Tag: pubmed

Int Urol Nephrol. 2025 Jan 31. doi: 10.1007/s11255-024-04339-4. Online ahead of print.

ABSTRACT

BACKGROUND: Managing lower calyceal stones poses significant challenges. Flexible ureteroscopy and laser lithotripsy (FURSL) are standard techniques for treating large stones (10-20 mm).

OBJECTIVE: This study evaluates the role of the T-tilt position (45-degree Trendelenburg with a 45-degree lateral tilt against the side of the stone) and hydrodilatation of the lower calyx with 50 cc saline injection as needed in optimizing stone-free rates and safety during FURSL for lower calyceal stones.

METHODS: Following ethical approval, a prospective randomized study with 197 patients was conducted. 13 patients were excluded (9 with renal anomalies or prior surgeries affecting anatomy, and four who refused participation). The remaining 184 were randomized into Group A (92 patients in T-tilt with hydrodilatation) and Group B (92 patients with hydrodilatation in lithotomy position). Randomization was achieved with computer-generated numbers stored in sealed envelopes. All patients had 10-20 mm stones and underwent FURSL using a 7.5 FR flexible ureteroscope and 200-micron Wolf laser fiber. Follow-up CT KUB was performed at 1 and 3 months, assessing stone-free status (no residual stones or residual < 3 mm) and the need for auxiliary procedures.

RESULTS: Both groups were statistically analyzed for age, sex, BMI, stone size, Hounsfield units (HU), infundibular dimensions, access sheath use, complications (fever, sepsis, hematuria) and hospital stay. No significant differences were found between the two groups in these variables. However, operative time was significantly longer in Group A than in Group B (P value = 0.018). The need for auxiliary procedures was significantly lower in Group A than in Group B (P value = 0.001), and the success rate was significantly higher in Group A than in Group B (P value = 0.001).

CONCLUSION: The T-tilt position and hydrodilatation significantly optimize outcomes and enhance stone-free rates for large lower calyceal stones (10-20 mm). This position improves intraoperative vision and facilitates access to the lower calyx, facilitating the clearance of stone fragments.

PMID:39888472 | DOI:10.1007/s11255-024-04339-4

J Med Syst. 2025 Jan 31;49(1):18. doi: 10.1007/s10916-025-02151-w.

ABSTRACT

PURPOSE: Mobile health plays an important role in providing individualized information about the health status of patients. Limited information exists on intensive care unit (ICU) patients with the risk of suffering from the post-intensive care syndrome (PICS), summarizing long-term physical, mental and cognitive impairment. This web-based survey study aims to identify specific needs of former ICU patients for utilizing a newly developed, so called Post-Intensive Care Outcome Surveillance (PICOS) app to collect relevant PICS-related parameters.

METHODS: A prototype app was developed following interaction principles for interactive systems of usability engineering. Patients from four different German hospitals were asked about demographics, interaction with technology and their perception of the prototype regarding hedonic motivation, perceived ease of use and performance expectancy.

RESULTS: 123 patients participated in the survey; the majority owned and used smartphones. Nearly half of respondents would seek help from family members or caregivers using the app. There was a difference in affinity for technology for participants who own a smartphone and those who do not, t(116) = – 0.97, p = .335, and no significant difference in affinity for technology whether the participants would like support when using the app or not, t(97) = 1.81, p = .073. The average hedonic motivation for using the app was M = 4.44 (SD = 1.304).

CONCLUSION: This app prototype was perceived as both beneficial and easy to use, indicating its success among former ICU patients. Due to aging and ongoing health impairments, every second patient would need assistance with the initial use of the app.

PMID:39888468 | DOI:10.1007/s10916-025-02151-w

Acta Diabetol. 2025 Jan 31. doi: 10.1007/s00592-025-02448-9. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia is a common condition in the elderly, especially in diabetics (DM). Metformin (MTF), known to reduce glucose levels, can also be a therapeutic intervention in age-related diseases, although it may contribute to muscle loss.

OBJECTIVES: To compare the prevalence of sarcopenia among elderly people treated for DM, with or without MTF, and non-diabetic patients (NDM) and evaluate whether there is an association between the use of MTF and the development of sarcopenia.

METHODS: 194 independent elderly people over 80 years old were analyzed. Sarcopenia was defined by handgrip (HG), calf circumference (CC), and gait speed (GS). Non-parametric statistical analysis and Kaplan-Meier survival curves were used.

RESULTS: The prevalence of DM was 24.7%, of which 56.25% used MTF. The median fasting blood glucose in the NDM and DM groups was 95 and 104 mg/dL. The median glycated hemoglobin in the NDM and DM groups was 5.7% and 6.4%. There was no statistical difference between the DM and NDM groups when comparing clinical characteristics, functionality, weight, physical tests, and mortality. The prevalence of sarcopenia was similar between NDM and DM (16.55% and 14.63%), with few cases of severe sarcopenia in both groups, without statistical differences. We did not find differences in the same variables when we analyzed NDM and DM using or not MTF. Survival curves showed no significant differences between patients with and without sarcopenia/severe sarcopenia.

CONCLUSIONS: Long-lived people with well-controlled DM did not show significant differences concerning those without DM for the outcome of sarcopenia or death.

PMID:39888448 | DOI:10.1007/s00592-025-02448-9

Clin Oral Investig. 2025 Jan 31;29(2):101. doi: 10.1007/s00784-025-06156-0.

ABSTRACT

OBJECTIVE: This study aimed to apply the DeepLabv3 + model and compare it with the U-Net model in terms of detecting and segmenting apical lesions on panoramic radiography.

METHODS: 260 panoramic images that contain apical lesions in different regions were collected and randomly divided into training and test datasets. All images were manually annotated for apical lesions using Computer Vision Annotation Tool software by two independent dental radiologists and a master reviewer. The DeepLabv3 + model, one of the state-of-the-art deep semantic segmentation models, was utilized using Python programming language and the TensorFlow library and applied to the prepared datasets. The model was compared with the U-Net model applied to apical lesions and other medical image segmentation problems in the literature.

RESULTS: The DeepLabv3 + and U-Net models were applied to the same datasets with the same hyper-parameters. The AUC and recall results of the DeepLabv3 + were 29.96% and 61.06% better than the U-Net model. However, the U-Net model gets 69.17% and 25.55% better precision and F1-score results than the DeepLabv3 + model. The difference in the IoU results of the models was not statistically significant.

CONCLUSIONS: This paper comprehensively evaluated the DeepLabv3 + model and compared it with the U-Net model. Our experimental findings indicated that DeepLabv3 + outperforms the U-Net model by a substantial margin for both AUC and recall metrics. According to those results, for detecting apical lesions, we encourage researchers to use and improve the DeepLabv3 + model.

CLINICAL RELEVANCE: The DeepLabv3 + model has the poten tial to improve clinical diagnosis and treatment planning and save time in the clinic.

PMID:39888441 | DOI:10.1007/s00784-025-06156-0

Eur J Nucl Med Mol Imaging. 2025 Jan 31. doi: 10.1007/s00259-025-07111-7. Online ahead of print.

ABSTRACT

PURPOSE: The loss of synaptic vesicle glycoprotein 2 A (SV2A) can lead to dysfunction of GABAergic neurons, but a direct comparison of SV2A and GABA_A receptor densities in humans has not been assessed. This study evaluated SV2A and GABA_A receptor abnormalities in patients with drug-resistant epilepsy (DRE) and compared the patterns to glucose hypometabolism.

METHODS: Eleven patients with DRE were retrospectively recruited and underwent PET imaging with [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG), [¹⁸F]Flumazenil (FMZ), and [¹⁸F]SynVesT-1. Visual assessments counted abnormal metabolic brain regions based on the Anatomical Automatic Labeling (AAL) atlas, while voxel-level analyses delineated the abnormal metabolic distributions. The relationship between hypo-metabolic distributions and the age of epilepsy onset was analyzed.

RESULTS: The hypometabolic regions in [¹⁸F]FDG PET, identified in the AAL atlas, was significantly broader than in [¹⁸F]FMZ (p = 0.0005) and [¹⁸F]SynVesT-1 (p = 0.0010) PET, with no statistical difference observed between [¹⁸F]FMZ and [¹⁸F]SynVesT-1 PET (p > 0.05). The voxel number in [¹⁸F]FDG PET was significantly higher than that of the [¹⁸F]FMZ and [¹⁸F]SynVesT-1 PET in both hypo-intensity area and severe hypo-intensity area. The ratio of the voxel number between these two area was higher for [¹⁸F]SynVesT-1 PET compared to [¹⁸F]FDG PET (p = 0.0195) and [¹⁸F]FMZ PET (p = 0.0237), and positively correlated with the age of epilepsy onset (r = 0.7397, p = 0.0145).

CONCLUSIONS: [¹⁸F]FMZ and [¹⁸F]SynVesT-1 PET images revealed a more restricted pattern of reduced uptake compared to [¹⁸F]FDG PET in DRE patients. The age of epilepsy onset correlated with a reduction in [¹⁸F]SynVesT-1 uptake but not in [¹⁸F]FMZ or [¹⁸F]FDG uptake.

PMID:39888422 | DOI:10.1007/s00259-025-07111-7

Eur J Nucl Med Mol Imaging. 2025 Jan 31. doi: 10.1007/s00259-025-07070-z. Online ahead of print.

ABSTRACT

PURPOSE: Imaging biomarkers bear great promise for improving the diagnosis and prognosis of cognitive impairment in Parkinson’s disease (PD). We compared the ability of three commonly used neuroimaging modalities to detect cortical changes in PD patients with mild cognitive impairment (PD-MCI) and dementia (PDD).

METHODS: 53 cognitively normal PD patients (PD-CN), 32 PD-MCI, and 35 PDD underwent concurrent structural MRI (sMRI), diffusion-weighted MRI (dMRI), and [¹⁸F]FDG PET. We extracted grey matter volumes (sMRI), mean diffusivity (MD, dMRI), and standardized uptake value ratios ([¹⁸F]FDG PET) for 52 cortical regions included in a neuroanatomical atlas. We assessed group differences using ANCOVA models and further applied a cross-validated machine learning approach to identify the modality-specific brain regions that are most indicative of dementia status and assessed their diagnostic accuracy for group separation using receiver operating characteristic analyses.

RESULTS: In sMRI, atrophy of temporal and posterior-parietal areas allowed separating PDD from PD-CN (AUC = 0.77 ± 0.07), but diagnostic accuracy was poor for separating PD-MCI from PD-CN (0.57 ± 0.10). dMRI showed most pronounced diffusivity changes in the medial temporal lobe, which provided excellent diagnostic performance for PDD (AUC = 0.87 ± 0.06), and a more modest but still significant performance for PD-MCI (AUC = 0.71 ± 0.09). Finally, [¹⁸F]FDG PET revealed pronounced hypometabolism in posterior-occipital regions, which provided the highest diagnostic accuracies for both PDD (AUC = 0.89 ± 0.05) and PD-MCI (AUC = 0.78 ± 0.05). In statistical comparisons, both [¹⁸F]FDG PET (p < 0.001) and dMRI (p < 0.031) outperformed sMRI for detecting PDD and PD-MCI.

CONCLUSION: Among the tested modalities, [¹⁸F]FDG PET was most accurate for detecting cortical changes associated with cognitive impairment in PD, especially at early stages. Diffusion measurements may represent a promising MRI-based alternative.

PMID:39888421 | DOI:10.1007/s00259-025-07070-z

J Elder Abuse Negl. 2025 Jan 31:1-25. doi: 10.1080/08946566.2025.2460835. Online ahead of print.

ABSTRACT

Elder mistreatment occurs in as many as one-half of the 11 million family care partnerships with persons living with Alzheimer’s disease or related dementias (AD/ADRD) in the United States. Knowledge and Interpersonal Skills to Develop Enhanced Relationships is an 8-week psychoeducational intervention to prevent psychological mistreatment among family caregivers to persons living with dementia by building healthy caregiving relationships. The investigators conducted a single-arm pre- and posttest study to assess KINDER‘s feasibility. A total of 45 caregivers enrolled, among whom 37 completed the follow-up survey (82.2% retention). Caregivers attended an average of 2.1 of 3 discussion sessions (SD = 0.76). Paired t-test analyses comparing outcomes at baseline and post-intervention demonstrated a statistically significant decrease in psychological mistreatment and relationship strain, and an increase in resourcefulness skills. These findings suggest KINDER is a feasible low- to moderate-intensity intervention to prevent psychological mistreatment with AD/ADRD caregiving. Future research will test KINDER‘s efficacy.

PMID:39886850 | DOI:10.1080/08946566.2025.2460835

S Afr J Surg. 2024 Dec;62(4):44-48.

ABSTRACT

BACKGROUND: Bowel trauma, encompassing injuries to the small and large intestine, represents a significant medical challenge due to its potential for morbidity and mortality. Management of bowel injuries remains surgical, but multiple factors influence the outcome in these patients. This study provides an in-depth analysis of the high-risk features of hollow visceral trauma in the ICU setting and the corresponding mortality rates, shedding light on the critical factors that influence outcomes in these cases.

METHODS: Retrospective review of patients admitted to the trauma intensive care unit (ICU) at Inkosi Albert Luthuli Hospital from January 2017 until September 2022 were reviewed to identify risk features associated with morbidity and mortality. Statistical analysis was performed using Python 3.10.

RESULTS: Ninety-four patients were reviewed, the majority (88.3%) were male and median age was 31.5 years. Mortality was 31.9%. The median length of stay in the ICU was 9.0 days (IQR 4-19 days, range 2-94 days). Small bowel injuries were more common than colonic injuries (75.3% vs 63.8%). Multiple colon injuries, renal injuries, extra hepatic biliary injuries and older age were associated with significant increase in mortality.

CONCLUSION: This study’s findings underscore the multifaceted nature of bowel injury management in an ICU population. A comprehensive, multidisciplinary approach that considers injury severity, anatomical site, and patient-specific factors is crucial for achieving favourable outcomes in bowel trauma cases.

PMID:39886827

S Afr J Surg. 2024 Dec;62(4):39-43.

ABSTRACT

BACKGROUND: Data on trauma burden and outcome varies amongst the nine South African Provinces. In Limpopo Province there is a paucity of data which this study aimed to quantify and characterise the severe trauma burden in the province.

METHODS: A retrospective chart review for all patients with injury severity score (ISS) > 16 over a 6-year period (Jan 2015-Dec 2020) at two central hospitals in Limpopo province. Descriptive analysis was undertaken of the following variables: patient demographics, injury patterns and outcomes.

RESULTS: The review identified 355 patients whose mean age was 31 years (Range 0.25-74 years). Eighty four per cent were males. Forty nine per cent were unemployed. The most common mechanisms of injury were interpersonal violence 49 % and motor vehicle crashes (MVCs) 34.9%. Head (41%), torso (25%) and limbs (15.2%) were the body-regions most frequently involved. The median ISS was 16 with IQR (16-16) (0). The median length of stay was 7 days with IQR (5-15) (10). Of the ICU admissions 50% were MVCs and 56% due to head injury. Of the 50 deaths 50% were due to MVC and pedestrian vehicle crashes (PVCs), and head injuries were present in 54% of those who died.

CONCLUSION: Young males were the most predominantly affected. Assault and MVC were the most common mechanisms of injury. The unemployment rate also seems to be a key factor in trauma epidemiology in the province. Further study of the wider trauma burden is required.

PMID:39886826

S Afr J Surg. 2024 Dec;62(4):35-38.

ABSTRACT

BACKGROUND: KwaZulu-Natal bears a significant trauma burden, with polytrauma patients often experiencing traumatic limb amputations. This study investigates traumatic limb amputations in the subgroup of severely injured polytrauma patients admitted to the trauma ICU in KwaZulu-Natal. This study aims to describe the management and outcomes of traumatic limb amputations in polytrauma patients at the trauma ICU.

METHODS: This retrospective observational study utilised data from the trauma ICU registry (BCA207/09). Descriptive methods were employed to analyse demographics, injury mechanisms, timing of amputations, anatomical sites affected, injury complexes, injury severity scores, and patient outcomes.

RESULTS: Twenty-three patients were included, with a mean age of 32 years. The most common injury mechanism was motor vehicle collision pedestrian (43%), 82% of included cases underwent early amputation. The left lower leg was the most frequently affected site (62%), with a median injury severity score (ISS) score of 25 (13-42) and median new injury severity score (NISS) of 34 (20-43). Most were ultimately above-knee amputations but started as below-knee amputations. Most patients were discharged to base (60.8%), while 22% died.

CONCLUSION: This study provides valuable insights into traumatic limb amputations in polytrauma patients, emphasising the need for comprehensive management strategies. The outcomes of traumatic limb amputations require optimised patient care and better rehabilitation services.

PMID:39886825