Tag: nevin manimala

Cardiovasc Diabetol. 2025 Sep 11;24(1):360. doi: 10.1186/s12933-025-02860-z.

ABSTRACT

BACKGROUND: Insulin resistance (IR) has been recognized as a critical factor in the progression of cardiovascular disease (CVD), yet its association with cardiovascular-kidney-metabolic (CKM) syndrome remains incompletely understood. This study aimed to evaluate the impact of IR, as measured by the estimated glucose disposal rate (eGDR), on the risk of future CVD events in individuals with CKM stages 0-3.

METHODS: This study included 325,312 participants from the UK Biobank with CKM stages 0-3. IR was quantified using eGDR, a non-insulin-dependent metric, with lower values indicating greater IR. Participants were stratified into quartiles based on eGDR distribution. The primary outcome was incident CVD, including coronary heart disease, stroke, atrial fibrillation, heart failure, and peripheral artery disease.

RESULTS: In the CKM 0-3 cohort, eGDR demonstrated the highest predictive value for future CVD events among non-insulin-dependent IR metrics. Incorporating eGDR significantly improved the predictive performance of the PREVENT Cardiovascular Disease Risk Equations (AUC: PREVENT Equations + eGDR 0.743 vs. PREVENT Equations 0.719, p < 0.001). Over a median follow-up of 13.57 years, 48,433 incident CVD cases were identified. The adjusted rates of CVD incidence (95% confidence interval [CI]) across eGDR quartiles (Q1-Q4) were 3.84 (3.62-4.07), 3.82 (3.66-3.98), 3.53 (3.41-3.65), and 3.37 (3.25-3.50) per 1000 person-years. RCS analysis revealed a significant nonlinear association between eGDR and CVD incidence (p for overall < 0.001; p for nonlinear = 0.020), with greater risk reduction at higher eGDR levels. A significant trend toward reduced CVD risk was observed across higher eGDR quartiles, with Q3 and Q4 demonstrating statistically significant reductions relative to Q1 (HR 0.920, 95% CI 0.871-0.971; and 0.883, 95% CI 0.827-0.942, respectively; p for trend < 0.001). Kaplan-Meier analysis further confirmed a graded decrease in CVD risk with increasing eGDR levels (log-rank p < 0.001).

CONCLUSION: This study establishes a strong association between IR severity and long-term CVD risk in individuals with CKM syndrome stages 0-3. The eGDR, a reliable surrogate marker of IR, independently predicts future CVD events and provides incremental predictive value beyond the PREVENT equations. These findings underscore the clinical utility of eGDR for risk stratification in CKM populations.

PMID:40936079 | DOI:10.1186/s12933-025-02860-z

Int J Colorectal Dis. 2025 Sep 12;40(1):196. doi: 10.1007/s00384-025-04995-7.

ABSTRACT

PURPOSE: Fistula Laser Closure (FiLaC®) is a sphincter-preserving technique for anal fistulas, but its efficacy and safety remain under discussion. Therefore, we aim to evaluate the efficacy and safety of FiLaC® in the management of patients with cryptoglandular fistulas.

METHODS: A systematic review was performed in MEDLINE, Embase, and Cochrane databases in January 2025, following PRISMA guidelines. We included randomized controlled trials (RCTs) and observational studies assessing FiLaC® for cryptoglandular fistulas, with or without surgical adjunctive measures. The main outcome was the primary healing rate. Secondary outcomes included fistula recurrence, incontinence, reoperation rates, and postoperative complications. Subgroup analyses explored variables related to the primary healing rate. Data are presented as percentages (95% confidence interval). Statistical analyses were performed using R (version 4.4.1 (2024-06-14 (ucrt)).

RESULTS: We included 24 studies with 1,503 patients. The pooled primary healing rate was 57.46% (49.40-65.33). Recurrence occurred in 18.48% of patients (10.14-28.47), while new-onset incontinence was rare (0.57%; 0.00-2.15). The reoperation rate was 36.49% (28.95-44.36), and anal abscesses or infections affected 6.54% (1.93-13.09) of patients. Subgroup analysis showed no statistically significant differences in the primary healing rate based on fistula type, adjunctive measures, or sex. Sensitivity analysis confirmed the robustness of our findings.

CONCLUSIONS: FiLaC® seems to be a safe option with an intermediate healing rate in patients with cryptoglandular fistulas, although it is associated with a considerable recurrence rate. While its sphincter preservation advantage is evident, further RCTs standardizing the technique and adjunctive approaches are needed to optimize outcomes and refine its application in fistula management.

PMID:40936062 | DOI:10.1007/s00384-025-04995-7

Int J Clin Oncol. 2025 Sep 11. doi: 10.1007/s10147-025-02870-7. Online ahead of print.

ABSTRACT

PURPOSE: Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, yet comprehensive nationwide epidemiologic data remain limited. This study aimed to provide an updated analysis of UM incidence, survival, and disparities in the United States (US) using near-complete population coverage.

METHODS: We analyzed data from the North American Association of Central Cancer Registries (NAACCR) and US Cancer Statistics (USCS) program between 1995 and 2018, covering 98-100% of the US population. Age-adjusted incidence rates (AAIRs) and relative survival were calculated using SEER*Stat and Joinpoint regression.

RESULTS: A total of 37,917 UM cases were identified, with an overall AAIR of 5.54 per million (95% CI: 5.48-5.59), showing a stable but slightly increasing trend (AAPC = 0.06). Incidence was highest in non-Hispanic whites (6.87 ppm), men (6.25 ppm), and those aged 75-79 years. Geographic variation was notable, with peak incidence in Oregon and Iowa. Most tumors (81.3%) were localized at diagnosis, and 27.4% of patients had another primary malignancy. 5- and 10-year relative survival rates were 83.3% and 73.9%, respectively, with worse outcomes in metastatic disease. A shift toward radiotherapy, especially brachytherapy, was observed, although survival gains remained limited.

CONCLUSIONS: This nationwide study refines US UM incidence estimates and highlights persistent disparities by sex, race, age, and geography. The high prevalence of secondary malignancies underscores the need for genetic counseling and extended surveillance. Despite advances in imaging, local therapies (e.g., brachytherapy, proton therapy), and emerging systemic approaches including immunotherapy, survival improvements in advanced UM remain limited.

PMID:40936061 | DOI:10.1007/s10147-025-02870-7

Int Urol Nephrol. 2025 Sep 11. doi: 10.1007/s11255-025-04788-5. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple myeloma (MM) is a plasma cell disorder frequently complicated by renal failure and this is associated with high mortality and significant health care costs. It has been estimated in previous studies that 20-40% of patients with MM develop renal impairment to a varying degree during the course of the disease, and up to 10% are described as presenting with severe acute kidney injury when MM is diagnosed. Its economic consequences are prolonged hospital stays and increased costs of care. Our study evaluates two decades of national mortality data to identify patterns and disparities in renal failure-related deaths among adults with MM in the U.S.

METHODS: We analyzed national mortality data using the CDC WONDER database (CDC, 2020), including adults (25-85 + years). Deaths were identified using the ICD-10 Code C90.0 (Multiple Myeloma) AND N17-N19 (Renal failure). Age-adjusted mortality rates calculated per 100,000 were abstracted by sex, race/ethnicity, census region, state, and urbanization. Temporal trends were assessed using Join-point regression models. Annual percentage changes in AAMR were estimated using Monte-Carlo permutation and 95% confidence intervals using the Parametric Method. A two-tailed t-test was employed to measure the statistical significance of APCs.

RESULTS: From 1999 to 2020, mortality trends initially increased for multiple myeloma due to renal failure (ages 25-85 +), then declined across various racial groups, genders, census regions, as well as state and urbanization levels. The overall age-adjusted mortality rate (AAMR) fell from 1.26 per 100,000 in 1999 to 1.02 per 100,000 in 2020. For men, rates increased until 2005 (APC = 1.65%), fluctuated for several years, then declined more sharply after 2012 (falling between 1.88% and 7.32% annually). For women, the increase lasted only until 2002 (APC = 3.64%), followed by a consistent yearly decline of 3.57%. Among racial groups, Asian, Black, and Hispanic communities showed a steady downward trend starting in 1999, decreasing annually by 3.11%, 2.98%, and 2.69%, respectively. Meanwhile, the White populations initially experienced an upward trend, with deaths rising 5.22% per year until 2002, then decreasing at 2.98% per year afterward. Regional trends indicated steady improvements in the Northeast and West, with death rates decreasing by 2.36% and 3.06% annually. The Midwest and South experienced early increases (peaking at 2.72% and 2.73% in 2003) before reversing course to decline annually by 2.97% and 2.82%.

CONCLUSION: From 1999 to 2020, the mortality from MM due to renal failure initially followed a rising trend and then declined among all geographic and demographic groups. These early rises were most evident in males, the White population, the Midwest and South, as well as small metro areas. These varying trends emphasized the need for targeted strategies to lower the renal-related mortality in high-risk multiple myeloma patients.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40936059 | DOI:10.1007/s11255-025-04788-5

Obes Surg. 2025 Sep 12. doi: 10.1007/s11695-025-08217-5. Online ahead of print.

ABSTRACT

BACKGROUND: Metabolic and bariatric surgery is linked to an increased risk of venous thromboembolism (VTE) and postoperative hemorrhage. Although thrombotic chemoprophylaxis is frequently provided to avert VTE, its impact on bleeding complications remains uncertain.

OBJECTIVES: This study intends to assess the effect of preoperative thrombotic chemoprophylaxis on the occurrence of postoperative hemorrhage in individuals undergoing sleeve gastrectomy.

METHODS: A retrospective cohort study was conducted including 226 individuals who underwent sleeve gastrectomy at KHMC over a 2-year period. Patients were classified into two groups based on the provision of preoperative thromboprophylaxis. Demographic data, comorbidities, and postoperative outcomes were analyzed using descriptive and inferential statistics.

RESULTS: Out of 226 patients, 149 (65.9%) underwent preoperative thromboprophylaxis. Postoperative bleeding occurred in 1.3% of patients. A statistically significant inverse association was identified between thromboprophylaxis and the installation of postoperative drains (P = 0.003). Nonetheless, no significant association was seen between thromboprophylaxis and postoperative bleeding following propensity-score matching (P = 1.00).

CONCLUSION: The preoperative administration of low-molecular-weight heparin (LMWH) did not substantially correlate with an elevated risk of postoperative hemorrhage. However its application was associated with a reduced incidence of postoperative drain placement. These findings enrich the expanding amount of research about the safety and outcomes of thrombotic chemoprophylaxis in metabolic and bariatric surgery.

PMID:40936054 | DOI:10.1007/s11695-025-08217-5

J Ultrasound. 2025 Sep 11. doi: 10.1007/s40477-025-01077-w. Online ahead of print.

ABSTRACT

PURPOSE: B-lines are among the key artifact signs observed in Lung Ultrasound (LUS), playing a critical role in differentiating pulmonary diseases and assessing overall lung condition. However, their accurate detection and quantification can be time-consuming and technically challenging, especially for less experienced operators. This study aims to evaluate the performance of a YOLO (You Only Look Once)-based algorithm for the automated detection of B-lines, offering a novel tool to support clinical decision-making. The proposed approach is designed to improve the efficiency and consistency of LUS interpretation, particularly for non-expert practitioners, and to enhance its utility in guiding respiratory management.

METHODS: In this observational agreement study, 644 images from both anonymized internal and clinical online database were evaluated. After a quality selection step, 386 images remained available for analysis from 46 patients. Ground truth was established by blinded expert sonographer identifying B-lines within rectangular Region Of Interest (ROI) on each frame. Algorithm performances were assessed through Precision, Recall and F1 Score, whereas to quantify the agreement between the YOLO-based algorithm and the expert operator, weighted kappa (kw) statistics were employed.

RESULTS: The algorithm achieved a precision of 0.92 (95% CI 0.89-0.94), recall of 0.81 (95% CI 0.77-0.85), and F1-score of 0.86 (95% CI 0.83-0.88). The weighted kappa was 0.68 (95% CI 0.64-0.72), indicating substantial agreement algorithm and expert annotations.

CONCLUSIONS: The proposed algorithm has demonstrated its potential to significantly enhance diagnostic support by accurately detecting B-lines in LUS images.

PMID:40936046 | DOI:10.1007/s40477-025-01077-w

Tissue Cell. 2025 Sep 9;98:103133. doi: 10.1016/j.tice.2025.103133. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and compare the antioxidant effects, influence on autophagy and mitophagy, and impact on cell viability of resveratrol, lutein, and crocetin in hydrogen peroxide (H₂O₂)-induced oxidative damage in ARPE-19 cells as an in vitro model of age-related macular degeneration (AMD).

METHODS: Oxidative damage was induced in ARPE-19 cells by exposure to 800 μM H₂O₂ for 1 h. Cell viability was assessed using the WST-1 assay. Subsequently, ARPE-19 cells were treated with lutein (5 and 10 μM), crocetin (10 and 20 μM), or resveratrol (100 μM), and the levels of oxidative damage biomarkers including malondialdehyde (MDA), glutathione (GSH), and nitric oxide (NO) were quantified via spectrophotometry. The autophagy- and mitophagy-related markers, LC3B, PINK1, and PARKIN, were visualized using confocal microscopy, and LC3B and PARKIN were further evaluated by western blotting (WB).

RESULTS: Cell viability results were 100 % in the control group, decreased to 73.5 % and 69.1 % with 10 and 20 μM crocetin, 62.7 % and 59.3 % with 5 and 10 μM lutein, and 52.7 % with 100 μM resveratrol, respectively, while H₂O₂ exposure reduced viability to 0.04 %. Exposure to H₂O₂ (800 µM, 1 h) induced significant oxidative damage in ARPE-19 cells, as indicated by a reduction in GSH levels (p < 0.01) and an increase in MDA (p < 0.001) and NO (p < 0.001) compared to the control group, along with a notable decrease in WST-1 viability. Among the interventions, 10 µM crocetin significantly decreased MDA (p = 0.019) and NO (p = 0.05) levels compared to those in the damage group, although the 20 µM concentration also reduced these markers without achieving statistical significance. 5 µM Lutein significantly reduced NO levels compared to the damage group, whereas reductions in MDA at concentrations of 5-10 µM were not statistically significant. GSH levels exhibited a numerical, albeit non-significant, increase with 10 µM lutein (p = 0.09), and showed modest, non-significant increases with crocetin and resveratrol. The highest LC3B expression was observed in the 5 μM lutein group compared to control and other treatment groups, while PARKIN expression was significantly elevated in the 10 μM lutein, 20 μM crocetin, and 100 μM resveratrol groups, with 20 μM crocetin and resveratrol levels also exceeding lutein 5 μM.

CONCLUSIONS: 10 μM Crocetin demonstrated the strongest antioxidant protection, while 5 μM lutein primarily improved cell survival, likely through autophagy activation and 100 μM resveratrol also activated both autophagy and mitophagy. These results highlighted the complementary concentration-dependent mechanisms of natural antioxidants in protecting RPE cells from oxidative stress related to AMD.

PMID:40934544 | DOI:10.1016/j.tice.2025.103133

Am J Sports Med. 2025 Sep 11:3635465251371644. doi: 10.1177/03635465251371644. Online ahead of print.

ABSTRACT

BACKGROUND: Posterolateral tibial plateau impaction fractures commonly occur in the setting of anterior cruciate ligament (ACL) tears and have been reported to affect clinical outcomes after ACL reconstruction (ACLR), but their biomechanical significance is not well understood.

PURPOSE: To evaluate the biomechanical effect of increasing depths of anteroposterior lateral tibial plateau bone loss on knee kinematics in the ACL-deficient knee and to evaluate the effect of ACLR with and without lateral extra-articular tenodesis (LET) on knee kinematics in the setting of posterolateral tibial plateau bone loss.

STUDY DESIGN: Controlled laboratory study.

METHODS: This study used 16 cadaveric knee specimens subjected to simulated pivot-shift, anterior tibial translation (ATT), and internal rotation (IR) testing via a robotic system. ACL-deficient specimens with 5, 10, and 15 mm of posterolateral tibial plateau bone loss were examined in addition to specimens that underwent ACLR with and without LET in the setting of 15-mm bone loss. Statistical analysis was performed using 1-factor, random-intercepts mixed-effects models to compare ATT, IR, and valgus angulation during a simulated pivot-shift test.

RESULTS: During pivot-shift testing, we observed significant increases in ATT, IR, and valgus angulation when comparing between the ACL intact with no bone loss state and all deficient ACL with bone loss states. For the reconstruction with 15-mm bone loss states, ACLR + LET was able to significantly improve ATT and IR, although valgus angulation remained significantly increased compared with the intact state (mean difference, 0.6 ± 4.0 mm, -4.8° ± 5.7°, and 2.0° ± 3.3°, respectively), while significant differences in ATT, IR, and valgus angulation remained when comparing isolated ACLR to the intact state (mean difference, 4.1 ± 2.8 mm, 3.2° ± 2.1°, and 3.4° ± 2.5°, respectively).

CONCLUSION: With increasing amounts of posterolateral tibial plateau bone loss, there were increased values of ATT, IR, and valgus angulation observed with a simulated pivot shift in ACL-deficient knees in a cadaveric model. In the setting of 15-mm posterolateral tibial plateau bone loss, ACLR combined with LET resulted in a significant decrease in both ATT and IR, but these parameters remained significantly elevated with isolated ACLR.

CLINICAL RELEVANCE: In the setting of high-grade posterolateral tibial plateau bone loss, significant laxity remained after ACLR compared with the ACL-intact state, whereas ACLR with LET was able to better restore kinematics to the ACL-intact state. This suggests that the addition of LET to ACLR should be considered in the setting of high-grade posterolateral tibial plateau bone loss.

PMID:40934532 | DOI:10.1177/03635465251371644

Vascular. 2025 Sep 11:17085381251379289. doi: 10.1177/17085381251379289. Online ahead of print.

ABSTRACT

ObjectiveEndovascular modality used in peripheral vascular intervention (PVI) varies widely. Long-term outcomes are poorly studied between covered stents (CS) and bare metal stents (BMS) for the SFA.MethodsPatients (2017-2021) undergoing CS and BMS to the SFA were identified at an academic institution. Comparative statistics and Kaplan-Meier analysis were used to evaluate outcomes by group.ResultsOne hundred and nineteen patients undergoing stenting were included with 60 patients undergoing CS (50%) and BMS in 59 (50%). There were no differences in sex (p = 0.5), preoperative ABI (p = 0.2) or indication for surgery between groups (p = 0.8). CS patients had undergone more prior SFA interventions (p = 0.03) and were younger (62 vs. 66 years; p = 0.04). Regarding anatomic and operative characteristics, CS patients had more TASC C/D lesions (69 vs. 47%; p = 0.006) less severe calcification (8 vs.17%; p = 0.0006) and more often underwent angioplasty and stenting (90 vs 51%; p < 0.0001) and less often angioplasty, DCB and stenting (5 vs. 43%; p < 0.0001). CS patients had larger SFA (5.7 vs 4; p < .0001), longer lesions (119 vs. 89 mm; p = 0.0008), higher popliteal runoff score (8.3 vs. 6.4; p = 0.02), longer surgery (140 vs. 118 min; p = 0.03), less fluoroscopy time (21 vs. 26 min; p = 0.03), larger SFA stent (6.2 vs. 5.6 mm; p < 0.0001), and longer stented length (260 vs. 171 mm; p < 0.0001). There were no differences in concomitant iliac/tibial treatment between groups (p = 0.3). Regarding outcomes, there were no differences in amputation (CS 10 vs. BMS 10.2%; p = 1) but overall mortality was lower in CS patients (8 vs 22%; p = 0.04) as was acute limb ischemia (17 vs. 34%; p = 0.03). CS patients underwent fewer endovascular (p = 0.03) and open reinterventions (p = 0.005) but a shorter time to first endovascular reintervention (5.6 vs. 17.8 months; p = 0.0002) on unadjusted analysis. Kaplan-Meier estimated survival at 48 months was 83% for CS and 75% for BMS (p = 0.28). At 36 months, primary patency was 35% for CS vs. 41% for BMS (p = 0.09), primary-assisted patency was 57% for CS vs. 68% for BMS (p = 0.04) and secondary patency for CS was 61% vs. 61% for BMS (p = 0.99).ConclusionsIn this series, CS was associated with lower reintervention rates than BMS despite higher TASC classification, longer lesions, and higher popliteal runoff scores. CS was more often used to salvage previous SFA intervention. At 3 years, however, patency was similar between groups. These data suggest some advantages for CS over BMS in endovascular salvage of failed SFA intervention and potentially a preferred modality for more complex SFA lesions than BMS.

PMID:40934524 | DOI:10.1177/17085381251379289

Clin Exp Optom. 2025 Sep 11:1-8. doi: 10.1080/08164622.2025.2558756. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Hypothyroidism is a common endocrine disorder that can influence various physiological processes throughout the human body.

BACKGROUND: Despite its clinical significance, there is a notable gap in directly comparing corneal characteristics between hypothyroid and euthyroid individuals within the same study cohort. This study aimed to explore the impact of hypothyroid and euthyroid states in the same participants on corneal topometry, tomography, densitometry, and aberrometry parameters.

METHODS: Thirty eyes from 30 newly diagnosed hypothyroid patients with clinically clear corneas were enrolled in this study. Corneal parameter analyses using Scheimpflug corneal topography (Pentacam®HR, Wetzlar, Germany) and specular microscopy (EM-4000; Tomey Corp. Nagoya, Japan) were performed at the time of hypothyroidism diagnosis and after thyroid replacement therapy.

RESULTS: The flat and mean keratometric readings of the anterior surface of the cornea were significantly higher in the euthyroid state than in the hypothyroid state (p < 0.001 and p = 0.002). After euthyroidism was provided, mean central corneal thickness and thinnest pachymetry values significantly decreased by 4.5 µm and 5.2 µm, respectively (p = 0.003 and p = 0.001). Significantly lower corneal densitometry values were detected in the euthyroid state (p < 0.05). Although there was no difference in pupil diameter, spherical aberration measurements were significantly higher at the time of diagnosis than during the euthyroidism period (p = 0.001). Average and maximal progression index significantly increased in the euthyroidism phase compared to the hypothyroidism phase, while maximum Ambrόsio relational thickness decreased (p < 0.05). The endothelial characteristics were statistically similar (p > 0.05).

CONCLUSION: The study suggests that patients with hypothyroidism may experience subtle corneal changes. The evaluation of a hypothyroid patient with corneal imaging devices may underestimate the risk of keratoconus and overestimate optic aberrations.

PMID:40934523 | DOI:10.1080/08164622.2025.2558756