Tag: nevin manimala

BMC Gastroenterol. 2025 May 3;25(1):333. doi: 10.1186/s12876-025-03801-6.

ABSTRACT

OBJECTIVES: This study aimed to investigate the factors affecting effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.

MATERIALS AND METHODS: The data of 160 patients who underwent ESWL for pancreatic duct stones in Department of Gastroenterology, First People’s Hospital of Hangzhou, Westlake University School of Medicine, from July 2017 to June 2023, were retrospectively analyzed. The age and sex of the patients were recorded. All patients underwent spiral computed tomography (CT) abdominal plain scan. The placement of the pancreatic duct stent was recorded. The maximum CT value of stones was manually measured. The regions of interest (ROI) was delineated using ITK-SNAP software, and the stone volume was recorded. According to the size of residual stones after lithotripsy, 99 patients were included in the complete lithotripsy group (CL Group) and 61 patients in the incomplete lithotripsy group (ICL Group). SPSS 26.0 software was used for processing and analysis. A P value < 0.05 was considered statistically significant.

RESULTS: The Sex, maximum CT value, and volume of pancreatic duct stones were statistically significant in both groups. Binary logistic regression analysis showed that female sex, maximum CT value, and volume of pancreatic duct stones were independent risk factors affecting incomplete ESWL fragmentation in pancreatic duct stones. ICL group had a higher mean number of treatments and mean number of impacts than CL group.

CONCLUSION: The Sex, maximum CT value, and volume of stones were related to the therapeutic effect of ESWL. Female sex, maximum CT value, and volume of stones were independent risk factors affecting incomplete stone fragmentation.

PMID:40319240 | DOI:10.1186/s12876-025-03801-6

BMC Pregnancy Childbirth. 2025 May 3;25(1):530. doi: 10.1186/s12884-025-07621-0.

ABSTRACT

BACKGROUND: While zygotes lacking pronuclei (0PN) or exhibiting a single pronucleus (1PN) may theoretically yield diploid embryos with developmental potential, current clinical protocols predominantly exclude these embryos from use. In the population undergoing preimplantation genetic testing for structural rearrangements (PGT-SR), there is a high rate of chromosomal aneuploidy abnormalities and needs a large number of embryos to obtain euploid embryos, so we will explore whether 0PN and 1PN embryos can be an option for them.

METHODS: This retrospective analysis examined pronuclear development in 4,868 zygotes derived from 4,902 injected metaphase II (MII) oocytes across 422 assisted reproductive cycles. In a subset of 54 cycles (12.8%), preimplantation genetic testing for structural rearrangements (PGT-SR) was implemented for blastocysts originating from 0PN and 1PN embryos that progressed to Day 5/6 development stage prior to vitrification. Comprehensive genomic haplotyping was performed on 343 embryos within this subgroup, including 33 0PN-derived, 36 1PN-derived, and 274 conventional 2PN-derived specimens. The investigation’s primary endpoint focused on neonatal survival outcomes, while secondary assessments evaluated both embryo transfer suitability and chromosomal normality rates.

RESULTS: Compared to 2PN embryos, the proportion of 0PN and 1PN embryos developing into blastocysts is significantly lower (5.41%, 21.56% vs. 56.51%, p-value < 0.001); the euploid rate of 0PN blastocysts is not statistically different from that of 2PN blastocysts (18.18% vs. 33.21%, p-value = 0.111), but significantly lower for 1PN blastocysts (11.11% vs. 33.21%, p-value = 0.004). In 54 cycles involving 0PN and 1PN blastocysts, the inclusion of 0PN and 1PN embryos resulted in an increase in the number of frozen embryos (5.81 ± 3.55 vs. 7.09 ± 3.52, p-value = 0.063), transferable embryos (1.59 ± 1.25 vs. 1.78 ± 1.30, p-value = 0.452), embryos transferred (0.98 ± 0.76 vs. 1.07 ± 0.75, p-value = 0.526), and patients undergoing transfer (74.07% vs. 79.63%, p-value = 0.494), although these changes were not statistically significant. The five 0PN and 1PN embryos transferred resulted in three live births, which was not a significant increase (56.36% vs. 56.67%, p-value = 0.974).

CONCLUSION: Chromosome abnormalities did not increase the occurrence of abnormal fertilization. There were already a large number of embryos in the PGT-SR population, and routine inclusion of 0PN and 1PN embryos in the PGT-SR cycle is not recommended in this study. Priority should be given to the transfer of 2PN embryos. If a couple receives fewer than three 2PN embryos, or no 2PN embryos at all, it may be considered to include 0PN and 1PN embryos, with preference given to the use of 0PN. Furthermore, genome-wide ploidy and haplotyping are recommended for detection, and aneuploid and ploidy abnormalities are excluded.

PMID:40319238 | DOI:10.1186/s12884-025-07621-0

BMC Pulm Med. 2025 May 3;25(1):213. doi: 10.1186/s12890-025-03684-z.

ABSTRACT

BACKGROUND: As a cardiovascular health (CVH) assessment tool, Life’s Crucial 9 (LC9) is often associated with diverse chronic health indicators. However, no study has yet explored the association of LC9 with multifactorial components of lung health. Thus, this study aimed to investigate the correlation of LC9 with lung health.

METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES), which covers individuals aged 40 years and older with complete LC9 and lung health data. Multiple regression was employed in linear relationships investigation, while Restricted Cubic Spline (RCS) was used to explore nonlinear relationships. Subgroup analyses and interaction tests demonstrated the stability of associations. Combining LC9 to build a Light Gradient Boosting Machine (LightGBM) machine learning (ML) model to predict lung health, Shapley Additive Explanations (SHAP) sorted the contribution of LC9 components to the model.

RESULTS: From a total of 10,461 study participants, 1725 had low CVH, 7476 had moderate CVH, and 1260 had high CVH. There was a strong positive correlation between LC9 score and lung health. This association remained consistent across subcomponent strata. RCS analysis revealed non-linear associations between LC9 and respiratory outcomes, including cough, asthma, and COPD. The LightGBM model incorporating LC9 demonstrated excellent predictive performance for lung health, with favorable metrics in Area Under the Curve (AUC), accuracy, and specificity. SHAP analysis identified depression, nicotine exposure, and BMI scores as the predominant contributors among LC9 components to the model’s predictive capability.

CONCLUSION: Individuals with better CVH as assessed by LC9 tended to have better lung health. The combination of the LightGBM model could achieve better prediction results.

PMID:40319236 | DOI:10.1186/s12890-025-03684-z

J Agromedicine. 2025 May 3:1-12. doi: 10.1080/1059924X.2025.2498342. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to 1) explore perceptions of air quality (AQ) monitoring, hazard communication, health impacts of smoke exposure, protective controls and training needs among agricultural supervisors in alignment with the major elements of the wildfire smoke rule, and 2) compare survey responses by the language in which the survey was completed to identify training needs by group.

METHODS: Bilingual personnel administered a 29-question survey in Spanish and English to agricultural supervisors and crew chiefs at two industry trainings in Washington (WA) State (12/2023, 1/2024). Data were analyzed in SPSS. Descriptive statistics were used to summarize the data with chi-squared tests for group comparisons by language.

RESULTS: A total of 116 surveys were collected, with 61% completed in Spanish. Almost one-fifth (18%) of respondents reported “hypertension/cardiovascular disease” as a condition that impacts their own health, and 19% reported “asthma/respiratory disease.” Of respondents, 80% agreed they have been exposed to wildfire smoke at work, and 77% reported they supervised workers who have been exposed to smoke. A significantly greater proportion of completers in Spanish (90%) reported being concerned with their own health and their workers’ health in relation to smoke exposure than those completing in English (64%). Most (81%) respondents agreed they can recognize signs/symptoms when a worker is not feeling well due to smoke exposure, but only 63% reported having had training on managing workers with smoke-related symptoms. N95 masks were identified as the most realistic protective control to implement when wildfire smoke is present. There were significant differences by language group regarding what resources respondents identified as accurate for AQ monitoring at work. Most respondents (79%) had heard of the wildfire smoke rule in Washington.

CONCLUSION: Wildfire smoke is an occupational health threat for outdoors workers that is expected to increase. Supervisors who work in agricultural workplaces are required by law in Washington, Oregon, and California to monitor AQ, manage workers’ symptoms, and implement protective controls at certain AQ thresholds. Study findings identify gaps in these areas and will support ongoing training of a critical subsector of the agricultural workforce.

PMID:40319235 | DOI:10.1080/1059924X.2025.2498342

BMC Pregnancy Childbirth. 2025 May 3;25(1):528. doi: 10.1186/s12884-025-07609-w.

ABSTRACT

OBJECTIVE: This study aimed to assess the incidence, trends, and adverse pregnancy outcomes associated with preeclampsia (PE), while further investigating whether these adverse outcomes differ by parity and the type of pregnancy-twin or singleton.

MATERIALS AND METHODS: A multicenter cross-sectional study was conducted in Hebei, China, spanning the years 2013 to 2022, enrolling a total of 455,456 women. The incidence rates and trends of PE and its subtypes were analyzed utilizing joinpoint regression analysis, while modified Poisson regression was employed to assess the association between PE and adverse pregnancy outcomes. Effect modification by parity, twin or singleton pregnancy was also evaluated.

RESULTS: The prevalence of PE and its stratification by singleton pregnancies and parity (primiparas versus multiparas) exhibited upward trends, with no statistically significant changes observed in the incidence of twins affected by PE from 2013 to 2022 in Hebei Province. After adjusting for sociodemographic characteristics and other comorbidities during pregnancy, patients with PE experienced significantly elevated risks of cesarean section (adjusted relative risk [aRR], 4.78; 95% confidence interval [CI], 4.54-5.02), postpartum hemorrhage (aRR, 1.97; 95% CI, 1.75-2.21), placental abruption (aRR, 1.52; 95% CI, 1.37-1.69), preterm birth (aRR, 5.35; 95% CI, 5.14-5.56), small for gestational age (SGA) newborns (aRR, 2.48; 95%CI, 2.38-2.58), maternal near-miss events (MNM) (aRR, 1.18; 95% CI, 1.01-1.38), and admission to the neonatal intensive care unit (NICU) (aRR, 1.27; 95% CI, 1.11-1.44). In contrast, the risk of placenta previa was significantly lower (aRR, 0.26; 95% CI, 0.21-0.32). The risks of cesarean section, postpartum hemorrhage, and preterm birth ascribable to PE were conspicuously augmented in twin pregnancies; conversely, the risk of placental abruption was more notable in singletons. The influence on cesarean delivery was pronounced in primiparas, while the risks of MNM, placental abruption, and preterm birth related to PE escalated in multiparas.

CONCLUSIONS: The incidences of PE in overall, singletons, primiparas and multiparas exhibited upward trends in Hebei from 2013 to 2022. Women afflicted with PE demonstrated a conspicuously augmented risk of adverse pregnancy outcomes and the magnitude of the influence of PE varied with singleton or twin pregnancies and parity.

PMID:40319233 | DOI:10.1186/s12884-025-07609-w

BMC Anesthesiol. 2025 May 3;25(1):227. doi: 10.1186/s12871-025-03106-x.

ABSTRACT

BACKGROUND: Pediatric patients undergoing upper gastrointestinal (GI) interventions frequently require sedation and analgesia due to the challenges associated with endoscopic probe placement, particularly the gag reflex. This study investigates the effects of nebulized dexmedetomidine as a premedication on the gag reflex in pediatric patients undergoing gastrointestinal endoscopy.

METHODS: We conducted a single-center, prospective, randomized controlled trial at the Pediatric Gastroenterology Clinic of Ondokuz Mayis University School of Medicine from January to April 2024. Participants aged 2-17 years scheduled for upper GI endoscopy were randomized to receive nebulized dexmedetomidine (2 µg /kg) or no premedication. The primary outcome measured was the severity of the gag reflex during the procedure. Secondary outcomes included cough incidence, separation anxiety, postoperative agitation, and endoscopist satisfaction. Statistical analyses were performed with significance set at p < 0.050.

RESULTS: A total of 120 patients were analyzed. The dexmedetomidine group demonstrated a significantly lower incidence of gag reflex (88.3% with no gag reflex vs. 30% in the control group, p < 0.001) and coughing (95% vs. 55%, p < 0.001). Separation anxiety scores were also significantly lower in the dexmedetomidine group (p < 0.005). Additionally, the need for additional anesthetics was reduced, and endoscopist satisfaction was significantly higher. No significant differences in complications were observed between the two groups (p = 0.600).

CONCLUSIONS: Nebulized dexmedetomidine is a safe and effective premedication for pediatric patients undergoing endoscopic procedures, significantly reducing gag and cough reflexes, decreasing anesthetic requirements, and enhancing endoscopist satisfaction. This approach improves the comfort and safety of pediatric endoscopy procedures.

TRIALS REGISTRATION: ClinicalTrials.gov: NCT06218797, date of registration 27/12/2023.

PMID:40319232 | DOI:10.1186/s12871-025-03106-x

BMC Anesthesiol. 2025 May 3;25(1):226. doi: 10.1186/s12871-025-03077-z.

ABSTRACT

BACKGROUND: Anxiety during anesthesia induction can lead to various negative outcomes and psychological burdens in children undergoing surgery. Nonpharmacological interventions are available for reducing anxiety in this context. However, due to a lack of evidence from head-to-head randomized controlled trials (RCTs), the specific effects of these methods on children with anxiety during anesthesia induction remain unclear.

OBJECTIVE: This network meta-analysis aimed to evaluate the comparative effects of all known nonpharmacological interventions for reducing anxiety in children during anesthesia induction and to rank these interventions based on their practical applicability.

DESIGN: Systematic review and Bayesian network meta-analysis.

METHODS: We searched PubMed, Embase, CINAHL, Cochrane Library, and Web of Science to identify articles published up to August 2024. Two reviewers independently assessed eligibility of potential studies and extracted data. Outcome measures of the meta-analysis were the anxiety levels of children during anesthesia induction, the anxiety levels of parents, and the child’s compliance during anesthesia induction. A consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probabilities of different nonpharmacological interventions.

RESULTS: A total of 34 RCTs with 3,040 participants and six intervention methods were included. All trials confirmed the safety of the six intervention methods, with no significant adverse events reported. The network meta-analysis showed that the Passive Distraction Intervention (PDI)-Parental Presence at Induction of Anesthesia (PPIA), Interactive Distraction Intervention (IDI)-PPIA, IDI, PDI, and PPIA interventions were associated with more substantial reductions in anxiety than usual care. However, the studied interventions showed no statistically significant differences for reducing parental anxiety. The PPIA, IDI, and IDI-PPIA interventions also improved compliance during anesthesia induction.

CONCLUSIONS: Our study confirmed that some nonpharmacological interventions are effective at reducing anxiety in children and enhancing compliance during anesthesia induction. Therefore, we recommend several interventions for clinical practice, including the PDI-PPIA, IDI-PPIA, PDI, IDI, and PPIA when working with children undergoing anesthesia induction.

REGISTRATION: We registered this network meta-analysis with PROSPERO (registration no. CRD42022262874).

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40319229 | DOI:10.1186/s12871-025-03077-z

World J Urol. 2025 May 3;43(1):262. doi: 10.1007/s00345-025-05660-y.

ABSTRACT

PURPOSE: PVC waste from urology care contributes to environmental pollution, greenhouse gas emissions, high energy use, and increased costs, impacting public health. Effective recycling strategies remain limited. This study aimed to assess the feasibility of a PVC recycling program for urology waste.

MATERIALS AND METHODS: This feasibility study implemented a recycling program for PVC waste in a urology unit. Healthcare staff, including physicians, residents, nurses, and janitorial personnel, were trained in the recycling process for empty irrigation bags, which were collected daily, weighed, and tracked. Bags were then sent to a facility to process them into high-quality PVC pellets. A cost analysis reflected financial conditions in Mexico City. Additionally, an electronic survey of 10 questions gauged participants’ ease of involvement, barriers, program impact, and improvement suggestions. Statistical and qualitative analyses were conducted.

RESULTS: Over 15 months, 2,805 irrigation bags were collected, which corresponded to 187.93 kg of waste, yielding 186.05 kg (99%) of PVC. On a further life cycle assessment, we concluded that by recycling we saved 2,418 L of water, reduced CO₂ emissions by 930 kg, and saved 3,720 kWh of energy. Projected five-year recycling estimates suggest a potential collection of 1,527.6 kg of PVC, which will amount to water savings of 19,858.8 L, a reduction of CO₂ emissions of 7,638 kg, and energy savings of 30,552 kWh. Potential financial savings could reach €25,333.66.

CONCLUSIONS: A PVC recycling program for irrigation bags is feasible, with economic and environmental benefits. This initiative supports waste reduction and public health efforts.

PMID:40319223 | DOI:10.1007/s00345-025-05660-y

Dig Dis Sci. 2025 May 3. doi: 10.1007/s10620-025-09074-z. Online ahead of print.

ABSTRACT

The rising number of gastrointestinal (GI) tumors, including esophageal, gastric, and colorectal tumors, makes it essential to develop more effective treatment methods. Endoscopic submucosal dissection (ESD) has become a popular intervention due to its ability to resect the tumor completely and prevent local recurrence. This study evaluates the safety and efficacy of ESD with rubber bands and clips (ESD-RBC) in the treatment of various GI tumors. We systematically searched Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane databases until April 20, 2024. Eligible studies included clinical trials and observational studies focusing on ESD-RBC alone or compared to conventional ESD (C-ESD) in patients with gastrointestinal tumors. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) tool. Statistical analyses were performed using RevMan and R software. ESD-RBC was superior to C-ESD in achieving R0 resection and en bloc resection (OR: 1.99 with 95% CI [1.17 to 3.36], P = 0.01, I² = 0%) and (OR: 5.98 with 95% CI [2.30 to 15.55]; P = 0.0002, I² = 0%), respectively. ESD-RBC enhanced the resection speed compared to C-ESD (MD: 8.48 mm²/min with 95% CI [3.12 to 13.83]; P < 0.00001, I² = 89%) and shortened the procedure duration (MD: – 11.94 min with 95% CI [- 21.98 to – 1.91]; P < 0.00001, I² = 7%). There was no statistically significant difference between both groups in terms of bleeding and delayed bleeding (OR: 1.08 with 95% CI [0.37 to 3.14]; P = 0.89, I² = 0%) and (OR: 0.69 with 95% CI [0.20 to 2.33]; P = 0.55, I² = 0%), respectively. The proportion of R0 resection using ESD-RBC was 90%, with 95% CI [65% to 98%] and I² = 78%. The en bloc resection rate was 96%, with 95% CI [95% to 97%], and I² = 0%. In addition, the raw mean (MRAW) of resection speed was 24.25 mm2/min, with 95% CI [13.48 to 35.02], and I² = 99.4%. ESD-RBC was superior to C-ESD in achieving en bloc resection and R0 resection with a comparable risk of bleeding and delayed bleeding. In addition, ESD-RBC enhanced the resection speed and shortened the procedure duration.

PMID:40319201 | DOI:10.1007/s10620-025-09074-z

Cardiooncology. 2025 May 2;11(1):42. doi: 10.1186/s40959-025-00339-0.

ABSTRACT

BACKGROUND: Dexrazoxane, a putative iron chelator, is effective in preventing doxorubicin-induced cardiotoxicity. However, dexrazoxane is also a catalytic inhibitor of topoisomerase 2b (Top2b), a key mediator of doxorubicin toxicity. Preclinical studies have shown that dexrazoxane induces Top2b degradation, and early administration (8 h before doxorubicin) can prevent doxorubicin-induced cardiotoxicity. In this study, we investigated the dose-response relationship and time course of dexrazoxane-induced Top2b degradation in human volunteers.

METHODS: Twenty-five healthy female volunteers received an intravenous infusion of dexrazoxane at doses ranging from 100 mg/m² to 500 mg/m². Blood samples were collected hourly from time zero to 12 h, as well as at 24- and 48-h post-infusion. Peripheral blood mononuclear cells (PBMCs) were isolated, nuclear fractions were extracted, and Top2b expression was analyzed by western blot using Lamin B1 as a control. A linear mixed-effects model was used to assess differences among the five dose groups.

RESULTS: Dexrazoxane infusion led to a rapid and sustained reduction of Top2b in PBMCs, lasting up to 12 h. Statistical analysis revealed a significant difference in Top2b levels among the five dose groups (p = 0.0002). Subgroup analysis identified a significant difference between the 100 mg/m² and 500 mg/m² groups (p = 0.005). However, topoisomerase 2a (Top2a), the molecular target of doxorubicin’s tumor-killing effect, remained unchanged following dexrazoxane infusion.

CONCLUSIONS: Findings from this dose-response and time-course study can inform the design of future clinical trials investigating the efficacy of early dexrazoxane administration in preventing doxorubicin-induced cardiotoxicity while minimizing the risk of tumor protection.

TRIAL REGISTRATION: (Funded by the National Institute of Health, RO1HL151993; PHOENIX trials, ClinicalTrials.gov number, NCT03930680.).

PMID:40317097 | DOI:10.1186/s40959-025-00339-0