Tag: nevin manimala

Ann Am Thorac Soc. 2025 Jul 28. doi: 10.1513/AnnalsATS.202501-054OC. Online ahead of print.

ABSTRACT

RATIONALE: Short-term ambient air pollution exposure may worsen asthma health. Effects of longer-term air pollution exposures on asthma exacerbations and risk mitigation by dietary factors are unknown.

OBJECTIVE: To examine associations between 48-month air pollution exposure and asthma exacerbations and whether a plant-based diet modifies these relationships.

METHODS: Women with asthma in the Nurses’ Health Study II were followed from 1997 to 2014. We estimated 48-month time-varying average residential ambient fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) exposures using nationwide spatiotemporal models. Plant-diet index (PDI) scores were calculated based on food frequency questionnaires administered every 4 years. Air pollution and diet assessments were repeated measures within-individuals, while asthma exacerbations in the past year were captured in 1998 and 2014. Average air pollutant exposure was assessed in the 48-months prior to each outcome assessment year. Single and multi-pollutant logistic regression models with generalized estimating equations to account for repeated measures within participants were used to assess the effects of each air pollutant on asthma exacerbation risk. We also evaluated effect measure modification by PDI scores on the effects of each air pollutant on asthma exacerbation risk using two-way interaction terms.

RESULTS: Of 4326 participants, median 48-month PM2.5, NO2 and O3 concentrations were 13.7 ug/m3, 12.0 ppb and 25.5 ppb, respectively, from July 1993 to June 1997 and 8.9 ug/m3, 6.6 ppb and 27.8 ppb, respectively, from July 2009 to June 2013. In adjusted single pollutant models, greater exposures to both PM2.5 and NO2 were associated with higher odds of asthma exacerbation (OR 1.43; 95% CI 1.14-1.80, and OR 1.25; 95% CI 1.12-1.38, respectively). In multi-pollutant models, greater exposure to NO2 was associated with higher odds of asthma exacerbation (OR 1.23; 95% CI 1.06-1.42). There were no statistically significant interactions between pollutants and PDI score on asthma exacerbations.

CONCLUSIONS: Long-term exposure to ambient NO2 and PM2.5 even at low levels, may increase asthma exacerbation risk in women, but is not attenuated by a plant-based diet as measured herein. Further research is needed on long-term effects of inhaled pollutants on asthma health and personal, modifiable strategies to reduce risk.

PMID:40720872 | DOI:10.1513/AnnalsATS.202501-054OC

JMIR Aging. 2025 Jul 28;8:e65374. doi: 10.2196/65374.

ABSTRACT

BACKGROUND: Individuals with probable sarcopenia have shown excess mortality, yet no specific treatment regimen has been established. While lifestyle factors improve health and longevity in general populations, their role in probable patients with sarcopenia remains unclear due to differing lifestyle patterns. Clarifying this could inform strategies to address this unmet need.

OBJECTIVE: We aim to quantify the impact of a healthy lifestyle on all-cause and cause-specific mortality in probable sarcopenic populations using a large-scale prospective cohort study.

METHODS: Participants were selected from the UK Biobank, aged 40-69 years, during 2006-2010. Probable sarcopenia was identified according to EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria, resulting in 20,654 participants being included in this study. Death dates and underlying causes were obtained from the National Health Service Information Center. Cox proportional hazard models and population-attributable risk were used to assess the associations between healthy lifestyle factors and premature mortality risk.

RESULTS: A total of 20,654 individuals with probable sarcopenia were included in this study. The median age of the population was 62.0 (IQR 56.0-66.0) years, and 60.6% (n=12,528) were women. During a median follow-up duration of 11.5 (IQR 10.8-12.3) years, 2447 participants died. All healthy lifestyle factors, including nonsmoking (P<.001), moderate alcohol intake (P<.001), regular physical activity (P<.001), a healthy diet (P=.01), limited television-watching time (P<.001), adequate sleep duration (P=.001), and strong social connections (P<.001), were independently associated with lower mortality risk. To evaluate the cumulative associations between modifiable lifestyle factors and mortality outcomes (all-cause and cause-specific) among patients with probable sarcopenia, we developed a healthy lifestyle index. Participants were assigned one point per adherence to each optimal lifestyle factor. Compared with individuals with 0-2 healthy lifestyle scores, hazard ratios of all-cause mortality for those with 3 to 6-7 factors were 0.67 (95% CI 0.59-0.76), 0.51 (95% CI 0.45-0.57), 0.43 (95% CI 0.38-0.49), and 0.33 (95% CI 0.29-0.39), respectively (P for trend <.001). There was also a dose-response relationship between the number of healthy lifestyle factors and mortality from cancer, cardiovascular disease, respiratory disease, digestive disease, and other causes (all P for trend<.001). Population-attributable risk analysis indicated that 25.7% (95% CI 22%-29%) of deaths were attributable to a poor lifestyle (scoring 0-5).

CONCLUSIONS: A healthy lifestyle is associated with a lower risk of all-cause mortality and mortality due to cancer, cardiovascular disease, respiratory disease, and digestive disease among individuals with probable sarcopenia. Adopting a healthy lifestyle (scoring 6-7) could prevent 25.7% of deaths in this population.

PMID:40720868 | DOI:10.2196/65374

Int J Periodontics Restorative Dent. 2025 Jul 28;0(0):1-25. doi: 10.11607/prd.7732. Online ahead of print.

ABSTRACT

This single-center pilot randomized clinical trial compared ridge dimensional changes following alveolar ridge preservation (ARP) with allograft (AG) versus xenograft (XG) in non molar sites with buccal dehiscence defects. 12 patients (6 per group) needing a single rooted tooth extraction were included. After extraction, sockets were grafted with the assigned bone substitute, covered with an absorbable membrane and collagen matrix. Cone beam computed tomography (CBCT) scans were taken at two time points: immediately post surgery and six months later. The need for additional bone augmentation at the time of implant placement was evaluated using implant planning software. Six months after ARP, AG demonstrated significantly better ridge width preservation (0.41 mm vs. 1.78 mm for XG, measured at 2 mm below the crest; p = 0.007). A trend favoring XG for better preservation of buccal and palatal/lingual ridge height was observed, though differences were not statistically significant (p = 0.11 and 0.58, respectively). Only one site (8.3%), from the AG group, required additional bone augmentation at implant placement. This pilot clinical trial suggests allograft and xenograft were both able to minimize dimensional changes when used for ARP in non-molar extraction sites with buccal dehiscence defect. Allograft may be more effective in minimizing ridge width reduction 2 mm from the crest while the xenograft appears to better preserve ridge height. Both bone graft materials are effective in reducing the need for additional bone augmentation; however, larger clinical studies are needed to confirm these findings.

PMID:40720844 | DOI:10.11607/prd.7732

Ann Intern Med. 2025 Jul 29. doi: 10.7326/ANNALS-24-03947. Online ahead of print.

ABSTRACT

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophilic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Rituximab has emerged as the standard of care in other types of ANCA-associated vasculitis, but controlled studies on its use in EGPA are yet lacking.

OBJECTIVE: To compare rituximab with conventional strategy for the induction of remission in patients with EGPA.

DESIGN: Phase 3, multicenter, randomized, controlled, double-blind, superiority trial. (ClinicalTrials.gov: NCT02807103).

SETTING: France.

PARTICIPANTS: Patients with a diagnosis of EGPA, newly diagnosed or relapsing disease at the time of screening, with active disease defined as a Birmingham Vasculitis Activity Score (BVAS) of 3 or greater.

INTERVENTION: Glucocorticoids plus rituximab (1 g 2 weeks apart) compared with the conventional strategy (glucocorticoids alone or in combination with cyclophosphamide in severe forms) for induction of remission.

MEASUREMENTS: The primary end point was remission defined as a BVAS, version 3, of 0 and a prednisone dose of 7.5 mg/d or less at day 180. Secondary end points included duration of remission during the study, average daily glucocorticoid dose, and safety.

RESULTS: A total of 105 participants were randomly assigned. Thirty-three (63.5%) patients in the rituximab group achieved the primary end point compared with 32 (60.4%) in the control group (relative risk, 1.05 [95% CI, 0.78 to 1.42]; P = 0.75). Results were similar at day 360. The mean duration of remission was 48.5 ± 6.51 weeks in the rituximab group and 49.1 ± 7.42 weeks in the conventional strategy group (P = 0.41). All relapse and major relapse rates were similar between the 2 groups. There was no statistically significant difference in the average daily glucocorticoid dose and no statistically significant differences in the rates of adverse events between the treatment groups.

LIMITATION: Design not appropriate to answer the question of equivalence between rituximab and cyclophosphamide in patients with severe EGPA.

CONCLUSIONS: Rituximab was not superior to a conventional remission induction strategy in EGPA.

PRIMARY FUNDING SOURCE: French Ministry of Health.

PMID:40720835 | DOI:10.7326/ANNALS-24-03947

J Med Internet Res. 2025 Jul 28;27:e56961. doi: 10.2196/56961.

ABSTRACT

BACKGROUND: To enhance patient empowerment, the Cantonal Hospital of Lucerne launched a patient portal (MyChart) in December 2019, granting patients access to their medical records, diagnoses, and laboratory results. Months later, the first COVID-19 case was reported in Switzerland, with the pandemic dramatically affecting health care services.

OBJECTIVE: This analysis aims to investigate how the pattern of patient portal registrations evolved during the pandemic, with reference to the spread of COVID-19, as well as local and federal policies.

METHODS: This retrospective observational study analyzed the distribution of patient portal registrations after its introduction at the study site from December 1, 2019, until July 31, 2022. The descriptive analysis included the 7-day mean of registrations, plotted alongside the number of administered COVID-19 tests and COVID-19 vaccinations. This was analyzed concerning predefined time periods and stratified by age and gender. Additionally, an interrupted time series analysis was conducted for the different time periods.

RESULTS: A total of 126,519 patients registered on the patient portal during the study period, with a slightly higher proportion of female patients (n=66,118, 52.3%) and 11.3% (n=14,259) being 65 years of age or older. The daily registration rate differed substantially over the course of the COVID-19 pandemic, whereby four peaks with >200 registrations per day were identified. The first and third peaks coincide with high COVID-19 testing rates in autumn 2020 and 2021, whereas the second and fourth peaks coincide with the release of the vaccine in spring 2021 and the booster at the end of 2021. These patterns are also reflected in the interrupted time-series analysis: for every transition from one period to the next, the immediate effect of the intervention (level change) is statistically significant with P<.05. Regarding patient portal users aged 65 years or older, only two major peaks in registrations can be identified which coincide with the release of the COVID-19 vaccine and booster.

CONCLUSIONS: The COVID-19 pandemic, with its disease dynamics, including testing and vaccinations, seems to have influenced the number of patient portal registrations. In addition, it appears that patients aged 65 years or older predominantly registered for COVID-19 vaccines.

PMID:40720825 | DOI:10.2196/56961

J Am Acad Orthop Surg. 2025 Jul 24. doi: 10.5435/JAAOS-D-25-00365. Online ahead of print.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) is frequently used in knee and hip arthroplasty because of its benefits. The literature is scarce on TXA and total ankle arthroplasty (TAA). The current systematic review aims to present the available literature on the subject.

METHODS: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on TAA and TXA. The MINORS score criteria were used to evaluate the strength and quality of the selected studies.

RESULTS: A total of eight studies including 263 TAA were completed with the usage of TXA and 228 TAA were without TXA. The average blood loss and change in hemoglobin in the TXA group was 335.4 mL and 1.45 g/dL, respectively. In the non-TXA group, average blood loss and change in hemoglobin was 441.8 mL and 1.78 g/dL, respectively. The total number of complications and wound complications reported in all studies for the TXA group were 19% and 6.8%; in the non-TXA group, 33.3% and 16.7% were observed, respectively. The difference in wound complication rate was statistically significant (P = 0.014). Trends favoring the TXA group were found for lower transfusion, pulmonary embolism, deep vein thrombosis, and cerebrovascular accident.

CONCLUSION: The utilization of TXA in TAA appears to be safe and effective. Wound complication rate was the only finding with a notable difference favoring the TXA group. The rest of the data from this systematic review demonstrate a trend toward lower in blood loss, hemoglobin decrease, and total complications when using TXA in TAA. Larger prospective studies and randomized controlled trials are needed to further guide evidence-based guidelines.

PMID:40720799 | DOI:10.5435/JAAOS-D-25-00365

Syst Biol. 2025 Jul 26:syaf051. doi: 10.1093/sysbio/syaf051. Online ahead of print.

ABSTRACT

The dependencies between characters used in phylogenetic analysis (e.g., inapplicabilities, functional dependencies) can be taken into account by using combinations of character states as possible ancestral morphotypes, and using appropriate rates of transformation between such morphotypes. As every morphotype represents a permissible combination of the original character states, this allows easily ruling out specific combinations of character states, and taking into account changes that are either less or more likely to co-occur, or to occur in certain contexts. For inapplicable characters, Goloboff et al. (2021) used morphotypes but proposed obtaining transition probabilities between morphotypes from products of transition probabilities of the original characters and factors to incorporate dependencies. The product of transition probabilities is shown here to be flawed (failing the time-continuity requirement of phylogenetic Markov models, essential for statistical consistency under the model). Tarasov (2023) used the same delimitation of morphotypes but proposed obtaining transition probabilities from rate matrices, synthesized in a stepwise fashion from the hierarchy of dependencies. This paper shows that the rate matrices can easily be created, instead of with a stepwise synthesis, from direct comparisons between legitimate morphotypes (as done by Goloboff and De Laet 2023 for parsimony). Based on a few simple rules, the resulting rate matrices are (for inapplicable characters) identical to those obtained by Tarasov (2023). Additionally, in the computer program TNT, biological dependencies beyond mere inapplicability can be specified by the user with a simple syntax for (combinations of) states in “parent” characters restricting the states that “child” characters can take, using AND and OR conjunctions for elaborate interactions. These researcher-defined rules are used to internally convert the original characters into morphotypes, discarding morphotypes made impossible by the rules. In the case of biological dependencies (where, depending on the parent characters, there can be restrictions in the states that dependent characters can take, instead of the character being inapplicable), the rates of transition between morphotypes cannot be calculated solely from comparisons of states differing in both morphotypes -consideration of the conditions of dependency is needed as well.

PMID:40720776 | DOI:10.1093/sysbio/syaf051

NCHS Data Brief. 2025 Jul;(107):1. doi: 10.15620/cdc/174605.

ABSTRACT

INTRODUCTION: Pedestrians and pedal cyclists are recognized as two classes of vulnerable road users, or those who travel on roads and highways without the physical protection provided by a motor vehicle, such as a car or truck. This report examines trends in pedestrian and pedal cyclist injury deaths from 2013 to 2023 by census region, sex, and age group.

METHODS: Data are from the National Vital Statistics System mortality files for 2013 through 2023. Deaths were identified using International Statistical Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death codes V01-V09 for pedestrians and V10-V19 for pedal cyclists. Age-adjusted death rates were calculated and tests for trends were performed to determine changes over time.

KEY FINDINGS: Between 2013 and 2023, the age-adjusted rate of pedestrian and pedal cyclist injury death in the United States rose from 2.1 deaths per 100,000 standard population to 2.9. Among both females and males ages 25-44 and 45-64 years, the rate of pedestrian and pedal cyclist injury death increased between 2013 and 2023. The death rate also increased for males age 65 and older and decreased for males ages 0-14 in this same period.

PMID:40720726 | DOI:10.15620/cdc/174605

Aesthet Surg J. 2025 Jul 26:sjaf152. doi: 10.1093/asj/sjaf152. Online ahead of print.

ABSTRACT

BACKGROUND: Palpebral bags are commonly managed with infraorbital fat excision during lower blepharoplasty. This surgical approach is based on the assumption of age-related anterior herniation of infraorbital fat. However, controversy remains regarding the true volumetric changes of infraorbital fat with aging.

OBJECTIVES: This study aimed to investigate longitudinal anatomical changes in the infraorbital region.

METHODS: A retrospective longitudinal analysis of serial magnetic resonance images from 50 healthy individuals (20 males and 30 females) aged 20-60 years was conducted; the mean interval between scans was 18.3 years. Six parameters were measured at the mid-pupillary level: the vertical height of orbital aperture (VHOA), infraorbital fat protrusion length (IPL), soft tissue thickness at the orbicularis retaining ligament (TORL), Anterior globe protrusion (GP), nasion-sella-orbital rim angle (NSO), and maxillary angle (MA). Statistical analyses evaluated parameter changes and correlations with the follow-up interval.

RESULTS: Significant increases in the VHOA and NSO and decreases in the TORL and MA were observed (p < 0.05), indicating progressive orbital skeletal remodeling and soft tissue thinning. IPL and GP remained unchanged in supine position, suggesting no volumetric change of infraorbital fat or displacement of the globe. Regression analysis confirmed follow-up interval as key predictor of VHOA and NSO changes.

CONCLUSIONS: Palpebral bags primarily result from structural changes that contribute to pseudoherniation of infraorbital fat and increased prominence above the tear trough. The volume of infraorbital fat itself remains relatively stable. These findings support a lower blepharoplasty approach that prioritizes correcting structural changes over aggressive fat excision.

PMID:40720713 | DOI:10.1093/asj/sjaf152

R I Med J (2013). 2025 Aug 1;108(8):45-49.

ABSTRACT

INTRODUCTION: Hip osteoarthritis (OA) is a common cause of hip pain in adults and a frequent presentation in primary care, emergency departments, and orthopedic clinics. To improve patient triage and optimize clinical efficiency, we developed a nine-item intake survey designed to assess patient symptoms and prior treatments. This study aimed to evaluate the survey’s ability to differentiate hip OA from other hip pathologies and assess its correlation with treatment recommendations.

METHODS: New patients presenting with hip pain were administered a nine-item multiple choice survey. Each response was assigned a score, and the total cumulative score was recorded. Diagnoses and treatment recommendations, including total hip arthroplasty (THA), were documented. Logistic regression was used to assess associations between the survey scores and both diagnosis and treatment recommendations. Receiver operating characteristic (ROC) analysis and Youden’s J statistics were applied to determine the optimal survey score threshold for diagnosing hip OA.

RESULTS: The survey effectively distinguished hip osteoarthritis from other hip pathologies based upon cumulative score. ROC analysis identified a total score of ≥9 as the optimal threshold, maximizing sensitivity (83.3%) and specificity (55.9%) for diagnosing hip OA. The positive predictive value for this threshold was 78.6%. Additionally, higher total survey scores were significantly associated with the recommendation for THA.

CONCLUSION: This study demonstrates that a simple nine-item, patient-reported survey can reliably differentiate hip OA from other hip conditions and may assist in guiding treatment decisions. Implementing such tools in primary care, emergency medicine, and orthopedic settings could enhance early diagnosis and streamline referrals.

LEVEL OF EVIDENCE: III.

PMID:40720687