Tag: pubmed

JAMA Netw Open. 2025 Sep 2;8(9):e2529399. doi: 10.1001/jamanetworkopen.2025.29399.

ABSTRACT

IMPORTANCE: The cost-effectiveness of adding early in-bed cycling to usual physiotherapy among adults receiving mechanical ventilation in the intensive care unit (ICU) compared with usual physiotherapy alone is unknown.

OBJECTIVE: To evaluate the cost-effectiveness of in-bed cycling plus usual physiotherapy compared with usual therapy alone in the Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) randomized clinical trial.

DESIGN, SETTING, AND PARTICIPANTS: This trial-based economic evaluation with a 90-day time horizon compared early cycling plus usual physiotherapy vs usual physiotherapy alone from a societal perspective. Adult ICU patients (aged ≥18 years) receiving mechanical ventilation were recruited from 16 ICUs in Canada, the US, and Australia. Enrollment occurred from November 1, 2016, to May 30, 2023, with the last follow-up on August 3, 2023.

INTERVENTIONS: Intervention group participants were offered 30 minutes per day of cycling in addition to usual physiotherapy on weekdays, starting within the first 4 days of mechanical ventilation. Cycling continued until the patient could march on the spot for 2 consecutive days, ICU discharge, or for 28 days, whichever occurred first. Usual care participants were offered individualized physiotherapy according to local practices and patient alertness.

MAIN OUTCOMES AND MEASURES: Differences in costs (in 2024 Canadian dollars [CA$]) and quality-adjusted life-years (QALYs) between the groups were calculated. In the absence of dominance (ie, 1 strategy is associated with higher costs and fewer QALYs), the results were reported in terms of incremental cost per QALY gained.

RESULTS: The CYCLE trial recruited 360 patients (mean [SD] age, 61.5 [15.6] years; 205 male [56.9%]). The estimated per-patient cost associated with providing early in-bed cycling (CA$321) represented 0.5% of the index hospitalization costs (CA$66 554). The per-patient differences in 90-day costs (CA$5841; 95% CI, -CA$7666 to CA$18 797) and QALYs (-0.0009; 95% CI, -0.0185 to 0.0182) between cycling plus usual physiotherapy vs usual physiotherapy alone were not statistically different from 0. The probability of cycling plus usual physiotherapy to be cost-effective was 0.19 at a willingness-to-pay threshold of $50 000 per QALY gained.

CONCLUSIONS AND RELEVANCE: In this trial-based economic evaluation, the differences in costs and QALYs between adding early in-bed cycling to usual physiotherapy and usual physiotherapy alone for adults receiving mechanical ventilation were not significantly different from 0. These results highlight the need for additional cost-effectiveness studies considering the full body of evidence regarding in-bed cycling for critically ill patients.

PMID:40920382 | DOI:10.1001/jamanetworkopen.2025.29399

JAMA Netw Open. 2025 Sep 2;8(9):e2529885. doi: 10.1001/jamanetworkopen.2025.29885.

ABSTRACT

IMPORTANCE: Trisomy 13 (T13) and trisomy 18 (T18) are chromosomal abnormalities with high mortality rates in the first year of life. Understanding differences in long-term survival between children with full vs mosaic or partial trisomy is crucial for prognosis and health care planning.

OBJECTIVE: To examine the differences in 10-year survival between children with full T13 and T18 vs those with mosaic or partial trisomy.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study assessed liveborn infants with T13 and T18 in the Texas Birth Defects Registry (deliveries from January 1, 1999, to December 31, 2008). Follow-up was through December 31, 2018 (the last date available at the time of analyses) to allow for 10 years of follow-up for all infants. All analyses were conducted from January 1, 2022, to December 31, 2024.

EXPOSURES: Cytogenetic status (full trisomy vs mosaic or partial trisomy).

MAIN OUTCOMES AND MEASURES: The primary outcome was survival to 10 years of age, assessed using Kaplan-Meier survival estimates. The association between cytogenetic status and mortality by 10 years of age was assessed using Cox proportional hazards regression to generate hazard ratios (HRs). Population attributable fraction was calculated to determine the percentage of survival attributable to mosaic or partial trisomy status.

RESULTS: The study cohort included 798 infants (463 female infants [58.0%]; mean [SD] maternal age, 30.9 [8.0] years) with T13 (n = 295) or T18 (n = 503). Among all cases with T13, 25 infants (8.5%; 95% CI, 5.5%-12.3%) survived to 10 years of age. Similarly, among all infants with T18, 43 (8.6%; 95% CI, 6.3%-11.3%) survived to 10 years of age. Kaplan-Meier survival estimates to 10 years of age were statistically significantly higher among children with mosaic or partial trisomy (13 [25.0%] and 14 [43.8%], respectively) compared with full trisomy (12 [4.9%] and 29 [6.6%], respectively) (both P < .001). Infants with full trisomy had statistically significantly increased 10-year mortality hazards compared with those with mosaic or partial trisomy for both T13 (HR, 2.00; 95% CI, 1.42-2.82) and T18 (HR, 3.34; 95% CI, 2.08-5.38). The results of the calculated proportion of 10-year survival due to the presence of nonfull trisomy status (population attributable fraction) was 41.7% for children with T13 and 27.9% for children with T18.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study of infants with T13 and T18 support differences in long-term survival based on cytogenetic status and emphasize the need to potentially reassess the context of these conditions generally being considered incompatible with life, particularly for those with mosaic trisomies. These findings offer context surrounding treatment decisions, such as withholding interventions, for affected infants in the future.

PMID:40920381 | DOI:10.1001/jamanetworkopen.2025.29885

JAMA Netw Open. 2025 Sep 2;8(9):e2530804. doi: 10.1001/jamanetworkopen.2025.30804.

ABSTRACT

IMPORTANCE: Approximately 35% of individuals seeking abortion care use Medicaid for health insurance. Although the Hyde Amendment restricts use of federal funds for most abortions, states can supplement coverage using state funds. Understanding the scope of abortion coverage across states and potential barriers to access may help address health care inequities and inform interventions.

OBJECTIVE: To characterize state Medicaid abortion policies by conducting a qualitative analysis of publicly available state documents on Medicaid policy.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study analyzed Medicaid abortion policies across all 50 states and the District of Columbia (hereinafter, states). Data were systematically collected from publicly available Medicaid documents and state websites from May 2023 to February 2024.

MAIN OUTCOMES AND MEASURES: The main outcomes were key themes and descriptive statistics reporting on the scope of Medicaid abortion coverage and requirements for coverage across states, including documentation and procedures required of patients and physicians. Thematic analysis was performed to extract key themes found in abortion coverage policies, and descriptive statistics were used to show prevalence of identified themes across states.

RESULTS: The analysis of 94 documents revealed 3 key themes. First, the scope of coverage across states was heterogeneous. Eighteen states aligned with the current wording of the Hyde Amendment, 10 states described life endangerment without use of current Hyde Amendment wording, 17 states outlined additional coverage for other specified conditions for abortions, 6 states covered all abortions, and 1 state’s policy did not mention required federal coverage for rape or incest exceptions. Second, states imposed various patient restrictions and requirements with regard to abortion care coverage, with 22 states mandating reporting requirements for abortions due to rape or incest, along with other administrative hurdles for patients seeking care. Third, physicians were tasked with many responsibilities, such as determining eligibility for Medicaid abortion coverage and complying with documentation and administrative requirements. Thirty-eight states explicitly required physician certification and justification for clinical conditions warranting coverage.

CONCLUSIONS AND RELEVANCE: The findings of this qualitative study of state Medicaid abortion policies suggest that there is substantial heterogeneity among states regarding the scope of Medicaid abortion coverage and that there are numerous obstacles for patients and physicians in accessing this coverage. This heterogeneity and burden may impose an additional layer of complexity to abortion access. Measures and policies that improve transparency, clarity, and efficiency may enhance access to essential abortion care for vulnerable populations.

PMID:40920379 | DOI:10.1001/jamanetworkopen.2025.30804

JAMA Netw Open. 2025 Sep 2;8(9):e2530946. doi: 10.1001/jamanetworkopen.2025.30946.

ABSTRACT

IMPORTANCE: Black individuals have a twofold higher rate of prostate cancer death in the US compared with the average population with prostate cancer. Few guidelines support race-conscious screening practices among at-risk Black individuals.

OBJECTIVE: To examine structural factors that facilitate or impede access to prostate cancer screening among Black individuals in the US.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative, mixed-methods study was conducted between September 1, 2021, and December 31, 2023, in clinical and community settings across Washington, Wyoming, Alaska, Montana, Idaho, and Oregon. It included semistructured interviews with Black adults (aged ≥18 years) at risk for prostate cancer with or without a history of prostate-specific antigen (PSA) testing and a survey of primary care practitioners (PCPs) and urologists.

MAIN OUTCOMES AND MEASURES: Patient and physician experiences, knowledge, attitudes, and practices of PSA testing and prostate cancer screening were evaluated. Consensus coding and thematic analysis were used to analyze interviews; surveys were analyzed using descriptive statistics.

RESULTS: A total of 29 Black men (median [range] age, 59 [32-72] years) participated in the interviews, and 31 PCPs (including 30 phyicians and 1 physician assistant) and 32 urologists (45 of 63 aged 30-59 years [71.4%]; 40 male [63.5%]) participated in the survey. Interview participants perceived that PCPs function as gatekeepers in accessing PSA testing but may lack knowledge specific to Black men’s risk for prostate cancer and hold attitudes about PSA testing that do not support its use. Interview participants also reported a lack of trusted relationships with PCPs to support shared decision-making. While both urologists and PCPs were highly aware of US Preventive Services Task Force guidelines, PCPs were much less likely than urologists to believe in the value of PSA testing or the role of early detection to prevent prostate cancer-related mortality (2 [6.5%] vs 24 [75.0%], respectively).

CONCLUSIONS AND RELEVANCE: In this qualitative study examining structural factors associated with access to prostate cancer screening among Black individuals, findings from the survey supported participants’ perceptions that PCPs do not value PSA testing for prostate cancer early detection or appreciate its role in reducing the risk of prostate cancer-related mortality. Primary care practitioner reliance on USPSTF guidelines, which currently do not provide guideline recommendations for screening high-risk groups, including Black individuals, suggests that incorporating evidence-driven guidance for PSA screening among Black individuals into these guidelines may substantially improve prostate cancer early detection among this high-risk population.

PMID:40920378 | DOI:10.1001/jamanetworkopen.2025.30946

Environ Toxicol Chem. 2025 Sep 8:vgaf224. doi: 10.1093/etojnl/vgaf224. Online ahead of print.

ABSTRACT

Several micro- and nanoplastic particle (MNP) traits, like polymer type, size, and shape, have been shown to influence MNP toxicity. However, the direction and strength of these moderating effects are often unclear, and generalizations from single studies are challenging to establish. Meta-analyses increase generalizability and derive more accurate and precise effect size estimates by combining measurements from published studies. We conducted a meta-analysis to investigate the effects of MNP exposure on the reproductive output of water fleas of the genus Daphnia by aggregating 369 data points from 64 studies. We show that daphnids exposed to MNP produce, on average, 13.6 less neonates, a reduction of 20.8% compared to the particle-free controls (control mean = 65.37 neonates). This effect is moderated by MNP concentration, exposure duration, experimental temperature, and size category, with microplastics eliciting a stronger negative effect than nanoplastic particles. Shape category, species, age, polymer type, size (µm), fluorescence, modification type, presence of surfactant, and dissolved organic matter (DOM) did not influence effect sizes significantly. Based on the high residual heterogeneity in the data, we suggest that additional factors likely influence observed effects and discuss how better particle characterization could improve our understanding of the drivers of MNP toxicity.

PMID:40920353 | DOI:10.1093/etojnl/vgaf224

J Telemed Telecare. 2025 Sep 8:1357633X251372681. doi: 10.1177/1357633X251372681. Online ahead of print.

ABSTRACT

IntroductionTo investigate the effectiveness of the remote video-based Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) exercise program in individuals with rheumatoid arthritis (RA) with wrist involvement.MethodsSeventy-three individuals were included in the study. Wrist joint position sense, wrist joint range of motion, wrist pain, wrist morning stiffness, subjective and objective hand function, grip strength, and disease-related health status were assessed at baseline and after 12 weeks. Following the baseline assessment, participants were randomly assigned into two groups as SARAH and Control. All participants maintained their pharmacological therapy. The SARAH group received SARAH exercise videos via a free messaging platform (WhatsApp Messenger) weekly and performed the program daily for 12 weeks. No additional intervention was provided to the control group.ResultsForty-nine individuals (SARAH group = 28, control group = 21) completed all study procedures. Both per-protocol and intention-to-treat (ITT) analyses showed significant improvements in all parameters in the SARAH group (p < 0.05), while no statistically significant changes were detected in the control group (p > 0.05). When the changes were compared between the groups, SARAH group showed greater improvements regarding the changes in wrist joint position sense, wrist flexion, extension (only in ITT analysis) and radial deviation joint range of motion, wrist pain, wrist morning stiffness duration (only in ITT analysis), hand function, grip strength, and disease-related health status compared to the control group (p < 0.05).DiscussionA 12-week remote video-based SARAH exercise program provides additional benefits in individuals with RA who present wrist related problems when added to pharmacological therapy.

PMID:40920335 | DOI:10.1177/1357633X251372681

Biomol Biomed. 2025 Sep 8. doi: 10.17305/bb.2025.12919. Online ahead of print.

ABSTRACT

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which dysregulated interferon regulatory factor 5 (IRF5) may amplify pro-inflammatory pathways; prior genetic studies of IRF5 single-nucleotide variants (SNVs) in RA are inconsistent across populations and have not included mestizo Mexicans or evaluated rs59110799 in RA. We aimed to test whether four IRF5 SNVs (rs2004640G/T, rs2070197T/C, rs10954213G/A, rs59110799G/T) confer susceptibility to RA in women from Central Mexico. In a case-control study of 239 women with RA and 231 female controls (all self-identified Mexican-Mestizos, ≥3 generations), genotyping was performed by real-time PCR with TaqMan® probes; 80% of samples were duplicated (100% concordance) and control genotypes conformed to Hardy-Weinberg equilibrium. Association was assessed under allelic and multiple genetic models using logistic regression adjusted for age and birthplace, with Bonferroni correction for 23 tests (α=0.0022). Haplotype and linkage disequilibrium (LD) were analyzed with Haploview; putative functional effects were explored in silico (SNPinfo; GTEx). The minor alleles rs2004640T [OR=1.69, 95% CI 1.29-2.21; p=1.2×10⁻⁴], rs2070197C [OR=1.85, 1.39-2.46; p=2.0×10⁻⁵], and rs10954213A [OR=1.47, 1.12-1.93; p=0.002] were associated with increased RA risk after correction. Genotype-based associations were observed for rs2004640 (codominant and recessive) and rs2070197 (codominant, dominant, recessive). rs59110799G/T showed no significant association after correction (dominant model OR=1.69, 1.15-2.48; p=0.007). Nine haplotypes were identified; the haplotype carrying all four risk alleles (TCAT) was not associated, and two haplotypes with nominal signals (GCAG, TTGT) had control frequencies <1% and were excluded; variants were not in strong LD (r²<0.80). Our findings-providing the first evaluation of these IRF5 variants in Mexican women and the first report of rs59110799 in RA-support a role for IRF5 (rs2004640, rs2070197, rs10954213) in RA susceptibility in this Latin American population. Given the female-only design and moderate statistical power, replication and functional studies are warranted.

PMID:40920333 | DOI:10.17305/bb.2025.12919

Cell Mol Biol (Noisy-le-grand). 2025 Sep 8;71(8):22-29. doi: 10.14715/cmb/2025.71.8.4.

ABSTRACT

Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by joint inflammation. Given the side effects of conventional treatments, this study focuses on the anti-inflammatory effects of purslane (Portulaca oleracea) and turmeric (Curcuma longa). The research is driven by the growing demand for plant based-treatment for safer therapeutic options for RA management. Five groups were formed; the control group included only healthy rats and was used for baseline comparison. RA was experimentally induced in male rats using Complete Freund’s Adjuvant (CFA). Treated groups received extracts of purslane, turmeric and combination of both and one group was left untreated (RA group). Bioactive compounds in plant extracts were identified by GC-MS analysis. Paw edema and body weight were monitored thrice weekly for statistical analysis, and neutrophil counts were assessed microscopically. Enzyme-linked immunosorbent assay (ELISA) was used to quantify the inflammatory biomarkers including IL-1, TNF-α, IL-6, IL10, CD14, CD4, MMP-1, alongside measuring cyclic citrullinated peptide (anti-CCP) levels. CFA-induced RA significantly increased paw edema, neutrophil counts (P<0.0001), and elevated levels of anti-CCP, CD4, IL-1, IL-6, and TNF-α compared to the control group (P<0.001). Treatments with purslane, turmeric and combination reduced paw swelling and these inflammatory markers in RA induced rats significantly (P< 0.01). Despite the increasing serum level of MMP-1, CD14 and IL-10 the reduction by plant extract did not show significant results. It is concluded that the bioactive compounds in the purslane and turmeric have anti-inflammatory effects through reducing inflammatory markers in RA induced rats.

PMID:40920325 | DOI:10.14715/cmb/2025.71.8.4

Cell Mol Biol (Noisy-le-grand). 2025 Sep 8;71(8):67-71. doi: 10.14715/cmb/2025.71.8.10.

ABSTRACT

Hormonal status and lymphatic invasion are two important prognostic factors among cases of breast cancer. This study aims to assess and evaluate the hormonal receptor status and lymph node involvement among female breast cancer patients in Duhok city, Kurdistan region, Iraq. A retrospective cross-sectional study was conducted, involving 156 diagnosed cases of breast cancer who had undergone surgical treatment and laboratory investigations at Azadi Teaching Hospital and Duhok Private Hospital for 30 months. Hormonal status (ER, PR, HER2 enriched, and Ki67), luminal staging, and lymphatic invasions were analyzed using SPSS version 26. Invasive ductal carcinoma not otherwise specified accounted for 87.8% of the total sample, with Luminal A being the most common form (42.31%), followed by Luminal B (37.17%). The prevalence of hormonal status among cases of breast cancer with lymphatic invasion was ER 42.5%, PR 41.2%, HER2 enriched 21.01%, and Ki67 36.8%; however, these differences were not statistically significant (P values: 0.586, 0.65, 0.253, and 0.469, respectively). In conclusion, invasive ductal carcinoma is the most common histological type of breast cancer, and the most frequent biological form is Luminal A. A significant number of breast cancer cases with positive lymphatic invasion show positive hormonal receptor levels; however, the number of lymphatic invasions is not correlated with the type of hormonal receptor positivity.

PMID:40920319 | DOI:10.14715/cmb/2025.71.8.10

Cell Mol Biol (Noisy-le-grand). 2025 Sep 8;71(8):80-88. doi: 10.14715/cmb/2025.71.8.12.

ABSTRACT

The global epidemic of overweight and obesity is closely linked to the development of chronic kidney disease (CKD), with extremely obese individuals facing a particularly high risk. This study aimed to assess the relationship between lipid profile levels, SIRT1 expression, and RNA-34a-5P in the regulation of blood lipid levels among severely obese individuals with renal diseases. Conducted over six months in three specialized hospitals, the study included 100 participants divided into two groups: 50 obese individuals with renal diseases and 50 obese controls without renal problems. Ethical standards, including confidentiality and informed consent, were strictly observed. Biochemical assessments included measurements of total cholesterol, LDL, HDL, triglycerides, creatinine, GFR, SIRT1 protein (via Western blotting), and RNA-34a-5P expression (via qPCR). Statistical analysis was performed using SPSS v26 and Pearson’s correlation. The results revealed a negative association between RNA-34a-5P expression and total cholesterol, LDL, triglycerides, and SIRT1 expression, while a positive but non-significant association was found with HDL and GFR. Notably, SIRT1 expression was significantly downregulated in the patient group compared to controls. These findings provide compelling evidence that SIRT1 expression is markedly reduced in extremely obese individuals with renal diseases, suggesting a potential molecular link between SIRT1, lipid metabolism, and renal dysfunction in severe obesity.

PMID:40920317 | DOI:10.14715/cmb/2025.71.8.12