Tag: pubmed

BMC Pregnancy Childbirth. 2025 Dec 17. doi: 10.1186/s12884-025-08579-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Group Antenatal Care (G-ANC) has emerged as an innovative model for improving maternal health service delivery in low- and middle-income countries (LMICs). This study assessed the utilization, satisfaction, and perceived effectiveness of G-ANC among pregnant women attending selected primary healthcare centers in Karu Metropolis, Nasarawa State, Nigeria.

METHODOLOGY: A descriptive cross-sectional study was conducted among 450 pregnant women systematically sampled from primary healthcare facilities. Data were collected using structured interviewer-administered questionnaires and analyzed using descriptive statistics and chi-square tests for associations (p < 0.05). Variables explored included socio-demographics, obstetric history, complications, G-ANC experiences, and perceived barriers to care.

RESULTS AND DISCUSSION: Most respondents (72.9%) were aged 20-25, with a majority being married (81.1%) and housewives (80%). A high proportion (85.8%) reported experiencing complications during pregnancy, notably hemorrhage (28.9%) and infections (52%). G-ANC was widely utilized, with 88.4% attending 7-9 sessions. Satisfaction with G-ANC services was high (88.4%), and 75.6% strongly agreed that G-ANC improved their understanding of antenatal care. Institutional delivery uptake was 95.6%, and 84.9% perceived that G-ANC contributed to reducing maternal morbidity and mortality. However, financial (36%) and geographic barriers (49.3%) persisted, and 28.4% reported delays in seeking care. G-ANC was well-accepted, enhanced maternal health literacy, and improved institutional delivery rates. However, barriers such as transportation and financial constraints limited optimal care-seeking. The findings align with similar Nigerian studies showing high satisfaction with G-ANC but call for system-level interventions. Integration of financial support schemes, community engagement, male involvement, and improved infrastructure are necessary for broader impact.

CONCLUSION: G-ANC presents a promising strategy to enhance maternal health outcomes in LMICs. Strategic scale-up, system-wide support, and longitudinal evaluations are essential to optimize its potential and address persistent health system barriers.

PMID:41408528 | DOI:10.1186/s12884-025-08579-9

BMC Pediatr. 2025 Dec 17. doi: 10.1186/s12887-025-06396-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Valsalva maneuvers are the initial line in management of paroxysmal supraventricular tachycardia in hemodynamically stable children. This study aimed to compare the efficacy of modified versus standard Valsalva maneuvers on the clinical outcomes and satisfaction of children with paroxysmal supraventricular tachycardia.

METHODS: The study used randomized controlled trial and recruited ninety children with paroxysmal supraventricular tachycardia from Pediatric Emergency Department and Pediatric Cardiac Intensive Care Unit at Tanta University Hospitals, El-Gharbia Governorate, Egypt. The researchers divided the studied children into three equal groups of thirty. A control group that received conventional hospital care, an intervention group I that received modified Valsalva maneuver plus conventional hospital care, and an intervention group II that received standard Valsalva maneuver plus conventional hospital care. The primary outcome was the return to sinus rhythm within the first 5 min of admission and the secondary outcomes were decreased dyspnea, decreased antiarrhythmic therapy use, length of stay time in hospital as well as children’s satisfaction.

RESULTS: More than half (53.3%) of the children who received the modified Valsalva maneuver returned to sinus rhythm within the first five minutes post-implementation compared to 33.3% of the children who received the standard Valsalva maneuver. Children within modified Valsalva maneuver group had a mean satisfaction score of 25.56 ± 1.67 that was significantly higher than those in the standard Valsalva maneuver group’s score of 20.10 ± 2.57 (P = 0.0001).

CONCLUSION: The modified version of the Valsalva maneuver was significantly more effective than the standard Valsalva maneuver in terminating supraventricular tachycardia and improving children’s clinical outcomes. This included a decrease in the degree of dyspnea within the first minute from severe to moderate and reducing the need for administering antiarrhythmic drugs for management of SVT episodes. Additionally, children in the MVM group had a higher mean satisfaction score than those in the SVM group, with highly statistically significant differences.

TRIAL REGISTRATION: PACTR202407479098909. Registered 15/07/2024.

PMID:41408522 | DOI:10.1186/s12887-025-06396-9

BMC Cancer. 2025 Dec 17. doi: 10.1186/s12885-025-15458-1. Online ahead of print.

ABSTRACT

BACKGROUND AND AIM: Melanomagenesis involves genetic alterations affecting multiple oncogenic pathways, with BRAF and NRAS mutations representing frequently studied drivers. Recent evidence suggests melanoma development encompasses a broader spectrum including KIT mutations and novel variants exhibiting population-specific patterns. This study aimed to characterize the genetic landscape of melanomagenesis by analyzing BRAF, NRAS, KIT and novel mutations across melanoma subtypes in a Turkish cohort.

METHODS: Sixty-six genetic materials from 55 melanoma patients (2000-2016) were analyzed using targeted next-generation sequencing of 17 melanoma-relevant genes. Mutation profiling characterized genetic diversity across histological subtypes, with associations between molecular alterations and clinicopathological parameters evaluated using Fisher’s exact test and Kruskal-Wallis test.

RESULTS: Significant genetic diversity was observed, with 60% of cases harboring mutations. Analysis identified 22 wild-type cases, 13 BRAF mutations (23.6%), 4 NRAS mutations (7.3%), 6 KIT mutations (10.9%), and various alterations in TP53, KNSTRN, KRAS, PIK3CA, CDKN2A, OXA1L, and RAC1. Multiple concurrent mutations occurred in 5 cases (9.1%). Notably, BRAF mutation patterns differed substantially from Western populations: complete absence in superficial spreading melanomas (0.0% versus 50-70% in Caucasian cohorts) with enrichment in nodular melanomas (36.4%). KIT mutations showed significant enrichment in mucosal melanomas (33.3%, P = 0.003). A novel OXA1L frameshift mutation (p.A54Sfs*100) was identified.

CONCLUSION: Melanomagenesis in the Turkish population demonstrates substantial genetic diversity with population-specific mutation patterns that diverge from Western paradigms. The absence of BRAF mutations in superficial spreading melanomas suggests distinct genetic pathways potentially related to different UV exposure patterns, genetic susceptibility, or gene-environment interactions. These findings have important implications for precision medicine, as therapeutic strategies developed in Western populations may require adaptation for diverse ethnic groups. Comprehensive genomic profiling including NF1 in larger multi-institutional cohorts is needed to fully characterize population-specific melanomagenesis mechanisms.

PMID:41408518 | DOI:10.1186/s12885-025-15458-1

J Dent Res. 2025 Dec 17:220345251399558. doi: 10.1177/00220345251399558. Online ahead of print.

ABSTRACT

Chronic apical periodontitis (CAP) is a persistent inflammatory condition caused by microbial infections in the root canal system, leading to bone loss and tissue damage. In this study, we tested the hypothesis that maresin 1 (MaR1), a specialized proresolving mediator, facilitates inflammatory resolution and promotes bone healing in CAP. We developed a CAP model in mice through pulp exposure. Animals received intracanal administration of either MaR1 or a vehicle. Micro-computed tomography (micro-CT) was used to analyze lesion size and bone volume changes. Inflammatory cell infiltration was assessed in hematoxylin and eosin-stained sections, and microbial diversity was analyzed using next-generation sequencing. The role of regulatory T cells (Tregs) was further explored through diphtheria toxin-induced depletion of Tregs in Foxp3eGFP/IL17 transgenic mice. All statistical analyses were performed using parametric methods, as confirmed by the Shapiro-Wilk test for data normality. Analysis of variance with Tukey’s post hoc and Bonferroni-corrected t tests was applied. P < 0.05 was considered significant. In 2-dimensional analyses, a significant difference was observed between the control and lesion groups, supporting the validity of the experimental model. MaR1 treatment significantly reduced lesion size (P < 0.0001). The bone volume/total volume ratio was significantly higher in the MaR1 group than in the vehicle group (P < 0.05). Bone mass was reduced in the lesion group, whereas MaR1 treatment significantly alleviated this loss (P < 0.05). The number of inflammatory cells was significantly lower in the MaR1 group compared to the vehicle group (P < 0.05). MaR1 also reduced Enterococcus faecalis, a key pathogen in persistent infections. This study highlights MaR1 as a promising treatment for chronic apical periodontitis, showing benefits in resolving inflammation, preserving bone, and reducing E. faecalis. Unlike conventional therapies, MaR1 supports immune modulation and tissue repair.

PMID:41408494 | DOI:10.1177/00220345251399558

J Robot Surg. 2025 Dec 18;20(1):97. doi: 10.1007/s11701-025-03063-0.

ABSTRACT

Buccal mucosa graft (BMG) ureteroplasty has emerged as a versatile technique for managing long-segment or complex ureteral strictures. However, the optimal surgical approach-Robotic-Assisted (RAS), Laparoscopic, or Open surgery-remains debated. We aimed to systematically evaluate and compare the perioperative outcomes and safety profiles of these three modalities. A systematic literature search was conducted in PubMed, Embase, and Web of Science up to November 2025, following PRISMA 2020 guidelines. Studies reporting outcomes of BMG ureteroplasty via robotic, laparoscopic, or open approaches were included. The primary outcome was surgical success rate. Secondary outcomes included operative time, hospital stay, and complication rates (total and Clavien-Dindo ≥ 3). Statistical analysis was performed using R software with a Generalized Linear Mixed Model (GLMM). Sixteen studies involving 398 patients (Robotic: n = 256; Laparoscopic: n = 98; Open: n = 44) were included. The pooled surgical success rates were uniformly high across all groups: Robotic (90.4%), Laparoscopic (92.5%), and Open (90.9%), with no statistically significant differences (P > 0.05). However, regarding safety, the robotic approach demonstrated a superior profile. Despite managing complex cases, the robotic cohort exhibited a minimal incidence of major complications (Clavien-Dindo ≥ 3) compared to laparoscopic and open groups. Sensitivity analysis confirmed the robustness of these findings, indicating that the efficacy of RAS is generalizable and not driven by single-center data. Robotic-assisted BMG ureteroplasty achieves excellent functional outcomes comparable to the open gold standard and the laparoscopic approach. In terms of safety, RAS demonstrates a favorable profile with a marked reduction in severe perioperative complications compared to laparoscopic and historical open cohorts. Consequently, RAS represents a safe and effective minimally invasive alternative for complex ureteral reconstruction, offering durability comparable to open repair with minimized morbidity.

PMID:41408485 | DOI:10.1007/s11701-025-03063-0

J Hum Genet. 2025 Dec 17. doi: 10.1038/s10038-025-01443-w. Online ahead of print.

ABSTRACT

Transmembrane protein 53 (TMEM53) is an outer nuclear membrane protein that plays a crucial role in maintaining skeletal homeostasis. Pathogenic variants in TMEM53 have been identified as the genetic cause of craniotubular dysplasia, Ikegawa type (CTDI), a rare form of sclerosing bone dysplasia characterized by skull hyperostosis, cranial deformities, and increased bone density. To date, the causal association of bi-allelic pathogenic variants of TMEM53 in CTDI has been identified in 14 patients from eight unrelated families. Mechanistically, TMEM53 negatively regulates BMP-SMAD signaling by restricting the nuclear import of phosphorylated SMAD1/5/9, thereby modulating osteoblast differentiation and bone formation. This review summarizes the current understanding of TMEM53 function and the consequences of its deficiency. We aim to clarify genotype-phenotype correlations, outline therapeutic prospects for CTDI, and explore the distinct mechanisms underlying cranial and tubular bone formation.

PMID:41408477 | DOI:10.1038/s10038-025-01443-w

Intensive Care Med Exp. 2025 Dec 18;13(1):131. doi: 10.1186/s40635-025-00843-8.

ABSTRACT

BACKGROUND: Patients with severe acute pancreatitis (SAP) frequently develop hypoxic acute respiratory failure (AHRF), with a mortality rate as high as 37%. However, the optimal partial pressure of oxygen (PaO₂) for SAP patients remains unclear to date. This study aims to investigate whether partial pressure of oxygen is associated with mortality in SAP patients.

METHODS: A retrospective cohort study was conducted on patients with severe acute pancreatitis (SAP) admitted to the First Affiliated Hospital of Nanchang University from 2015 to 2024. Propensity score matching (based on whether arterial oxygen partial pressure PaO₂ ≥ 80 mmHg during the first 3 days after ICU admission, assigning patients to the liberal PaO₂ group or conservative PaO₂ group), univariate logistic regression analysis, Cox regression analysis, subgroup analysis, Kaplan-Meier (K-M curve) survival analysis, and sensitivity analysis were employed to thoroughly evaluate the association between PaO₂ and mortality in SAP patients. The primary outcome was 28-day mortality.

RESULTS: The study included 1585 patients. We found that higher PaO₂ was associated with lower 28-day mortality rates. In logistic regression analysis after propensity score matching, the incidence rates of adverse outcomes such as persistent circulatory failure (OR 0.50; 95% CI 0.35-0.69; P < 0.001) and persistent multiple organ failure (OR 0.60; 95% CI 0.47-0.78; P < 0.001) significantly decreased. The K-M curve demonstrated significant reductions in 28-day mortality (P = 0.02), 90-day mortality (P = 0.0079), and overall mortality (P = 0.008) in the liberal PaO₂ group, with all P values showing statistical significance. Subgroup analysis revealed that the association between higher PaO₂ and mortality in SAP patients varied across different age groups, BMI values, SIRS and APACHE II scores, and smoking status. Sensitivity analysis demonstrated stable results after excluding specific populations. On the third day of ICU admission (P = 0.016), higher PaO₂ correlated with improved outcomes compared to the conservative group, particularly when PaO₂ stabilized around 100 mmHg.

CONCLUSIONS: Early maintenance of higher PaO₂ (≥80 mmHg) during the initial ICU period was associated with lower mortality.

PMID:41408473 | DOI:10.1186/s40635-025-00843-8

Eur J Pediatr. 2025 Dec 18;185(1):25. doi: 10.1007/s00431-025-06680-x.

ABSTRACT

Limiting healthcare-associated infections (HAI) SARS-CoV-2 transmission has been a global challenge. We assessed characteristics of pediatric SARS-CoV-2 HAI outbreaks to better understand HAI transmission in pediatric care. We analyzed PCR-confirmed SARS-CoV-2 outbreak cases notified through statutory surveillance, at case level and at outbreak level, in Germany between 24 February 2020 and 31 December 2023 to describe SARS-CoV-2 HAI outbreaks in pediatric care and compare them with non-pediatric outbreaks. Pediatric outbreaks included any outbreak in pediatric care or with > 50% of cases among patients aged < 18 years. We calculated age-disaggregated median monthly incidences of SARS-CoV-2 HAI outbreak cases per 100,000 hospitalizations using reimbursement data. Among 36,371 SARS-CoV-2 HAI hospital outbreak cases from 3191 outbreaks, we identified 25 pediatric outbreaks with 241 cases. Of 218 cases with case status information, 181 (83%) were healthcare workers (HCW) and 37 (17%) were patients < 18 years old. Among all 241 cases, five (2%) were severe including one death case whereas 2580 (7%) of non-pediatric HAI cases were severe and 2736 (8%) deaths. Age-disaggregated median monthly outbreak case incidence < 18 years (0.3/100,000 hospitalizations; range 0.1-7.6) was markedly lower than among the non-pediatric age group of 18-59-year olds (14.8/100,000 hospitalizations; range 0.1-215.7).

CONCLUSION: Our results suggest limited SARS-CoV-2 HAI transmission in pediatric care. The high proportion of cases among HCW in pediatric outbreaks underlines the need to protect HCW from infections to further limit HAI transmission. Our findings highlight the value of outbreak surveillance for monitoring HAI transmission patterns in vulnerable sub-groups such as pediatric patients.

WHAT IS KNOWN: • Children and adolescents experience less severe SARS-CoV-2 illness. • Pediatric care poses unique infection prevention and control challenges.

WHAT IS NEW: • Pediatric outbreaks were very rare with few severe cases suggesting that pediatric care was less affected by SARS-CoV-2 outbreaks. • Most cases in pediatric outbreaks occurred among healthcare workers pointing to the need to protect HCW from infections and a limited role of pediatric patients and caregivers.

PMID:41408457 | DOI:10.1007/s00431-025-06680-x

Dig Dis Sci. 2025 Dec 17. doi: 10.1007/s10620-025-09620-9. Online ahead of print.

ABSTRACT

BACKGROUND: The proton pump inhibitors (PPIs) are widely prescribed for the treatment of dyspepsia and heartburn. However, their use carries the long-term potential for drug-drug interactions, osteopenia, opportunistic infections, adverse cardiovascular outcomes, and altered gut microbiome. Proper indication for and PPI dose optimization would be clinically beneficial.

AIMS: Examine the use of endoscopy with esophageal 96-h ambulatory pH monitoring with patients off- and on-PPI, to guide clinicians in prescribing PPI, thereby minimizing inappropriate use, or adverse effects. Specifically, examine (1) the prevalence of normal and abnormal acid exposure time (AET) in PPI users and non-users; (2) the degree, if any, of restrictive diet on AET in the presence or absence of PPI use. We hypothesized that such patients would have inadequate esophageal pH control and that restrictive diet would be beneficial.

PATIENTS AND METHODS: Retrospective cohort study of consecutive patients presenting with PPI-refractory symptoms of gastroesophageal reflux disease (GERD). All patients underwent an endoscopy with wireless esophageal ambulatory pH monitoring performed either off-PPI or on-PPI therapy for 96 h, following a “liberal diet” for the first 48 h and a “restricted diet” for the latter 48 h of the study. AET was defined as the % time the pH in the distal esophagus was < 4.0; values ≥ 6% per 24 h defined an abnormal AET off-PPI. Control of AET on-PPI was defined as distal esophageal pH < 4 < 1.6% total time. For each patient, the average from the first 2 days (on liberal diet) was considered as the baseline AET and was compared with the average from the latter 2 days (on restricted diet). Depending on the baseline (first 48 h) AET, patients were further divided into 2 groups: those with normal and those with abnormal AET.

RESULTS: We studied 54 consecutive patients with PPI-refractory GERD symptoms. There were 2 groups: those who underwent pH monitoring off-PPI (n = 32) and those who were studied on-PPI (n = 22). In the off-PPI group, there were 26 women (81%) and 6 men (19%), median age 59 years (range 43-76). In the on-PPI group, there were 16 women (73%) and 6 men (27%), median age 66 years, (range 44-78). Of the 32 patients studied off-PPI, 12 (38%) exhibited abnormal AET (% > 6), while the remaining 20 (62%) had normal AET. Of the 22 patients studied on-PPI, 7 (32%) exhibited abnormal AET (% > 1.6), while 15 (68%) had normal AET. The dietary restriction had a statistically significant impact on reducing and (often normalizing) AET in both PPI users and non-users.

CONCLUSIONS: Together with endoscopy, ambulatory 96-h pH monitoring, is feasible and well-tolerated. Most patients (62-68%) with symptomatically PPI-refractory GERD studied either off- or on-PPI, exhibit normal AET. Restrictive diet has a favorable impact on AET in most such patients, but its long-term impact remains unknown.

PMID:41408433 | DOI:10.1007/s10620-025-09620-9

J Cancer Res Clin Oncol. 2025 Dec 17;152(1):14. doi: 10.1007/s00432-025-06377-6.

ABSTRACT

BACKGROUND: Thyroid cancer (TC) is one of the most prevalent endocrine malignancies, and its recurrence presents a major clinical challenge that can adversely affect patient prognosis and treatment outcomes. Despite the progress in diagnostic methods, traditional statistical models still face limitations in accurately predicting TC recurrence due to the intricate interactions between clinical and pathological factors.

METHODS: To address this challenge, the study presented a novel stacking ensemble learning framework for TC recurrence prediction. The dataset included a total of 383 patients, comprising 108 recurrence and 275 non-recurrence cases, and was stratified into training set (n = 268) and testing set (n = 115) using a 70:30 ratio. The proposed stacking framework integrated three heterogeneous base learners, namely Stochastic Gradient Descent (SGD), Extra Trees (ET), and Decision Trees (DT) with eXtreme Gradient Boosting (XGBoost) as the meta learner. The hyperparameter optimization of various learners was performed through 5-fold cross-validation on the training set. The model performance was evaluated on testing set using accuracy, precision, recall, F1-score, AUC, and Brier score (BS). To enhance the model’s interpretability, the Shapley Additive Explanations (SHAP) method was utilized to identify the overall top influential factor and provide local interpretation for specific individual patient based model outcome.

RESULTS: The proposed stacking model achieved accuracy of 96.52%, precision of 96.67%, recall of 90.62%, and F1-Score of 93.55%, AUC of 0.9921 on the testing set. The SHAP analysis revealed the top 5 critical factors to TC recurrence, including treatment response, age, N-stage, risk stratification, and adenopathy. Furthermore, an interactive and user-friendly prediction tool, TCCheck, was developed based on optimized stacking model, accessible online at https://tccheck-prediction-tool.streamlit.app/ .

CONCLUSION: The study presented an effective and interpretable stacking ensemble learning framework for predicting TC recurrence. By deploying the proposed framework as a web prediction tool, it enables explainable and individualized clinical decision support, thereby enhancing its translational value in real-world settings. Furthermore, the framework serves as a methodological reference for recurrence prediction in other cancer types.

PMID:41408410 | DOI:10.1007/s00432-025-06377-6