Tag: pubmed

Crit Care. 2025 Jun 13;29(1):237. doi: 10.1186/s13054-025-05384-w.

ABSTRACT

BACKGROUND: The duration of episodes of intracranial hypertension is related to poor outcome, hence the need for prompt diagnosis. Numerous issues can lead to delays in the implementation of invasive intracranial pressure (ICP) monitoring, thereby increasing the dose of intracranial hypertension to which the patient is exposed. The aim of this prospective, observational, multicenter study was to assess the magnitude of this delay, evaluating the time required for initiation of invasive ICP monitoring, from indication (T1) to initiation of the maneuver (T2) when performed by neurosurgeons compared to intensive care physicians.

METHODS: We evaluated the impact of the operator performing the maneuver (neurosurgeon vs. intensivist) on the T2-T1 time interval, where T1 represents the time at which indication for invasive ICP monitoring is declared, and T2 the time at which the maneuver starts, defined as the skin incision. The effect of the operator performing the maneuver was evaluated through a parametric survival model. Both intraparenchymal catheters (IPCs) and external ventricular drains (EVDs) were considered as invasive ICP monitoring devices. Invasive monitoring could be performed in intensive care unit (ICU) or in operating room (OR).

RESULTS: A total of 112 patients were included into the final analysis; 39 IPCs were placed by intensivists within the ICU, and a total of 73 IPCs and EVDs by neurosurgeons both within the ICU and OR settings. The mean difference in T2-T1 time for IPCs placement in the ICU was 69 min (CI 50.1-94.8) in the intensivist group and 145 min (CI 103.4-202.9) in neurosurgeon group. The mean difference between these groups, 76 min, was found to be statistically significant (p-value = 0.0021). In the group treated by neurosurgeons, no statistically significant differences were found in timing between the ICU and the OR.

CONCLUSIONS: Invasive ICP monitoring performed with IPCs in ICU begins earlier when performed by intensivists rather than neurosurgeons. This finding suggests the possibility to obtain a prompt diagnosis of intracranial hypertension when intensivists intervein directly at patient’s bedside. Further studies are needed to confirm these findings and investigate their effect on outcome.

PMID:40506776 | DOI:10.1186/s13054-025-05384-w

Int J Retina Vitreous. 2025 Jun 12;11(1):64. doi: 10.1186/s40942-025-00688-z.

ABSTRACT

BACKGROUND: Retinal vessel geometry characteristic have been studied as one of the signs of microvascular changes in diabetic retinopathy (DR) that necessitates early screening. This study aimed to investigate the differences in retinal vessel tortuosity (VT) and fractal dimension (FD) between patients with and without DR.

METHODS: This retrospective study analyzed medical records and OCT-A images of DR and No-DR patients. DR severity was graded by a vitreoretinal specialist following the International Clinical Diabetic Retinopathy and Diabetic Macular Edema Severity Scales. Retinal VT and FD were quantified using ImageJ software. Comparison between groups using non-parametric and Generalized Estimating Equations (GEE) statistical analysis combined with cluster bootstrapping.

RESULTS: We analyzed 96 (161 eyes) with the mean age of 52.7 ± 9.9 years. Compared to No-DR, VT was significantly higher in all DR groups (p < 0.05). Mild non proliferative DR (β = +0.0621), Moderate NPDR (β = +0.0412), Severe NPDR (β = +0.0441), and proliferative DR (β = +0.0404). FD of the superficial capillary plexus (SCP) showed no significant difference among the groups and a significantly lower FD of the deep capillary plexus (DCP) compared to the No-DR groups (moderate NPDR (β = -0.0131), severe NPDR ( β = -0.0316) and PDR ( β = -0.0326)).

CONCLUSION: Compared to No-DR group, VT was found significantly higher in DR group, and FD of the DCP found significantly lower in the DR group. These parameters offer unique insights beyond simple vessel loss and complementary information into the geometric complexity and structural alterations of the retinal microvasculature in DR.

PMID:40506774 | DOI:10.1186/s40942-025-00688-z

Mil Med Res. 2025 Jun 13;12(1):30. doi: 10.1186/s40779-025-00613-3.

ABSTRACT

BACKGROUND: More efficacious, noninvasive screening methods are needed for advanced colorectal neoplasia. miR-92a is a reliable and reproducible biomarker for early colorectal cancer detection in stool samples. We compared the diagnostic efficacies of miR-92a, immunochemical fecal occult blood testing (FIT), and their combination (FIT + miR-92a) in a prospective multicenter screening trial.

METHODS: Overall, 16,240 participants aged 30-75 years were enrolled between April 1, 2021, and December 31, 2023. A total of 15,586 participants returned samples available for both FIT and miR-92a tests. All those with positive, and a random selection of those with negative screening tests were recommended to undergo colonoscopy. Follow-ups were performed until participants completed the colonoscopic examination. A total of 1401 screen-positive and 2079 randomly selected screen-negative individuals completed colonoscopies. Primary outcomes included sensitivity, number needed to screen (NNS), Youden index and receiver operating characteristic area under the curve (AUC) for advanced adenomas and colorectal cancer [advanced neoplasia (AN)] for each screening modality in the diagnostic performance analysis.

RESULTS: Colonoscopy was performed in 3480 individuals. The colonoscopy compliance rate was 47.8% for screen-positive individuals. The sensitivity of miR-92a versus FIT for AN was 70.9% versus 54.3% (P < 0.001), NNS was 24.7 versus 32.2 (P = 0.001), Youden index was 47.9% versus 35.0% (P < 0.001), AUC was 0.74 versus 0.67 (P = 0.010). FIT + miR-92a had a sensitivity of 85.4%, an NNS of 20.5, a Youden index of 47.9% and an AUC of 0.74 for AN.

CONCLUSIONS: For AN screening, miR-92a demonstrated better sensitivity, NNS, Youden index and AUC as compared with FIT. Compared with FIT, using miR-92a appears to be more efficient for population-based screening programs. Screening sensitivity for AN can be further enhanced if conditionally used in combination with FIT.

TRIAL REGISTRATION: Chinese Clinical Trial Registration Number: ChiCTR2200065415.

PMID:40506768 | DOI:10.1186/s40779-025-00613-3

J Health Popul Nutr. 2025 Jun 12;44(1):194. doi: 10.1186/s41043-025-00969-1.

ABSTRACT

OBJECTIVE: This study aims to evaluate the effects of vitamin D supplementation on glycemic control, insulin sensitivity, and pregnancy outcomes in patients with gestational diabetes mellitus (GDM) undergoing dietary therapy.

METHODS: This is a retrospective cohort study that included 98 patients diagnosed with GDM according to the IADPSG criteria. Patients were divided into two groups based on vitamin D supplementation: the Vitamin D group (n = 49) and the Control group (n = 49). The Vitamin D group received 400 IU of vitamin D daily until delivery. All patients followed a standardized dietary management plan. The primary outcome was the time to achieve glycemic control. Secondary outcomes included changes in HbA1c, HOMA-IR, LDL-C, hs-CRP, MDA, and pregnancy and neonatal outcomes. Propensity score matching (PSM) was used to adjust for baseline differences, and statistical analyses were performed using SPSS version 28.0.

RESULTS: A total of 98 patients (49 per group) were included after propensity score matching (PSM), with similar baseline characteristics between groups (all P > 0.05), except for higher gestational edema scores in the control group (P = 0.001). The Vitamin D group achieved glycemic control faster than the control group (adjusted HR = 2.30, 95% CI 1.50-3.52, P < 0.001) and required less insulin (β = -0.11 U/kg/day, 95% CI -0.14 to -0.08, P < 0.001). Significant improvements were observed in key metabolic and inflammatory markers, including HbA1c, fasting blood glucose, 2-hour postprandial glucose, HOMA-IR, LDL-C, hs-CRP, MDA, BMI, and gestational edema score (all P < 0.001), with no change in mid-upper arm circumference. The Vitamin D group also had significantly lower risks of pregnancy complications, adverse outcomes, and neonatal issues (P < 0.05), including reduced rates of pregnancy-induced hypertension, fetal distress, and postpartum hemorrhage.

CONCLUSION: Vitamin D supplementation significantly improves glycemic control, enhances insulin sensitivity, and positively impacts pregnancy outcomes in patients with gestational diabetes. Vitamin D supplementation should be considered in the management of GDM.

PMID:40506758 | DOI:10.1186/s41043-025-00969-1

J Cardiothorac Surg. 2025 Jun 12;20(1):261. doi: 10.1186/s13019-025-03482-y.

ABSTRACT

BACKGROUND: The study aimed to investigate the correlation of carotid plaque and peripheral carotid adipose tissue (PCAT) characteristics with coronary computed tomography-derived fractional flow reserve (CT-FFR) values.

METHODS: Data of 136 patients who underwent head and neck computed tomography angiography (CTA) followed by coronary CTA were retrospectively reviewed. Based on their CT-FFR values, they were divided into CT-FFR ≤ 0.8 and CT-FFR > 0.8 groups. The patients’ baseline data, carotid plaque and PCAT characteristics were collected. Univariate analysis and multivariate logistic regression were employed to identify differences between groups.

RESULTS: Univariate analysis indicated a statistical differences in carotid plaque thickness, plaque area, plaque load, the carotid plaque Crouse score, minimum plaque density, and net enhancement value of PCAT of patients (P < 0.05). Based on this, multivariate logistic regression analysis demonstrated that carotid plaque thickness (odds ratio (OR) = 0.553; 95% confidence interval (CI) = 0.360-0.847), the carotid plaque Crouse score (OR = 0.653; 95% CI = 0.514-0.830), and net enhancement value of PCAT (OR = 0.820; 95% CI = 0.730-0.919) were independent predictors of the diagnosis of CT-FFR ≤ 0.8. Furthermore, receiver operating characteristic curve analysis showed that the area under the curve of plaque thickness, the carotid plaque Crouse score, and net enhancement value of PCAT for the diagnosis of CT-FFR ≤ 0.8 were 0.816, 0.843, and 0.836, respectively.

CONCLUSION: Carotid plaque thickness, the carotid plaque Crouse score, and net enhancement value of PCAT are independent related indicators of CT-FFR ≤ 0.8, which can be simultaneously clarified by head and neck CTA alone, as well as the severity of coronary atherosclerosis.

PMID:40506756 | DOI:10.1186/s13019-025-03482-y

Aust Vet J. 2025 Jun 12. doi: 10.1111/avj.13456. Online ahead of print.

ABSTRACT

OBJECTIVE: To quantify the intensity of sound associated with breathing in brachycephalic dogs and determine detectability on a mobile phone application (app). In addition, analyse differences in sound volume before and after sedation, and 2 weeks post-surgical treatment of brachycephalic obstructive airway syndrome (BOAS).

STUDY DESIGN: Clinical prospective pilot study.

ANIMALS: 28 brachycephalic dogs.

METHODS: A mobile phone app was used to measure and record the sound of breathing in decibels (dB) in a quiet room before and after sedation, as well as 10-14 days following corrective surgery. Statistical analysis was performed to determine if there was an improvement in breathing volume between each time point.

RESULTS: Prior to sedation, the mean sound intensity was 30.8 dB. After sedation of 5 minutes, it decreased significantly to 25.8 dB (p = 0.0013). At the post-operative consultation (10-14 days later), the mean intensity had further declined to 22.9 dB, significantly lower than both pre-sedation and post-sedation values (P < 0.001).

CONCLUSION: The intensity of a brachycephalic patient’s breathing is detectable by a mobile phone app and significantly reduces following surgical treatment involving palatoplasty, sacculectomy and alarplasty.

CLINICAL SIGNIFICANCE: With further research, the loudness of breathing may prove to be a useful, readily available, objective measurement tool to add to the current BOAS grading systems, allowing communication between veterinarians regarding the severity of BOAS. Future prospective studies may also involve the correlation of measurements with the risk of complications.

PMID:40506753 | DOI:10.1111/avj.13456

Addict Sci Clin Pract. 2025 Jun 12;20(1):49. doi: 10.1186/s13722-025-00578-7.

ABSTRACT

BACKGROUND: Substance use disorder (SUD) is a growing public health concern in Sweden. Various treatments for SUD exist, with motivational treatment, cognitive behavioral therapy, and relapse prevention being the nationally recommended approaches. Attachment theory and the salutogenic theory with its core concept, sense of coherence (SOC) provides valuable insights into individuals’ available personal resources and their potential for adherence to treatment. The aims of the present study were to examine attachment styles (secure, insecure-avoidant, and insecure-anxious) and SOC (overall and dimensional – comprehensibility, manageability, and meaningfulness- scores) in individuals with SUD; to explore potential correlations between these constructs ; and to assess their predictive value for treatment completion.

METHODS: Clinical data were collected between 2014 and 2023 from 164 clients at a Swedish outpatient clinic for addiction who initiated the intensive, integrated treatment program. The sample comprised 109 men and 55 women, aged 18 to 72 years (M = 40.71). Data were gathered using validated self-report instruments (the Attachment Style Questionnaire and the Sense of Coherence Questionnaire). Statistical analyses included descriptive statistics, correlation analysis, and logistic regression.

RESULTS: Individuals with SUD predominantly exhibited an insecure-avoidant attachment style. The four dimensions reflecting insecure attachment (discomfort with relationships, relationships as secondary, need for approval, and preoccupation with relationships) were negatively correlated with overall SOC and its three components. In contrast the secure attachment dimension (confidence in self and others) showed positive association with SOC. The strongest associations were found between the manageability component of SOC and all attachment dimensions. The insecure-anxious attachment style showed the strongest association with early dropout from treatment, while higher manageability was significantly associated with an increased likelihood of treatment completion.

CONCLUSION: The predominance of an insecure-avoidant attachment style among clients undergoing intensive, integrated treatment for SUD underscores the importance of reinforcing a secure attachment and strengthening SOC to facilitate treatment completion. These findings highlight the need for comprehensive, integrated social and psychiatric care for individuals with SUD.

PMID:40506751 | DOI:10.1186/s13722-025-00578-7

J Med Case Rep. 2025 Jun 12;19(1):272. doi: 10.1186/s13256-025-05343-7.

ABSTRACT

BACKGROUND: Renal tubular acidosis is a rare disorder affecting acid-base balance, and its coexistence with endocrine abnormalities such as hyperparathyroidism and pheochromocytoma is exceptionally uncommon. This combination presents unique diagnostic and therapeutic challenges requiring a multidisciplinary approach.

CASE PRESENTATION: A 25-year-old Iranian woman presented with recurrent flank pain, episodic palpitations, headaches, and intermittent hypertension. Imaging revealed bilateral nephrolithiasis, leading to ureteroscopic lithotripsy. Biochemical evaluation confirmed distal renal tubular acidosis (type 1), hyperparathyroidism, and pheochromocytoma, a rare and complex association. Metabolic acidosis, hypokalemia, and elevated catecholamine metabolites were noted. Potassium citrate was prescribed for stone prevention, and the patient remains asymptomatic after a year of follow-up.

CONCLUSION: This case underscores the need for heightened clinical suspicion when nephrolithiasis is accompanied by systemic symptoms. The rare coexistence of renal tubular acidosis, hyperparathyroidism, and pheochromocytoma highlights the importance of early recognition and a multidisciplinary approach to prevent complications and optimize patient outcomes.

PMID:40506745 | DOI:10.1186/s13256-025-05343-7

Mov Ecol. 2025 Jun 12;13(1):41. doi: 10.1186/s40462-025-00567-0.

ABSTRACT

BACKGROUND: Animal movement is influenced by both the physical environment and social environment. The effects of both environments are not independent from each other and identifying whether the resulting movement trajectories are shaped by interactions between individuals or whether they are the result of their physical environment, is important for understanding animal movement decisions.

METHODS: Here, we assessed whether the commonly used methods for inferring interactions between moving individuals could discern the effects of environment and other moving individuals on the movement of the focal individual. We used three statistical methods: dynamic interaction index, and two methods based on step selection functions. We created five scenarios in which the animals’ movements were influenced either by their physical environment alone or by inter-individual interactions. The physical environment is constructed such that it leads to a correlation between the movement trajectories of two individuals.

RESULTS: We found that neglecting the effects of physical environmental features when analysing interactions between moving animals leads to biased inference, i.e. inter-individual interactions spuriously inferred as affecting the movement of the focal individual. We suggest that landscape data should always be included when analysing animal interactions from movement data. In the absence of landscape data, the inference of inter-individual interactions is improved by applying ‘Spatial+’, a recently introduced method that reduces the bias of unmeasured spatial factors.

CONCLUSIONS: This study contributes to improved inference of biotic and abiotic effects on individual movement obtained by telemetry data. Step selection functions are flexible tools that offer the possibility to include multiple factors of interest as well as combine it with Spatial+.

PMID:40506736 | DOI:10.1186/s40462-025-00567-0

Crit Care. 2025 Jun 12;29(1):239. doi: 10.1186/s13054-025-05469-6.

ABSTRACT

BACKGROUND: Invasive group A streptococcus (iGAS) infection incidence is rising. These infections have been studied as a whole but can be associated with critical illness in a population with a wide array of underlying conditions, sites of infection and clinical presentations. Using an unsupervised clustering approach, we aimed to identify specific clinical phenotypes regarding presentation, management and outcome.

METHODS: This was a retrospective multicentric study including all patients admitted to one of 9 ICUs of Paris University Hospitals for an iGAS infection between 01/03/2018 and 01/08/2023. iGAS infection was defined as GAS growth in any microbiological sample from a sterile site. Patients were grouped according to a clustering algorithm (k-prototypes) using a comprehensive set of clinical and biological variables available upon ICU admission. Clusters were described and clinical presentation, management and outcome were compared.

RESULTS: 148 patients were included. According to the Silhouette criterion, patients were grouped in 3 clusters, and 7 patients remained unclassified. Cluster 1 (n = 73) comprised a greater proportion of less severely-ill female patients with painful skin and soft tissue infections, a quarter of whom had taken non-steroidal anti-inflammatory drugs. Cluster 2 (n = 42) was characterized by a high rate of respiratory infections with frequent viral co-infections. Cluster 3 (n = 26) included mostly socially deprived patients with high rates of chronic alcohol consumption and psychiatric illness, with severe organ dysfunction related to otherwise pauci-symptomatic skin and soft tissue infections. There was no significant difference in time to source control across clusters (0 [0-0] vs 0 [0-0] vs 0 [0-1] days, p = 0.12). Patients included in cluster 2 less frequently received antitoxin antibiotics than patients from clusters 1 and 3 (79% vs 45% vs 69%, p < 0.001) and tended to more frequently require ECMO support (3% vs 12% vs 0%, p = 0.07), while those from cluster 1 were less likely to receive invasive mechanical ventilation (48% vs 74% vs 77%, p = 0.005). There was no difference in ICU-mortality between clusters (19% vs 29% vs 31%, p = 0.32).

CONCLUSIONS: Based on simple and readily available clinical admission characteristics of critically ill patients with iGAS, unsupervised clustering analysis identified three specific patient populations that differed regarding ICU management. Whether tailoring management would affect outcome warrants further research.

PMID:40506732 | DOI:10.1186/s13054-025-05469-6