Tag: pubmed

Indian J Gastroenterol. 2025 Dec 29. doi: 10.1007/s12664-025-01888-z. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Risk stratification of patients with upper gastrointestinal bleeding (UGIB) is crucial for streamlining healthcare in resource-limited settings, thereby minimizing both morbidity and mortality. Our objective was to validate clinical outcomes of the pre-existing risk assessment scores as full Rockall score (FRS), Glasgow-Blatchford bleeding score (GBS), Progetto Nazionale Emorragia Digestiva (PNED) and AIMS65 (an acronym of albumin, International Normalized Ratio [INR], mental status, systolic blood pressure, age > 65 years) scores and a proposed acronymic A2BC score incorporating four variables as age, serum albumin, mean blood pressure and serum creatinine in our setting.

METHODS: Prospective study over a three-year period of patients presenting with UGIB at the Department of Medical Gastroenterology, Medical College, Kolkata.

RESULTS: The mean age of the 535 subject population was 52.84 ± 17.13 years, with male predominance (n = 284, 53.08%) and a majority being non-variceal bleeders (n = 336, 62.8%). The median (IQR) of FRS, GBS, PNED, AIMS65 and A2BC scores with composite risk defined as the presence of one or more of the following: need for blood transfusion during hospitalization, therapeutic intervention in non-malignant NVUGIB, rebleeding and death both within 42 days were 4 (3-6), 14 (12-16), 6 (2-10), 1 (0-2) and 1 (0-2) in comparison to those without the risk 2 (2-3), 10 (8-11), 3 (0-4), 0 (0-0) and 0 (0-0), respectively, all of which were statistically significant (p < 0.001). The discriminant cut-offs of FRS, GBS, PNED, AIMS65 and A2BC scores to predict composite risk of the subjects were ≥ 2, ≥ 7, ≥ 1, ≥ 1 and ≥ 1, respectively, with accuracies of 64.85%, 68.97%, 68.59%, 73.83%, and 77.57% respectively.

CONCLUSION: Our study validates the commonly used prognostic scores in our context and encourages further studies on the newly formulated A2BC score.

PMID:41460457 | DOI:10.1007/s12664-025-01888-z

Indian J Gastroenterol. 2025 Dec 29. doi: 10.1007/s12664-025-01821-4. Online ahead of print.

ABSTRACT

BACKGROUND: Phenotyping of gastroesophageal reflux disease (GERD) requires endoscopy, high-resolution esophageal manometry (HREM) and 24-hour pH testing.

METHODS: The present study was conducted to determine HREM parameters associated with positive reflux test (acid exposure time > 4% on 24-hour pH test). Further, creation and validation of manometry GERD score (MGS) to predict positive reflux test was done. Consecutive patients > 18 years referred for HREM and 24-hour pH study between May 2019 and December 2024 were included prospectively. Based on the findings in patients enrolled between May 2019 and May 2022, HREM parameters significantly different in patients with and without positive reflux were noted. Based on odds ratio, each parameter was assigned weightage points to formulate MGS. This score was validated prospectively. Data was analyzed for sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and area under the receiver-operating characteristic (AUROC) curve. Optimal cut-off was interpreted based on Index of Union test. A p value < 0.05 was considered statistically significant.

RESULTS: Calibration cohort included 144 patients (90 males)-98 (68%) had positive reflux test. Patients with positive reflux test had higher incidence of abnormal multiple rapid swallows (MRS, p 0.006), esophagogastric junction (EGJ) contractile integral (CI) < 39 (p < 0.0001) and type 2/3 EGJ morphology (p < 0.0001). These parameters were allotted weightage points to formulate MGS (total 5 points). In the validation cohort (n = 151, 95 males), 65 (43%) patients had a positive reflux test. A majority of patients with positive reflux test had MGS > 3.5 (83.1%). MGS score had AUROC equal to 0.85. MGS > 3.5 had sensitivity of 83.1% and specificity 80.2% to detect positive reflux test.

CONCLUSION: EGJ morphology type 2/3, EGJ-CI < 39 mmHg and abnormal MRS were significantly more common in patients with positive reflux test. MGS is useful in predicting positive reflux test.

PMID:41460456 | DOI:10.1007/s12664-025-01821-4

Discov Ment Health. 2025 Dec 29;5(1):202. doi: 10.1007/s44192-025-00333-z.

ABSTRACT

BACKGROUND: High stress affects mental and physical health, with African Americans at greater risk due to systemic inequities. The Community Resiliency Model (CRM)^®, an evidence-based intervention teaching sensory awareness skills to enhance resiliency, was evaluated among African American and White elderly participants with memory impairment to assess its effectiveness on stress-related outcomes.

METHODS: Fifty-four African American and White participants with mild cognitive impairment (MCI) were recruited in Atlanta, Georgia, for a 3-h online CRM workshop in 2021-2022 delivered by a CRM-trained nurse practitioner. Participants completed surveys pre- and 4 weeks post-intervention, including Perceived Stress Scale (PSS-10), Patient Health Questionnaire (PHQ-9), Somatic Symptoms Scale (SSS-8), and Connor-Davidson Resilience Scale (CD-RISC-10). Paired t-tests assessed the changes in outcome measures.

RESULTS: Among fifty-four participants, twelve were lost to follow-up. Mean age was 68 (range: 39-83 years); majority were female (81%) and African American (71%). Participants showed improvements in mean differences for depressive symptoms (PHQ-9 difference: 1.4; [95% CI 0.5, 2.4]; p-value = 0.0035), somatic symptoms (SSS-8 difference: 1.9; [95% CI 0.81, 3.0]; p-value = 0.0011), and resilience (CD-RISC-10 difference: – 1.4; [95% CI – 2.8, – 0.0026]; p-value = 0.05). Perceived stress improved but was not statistically significant (PSS-10 difference: 1.0; 95% CI – 0.77, 2.9; p-value = 0.25). No racial differences were observed.

CONCLUSION: CRM can enhance mood, alleviate somatic symptoms, and improve resilience in elderly participants with memory concerns. It shows promise as a brief, accessible intervention for mental well-being in diverse populations. Larger studies are needed for generalizability, given the limited sample size.

PMID:41460432 | DOI:10.1007/s44192-025-00333-z

Aging Clin Exp Res. 2025 Dec 29;38(1):8. doi: 10.1007/s40520-025-03241-y.

ABSTRACT

BACKGROUND: Cognitive impairment may hinder effective self-management of cardiovascular disease and lead to worsening cardiovascular risk.

AIMS: This study aimed to describe the rate of uncontrolled blood pressure, blood lipids, and blood glucose across different cognitive levels to identify priority groups for managing risk factors in patients with cardiovascular disease.

METHODS: A total of 10,707 patients with cardiovascular disease or individuals at high cardiovascular risk were enrolled from Beijing Anzhen Hospital. Cognitive function, assessed using the Montreal Cognitive Assessment (MoCA) scale, was categorized as normal (MoCA ≥ 26) or impaired (MoCA < 26). Logistic regression was used to explore the association between cognitive function and the rates of uncontrolled blood pressure, lipids, and glucose.

RESULTS: Among diabetic patients, the rate of uncontrolled blood glucose in those with cognitive impairment was significantly higher in patients with cognitive impairment than in those with normal cognition [hemoglobin A1c ≥ 7%, 65.7% vs. 56.6%, adjusted odds ratio (aOR) (95% confidence interval, 95% CI):1.40(1.21-1.62), P < 0.001]. The rate of uncontrolled blood pressure and blood lipids were slightly higher in cognitive impairment than normal cognition, however, the differences were not statistically significant [systolic blood pressure(SBP) ≥ 130mmHg and/or diastolic blood pressure(DBP) ≥ 80mmHg, 74.6% vs. 70.5%, aOR(95% CI):1.07 (0.96-1.20), P = 0.206; SBP ≥ 140mmHg and/or DBP ≥ 90mmHg, 45.4% vs. 40.0%, aOR(95% CI):1.08(0.98-1.91), P = 0.125; poor blood lipids management, 72.2% vs. 70.5%, aOR (95% CI):1.00(0.89-1.13), P = 0.994].

CONCLUSIONS: In this cross-sectional study, a significant association was observed between cognitive impairment and an unfavorable cardiovascular risk profile. This may reflect challenges in self-management and underscores the need for proactive care.

PMID:41460429 | DOI:10.1007/s40520-025-03241-y

J Robot Surg. 2025 Dec 29;20(1):127. doi: 10.1007/s11701-025-03094-7.

ABSTRACT

The purpose of this study was to evaluate the safety and efficacy of perioperative outcomes of the KangDuo Surgical Robot System versus the Da Vinci System in robot-assisted renal surgery. We conducted a comprehensive systematic search in key databases including PubMed, the Cochrane Library, Embase, and Web of Science, encompassing studies in all languages, with the final search date being October 2025. We also excluded articles comprising reviews, letters, and single-arm studies. Variables were assessed using metrics of Weighted Mean Difference (WMD), Standardized Mean Difference (SMD), and Odds Ratio (OR). The statistical synthesis of the data, encompassing diverse outcome measures, was conducted utilizing the Review Manager software. Moreover, the protocol for this systematic review and meta-analysis is publicly available on PROSPERO (Registration number: CRD420251181530). In a pooled analysis of 370 participants from five trials, the KangDuo Surgical Robot System demonstrated a significantly extended docking time relative to the Da Vinci System (SMD = 1.55, 95% CI: 1.21-1.90; p < 0.00001). Conversely, comparisons of operative time, estimated blood loss, incidence of minor complications, ischemia time, and postoperative renal function (assessed by 4-week serum creatinine and eGFR) yielded comparable results, with no statistically significant differences. In this meta-analysis with limited sample size, geographic focus on Chinese centers, and short-term follow-up, the pooled data indicate that the KangDuo (KD) Surgical Robot System achieved non-inferiority to the Da Vinci System on several key perioperative metrics in robot-assisted renal surgery, although with a longer docking time. These findings support the KD system as a promising alternative in comparable settings, yet they should be interpreted within the constraints of the available evidence. Future research, particularly large-scale, multicenter randomized trials with long-term monitoring of survival and renal function, is necessary to confirm its efficacy and safety profile for widespread clinical adoption.

PMID:41460419 | DOI:10.1007/s11701-025-03094-7

J Gastrointest Cancer. 2025 Dec 29;56(1):247. doi: 10.1007/s12029-025-01369-8.

ABSTRACT

PURPOSE: Gallbladder cancer is the fifth most common gastrointestinal cancer worldwide, often diagnosed incidentally after cholecystectomy for presumed benign disease. Previous studies have reported geographic variations in the incidence of incidental gallbladder cancer (IGBC), but comprehensive pooled estimates examining multiple predictors of IGBC are lacking. The study aims to synthesize the risk factors and clinical predictors associated with IGBC in patients undergoing cholecystectomy for benign gallbladder conditions.

METHODS: This systematic review and meta-analysis assessed studies published between January 2010 and February 2024 in databases from EMBASE, PUBMED-MEDLINE, and Scopus. Eligible studies included observational study designs evaluating risk or predictive factors for IGBC diagnosed during or after cholecystectomy for presumed benign gallbladder disease. Heterogeneity across studies was assessed using the I² statistic. Sensitivity analyses were conducted to explore the robustness of the pooled estimates.

RESULTS: Of 2899 studies screened, 18 were included in the systematic review and 9 of these were included in the meta-analysis, covering 788,214 patients undergoing cholecystectomy. Advancing age (OR:1.09; 95% CI:1.07-1.12, I²=55.9%), female gender (OR:1.91; 95% CI:1.33-2.75, I² = 72.1% ), elevated alkaline phosphatase (OR:1.68; 95% CI:1.41-2.00, I² = 0%), polyp size > 10 mm (OR:8.63; 95% CI:1.95-38.26, I² = 0%), and open cholecystectomy (OR:9.20; 95% CI:5.68-14.89, I² = 83.5%) were found to have association with IGBC. Large gallstones (> 3 cm) showed no significant association. Risk of bias was low, and sensitivity analyses confirmed model robustness.

CONCLUSION: This review identifies key demographic, and clinical factors associated with IGBC. These findings support the need for risk-based preoperative evaluation and careful intraoperative vigilance, particularly in patients with advanced age, female gender, elevated alkaline phosphatase, and larger gallbladder polyps. Incorporating these predictors into clinical decision-making may guide targeted histopathological examination policies, leading to earlier GBC detection and improved patient outcomes. PROSPERO Registration No: CRD42024528982.

PMID:41460407 | DOI:10.1007/s12029-025-01369-8

J Robot Surg. 2025 Dec 29;20(1):126. doi: 10.1007/s11701-025-03012-x.

ABSTRACT

This study aims to systematically examine how minimally invasive thymectomy-covering both video-assisted and robotic-assisted methods-compares with open thymectomy in terms of perioperative safety and effectiveness for treating large thymomas. We thoroughly searched several databases for relevant studies, including randomized controlled trials and cohort studies, published up until October 2025. Data on perioperative factors, including surgical duration, blood loss, length of hospitalization, complications, and recurrence rates, were extracted and analyzed using random-effects models in STATA 18. Seven studies involving 12,880 patients were included. open surgery showed significantly more blood loss (WMD = 110.43, 95% CI 105.83-115.03; P < 0.05), longer hospital stays (WMD = 2.04, 95% CI 1.38-2.7; P < 0.05) compared to MIT. No notable difference in surgical duration was observed. Moreover, minimally invasive thymectomy (MIT) was associated with a reduced rate of recurrence after surgery (OR = 0.54, 95% CI 0.35-0.84; P < 0.05) as well as fewer postoperative complications (OR = 0.27, 95% CI 0.19-0.39; P < 0.05). MIT offers significant advantages over open surgery for large thymomas, including reduced blood loss, shorter hospital stays, and lower rates of complications and recurrence, though operative time was similar. Further large-scale studies are needed to confirm these findings and assess long-term efficacy.

PMID:41460396 | DOI:10.1007/s11701-025-03012-x

Lifetime Data Anal. 2025 Dec 29;32(1):6. doi: 10.1007/s10985-025-09680-z.

ABSTRACT

We consider semiparametric random-effects models for recurrent events in the presence of a terminal event. The recurrent events have either a proportional marginal rate model (Cox in J Roy Stat Soc Ser B 34:406-424, 1972) or a proportional marginal mean model (Ghosh and Lin in Stat Sin 34: 663-688, 2002), while the marginal rate of the terminal event is given by a proportional model. The dependency between the recurrent events and the terminal event is described by two variants of random effects models that allow the processes to share the random effect, either fully or partly. The models are formulated as two-stage models, where the marginals can be fitted in an initial stage, and then subsequently random effects parameters can be estimated. The estimation of parameters does not require the choice of any tuning parameters, in contrast to procedures based on numerical integration, and the numerical procedure works well. Standard errors were computed by bootstrapping. The methods are applied to the Taichung Peritoneal Dialysis Study (Chen et al. in Biom J 57(2):215-233, 2015) that considered recurrent inflammations in dialysis patients.

PMID:41460389 | DOI:10.1007/s10985-025-09680-z

Lasers Med Sci. 2025 Dec 29;41(1):4. doi: 10.1007/s10103-025-04797-x.

ABSTRACT

This pilot study aimed to investigate the effects of intravascular laser irradiation of blood (ILIB) on anxiety levels and vital signs in patients undergoing third molar extraction. A randomized, placebo-controlled clinical trial was conducted with 26 patients who underwent mandibular third molar extraction. Participants were allocated to either the placebo group (n = 13) or the ILIB group (n = 13). ILIB was applied via transcutaneous over the radial artery for 30 min before the surgical procedure. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI-Y, state subscale) at baseline and four minutes after local anesthesia. Vital signs, including heart rate (HR), systolic and diastolic blood pressure, and oxygen saturation, were also recorded at these two time points. There was no significant difference in anxiety status between the ILIB and placebo groups. However, the ILIB group demonstrated a statistically significant HR stability after local anesthesia compared to the placebo group. All parameters remained within normal limits throughout the procedure. Despite its pilot nature and small sample size, this study indicates that ILIB is feasible in routine clinical practice. Although it did not reduce anxiety compared to a placebo, ILIB helped stabilize HR after local anesthesia, suggesting a potential physiological benefit. Further research is needed to assess its clinical relevance, especially in patients with severe anxiety or systemic conditions. Brazilian Clinical Trials Registry – REBEC no. RBR-9ycg67p. Registration, March 10^th, 2023.

PMID:41460388 | DOI:10.1007/s10103-025-04797-x

J Neurooncol. 2025 Dec 29;176(2):138. doi: 10.1007/s11060-025-05390-6.

ABSTRACT

INTRODUCTION: Cerebellar glioblastoma (cGBM) is a rare subtype, comprising of < 1% of patients with GBMs. This study sought to identify predictors of survival for patients with cGBM through an individual patient data (IPD) meta-analysis, focusing on the impact of chemoradiotherapy (CRT) and extent of resection (EOR).

METHODS: Following PRISMA-IPD guidelines, we conducted a systematic review and Individual Patient Data (IPD) meta-analysis of 13 retrospective studies (113 adults) with IDH-wildtype cerebellar glioblastoma. Variables included demographics, tumor location, KPS, MGMT, TP53, extent of resection (GTR, STR, PR, biopsy), and CRT. Kaplan-Meier estimated OS and PFS; unadjusted and adjusted Cox models assessed predictors. Hazard ratios for CRT vs. monotherapy and GTR vs. incomplete resection were pooled in a two-stage random-effects model (Hartung-Knapp). Analyses used R (v4.4.2) and JMP Pro 17.

RESULTS: Mean age was 54.9 years; 64% were male. GTR was performed in 37%, PR in 43%, STR in 11%, and biopsy in 10%. CRT was associated with improved OS (18 vs. 7 months; p = 0.02) and PFS (12 vs. 2.5 months; p = 0.0205) compared to monotherapy on Kaplan-Meier analysis. Two-stage IPD meta-analysis showed a 72% reduced risk of death with CRT (HR 0.28; 95% CI: 0.15-0.51; p = 0.0119), with similar significance in one-stage unadjusted Cox models (HR 0.49; 95% CI: 0.26-0.91; p = 0.0233). EOR comparisons were non-significant in meta-analyses, though GTR vs. biopsy showed early separation on Wilcoxon testing (p = 0.0422).

CONCLUSION: In this pooled IPD meta-analysis of cGBM, the use of CRT remained the only consistent and independent predictor of improved survival. GTR conferred a survival advantage over biopsy, likely reflecting the clinical benefit of debulking, however its advantage over subtotal resection was not statistically significant. These findings reinforce CRT as the maintstay of treatment highlighting the need for individualized strategies in cGBM. In selected cGBM patients, gross total surgical resection and adjuvant chemo-RT result in overall survival outcomes comparable with supratentorial GBM.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41460384 | DOI:10.1007/s11060-025-05390-6