Tag: pubmed

Int Braz J Urol. 2025 Mar-Apr;51(2):e20240490. doi: 10.1590/S1677-5538.IBJU.2024.0490.

ABSTRACT

PURPOSE: Radical cystectomy (RC) is the standard of care for patients with bladder cancer, and pelvic lymph node dissection (PLND) is a pivotal step that can be carried out either before or after RC. Evidence on the optimal timing for PLND remains limited.

MATERIALS AND METHODS: We searched PubMed, Embase, Cochrane Central, Scopus and Google Scholar for studies comparing PLND before versus after RC. Outcomes assessed were total operative time, PLND time, RC time, number of lymph nodes (LN) dissected, and estimated blood loss. Mean differences (MDs) and 95% confidence intervals (CIs) were computed using a random-effects model. Subgroup analysis was conducted for robot-assisted RC (RARC).

RESULTS: A total of 801 patients from six studies were included, of whom 360 (44.94%) underwent PLND before RC. There were no significant differences in total operative time (MD -17.49; 95% CI -41.65,6.67; p = 0.16; I2 = 94%), PLND time (MD -14.91; 95% CI -44.91,15.09; p = 0.33; I2 = 96%), LN yielded (MD -1.13; 95% CI -4.81,2.55; p = 0.55; I2 = 83%), and estimated blood loss (MD 0.17; 95% CI -51.33,51.68; p = 0.99; I2 = 81%). However, RC time was significantly reduced (MD -28.89; 95% CI -42.84,-14.93; p < 0.0001; I2 = 75%) when PLND was performed prior to RC. In RARC studies, PLND before RC decreased total operative time, RC time, and estimated blood loss.

CONCLUSIONS: The timing of lymphadenectomy was not associated with a significant reduction in total operative time, PLND time, LN yield, and estimated blood loss.

PMID:39913090 | DOI:10.1590/S1677-5538.IBJU.2024.0490

Cerebellum. 2025 Feb 6;24(2):43. doi: 10.1007/s12311-025-01792-4.

ABSTRACT

Cerebellar functional connectivity changes have been reported in Alzheimer’s disease (AD), but a comprehensive framework integrating these findings is lacking. This retrospective study investigates the cerebello-thalamo-cortical (CTC) circuit in AD, using functional gradient analysis to elucidate deficits and potential biomarkers. We analyzed data from 246 participants enrolled in the Alzheimer’s Disease Neuroimaging Initiative (ADNI-3; NCT02854033), including 58 with AD, 103 with mild cognitive impairment (MCI), and 85 cognitively normal (CN) controls, matched for age and sex. All individuals underwent comprehensive neuropsychological assessments (MMSE, MoCA, ADAS-Cog) and MRI scans. We extracted mean time series for 270 brain regions (an extended Power atlas) and computed pairwise functional connectivity, focusing on CTC circuitry. Thalamic and cerebellar connectivity gradients were derived using voxel-wise correlation matrices and the BrainSpace toolbox, defining thalamic and cerebellar masks from the Melbourne subcortical atlas and AAL atlas, respectively. ANCOVA with post hoc analyses, controlling for age and sex, was conducted to assess abnormal CTC connectivity across AD, MCI, and CN groups. LASSO regression identified edges within the CTC circuitry that significantly differed between AD and CN, MCI and CN, AD and MCI, as well as was used to construct Logistic classification model. Pearson correlations were performed to examine relationships between mean CTC connectivity, individual edges, and cognitive scores (MMSE, MoCA, ADAS-Cog). To explore the hierarchical organization of the thalamus and cerebellum, global gradient distributions were compared across groups using two-sample Kolmogorov-Smirnov tests. Additionally, ANCOVA was applied to compare subfield- and functional-level gradients of the thalamus and cerebellum among AD, MCI, and CN. False discovery rate (FDR) corrections were used, setting the statistical significance threshold was set at P < 0.05. AD and MCI individuals exhibited increased CTC connectivity compared to CN (all P < 0.05). Average CTC connectivity did not correlate with cognitive scores (P > 0.05), but specific CTC edges were correlated. LASSO regression identified 20 discriminative edges, achieving high accuracy in AD-CN classification (AUC = 0.92 training, AUC = 0.80 test). Thalamic and cerebellar gradient distributions differed significantly across groups (all P < 0.05), with specific regions showing distinct gradient scores. Five cerebellar functional networks exhibited decreased gradient scores. Significant CTC hyperconnectivity in AD and MCI compared with CN suggests early thalamic and cerebellar dysregulation. Classification analyses effectively distinguished AD vs. CN but were moderate for MCI vs. CN and limited for MCI vs. AD. Gradient analyses revealed global- and subfield-level disruptions in AD, emphasizing the role of thalamic and cerebellar interactions in cognitive decline and offering potential diagnostic markers and therapeutic targets.

PMID:39913059 | DOI:10.1007/s12311-025-01792-4

Eur J Health Econ. 2025 Feb 6. doi: 10.1007/s10198-025-01758-7. Online ahead of print.

ABSTRACT

BACKGROUND: Most of the studies investigate impact of affordability at national or regional levels with less attention being paid on changes in affordability and their impact on different socio-economic groups.

OBJECTIVES: The aim of this article is better understanding of variations in alcohol male mortality in different socio-economic groups by a careful examination of changes in disposable income and alcohol affordability in households of different education levels.

METHODS: Data (2004-2018) on disposable income per household member were taken from a survey – Statistics Poland. Mortality data were taken from the national death register of Statistics Poland based on death certificates. Linear regression models were used to establish relationship between income, affordability and mortality.

RESULTS: In the study period, disposable incomes increased substantially in the households with primary, vocational, and secondary education. In the households with university education, where incomes were much higher their pace of growth was much lower. Parallel, proportional alcohol male mortality increased substantially in three lower educational groups while remained almost stable among men with university education, in particular in the last ten years under the study. Clear, linear relationship was found within primary, vocational, and secondary education between proportional alcohol mortality and disposable income. Even, after inclusion into the model alcohol affordability, crucial role of changes in disposable income was confirmed as it explained much higher variation in mortality than affordability. No association was identified within households with university education.

CONCLUSIONS: The results of this study do not entirely confirm the relationship between alcohol affordability and mortality due to alcohol consumption in men as noted in the literature. Substantial and rapid increases in disposable income were shown as having much stronger impact. Policies which aim to reduce income disparities may produce negative unintended side-effects such as higher alcohol mortality among beneficiaries of these policies.

PMID:39913042 | DOI:10.1007/s10198-025-01758-7

Child Psychiatry Hum Dev. 2025 Jan 30. doi: 10.1007/s10578-025-01810-w. Online ahead of print.

ABSTRACT

Health-threatening underweight and poor growth is a frequent consequence of Avoidant restrictive food intake disorder (ARFID) and should be a priority for treatment in children and adolescents (young people, YP). Coexisting autism is more prevalent in YP with ARFID than in YP with other eating disorders. Treatment studies are still sparse for ARFID, and it is not known whether treatment response is lower in those with coexisting autism, as it is documented in other eating disorders. In this study we examined if family-based treatment for ARFID (FBT-ARFID) was associated with weight gain in underweight young people (YP) with ARFID and if coexisting autism affected weight gain. A clinical naturalistic prospective case series of 33 YP aged 6.3-18 years with ARFID presentations and underweight were offered a manualized FBT-ARFID with weight monitoring. We examined changes in body weight between start and end of treatment in those with and without diagnosed coexisting autism. The majority of participants (N = 26, 79%) had a weight gain between 1 and 15 kg, whereas 7 YP (21%) had a stable body weight between start and end of treatment (differences between – 0.6 kg and + 0.9 kg). At the group level, weight gain was statistically significant between start and end (Median = 3.9 kg (4.0, -0.6 -15.1) z = 4.491, p <.001). There was no significant difference in weight gain between participants with (N = 14, 42%) and without (N = 19, 58%) coexisting autism. Participants had a significant weight gain at the group level, suggesting that FBT-ARFID is associated with weight gain in the majority of underweight ARFID patients, both with and without coexisting autism. However, a subgroup may need additional interventions in order to secure weight rehabilitation.

PMID:39913038 | DOI:10.1007/s10578-025-01810-w

Geroscience. 2025 Feb 6. doi: 10.1007/s11357-025-01549-1. Online ahead of print.

ABSTRACT

Current European Stroke Organisation (ESO) guidelines recommend extended time window reperfusion therapies (4.5-9 h for thrombolysis, 6-24 h for thrombectomy) based on advanced imaging. However, the workload and clinical benefit of this strategy on a population basis are not known. To determine the caseload, treatment rates, and outcomes in the extended as compared to the standard time windows. All consecutive ischaemic stroke patients within 24 h of last known well between 1st March 2021 and 28th February 2022 were included in a prospective single-centre study. Treatment eligibility in the extended time windows or wake-up strokes recognized within 4 h was based on current ESO guideline criteria using MRI DWI-PWI or DWI-FLAIR mismatch. MRI was only available during working hours (8-20 h); otherwise, CT/CTA was used. Clinical outcome in treated patients was assessed at three months. Among the 777 admitted patients, 252 (32.4%) had MRI. The thrombolysis rate was 119/304 (39.1%) in standard and 14/231 (6.1%) in the extended time window. The thrombectomy rate was 34/386 (8.8%) in standard and 15/391 (3.8%) in the extended time window. Independent clinical outcomes (mRS ≤ 2) were not statistically different in early and late-treated patients both for thrombolysis (48% vs. 28.6%, p = 0.25) and thrombectomy (38.4% vs. 33.3%, p = 0.99). Even with a limited availability of advanced imaging extending therapeutic time windows resulted in an 11.7% increase in thrombolysis and a 44% increase in thrombectomy with comparable clinical outcomes in early and late-treated patients at the price of a twofold burden in clinical and advanced imaging screening.

PMID:39913034 | DOI:10.1007/s11357-025-01549-1

Aging Clin Exp Res. 2025 Feb 6;37(1):36. doi: 10.1007/s40520-025-02935-7.

ABSTRACT

BACKGROUND: Low physical activity is a major risk for sarcopenia. Whether training according to physical activity guidelines accompanied with cognitive training is effective on sarcopenia, remains unclear.

AIMS: We investigated whether the effects of 12-month physical and cognitive training (PTCT) and physical training (PT) on grip and knee extension strength, muscle mass, and walking speed differed between older adults with and without sarcopenia.

METHODS: Community-dwelling older adults (N = 314, mean age 74.5 ± 3.8 years, 60% women) who did not meet physical activity guidelines were randomized to PTCT and PT groups. PT for both groups included supervised and home-based multicomponent physical training. Cognitive training (CT) included computer-based exercises for executive functioning. Sarcopenia was determined according to the European Working Group on Sarcopenia in Older People 2019 criteria. Generalized estimation equation analysis were conducted.

RESULTS: Compared to PT, PTCT had no additive effect on strength, muscle mass, or walking speed in participants with or without sarcopenia. In pooled data (PT + PTCT) change in the grip strength was greater in sarcopenia (n = 49) group compared to non-sarcopenia (n = 264) group (interaction, p =.014). Both groups improved knee extension strength, and walking speed, but no statistically significant difference between the groups were observed. Muscle mass did not change in either group.

CONCLUSION: Physical training according to physical activity recommendations improves muscle strength, walking speed, and maintains muscle mass in sarcopenia. Additional cognitive training had no benefits on these outcomes.

TRIAL REGISTRATION NUMBER: ISRCTN52388040 and date of registration 20/1/2017.

PMID:39913030 | DOI:10.1007/s40520-025-02935-7

Curr Urol Rep. 2025 Feb 6;26(1):27. doi: 10.1007/s11934-025-01254-8.

ABSTRACT

PURPOSE OF REVIEW: This review evaluates the current landscape of same-day discharge (SDD) following robotic-assisted laparoscopic prostatectomy (RARP), highlighting perioperative management strategies and proposing future research directions.

RECENT FINDINGS: RARP has been shown to improve perioperative outcomes including reduced blood loss, postoperative pain, and hospital length of stay (LOS) when compared to open radical prostatectomy. Recently, the question of the feasibility of SDD for RARP has been proposed, aiming to reduce postoperative complications, hospital-acquired infections, and healthcare costs. The advent of single-port robotic systems aims to further minimize postoperative morbidity. Recent literature has reported SDD for RARP is safe and feasible in appropriately selected patients, with postoperative outcomes, including complication and readmission rates, similar to inpatient RARP. Our findings show SDD can be safely implemented without compromising patient outcomes, as evidenced by similar complication, readmission, and emergency department visit rates compared to inpatient cohorts. Future research should be aimed to refining patient selection criteria, enhancing opioid-free anesthesia pathways, and exploring new surgical technologies to improve SDD outcomes.

PMID:39913027 | DOI:10.1007/s11934-025-01254-8

Spine (Phila Pa 1976). 2025 Feb 6. doi: 10.1097/BRS.0000000000005284. Online ahead of print.

ABSTRACT

STUDY DESIGN: Cross-sectional study.

OBJECTIVE: The objective of this study was to quantify whether interapical distance and coronal balance measured on 3D ultrasound (3DUS) images differed among ten standing positions of participants with and without adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA: Apical vertebral translation (AVT) is an indicator of clinical symptoms and treatment outcomes in AIS. Stereo-radiography simultaneously captures a frontal and lateral image, yet patients are required to elevate their arms during the examination and varied positioning may impact coronal plane measurements. Ultrasound can assess these measurements without exposing participants to radiation.

METHODS: Females with and without AIS were recruited from a scoliosis clinic, and email advertisements, respectively. Participants underwent 3DUS scans in ten positions: standing; arms anteriorly supported in 60° of shoulder flexion; fingers to clavicles, chin, zygomatic processes, and eyebrows; shoulders abducted at 90° with hands open and thumbs on shoulders; hands on anterior wall with and without blocks; and hands unsupported. AVT and coronal balance measurements were obtained using custom software. Positions and groups were compared using repeated measures ANOVAs with Sidak pairwise comparisons.

RESULTS: Fifty-nine females had a mean age, height, and weight of 17.5±4.9 years, 162.8±5.8 cm, and 56.2±10.6 kg, respectively. Seventeen single and 14 double curve participants were included with mean maximum curve angles of 26.4°±3.6° and 25.2°±3.1°, respectively. Overall, there were no statistically significant differences in interapical distance or coronal balance among the ten positions, as well as in coronal balance between the groups (P>0.05). The interapical distance of participants without AIS significantly differed from those with single curves in eight positions and from those with double curves in all ten positions.

CONCLUSIONS: The positions evaluated may be interchangeable for coronal plane lateral deviation measurements of females with AIS.

PMID:39912326 | DOI:10.1097/BRS.0000000000005284

J Oral Rehabil. 2025 Feb 6. doi: 10.1111/joor.13948. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial Intelligence (AI) has been widely used in health research, but the effectiveness of large language models (LLMs) in providing accurate information on bruxism has not yet been evaluated.

OBJECTIVES: To assess the readability, accuracy and consistency of three LLMs in responding to frequently asked questions about bruxism.

METHODS: This cross-sectional observational study utilised the Google Trends tool to identify the 10 most frequent topics about bruxism. Thirty frequently asked questions were selected, which were submitted to ChatGPT-3.5, ChatGPT-4 and Gemini at two different times (T1 and T2). The readability was measured using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKG) metrics. The responses were evaluated for accuracy using a three-point scale, and consistency was verified by comparing responses between T1 and T2. Statistical analysis included ANOVA, chi-squared tests and Cohen’s kappa coefficient considering a p value of 0.5.

RESULTS: In terms of readability, there was no difference in FRE. The Gemini model showed lower FKG scores than the Generative Pretrained Transformer (GPT)-3.5 and GPT-4 models. The average accuracy of the responses was 68.33% for GPT-3.5, 65% for GPT-4 and 55% for Gemini, with no significant differences between the models (p = 0.290). Consistency was substantial for all models, with the highest being in GPT-3.5 (95%). The three LLMs demonstrated substantial agreement between T1 and T2.

CONCLUSION: Gemini’s responses were potentially more accessible to a broader patient population. LLMs demonstrated substantial consistency and moderate accuracy, indicating that these tools should not replace professional dental guidance.

PMID:39912320 | DOI:10.1111/joor.13948

Acta Ophthalmol. 2025 Feb 6. doi: 10.1111/aos.17459. Online ahead of print.

ABSTRACT

Pregnancy induces a variety of changes in the eye. Mapping these changes provides a pathophysiological basis for understanding pregnancy-associated ocular disorders. In this systematic review and meta-analysis, our aim was to determine how pregnancy affects subfoveal choroidal thickness and to explore temporal changes in subfoveal choroidal thickness during pregnancy and postpartum. On April 7, 2024, we searched eight literature databases for studies which used macular optical coherence tomography to evaluate subfoveal choroidal thickness in healthy pregnant women. We identified 26 studies summarizing data from 1935 healthy women, of which 1096 were pregnant and 839 non-pregnant. We found that pregnant women had a subfoveal choroidal thickness which was 31.1 μm (95% CI: 19.4-42.7 μm) thicker than non-pregnant women. No statistically significant changes were observed throughout trimesters. From the 3rd trimester to postpartum, we found a reduction in the subfoveal choroidal thickness at -41.9 μm (95% CI: -68.5 to -15.2 μm). In conclusion, in healthy women without ocular disease, pregnancy is associated with a thicker subfoveal choroid indicating a higher choroidal perfusion. Choroidal thickness remains stable across trimesters and is reduced postpartum, indicating a temporary physiological adaptation during pregnancy.

PMID:39912315 | DOI:10.1111/aos.17459