Tag: nevin manimala

BMC Med. 2025 Jun 9;23(1):342. doi: 10.1186/s12916-025-04190-z.

ABSTRACT

BACKGROUND: Early diagnosis of low ejection fraction (EF) remains challenging despite being a treatable condition. This study aimed to evaluate the effectiveness of an electrocardiogram (ECG)-based artificial intelligence (AI)-assisted clinical decision support tool in improving the early diagnosis of low EF among inpatient patients under non-cardiologist care.

METHODS: We conducted a pragmatic randomized controlled trial at an academic medical center in Taiwan. 13,631 inpatient patients were randomized to either the intervention group (n = 6,840) receiving AI-generated ECG results or the control group (n = 6,791) following standard care. The primary outcome was the incidence of newly diagnosed low EF (≤ 50%) within 30 days following the ECG. Secondary outcomes included echocardiogram utilization rates, positive predictive value for low EF detection, and cardiology consultation rates. Statistical analysis included hazard ratios (HR) with 95% confidence intervals (CI) for time-to-event outcomes and chi-square tests for categorical variables.

RESULTS: The intervention significantly increased the detection of newly diagnosed low EF in the overall cohort (1.5% vs. 1.1%, HR 1.50, 95% CI: 1.11-2.03, P = 0.023), with a more pronounced effect among AI-identified high-risk patients (13.0% vs. 8.9%, HR 1.55, 95% CI: 1.08-2.21). While overall echocardiogram utilization remained similar between groups (17.1% vs. 17.3%, HR 1.00, 95% CI: 0.92-1.09), the intervention group demonstrated higher positive predictive value for identifying low EF among patients receiving echocardiogram (34.2% vs. 20.2%, p < 0.001). Post-hoc analysis revealed increased cardiology consultation rates among high-risk patients in the intervention group (29.3% vs. 23.5%, p = 0.027).

CONCLUSIONS: Implementation of an AI-ECG algorithm enhanced the early diagnosis of low EF in the inpatient setting, primarily by improving diagnostic efficiency rather than increasing overall healthcare utilization. The tool was particularly effective in identifying high-risk patients who benefited from increased specialist consultation and more targeted diagnostic testing.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05117970.

PMID:40484925 | DOI:10.1186/s12916-025-04190-z

BMC Health Serv Res. 2025 Jun 9;25(1):814. doi: 10.1186/s12913-025-12874-8.

ABSTRACT

BACKGROUND: Since August 2017, approximately 960,000 Rohingya refugees have settled in Cox’s Bazar, Bangladesh. Water, sanitation, and hygiene (WASH) infrastructure and programs were implemented across the camps to address the needs of the population and reduce the burden of linked infectious diseases. However, monitoring and maintenance of this infrastructure has been inconsistent. This study aimed to assess progress in WASH in the camps of Cox’s Bazar since the early emergency phase in 2018, and to update the priorities for intervention.

METHODS: From January to March 2022, a lot quality assurance sampling (LQAS) survey was conducted across 19 camps. Nineteen households were randomly selected per camp. Data on access to and quality of WASH services, household practices, and health outcomes including skin infections among children under five years of age were collected. Crude and weighted averages with 95% confidence intervals were calculated for each indicator and compared with targets pre-defined based on Sphere guidelines and Médecins Sans Frontières WASH experts. Chi-squared tests were used to compare the results to a 2018 LQAS survey.

RESULTS: More than half of the indicators (59%; 16/27) did not meet the pre-determined targets. Performance was adequate on three of five water quality and supply indicators, with less than half of households (44%, 95% CI: 39-49%) reporting that water was continuously available in the past week. Regarding water storage, performance on three indicators was considered adequate, as the proportion of households that keep water for less than one day was 27% (95% CI: 23-32%). Of six hygiene indicators, adequate performance was identified for only one. Performance on the sanitation indicators was inadequate, with 11% (95% CI: 8-15%) of households using an improved sanitation facility. In solid waste management, two of four indicators suggested adequate performance, and for health outcomes, the proportion of children who hadn’t shown any skin infection was inadequate at 69% (95% CI: 64-73%).

CONCLUSIONS: Improvements in the WASH situation in Cox’s Bazar have been observed in 2022 compared to 2018. However, significant gaps remain in water supply, sanitation facilities, and hygiene services. LQAS can be an effective monitoring tool to support long-term multisectoral interventions in protracted emergencies.

PMID:40484924 | DOI:10.1186/s12913-025-12874-8

Int Wound J. 2025 Jun;22(6):e70703. doi: 10.1111/iwj.70703.

ABSTRACT

High specification mattresses periodically redistribute pressure using alternating air cells, offloading tissues. This study aimed to evaluate the effects of alternating air pressure gradients on sacral tissue physiology. This randomised cross-over study recruited 15 healthy participants to test the three mattress settings (fast cycle, normal cycle, and slow cycle). Participants were asked to adopt supine, lateral, and high sitting (head of bed at 40°) postures, whilst transcutaneous tissue gas tensions and interface pressures at the sacrum were continuously monitored. Comparison between mattress settings and postures showed no statistical difference (p > 0.05) between peak pressure index values at the sacrum for each air inflation cycle speed setting. By contrast, a significantly higher sacral (p < 0.05) contact area was observed for high sitting. During high sitting, ischemic responses during both fast and normal air inflation cycle speed settings were recorded. During the slow air inflation cycle speed, most participants (60%-100%) showed high levels of perfusion. The present study identified a main effect of posture on interface pressure and perfusion over the sacrum. The alternating mattress speed influenced local tissue perfusion, with the greatest changes in tissue oxygenation occurring in a high-speed setting.

PMID:40484907 | DOI:10.1111/iwj.70703

World J Urol. 2025 Jun 8;43(1):364. doi: 10.1007/s00345-025-05734-x.

ABSTRACT

BACKGROUND: Urinary tract stone disease is quite common in the population, and treatment modalities are constantly evolving. Technological advancements in endourology have led to a shift towards more minimally invasive treatments. Nowadays, robotic flexible ureteroscopy is becoming increasingly popular, showing promising results. This systematic review and meta-analysis aimed to evaluate the outcomes of robotic flexible ureteroscopy.

MATERIALS AND METHODS: We conducted a systematic review in the PubMed, Scopus and Web of Science databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Study protocol was registered at PROSPERO (CRD420251017383). All robotic flexible studies published until April 2025, which defined and provided the stone-free rate, were included. To assess surgical efficacy and reliability, stone size, operation time, and complications were also evaluated. Stone size was measured in a one-dimensional manner, based on the maximum length.

RESULTS: A total of 320 studies were initially identified, with 11 full-text articles meeting the inclusion criteria, involving 656 patients and 660 renal units. The analysis included data from various robotic systems, including the Roboflex Avicenna, ILY, Senhance, and MONARCH platforms. The mean pooled stone-free rate was 86.0%, with a range from 57.7 to 96.5%, indicating variability across studies. The use of a random-effects model was justified by the presence of moderate-to-substantial heterogeneity across studies (I² = 63.5%, τ² = 0.627), and a statistically significant Q-test (p = 0.0022). The studies defined stone-free status as either complete stone clearance or residual fragments smaller than 2 mm.

CONCLUSION: The analysis suggests that robotic URS is an effective and feasible treatment option for selected patients with urinary stones. Future research should focus on standardized reporting, comparative effectiveness studies, and cost-benefit analyses, while also addressing surgeon-centered outcomes such as ergonomic strain and musculoskeletal pain, to better define the role of robotic technology in endourological practice.

PMID:40484898 | DOI:10.1007/s00345-025-05734-x

Discov Oncol. 2025 Jun 8;16(1):1032. doi: 10.1007/s12672-025-02794-8.

ABSTRACT

Colorectal cancer (CRC) ranks as the third most common cancer globally and is the second leading cause of cancer-related deaths, following lung cancer. Despite the immune system’s capacity for tumor surveillance and elimination, CRC tumors can evade immune responses through complex mechanisms, ultimately escaping immune detection. T and B lymphocytes play a critical role in adaptive immunity against tumors, with T cells, particularly CD8⁺ cytotoxic T cells, driving tumor elimination. Additionally, B cells contribute by producing tumor-specific antibodies, including various immunoglobulin G (IgG) subclasses that participate in immune modulation. However, the effectiveness of adaptive immunity in CRC is often limited due to tumor-driven immunosuppression. This study investigates the expression of T and B cell activation genes in peripheral blood mononuclear cells (PBMCs) isolated from CRC patients. A panel of 84 genes involved in T and B cell activation was analyzed to assess changes in expression using RT² QPCR arrays. Additionally, we measured serum levels of the four IgG subclasses (IgG1, IgG2, IgG3, and IgG4) in CRC patients to explore possible alterations in humoral immunity. Compared to healthy controls, 5 genes were found to be downregulated in PBMCs of all CRC patients’ groups; CCL3 (fold regulation – 6.36), IL6 (fold regulation – 12.46), CSF2 (fold regulation – 7.50), CXCR3 (fold regulation – 3.01), and TNFSF14 (fold regulation – 4.90). Moreover, 13 genes were upregulated in PBMCs of all CRC patients’ groups; CCR3 (fold regulation 59.21), CD2 (fold regulation 3.07), CD27 (fold regulation 6.39), CD3G (fold regulation 4.15), CD8B (fold regulation 3.25), FAS (fold regulation 3.94), IL10 (fold regulation 39), IL18R1 (fold regulation 82.39), IL5 (fold regulation 20.4), LAG3 (fold regulation 19.88), MAP3K7 (fold regulation 4.07), TLR1 (fold regulation 6.45), and TLR6 (fold regulation 18.87). The serum levels of the four IgG subclasses were however statistically insignificant in CRC patients compared to healthy controls. Our findings provide insights into the adaptive immune dysfunction in CRC, offering a detailed profile of gene expression changes associated with T and B cell activation and antibody production. Understanding these dysregulations may enhance the development of targeted immunotherapies, potentially improving outcomes for CRC patients through more personalized immunomodulatory approaches.

PMID:40484866 | DOI:10.1007/s12672-025-02794-8

Zhonghua Yan Ke Za Zhi. 2025 Jun 11;61(6):442-450. doi: 10.3760/cma.j.cn112142-20241005-00434.

ABSTRACT

Objective: To investigate the efficacy and safety of limbal relaxing incisions (LRI) combined with implantable Collamer lens (ICL) implantation and Toric ICL (TICL) implantation in correcting high myopia with astigmatism. Methods: A prospective nonrandomized controlled clinical study was conducted. Patients with high myopia and astigmatism who underwent ICL implantation at Beijing Tongren Eye Center of Beijing Tongren Hospital Affiliated to Capital Medical University from March 1, 2022 to February 15, 2023 were enrolled in this study. These patients were divided into the TICL group (TICL implantation) and the LRI group (LRI combined with ICL implantation). The uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (recorded as the logarithm of the minimum resolution angle), refractive power, corneal and anterior chamber conditions, surgically induced astigmatism, and target-induced astigmatism before and 1 and 3 months after surgery were observed. The correction index, efficiency index, and safety index were calculated, and predictability was observed. Statistical analysis was conducted using the independent sample t-test, Mann Whitney U test, and linear regression equation. Results: Twenty patients (20 right eyes) were included in the TICL group, and 17 patients (17 right eyes) were included in the LRI group. There was no statistically significant difference in preoperative visual acuity, refractive error, corneal astigmatism, corneal and anterior chamber conditions between the two groups (all P>0.05). At 1 and 3 months postoperatively, the UDVA of the TICL group [-0.10 (-0.10, 0.00), 0.00(-0.08, 0.00)] showed statistically significant differences compared to the preoperative value [1.30 (1.11, 1.49)] (both P<0.05). The postoperative UDVA in the LRI group [-0.10 (-0.10, 0.00), -0.08 (-0.08, -0.04)] also showed statistically significant differences compared to the preoperative value [1.30 (1.22, 1.46)] (both P<0.05). The difference in UDVA between the LRI group and the TICL group at 3 months postoperatively was statistically significant (P<0.05). The corneal astigmatism degree in the LRI group at 3 months postoperatively [(-0.87±0.47) D] was significantly different from that before surgery [(-1.32±0.91) D] (P<0.05). There was no statistically significant difference in the safety index (1.17±0.17 and 1.16±0.14) and efficacy index (1.12±0.18 and 1.18±0.16) between the two groups at 3 months postoperatively (both P>0.05). The achieved correction of refractive power of all operated eyes in both groups was within ±0.50 D of the attempted correction of refractive power at 3 months. There was no statistically significant difference in surgically induced astigmatism and target-induced astigmatism between the two groups (both P>0.05), and the correction index of both groups was slightly greater than 1. There were no complications during or after the surgical treatment in both groups. Conclusion: For high myopia with low to moderate astigmatism, LRI combined with ICL implantation has good efficacy, safety, and predictability in the early to mid-term postoperative period.

PMID:40484853 | DOI:10.3760/cma.j.cn112142-20241005-00434

Zhonghua Yan Ke Za Zhi. 2025 Jun 11;61(6):434-441. doi: 10.3760/cma.j.cn112142-20240626-00282.

ABSTRACT

Objective: To investigate the consistency between automatic corneal marking using a surgical navigation system and manual corneal marking assisted by a slit-lamp microscope. Methods: This was a retrospective case series study. Patient data from the Ophthalmology Outpatient Department of Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from June 2021 to July 2023 were continuously collected. All patients underwent manual corneal marking assisted by a slit-lamp microscope, followed by automatic marking using a surgical navigation system. Patients were divided into two groups: the manual marking group and the automatic marking group. The manual marking group was further divided into three subgroups based on the marking measurement methods: manual marking (upper to lower edge), manual marking (lower to upper edge), and manual marking (midpoint). The horizontal meridian angle and the deviation of the central axis were calculated for the four marking methods using the image processing software. Statistical differences among the measurement methods were compared, and the consistency was evaluated using the Bland-Altman plots and intraclass correlation coefficient (ICC). Results: A total of 143 cataract patients (201 eyes) were included in the study, with an average age of (60.27±19.13) years, including 58 males and 85 females. The absolute mean deviations of the horizontal meridian angle for manual marking (upper to lower edge), manual marking (lower to upper edge), manual marking (midpoint), and automatic marking were 3.61°, 4.76°, 3.20°, and 2.45°, respectively, with statistically significant differences among them (P<0.001). The differences between automatic marking and the three manual marking methods were also statistically significant (P<0.05). The mean deviations of the central axis were 2.35, 2.35, 2.24, and 0.40 mm, respectively, with statistically significant differences among them (P<0.001). The deviation of the automatic marking method was significantly lower than that of the manual marking methods (P<0.001), while no significant difference was observed between the three edge-based manual marking methods (P>0.05). The ICC for the horizontal meridian angle between manual marking (midpoint) and automatic marking was 0.88, while the ICC for the central axis deviation was -0.04, indicating good consistency in the horizontal meridian angle between manual marking (midpoint) and automatic marking, but poor consistency in the central axis deviation. Conclusions: The horizontal meridian angle values of automatic corneal marking using a surgical navigation system and manual corneal marking (midpoint) assisted by a slit-lamp microscope showed good consistency. However, digital navigation automatic marking demonstrated significantly better control in the centralization of the radial offset, providing a robust basis for accurate axis positioning during toric intraocular lens implantation.

PMID:40484852 | DOI:10.3760/cma.j.cn112142-20240626-00282

Zhonghua Yi Xue Za Zhi. 2025 Jun 10;105(22):1840-1846. doi: 10.3760/cma.j.cn112137-20250212-00318.

ABSTRACT

Objective: To explore the association of lean body mass (LBM), lean body mass index(LBMI), fat mass (FM) and fat mass index(FMI) with depressive symptoms in adults aged 65 and above in 18 longevity areas in China. Methods: A cross-sectional study. The study participants were from the Chinese Longitudinal Healthy Longevity Biomarker Cohort Study, comprising elderly individuals aged 65 years and above. Demographic characteristics, lifestyle factors, physical function status, and disease history were collected. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). LBM and FM were measured to calculate LBMI and FMI, respectively. Participants were categorized into the depressive group and non-depressive group based on whether the PHQ-9 score≥10 points, and the differences in LBM, LBMI, FM, and FMI between the two groups were compared. Restricted cubic spline models were used to illustrate exposure-response relationships between LBM, LBMI, FM, FMI and the presence of depressive symptoms. Participants were categorized into low, moderate, and high groups based on the tertiles of LBM, LBMI, FM and FMI, respectively, and multivariable logistic regressions were applied to examine the associations of LBM, LBMI, FM, and FMI with depressive symptoms. Results: A total of 4 246 older adults were included, with 2 034 males (47.9%) and a mean age of (81.8±10.2) years. In the non-depressive group (n=4 008), the mean age was (81.9±10.2) years, with 1 957 males (48.8%). In the depressive group (n=238), the mean age was (80.8±9.6) years, with 77 males (32.4%). The LBM of the depvessive group was lower than that of the non-depressive group [(36.8±6.8) kg vs (39.0±7.5) kg, P<0.001]. Restricted cubic spline analysis indicated no non-linear exposure-response relationships between LBM, LBMI, FM, FMI, and the presence of depressive symptoms (all P>0.05). Multifactor logistic regression analysis showed that LBM and LBMI were negatively associated with the risk of depression (all P<0.05). Compared with the low LBM (or LBMI) group, the high LBM group (OR=0.458, 95%CI: 0.291-0.715) and the high LBMI group (OR=0.646, 95%CI: 0.442-0.939) had a lower likelihood of experiencing depressive symptoms. No statistically significant associations were found between FM, FMI, and depressive symptoms (all P>0.05). Conclusion: Among adults aged 65 years and above in longevity regions of China, higher LBM and LBMI are negatively associated with the risk of depressive symptoms.

PMID:40484846 | DOI:10.3760/cma.j.cn112137-20250212-00318

Zhonghua Yi Xue Za Zhi. 2025 Jun 10;105(22):1820-1826. doi: 10.3760/cma.j.cn112137-20250422-00995.

ABSTRACT

Objective: To investigate the value of short-term ¹⁸F-fluorodeoxyglucose (FDG) total-body (TB) dynamic PET(dPET)-CT scanning in the diagnosis of Takayasu arteritis (TA). Methods: A retrospective analysis was performed on 8 TA patients underwent dPET-CT scanning in the First Affiliated Hospital of Shandong First Medical University from March to October 2022, who met the diagnostic criteria for TA proposed by the American College of Rheumatology in 1990. Patients were divided into active inflammation and inactive inflammation groups according to National Institutes of Health (NIH) criteria. All patients underwent 1 h TB dPET scan and 2 h delayed scan, and 1 h static PET was reconstructed by dPET scan for 50-60 min, and nineteen regions of interest in the arterial wall were delineated for each patient. One hour dPET scan images were reconstructed into 10, 20, 30, 40 and 60 min K_i parameter images and compared with 1 h static and 2 h delayed PET images. The clinical data of patients in the active inflammation group and the inactive inflammation group were compared. The image quality of dPET and static PET at different scanning times [including lesion target ratio (TBR), lesion contrast-to-noise ratio (CNR)] and the detection rate of active lesions were compared. Results: A total of 152 branch vessels of 8 patients were included, including 3 males and 5 females, aged 21 to 40 years old. A total of 68 (89.5%) diseased blood vessels were detected in 4 patients in the active inflammation group, and a total of 50 (65.8%) diseased blood vessels were detected in 4 patients in the inactive inflammation group (P=0.001). The TBRs of dPET at 10, 20, 30, 40 and 60 min were 1.870 (1.301, 2.815), 2.991 (1.926, 4.265), 3.310 (2.308, 4.786), and 3.315 (2.333, 4.361), 2.986 (2.177, 4.344)), respectively. The CNRs were -0.799 (-1.356, 0.300), 0.691 (-0.212, 1.900), 1.563 (0.550, 2.778), 2.236 (1.012, 3.271), and 2.344 (1.324, 4.134), respectively. Both TBR and CNR gradually increased (both P_trend<0.001). Pairwise comparisons revealed that the dPET TBR at 30, 40, and 60 minutes and the dPET CNR at 40 and 60 minutes were all higher than those of the 1-hour static and 2-hour delayed PET, respectively (all P<0.001). The differences in the detection rates of diseased blood vessels between the active inflammation group and the inactive inflammation group at different scanning times of dPET, 1-hour static PET, and 2-hour delayed PET were all statistically significant (all P<0.05). Pairwise comparisons revealed that the detection rates of diseased blood vessels in the 30-and 40-minute dPET scans between the two groups of patients were 60.5% (46 lesions), 31.6% (24 lesions), 81.6% (62 lesions), and 44.7% (34 lesions), respectively. All were higher than 42.1% (32 pieces) and 9.2% (7 pieces) of 1-hour static PET (all P<0.05); the detection rates of diseased blood vessels in 40-minute dPET scans were both higher than 50.0% (38 lesions) and 30.3% (23 lesions) in 2-hour delayed PET scans (both P<0.001). Conclusions: It is feasible to shorten the time of dPET scanning for the assessment of arterial activity in TA patients, and parametric images with higher image quality and diseased blood vessels detection rate can be obtained by dPET scanning for 30 min.

PMID:40484843 | DOI:10.3760/cma.j.cn112137-20250422-00995

Zhonghua Yi Xue Za Zhi. 2025 Jun 3;105(21):1728-1736. doi: 10.3760/cma.j.cn112137-20250317-00652.

ABSTRACT

Objective: To evaluate the efficacy and safety of sulodexide in preventing venous thromboembolism (VTE) in high-risk populations and reducing recurrence in established VTE patients. Methods: A literature search was conducted in databases including China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Periodical Database, China Biology Medicine disc, PubMed, Embase, the Cochrane Library, and Web of Science to retrieve relevant literature on sulodexide in the treatment of VTE, with the retrieval time frame set from the establishment of the databases to April 2024. According to the inclusion and exclusion criteria, two researchers independently screened the literature and extracted the data. The Cochrane risk of bias tool or the Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. Meta-analysis was performed using Revman5.4.1 software, with the RR value as the effect measure. The trial group comprised high-risk individuals or VTE patients treated with sulodexide, while the control group consisted of patients treated with other traditional anticoagulants or placebos. The outcome measures included the incidence and recurrence rate of VTE, the incidence of post-thrombotic syndrome (PTS), and the risk of bleeding, among others. Results: A total of 11 articles involving 11 studies and 3 364 patients were included according to the inclusion and exclusion criteria. For high-risk populations of VTE, prophylactic use of sulodexide was more effective than the control group in reducing the incidence of VTE in high-risk individuals [2.2% (3/138) vs 10.9% (15/138), RR=0.25, 95%CI: 0.09-0.72, P=0.010]. For VTE patients, sulodexide was more effective than control group in reducing the recurrence rate of VTE [5.6% (56/996) vs 9.7% (198/2 043), RR=0.59, 95%CI: 0.44-0.80, P<0.001]. There was no statistically significant difference in the incidence of PTS between patients treated with sulodexide and those treated with other traditional anticoagulants [14.0% (36/257) vs 16.6% (149/897), RR=0.86, 95%CI: 0.61-1.20, P=0.370]. Moreover, the incidence of bleeding events was lower in patients treated with sulodexide compared to those treated with other traditional anticoagulants [0.8% (2/251) vs 6.1% (40/656), RR=0.11, 95%CI: 0.03-0.37, P<0.001]. Conclusion: Sulodexide exhibits favorable efficacy and safety for VTE prevention in high-risk populations and recurrence reduction in VTE patients.

PMID:40484836 | DOI:10.3760/cma.j.cn112137-20250317-00652