Tag: nevin manimala

Sports Med Open. 2025 Jun 8;11(1):67. doi: 10.1186/s40798-025-00872-3.

ABSTRACT

BACKGROUND: Breast cancer survivors undergoing cancer therapy are at an increased risk of developing cardiovascular disease. As a result, exercise has become a research hotspot in preventing decreased cardiorespiratory fitness (CRF) in breast cancer survivors. However, there is no consensus on which type of exercise is the most effective in improving cardiorespiratory function of breast cancer survivors. Therefore, this network meta-analysis (NMA) aims to compare the effects of different exercise therapies and explore the possible optimal choice to improve CRF in breast cancer survivors.

METHODS: A systematic search was conducted in EMBASE, the Cochrane Library, PubMed, Web of Science, and CINAHL to identify relevant randomized controlled trials (RCTs). The analysis was then performed using R Version 3.5.1 and GEMTC software, employing a NMA with a Bayesian random effects model to synthesize the comparative effectiveness of different exercise schemes on CRF in breast cancer survivors. A network graph was constructed to visualize the relative relationship for each exercise therapy in relation to the others. Direct and mixed evidence were estimated with mean difference (MD) and 95% credible interval (CrI) and presented in a forest plot and league table. The cumulative rank plot was created and surface under the cumulative ranking (SUCRA) scores were calculated to rank the exercise schemes. Additionally, a network meta-regression analysis was conducted to evaluate if the different timing of exercise (during and after cancer treatment) has an influence on the effects found in this NMA.

RESULTS: The analysis included 41 eligible RCTs and a total of 2606 participants. The results indicated that moderate-intensity continuous aerobic training (MICT; MD: 1.6, 95%Cr 0.13 to 3.1), moderate-to-vigorous aerobic exercise (M-V; MD: 3.4, 95%CrI 1.9 to 5.0), high-intensity interval training (HIIT; MD: 2.9, 95%CrI 1.2 to 4.6), and moderate-to-vigorous aerobic training combined with resistance exercise (M-V + RE; MD: 4.3, 95%CrI 2.5 to 6.1) had better efficacy than usual care on CRF. M-V + RE was significantly better than MICT (MD: 2.7, 95%CrI 0.4 to 5.0). Amongst 12 exercise interventions, M-V + RE was shown to have the highest-ranking probability of being the best treatment (SUCRA: 88.15%). No statistical difference was observed for the relative effects of different timing of exercise for CRF improvement compared to usual care in network meta-regression analyses.

CONCLUSIONS: This NMA suggests MICT, M-V, HIIT, and M-V + RE as available options for improving CRF in breast cancer survivors, and M-V + RE is likely to be the optimal choice for improving CRF. Further high-quality studies are needed to continue to confirm the role of M-V + RE in improving CRF among breast cancer survivors.

PMID:40483630 | DOI:10.1186/s40798-025-00872-3

Sports Med Open. 2025 Jun 8;11(1):69. doi: 10.1186/s40798-025-00870-5.

ABSTRACT

BACKGROUND: Less-experienced runners are proposed to sustain more running related injuries (RRIs) than more-experienced runners because of differences in their gait biomechanics. However, the effects of running experience on biomechanics remain inconclusive. The objective of this systematic review was to examine the evidence concerning the influence of experience on running biomechanics and summarize the criteria used to classify running experience. A classification procedure for running experience was proposed based on the results.

METHODS: Five common databases were searched for relevant articles following PRISMA guidelines (PROSPERO_ID CRD42022296734) and the PICO framework. Peer-reviewed research reporting a statistical effect of running experience on running gait biomechanics in adults (18-65 years) were included. Exclusion criteria were: subjects with current pathologies or symptomatic injuries; reporting running only barefoot, in minimalist shoes, during sprinting, or incline/decline running; classified experience only through performance-related measures; or did not specify running experience group definition. Risk of bias was assessed with the Downs and Black checklist. Extracted data were organized in tables and synthesized descriptively due to study heterogeneity.

RESULTS: Twenty-eight studies with 916 total subjects were included. Although most studies found significance in their comparisons, no studies comparing similar gait variables found the same statistical result. Some variables compared between experience levels were examined in only one study. Experience classification criteria were inconsistent between studies; cut-offs for more-experienced ranged between 2 and 10 years and/or 15-50 km/week and cut-offs for less-experienced ranged between 0.5 and 3 years and/or 0-20 km/week. Meta-analysis was not possible due to heterogeneity among the included studies.

CONCLUSION: Effects of experience on running mechanics were inconsistent in the current literature. The lack of consistent findings may be due to the heterogeneous criteria used to classify runners into experience groups and the inconsistency of the variables investigated. Replication studies, heterogeneous study design, and longitudinal studies are needed to determine if or how running biomechanics change as runners gain experience. Heterogeneous study designs must begin with standard experience classification criteria for the effect of experience on running biomechanics to be identified. We propose an updated taxonomy to classify runners into groups considering three facets: exposure, performance, and intention.

TRIAL REGISTRATION: PROSPERO ID CRD42022296734. Registered 28 September 2022-Retrospectively registered, https://www.chictr.org.cn/bin/project/edit?pid=149714 .

PMID:40483619 | DOI:10.1186/s40798-025-00870-5

Intern Emerg Med. 2025 Jun 8. doi: 10.1007/s11739-025-04002-5. Online ahead of print.

ABSTRACT

Aspiration pneumonia (AP) is common in patients with pneumonia evaluated in Emergency Department (ED). The therapeutic management of these patients often involves secretion suctioning through two main techniques: laryngotracheal aspiration (LTA) and fibrobronchoscopic aspiration (FBA). Despite both techniques being employed, there are no studies comparing the clinical outcomes. This prospective single-center observational case control study was conducted in the ED of Careggi University Hospital in Italy. Adult patients with radiological evidence of pneumonia, clinical diagnosis of AP and need for oxygen therapy were included from the 12th December 2023 to the 31st December 2024. The primary endpoints were 30 day-mortality and the length of hospital stay. Secondary endpoints included admission setting, changes in Horowitz index and O2 delivery device, and procedure-related complications. Statistical analysis was conducted on the entire sample and subsequently on a selected population using propensity score matching (PSM). 257 patients with a mean age of 78.0 ± 15.2 years were included in the study. There were no significant differences between LTA and FAB groups regarding 30-day mortality (37.7% FBA group vs 32% LTA group; p = 0.28) and length of hospital stay (11.8 ± 11.0 days FBA vs 9.5 ± 9.1 days LTA group; p = 0.45). No significant differences were observed for all secondary outcomes among the two groups. Also considering selected population based on PSM, no significant differences were observed. No significant differences were found in terms of mortality, length of hospital stay, morbidity and procedure-related complications among patients with AP treated with LTA or FBA.

PMID:40483618 | DOI:10.1007/s11739-025-04002-5

J Robot Surg. 2025 Jun 8;19(1):276. doi: 10.1007/s11701-025-02460-9.

ABSTRACT

Total mesorectal excision (TME) is the gold standard for rectal cancer surgery. Robotic (RoTME) and transanal (TaTME) approaches have gained popularity, but their comparative effectiveness remains uncertain and previous meta-analysis include many retrospective studies which are prone to biases. This meta-analysis aims to bridge this gap. A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched for prospective studies comparing RoTME and TaTME. Meta-analysis was performed using random-effects models. Sensitivity analysis included a “leave-one-out” approach. Subgroup analysis was performed for overweight patients. Five non-randomized prospective studies (n = 1941) were included. RoTME and TaTME had no significant differences regarding operative duration (MD: 27.29, 95% CI -56.18 to 110.76, P = 0.29, I² = 95%) and comparable hospital stay (MD: 3.12, 95% CI -6.14 to 12.39, P = 0.27, I² = 98%). Blood loss was similar (MD: -22.70, 95% CI -145.80 to 100.40, P = 0.42, I² = 89%). Conversion rates favored TaTME (OR: 2.39, 95% CI 0.39 to 14.69, P = 0.04, I² = 26%) but with a wide confidence interval, limiting significance. Sphincter preservation favored TaTME (OR: 0.44, 95% CI 0.17 to 1.16, P < 0.0001, I² = 32%), but with wide confidence interval, limiting significance. No significant differences were noted for minor complications (OR: 0.88, P = 0.51, I² = 37%), major complications (OR: 1.21, P = 0.24, I² = 7%), anastomotic leakage (OR: 1.35, P = 0.09, I² = 0%), mortality (OR: 1.15, P = 0.82, I² = 0%), and morbidity (OR: 1.26, P = 0.75, I² = 95%). R0 resection was significantly higher in RoTME (OR: 1.70, 95% CI 0.92 to 3.16, P = 0.02, I² = 0%), but with wide confidence interval limiting its significance. No difference was found in lymph node yield (MD: 1.83, 95% CI -2.57 to 6.24, P = 0.06, I² = 51%). Sensitivity analysis revealed that excluding specific studies reduced heterogeneity and affected operative duration and anastomotic leakage trends. In the overweight subgroup, only hospital stay was significantly shorter in TaTME (MD: 1.50, 95% CI 1.07 to 1.92, P < 0.00001, I² = 0%). RoTME and TaTME yield comparable perioperative, postoperative, and short-term oncological outcomes. While the pooled results for conversion rate and sphincter preservation numerically favored TaTME, the confidence intervals crossed the line of no effect, indicating that these differences were not statistically significant. Sensitivity analysis highlighted variability among studies. In overweight patients, TaTME reduced hospital stay, though data were limited. Due to the limited number of identified studies and moderate risk of bias, no recommendations can be made to surgeons, patients and healthcare policy makers. Future large-scale RCTs are needed to clarify long-term outcomes, cost-effectiveness, and functional results and determine superiority of either approach. PROSPERO registration: CRD420250654891.

PMID:40483613 | DOI:10.1007/s11701-025-02460-9

Eur Arch Paediatr Dent. 2025 Jun 8. doi: 10.1007/s40368-025-01069-8. Online ahead of print.

ABSTRACT

PURPOSE: Early childhood caries is a major public health issue worldwide. Midwives, as primary healthcare providers for young children, play an essential role in promoting oral health practices. This study aimed to assess the knowledge of midwives in France regarding early childhood caries, their prevention, and dietary risk factors for dental caries in young children.

METHODS: A national online survey via self-administrated questionnaire was conducted among midwives in France, with a focus on their understanding of oral health recommendations, including the timing of the first dental examination, fluoride use, and dietary habits.

RESULTS: The results revealed that while midwives demonstrated knowledge of basic oral hygiene practices, there were gaps in their understanding of the timing of the first oral examination and the use of fluoride toothpaste. In addition, many midwives did not recognise breastfeeding, especially night-time breastfeeding, as a cariogenic factor. Moreover, a statistically significant difference between generations was identified in the approach to oral health prevention during prenatal and postnatal consultations.

CONCLUSION: This study highlights the need for improved oral health training for midwives and a greater integration of oral health education into their professional practice to enhance early prevention of early childhood caries.

PMID:40483611 | DOI:10.1007/s40368-025-01069-8

J Vasc Surg. 2025 May 30:S0741-5214(25)01005-5. doi: 10.1016/j.jvs.2025.04.043. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate and compare the outcomes of transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (tfCAS) in patients with nonatherosclerotic carotid diseases, including dissection, trauma, and fibromuscular dysplasia.

METHODS: Patients who underwent TCAR and tfCAS for nonatherosclerotic carotid diseases between 2016 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were classified into TCAR or tfCAS based on the procedure performed. Baseline characteristics, demographics, and operative details were collected. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE), which was defined as the composite of stroke, myocardial infarction, and death. Secondary outcomes included perioperative complications. Descriptive statistics, univariable comparisons, and multivariable logistic regression analyses were performed to evaluate the association between procedure type and outcomes. A two-tailed P value of <.05 was considered statistically significant.

RESULTS: Six hundred seventy six patients were identified (tfCAS, n = 503; TCAR, n = 173). TCAR patients were older (64 ± 14 years vs 56 ± 16 years; P < .001), and had higher rates of hypertension (74% vs 60.4%; P = .001) and coronary artery disease (34.1% vs 22.2%; P = .002). Dissection was the most common etiology (TCAR, 77.5%; tfCAS, 77.9%), followed by fibromuscular dysplasia (TCAR, 14.5%; tfCAS, 10.5%) then trauma (TCAR, 8.1%; tfCAS, 11.5%). Intraoperatively, TCAR patients had shorter fluoroscopy times (5 minutes vs 18.25 minutes; P < .001) and required less radiocontrast (30 mL vs 95 mL; P < .001), but had slightly longer procedure times (75.5 minutes vs 69 minutes; P = .055). When analyzed by procedure type, TCAR was associated with significantly lower rates of MACE (1.2% vs 7%; P = .004) and stroke/death (1.2% vs 6.4%; P = .007) compared with tfCAS. Furthermore, when stratified by symptomatic status, TCAR consistently had lower rates of MACE and stroke/death. On multivariate analysis, TCAR was independently associated with a significantly lower risk of MACE (odds ratio, 0.09; 95% confidence interval, 0.01-0.74; P = .025) and stroke/death (odds ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .045).

CONCLUSIONS: TCAR was associated with superior perioperative outcomes compared with tfCAS in the treatment of nonatherosclerotic carotid diseases. These findings highlight TCAR’s potential to be a safer and more effective treatment option for this challenging patient population.

PMID:40483606 | DOI:10.1016/j.jvs.2025.04.043

Disabil Rehabil. 2025 Jun 8:1-12. doi: 10.1080/09638288.2025.2514260. Online ahead of print.

ABSTRACT

PURPOSE: To explore the impact of self-efficacy on self-management with the parallel mediating effects of impulsivity and good control, as well as the moderating effect of emotion regulation.

METHODS: Convenience sampling method was used in this study. From March to July 2024, stroke patients were recruited from a tertiary hospital in Henan Province, China. Questionnaires were administered to collect sociodemographic data, self-control, self-efficacy, emotion regulation, and self-management. Descriptive statistics and Process Macro Models 4 and 14 in the SPSS program (SPSS Inc., Chicago, IL) were used for data analysis.

RESULTS: A total of 519 stroke survivors reported self-management with a moderate standardization score. Impulsivity and good control co-mediating the association of self-efficacy and self-management. After adding the cognitive reappraisal as the moderator, the moderated mediation model of impulsivity was confirmed with adequate fit indices. However, cognitive reappraisal did not play a moderating role in good control and self-management.

CONCLUSIONS: Self-efficacy can promote self-management in stroke survivors by reducing impulsivity and enhancing self-control. Notably, cognitive reappraisal may suppress impulsive thoughts in stroke survivors and promote self-management.

PMID:40483588 | DOI:10.1080/09638288.2025.2514260

J Child Adolesc Ment Health. 2025 Jun 8:1-17. doi: 10.2989/17280583.2025.2490650. Online ahead of print.

ABSTRACT

Background: Adolescence is a critical period marked by increased vulnerability to anxiety-related conditions. With the widespread use of the internet, persistent concerns about health may manifest as cyberchondria in this age group.Objective: The study aimed to evaluate the effect of students’ characteristics (e.g., sex, student’s grade level) and their cyberchondria levels on their health anxiety levels.Methods: A descriptive cross-sectional study was completed with 328 students (mean age = 15.63 years, SD = 2.07 years). The study was conducted among 14 to 17-year-old students studying in the 1^st, 2^nd, 3^rd, and 4^th grades of a public high school between February 2021 and April 2023. Study data were collected using sociodemographic information, health anxiety, and cyberchondria severity measures. Backward elimination linear regression analyses were performed to reveal the factors that predicted health anxiety.Results: Almost half of the sample (n = 132, 40.2%) were male and 196 (59.8%) were female. There were statistically significant differences in terms of total and subscale scores of the Health Anxiety Inventory by sex. Specifically, the mean scores of female students (mean = 16.41, SD = 7.19) were significantly higher than those of male students (mean = 13.49, SD = 6.49) on the total scale (p < 0.001). Accordingly, the mean hypersensitivity to physical symptoms and anxiety subscale scores were significantly higher for female students (mean = 12.83, SD = 5.84) than for males (mean = 10.41, SD = 5.14) (p < 0.05). Similarly, the mean negative consequences of illness subscale scores were significantly higher for females (mean = 3.58, SD = 2.41), than for males (mean = 3.08, SD = 2.49) (p < 0.05). Regression analysis results indicated that sex (β = -0.222), doing research on the internet very frequently (β = 0.175), and Cyberchondria Severity Scale total scores (β = 0.428) significantly predicted health anxiety scores, respectively (F(3.324) = 47.732, p < 0.001). Together, all three significant variables explain 31% of the variance.Conclusions: There was a positive and weak to moderate correlation between students’ health anxiety levels and cyberchondria levels, and their health anxiety levels increased with an increase in their cyberchondria levels.

PMID:40483571 | DOI:10.2989/17280583.2025.2490650

Br J Clin Pharmacol. 2025 Jun 8. doi: 10.1002/bcp.70119. Online ahead of print.

ABSTRACT

Developing high-quality pharmacology multiple-choice questions (MCQs) is challenging in large part due to continually evolving therapeutic guidelines and the complex integration of basic science and clinical medicine in this subject area. Large language models (LLMs) like ChatGPT-4 have repeatedly demonstrated proficiency in answering medical licensing exam questions, prompting interest in their use for generating high stakes exam-style questions. This study evaluates the performance of ChatGPT-4o in generating USMLE-style pharmacology questions based on American Society for Pharmacology and Experimental Therapeutics/Association of Medical School Pharmacology Chairs (ASPET/AMSPC) knowledge objectives and assesses the impact of retrieval-augmented generation (RAG) on question accuracy and quality. Using standardized prompts, 50 questions (25 RAG and 25 non-RAG) were generated and subsequently evaluated by expert reviewers. Results showed higher accuracy for non-RAG questions (88.0% vs. 69.2%), though the difference was not statistically significant. No significant differences were observed in other quality dimensions. These findings suggest that sophisticated LLMs can generate high-quality pharmacology questions efficiently without RAG, though human oversight remains crucial.

PMID:40483567 | DOI:10.1002/bcp.70119

Neurol Res. 2025 Jun 7:1-10. doi: 10.1080/01616412.2025.2515194. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) tools for large vessel occlusion (LVO) detection are increasingly used in acute stroke triage to expedite diagnosis and intervention. However, variability in access and workflow integration limits their potential impact. This study assessed current usage patterns, access disparities, and integration levels across U.S. stroke programs.

METHODS: Cross-sectional, web-based survey of 97 multidisciplinary stroke care providers from diverse institutions. Descriptive statistics summarized demographics, AI tool usage, access, and integration. Two-proportion Z-tests assessed differences across institutional types.

RESULTS: Most respondents (97.9%) reported AI tool use, primarily Viz AI and Rapid AI, but only 62.1% consistently used them for triage prior to radiologist interpretation. Just 37.5% reported formal protocol integration, and 43.6% had designated personnel for AI alert response. Access varied significantly across departments, and in only 61.7% of programs did all relevant team members have access. Formal implementation of the AI detection tools did not differ based on the certification (z = -0.2; p = 0.4) or whether the program was academic or community-based (z =-0.3; p = 0.3).

CONCLUSIONS: AI-enabled LVO detection tools have the potential to improve stroke care and patient outcomes by expediting workflows and reducing treatment delays. This survey effectively evaluated current utilization of these tools and revealed widespread adoption alongside significant variability in access, integration, and workflow standardization. Larger, more diverse samples are needed to validate these findings across different hospital types, and further prospective research is essential to determine how formal integration of AI tools can enhance stroke care delivery, reduce disparities, and improve clinical outcomes.

PMID:40483553 | DOI:10.1080/01616412.2025.2515194