Tag: pubmed

J Turk Ger Gynecol Assoc. 2025 Dec 3;26(4):276-283. doi: 10.4274/jtgga.galenos.2025.2025-7-2.

ABSTRACT

OBJECTIVE: To assess the diagnostic performance of the ultrasound-based #Enzian classification in comparison with laparoscopic surgical findings in patients with endometriosis.

MATERIAL AND METHODS: This retrospective cohort study included patients who underwent laparoscopic excisional surgery for endometriosis between September 2023 and October 2024. Preoperative transvaginal ultrasound assessments were performed using the International Deep Endometriosis Analysis protocol, with findings recorded according to the updated #Enzian classification. Diagnostic performance was evaluated through sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. Statistical analyses were conducted using SPSS version 26.0.0.0, with statistical significance set at p<0.05.

RESULTS: The study included 66 patients. The #Enzian classification demonstrated the highest diagnostic accuracy in compartments FA and FB (98.82% and 98.59%, respectively), both with perfect sensitivity and minimal false positives. The left ovary (O left) also showed strong performance (92.87% accuracy). In contrast, compartment A had low sensitivity (12.12%) despite a low false-positive rate. Compartments B left and C exhibited good accuracy (86.82% and 91.88%), with minimal false positives and moderate sensitivity. Variable results were observed in compartments O right and T. Although sensitivity was incomplete for FU, FI, and FO, specificity remained high across these subgroups.

CONCLUSION: The #Enzian ultrasound classification provides a reliable diagnostic framework, demonstrating high accuracy across multiple compartments. It is recommended that future studies include larger sample sizes and longitudinal design to further validate these findings.

PMID:41334622 | DOI:10.4274/jtgga.galenos.2025.2025-7-2

Int J Gynaecol Obstet. 2025 Dec 3. doi: 10.1002/ijgo.70696. Online ahead of print.

ABSTRACT

OBJECTIVE: This study identifies and describes global caesarean section (CS) training practices, comparing high-income countries (HIC) and low- and middle-income countries (LMIC).

METHODS: A convergent parallel mixed-methods study was conducted with a cross-sectional survey. The survey was distributed through professional networks and social media. Participation was voluntary and anonymous.

RESULTS: A total of 411 participants from 42 countries were included, with 42% (172) representing HIC and 58% (239) LMIC. Most participants were working in obstetrics and gynecology as specialists (52%, 214) or trainees (26%, 107). Participants from LMIC performed more CS annually, with a mean of 138 (±221) cases, compared to those from HIC with 44 (±64) cases (P < 0.001). Most were taught by an apprenticeship model (75%, 310). Feedback practices were predominantly informal, reported by 64% (263), while formal competence assessment was reported by 22% (38/172) of HIC participants and 9% (21/239) from LMIC (P < 0.001). Participants from LMIC completed fewer supervised cases compared to their HIC counterparts, with a median of 10 (interquartile range 5-20) compared to 50 (interquartile range 30-100) (P < 0.001). LMIC participants reported a higher incidence of major complications or mortality during training: 11% (24/202) versus 3% (3/120). Seventy percent (174/250) of the participants advocated for a formal training program for CS, suggesting that it could improve the quality and safety of CS.

CONCLUSION: The study highlights current practices and differences in CS training in LMIC and HIC. The outcomes associated with CS are influenced by multiple patient- and system-level factors, including access to care, patient risk profiles, and resources. However, training remains an essential and modifiable component, which, according to participants in this study, could be strengthened by incorporating evidence-based educational practices.

PMID:41334611 | DOI:10.1002/ijgo.70696

Int J Dent. 2025 Nov 23;2025:1485407. doi: 10.1155/ijod/1485407. eCollection 2025.

ABSTRACT

BACKGROUND/AIM: This study aimed to conduct a retrospective epidemiological investigation of patients treated in an extension project at a Brazilian dental school over the past 13 years.

MATERIAL AND METHODS: Clinical records of patients treated at a university hospital in Brazil as part of a specialized dental trauma care project were reviewed. The study included both primary and permanent teeth and covered the period from 2011 to 2024. Statistical analysis was conducted using the Pearson chi-square, with a significance level set at 5%.

RESULTS: Of the 460 records evaluated, 375 met the inclusion criteria, encompassing a total of 833 affected teeth (220 primary and 613 permanent teeth). Males (n = 248) represented the majority of individuals treated and exhibited a higher prevalence of hard tissue injuries (n = 208) compared with females (n = 93). The most common type of hard tissue injury was enamel and dentin fractures without pulp exposure (n = 139). Patients with hard tissue injuries generally sought care promptly after the traumatic event (p < 0.0001) and showed a significantly higher incidence of endodontic treatment needs (p < 0.0001) than those soft tissue fractures. Falls were identified as the leading cause of all types of hard tissue fractures (p < 0.0001).

CONCLUSIONS: The study identifies a high-risk profile for hard issue injuries, predominantly affecting children from infancy to early adolescence (ages 0-14 years), with falls being the most frequent cause. Additionally, hard tissue injuries were associated with faster care-seeking behavior and a higher likelihood of requiring endodontic treatment.

PMID:41334568 | PMC:PMC12665489 | DOI:10.1155/ijod/1485407

Front Physiol. 2025 Nov 17;16:1668129. doi: 10.3389/fphys.2025.1668129. eCollection 2025.

ABSTRACT

STUDY OBJECTIVE: Acute sleep deprivation significantly impacts cognitive function, contributes to accidents, and increases the risk of chronic illnesses, underscoring the need for reliable and objective diagnosis. Our work aims to develop a machine learning-based approach to discriminate between EEG recordings from acutely sleep-deprived individuals and those that are well-rested, facilitating the objective detection of acute sleep deprivation and enabling timely intervention to mitigate its adverse effects.

METHODS: Sixty-one-channel eyes-open resting-state electroencephalography (EEG) data from a publicly available dataset of 71 participants were analyzed. Following preprocessing, EEG recordings were segmented into contiguous, non-overlapping 20-second epochs. For each epoch, a comprehensive set of features was extracted, including statistical descriptors, spectral measures, functional connectivity indices, and graph-theoretic metrics. Four machine learning classifiers – Light Gradient-Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), Random Forest (RF), and Support Vector Classifier (SVC) – were trained on these features using nested stratified cross-validation to ensure unbiased performance evaluation. In parallel, three deep learning models-a Convolutional Neural Network (CNN), Long Short-Term Memory network (LSTM), and Transformer-were trained directly on the raw multi-channel EEG time-series data. All models were evaluated under two conditions: (i) without subject-level separation, allowing the same participant to contribute to both training and test sets, and (ii) with subject-level separation, where models were tested exclusively on unseen participants. Model performance was assessed using accuracy, F1-score, and area under the receiver operating characteristic curve (AUC).

RESULTS: Without subject-level separation, CNN achieved the highest accuracy (95.72%), followed by XGBoost (95.42%), LightGBM (94.83%), RF (94.53%), and SVC (85.25%), with the Transformer (77.39%) and LSTM (66.75%) models achieving lower accuracies. Under subject-level separation, RF achieved the highest accuracy (68.23%), followed by XGBoost (66.36%), LightGBM (66.21%), CNN (65.35%), and SVC (65.08%), while the Transformer (63.35%) and LSTM (61.70%) models achieved the lowest accuracies.

CONCLUSION: This study demonstrates the potential of EEG-based machine learning for detecting acute sleep deprivation, while underscoring the challenges of achieving robust subject-level generalization. Despite reduced accuracy under cross-subject evaluation, these findings support the feasibility of developing scalable, non-invasive tools for sleep deprivation detection using EEG and advanced ML techniques.

PMID:41334558 | PMC:PMC12665582 | DOI:10.3389/fphys.2025.1668129

Front Physiol. 2025 Nov 17;16:1703742. doi: 10.3389/fphys.2025.1703742. eCollection 2025.

ABSTRACT

INTRODUCTION: Fertility decline in aging turkey breeder hens is associated with reduced sperm storage in the uterovaginal junction (UVJ), inflammation, oxidative stress, and tissue aging. The mucosal microbiome is an important contributor to subfertility, with shifts in immune function, inflammation, and oxidative stress linked to microbial changes. Bardoxolone methyl, a potent activator of the nuclear erythroid 2-related factor 2 (NRF2) pathway, enhances antioxidant defenses and reduces inflammation. This study investigated if bardoxolone methyl treatment alters the microbial composition and diversity of the UVJ and vagina in turkey hens.

METHODS: Forty turkey hens (59 weeks old) were randomly assigned to a bardoxolone methyl group (n = 20) or a control group (n = 20). Birds received intramuscular tail injections of bardoxolone methyl or vehicle, every other day for two weeks. Swabs from the UVJ and vagina (VAG) were collected for 16S rRNA sequencing. Microbial diversity, differential taxonomic composition, and predicted functional pathways were assessed using QIIME2, PICRUSt2, and R-based statistical packages. Microbiome profiles revealed significant differences between UVJ and VAG communities.

RESULTS: The VAG showed higher bacterial richness, while both sites were dominated by Firmicutes, Proteobacteria, Thermoproteota, and Actinobacteriota phyla, indicator species analyses identified enrichment of Staphylococcus and Escherichia in UVJ, and Lactobacillaceae in VAG. Bardoxolone methyl did not significantly alter global alpha diversity but selectively modulated unweighted beta diversity and low-abundance taxa, enriching Corynebacterium in UVJ and rare taxa like Armatimonadota and Omnitrophota in the VAG. Functional predictions indicated bardoxolone methyl’s association with enrichment of pathways including energy metabolism, nucleotide biosynthesis, protein quality control, and redox balance, particularly in the UVJ.

DISCUSSION: This study provides the first characterization of the turkey lower reproductive tract microbiome, revealing tissue-specific communities and functional profiles between the UVJ and vagina. Bardoxolone methyl treatment did not alter overall microbial diversity, but selectively enriched low-abundance taxa and metabolic pathways related to energy metabolism, nucleotide biosynthesis, and stress resilience, particularly in the UVJ. These findings indicate that bardoxolone methyl treatment can finetune microbial functional capacity without destabilizing overall community structure. The results also highlight the importance of considering tissue-specific differences and functional potential when investigating reproductive function.

PMID:41334554 | PMC:PMC12665593 | DOI:10.3389/fphys.2025.1703742

Eur Urol Open Sci. 2025 Nov 18;83:9-14. doi: 10.1016/j.euros.2025.11.002. eCollection 2026 Jan.

ABSTRACT

BACKGROUND AND OBJECTIVE: Incising or breaking a tumor during surgery for renal cell carcinoma (RCC) is considered an adverse event. The aim of our study was to examine oncological outcomes for patients with accidental tumor incision (ATI) during partial nephrectomy (PN) for cT1 RCC.

METHODS: We conducted a retrospective single-center study of patients who underwent open, laparoscopic, or robot-assisted PN for cT1a-b RCC. The cohort was divided into groups with and without ATI during PN. The Kaplan-Meier method and a log-rank test were used to estimate and compare recurrence-free survival (RFS) and cancer-specific survival (CSS) for the two groups.

KEY FINDINGS AND LIMITATIONS: Among 813 patients, ATI was recorded for 103 cases (13%). Disease recurrence during follow-up occurred in 15 patients in the ATI group and 15 in the group without ATI. RFS differed significantly between the groups according to Kaplan-Meier analysis (p < 0.001) during median follow-up of 52 mo. ATI was associated with larger tumor diameter and higher RENAL score. The difference in CSS between the groups was not statistically significant (p = 0.8). Limitations of the study include the possibility of ATI cases being missed if not reported by the surgeon.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Our results demonstrate that ATI during PN is associated with greater risk of disease recurrence in T1 RCC, even though there was no significant difference in CSS over intermediate follow-up. Clinicians should take intraoperative precautions to minimize ATI and consider extended surveillance for patients in whom ATI occurs. Further research is warranted to explore preventative strategies and the long-term impact of ATI on survival.

PATIENT SUMMARY: We looked at cancer control outcomes after accidental incision into a tumor (ATI for short) during partial kidney removal for kidney cancer. The rate of cancer recurrence was higher in the group with ATI than in the group without ATI.

PMID:41334534 | PMC:PMC12666582 | DOI:10.1016/j.euros.2025.11.002

Eur Urol Open Sci. 2025 Nov 18;83:1-8. doi: 10.1016/j.euros.2025.10.019. eCollection 2026 Jan.

ABSTRACT

BACKGROUND AND OBJECTIVE: In-hospital infectious complications after cystectomy are understudied, with no reliable predictive tools. The aim of our study was to (1) comprehensively and prospectively evaluate these complications, (2) compare results between ileal conduit (IC) and ileal neobladder (NB) groups, and (3) evaluate the suitability of interleukin-6 (IL-6) and procalcitonin (PCT) levels and culture results for wound drainage fluid (WDF) as early indicators of infection.

METHODS: We monitored in-hospital complications among patients undergoing cystectomy and analyzed IL-6 and PCT levels and WDF cultures on the first postoperative day. Statistical analysis included logistic regression and Spearman correlation analysis. The trial was registered on ClinicalTrials.gov as NCT05153694.

KEY FINDINGS AND LIMITATIONS: From December 2021 to October 2024, 205 patients underwent open cystectomy in our department, of whom 186 consented to participate (66% IC, 34% NB). The median patient age was 71.6 yr and 80% were male. During their inpatient stay, 47% of patients developed fever and 44% received additional intravenous antibiotics. We found no significant differences between the IC and NB groups regarding postoperative fever, additional antibiotic use, positive blood cultures, the incidence of complications by Clavien-Dindo grade, Comprehensive Complication Index scores, or the incidence of wound infection or other infections. Microbial growth was detected in 13% of WDF samples; Escherichia coli and Enterococcus spp. were the most prevalent bacteria. We observed little to no correlations between IL-6 or PCT levels or WDF culture results and infectious complications.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Our prospective study revealed unexpectedly high incidence of in-hospital infections among cystectomy patients, with no significant differences between IC and NB groups. IL-6 and PCT levels and WDF culture results on the first postoperative day were not suitable as early indicators of infectious complications after open cystectomy.

PATIENT SUMMARY: We looked at infectious complications during their hospital stay for patients undergoing surgical removal of their bladder. We found no difference in the rate of infectious complications between two common surgical procedures that create a new pathway for urine to leave the body. We also found that levels of the markers interleukin-6 and procalcitonin, and bacterial culture results for wound drainage fluid were not helpful in predicting infectious complications for these patients.

PMID:41334533 | PMC:PMC12666572 | DOI:10.1016/j.euros.2025.10.019

Internet Interv. 2025 Nov 15;42:100890. doi: 10.1016/j.invent.2025.100890. eCollection 2025 Dec.

ABSTRACT

OBJECTIVES: This study aims to investigate the perspectives of patients, caregivers, and healthcare providers on how the Heart@Home application improves self-management following a two-week period of usage and how to improve the application for further utilization.

METHODS: This qualitative study used a case study approach. We conducted semi-structured in-depth interviews with patients, caregivers, and healthcare providers and evaluated patients’ quality of life before and after using the application. Purposeful sampling was employed, and thematic analysis was performed for qualitative data analysis.

RESULT: Nine patients, seven caregivers, and two healthcare providers were included in the analysis. The potential benefits for health behavior modification were noted through several mechanisms, including increasing self-awareness of patient’s current health status, guide for managing symptoms related to health status changes, and providing emotional assessment, reassurance and a sense of being cared for. In addition, more function in application is needed to increase engagement with application usage. Although the pre-post pilot analysis shows no statistically significant changes in participants’ quality of life, as measured by the EQ-5D questionnaire, promising trends were observed in the domains of self-management and daily activity.

CONCLUSION: The Heart@Home mobile application shows promise in promoting self-management and behavior modification among heart failure patients. Future development should focus on improving technical stability, incorporating personalized feedback, and enabling direct messaging with healthcare providers to enhance the application’s effectiveness in managing heart failure.

PMID:41334531 | PMC:PMC12666718 | DOI:10.1016/j.invent.2025.100890

JSLS. 2025 Oct-Dec;29(4):e2025.00064. doi: 10.4293/JSLS.2025.00064. Epub 2025 Nov 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Little is known about predictors of opioid use in the acute postoperative phase after hysterectomy. Inadequate pain support during this time can result in increased postoperative complications, and persistent postoperative pain. Objective is to determine predictors of increased opioid use in the acute perioperative phase (intraoperatively and 1 hour and 24 hours postoperatively).

METHODS: A prospective cohort study involving 200 participants undergoing nonurgent hysterectomy via laparoscopic, vaginal, abdominal, or robotic approaches at an academic tertiary hospital in Toronto, Canada. Data collected included demographics, preoperative validated pain questionnaire scores, pain scores at 1 and 24 hours postoperatively, and analgesic medications used. Nonparametric statistical methods and multivariate analyses were used to examine the association between clinical predictors and opioid use. Opioid use was converted into morphine equivalent dose (MED).

RESULTS: Pain sensitivity questionnaire (PSQ) score and body mass index were strongly associated with increased intraoperative MED. Twenty-four-hour postoperative opioid use was negatively correlated to age. Multivariate analysis identified PSQ total score and open hysterectomy as predictors of higher intraoperative MED. The number of preoperative pain medications, open hysterectomy, and PSQ total score were significant predictors of total MED requirements. One additional pain medication and one additional total PSQ point were associated with an increase in total MED of 10.76 and 5.17 mg, respectively.

CONCLUSIONS: This study is the first step in identifying clinical predictors of increased opioid requirements in the first 24 hours postoperatively. These predictors can inform patient-tailored management plans to ensure adequate pain support and appropriate opioid use.

PMID:41334498 | PMC:PMC12668372 | DOI:10.4293/JSLS.2025.00064

JSLS. 2025 Oct-Dec;29(4):e2025.00095. doi: 10.4293/JSLS.2025.00095. Epub 2025 Oct 31.

ABSTRACT

OBJECTIVE: Retrospective clinical report to demonstrate the use of abdominal wall elevation device with closed technique direct entry with 3-mm port.

DESIGN: An abdominal wall elevation device (LevaLap 1.0) was used during abdominal entry for laparoscopic and robotic gynecologic procedures. The primary outcomes were major vascular or visceral injury. Other events assessed included number of entry attempts, failed entry, and adverse events during entry. Descriptive statistics were used to characterize the patient population and the incidence of abdominal entry injuries or events.

SETTING: Tertiary hospital.

PATIENTS: Female patients undergoing laparoscopic gynecologic procedures with or without robotic assistance using an abdominal wall elevation device with direct entry technique from July 2023 to May 2024. Exclusion criteria were patients less than 18 years of age.

INTERVENTIONS: Use of abdominal elevation device at initial entry.

MEASUREMENTS AND MAIN RESULTS: The elevation device was used in 25 patients with a 3-mm direct trocar. Entry was achieved on the first attempt in all cases. There were no major vascular, visceral injuries, or failed entry events.

CONCLUSION: Use of a device to elevate the abdominal wall in a standardized fashion is feasible with direct entry using 3-mm port may help reduce the risk of retroperitoneal major vascular injury; however, larger comparative studies are required to confirm efficacy.

PMID:41334494 | PMC:PMC12668369 | DOI:10.4293/JSLS.2025.00095