Tag: pubmed

Radiol Med. 2025 Nov 3. doi: 10.1007/s11547-025-02142-4. Online ahead of print.

ABSTRACT

PURPOSE: Serous cystadenomas (SCAs), solid pseudopapillary neoplasms (SPNs), neuroendocrine neoplasms (NENs), and mucinous cystic neoplasms (MCNs) are pancreatic tumors that frequently develop calcifications. Identifying the presence and pattern of calcifications on unenhanced CT scans can significantly aid radiologists in differential diagnosis.

METHODS: Patients were included if they had a confirmed diagnosis through pathology or endoscopic ultrasound and MRI follow-up for at least one year. Exclusion criteria were the absence of CT imaging and multiple pancreatic lesions. Two radiologists independently reviewed unenhanced CT scans to assess lesion location, size, presence of calcifications, and calcification patterns, categorized as Type 1 (punctate), Type 2 (curvilinear/elongated), and Type 3 (coarse). Statistical analysis was performed using Fisher’s test for categorical variables, Kruskal-Wallis and Mann-Whitney tests for numerical variables, and logistic regression models to assess the impact of calcification patterns on diagnosis. Sensitivity, specificity, accuracy, and AUC-ROC were calculated for predictive models.

RESULTS: 311 patients (mean age 61 ± 14 years; 56.9% female) were included. Calcifications were present in 27.7% of cases. Calcified NENs and SPNs were more frequently in the body/tail (p = 0.003), and calcified NENs were larger than non-calcified ones (p < 0.001). Punctate calcifications were most common in NENs, while coarse calcifications predominated in SCAs, decreasing the likelihood of a NEN diagnosis and increasing the probability of SCA. The AUC-ROC values were 0.891 for NENs and 0.986 for SCAs.

CONCLUSIONS: Approximately 30% of pancreatic tumors exhibit calcifications. Punctate intratumoral calcifications are more indicative of NENs, whereas coarse calcifications strongly suggest SCAs, influencing the differential diagnosis.

PMID:41184716 | DOI:10.1007/s11547-025-02142-4

Geroscience. 2025 Nov 4. doi: 10.1007/s11357-025-01957-3. Online ahead of print.

ABSTRACT

Nearly half of patients with dementia have comorbid hypertension. However, evidence on the clinical outcomes of antihypertensive medications (AHMs) in these patients remains inconsistent. This review synthesises evidence on cognitive, functional and behavioural outcomes, cardiovascular events, hospitalisation, mortality and adverse drug events related to the use of AHMs in patients with dementia. The review was registered with PROSPERO (CRD42024619054) and is reported following the PRISMA guidelines. We searched MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL and Google Scholar. Random-effects meta-analyses were conducted. We included 36 studies (10 randomised controlled trials (RCTs) and 26 observational follow-up studies) involving 276,793 patients. Meta-analysis showed a small but statistically significant cognitive benefit with AHM use versus non-use in observational studies (standardised mean difference (SMD) 0.23; 95% CI 0.20 to 0.27; p < 0.001), but not in RCTs (SMD – 0.01; 95% CI – 0.16 to 0.14; p = 0.92). Associations with functional outcomes (SMD 0.45; 95% CI – 0.52 to 1.42; p = 0.36), behavioural outcomes (SMD – 0.11; 95% CI – 0.79 to 0.57; p = 0.75) and mortality (hazard ratio 1.32; 95% CI 0.41 to 4.27; p = 0.64) were not significant. Regimens containing renin-angiotensin system blockers (RASBs) showed less cognitive decline compared to other AHMs. Data on the cardiovascular outcomes of AHM use were limited. In summary, AHM use was associated with slower cognitive decline in observational studies (not in RCTs), but no significant relationships with functional, behavioural, or mortality outcomes. The slowed cognitive decline was most pronounced with RASBs. More research, especially RCTs, examining the clinical benefits of AHM use in people with dementia is required.

PMID:41184695 | DOI:10.1007/s11357-025-01957-3

Surg Endosc. 2025 Nov 3. doi: 10.1007/s00464-025-12321-z. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic surgery demands specialized training to ensure proficiency and patient safety. Deliberate practice using Virtual Reality (VR) robotic simulation platforms provides a safe method for skill acquisition. The first part of our Initial curriculum (IC) consisted of 33 VR drills on the SimNow Simulator, which was refined in 2021 to 19 VR drills using a Simulation-Based Mastery Learning (SBML) approach. This study evaluates the feasibility and effectiveness of our refined curriculum (RC).

METHODS: A total of 87 general surgery residents were included. IC was completed by 41 residents, while 46 residents completed the RC. Metrics such as console time, pre- and post-test VR drill scores, and inanimate drill performance were assessed. Statistical analyses included independent or paired t-tests and Mann-Whitney U, or Wilcoxon Signed Rank tests for non-parametric data.

RESULTS: In the IC, 83% of participants achieved mastery versus 100% in the RC. Mean console training time was significantly reduced from 7 h 6 m (95% CI: 6.20-7.92) in the IC to 5 h 42 m (95% CI: 4.74-6.10) in the RC (p = 0.005), demonstrating enhanced efficiency. For VR drills, the IC median score improved from 62 (126-28) to 353 (366-317) (p < 0.001), with a median time reduction of 847 s (1169-565) (p < 0.001). In the RC, the median test score improved from 65.5 (138.75-37.75) to 344.5 (365.5-291.25) (p < 0.001), with a median time reduction of 999 s (1449.5-548.25) (p < 0.001). Inanimate drill times also improved: the IC median time decreased from 928.5 s (1066-853.5) to 741.5 s (859-613.5) (p < 0.001), while the RC median time decreased from 909.5 s (1037.7-744.7) to 464.5 s (518-413.7) (p < 0.001).

CONCLUSION: Reducing VR drills from 33 to 19 content-aligned drills with new proficiency benchmarks maintained effectiveness while significantly decreasing VR console training time. These findings support the feasibility of implementing this streamlined robotic training curriculum in general surgery residency programs without compromising skill acquisition.

PMID:41184674 | DOI:10.1007/s00464-025-12321-z

Intern Emerg Med. 2025 Nov 3. doi: 10.1007/s11739-025-04168-y. Online ahead of print.

ABSTRACT

Clostridioides difficile infection (CDI) poses a significant healthcare burden. Patients with diabetes mellitus (DM) are at increased risk of poor outcomes. This study aims to compare CDI outcomes, including mortality, in patients with and without DM. Retrospective data between (2014-2024) from Clalit Health Services (CHS) electronic database were analyzed. Among 2319 patients with confirmed CDI, 1005 had DM, and 1314 did not. DM patients were significantly older (74.5 ± 12.0 vs. 68.6 ± 20.4 years; p < 0.001), more likely to be male (p = 0.029), and disproportionately represented in lower socioeconomic status (SES) groups (30.1% vs. 22.4%; p < 0.001). Additionally, patients with DM had a significantly higher prevalence of comorbidities, with a median Charlson comorbidity Index (CCI) of 7.5 compared to 4.9 (p < 0.001), along with higher serum creatinine levels and lower albumin levels (p < 0.001). All-cause mortality was significantly higher in the DM group (p < 0.001). Deceased patients were notably older (p < 0.001), more likely male, and had lower SES (27% vs. 25.1%, p = 0.028). Patients with DM and CDI exhibited different comorbidities compared to those without diabetes. DM, advanced age, low SES, and male gender are linked to poorer outcomes, including mortality, among patients with CDI. These findings underscore the need for intensive management in patients with diabetes and CDI.

PMID:41184669 | DOI:10.1007/s11739-025-04168-y

J Biomech. 2025 Oct 28;194:113035. doi: 10.1016/j.jbiomech.2025.113035. Online ahead of print.

ABSTRACT

Graft restenosis remains a significant challenge in coronary artery bypass grafting (CABG). Traditional function assessments, primarily relying on blood flow rate, often fail to capture the geometric and hemodynamic influences on graft patency. To address these limitations, this retrospective study aimed to establish a comprehensive risk prediction model that incorporates both flow dynamics and geometric features, facilitating clinically applicable evaluations. A total of 110 patient-specific CABG geometries were reconstructed from coronary computed tomography angiography (CCTA) images to extract key geometric parameters for subsequent statistical analysis. An additional 28 cases were analyzed for statistical and hemodynamic validation. Three logistic regression models were built and validated for restenosis risk prediction. Computational fluid dynamics (CFD) simulations were performed to investigate the hemodynamic characteristics of high-risk grafts. A MATLAB-based software tool was also developed to automate the analysis workflow. Among the three prediction models, the one combining graft flow and geometric factors balanced sensitivity and specificity, and performed best in the validation cohort (area under curve = 0.758, sensitivity = 89.1 %). CFD simulations on the validation cohort confirmed that grafts with high predicted risk exhibited poor hemodynamic conditions, including low time-averaged wall shear stress, high oscillatory shear index, and high relative residence time. Further statistical analysis revealed complex context-dependent interactions between graft flow and geometry. This study presents an integrated approach to restenosis risk prediction by combining patient-specific flow and geometric features. These findings are expected to enhance clinical decision-making and support more individualized postoperative management strategies in CABG.

PMID:41183428 | DOI:10.1016/j.jbiomech.2025.113035

Auris Nasus Larynx. 2025 Nov 2;52(6):769-775. doi: 10.1016/j.anl.2025.10.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surgery (VANS).

METHODS: Single-center retrospective review of 31 consecutive thyroid lobectomies: 16 VANS (Nov 2020-Feb 2025) and 15 TART (Mar 2022-Feb 2025). TART used da Vinci Surgical system (da Vinci) Xi for early cases and predominantly da Vinci SP thereafter. Indications included differentiated cancer ≤4 cm, cN0, unilateral disease without extrathyroidal invasion, or follicular tumors 3-5 cm. Operative time, blood loss, hospital stay, complications, and cosmetic outcomes were evaluated and compared with statistical analysis.

RESULTS: All procedures were completed without conversion to open surgery. Blood loss (16.5 g vs 25.8 g) and length of stay (6.3 vs 6.1 days) were comparable. Complications included two transient recurrent laryngeal nerve palsies after VANS and, after TART, one axillary bleed controlled under local anesthesia and one lymphatic leak; overall rates were similar. High cosmetic satisfaction was reported in both cohorts.

CONCLUSION: Early experience shows TART is feasible and safe in Japan, achieving perioperative outcomes comparable to VANS with excellent cosmetic results.

PMID:41183426 | DOI:10.1016/j.anl.2025.10.006

Diagn Microbiol Infect Dis. 2025 Oct 22;114(2):117165. doi: 10.1016/j.diagmicrobio.2025.117165. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the comparative diagnostic efficacy of metagenomic next-generation sequencing (mNGS) versus conventional microbiological culture in spinal infections.

METHODS: A retrospective analysis was conducted in a cohort of 80 patients with suspected spinal infections who underwent concurrent testing via metagenomic next-generation sequencing (mNGS), microbial culture, and histopathological examination. Diagnostic performance of mNGS and microbial culture was compared using a composite clinical reference standard (definitive diagnosis integrating histopathology, clinical history, and laboratory findings) as the diagnostic gold standard.

RESULTS: Pathogens were detected in 64 cases (80 %) by mNGS, compared to 34 cases (42.5 %) via conventional microbial culture, demonstrating a statistically significant difference in detection rates (P < 0.001). Using clinical diagnosis (histopathology combined with medical history and laboratory findings) as the gold standard, mNGS exhibited superior sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) in tissue specimens. Conversely, microbial culture showed higher specificity. In pus specimens, mNGS maintained advantages in sensitivity, accuracy, and PPV, while culture demonstrated higher specificity and NPV.

CONCLUSION: Compared to conventional microbial culture, mNGS demonstrates superior diagnostic performance in spinal infections, with significantly higher pathogen detection rates and enhanced sensitivity, accuracy PPV and NPV. mNGS exhibits significant advantages over culture in identifying both common pathogens and fastidious organisms, while also demonstrating robust fungal detection capabilities. Additionally, in tissue specimens, mNGS demonstrates relatively pronounced advantages compared to conventional microbial culture. For purulent specimen testing, comprehensive sensitivity and specificity in diagnosis can be achieved through a combined strategy of mNGS and microbial culture.

PMID:41183417 | DOI:10.1016/j.diagmicrobio.2025.117165

Injury. 2025 Oct 29;56(12):112850. doi: 10.1016/j.injury.2025.112850. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacral fractures are an increasingly recognized clinical entity, particularly among older adults with osteoporosis. However, national-level data on long-term trends in incidence, diagnostic imaging, treatment strategies, and the recognition of underlying bone fragility remain limited. This study aimed to evaluate nationwide trends in sacral fracture care in Germany over a 19-year period.

METHODS: We conducted a retrospective analysis of all inpatient cases with a primary diagnosis of sacral fracture (ICD-10-GM: S32.1) recorded in the German Federal Statistical Office database from 2005 to 2023. Fragility fractures were defined as cases in patients aged ≥65 years. Outcomes included use of CT and MRI (OPS codes), surgical versus conservative treatment, and coded diagnoses of osteoporosis (ICD-10: M80-M82). Time trends were analyzed using linear regression; group comparisons were conducted with t-tests and chi-square tests (p < 0.05).

RESULTS: A total of 162,116 sacral fractures were identified. Annual cases increased from 1,861 in 2005 to 7,695 in 2023. Fragility fractures in women aged ≥65 years rose significantly, from 985 to 12,901 cases (p < 0.0001). CT use increased by 241% and MRI by 175%, with a significant shift toward CT as the preferred modality (p < 0.0001). Despite increased access to minimally invasive options, surgical treatment rates remained stable at approximately 20% (p = 0.15). Osteoporosis was documented in only 1.5% of cases.

CONCLUSIONS: The incidence of sacral fractures in Germany has risen markedly, driven by an aging population and under-recognized bone fragility. While cross-sectional imaging use has expanded, surgical treatment remains underutilized, and osteoporosis continues to be grossly underdiagnosed. These findings underscore a systemic gap in secondary prevention and highlight the need for integrated, bone-focused trauma care models.

PMID:41183411 | DOI:10.1016/j.injury.2025.112850

J Glaucoma. 2025 Nov 1;34(11):888-894. doi: 10.1097/IJG.0000000000002617. Epub 2025 Aug 19.

ABSTRACT

PRCIS: Evaluation of aqueous humor outflow (AHO) pathways shows a segmental pattern with the nasal quadrant having the maximum and the temporal quadrant having the least AHO pathways in nonglaucomatous subjects.

AIM: To evaluate circumferential aqueous humor outflow (AHO) pathways in nonglaucomatous subjects using aqueous angiography (AA).

METHODS: A cross-sectional, observational, single-center study recruited 30 subjects with visually significant age-related cataract planned for phacoemulsification. AA was performed using indocyanine green (ICG) dye 0.1% just before phacoemulsification. Images were analyzed at 60 seconds from the injection of ICG dye for angiographic signal intensity in 4 quadrants and 8 sectors, circumferentially (360 degrees) along the limbus. Signal intensities were evaluated and compared between quadrants and sectors as the primary outcome measure. Signal intensities between males and females, right and left eyes were assessed as secondary outcome measures, using appropriate statistical tests.

RESULTS: The mean age of the patients was 61.53±5.5 years (range: 49-68 y) with 16 males and 14 females; 16 right eyes and 14 left eyes. Segmental AHO was noted in all patients. The median signal intensity was highest in the nasal quadrant [45.95(35.59-54.34)] followed by the inferior [31.56 (24.82-41.71)], superior [30.16 (28.2-37.43)], and temporal [26.66 (22.92-34.33)] quadrants, and their difference was statistically significant (P<0.0001). Median signal intensity among 8 sectors was highest in the nasosuperior sector [23.05 (17.14-29.20)] and least in the temporoinferior sector [12.98 (10.82-17.51)] (P<0.0001). No significant difference was observed in median signal intensities between males [132.83 (115.82-174.18)] and females [143.74 (122.43-166.00)] (P=0.771) and right eyes [143.74 (118.53-170.6)] and left eyes [133.51 (122.43-153.86)] (P=0.967). Anterior capsule rupture and vitreous staining were noted in one patient each.

CONCLUSION: Nonuniform, segmental AHO pathways were seen in nonglaucomatous subjects using AA. The nasal quadrant had the maximum AHO functional channels, followed by the inferior, superior, and least in the temporal quadrant. Within the sectors, the nasosuperior sector had the highest signal intensity.

PMID:41183392 | DOI:10.1097/IJG.0000000000002617

JMIR Public Health Surveill. 2025 Nov 3;11:e78068. doi: 10.2196/78068.

ABSTRACT

BACKGROUND: The triglyceride-glucose (TyG) index and blood pressure (BP) status are key indicators associated with coronary heart disease (CHD). However, limited research has focused on individuals with disabilities.

OBJECTIVE: This study explores the potential combined effects of the TyG index and BP status on CHD risk in groups with varying disability characteristics.

METHODS: This study analyzed data from the Shanghai Disability Health Survey, conducted between January 2012 and December 2022. Participants were then categorized into 3 BP status groups: nonelevated BP, elevated BP, and hypertension. Cox proportional hazards regression models were used to assess the associations between BP status, the TyG index, and CHD incidence. Additionally, the mediating, interaction, and combined effects of these factors on CHD risk were examined. A stratified analysis was performed based on participants’ disability characteristics, including disability type and severity, to explore potential variations in the associations.

RESULTS: Among the 21,628 participants, the mean age was 53.30 (SD 10.57) years, and 50.89% (11007/21628) were male. In a follow-up of 77.45 months, CHD events occurred in 2312 participants (10.69%). The TyG index and BP status were independently associated with an increased risk of CHD. Mediation analysis showed that TyG explained 20.5% (95% CI 13.6%-22.0%) of the BP and CHD association. Significant multiplicative interactions were identified (hazard ratio [HR] 1.41, 95% CI 1.02-1.94), and joint analysis indicated the highest CHD risk in those with both hypertension and elevated TyG (HR 1.92, 95% CI 1.52-2.42). Stratified analyses revealed stronger mediation in participants with physical disabilities (22.6%, 95% CI 9.0%-60%) or visual disabilities (16.6%, 95% CI 4.8%-51%), while this was not significant in those with hearing or speech (P=.07) or intellectual or mental disabilities (P=.13). By disability grading, the mediated proportion was 22.3% (95% CI 9.2%-59.4%) in mild or moderate and 18.8% (95% CI 15.7%-29%) in severe or very severe groups. Joint associations showed consistently higher CHD risk across most disability classifications, with particularly elevated risk in people with intellectual or mental disabilities (HR 3.51, 95% CI 1.89-6.50).

CONCLUSIONS: BP and the TyG index were significantly associated with CHD risk in individuals with disabilities, with TyG mediating a part of this association and showing stronger effects in physical and mild to moderate disabilities. Significant interactions between BP and TyG further highlight their combined impact, underscoring the need for integrated interventions targeting both factors.

PMID:41183379 | DOI:10.2196/78068