Tag: pubmed

Arch Esp Urol. 2025 Sep;78(8):1045-1055. doi: 10.56434/j.arch.esp.urol.20257808.137.

ABSTRACT

BACKGROUND: We aimed to determine which parameters other than the time until torsion surgery can predict orchiectomy risk in acute testicular torsion (TT).

METHODS: The medical records of acute TT who applied to five different health centres in Turkey between 2016 and 2023 were analysed retrospectively. Patients who underwent orchiectomy because blood flow cannot be detected were defined as Group I, and patients with testicles preserved and fixed were defined as Group II. The differences between the two groups and potential predictors of testicular salvage were analysed.

RESULTS: Eighty-three patients with TT were included in the study. Amongst them, 44 (53.01%) were included in Group I and 39 patients (46.99%) in Group II. Time from the onset of pain to surgery and mean platelet volume (MPV) were significantly higher in Group I (p < 0.05). In Group II, the ipsilateral Prehn’s sign negativity rates, the rate of normal ipsilateral testicular echogenicity, and the rate of normal volume on ultrasonography were significantly higher than those in Group I (p < 0.05). We created a new scoring system named Time, MPV, Prehn’s sign, Echogenicity, and Volume (TMPEV) that can predict the risk of orchiectomy in TT by using the parameters that differed statistically between Groups I and II.

CONCLUSIONS: The time until surgery may not be the only factor affecting the possibility of testicular recovery in acute TT. MPV, positivity of Prehn’s sign, differentiations in ipsilateral testicular echogenicity and volume changes on ultrasonography, may have significant value in predicting the possibility of orchiectomy after open detorsion surgery. If more comprehensive and clear nomograms similar to our new TMPEV scoring system can be created, more proactive algorithms can also be developed for predicting orchiectomy after TT and managing TT.

PMID:41111376 | DOI:10.56434/j.arch.esp.urol.20257808.137

Arch Esp Urol. 2025 Sep;78(8):986-994. doi: 10.56434/j.arch.esp.urol.20257808.129.

ABSTRACT

BACKGROUND: Alpha blockers (ARBs) are important agents in treating benign prostatic hyperplasia (BPH). Although multiple ARBs are available, comparative data on their early and mid-term effects are limited. This study aimed to evaluate and compare the early clinical efficacy of three ARBs (alfuzosin, tamsulosin and silodosin) in patients with lower urinary tract symptoms due to BPH.

METHODS: This retrospective study was conducted using a 1:1:1 matched design on the basis of age, prostate-specific antigen level and prostate volume. Eligible patients were subsequently grouped for comparison. Patients received 10 mg of alfuzosin, 0.4 mg of tamsulosin or 8 mg of silodosin once daily for 3 months. Uroflowmetry parameters, including maximum urinary flow rate (Qmax), average urinary flow rate (Qave) and post-void residual volume (PVR), were assessed at baseline, 6 h after the first dose and at the first and third months. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores were evaluated at baseline and the first and third months. Repeated-measure analysis of variance (ANOVA) and Bonferroni post-hoc tests were applied.

RESULTS: A total of 117 patients were included in the final analysis, with 38 in the alfuzosin group, 40 in the tamsulosin group and 39 in the silodosin group. Repeated-measure ANOVA revealed that all groups showed significant improvements over time in Qmax, IPSS and QoL scores (p < 0.001). Silodosin provided a significantly greater increase in Qmax at 6 h than alfuzosin (p = 0.013) and tamsulosin (p = 0.044), though no statistically significant differences were observed between groups at the first or third month (p = 1.000). PVR values decreased in all groups over time, but intergroup differences were not statistically significant (p > 0.05).

CONCLUSIONS: Silodosin provided the most rapid symptomatic improvement following initial administration, likely due to its high α1A-receptor selectivity. However, by the third month, all three agents showed similar clinical efficacy, supporting their use as viable treatment options tailored to patient-specific needs.

PMID:41111368 | DOI:10.56434/j.arch.esp.urol.20257808.129

Diabetes Obes Metab. 2025 Oct 20. doi: 10.1111/dom.70204. Online ahead of print.

ABSTRACT

AIMS: We aimed at comparing different approved strategies (obesity management medications-OMM, endoscopic bariatric procedures-EBP, and metabolic bariatric surgery-MBS) with lifestyle intervention/placebo/no therapy (LSI/Pbo/NT) for the treatment of different BMI-based classes of obesity (i.e., overweight-BMI: 25-29.9 kg/m²; class I-BMI: 30-34.9 kg/m²; class II-BMI: 35-39.9 kg/m²; class III-BMI >39.9 kg/m²).

MATERIALS AND METHODS: This systematic review (SR) and network meta-analysis (NMA) included randomised clinical trials (RCTs) comparing OMM, EBP, and MBS versus either LSI/Pbo/NT or active comparators in individuals with overweight or obesity. A Medline and Embase search was performed up to 31st January 2025 for RCTs on EMA (European Medicines Agency)-approved weight-loss interventions in adults with overweight/obesity. The primary endpoint was total body weight loss (TBWL%), analysed at different time points: 26-52, 53-104, 105-156, and ≥156 weeks. Secondary endpoints included all-cause mortality, quality of life, and serious adverse events (SAE). Weighted mean difference and 95% confidence intervals (WMD, 95% CI) for continuous variables and Mantel-Haenszel odds ratio (MH-OR, 95% CI) for categorical variables were calculated using random effect models. The study was registered on the PROSPERO website (CRD42024625338).

RESULTS: In trials enroling subjects in class I of obesity, tirzepatide resulted in equal effectiveness to both OAGB and RYGB, and it was significantly superior to all the other comparisons. In trials on class II of obesity, tirzepatide was significantly superior to all the other comparisons and inferior to both OAGB and RYGB. Semaglutide was associated with a higher TBWL% than the other OMMs (with the notable exception of tirzepatide), and it was equally effective to EBP, GCP, and LAGB. In trials enroling patients with a mean BMI >40 kg/m², the procedure with the highest estimated weight loss was BPD. Semaglutide was statistically less effective than SG and gastric bypass, but not inferior to GCP and LAGB. Both RYGB and OAGB were superior to SG.

CONCLUSION: In patients affected by mild to moderate obesity, newer OMMs (i.e., tirzepatide and semaglutide) appear to be valid alternatives to EBP and MBS. They could be preliminarily chosen as a first-line option based on similar efficacy and greater safety and tolerability. Higher degrees of obesity could be more effectively treated with MBS, the efficacy of which, with the notable exception of LAGB and GCP, appears superior to other treatments, especially in the long term.

PMID:41111360 | DOI:10.1111/dom.70204

Pharm Stat. 2025 Nov-Dec;24(6):e70044. doi: 10.1002/pst.70044.

ABSTRACT

The initiation of dose optimization has driven a paradigm shift in oncology clinical trials to determine the optimal biological dose (OBD). Early-phase trials with randomized doses can facilitate additional investigation of the identified OBD in targeted populations by incorporating safety, efficacy, and biomarker data. To support dose comparison in such settings, we propose to extend the utility score-based approach (U-MET) to account for multiple endpoints and doses. The utility-based dose optimization approach for multiple-dose randomized trial designs accounting for multiple (≤ 3) endpoints and doses (U-MET-m) extends the U-MET, using a utility score to account for multiple endpoints jointly (e.g., toxicity-efficacy trade-off). When there are > 3 endpoints, assigning weights jointly is quite complicated; therefore, we suggest an alternative approach with CUI-MET (clinical utility index dose optimization approach for multiple-dose randomized trial designs), which uses a utility index to account for multiple endpoints marginally. We demonstrate the relationship between U-MET-m and CUI-MET to offer a guide in weight selection for U-MET-m when there are up to three endpoints. U-MET-m and (extended) CUI-MET use Bayesian inference within a hypothesis framework to compare utility metrics across doses to identify the OBD. Here we describe simulation studies and present examples to compare both the U-MET-m and CUI-MET designs with the empirical design. The U-MET-m design and CUI-MET were shown to have satisfactory operating characteristics for selecting the OBD. Based on these findings, we recommend the U-MET-m with ≤ 3 endpoints and CUI-MET with > 3 endpoints as the primary dose comparison approach to select the OBD.

PMID:41111350 | DOI:10.1002/pst.70044

Cancer. 2025 Nov 1;131(21):e70067. doi: 10.1002/cncr.70067.

ABSTRACT

BACKGROUND: There are suspected disparities in clinical research (CR) development among low- and middle-income countries (LMICs). This study investigated differences in number and complexity of clinical trials (CTs) and how economic growth (EG) might contribute to these disparities.

METHODS: For countries classified as LMICs in 2000, number, proportion of phase 1-2/3 and independent/pharma-sponsored CTs were documented. For correlations with EG, correlation coefficients (CC) were produced, indicating very weak, weak, moderate, strong, and very strong correlation.

RESULTS: A total of 16,977 CTs were identified. Asian countries China and South Korea experienced strong EG and increases in CTs (very strong CC). South/Southeast Asian countries had strong EG but modest increases in CTs (variable CC). Most East European countries and West Asian/Southeast European Turkey experienced robust EG and increases in CTs (moderate to strong and very strong CC, respectively). South/North American Argentina, Brazil, and Mexico had inconsistent EG but increases in CTs (weak to moderate CC). Among African countries, Egypt showed strong EG with a corresponding increase in CTs (strong CC), whereas South Africa had a weak CC. Most LMICs, except for China and South Korea, relied heavily on pharma-sponsored CTs, with a persistently low proportion of early-phase (1-2) compared to late-phase (3) CTs.

CONCLUSION: CR development has been unequal among LMICs. Strong EG could be a contributing factor but only to some extent. Only China and South Korea meaningfully developed independent and high-complexity CR. These data reinforce the need for initiatives to support cancer research in LMICs.

PMID:41111348 | DOI:10.1002/cncr.70067

Disaster Med Public Health Prep. 2025 Oct 20;19:e299. doi: 10.1017/dmp.2025.10218.

ABSTRACT

BACKGROUND: Preparation for mass casualty incidents (MCIs) requires knowledge of the number of victims to be treated on site and transferred to hospitals. The objective was to collect this information for MCIs with hospital admissions in Europe over the last 30 years.

METHOD: This was a scoping review of MCIs with hospital admissions in Europe between 1991 and 2023. The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines with PubMed, the Web of Science, Industrial and Transport Accident Reports, and two global databases on terrorism and disasters. Events with ten victims transferred to hospitals were included.

RESULTS: In total, 2,498 documents were identified, and 82 documents covering 62 MCIs were selected. In Europe, there was a median of 73 MCI: 9 victims died on site (12%), 48 were transferred to hospitals (66%), and 13 with serious casualties (17%). MCI is divided into 7 categories: explosion, ballistic, fire, road, ram raid, railway, and industrial accident.

CONCLUSIONS: By improving our knowledge of past MCIs and their casualty figures, we can now train more realistically and be better prepared to respond to future MCIs.

PMID:41111321 | DOI:10.1017/dmp.2025.10218

Ren Fail. 2025 Dec;47(1):2570817. doi: 10.1080/0886022X.2025.2570817. Epub 2025 Oct 20.

ABSTRACT

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy in severe respiratory and/or cardiovascular failure. Acute kidney injury (AKI) is a frequent complication of ECMO that increases morbidity and mortality. We report the outcomes of patients with AKI who received ECMO.

METHODS: Clinical, management, and 30-d kidney and patient outcome data of adult inpatients with AKI who received ECMO in seven public hospitals in Kuwait from 1 January to 31 December 2021, were prospectively collected and analyzed.

RESULTS: There were 3,744 AKI referrals to nephrology during study period, of which 121 received ECMO (3.2%). Patients with AKI on ECMO had a mean age of 56.3 years and a mean baseline eGFR of 81.6 mL/min. Preexisting chronic kidney disease was reported in 21.5% of patients, diabetes in 58.7%, and hypertension in 48%. COVID-19 infection contributed to AKI in 69% of the cases. AKI developed before ECMO initiation in 62% of cases. ECMO was veno-venous in 90% of cases. Dialysis was performed in 92% of cases, 97% of which was continuous modality. Mechanical ventilation was required in 94.2% of patients (all on inotropic support). At 30 d, 86.8% of the cohort died (91% of the deceased were on dialysis), 5% remained on dialysis, and only 3.3% recovered kidney function completely.

CONCLUSIONS: AKI in patients receiving ECMO was associated with a high need for dialysis, and a high mortality rate. COVID-19 pandemic may have contributed to this outcome. ECMO modality, and whether AKI was pre or post ECMO did not affect the outcome.

PMID:41111310 | DOI:10.1080/0886022X.2025.2570817

SAR QSAR Environ Res. 2025 Oct 20:1-25. doi: 10.1080/1062936X.2025.2569865. Online ahead of print.

ABSTRACT

Enhancer of Zeste Homolog 2 (EZH2) inhibitors have demonstrated selective efficacy, but their broader therapeutic potential remains limited, highlighting the need to clarify the structural basis of their activity. The central aim of our study is to systematically analyse the structural diversity and activity patterns of known EZH2 inhibitors to provide insights that may guide incremental scaffold optimization. We examined 531 potential EZH2 inhibitors retrieved from ChEMBL through a cheminformatics workflow encompassing clustering, scaffold identification, activity cliff detection, and chemical space visualization. Using RDKit and NetworkX, 94 clusters were generated, of which 13 contained ten or more compounds. Notably, clusters 6, 16, 20, 21, and 31 exhibited favourable balances of structural homogeneity and enrichment scores, suggesting chemical cohesiveness and biological relevance for structure – activity relationship (SAR) prioritization. Statistical analyses revealed significant differences in mean pIC₅₀ values across clusters, underscoring distinct activity distributions linked to structural groups. Scaffold analysis highlighted pyrrole – benzamide derivatives, particularly those incorporating morpholine and piperidine motifs, as enriched among potent inhibitors. Substructure evaluation further indicated that aromatic rings and aromatic amine groups were positively correlated with bioactivity. These findings delineate key SAR features of EZH2 inhibitors and provide guidance for scaffold refinement, hit identification, and lead optimization.

PMID:41111308 | DOI:10.1080/1062936X.2025.2569865

Philos Trans R Soc Lond B Biol Sci. 2025 Oct 20;380(1937):20240222. doi: 10.1098/rstb.2024.0222. Epub 2025 Oct 20.

ABSTRACT

Most of the world’s languages have numeral systems with a decimal base, but in some areas, such systems are rare. This article focuses on languages with either restricted numeral systems or systems featuring compositional anchors that are not bases, examining how they are used in the creation of non-atomic numerals. We investigate anchor choice from an explicitly diachronic perspective by modelling it on phylogenetic trees for language families from two areas: northern lowland South America (Arawakan, Pano-Tacanan, Tucanoan and Tupian) and Papuan languages of New Guinea (Nuclear Torricelli, Nuclear Trans New Guinea, Ramu and Sepik). We find languages with restricted numeral systems lacking anchors, as well as systems with anchor 2 or 5. Phylogenetic analyses suggest that the proto-languages of these families likely had restricted or anchor 2 systems, with shifts to anchor 5 occurring in specific groups, indicating some time depth, although statistical power is limited by small family sizes. Further research should study linguistic systems alongside cultural counting practices, reconstruct both linguistic forms and cultural practices and model the impact of contact, especially given the global dominance of decimal systems.This article is part of the theme issue ‘A solid base for scaling up: the structure of numeration systems’.

PMID:41111297 | DOI:10.1098/rstb.2024.0222

Diagn Interv Radiol. 2025 Oct 20. doi: 10.4274/dir.2025.253585. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to present our institutional experience with the use of percutaneous balloon-expandable biodegradable magnesium biliary stents (MBS) in the treatment of benign, refractory anastomotic strictures (AS), where initial percutaneous or endoscopic approaches fail or are ineffective, after liver transplantation (LT).

METHODS: In this retrospective single-center study, 13 patients with clinically refractory AS who underwent MBS placement between July 2021 and August 2024 were evaluated. Statistical analyses included Kaplan-Meier survival analysis for patency and Spearman’s correlation for recurrence risk. Primary outcomes included stricture recurrence and time to reintervention during follow-up.

RESULTS: The median age of patients was 35 years [interquartile range (IQR): 22-48], and 11 were male (85%). Living donor LT was performed in 12 (92%). The MBS were placed at a median of 8 months post-transplant (IQR: 5-44), with a technical success in all cases (100%). Before MBS placement, patients underwent a median of one endoscopic retrograde cholangiopancreatography (IQR: 0-3) and three percutaneous transhepatic biliary drainage procedures (IQR: 1-8). The median follow-up was 25 months (IQR: 15-33). The MBS patency rates were 93%, 85%, and 67% at 6, 12, and 24 months, respectively. Stricture recurrence occurred at a median of 30 months post-placement (95% confidence interval: 23.6-36.3). A moderate positive correlation was observed between the number of pre-stent interventions and recurrence risk (rho: 0.582, P = 0.023). Post-procedural complications (cholangitis) occurred in 1 patient.

CONCLUSION: Balloon-expandable biodegradable MBS may provide a safe and effective treatment for refractory AS following LT. Early placement of MBS, particularly after fewer prior interventions, appears to be associated with improved patency and longer stricture-free survival.

CLINICAL SIGNIFICANCE: Early use of biodegradable magnesium stents after LT may reduce the need for multiple interventions and improve long-term biliary patency.

PMID:41111279 | DOI:10.4274/dir.2025.253585