Tag: nevin manimala

Pediatr Transplant. 2025 Nov;29(7):e70174. doi: 10.1111/petr.70174.

ABSTRACT

BACKGROUND: Fontan-associated liver disease can progress to advanced fibrosis, raising the potential need for combined heart-liver transplantation (CHLT) in selected patients. However, the benefits of CHLT over isolated orthotopic heart transplantation (HT), particularly in terms of mortality, remain uncertain. In this systematic review, we compared mortality outcomes following CHLT versus HT in patients with Fontan circulation, with the aim of supporting clinical decision-making.

METHODS: This systematic review was conducted according to the 2020 PRISMA guidelines and registered in PROSPERO. PubMed, Scopus, and Embase were searched. Studies examining HT or CHLT in patients with Fontan circulation that provided information about total and/or 1-year mortality were included. Bias risks were assessed using the Newcastle-Ottawa Scale. We used random- and fixed-effect models, depending on heterogeneity, to estimate pooled effects.

RESULTS: Sixteen studies were included in this analysis. CHLT was associated with a lower mortality rate per patient-year compared to HT (0.03 vs. 0.09; p < 0.01). However, after excluding studies in which transplantations were performed before the year 2000, the difference between groups was no longer statistically significant. One-year mortality rates were also not significantly different between CHLT and HT (0.09 vs. 0.14; p = 0.28), with similar results observed after excluding pre-2000 studies.

CONCLUSION: Overall, this systematic review suggests that CHLT may result in mortality rates comparable to those of isolated HT. These findings support the consideration of CHLT in patients with concomitant liver disease and reinforce the importance of comprehensive liver evaluation in transplant candidates.

PMID:40916564 | DOI:10.1111/petr.70174

Cancer. 2025 Sep 15;131(18):e70009. doi: 10.1002/cncr.70009.

ABSTRACT

BACKGROUND: Opioid exposure during cancer therapy may increase long-term unsafe opioid prescribing. This study sought to determine the rates of coprescription of benzodiazepine and opioid medications and new persistent opioid use after surgical treatment of early-stage cancer.

METHODS: A retrospective cohort study was conducted among a US veteran population via the Veterans Affairs Corporate Data Warehouse database. Participants were opioid-naive persons aged ≥21 years with a new diagnosis of stage 0-III cancer between January 1, 2015, and December 31, 2016. Outcomes were days of coprescription of benzodiazepines and opioids in the 13 months posttreatment and new persistent opioid use. The exposure was total morphine milligram equivalents (MMEs) attributed to treatment and prescribed from 30 days before through 14 days after the index surgical procedure.

RESULTS: Among 9213 veterans, coprescription of benzodiazepines and opioids occurred in 366 patients (4.0%) and new persistent opioid use in 981 patients (10.6%). In a linear model adjusting for patient, clinical, and geographic factors, persons in the highest quartile compared to no opioid exposure had increased days with coprescription of benzodiazepines and opioids (mean difference, 1.0; 95% CI, 0.3-1.7). In a discrete time survival analysis, persons in the highest quartile of MME exposure compared to none had a greater risk of new persistent opioid use (hazard ratio, 1.6; 95% CI, 1.3-1.9).

CONCLUSIONS: More than one of 10 opioid-naive veterans undergoing curative-intent surgical treatment for cancer developed new persistent opioid use. Optimizing cancer treatment pain management strategies to mitigate long-term opioid-related health risks is crucial.

PMID:40916563 | DOI:10.1002/cncr.70009

Nan Fang Yi Ke Da Xue Xue Bao. 2025 Aug 20;45(8):1768-1776. doi: 10.12122/j.issn.1673-4254.2025.08.21.

ABSTRACT

OBJECTIVES: To explore the key role of myeloid-derived suppressive cells (MDSCs) in pre-metastatic niche (PMN) and analyze their interrelationships with the main components in the microenvironment using a mathematical model.

METHODS: Mathematical descriptions were used to systematically analyze the functions of MDSCs in tumor metastasis and elucidate their association with the major components (vascular endothelial cells, mesenchymal stromal cells, and cancer-associated macrophages) contributing to the formation of the pre-metastatic microenvironment. Based on the formation principle of the pre-metastatic microenvironment of tumors, the key biological processes were assumed to construct a coupled partial differential diffusion equation model. The existence and uniqueness of the model solutions were investigated using approximation methods, the qualitative theory of partial differential equations and Banach’s immovable point theorem, and numerical simulations were carried out by differential numerical methods to verify the reliability and accuracy of the model.

RESULTS: The existence and uniqueness of the local and overall solutions of the model were proved using the approximation method, the qualitative theory of partial differential equations and Banach’s immovable point theorem in combination with the regularity estimation of the local solutions and the embedding inequality. Numerical simulation results further validated the reliability of the model and demonstrated the important role of MDSCs in the pre-metastatic microenvironment of tumors, especially in angiogenesis and immunosuppression.

CONCLUSIONS: This study reveals the important functions of MDSCs in the pre-metastatic microenvironment of tumors through mathematical modeling and numerical simulation, which provides an important theoretical basis for understanding the mechanism of tumor metastasis and devising cancer treatment strategies.

PMID:40916538 | DOI:10.12122/j.issn.1673-4254.2025.08.21

J Forensic Sci. 2025 Sep 7. doi: 10.1111/1556-4029.70158. Online ahead of print.

ABSTRACT

In routine forensic chemical casework where measurements are performed on reference materials, determination of measurement uncertainty is described in several guidelines. The proposed methods often have the drawback that they are not derived from a statistical framework and may lead to conservative confidence intervals. Furthermore, the formulas involved may vary considerably for different types of reference material. The current study presents a method for determination of measurement uncertainty that is both statistically sound and uniform for different types of reference material, namely material from proficiency tests, certified reference material, and noncertified reference material. The statistical model used for measurements uses relative standard deviations. The method is based on analysis of two sources of uncertainty, namely the random variation in the measurement itself and uncertainty connected to the bias of the process. It is explained how the method works when there is bias correction of results. It is also described how the method works if no correction is applied. Furthermore, the results are compared using simulation experiments, showing a better performance of the proposed method when compared with commonly used alternatives.

PMID:40916084 | DOI:10.1111/1556-4029.70158

Anat Sci Educ. 2025 Sep 7. doi: 10.1002/ase.70120. Online ahead of print.

ABSTRACT

Educational materials advocating whole-body donation must be accurate, easy to read, and transparent, as one potential solution to the fact that the supply of donations is not keeping pace with educational demand, thereby disrupting anatomy education programs. The use of AI technologies to supplement communications with prospective donors and next of kin deserves investigation to determine whether LLM-based approaches meet the common requirements for effective communication. This study contributes to the limited literature on LLM-supported communications by presenting a comparative quantitative benchmark and an adaptable evaluation framework. Five LLMs (ChatGPT-4o, Grok3.0, Claude4Sonnet, Gemini2.5 Flash, DeepSeekR1) were used to generate responses to six frequently asked questions about body donation in Turkish. Four anatomists evaluated accuracy, quality, readability, and vocabulary diversity. Differences between models were statistically analyzed. The two top-performing models, ChatGPT-4o and Grok3.0, achieved mean quality scores of 21.7 ± 2.8 and 21.0 ± 5.1 on a 25-point checklist, and 4.58 ± 0.88 and 4.25 ± 1.03 on a 5-point global quality scale, significantly outperforming the remaining three systems (p < 0.037). Both maintained a below-secondary-school level on two validated readability indices (scores ≥67.8 and ≥40.2). LLM-produced body donation materials (e.g., informational texts and FAQs) may help promote the importance of whole-body donations by providing accessible and reliable information, potentially streamlining the creation of first drafts and reducing staff workload. Given the sensitivity of donation decisions, ethical transparency, cultural sensitivity, and continuous human oversight are essential safeguards. Therefore, LLM use for such purposes should be governed by clear governance frameworks, regular expert audits, and publicly disclosed quality metrics.

PMID:40916067 | DOI:10.1002/ase.70120

J Fish Biol. 2025 Sep 7. doi: 10.1111/jfb.70217. Online ahead of print.

ABSTRACT

The harvest of animals from the wild is a pervasive selective force, especially in fisheries, where harvesting often targets individuals with specific traits. While most research has focused on large-scale commercial or recreational fisheries, little attention has been paid to artisanal fisheries, particularly those targeting ornamental species. Furthermore, environmental factors such as temperature and oxygen levels influence the behaviour of fishes, such as boldness and sociability, but their role in the harvesting process remains poorly understood. Here, we used underwater video to examine how two ornamental Amazonian fishes, Hemigrammus sp. and Copella nattereri, interact with artisanal trap gear. We quantified the number of passes, inspections, entries and exits using latency to inspect and enter traps as proxies for boldness, and coefficients of dispersion (CDs) to assess sociability and group coordination. We found that the majority of fish that inspected traps did not enter them, and a given trap typically caught one species over the other. Overall, Copella were captured more frequently, but within individual trials there was no statistical difference in catch numbers between species. While both species inspected traps, Hemigrammus exhibited significantly more passes and a higher rate of inspection. Latency to inspect and enter traps did not differ between species but decreased with increasing temperature for both. Hemigrammus also displayed greater group coordination, with higher CD values across behaviours. Notably, temperature had opposing effects on coordination: for Hemigrammus, CD of inspections increased with temperature and CD of exits decreased, whereas for Copella, inspection CD decreased and exit CD increased. These findings reveal that different species interact with fishing gear in behaviourally distinct ways, influenced by environmental conditions. This highlights the potential for selective pressures to vary not only by species, but also with ecological context. Understanding such dynamics is critical for predicting how artisanal fisheries may shape behavioural traits in wild populations.

PMID:40916050 | DOI:10.1111/jfb.70217

Diagn Progn Res. 2025 Sep 8;9(1):19. doi: 10.1186/s41512-025-00205-8.

ABSTRACT

BACKGROUND: Hospital-acquired venous thromboembolism (HA-VTE) is a leading cause of morbidity and mortality among hospitalized adults. Numerous prognostic models have been developed to identify those patients with elevated risk of HA-VTE. None, however, has met the necessary criteria to guide clinical decision-making. This study outlines a protocol for refining and validating a general-purpose prognostic model for HA-VTE, designed for real-time automation within the electronic health record (EHR) system.

METHODS: A retrospective cohort of 132,561 inpatient encounters (89,586 individual patients) at a large academic medical center will be collected, along with clinical and demographic data available as part of routine care. Data for temporal, geographic, and domain external validation cohorts will also be collected. Logistic regression will be used to predict occurrence of HA-VTE during an inpatient encounter. Variables considered for model inclusion will be based on prior demonstrated association with HA-VTE and their availability in both retrospective EHR data and routine clinical care. Least absolute shrinkage and selection operator (LASSO) with tenfold cross-validation will be used for initial variable selection. Variables selected by the LASSO procedure, along with those deemed necessary by clinicians, will be used in an unpenalized multivariable logistic regression model. Discrimination and calibration will be reported for the derivation and validation cohorts. Discrimination will be measured using Harrell’s C statistic. Calibration will be measured using calibration intercept, calibration slope, Brier score, integrated calibration index, and visual examination of non-linear calibration curve. Model reporting will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines for clinical prediction models using machine learning methods (TRIPOD + AI).

DISCUSSION: We describe methods for developing, evaluating, and validating a prognostic model for HA-VTE using routinely collected EHR data. By combining best practices in statistical development and validation, knowledge engineering, and clinical domain knowledge, the resulting model should be well suited for real-time clinical implementation. Although this protocol describes our development of a model for HA-VTE, the general approach can be applied to other clinical outcomes.

PMID:40916049 | DOI:10.1186/s41512-025-00205-8

BMC Womens Health. 2025 Sep 7;25(Suppl 1):427. doi: 10.1186/s12905-025-03969-9.

ABSTRACT

BACKGROUND: Evidence from multiple pilots and post-introduction scale-up initiatives have demonstrated that self-administered subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) has potential to improve contraceptive continuation rates and expand contraceptive access to populations with limited utilization of facility-based health services. Only a few of these studies have been conducted in South Asian countries, and none where most contraceptive use is of non-hormonal methods that require limited to no contact with the health system, leaving policymakers in countries like Pakistan with limited context-specific evidence to guide decisions on whether, how, and for whom to introduce DMPA-SC.

METHODS: A prospective cohort study will be conducted in 41 health facilities and surrounding communities in Punjab, Pakistan. The primary objective of the study is to compare the 12-month contraceptive continuation rate for women who receive DMPA-SC with that for women who receive intramuscular depot-medroxyprogesterone acetate (DMPA-IM). The secondary objectives are to compare characteristics and experiences of participants who opt for DMPA-SC with those of women who opt for DMPA-IM, which must be administered by a health worker. Additionally, a sub-study is planned to assess how well women opting for self-injection of DMPA-SC adhere to standards for commodity storage, injection timing, injection technique and waste disposal.

DISCUSSION: This research offers an opportunity to contribute to global efforts to reduce inequities in access to contraceptive method choices, while generating actionable evidence to inform health sector decision-making in Pakistan. Although study sites are limited to health facilities where a woman’s first self-injection of DMPA-SC is supervised by a nurse, midwife, medical officer, Lady Health Visitor, Family Welfare Worker or Family Welfare Councilor, the research protocol and findings will provide a foundation for future studies testing alternative service provision and self-injection support models.

TRIAL REGISTRATION: Registered on clinicaltrials.gov as an observational study (NCT05774626).

PMID:40916043 | DOI:10.1186/s12905-025-03969-9

Reprod Health. 2025 Sep 7;22(Suppl 3):159. doi: 10.1186/s12978-025-02123-w.

ABSTRACT

BACKGROUND: The COVID-19 pandemic disrupted the provision of sexual and reproductive health services, including contraceptive and family planning (FP) services. The World Health Organization conducted a multi-country study in India, Nigeria and Tanzania to assess the impact of the pandemic on the health system’s capacity to provide contraceptive and FP services. In this paper, we share the results of a qualitative study aimed at understanding clients’ perspectives at the primary healthcare level on accessing contraceptive services in COVID-19-affected areas in the three aforementioned countries.

METHODS: We conducted interviews with 644 clients seeking contraceptive services across 11, 6 and 33 primary health facilities in India, Nigeria and Tanzania. A total of 44 focus group discussions (FGDs) and 128 in-depth interviews were conducted with clients at the facility and 22 FGDs within the community. Data collection took place from May 2022 to August 2022. Ethical approval was obtained from the WHO Ethics Review Committee and national regulatory bodies. All interviews were analysed using the general approach of content analysis.

RESULTS: Clients at primary health care facilities faced several challenges in accessing contraceptive services. These challenges were grouped into two main categories. The first was related to the unprepared health system (supply), such as a shortage of health workers, stock out of contraceptives or high cost of FP services. The second category was outside the remit of the health system and included insufficient knowledge amongst clients about the availability of FP services, socio-cultural issues like spousal and in-laws’ dominance on decision making, restriction in movement due to lockdown and fear of COVID-19 infection.

CONCLUSIONS: This study highlights the obstacles clients faced in accessing contraceptives during the COVID-19 pandemic in Nigeria, India, and Tanzania. To address these barriers in future crises, ministries of health must establish functional emergency preparedness across all healthcare levels. These plans should prioritize both on the sufficient number/gender of skilled health providers and the availability of contraceptives till the last mile. Utilizing e-health can help keep communities well informed on where, how and when to avail FP services during such emergencies. Health educational programs should actively engage men to gain further support.

PMID:40916041 | DOI:10.1186/s12978-025-02123-w

Nutr J. 2025 Sep 7;24(1):135. doi: 10.1186/s12937-025-01201-w.

ABSTRACT

OBJECTIVE: This study analyzed data from the US population to examine how oral microbiome diversity and diet quality individually and synergistically affect frailty.

METHODS: This study included 6,283 participants aged 20 years or older from the 2009-2010 and 2011-2012 NHANES cycles. A frailty index (FI) consisting of 36 items was developed, with items related to nutritional status excluded. The diversity of the oral microbiome was assessed using α-diversity, including observed ASVs, the Shannon-Weiner index, Faith’s phylogenetic diversity (PD), and the Simpson index. Dietary quality was assessed using Dietary Inflammatory Index (DII), Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet Score (MED), and Alternate Healthy Eating Index (AHEI). Multivariable logistic models were employed to examine the separate and combined associations of oral microbiome diversity and four dietary quality scores with FI, with interaction effects were explored. Several subgroup analyses and sensitivity analyses were conducted to assess the robustness of our findings. Furthermore, the mediation analysis was used to explore oral microbiome diversity as a mediator in the relationship between dietary scores and FI.

RESULTS: Both oral microbiome diversity and dietary quality scores showed significant individual associations with FI. Jointly, those in the highest tertile of oral microbiome diversity and the lowest tertile of DII had lower FI [β_{Observed ASVs} (95% CI) = -2.544(-3.678,-1.411); β_{Faith’s PD} (95% CI) = -2.688(-3.783,-1.593); β_{Shannon-Weiner index} (95% CI) = -2.359(-3.333,-1.386); β_{Simpson index} (95% CI) = -1.93(-2.879,-0.981)], compared to participants in the lowest tertile of oral microbiome diversity and the highest tertile of DII. A significant interaction between oral microbiome diversity (Observed ASVs and Faith’s PD) and DII in relation to FI reduction was found (P for interaction_{Observed ASVs*DII} = 0.032, P for interaction_{Faith’s PD*DII} = 0.014). Other dietary scores showed similar joint associations of oral microbiome diversity with FI, but no significant interactions were observed. Further mediation analysis indicated that the proportion of DII’s effect on FI mediated through Observed ASVs, Faith’s PD, and the Shannon-Weiner index was 8.7%, 7.5%, and 3.4%, respectively.

CONCLUSION: This study demonstrates that a high-quality diet and greater α-diversity of oral microbiota are significantly associated with a reduced risk of frailty. Notably, the interaction between DII and the diversity of the oral microbiota exerts a particularly substantial influence on frailty risk.

PMID:40916036 | DOI:10.1186/s12937-025-01201-w