Tag: nevin manimala

Lipids Health Dis. 2025 Dec 18. doi: 10.1186/s12944-025-02834-w. Online ahead of print.

ABSTRACT

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Insulin resistance and visceral adiposity play pivotal roles in its pathogenesis; however, the prognostic significance of the triglyceride glucose-body roundness index (TyG-BRI) and its interaction with nutritional status remain uncertain.

METHODS: A total of 1,015 patients with HFpEF were prospectively enrolled. The TyG-BRI was calculated as the product of the triglyceride-glucose index (TyG index) and the body roundness index (BRI). Cox regression models were used to evaluate its prognostic value for adverse outcomes, with subgroup analyses stratified by nutritional status and mediation analysis assessing the role of exercise tolerance.

RESULTS: During follow-up, 232 (22.9%) all-cause and 158 (15.6%) cardiovascular (CV) deaths occurred. In multivariate Cox regression analysis, patients in the highest TyG-BRI tertile exhibited significantly higher risks of all-cause (hazard ratio [HR] = 2.59, 95% confidence interval [CI]: 1.82-3.71; P for trend < 0.001) and CV mortality (HR = 2.43, 95% CI: 1.59-3.72; P for trend < 0.001) compared with those in the lowest tertile. The prognostic value of the TyG-BRI for all-cause mortality was more prominent among participants with impaired nutritional status (malnourished or at risk of malnutrition) (P for interaction < 0.1). Incorporation of the TyG-BRI into the baseline risk model for all-cause death significantly improved model discrimination (C-statistic = 0.701 vs. 0.626; P < 0.001) and outperformed its individual components (P < 0.05). Mediation analysis further revealed that the six-minute walk distance mediated 14.6% of the association between the TyG-BRI and all-cause mortality.

CONCLUSIONS: In patients with HFpEF, the TyG-BRI was independently associated with adverse outcomes, with its prognostic value particularly evident among those with impaired nutritional status. Incorporating the TyG-BRI into the risk model modestly improved prognostic discrimination, and reduced exercise capacity appeared to partly mediate this association.

PMID:41408310 | DOI:10.1186/s12944-025-02834-w

Infect Agent Cancer. 2025 Dec 17. doi: 10.1186/s13027-025-00721-8. Online ahead of print.

ABSTRACT

Progression from infection with human papillomavirus (HPV) to cervical cancer in some women is thought to involve a permissive host environment, one in which immune response is mobilized in an inappropriate manner. Interleukin-2 (IL-2) is one of the most studied cytokines driving T-cell proliferation and survival. Soluble Interleukin-2 receptor (sIL2R) was found to play an immunoregulatory role and is detected in the serum of healthy individuals but increases in association with certain types of neoplasms. The aim of the current study was to assess the serum level of sIL2R in HPV infected female patients with genital warts compared to healthy control women and to correlate the results with cervical cytology (pap smear) results to determine the utility of measuring the serum sIL2R levels in screening of precancerous changes in cervix. The study was conducted on 90 Egyptian female patients with genital warts and 90 apparently healthy controls. Cervical brush samples were taken for both conventional Pap cytology and detection of HPV-DNA. Serum levels of sIL2R were measured by enzyme-linked immunosorbent assay (ELISA). Patients were divided into two groups according to the result of Pap smear: group 1 with Low-grade squamous intraepithelial lesion (LSIL) having flat condyloma on cervix and group 2 with normal pap smear having condyloma accuminata lesions. Serum sIL2R levels of HPV infected patients showed a statistically significant higher median when compared to controls (p value < 0.0001). Also, group 1 showed a statistically significant higher median compared to group 2 regarding sIL2R levels (p value < 0.0001). sIL2R was found to be perfect and reliable in differentiation between group 1 and group 2. Also, it may be useful to use serum sIL2R level for screening of HPV infections and cervical cancer.

PMID:41408300 | DOI:10.1186/s13027-025-00721-8

Int J Health Geogr. 2025 Dec 17. doi: 10.1186/s12942-025-00439-1. Online ahead of print.

ABSTRACT

In rapidly urbanizing megacities, the allocation of healthcare resources has long faced the dual challenges of spatial inequity and insufficient hierarchical diagnosis and treatment systems. This study constructed a multi-scale spatial analysis framework in Nanjing, China, to systematically diagnose the supply-demand mismatch of healthcare resources. By integrating the community-level detailed units and 100-meter population raster data, we combined the Hierarchical Two-Step Floating Catchment Area (H2SFCA) method with empirically calibrated service radii and introduced the “per capita bed compliance rate” to address the contradictions between “statistical adequacy” and “functional efficiency” in high-density clusters. The study revealed three key findings: First, medical resources in Nanjing present a “core-periphery” mismatch structure, tertiary hospitals are over-concentrated in the urban core (HH cluster), while per capita bed availability falls below the threshold (0.8 beds per thousand people), posing a hidden risk of overload. Second, secondary hospitals demonstrate a double paradox (LH-type shortages in old city and HL-type excesses in the suburbs), while the primary facilities fail to serve 32.57% of high-demand communities, contrasting sharply with inefficient HL-type redundancies found in remote suburbs. Additionally, 5% of transitional areas show statistically insignificant supply-demand correlations due to the disconnect between population mobility and static data. Based on these insights, the study proposes a two-path optimization framework-“Targeted interventions by LISA cluster type + hierarchical coordination (via referral networks)”-which offers an actionable pathway toward precision-oriented resource allocation. This approach not only provides practical solutions for establishing a”15-minute medical circle” in Nanjing but also presents a methodological paradigm applicable to high-density cities worldwide seeking effective strategies for hierarchical diagnosis and treatment.

PMID:41408284 | DOI:10.1186/s12942-025-00439-1

Malar J. 2025 Dec 18. doi: 10.1186/s12936-025-05737-4. Online ahead of print.

ABSTRACT

BACKGROUND: Malaria remains endemic in Peru, particularly in the Amazonas Region, with the highest burden reported in the Río Santiago District, Condorcanqui Province. As part of ongoing malaria elimination efforts, special attention must be given to submicroscopic infections, which may serve as silent reservoirs that sustain transmission. This study aimed to determine the prevalence of submicroscopic malaria infections and to identify the sociodemographic and clinical-epidemiological factors associated with these infections in the indigenous communities of Río Santiago.

METHODS: A cross-sectional study was conducted in four native communities, with data collected during wet season through active case detection interventions. Blood samples were collected from participants for both microscopic diagnosis and molecular confirmation (qPCR) of Plasmodium spp. infections, alongside sociodemographic and clinical data. Data analysis included descriptive statistics and univariate and multivariate regression models to assess factors associated with submicroscopic malaria infections.

RESULTS: A total of 926 individuals were enrolled in this study, of whom 157 (17.0%; 157/926) tested positive for Plasmodium spp. Plasmodium vivax was the most frequently detected species by both microscopy and qPCR. The prevalence of submicroscopic infections was 8.5% (79/926), with the community of Caterpiza exhibiting the highest prevalence (20.3%; 35/172). Among submicroscopic infections, 74.7% (59/79) were asymptomatic. Multivariate analysis showed that asymptomatic individuals had 2.32-fold higher prevalence of submicroscopic infection (aPR = 2.32, 95% CI 1.63-3.29). Conversely, the presence of household animals was associated with a 36% reduction in prevalence (aPR = 0.64, 95% CI 0.48-0.85). Additionally, living in Caterpiza was significantly associated with a higher prevalence, with individuals showing a 2.34-fold compared to those living in Alianza Progreso (aPR = 2.34, 95% CI 1.68-3.24).

CONCLUSIONS: Submicroscopic malaria infections were highly prevalent in the Río Santiago District, influenced by individual, household and community-level factors. These findings underscore the need for improved diagnostic strategies beyond symptom-based approaches such as molecular diagnostic tools within malaria surveillance systems to better detect and control hidden malaria transmission.

PMID:41408276 | DOI:10.1186/s12936-025-05737-4

J Surg Res. 2025 Dec 16;317:355-364. doi: 10.1016/j.jss.2025.11.058. Online ahead of print.

ABSTRACT

INTRODUCTION: Firearm-related injuries have become the leading cause of death for US children. Although a “volume-outcome” relationship is well-established in adults, it is less understood in pediatric penetrating trauma. This study aimed to evaluate the relationship between trauma center volume and patient outcomes in pediatric penetrating injuries.

METHODS: Utilizing the National Trauma Data Bank (2017-2021), we conducted a retrospective database study of pediatric patients (1-18 y) with stab or gunshot wounds (GSWs), treated at level I or II trauma centers. Patients with GSW to the head, interfacility transfers, or emergency department deaths were excluded. Trauma centers were categorized into quartiles based on penetrating injury volume. Primary outcomes were in-hospital mortality, intensive care unit length of stay, and ventilator dependency duration.

RESULTS: Of 666,111 patients, 34,064 with penetrating trauma were included, with 22,237 sustaining GSW. In-hospital mortality (4%-5%) did not significantly differ across volume quartiles. Patients at the highest-volume facilities (q4) experienced longer intensive care unit stays (4.33 d in q1 versus 5.45 d in q4, P < 0.001) and longer ventilator duration (3.22 d in q1 versus 4.90 d in q4, P < 0.001). After 3:1 matching to minimize confounding, prolonged ventilator dependency remained statistically significant in q4 facilities (relative risk = 1.256, P = 0.008), a trend also seen in the GSW subgroup (relative risk = 1.264, P = 0.016).

CONCLUSIONS: This study indicates that while trauma center volume may influence resource utilization for pediatric penetrating trauma, it does not significantly affect in-hospital mortality. Further research with more anatomically precise injury matching is warranted.

PMID:41406543 | DOI:10.1016/j.jss.2025.11.058

Eur J Surg Oncol. 2025 Dec 12;52(2):111354. doi: 10.1016/j.ejso.2025.111354. Online ahead of print.

ABSTRACT

INTRODUCTION: Oesophageal resection carries significant morbidity and mortality. Artificial intelligence (AI) advances in medical research enable enhanced predictions, flexibility, and interpretability, especially for complex interactions and nonlinear relationships.

MATERIAL AND METHODS: We used a register-based case-control design nested within prospectively collected data from the Swedish National Quality Register for Oesophageal and Gastric Cancer (NREV) to perform traditional logistic regression (LR) and machine learning (ML) with explainable AI (XAI) to predict 90-day mortality and anastomotic leakage in 1846 patients who underwent oesophageal resection between November 2005 and February 2018.

RESULTS: The 90-day mortality was 6.0 % and anastomotic leakage was 12.4 %. XAI models yielded an area under the curve (AUC) of 0.95 for 90-day mortality, compared to 0.88 for LR. For anastomotic leakage, the AUC was 0.84 with XAI versus 0.74 with LR. LR identified significant odds ratios for 90-day mortality associated with age, ASA 2-3, BMI, and anastomotic leakage. ML models identified the same variables plus year of surgery as significant. For anastomotic leakage, LR was significant only for ASA 3, whereas ML found all examined variables to be significant predictors. XAI showed age and perioperative bleeding as important survival factors, while high BMI and age were significant risk factors for anastomotic leakage. All factors demonstrated nonlinear associations. XAI also visualises individual risk assessments for each procedure.

CONCLUSIONS: By applying XAI, we advance surgical understanding of anastomotic leakage and mortality after oesophagectomy. Our data contain significant nonlinear relationships that cannot be visualised LR. With XAI, we extract personalised risk assessments, bringing oesophageal surgery closer to personalised medicine.

PMID:41406537 | DOI:10.1016/j.ejso.2025.111354

Rev Invest Clin. 2025 Dec 16;77(6):100030. doi: 10.1016/j.ric.2025.100030. Online ahead of print.

ABSTRACT

BACKGROUND: The efficacy and safety of thrombolytics within the first 4.5h of ischemic stroke symptom onset are well documented; however, evidence beyond this timeframe remains contentious.

OBJECTIVE: To assess the efficacy and safety of delayed thrombolysis (4.5-24-h window) for ischemic stroke.

METHODS: We conducted a systematic search to identify studies comparing thrombolytics to placebo or standard care in ischemic stroke patients treated within 4.5-24h of symptom onset. The primary outcome was functional independence at 90 days, with additional efficacy outcomes exploring recanalization and reperfusion at 24h, as well as safety outcomes of 90-day mortality and symptomatic intracranial hemorrhage. The statistical analysis was performed using R studio.

RESULTS: We included five randomized controlled trials with 1398 patients. The mean age was 70.2 years, 61% were male, and the median NIHSS score was 10.2. Compared with controls, thrombolysis improved functional independence at 90 days (OR 1.32; 95% CI: 1.06-1.63; p=0.01; I²=0%), although it increased the risk of symptomatic intracranial hemorrhage (OR 2.5; 95% CI: 1.10-5.71; p=0.02; I²=0%). No significant difference in mortality at 90 days was observed (OR 1.15; 95% CI: 0.84-1.57; p=0.39; I²=0%).

CONCLUSIONS: In ischemic stroke, thrombolytics administered within 4.5-24h improve functional independence at 90 days, also increasing the risk of symptomatic intracranial hemorrhage. At this point, careful and individualized patient selection, including advanced imaging, is mandatory for thrombolysis beyond the conventional 4.5-h treatment window.

PMID:41406536 | DOI:10.1016/j.ric.2025.100030

J Hazard Mater. 2025 Dec 14;501:140832. doi: 10.1016/j.jhazmat.2025.140832. Online ahead of print.

ABSTRACT

The environmental behavior of uranium (U) in soils is predominantly governed by its speciation, which is mediated by soil properties and environmental conditions. Soil water content is a critical driver of soil properties, but the specific mechanisms underlying its impacts on U speciation and stability remain poorly understood. Here, we investigated the mechanisms controlling U fraction and stability in U-contaminated soils under different water content conditions, by employing soil incubation experiments, chemical extraction, stirred-flow experiments, kinetic modeling, and statistical analyses. Results revealed that, relative to soils with a lower water content (e.g., 28 %), those with a higher water content (e.g., 58 %) significantly enhanced U stability, due to the prevalent reducing microenvironments (e.g., low redox potential). Such reducing conditions promoted the transformation of Fe/Mn oxide-U to organic matter-U during the microbial reductive dissolution of Fe minerals (e.g., hematite), and favored U(VI) reduction by Fe(III)-reducing bacteria (e.g., Pseudomonas and Anaeromyxobacter). Furthermore, dry-wet cycle process suppressed U release into soil solution by facilitating the formation of more stable U species (e.g., organic matter-U and residual U), a transformation mediated by Fe(III) reduction under wet conditions and Fe(II) oxidation/Fe mineral precipitation under dry conditions. Statistical analyses identified reactive Fe minerals and soil DOM as the two most critical drivers of U fraction. Additionally, the exchangeable U fraction was the most labile component governing release kinetics, while organic matter-U and carbonate-U fractions dominated U stabilization. Our results provide insights into the migration and transformation behavior of U in contaminated soils surrounding U tailings ponds.

PMID:41406526 | DOI:10.1016/j.jhazmat.2025.140832

Mar Pollut Bull. 2025 Dec 16;224:119005. doi: 10.1016/j.marpolbul.2025.119005. Online ahead of print.

ABSTRACT

Understanding the mechanisms that regulate carbon accumulation in mangrove ecosystems remains critical for supporting coastal climate-mitigation strategies. In this study, we integrate high-resolution airborne LiDAR data, sediment geochemistry, and hydrodynamic modeling to quantify the multi-scale controls on biomass and sediment carbon stabilization across 14 representative mangrove stands in subtropical and tropical China. Unlike previous regional assessments that emphasize latitudinal patterns, our approach focuses on how forest structural complexity, root-zone redox conditions, and hydrological connectivity shape long-term carbon storage. We found that stands characterized by dense prop-root networks and high canopy heterogeneity stored up to 47 % more sediment carbon than structurally simple forests. Sediment profiles revealed that prolonged anoxic conditions enhanced organic matter preservation, whereas periodic oxygenation events caused by storm-driven tidal surges accelerated carbon mineralization. Hydrodynamic simulations indicated that limited water exchange-not tidal amplitude alone-was the strongest predictor of belowground carbon retention. Metal pollutants and suspended solids played only secondary roles and mainly affected carbon stabilization in areas with restricted flushing. Nitrogen availability influenced productivity non-linearly: moderate ammonium enrichment enhanced growth, but high concentrations suppressed both net primary production and root respiration. Our findings highlight the importance of forest structure, micro-scale sediment chemistry, and hydrological isolation in governing China’s mangrove carbon balance, providing a new framework for restoration programs targeting long-term carbon sequestration rather than biomass recovery alone.

PMID:41406510 | DOI:10.1016/j.marpolbul.2025.119005

EBioMedicine. 2025 Dec 16;123:106075. doi: 10.1016/j.ebiom.2025.106075. Online ahead of print.

NO ABSTRACT

PMID:41406507 | DOI:10.1016/j.ebiom.2025.106075