Tag: nevin manimala

JCO Clin Cancer Inform. 2025 Apr;9:e2400227. doi: 10.1200/CCI-24-00227. Epub 2025 Apr 18.

ABSTRACT

PURPOSE: Recurrences after curative resection in early-stage and locoregionally advanced non-small cell lung cancer (NSCLC) are common, necessitating a nuanced understanding of associated risk factors. This study aimed to establish a natural language processing (NLP) system to efficiently curate recurrence data in NSCLC and analyze risk factors longitudinally.

PATIENTS AND METHODS: Electronic health records of 6,351 patients with NSCLC with >700,000 notes were obtained from Mount Sinai’s data sets. A deep learning-based customized NLP system was developed to identify cohorts experiencing recurrence. Recurrence types and rates over time were stratified by various clinical features. Cohort description analysis, Kaplan-Meier analysis for overall recurrence-free survival (RFS) and distant metastasis-free survival (DMFS), and Cox proportional hazards analysis were performed.

RESULTS: Of 1,295 patients with stage I-IIIA NSCLC with surgical resections, 336 patients (25.9%) experienced recurrence, as identified through NLP. The NLP system achieved a precision of 94.3%, a recall of 93%, and an F1 score of 93.5. Among 336 patients, 52.4% had local/regional recurrences, 44% distant metastases, and 3.6% unknown recurrence. RFS rates at years 1-5 were 93%, 81%, 73%, 67%, and 61%, respectively (96%, 89%, 84%, 80%, and 75% for distant metastasis). Stage-specific RFS rates at year 5 were 73% (IA), 62% (IB), 47% (IIA), 46% (IIB), and 20% (IIIA). Stage IB patients had a significantly higher likelihood of recurrence versus stage IA (adjusted hazard ratio [aHR], 1.63; P = .02). The RFS was lower in patients with clinically significant TP53 alteration (v TP53-negative or unknown significance), affecting overall RFS (aHR, 1.89; P = .007) and DMFS (aHR, 2.47; P = .009) among stage IA/IB patients.

CONCLUSION: Our scalable NLP system enabled us to generate real-world insights into NSCLC recurrences, paving the way for predictive models for preventing, diagnosing, and treating NSCLC recurrence.

PMID:40249880 | DOI:10.1200/CCI-24-00227

Photodermatol Photoimmunol Photomed. 2025 May;41(3):e70023. doi: 10.1111/phpp.70023.

ABSTRACT

BACKGROUND: Verrucae (warts) are caused by human papilloma viruses. Photodynamic therapy (PDT) is a widely recommended option to treat warts.

OBJECTIVES: To assess the role of liquid crystal loaded methylene blue (MB) combined with intense pulsed light (IPL) in the treatment of verrucae.

PATIENTS AND METHODS: A total of 42 clinically and dermoscopically confirmed patients complaining of at least four cutaneous warts of various types were recruited in this clinical study. The lesions for the same patient were divided into 4 groups: Group (1) received topical 10% liquid crystal loaded MB, then was subjected to two passes of IPL with a 650 nm cutoff filter; Group (2) was subjected to two passes of IPL; and Group (3) received topical 10% liquid crystal loaded MB gel. They underwent four sessions at 2-week intervals. Group (4) was left with no treatment (control).

RESULTS: Complete disappearance of warts was observed in 52.4%, 19%, and 4.8% in Group 1, 2, and 3, respectively, with no recurrence throughout the following 3 months. Regarding PDT-treated group, verruca plantaris showed the best result, followed by verruca plana, then verruca vulgaris. Comparing all groups, there was a statistically significant difference in which the PDT group showed the best result.

CONCLUSION: PDT using 10% liquid crystal loaded MB combined with IPL is an effective option in wart treatment with the best results in V. plantaris, followed by V. plana and V. vulgaris.

PMID:40249838 | DOI:10.1111/phpp.70023

Pediatr Infect Dis J. 2025 Apr 17. doi: 10.1097/INF.0000000000004834. Online ahead of print.

ABSTRACT

BACKGROUND: Bacterial meningitis remains a life-threatening condition in pediatric patients with cerebrospinal fluid (CSF) shunts. While infection prevention has been extensively studied, risk factors for severe outcomes such as death and neurological sequelae remain poorly understood. We examined the clinical characteristics of pediatric bacterial meningitis with CSF shunts, focusing on the risk factors associated with poor outcomes.

METHODS: This study is part of a nationwide surveillance of pediatric bacterial meningitis in Japan from 2009 to 2021. We extracted pediatric meningitis cases with CSF shunts from the database. Clinical characteristics, risk factors for poor outcomes, defined as death or severe neurological sequelae and causative organisms were assessed. Logistic regression models were used to identify significant risk factors.

RESULTS: In this study, 167 pediatric cases of bacterial meningitis with CSF shunts were included. In multivariable analysis, male sex [odds ratio (OR): 2.82, 95% confidence interval (CI): 1.00-7.96, P = 0.04] and younger age (OR: 0.98, 95% CI: 0.97-1.00, P = 0.002) were significant risk factors for poor outcomes. The most common causative organism was Staphylococcus spp. (65.9%), predominantly coagulase-negative Staphylococci (45.3%). While the reduction in Streptococcus pneumoniae and Haemophilus influenzae cases following vaccine introduction was not statistically significant, a decreasing trend was observed.

CONCLUSION: Younger age and male sex were significant risk factors for poor outcomes. In addition, vaccination may have contributed to a decline in Streptococcus pneumoniae and Haemophilus influenzae infections.

PMID:40249832 | DOI:10.1097/INF.0000000000004834

Sci Adv. 2025 Apr 18;11(16):eads4609. doi: 10.1126/sciadv.ads4609. Epub 2025 Apr 18.

ABSTRACT

Molecular movement and interactions at the single-molecule level, particularly in live cells, are often studied using fluorescence correlation spectroscopy (FCS). While powerful, FCS has notable drawbacks: It requires high laser intensities and long acquisition times, increasing phototoxicity, and often relies on problematic statistical assumptions in data fitting. We introduce fluorescence intensity trace statistical analysis (FITSA), a Bayesian method that directly analyzes fluorescence intensity traces. FITSA offers faster, more stable convergence than previous approaches and provides robust parameter estimation from far shorter measurements than conventional FCS. Our results demonstrate that FITSA achieves comparable precision to FCS while requiring substantially fewer photons. This advantage becomes even more pronounced when accounting for statistical dependencies in FCS analysis, which are often overlooked but necessary for accurate error estimation. By reducing laser exposure, FITSA minimizes phototoxicity effects, representing a major advancement in the quantitative analysis of molecular processes across fields.

PMID:40249821 | DOI:10.1126/sciadv.ads4609

Proc Natl Acad Sci U S A. 2025 Apr 22;122(16):e2414174122. doi: 10.1073/pnas.2414174122. Epub 2025 Apr 18.

ABSTRACT

The elastic properties of nanoscale extracellular vesicles (EVs) are believed to influence their cellular interactions, thus having a profound implication in intercellular communication. However, accurate quantification of their elastic modulus is challenging due to their nanoscale dimensions and their fluid-like lipid bilayer. We show that the previous attempts to develop atomic force microscopy-based protocol are flawed as they lack theoretical underpinning as well as ignore important contributions arising from the surface adhesion forces and membrane fluctuations. We develop a protocol comprising a theoretical framework, experimental technique, and statistical approach to accurately quantify the bending and elastic modulus of EVs. The method reveals that membrane fluctuations play a dominant role even for a single EV. The method is then applied to EVs derived from human embryonic kidney cells and their genetically engineered classes altering the tetraspanin expression. The data show a large spread; the area modulus is in the range of 4 to 19 mN/m and the bending modulus is in the range of 15 to 33 [Formula: see text], respectively. Surprisingly, data for a single EV, revealed by repeated measurements, also show a spread that is attributed to their compositionally heterogeneous fluid membrane and thermal effects. Our protocol uncovers the influence of membrane protein alterations on the elastic modulus of EVs.

PMID:40249788 | DOI:10.1073/pnas.2414174122

Am Surg. 2025 Apr 18:31348251337143. doi: 10.1177/00031348251337143. Online ahead of print.

ABSTRACT

BackgroundHyperkinetic and hypokinetic biliary dyskinesia commonly present with right upper quadrant pain, mimicking biliary colic or cholecystitis. Only gallbladder hypokinesia is a well-accepted indication for cholecystectomy. While there is less literature on the topic, patients with gallbladder hyperkinesia may also benefit from cholecystectomy.MethodsThis single-center cross-sectional study looked at patients 18 years or older, with EF >80% on HIDA scan who underwent cholecystectomy and at least one postoperative visit from January 1, 2018, to February 28, 2023. The primary outcome was symptomatic resolution or improvement.ResultsIn total, 67 patients were identified, with a median age of 46 years, 75% female sex, and a median 30-day follow-up period. All patients presented with abdominal pain, 64% presented with nausea and vomiting, and 31% presented with chronic diarrhea. Partial symptomatic improvement was noted in 94% of patients, while 85% had complete resolution. There was a statistically significant difference in gallbladder ejection fraction between 2 groups: 94% (IQR 90-98%) for those with complete symptom resolution vs 88% (IQR 83-97%) for those who did not have symptom resolution (P = 0.033). Chronic cholecystitis was demonstrated in 73% of specimens.ConclusionsThis data adds to a body of evidence supporting laparoscopic cholecystectomy for gallbladder hyperkinesia. The study further establishes a higher degree of gallbladder ejection fraction to have an association with complete symptomatic improvement after cholecystectomy. A patient’s presenting symptoms do not appear to have an association with complete symptom resolution.

PMID:40249640 | DOI:10.1177/00031348251337143

J Craniofac Surg. 2025 Apr 18. doi: 10.1097/SCS.0000000000011360. Online ahead of print.

ABSTRACT

Facial feminization surgeries (FFS) aim to feminize facial features in transgender women and include frontal sinus setback, rhinoplasty, and genioplasty. FFS may be performed with virtual surgical planning (VSP) to help generate reproducible and predictable results. However, quantification of changes is challenging because these changes often occur in multiple axes and dimensions that are not easily reduced to a single error metric. The objective of this study was to apply cephalometrics and geometric morphometrics analyses to evaluate shape changes in FFS patients undergoing genioplasty and mandibular contouring. Fourteen patients who underwent genioplasty, mandibular contouring, or both, with a single surgeon and also had matching post-operative followup scans were included. Three-dimensional reconstructions of preoperative, postoperative, and VSP-guided “planned” computed tomography scans of each patient were created using 3D Slicer. Cephalometrics and geometric morphometrics were used to analyze changes. Pairwise 1-tailed t tests showed that postoperative bigonial width values significantly aligned with planned values across individuals. Geometric morphometric analyses, specifically Generalized Procrustes Analysis, demonstrated that the postoperative scans significantly aligned with planned scans in the fixed landmark data set (3-piece genioplasty) and gonial angle semi-landmark data set (mandibular contouring). Among scan sets that did not meet this hypothesis, the final postoperative shape was often between the preoperative and planned shapes, presumably due to post-osteotomy burring that is not captured on VSP. Future work using a greater number of landmarks, such as using statistical shape modeling approaches, may help to evaluate bony changes after FFS  to better integrate changes in bone position with concomitant changes in bony shape.

PMID:40249638 | DOI:10.1097/SCS.0000000000011360

Cancer Med. 2025 Apr;14(8):e70811. doi: 10.1002/cam4.70811.

ABSTRACT

INTRODUCTION: With the reduction in human immunodeficiency virus (HIV)-related mortality secondary to antiretroviral therapy, chronic medical conditions and age-related cancers account for a larger proportion of mortality among those with HIV. Cancer risk overall remains elevated in HIV patients, and cancer screening data in this population is limited. The primary study aim was to determine whether screening colonoscopy findings differed between HIV and non-HIV patients.

METHODS: A retrospective review of adults with/without HIV undergoing screening colonoscopy between February 2015 and September 2022 was performed. HIV patients were matched with non-HIV patients by sex, race, and age, undergoing screening colonoscopy within six business days of their matched patients. Demographic data included age, race, sex, family history of colorectal cancer (CRC), smoking status, alcohol use, along with endoscopic and histologic findings that were compared between the matched pairs.

RESULTS: Ninety matched pairs of HIV and non-HIV patients undergoing screening colonoscopy comprised the study population. The study group was 78.9% African American, 55.6% male, with a mean age of 59.0 years in HIV patients and 54.9 years in non-HIV patients. Procedure indication was average risk screening in 91.1% of patients. No statistically significant differences in screening colonoscopy findings or polyp histology were observed between HIV and non-HIV patients.

DISCUSSION: Similar rates of polyps were found at screening colonoscopy regardless of HIV status. CRC screening recommendations are appropriate for the HIV patient population without limitation.

PMID:40249627 | DOI:10.1002/cam4.70811

Cancer Med. 2025 Apr;14(8):e70866. doi: 10.1002/cam4.70866.

ABSTRACT

BACKGROUND: We examined the association between academic center status and neurosurgical resection volume with surgical procedures performed and subsequent survival.

METHODS: In a population-based study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked databases, we identified patients > 65 years diagnosed with primary WHO grade III-IV glioma from 2008 to 2017. Surgical procedures were identified through Medicare claims from 2007 to 2019. Associations between center type (academic vs. not) and center volume (top 10% of distribution of resections during the study period vs. the bottom 90%) were estimated with upfront surgery procedure (resection vs. biopsy vs. none) and survival by estimating hazard ratios (HRs) and 95% confidence intervals (CIs) from multivariable regression models accounting for within-center provider cluster correlation.

RESULTS: We identified 8592 patients, of whom 8128 could both be attributed to a provider and received neurosurgical intervention attributed to resection or biopsy. When considered together, center volume, not center academic status, drove surgical decisions for first procedure type such that patients treated by a top 10% volume center were 23% more likely to receive resection (95% CI: 14%-34%, p < 0.0001). When considered together, resection, not center volume, drove improvement in overall survival such that patients who received resection, regardless of center volume, were 22% less likely to die during the study period (95% CI: 17%-27%, p < 0.0001).

CONCLUSIONS: We provide the first population-based evidence that older patients diagnosed with grade III-IV glioma who seek treatment from higher-volume centers are more likely to receive aggressive neurosurgical care. Aggressive neurosurgical care, even if received from low-volume centers, improves survival.

PMID:40249626 | DOI:10.1002/cam4.70866

JAMA Netw Open. 2025 Apr 1;8(4):e254483. doi: 10.1001/jamanetworkopen.2025.4483.

ABSTRACT

IMPORTANCE: Singapore is considering subsidizing left ventricular assist devices (LVADs) for end-stage heart failure (ESHF) and uses cost-effectiveness evidence to inform the determination. Yet, no economic evaluation has thus far been conducted.

OBJECTIVE: To estimate the lifetime cost-effectiveness of LVAD compared with optimal medical management for transplant-ineligible patients.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used a Markov model to simulate survival, stroke incidence, other adverse events, and heart failure hospitalizations for a cohort of adult patients in Singapore with transplant-ineligible ESHF, most of whom were inotrope dependent. Latest LVAD mortality data from a randomized clinical trial were age-adjusted, and an indirect comparison of prior trial results was performed to estimate survival for inotrope-dependent and inotrope-independent patients. Costs were estimated (in 2023 Singapore dollars [SGD]) using cohort billing data from 2017 to 2022 and National Heart Centre Singapore LVAD charges. Statistical analysis was performed from December 2023 to July 2024.

EXPOSURE: HeartMate 3 LVAD (Abbott).

MAIN OUTCOMES AND MEASURES: Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) evaluated against a threshold of SGD 114 000 (US $85 075) per QALY gained.

RESULTS: At model initiation, the cohort had a mean (SD) age of 64 (12) years, and 78% (range, 68%-86%) of patients were inotrope dependent. In the base case analysis, LVAD yielded an additional 3.45 QALYs at an incremental cost of SGD 404 678 (US $301 999), producing an ICER of SGD 117 370 (US $87 590) per QALY gained for the transplant-ineligible population. The ICER differed for inotrope-use subgroups at SGD 106 458 (US $79 446) per QALY gained for inotrope-dependent patients and SGD 174 798 (US $130 446) per QALY gained for inotrope-independent patients (with 59% and 19% probabilities, respectively, of attaining high value). The inotrope-dependent ICER was sensitive to model input changes and structural assumptions, whereas the inotrope-independent ICER consistently exceeded the high-value threshold in scenario analyses. In threshold analyses, a 44% reduction in the total implantation price or a 54% reduction in the all-cause mortality hazard were required for LVAD to be high value for inotrope-independent patients. Confidence that the inotrope-dependent ICER is high value increased to 75% and 85% with respective 20% and 33% reductions in total implantation price.

CONCLUSIONS AND RELEVANCE: In this economic evaluation comparing LVAD with optimal medical management, LVAD was potentially high value for most transplant-ineligible patients who are inotrope dependent. Confidence in this result was improved with plausible price reductions, yet only extreme changes rendered LVAD high value for inotrope-independent patients.

PMID:40249620 | DOI:10.1001/jamanetworkopen.2025.4483