Neonatal Care. 2025 Dec 15. doi: 10.1097/ANC.0000000000001331. Online ahead of print.

ABSTRACT

BACKGROUND: Palliative care is underutilized in the neonatal intensive care unit (NICU). Many patients who qualify for palliative care in the NICU are not being referred.

PURPOSE: The project’s purpose was to promote the integration of palliative care in the NICU by increasing the number of palliative care consultations through a diagnosis trigger list.

METHODS: The project director conducted a literature review and created and implemented a facility-specific diagnosis trigger list and educational module. Retrospective chart reviews were conducted from June 2023 through August 2023 to gather baseline data and from June 2024 through August 2024 to assess the project’s impact. The Neonatal Palliative Care Questionnaire for Nurses (NPCQN) and the Neonatal Palliative Care Attitude Scale (NiPCAS) were administered to neonatal nurse practitioners at the facility by pre- and post-tests before and after receiving the module.

RESULTS: The percentage of palliative care consultations placed improved from 4% to 13%. The NPCQN showed statistically significant improvement in knowledge with a P < .001. The NiPCAS showed statistically significant improvement in attitude concerning 2 of 26 questions, with values of P = .016 and P = .047.

IMPLICATIONS FOR PRACTICE AND RESEARCH: The implementation of a neonatal palliative care trigger list can increase the number of consultations placed. A palliative care trigger list can be generalized to other populations.

PMID:41405842 | DOI:10.1097/ANC.0000000000001331

Clin Exp Nephrol. 2025 Dec 17. doi: 10.1007/s10157-025-02800-x. Online ahead of print.

ABSTRACT

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome, integrating cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic dysfunction, is a construct proposed by the American heart association. Although associations with CVD are well recognized, evidence linking CKM stage to renal outcomes remains limited.

METHODS: We analyzed health checkup data of 266,256 Japanese aged 40-74 years. Participants were classified into CKM stages 0-4a. Outcomes included all-cause mortality, cardiovascular death, and a composite renal outcome (end-stage kidney disease [eGFR < 15 mL/min/1.73 m²], ≥ 40% eGFR decline, or doubling of serum creatinine). Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs), with CKM stage 0 as the reference.

RESULTS: CKM stage 2 was the most prevalent stage (65.0%). Stage 4a showed the strongest association with all-cause and cardiovascular mortality (HRs 1.79, 3.16; 95% CIs 1.41-2.28, 1.92-5.20, respectively). In contrast, stage 3 conferred the highest risk of renal outcomes (HR 15.29, 95% CI 10.13-23.08). The number and type of metabolic risk factors correlated with outcomes, furthermore, severe CKD and prior CVD were stronger drivers of adverse outcomes than metabolic dysfunction.

CONCLUSION: CKM staging stratifies risk in the general population. No significant increase in risk was observed until CKM stage 2, and these findings underscore the progressive, cumulative nature of CKM syndrome. Metabolic dysfunction plays a crucial role in progression, stage 3 marks a pivotal inflection point for renal deterioration, and stage 4a identifies individuals at the greatest mortality risk. Early interventions targeting metabolic dysfunction may help prevent progression to advanced CKM stages and improve long-term outcomes.

PMID:41405790 | DOI:10.1007/s10157-025-02800-x

Clin Implant Dent Relat Res. 2025 Dec;27(6):e70109. doi: 10.1111/cid.70109.

ABSTRACT

OBJECTIVES: To investigate patients’ awareness, trust, and acceptance of robot-assisted dental implant surgery in South China, identify the influencing factors, and evaluate the opportunities and challenges to clinical use.

MATERIAL AND METHODS: A cross-sectional survey was conducted from November 2024 to August 2025 in three public hospitals in South China. Electronic questionnaires were distributed to patients who had or were scheduled to undergo implant surgery or were considering dental implant treatment. Participants were assigned to Questionnaire A (patients who underwent robot-assisted implantation) or Questionnaire B (patients without such experience). The questionnaire covered the demographic characteristics, awareness level, trust, acceptance, and experience of those treated with robot assistance.

RESULTS: Three hundred and ninety six valid questionnaires were administered. Among these, 26.51% accepted robot-assisted implants, 27.78% rejected, and 45.70% were uncertain. In the inexperienced group (n = 382), 61.00% expressed distrust, which was associated with the age, humanistic care, safety, and emergency capabilities of the new technique. In the experienced group (n = 14), 78.60% of patients expressed their willingness to undergo robotic surgery again. The regression analysis revealed that preoperative information negatively affected satisfaction (β = -0.239, p = 0.019), whereas intraoperative experience exhibited a positive effect (β = 0.268, p = 0.014).

CONCLUSIONS: Patients in South China demonstrated limited awareness of robot-assisted dental implant surgery. Trust was mainly influenced by demographics and safety perceptions, whereas satisfaction relied on intraoperative experiences and recovery. The promotion of robot-assisted implant technology should emphasize technical reliability, doctor-patient communication, improved patient experience, and tailored management for different groups.

PMID:41405772 | DOI:10.1111/cid.70109

Int Ophthalmol. 2025 Dec 17;46(1):38. doi: 10.1007/s10792-025-03918-3.

ABSTRACT

INTRODUCTION: This study aims to evaluate the long-term outcomes of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) at a tertiary care center in Saudi Arabia over a 15-year period, focusing on the graft survival, visual improvement, complications rates, and graft insertion techniques.

METHODS: This is a retrospective study that included all patients who underwent DSAEK at King Abdulaziz University Hospital (KAUH), Riyadh, between 2009 and 2024. Data were collected on demographics, surgical details, visual acuity, graft survival, and complications. Primary and secondary graft failures were clarified, and risk factors were analyzed using univariate and multivariate Cox regression. Kaplan-Meier survival curves were used to represent the grafts survival, and surgical techniques (Lens Glide vs. Busin Glide) were compared.

RESULTS: A total of 179 eyes from 163 patients were included. The overall graft survival rate was 69.3%, with cumulative survival of 81.0% at 1 year, 63.8% at 3 years, and 51.7% at 5 years. Visual acuity improved in 46.9% of patients, and 22.0% achieved 20/40 or better. Postoperative complications occurred in 38.5% of cases, with endothelial rejection being the leading cause of graft failure (49.1%). In multivariate analysis, postoperative complications were the only independent risk factor for failure (HR = 2.67, 95% CI: 1.71-4.18, p < 0.001). Although not statistically significant, a trend toward decreasing survival rates was evident with repeated DSAEK. Among surgical techniques, the lens glide group had no primary failures in the single-surgeon subgroup and demonstrated higher success rates than busin glide (p = 0.026).

CONCLUSIONS: DSAEK provides favorable long-term outcomes, though prior surgeries, glaucoma, and postoperative complications, specifically endothelial rejection, can negatively impact graft survival. Surgical technique may influence early failure rates, emphasizing the importance of gentle tissue handling and surgeon expertise.

PMID:41405761 | DOI:10.1007/s10792-025-03918-3

J Thromb Thrombolysis. 2025 Dec 17. doi: 10.1007/s11239-025-03218-8. Online ahead of print.

ABSTRACT

Lung cancer is one of the most common malignancies, characterized by a wide prognosis spectrum, different histological subtypes, and a high mortality rate. Hemostatic system imbalance in patients with lung cancer often leads to increased mortality. Intracellular RNAs that share common miRNA binding sites create a competing endogenous RNA (ceRNA) network that plays an important role in gene expression regulation. The emerging role of ceRNAs in tumor development is increasingly being recognized; however, their connection to hemostatic system imbalance in lung squamous cell carcinoma (LUSC) remains unclear. In this study, RNA-seq data of LUSC and normal tissues were downloaded from the TCGA data portal. Differentially expressed mRNAs (DEmRNAs), miRNAs (DEmiRNAs), and lncRNAs (DElncRNAs) between LUSC and corresponding paracancerous tissues were analyzed using the DESeq2 package in R statistical software. Hemostasis-related genes linked to coagulation and complement cascades (hsa04610) and platelet activation (hsa04611) pathways were identified using the KEGGREST package. The ceRNA network associated with system hemostasis was constructed using differentially expressed RNAs (DERNAs), including mRNAs, lncRNAs, and miRNAs. The GO and KEGG enrichment analysis of DEmRNAs was conducted using the enrichR package. Hazard ratio (HR) and Kaplan-Meier curve were employed to assess the prognostic value of DERNAs using the survival and survminer packages. A ceRNA network comprising 100 hemostasis-related genes, 5 miRNAs, and 57 lncRNAs was constructed. Of these, 19 hemostasis genes, one miRNA (miR-23-3p), and 6 lncRNAs (LINC01615, LINC00707, LINC00702, FEZF1-AS1, DLX6-AS1, CLRN1-AS1) were significantly associated with prognosis in LUSC. Based on correlation analysis, MEF2C-AS1/miR-429/F8, RAP1A, GNAI2, C3AR1, F13A1, P2RY12, LCP2, C1QC axis and CASC11, CASC9, PVT1, BBOX1-AS1/ miR-23b-3p/ PLAU axis may represent key pathways involved in hemostatic system imbalance and the pathogenesis of LUSC. Our analysis revealed a complex ceRNA network associated with system hemostasis and the prognosis of LUSC. These findings may contribute to the development of personalized therapies and valuable prognostic biomarkers for LUSC patients.

PMID:41405758 | DOI:10.1007/s11239-025-03218-8

J Thromb Thrombolysis. 2025 Dec 17. doi: 10.1007/s11239-025-03220-0. Online ahead of print.

ABSTRACT

Amyloid microclots have been implicated in thrombotic complications across various pathological conditions such as Long COVID symptoms, yet their resistance to enzymatic fibrinolysis causes a therapeutic challenge. In this study we examine the effects of three fibrinolytic enzymes rtPA, Lumbrokinase, and Nattokinase on plasma-derived amyloid microclots, in combination with ultrasound-induced microstreaming and microbubbles. A lab-on-chip platform was used to expose the clots to ultrasound at 150, 300, and 500 kHz. Quantitative analysis revealed that ultrasound alone significantly disrupted clot structures, particularly at 150 kHz, where mean clot diameter was reduced by over 60% and large-clot count (> 30 μm) dropped by more than 80% compared to controls. The addition of fibrinolytic enzymes, however, did not produce statistically significant effects at 150-300 kHz which indicates that mechanical forces were the dominant contributors to clot disruption. At 500 kHz, where ultrasound alone was less effective, enzymatic treatment moderately enhanced the reduction in large-clot burden. These results show the potential of low-frequency ultrasound as a primary method of amyloid microclot breakdown, with enzyme co-treatment offering limited but measurable effect.

PMID:41405757 | DOI:10.1007/s11239-025-03220-0