Tag: nevin manimala

J Neurooncol. 2025 Sep 9. doi: 10.1007/s11060-025-05206-7. Online ahead of print.

ABSTRACT

PURPOSE: Resection of glioblastomas infiltrating the motor cortex and corticospinal tract (CST) is often linked to increased perioperative morbidity. Navigated transcranial magnetic stimulation (nTMS) motor mapping has been advocated to increase patient safety in these cases. The additional impact of patient frailty on overall outcome after resection of cases with increased risk for postoperative motor deficits as identified with nTMS needs to be investigated.

METHODS: Patients with newly diagnosed motor eloquent glioblastomas were retrospectively evaluated. Patients underwent nTMS- and tractography-based neuronavigation. Demographic, imaging- and nTMS-derived data and the 11-item modified frailty index (mFI-11) were collected. Primary endpoint was discharge home after tumor resection. A 4-item score comprising preoperative motor deficit, mFI-11 ≥ 2 points, distance to the CST < 12 mm and infiltration of nTMS-positive cortex was established to predict overall outcome.

RESULTS: N = 64 patients with a mean age of 64.8 ± 9.6 years (60.9% male) were included. 46 patients (71.9%) could be discharged to their homes. Risk factors for non-home discharge were greater mFI-11 (p = 0.027), surgery-related motor deficit (p < 0.001) and overall complications (p < 0.001 for non-surgical and p = 0.006 for surgical complications). In multiple regression analyses, mFI-11 and surgery-related deficit were statistically robust. The 4-item score predicted non-home discharge with an AUC = 0.745, 95%CI = 0.62-0.87, p < 0.001.

CONCLUSION: In patients with newly diagnosed motor-eloquent glioblastomas, nTMS-based planning helps to predict postoperative surgery-related motor deficits. Patient frailty needs to be respected in decision making in addition to nTMS- and tractography-based planning in order to avoid postsurgical motor deficits and to keep overall surgical morbidity on a low level.

PMID:40924322 | DOI:10.1007/s11060-025-05206-7

Int Urol Nephrol. 2025 Sep 9. doi: 10.1007/s11255-025-04725-6. Online ahead of print.

ABSTRACT

PURPOSE: Living donor kidney transplantation is a critical strategy to address the growing burden of end-stage kidney disease (ESKD) in Malaysia. Whilst living donation is generally safe, concerns remain regarding long-term donor outcomes. This study aimed to evaluate renal function and morbidity changes in living kidney donors 1 year post-donation, and to identify predictors of impaired kidney function.

METHODS: A retrospective cohort study was conducted using clinical records of 230 living kidney donors who underwent nephrectomy at University Malaya Medical Centre between 2003 and 2021. Donor sociodemographic characteristics, comorbidities, and estimated glomerular filtration rate (eGFR) were assessed pre-donation and at 1 year post-donation. Impaired kidney function was defined as eGFR < 90 mL/min/1.73m². Data were analysed using descriptive statistics and multivariate logistic regression.

RESULTS: At 1 year post-donation, 76.2% of donors exhibited impaired kidney function. Additionally, the proportion of donors with diabetes and dyslipidaemia increased significantly post-donation. Male sex and increasing age were significant predictors of reduced eGFR. Ethnic Chinese and ‘Others’ ethnicities were found to have a lower risk of impaired renal function compared to Malays. No significant association was found between baseline comorbidity status and post-donation eGFR.

CONCLUSION: The study highlights the importance of age, gender, and ethnicity in predicting renal outcomes post-donation. These findings underscore the need for standardised pre-donation screening and structured post-donation surveillance. Strengthening clinical protocols and policy frameworks is essential to ensure donor safety and the sustainability of living donor transplantation in Malaysia.

PMID:40924294 | DOI:10.1007/s11255-025-04725-6

Anal Sci. 2025 Sep 9. doi: 10.1007/s44211-025-00846-1. Online ahead of print.

ABSTRACT

Surface-enhanced Raman scattering (SERS) is a powerful analytical technique; however, its quantitative application has been limited by the instability of substrates and significant signal fluctuations. In this study, we demonstrated that 4-aminobenzenethiol (4-ATP) can be quantitatively detected through statistical analysis of SERS signal intensity distributions obtained using citrate-stabilized AuNPs, biotin-functionalized AuNPs, and gold nanoparticle (AuNP)-bound polystyrene (PS) microparticles. Raman spectra obtained in bulk aqueous solution under static conditions showed that the detection sensitivity of 4-ATP using AuNP-bound PS microparticles was approximately twice that achieved with citrate-stabilized AuNPs or biotin-modified AuNPs. Furthermore, the detection sensitivity of 4-ATP was enhanced by introducing AuNP-bound PS microparticles into a microfluidic chip and delivering an aqueous 4-ATP solution under controlled flow conditions. Analysis of the flow rate dependence of SERS signal intensity revealed that the optimal detection sensitivity for 4-ATP was achieved at a flow rate of 0.66 μL·min⁻¹, with a corresponding detection limit of 1.9 μM under these conditions. These results demonstrate that AuNP-bound PS microparticles introduced into the microfluidic chip serve as efficient SERS substrates, enabling highly sensitive and quantitative detection under flow conditions.

PMID:40924288 | DOI:10.1007/s44211-025-00846-1

Cardiovasc Interv Ther. 2025 Sep 8. doi: 10.1007/s12928-025-01185-8. Online ahead of print.

ABSTRACT

The outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) is still controversial for patients with left main coronary artery (LMCA) disease. This multicenter cohort study aimed to evaluate the clinical outcomes of LMCA disease patients who underwent PCI or CABG. We reviewed 875 consecutive patients diagnosed with LMCA disease between January 2009 and December 2020 who underwent coronary revascularization by PCI (n = 404) or CABG (n = 471). A one-to-one propensity score matching was employed to control the potential biases. The primary outcome was any major adverse cardiac events (MACE), which were composed of all causes of death, myocardial infarction, or stroke. Before propensity score matching, both groups significantly differed in essential baseline characteristics. Patients undergoing PCI were significantly older (age 72.4 vs. 70.5 years). They had a better baseline left ventricular function (left ventricular ejection fraction (LVEF) 59.1% vs. 55.8%). Moreover, patients in the PCI group had less coronary artery disease burden, such as less frequency of SYNTAX scores ≥ 33 (25.1% vs. 49.0%) and true left main bifurcation disease (18.6% vs. 33.1%). After propensity score analysis, 191 pairs of patients were successfully matched, and the median follow-up time was 4.5 years. A primary outcome event occurred in 8.9% of the patients in the PCI group and 15.2% in the CABG group (HR 0.70; 95% confidence interval [CI] 0.38-1.28; P = 0.253). All causes of death were lower in the PCI group than in the CABG group (8.4% vs. 13.6%; P = 0.347), but the difference was insignificant. In PCI and CABG groups, the incidence of cardiovascular death (1.6% vs. 1.1%), myocardial infarction (1.1% vs. 1.1%), and stroke (0% vs. 1.6%) were also not significantly different. However, the incidence of any revascularization and hospitalization for heart failure tended to be higher in the PCI group than in the CABG group, but the difference was not significant. In this propensity-matched study, PCI showed a statistically insignificant difference in all causes of death, myocardial infarction, or stroke compared with CABG for the treatment of LMCA disease. Furthermore, PCI showed no statistically significant difference compared to CABG in overall endpoints, including any revascularization.

PMID:40924282 | DOI:10.1007/s12928-025-01185-8

J Thromb Thrombolysis. 2025 Sep 9. doi: 10.1007/s11239-025-03176-1. Online ahead of print.

ABSTRACT

In this review, we aimed to evaluate Sonothrombolysis when combined with primary percutaneous coronary intervention (pPCI) in STEMI patients with regard to improving cardiac function and clinical outcomes. This study primarily assesses short-term efficacy outcomes, while long-term impacts, such as mortality, were not evaluated. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, Scopus, Cochrane Library, and Web of Science) to identify eligible studies reported up to November 2024. Four studies, with a total population of 252 participants, were included. The sonothrombolysis group demonstrated an overall greater improvement in left ventricular ejection fraction compared to the control group (MD = 3.07, 95% CI [1.20 to 4.94], p = 0.001), with no heterogeneity (p = 0.44, I² = 0%). When subgrouped according to the follow-up period, there was no significant difference between the two groups (MD = 2.56, 95% CI [-0.35 to 5.46]) after 2 to 6 months. Infarction size, microvascular obstruction, left ventricular end-diastolic volume, and left ventricular end-systolic volume showed no statistically significant difference between the two groups. Sonothrombolysis following pPCI is associated with better left ventricular ejection fraction, emphasizing the potential role of sonothrombolysis as an adjunctive therapy to pPCI in the management of STEMI.

PMID:40924279 | DOI:10.1007/s11239-025-03176-1

Adv Ther. 2025 Sep 9. doi: 10.1007/s12325-025-03339-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemophilia A, an X-linked recessive bleeding disorder, is characterized by reduced factor VIII (FVIII) activity. Hemophilia A can significantly impact a person’s quality of life because of the risk of spontaneous bleeding. Treatment for hemophilia A aims to prevent bleeding from occurring. The innovation of gene therapies for use in hemophilia has the potential to replace prophylaxis treatment by enabling a single treatment infusion that sustains endogenous FVIII production for years. This analysis assessed the comparative effectiveness of valoctocogene roxaparvovec, a gene therapy, versus prophylactic FVIII replacement therapy with efanesoctocog alfa, given the current lack of comparative evidence between these treatments.

METHODS: Comparison between valoctocogene roxaparvovec and efanesoctocog alfa was conducted using matching-adjusted indirect comparison (MAIC). Patient-level data from the phase III GENEr8-1 trial of valoctocogene roxaparvovec were reweighted to align with baseline characteristics of aggregate-level data from XTEND-1, a phase III trial of efanesoctocog alfa. Matching variables included proportion of patients with zero treated bleeds and mean annualized bleed rate (ABR) for treated bleeds prior to initiating therapy. Following reweighting, the proportion of patients who had experienced zero bleeds after 52 weeks was compared, along with mean ABR-each population was assessed for treated bleeds, treated joint bleeds, and treated spontaneous bleeds.

RESULTS: Following MAIC weighting, patients treated with valoctocogene roxaparvovec had higher odds of experiencing zero treated bleeds (OR 2.68, 95% CI 1.18-6.14) and zero treated joint bleeds (OR 2.75, 95% CI 1.09-6.86) compared with efanesoctocog alfa. Odds of zero treated spontaneous bleeds were also higher for valoctocogene roxaparvovec, but not statistically significant. Mean ABRs for treated bleeds, treated joint bleeds, and treated spontaneous bleeds were similar between groups, with no statistically significant differences.

CONCLUSION: This MAIC suggests that valoctocogene roxaparvovec provides a greater likelihood of patients experiencing zero treated bleeds compared with efanesoctocog alfa during the first year following treatment initiation.

PMID:40924278 | DOI:10.1007/s12325-025-03339-9

Acta Anaesthesiol Scand. 2025 Oct;69(9):e70121. doi: 10.1111/aas.70121.

ABSTRACT

BACKGROUND: This study assessed the prevalence and incidence of potentially inappropriate medication use for older patients undergoing surgery and its association with polypharmacy.

METHODS: A retrospective, population-based cohort study with patients ≥ 65 undergoing first surgery at Landspitali-The National University Hospital of Iceland from 2005 to 2018. Participants were categorized by number of medications filled before and following their surgical episode into: non-polypharmacy (< 5), polypharmacy (5-9), and hyper-polypharmacy (≥ 10). The prevalence and incidence of PIM use were compared between polypharmacy categories based on the 2019 Beers criteria.

RESULTS: A total of 17,198 admissions associated with surgery were assessed (53.8% female) with a median [IQR] age of 75 [70, 81]. The prevalence of potentially inappropriate medication among patients with non-polypharmacy (< 5) was 36.6% (95% CI: 35.1-38.2), with polypharmacy (5-9) 80.2% (95% CI: 79.2-81.2), and with hyper-polypharmacy 95.8% (95% CI: 95.3-96.2). New potentially inappropriate medication use post-surgery occurred in 38.5% (95% CI: 37.0-40.1). Risk factors included female sex, increased comorbidity, and prior use of a multidose dispensing service. Compared with patients without potentially inappropriate medication use, patients with potentially inappropriate medication use had a higher rate of postoperative diagnosis of medication-related harm (12.6% vs. 11.3%), increased 30-day mortality (5.2% vs. 0.3%), longer hospital stay (3 [1, 8] vs. 2 [1, 5] days), and increased 30-day readmission rate (11.3% vs. 6.5%).

CONCLUSIONS: Potentially inappropriate medication use is strongly associated with polypharmacy/hyper-polypharmacy and adverse outcomes in older surgical patients. Surgical hospitalization offers a critical window for medication review, deprescribing, and follow-up planning to reduce medication-related harm.

PMID:40923285 | DOI:10.1111/aas.70121

J Clin Oncol. 2025 Sep 9:JCO2500788. doi: 10.1200/JCO-25-00788. Online ahead of print.

ABSTRACT

PURPOSE: WU-KONG1B (ClinicalTrials.gov identifier: NCT03974022) is a multinational phase II, dose-randomized study to assess the antitumor efficacy of sunvozertinib in pretreated patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations (exon20ins).

METHODS: Eligible patients with advanced-stage EGFR exon20ins NSCLC were randomly assigned by 1:1 ratio to receive sunvozertinib 200 mg or 300 mg once daily (200 and 300 mg-rand cohorts). After predefined interim analysis, additional patients were enrolled and treated with the 300 mg dose once daily. The primary end point was blinded independent review committee (IRC)-assessed confirmed objective response rate (cORR), and the key secondary end point was duration of response (DoR).

RESULTS: Among 85, 89, and 107 efficacy-evaluable patients in 200 mg-rand, 300 mg-rand, and 300 mg-all (including randomly assigned and nonrandomized patients) cohorts, the cORRs were 45.9% (97.5% CI, 33.6% to 58.5%), 47.2% (97.5% CI, 35.1% to 59.5%), and 45.8% (97.5% CI, 34.8% to 57.0%), respectively, per IRC assessment. The predefined null hypothesis was rejected with statistical significance (P < .0001). Comparing 300 and 200 mg-rand cohorts, higher cORRs were observed in patients with baseline brain metastasis (52.4% v 28.6%) and previous amivantamab treatment (41.7% v 25%), as well as longer DoR (13.8 v 11.1 months). At 200 and 300 mg once daily, the most common treatment-related adverse events with grade ≥3 included diarrhea (2.2% v 18%), blood creatine phosphokinase increased (6.6% v 12.6%), and anemia (4.4% v 6.3%).

CONCLUSION: Sunvozertinib is efficacious at both 200 and 300 mg once daily in treating platinum-pretreated patients with advanced EGFR exon20ins NSCLC. The treatment-related adverse events of sunvozertinib were consistent with an EGFR tyrosine kinase inhibitor, with a more favorable safety profile at 200 mg than 300 mg once daily.

PMID:40923280 | DOI:10.1200/JCO-25-00788

J Biopharm Stat. 2025 Sep 9:1-16. doi: 10.1080/10543406.2025.2547590. Online ahead of print.

ABSTRACT

A randomized clinical trial with multiple experimental groups and one common control group is often used to speed up development to select the best experimental regimen or to increase the chance of success of clinical trials. Most of the time, multiple dose levels of an experimental drug or multiple combinations of one experimental drug with other drugs comprise multiple experimental groups. Because the experimental drug appears in multiple comparisons with a shared control group, multiple testing adjustments to control the family-wise type I error rate are needed. We extend the stepwise over-correction (SOC) method that is applied to a multi-arm trial with a response rate as its endpoint to a multi-arm trial where time to event is the primary endpoint and confidence interval of the hazard ratio determines the statistical significance. We provide the formula of the bias of the maximum treatment effect estimate toward the true treatment effect between the selected experimental group and the shared control group. We aim to use the bias-corrected estimate for the inference of treatment effects in multi-arm trials on the full alpha level and demonstrate a completely new type of reject region. This approach does not require us to split alpha level among the multiple comparisons or to specify the test order ahead of time. The type I error control and the power enhancement of the proposed approach are both held.

PMID:40923261 | DOI:10.1080/10543406.2025.2547590

J Anim Sci. 2025 Sep 5:skaf252. doi: 10.1093/jas/skaf252. Online ahead of print.

ABSTRACT

Fish oil is a source of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) that confer several health benefits. To ensure continuity in the supply of n-3 fatty acids, alternative sources are being sought. Algal oil may serve as a promising alternative to fish oil for supplementing DHA in cat foods. The purpose of this study was to determine if inclusion of algal oil in place of fish oil in feline foods would result in similar serum DHA and EPA concentrations. Cats were first fed a control food for 5 weeks and then randomized into two groups and fed test foods containing either fish oil or algal oil in sequential increasing concentrations of DHA (0.2%, 0.4%, and 0.6%). Serum was analyzed at the beginning and end of each of these 5-week feeding periods. Oil type had no effect on body weight of cats consuming foods containing either algal oil or fish oil; only cats that consumed the algal oil food with 0.6% DHA had a significant decrease from baseline in food intake (P = 0.0011). Analysis of serum fatty acid concentrations showed that serum DHA increased at similar rates when fish oil and algal oil levels were increased in the food. Although increasing levels of fish and algal oil both increased serum EPA concentrations, the higher concentrations of EPA in the fish oil foods resulted in higher circulating concentrations of EPA in those cats. Algal oil was included at levels 3.7-fold lower than fish oil due to the high DHA content of algal oil. Overall, these data indicate that algal oil may serve as a good alternative dietary source of DHA. Fatty acid profiles of algal oil should be considered when selecting a replacement for fish oil in feline foods.

PMID:40923230 | DOI:10.1093/jas/skaf252