Tag: pubmed

Cancer Biother Radiopharm. 2025 Oct 6. doi: 10.1177/10849785251379696. Online ahead of print.

ABSTRACT

Colorectal cancer (CRC) remains a significant factor contributing to the morbidity and mortality rates linked with cancer throughout the world, especially in its stages of progression. Increasingly attractive therapeutic options include immune modulation combined with preoperative chemotherapy and radiation therapy (CRT). Recent studies have revealed that the protein serine peptidase inhibitor Kazal type 4 (SPINK4), which is abundantly expressed in gastrointestinal tract tissues, plays a role in immune evasion and treatment resistance in cancers. This meta-analysis aims to assess the relationship between SPINK4 expression levels and the therapeutic effectiveness of radiolabeled immune modulators in patients with advanced CRC who are undergoing preoperative chemotherapy and radiation treatment. The degree of SPINK4 expression and a lower objective response to radiolabeled immune modulators showed a statistically significant link. Conversely, patients with low SPINK4 expression have more favorable treatment responses and ongoing clinical improvement following CRT. High SpINK4 expression can act as a negative prognostic biomarker for radiolabeled immune control in advanced CRC.

PMID:41047949 | DOI:10.1177/10849785251379696

Br J Clin Pharmacol. 2025 Oct 6. doi: 10.1002/bcp.70308. Online ahead of print.

ABSTRACT

AIMS: The Medicines and Healthcare products Regulatory Agency (MHRA) introduced a risk-proportionate approach to assess clinical trial applications for authorisation in August 2023. This study evaluates the impact of this approach on the timelines for reviewing proposals.

METHODS: Data on new clinical trial initial submissions and substantial amendments were extracted from the MHRA’s clinical trials unit database. The primary endpoint was the number of days for the MHRA’s first review of initial applications. The secondary endpoints were the days taken by the sponsor’s replies to grounds for nonacceptance, the MHRA’s days to issue the final decision and the percentage of reviews within statutory timelines. For substantial amendments, the days for the final decision and the percentage of statutory timelines met were the endpoints.

RESULTS: Between September 2023 and August 2024, 4617 applications were received, 615 relating to initial clinical trial submissions, while 4002 were substantial amendments. The first review was completed within the statutory timelines for 99% of submissions, with a median of 28 days (interquartile range [IQR] 27-30); 48.5% of sponsors’ replies to grounds for nonacceptance met the statutory timelines with no statistically significant difference between the commercial and noncommercial sponsors (median 15 days, IQR 9-22). The final decision from the MHRA was within the nonstatutory timelines (median 15 days, IQR 13-27); 99.9% of the substantial amendments were completed within the statutory timelines (median 31 days, IQR 24-34).

CONCLUSION: The MHRA’s risk-proportionate approach enabled the Clinical Trials Unit to consistently meet its timelines, confirming its reliability, consistency and predictability while maintaining its priority to protect patient safety.

PMID:41047928 | DOI:10.1002/bcp.70308

Disaster Med Public Health Prep. 2025 Oct 6;19:e289. doi: 10.1017/dmp.2025.10199.

ABSTRACT

OBJECTIVE: Earthquakes cause significant mortality and morbidity, particularly through crush injuries and their complications. This study aimed to evaluate whether systemic immune inflammation index (SII) and Pan-immune inflammatory values (PIV) obtained from complete blood count parameters can predict intensive care needs, dialysis requirements, and mortality in patients with crush injuries following earthquake.

METHODS: We retrospectively analyzed data from 76 patients with crush injuries admitted to a university hospital following the earthquake. Blood samples were collected upon admission. SII and PIV were calculated and compared with conventional laboratory markers for their ability to predict clinical outcomes.

RESULTS: Intensive care unit (ICU) admission was required in 40.8% of patients, and 21.1% required dialysis. In ROC analysis, an SII value above 1372 predicted ICU admission with 67.7% sensitivity and 66.7% specificity (P < .001), while an SII value above 1735 predicted dialysis requirement with 75.0% sensitivity and 73.3% specificity (P < .001). Similarly, a PIV value above 1345 predicted ICU admission with 74.2% sensitivity and 73.3% specificity (P < .001), and a value above 1906 predicted dialysis requirement with 81.3% sensitivity and 78.3% specificity (P < .001).

CONCLUSIONS: Complete blood count-derived inflammatory markers may serve as accessible, early indicators to complement clinical assessment for resource allocation following earthquake-related crush injuries, particularly in resource-limited disaster settings. These tools may aid in patient triage and care planning when comprehensive laboratory testing is limited.

PMID:41047911 | DOI:10.1017/dmp.2025.10199

J Matern Fetal Neonatal Med. 2025 Dec;38(1):2566235. doi: 10.1080/14767058.2025.2566235. Epub 2025 Oct 6.

ABSTRACT

OBJECTIVE: To evaluate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and other related indices measured at the time of admission for threatened preterm labor and their association with the risk of preterm birth.

METHODS: A prospective observational cohort study was conducted between January 2021 and December 2023 at two regional maternity hospitals. Blood samples were collected from all patients upon hospitalization, prior to the administration of any medical treatment. Patients were categorized into two groups based on delivery time: preterm birth and term delivery. The preterm birth group was further subdivided into early preterm birth (<34 weeks) and late preterm birth (34-36.6 weeks). Demographic characteristics, complete blood count parameters, and systemic inflammatory indices were compared across these groups. To identify independent predictors of preterm birth and early preterm birth, multivariate logistic regression analysis was performed.

RESULTS: The final analysis included 311 pregnant women admitted for threatened preterm labor. The preterm birth group had a higher maternal age and a lower gestational age at admission compared to the term delivery group (p = 0.04, p = 0.02, respectively). The preterm group was statistically associated with higher WBC, neutrophil count, monocyte count, and platelet count. Furthermore, the median NLR, SII, and SIRI values were significantly higher in the preterm group. After adjusting for confounders multivariate regression analysis showed that higher levels of NLR and SII were independently associated with an increased risk of preterm birth.

CONCLUSION: We found that NLR and SII are independent prognostic markers for preterm birth in patients with TPTL, and they demonstrate superior prognostic ability compared to single hemogram parameters.

PMID:41047899 | DOI:10.1080/14767058.2025.2566235

Jpn J Nurs Sci. 2025 Oct;22(4):e70026. doi: 10.1111/jjns.70026.

ABSTRACT

AIM: To evaluate the feasibility of a breast stimulation program using a breast pump shortly after cesarean section (CS) to enhance the onset of lactogenesis II.

METHODS: We used a convergent mixed-methods design. It provided an overall picture through quantitative results, which were complemented by qualitative findings. The results were presented using a joint display. Participants were full-term women who underwent CS at a regional perinatal hospital and nurse-midwives from January to March 2025. The program included: (1) providing information about breastfeeding after CS; and (2) providing breast pump-mediated nipple stimulation, starting within 6 h postpartum and continuing until day 2, at least four times daily under researcher supervision. Main outcomes focused on the feasibility of the program, including acceptability, practicality, and implementation. An eight-item questionnaire and open-ended questions were administered. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using content analysis.

RESULTS: Seven full-term women with planned CS and 29 nurse-midwives. Most used a breast pump four times within the first 24 h after CS. Women were satisfied with painless nipple stimulation and early milk expression. Both designs complemented each other, and the program was deemed acceptable based on early postpartum breast milk volume data. Identified challenges included pump operability, individual adaptation, and preparation time.

CONCLUSION: The breast stimulation program initiated shortly after CS was feasible, well accepted, and aspects of breast milk volume. A future randomized controlled trial should consider individual differences and adjustments in the frequency of breast pump usage.

PMID:41047890 | DOI:10.1111/jjns.70026

Disaster Med Public Health Prep. 2025 Oct 6;19:e276. doi: 10.1017/dmp.2025.10206.

ABSTRACT

OBJECTIVES: To compare the effectiveness of tabletop exercises (TTX) and high-fidelity in-person simulations (IPS) in improving knowledge, confidence, and perceived preparedness in disaster medicine among emergency medicine residents.

METHODS: A prospective, randomized educational intervention was conducted across 2 urban emergency medicine residency programs. Sixty-three residents were randomized to TTX or IPS groups. Each group completed a preintervention knowledge and confidence assessment, participated in their assigned exercise based on a simulated mass casualty incident (MCI), and underwent a structured debrief. Postintervention surveys assessed change in knowledge and self-reported comfort levels. A paired 2-tailed Student’s t-test was utilized to compare results. Statistical significance was defined as P < 0.01.

RESULTS: Both groups demonstrated increased self-reported confidence and knowledge regarding management of MCIs. TTX participants showed higher median post-test scores (77.4%, N = 38) compared to IPS participants (67.4%, N = 25). Results were not statistically significant (P = 0.079).

CONCLUSIONS: TTX is an effective modality for disaster medicine education, with outcomes comparable to IPS. While TTX may better align with knowledge-based assessments, IPS remains essential for practicing real-time decision-making under stress. Combining these 2 modalities may provide both the knowledge base and psychological duress required for robust disaster scenario training.

PMID:41047872 | DOI:10.1017/dmp.2025.10206

J Fish Biol. 2025 Oct 6. doi: 10.1111/jfb.70245. Online ahead of print.

ABSTRACT

The John Dory Zeus faber is a commercially exploited demersal fish species with a known distribution ranging from the Northeast Atlantic to parts of the Indian and Pacific oceans. A previous genetic survey using cytochrome c oxidase subunit I (COI) DNA barcodes suggested the presence of two geographically segregated taxonomic units within Z. faber. We revisit this hypothesis by expanding the number and geographic coverage of DNA barcodes, addressing a major data gap along parts of the Atlantic coast of Africa and conducting a comprehensive phylogeographic analysis. Our findings consolidated the existence of two highly divergent mitochondrial clades, Clade A and Clade B (mean K2P distance: 7.4%), with the transition zone between them located along the Atlantic coast of Morocco. Clade A exhibited no phylogeographic structure, with haplotypes shared between Northeast Atlantic and Mediterranean populations. Conversely, four geographically structured subclades (mean K2P distance: 0.9%) were detected within Clade B, extending south and eastward from Morocco to Japan and New Zealand. Historical demographic events driving allopatric divergence, along with oceanographic and environmental factors, likely shaped the current geographic distribution of the two clades. These findings not only prompt the need to re-evaluate the taxonomic status of Z. faber but also highlight the probable existence of multiple evolutionarily significant units (ESUs) that must be considered in the scope of stock assessment, fisheries management and conservation purposes.

PMID:41047867 | DOI:10.1111/jfb.70245

Health Promot Pract. 2025 Oct 6:15248399251368310. doi: 10.1177/15248399251368310. Online ahead of print.

ABSTRACT

Adolescence is a critical period for young people’s sexual and reproductive health (SRH), emphasizing the need for support with regards to the prevention of unintended pregnancy or sexually transmitted infections. Multi-level, community-wide initiatives are a widely promoted approach to support young peoples’ SRH, yet research evaluating their impact is scarce, limiting the opportunity for these initiatives to be incorporated into evidence-based practice. This study responds to this evidence gap by estimating the early effects of a city-wide youth sexual health initiative on population-level youth sexual health indicators (condom use, birth control use, combined method use, abstinence, early sex (<15 years), number of sexual partners). A quasi-experimental, difference-in-differences design with propensity weighting was employed using a nearby city as a comparison group and Youth Risk Behavior survey data from from 6,978 high school students. Estimates were generated using logistic regression. Overall, no statistically significant effects on youth sexual health indicators were detected, although the direction of non-significant findings was promising. Effect heterogeneity was detected by grade and race, suggesting that younger and Black/African American youth experienced more favorable impacts of the initiative. This study contributes to the small but growing evaluation research on multi-level, community-wide youth sexual health initiatives and provides a blueprint approach to evaluate similar initiatives using a publicly available data source. Findings highlight the potential for community-wide sexual health initiatives to address disparities in adolescent SRH, support continued effect estimation over longer time periods, and emphasize the value of culturally responsive sexual health programming.

PMID:41047855 | DOI:10.1177/15248399251368310

Ophthalmic Res. 2025 Oct 4:1-12. doi: 10.1159/000548751. Online ahead of print.

ABSTRACT

PURPOSE: Previous studies have demonstrated the efficacy of Faricimab where the intervention in treatment-resistant neovascular age-related macular degeneration (nAMD) had been switched from Aflibercept to Faricimab. This exploratory study aimed to assess the clinical anatomical and functional outcomes of a single intravitreal Faricimab (IVF) injection in those with treatment-resistant nAMD who switched from Aflibercept, in a single tertiary ophthalmology centre.

METHODS: This retrospective, observational real-world study assessed 20 patients (21 eyes) with treatment-resistant nAMD who were switched from intravitreal Aflibercept (IVA) to Faricimab due to persistent subretinal fluid (SRF) despite frequent Aflibercept injections. Patients were switched to a regimen of Faricimab consisting of three loading doses administered at 4-weekly injections. Anatomical and functional measures were assessed at two time points: immediately before the initial Faricimab injection and approximately 4 weeks later, before the second Faricimab injection. The outcome measures were: visual acuity, central macular thickness (CMT), macular volume, and the presence of SRF were evaluated pre- and post-switch.

RESULTS: Twenty-one eyes from 20 patients were analyzed. Statistically significant reductions in CMT (from 570.2 to 482.7 μm; p < 0.01) and macular volume (from 8.57 to 7.87 mm³; p = 0.02) were observed post-switch, while the change in visual acuity did not reach statistical significance (p = 0.051). The number of eyes with SRF decreased from 21 pre-switch to 9 post-switch.

CONCLUSION: The findings from this exploratory study suggests that switching from Aflibercept to Faricimab demonstrated significant physiological improvements among patients with treatment-resistant nAMD. Faricimab may serve as an effective and safe option in this patient population. The exploratory study also identifies changes in CMT and macular volume as outcome measure candidates for future large-scale investigations.

PMID:41047829 | DOI:10.1159/000548751

Diagnosis (Berl). 2025 Oct 7. doi: 10.1515/dx-2025-0089. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical reasoning skills are required for safe care, yet they are not consistently taught to advanced practice providers (APPs). In hospital medicine, where APPs work semi-independently, gaps in clinical reasoning can increase the likelihood of error. To address this, we developed a module that uses diagnostic root cause analysis (RCA) to teach clinical reasoning skills to hospital medicine APP fellows.

METHODS: The curriculum was delivered from July 2021 to March 2025. Fellows selected real-world diagnostic errors encountered during clinical rotations, created cognitive fishbone diagrams, and presented their analysis in small-group.

RESULTS: Twenty-seven fellows completed the module and pre-post assessment surveys. Statistically significant improvements were observed across all six domains of knowledge and confidence related to identifying error contributors, analyzing cases, and setting goals. Free-text responses highlighted the module’s emotional safety, peer learning value, and normalization of diagnostic reflection. Two learners published their projects as academic posters, and one graduate now co-facilitates the sessions.

CONCLUSIONS: This module offers a scalable, time-efficient approach to clinical reasoning education that is adaptable across learner levels and specialties. Its peer-led design fosters psychological safety, reflective practice, and creates a natural pathway for APPs to engage in microscholarship – addressing a critical gap in both education and academic inclusion.

PMID:41047825 | DOI:10.1515/dx-2025-0089