Tag: pubmed

JAMA Netw Open. 2025 Apr 1;8(4):e252861. doi: 10.1001/jamanetworkopen.2025.2861.

ABSTRACT

IMPORTANCE: The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS.

OBJECTIVE: To describe the epidemiology of pediatric iGAS over a 32-year period.

DESIGN, SETTING, AND PARTICIPANTS: This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including emm typing from Canada’s National Microbiology Laboratory and population data from Statistics Canada. All children (age <18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting emm types; and antimicrobial resistance.

RESULTS: Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100 000 population per year in 1992 to 2011 to 2.4 events per 100 000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100 000 population per year in 2020 and 0.5 events per 100 000 population per year in 2021 before increasing to 6.0 events per 100 000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (P < .001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common emm types were emm1 (182 of 471 isolates [38.6%]), emm12 (75 isolates [15.9%]), and emm4 (31 isolates [6.6%]). The M1UK subtype was first identified in 2019 and comprised 32 of 46 emm1 isolates (70.0%) from 2019 to 2023. Compared with other emm types, emm1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); emm4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of emm types included in the 30-valent GAS vaccine.

CONCLUSIONS AND RELEVANCE: This case series found that pediatric iGAS incidence increased in south-central Ontario prior to and after the COVID-19 pandemic in association with increased iGAS infections of the respiratory tract. Respiratory viral coinfections were common. Different emm types were associated with differing presentations and severity.

PMID:40168022 | DOI:10.1001/jamanetworkopen.2025.2861

Environ Sci Technol. 2025 Apr 1. doi: 10.1021/acs.est.4c09065. Online ahead of print.

ABSTRACT

How to scientifically and efficiently quantify the impact and hazards of volatile organic compounds (VOCs) pollution and volatilization from complex groundwater systems on surface air environments is a critical environmental issue. This paper employed an integrated modeling approach, incorporating numerical simulations, statistical analyses, and machine learning to address this issue. We comprehensively accounted for the different driving mechanisms, along with the various migration and transformation processes of groundwater VOCs. This investigation identified 11 key factors influencing surface pollutant flux. The data-enhanced statistical surrogate models and sampling-fusion-based support vector machine (SVM) surrogate models were established for appropriate generic modeling applications in which the high computation burden and difficulty could be avoided of the complicated numerical modeling. Those models would enable accurate prediction of surface fluxes and reliable classification of environmental risks. Notably, the pollutant fluxes through the soil-air interface over a short period could be sufficient to cause slow-airflow space air concentrations to exceed acceptable levels. Particularly, the established generic statistical surrogate models and SVM surrogate models have significant implications in efficiently and rapidly assessing the VOCs surface fluxes and environmental risk with meaningful quantified uncertainties for specific site conditions.

PMID:40168018 | DOI:10.1021/acs.est.4c09065

Crit Care Nurse. 2025 Apr 1;45(2):50-59. doi: 10.4037/ccn2025404.

ABSTRACT

BACKGROUND: Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources.

LOCAL PROBLEM: An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention.

METHODS: A quality improvement initiative incorporating tele-intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used.

RESULTS: For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after implementation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02).

CONCLUSION: Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.

PMID:40168011 | DOI:10.4037/ccn2025404

Gigascience. 2025 Jan 6;14:giaf024. doi: 10.1093/gigascience/giaf024.

ABSTRACT

BACKGROUND: Electric eels evolved remarkable electric organs that enable them to instantaneously discharge hundreds of volts for predation, defense, and communication. However, the absence of a high-quality reference genome has extremely constrained the studies of electric eels in various aspects.

RESULTS: Using high-depth, multiplatform sequencing data, we successfully assembled the first telomere-to-telomere high-quality reference genome of Electrophorus electricus, which has a genome size of 833.43 Mb and comprises 26 chromosomes. Multiple evaluations, including N50 statistics (30.38 Mb), BUSCO scores (97.30%), and mapping ratio of short-insert sequencing data (99.91%), demonstrate the high contiguity and completeness of the electric eel genome assembly we obtained. Genome annotation predicted 396.63 Mb repetitive sequences and 20,992 protein-coding genes. Furthermore, evolutionary analyses indicate that Gymnotiformes, which the electric eel belongs to, has a closer relationship with Characiformes than Siluriformes and diverged from Characiformes 95.00 million years ago. Pairwise sequentially Markovian coalescent analysis found a sharply decreased trend of the population size of E. electricus over the past few hundred thousand years. Furthermore, many regulatory factors related to neurotransmitters and classical signaling pathways during embryonic development were significantly expanded, potentially contributing to the generation of high-voltage electricity.

CONCLUSIONS: This study not only provided the first high-quality telomere-to-telomere reference genome of E. electricus but also greatly enhanced our understanding of electric eels.

PMID:40167991 | DOI:10.1093/gigascience/giaf024

Drugs. 2025 Apr 1. doi: 10.1007/s40265-025-02171-3. Online ahead of print.

ABSTRACT

BACKGROUND: Neurogenic lower urinary tract dysfunction (NLUTD), a complex abnormality caused by multiple neurologic disorders, is a serious threat to patients’ prognosis and quality of life. However, benefit and safety for various treatments are inconsistent. The aim of the current study was to investigate the available trials of adult NLUTD treatments and provide valuable insights for clinical practice.

METHODS: The data sources were Medline, Embase, and Cochrane databases up to 31 December 2023. A Bayesian network meta-analysis was conducted with randomized controlled trials in patients who were diagnosed with NLUTD, reporting clinical symptoms and urodynamic data. The main outcomes were incontinence episodes frequency (IEF) and maximum cystometric capacity (MCC). Secondary outcomes included frequency, maximum detrusor pressure, bladder compliance, volume of involuntary detrusor contraction, voided volume, incontinence, quality of life, and adverse events.

RESULTS: A total of 54 articles were eligible, evaluating 28 treatments and 4478 patients for efficacy and safety. Compared with the control group, the oxybutynin instillation demonstrated a mean reduction in IEF of – 2.65 episodes (95% confidence interval [CI]: – 4.64 to – 0.67), with a surface under the cumulative ranking curve (SUCRA) value of 85.8%. Botulinum toxin trigone-combined injection resulted in a reduction of -2.30 episodes (95% CI: -3.23 to – 1.44; SUCRA 84.2%). Additionally, intravesical therapies significantly increased MCC: oxybutynin instillation (mean 227.75 mL, 95% CI 147.00 to 311.42, SUCRA 99.1%) and BTX300U (mean 147.88 mL, 95% CI 100.45-190.32, SUCRA 83.2%). Botulinum toxin injection emerged as the preferred option for improving most urodynamic outcomes and quality of life. However, the incidence of adverse events associated with intravesical injections was higher compared with oral medications and other noninvasive therapies. The three types of botulinum toxins (onabotulinum toxin, abobotulinum toxin, and incobotulinum toxin) demonstrated consistent efficacy in treating both IEF and MCC. Individual studies were sequentially excluded for analysis of network stability. Most results from the alternative networks were consistent with the original analysis, although specific trials influenced certain therapy rankings.

CONCLUSIONS: Overall, oxybutynin instillation and intravesical botulinum toxin injection demonstrated significant advantages in improving symptoms and urodynamic parameters. Our findings support intravesical treatment as a safe and effective option, provided that patients are fully informed about their treatment choices. Clinically, intravesical therapies, oral medications, nerve stimulation, and other treatments should be integrated into shared decision-making processes, while some options require further research to bolster the supporting evidence.

PMID:40167970 | DOI:10.1007/s40265-025-02171-3

Dig Dis Sci. 2025 Apr 1. doi: 10.1007/s10620-025-09022-x. Online ahead of print.

ABSTRACT

PURPOSE: The differences in the animal model construction of different subtypes of gastroesophageal reflux disease (GERD) have not been clearly demonstrated at present. We aim to reveal the characteristics and differences between them.

METHODS: The literature related to GERD animal model construction in the past decade was searched and data on animal strains, modeling modes, modeling cycles, and detection indices were extracted, and the results were presented by using descriptive statistical methods of frequency and relative frequency.

RESULTS: 88 papers finally met the criteria. Sprague-Dawley (68.25%) rats were most often used to induce reflux esophagitis (RE), whereas Swiss mice (50.00%) and C57BL/6 mice (57.89%) for non-erosive reflux disease (NERD) and Barrett’s esophagus (BE), respectively. RE and NERD were most frequently constructed using fore-stomach-glandular transition ligation together with pyloric insufficiency (37.68%, 50.00%), yet their median modeling cycles were 14 and 7 days, respectively. BE was most frequently constructed using L2-IL-1β transgenic mice (27.27%), and the median modeling cycle over 270 days. Determining esophageal mucosal permeability was common in NERD, while finding intestinal chemotaxis markers, squamous epithelium, and columnar epithelium was common in BE. In animal models of RE, researchers tended to look for markers associated with the inflammatory response and oxidative stress.

CONCLUSIONS: The induction methods vary among the animal models of GERD’s three subtypes. Inflammatory stimulation is crucial for inducing RE and BE, differing in modeling cycle. In contrast, Visceral hypersensitivity draws more attention in NERD animal models, reflecting researchers’ thoughts on distinct pathogenesis.

PMID:40167947 | DOI:10.1007/s10620-025-09022-x

Discov Ment Health. 2025 Apr 1;5(1):45. doi: 10.1007/s44192-025-00175-9.

ABSTRACT

OBJECTIVE: This study examined the prevalence and severity of burnout and depression in first-year medical students at different points in the academic year.

METHODS: U.S. first-year allopathic medical students with a pass/fail preclinical curriculum were emailed through the school’s email list with four rounds of surveys consisting of the full set of questions from the Copenhagen Burnout Inventory and the Patient Health Questionnaire-9, with the question order randomized. The surveys were sent before winter break, during block final exams, the subsequent block’s midpoint, and after the subsequent block’s midterm examinations.

RESULTS: A total of 147 students completed the questionnaire (29.4%; n = 147/500). Most participants (73.5%) reported experiencing symptoms of work-related burnout, and 44.2% reported symptoms of depression. Client-related burnout and PHQ-9 scores were strongly correlated (Spearman r = 0.645, p < 0.001). Work-related burnout was also strongly related to client-related burnout (r = 0.739, p < 0.001) and PHQ-9 scores (r = 0.786, p < 0.001). No statistically significant differences in depression or burnout were noted throughout all four survey rounds.

CONCLUSIONS: Burnout and depression severity in first-year medical students remain statistically similar throughout the academic year despite significant events such as exams or breaks. This may indicate that scheduling exams after breaks reduces any protective effect it may have on burnout/depression. It may also suggest that institutional changes such as a pass-fail preclinical curriculum meant to improve medical students’ mental health have not had the intended positive effect.

PMID:40167940 | DOI:10.1007/s44192-025-00175-9

Radiol Med. 2025 Apr 1. doi: 10.1007/s11547-025-01993-1. Online ahead of print.

ABSTRACT

BACKGROUND: Perineural invasion (PNI) is closely related to the prognosis of gastric cancer (GC) patients. However, a noninvasive tool for accurately and reliably predicting the PNI is lacking.

METHODS: The clinical and imaging data of 278 patients from institution I and 39 patients from institution II were retrospectively analyzed. Radiomic features were extracted from the intratumoral and peritumoral regions. Seven independent machine learning (ML) algorithms are used to develop the models. Kaplan-Meier survival analysis and Cox proportional hazards analysis were carried out to compare 3-year and 5-year overall survival (OS) differences among various subgroups based on PNI and radiomic scores.

RESULTS: T stage and lymphovascular invasion (LVI) were significantly correlated with the PNI (P < 0.01). The OS of patients with different PNI status was significantly different (P < 0.05). Gradient boosting tree is the best ML algorithm. The area-under-the-curve (AUC) values of the optimal radiomics model in the internal test set and external test set were 0.901 and 0.886, respectively. After the introduction of clinical variables T stage and LVI, the performance of the model further improved in predicting the PNI of GC patients, with the AUC of 0.904 in the internal test set and 0.886 in the external test set. The difference in 3-year OS (P = 0.005) and 5-year OS (P = 0.015) among patients with varying radiomic scores was statistically significant.

CONCLUSION: Radiomics combined with intratumoral and peritumoral features is feasible for evaluating the PNI of GC patients. The prognosis of patients with different radiomic scores was statistically significant.

PMID:40167935 | DOI:10.1007/s11547-025-01993-1

Radiol Med. 2025 Apr 1. doi: 10.1007/s11547-025-01986-0. Online ahead of print.

ABSTRACT

PURPOSE: To use simple CT measurements of musculoskeletal and cardiovascular systems to create a CT-based score to predict mortality in patients admitted to the Emergency Department (ED).

METHODS: The study received IRB approval. Non-contrast abdominal CT of > 18 year old patients admitted to the ER between January 2019 and January 2020 were evaluated by a team of twelve radiologists to calculate: (1) diameter of the infrarenal aorta in millimeter; (2) cross sectional area and composition (Hounsfield units) of the psoas muscle at the third lumbar vertebra (LV); (3) bone density, as quantified at the first lumbar vertebra (LV); (4) presence or absence of dilated abdominal aorta. Thirty-day all-cause mortality (ACM) was determined through hospital and electronic records.

RESULTS: N = 1920 unique patients were evaluated. The mean age was 65 ± 19 years and 46% were female. Death occurred in 7.9% of patients by 30 days from admission. The derivation dataset comprised 1462 patients. At multivariable analysis, age (OR 1.02, 95% CI: 1.007-1.04, p = 0.005), psoas cross sectional area (OR 0.99, 95% CI: 0.997-0.999, p < 0.001) and density (OR 0.96, 95% CI: 0.95-0.98, p < 0.001), and dilated infrarenal aorta (OR 1.85, 95% CI: 1-3.28, p = 0.04) were predictors of the outcome. We accordingly derived a 4-item risk score. In the derivation dataset, the score yielded moderate-high discrimination, with an AUC of 0.73 and excellent diagnostic agreement. In the validation dataset (N = 458), discrimination was high (AUC = 0.83).

CONCLUSION: Simple measurements gathered during a standard CT may allow determining the risk of mortality in the heterogeneous patient population admitted to the ED in a cost- and time-effective manner.

PMID:40167933 | DOI:10.1007/s11547-025-01986-0

Int Ophthalmol. 2025 Apr 1;45(1):136. doi: 10.1007/s10792-025-03514-5.

ABSTRACT

PURPOSE: Twitter has become increasingly popular within academia due to ease of use in disseminating accurate medical information, networking with colleagues, and promoting research. Given the rapidly increasing presence of ophthalmologists on social media platforms, we determined how Twitter patterns amongst authors, institutions, and journals affects the academic impact of ophthalmology research articles.

METHODS: Data from 1086 research articles in the top 7 ophthalmology journals as determined by SCimago Journal Rank (SJR) was recorded for 2021 issues. Article citations, article captures, and Twitter metrics were retrospectively recorded using the Scopus database and PlumX Metrics on Scopus.

RESULTS: The number of citations and captures original research articles received had a significant positive correlation with the total tweets and retweets in general as well as self-tweets by authors of the article (p < 0.0001). Furthermore, articles tweeted by at least one author had a 1.7 fold increase in citations (p = 0.0012). While there was no significant effect on citations when a senior author or middle author tweeted about the publication, we observed a significantly greater number of citations when a first author tweeted about the publication (p = 0.0329). Both the author’s affiliated institution and the journal tweeting about a publication were associated with more citations for that article (p < 0.0001 and p = 0.0025, respectively) and captures for that article (p < 0.0001 and p = 0.0025, respectively).

DISCUSSIONS: Twitter mentions of ophthalmology articles may reflect their future academic impact. Authors of recent ophthalmology publications, ophthalmology journals, academic institutions may benefit from promoting research articles on Twitter to increase visibility and citations.

PMID:40167899 | DOI:10.1007/s10792-025-03514-5