Tag: pubmed

J Clin Oncol. 2025 Aug 11:JCO2500221. doi: 10.1200/JCO-25-00221. Online ahead of print.

ABSTRACT

PURPOSE: Hippocampal avoidance (HA) during therapeutic whole-brain radiotherapy reduces the risk of neurocognitive function (NCF) toxicity in patients with brain metastasis. This trial hypothesized that HA during prophylactic cranial irradiation (PCI) in patients with small cell lung cancer (SCLC) leads to noninferior intracranial relapse (ICR) and reduction in NCF toxicity.

METHODS: This randomized phase II/III trial enrolled patients with SCLC, no brain metastases, and response to chemotherapy. The primary end points were 12-month ICR (noninferiority design, randomized phase II) and 6-month Hopkins Verbal Learning Test-Revised (HVLT-R) Delayed Recall (DR) failure (phase III). Secondary end points were failure in any NCF test, health-related quality of life (HRQOL), overall survival (OS), and toxicity.

RESULTS: From December 2015 to June 2022, 393 patients were randomly assigned. The median age was 64 years. Stage and memantine usage were balanced. The median follow-up was 17.0 months (all patients) and 30.8 months (alive patients). HA-PCI had noninferior 12-month ICR rate (PCI 14.8% v HA-PCI 14.7%, P < .0001). Six-month HVLT-R DR deterioration was not significantly different (PCI 30.0% v HA-PCI 25.5%, P = .28). Addition of HA to PCI reduced the risk of failure in any NCF test (adjusted hazard ratio [HR], 0.78; 95% CI [0.61 to 0.99]; P = .039). Addition of HA to PCI was not associated with longitudinal change in any HRQOL domain. There were no differences in OS (adjusted HR, 0.88 [95% CI, 0.67 to 1.14]; P = .33) or grade ≥3 toxicity (PCI 31.4% v HA-PCI 30.7%, P = .88).

CONCLUSION: Although the study did not meet its primary end point of DR preservation, HA during PCI reduces the risk of overall neurocognitive toxicity with noninferior ICR risk and similar survival.

PMID:40789106 | DOI:10.1200/JCO-25-00221

Neurology. 2025 Sep 9;105(5):e213983. doi: 10.1212/WNL.0000000000213983. Epub 2025 Aug 11.

ABSTRACT

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is associated with increased risk of both death and dementia in older adults, but no prognostic models currently exist to help identify which individuals are at greatest risk of long-term adverse outcomes. Our primary objective was to develop a single prognostic model that uses electronic health record (EHR) data to predict 5-year risk of dementia or death in older veterans who have experienced TBI.

METHODS: We performed a retrospective cohort study using EHR data from the US Department of Veterans Affairs Health Care System. Participants were US veterans aged 55 years or older without dementia who had a TBI diagnosis and received care between 2002 and 2019. Potential predictor variables included demographics, medical comorbidities, mental health conditions, and health care utilization factors. We used multinomial logistic regression with least absolute shrinkage and selection operator to develop a prognostic model for 5-year risk of dementia or death.

RESULTS: Cohort members (N = 113,779) had a mean ± SD age of 68 ± 10 years; 6% were female, and 20% were non-White or Hispanic. The key predictors of dementia or death included older age; male sex; number of inpatient visits; and comorbidities such as Parkinson disease, diabetes, weight loss, epilepsy, substance use disorder, and psychosis. The c-statistics were 0.756 (95% CI 0.751-0.761) for dementia and 0.783 (0.779-0.786) for death. Among those in the lowest predicted decile of dementia risk, 3% developed dementia within 5 years, compared with 43% of those in the highest predicted decile of risk. Similarly, the proportion of participants who died without dementia was 4% among those in the lowest predicted decile of risk compared with 64% in the highest predicted decile of risk.

DISCUSSION: A single prognostic model that includes demographics, comorbidities, and utilization variables can predict risk of dementia or death in older veterans who have experienced TBI with good accuracy. Additional studies are needed to determine how this information might be best used to support better care.

PMID:40789104 | DOI:10.1212/WNL.0000000000213983

Neurology. 2025 Sep 9;105(5):e213979. doi: 10.1212/WNL.0000000000213979. Epub 2025 Aug 11.

ABSTRACT

BACKGROUND AND OBJECTIVES: Food deserts (FDs) are low-income areas with poor access to healthy foods. FD residents have higher rates of several cardiovascular risk factors, but the link between FDs and stroke has not been well studied. We evaluated whether FD residence was associated with incident ischemic stroke within the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) and whether this association was due to low income, poor food access, or both.

METHODS: All hospitalized stroke cases in the GCNK region were ascertained during calendar year 2015 using ICD-9 and ICD-10 codes for screening and confirmed by physician review. Patient home addresses were geocoded using Decentralized Geomarker Assessment for Multi-Site Studies. FD locations were obtained from the US Department of Agriculture Food Access Research Atlas, defined as census tracts with both poor food access and low income according to established definitions based on proximity to healthy food sources as well as area poverty rates and median household income. Population estimates were obtained from the 2015 5-year American Community Survey. Poisson regression models were used to calculate census tract-level incidence rates by FD status, as well as by food access and income categories, adjusting for age, sex, race, and income-by-access interaction.

RESULTS: A total of 1,802 first-ever ischemic stroke incidents occurred in the region during the study period. Stroke patients had a mean age of 69.7 years, and 53% were female. In unadjusted models, FD residence (vs non-FD) was associated with higher stroke incidence (incidence rate ratio [IRR] 1.23; 95% CI 1.06-1.42; p < 0.01). After adjustment for age, sex, and race, this relationship was attenuated and no longer statistically significant (IRR 1.11; 95% CI 0.96-1.30; p = 0.17). In a model where FD status was replaced by area income and food access (i.e., the 2 components of the FD definition), low income was associated with greater stroke incidence after full adjustment (IRR 1.21; 95% CI 1.05-1.39; p = 0.01) while poor food access was not (IRR 0.91; 95% CI 0.81-1.01; p = 0.08).

DISCUSSION: FD residents are at increased stroke risk, and this is primarily due to low area income rather than poor food access. Alternative measures of the food environment may help elucidate the links between income, dietary patterns, and stroke risk.

PMID:40789103 | DOI:10.1212/WNL.0000000000213979

Isotopes Environ Health Stud. 2025 Aug 11:1-23. doi: 10.1080/10256016.2025.2543001. Online ahead of print.

ABSTRACT

This pioneering study assesses the radiological risk of naturally occurring radionuclides in soil around the Bheramara 410 MW Combined Cycle Power Plant (natural gas and high-speed diesel) in Kushtia, Bangladesh. Thirty soil samples were collected at radial distances of 50 m, 500 m, 1000 m, and 3000 m from the plant, these distances were strategically selected to represent immediate proximity (50 m), near-field (500 m), mid-range (1000 m), and far-field (3000 m) zones, enabling a gradient analysis of potential radiological impact. Using high-purity germanium (HPGe) gamma-ray spectrometry, the activity concentrations of ²²⁶Ra, ²³²Th, and ⁴⁰K were found to range from 20 ± 2 to 28 ± 3 Bq/kg, 25 ± 2 to 41 ± 4 Bq/kg, and 310 ± 21 to 440 ± 34 Bq/kg, respectively. While ²²⁶Ra concentrations were below the global average (30 Bq/kg), some measured values of ²³²Th exceeded the global average of 35 Bq/kg, and ⁴⁰K concentrations in certain samples were higher than the global average of 400 Bq/kg. No detectable ¹³⁷Cs was observed, confirming no artificial contamination. Radiological hazard indices such as radium equivalent activity (mean: 100.60 Bq/kg), outdoor absorbed dose rate (mean: 48.56 nGy/h), outdoor annual effective dose (mean: 0.06 mSv/year), external hazard index (mean: 0.27), gamma representative level index (mean: 0.74), and excess lifetime cancer risk (mean: 0.22 × 10^-3) were all within recommended safety limits. Various statistical analyses, including descriptive statistics, Pearson correlation, principal component analysis (PCA), and hierarchical cluster analysis (HCA), were performed and these revealed that ²²⁶Ra and ²³²Th were the main contributors to radiological risk, while ⁴⁰K showed weaker associations. The findings suggest that the soil is safe for agricultural and construction use, but routine monitoring is recommended to ensure environmental protection. This study provides essential baseline data and analytical insight into radiological risk management in power generation industrial regions of Bangladesh.

PMID:40789079 | DOI:10.1080/10256016.2025.2543001

Adv Sci (Weinh). 2025 Aug 11:e04562. doi: 10.1002/advs.202504562. Online ahead of print.

ABSTRACT

Alternative polyadenylation of pre-mRNA generates mRNAs with alternative 3′ ends, thereby increasing the complexity of the transcriptome and proteome. This process is carried out by pre-mRNA 3′ end processing complexes, with the specificity and site selection of polyadenylation primarily defined by the interaction between these complexes and conserved pre-mRNA cis-elements. However, the cis-element recognized by the polyadenylation CFII complex and the downstream cis-element of the poly(A) site remain unknown. Here, FPA, a conserved Spen family RNA-binding protein, is identified to physically interacts with the CFII complex in Arabidopsis. FPA specifically binds to a GA-rich cis-element downstream of the proximal poly(A) site, which is required for the CFII complex to promote proximal poly(A) site usage and prevent 3′ extension. Thus, the CFII complex recognizes the downstream cis-element of the poly(A) site through its interaction with FPA, highlighting the role of RNA-binding proteins as accessory factors in alternative polyadenylation.

PMID:40789077 | DOI:10.1002/advs.202504562

Proc Natl Acad Sci U S A. 2025 Aug 19;122(33):e2514378122. doi: 10.1073/pnas.2514378122. Epub 2025 Aug 11.

ABSTRACT

We use remote sensing observations to document surface deformation caused by the 2025 M_w7.7 Mandalay earthquake. This event is a unique case of an extremely long (~510 km) and sustained supershear rupture probably favored by the rather smooth and continuous geometry of this section of the structurally mature Sagaing Fault. The seismic rupture involved the locked portion of the fault over its entire depth extent (0 to 13 km) with a remarkably uniform slip distribution that averages 3.3 m, and an average stress drop of 4.7 MPa. No shallow-slip deficit is observed. The rupture extent challenges usual scaling laws relating earthquake magnitude, fault length, and slip. The fault ruptured along a known seismic gap that last ruptured in 1839 and tailed off into sections that ruptured during large earthquakes in 1930 and 1946. The amplitude and spatial distribution of fault slip in the 2025 event conform only approximatively to the slip-predictable model and the segmentation inferred from the fault geometry and past ruptures. Plausible sequences of earthquakes with variable magnitude, segmentation, and return periods, including events similar to the 2025 earthquake are produced in quasidynamic simulations using a simplified but nonplanar fault geometry. Based on this simulation, M_w>7.5 events return irregularly with an interevent time of ~141 y on average and a SD of ~40 y. The simulation is consistent with the historical seismicity and with the maximum magnitude ~M_w7.9 and return period (~250 y) derived from moment conservation. Data assimilation into such simulations could provide a way for time-dependent hazard assessment in the future.

PMID:40789035 | DOI:10.1073/pnas.2514378122

Proc Natl Acad Sci U S A. 2025 Aug 19;122(33):e2501224122. doi: 10.1073/pnas.2501224122. Epub 2025 Aug 11.

ABSTRACT

A current tenet in the science of cities is the emergence of power-law relations between population size and a variety of urban indicators, echoing allometric scaling in living organisms akin to Kleiber’s law. However fascinating, existing scaling theories suffer from biases related to the ad-hoc definition of city boundaries and to their neglect of intraurban variability of city properties. Here, to deal rigorously with biases, we explore the hypothesis that the empirical statistics of intracity variations in population counts, road networks, and carbon emissions-across various cities and spatial scales-can be interpreted as resulting from the joint fluctuations of spatially dependent random variables. Rather than relating urban characteristics to overall city size, we focus on how intraurban properties and local population patterns vary together across space. We find that the marginal and joint probability distributions are characterized by finite-size scaling functions which, upon suitable rescaling, collapse onto a set of universal curves. These results are analogous to those relating intraspecies variability in living organisms where the scaling of mean body mass with a characteristic metabolic rate clouds the effects of the variance of both traits. Our findings lay the foundations for a generalized theory of urban metabolism, linking city-scale quantities to the covariation of intraurban characteristics. This also opens up opportunities for a full exploitation of available urban data allowing the integration of biologically inspired theories into the modeling and planning of cities.

PMID:40789025 | DOI:10.1073/pnas.2501224122

Health Rep. 2025 Jul 16;36(7):15-28. doi: 10.25318/82-003-x202500700002-eng.

ABSTRACT

BACKGROUND: Most older Canadians would prefer to stay in their own homes and communities rather than move to long-term care (LTC) facilities. A growing older population, limited LTC capacity, and costs have increased demand for initiatives that enable people to age in their communities for as long as possible.

METHODS: Data from the 2019/2020 Canadian Health Survey on Seniors were used to estimate the prevalence of four types of supports and services (SSs) that assist with living in the community: home adaptations, informal care, home care, and community support services. Separate multivariable logistic regressions for each SS, stratified by age group (65 to 79 years and 80 years or older), examined associations with need-related factors, enabling resources, and predisposing characteristics.

RESULTS: At 25.0% of 65- to 79-year-olds and 51.9% of those aged 80 years or older, home adaptations were the most prevalent SS used in Canada. Use of home care, community support services and informal care was less common, ranging from 5.5% to 11.6% among Canadians aged 65 to 79 and 17.2% to 33.2% among those aged 80 or older. Nonetheless, substantial proportions of the younger (65.4%) and older (31.8%) age groups reported no SS use. In general, having a poor health status, having impairment, not driving, being older, living alone, having a regular health care provider, and being a woman increased the odds of using SSs.

INTERPRETATION: Understanding the factors associated with SS use can help inform policies and programs aimed at assisting older Canadians with aging in the community.

PMID:40789000 | DOI:10.25318/82-003-x202500700002-eng

Health Rep. 2025 Jul 16;36(7):3-14. doi: 10.25318/82-003-x202500700001-eng.

ABSTRACT

BACKGROUND: Low staffing levels and high turnover rates are longstanding issues in long-term care (LTC) facilities that were further exacerbated by the COVID-19 pandemic. Consequently, residents and staff were disproportionately affected, with high morbidity and mortality rates. This study examines changes in staffing levels, overall and by direct care worker category, across the LTC facilities sector by ownership status in Canada before and during the pandemic. It also explores differences in facility expenditures allocated towards employee wages, benefits, and subcontracts across homes by ownership status.

DATA AND METHODS: Data were from the 2020 and 2021 Nursing and Residential Care Facility Survey, which collected information on facility characteristics, including expenses, revenue, ownership status, and staffing levels. Summary statistics and multivariate linear regression models were used to examine the association between staffing levels and ownership status, with analyses stratified by direct care worker category.

RESULTS: On average, public LTC facilities had higher staffing levels and spent a greater proportion of their total costs on employee wages and benefits before and during the pandemic, compared with for-profit and non-profit private facilities. While the total hours of care per resident day (HPRD) increased during the pandemic, there were notable variations by region, ownership status, and direct care worker category. For example, Ontario public nursing homes provided 10% more HPRD from registered nurses during the pandemic, compared with the period before.

INTERPRETATION: Staffing levels of direct care workers in LTC facilities, overall and separately, are associated with ownership status. Allocation of employee-related expenses also differed by ownership. Further research is needed to explore interactions between ownership status, staffing levels, and quality of care for residents.

PMID:40788999 | DOI:10.25318/82-003-x202500700001-eng

Ophthalmic Plast Reconstr Surg. 2025 Aug 11. doi: 10.1097/IOP.0000000000003007. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the subjective assessment of 8 orbital CT features for predicting dysthyroid optic neuropathy (DON).

METHODS: Scan montages from 137 orbits without DON and 121 with DON were each graded independently by 3 observers for 8 imaging features: namely, degree of apical crowding, extraocular muscle enlargement, expansion of orbital fat, clarity of the superior orbital fissure, fat prolapse through the superior orbital fissure, medial wall bowing, general orbital vascular congestion, and dilation of the superior ophthalmic vein. Gradings were analyzed individually and also averaged across observers. Associations with DON were assessed using univariate and multivariate logistic regression, and performance of the latter was assessed using area under the receiver-operating-characteristic curve, sensitivity, specificity, and calibration plots.

RESULTS: Unadjusted models showed apical crowding (p < 0.001), extraocular muscle enlargement (p < 0.001), vascular congestion (p = 0.001), and medial wall bowing (p < 0.001) were each associated with DON, across all observers. Models for observers 1 and 3 included only apical crowding, with a 1-unit grading-increase giving, respectively, a 2.88-fold and 3.04-fold increase in DON odds (p < 0.001). The observer 2 model included extraocular muscle enlargement (odds ratio: 2.95; p < 0.001) and vascular congestion (odds ratio: 2.57; p = 0.023). The “averaged-score” model for all observers included only apical crowding, with a 3.76-fold increased odds per unit increase in grading (p < 0.001). The models showed borderline-acceptable discrimination (area under the receiver-operating-characteristic curve: 0.68-0.75) and good calibration, with the averaged-score model performing best.

CONCLUSIONS: Apical crowding, extraocular muscle enlargement, vascular congestion, and medial wall bowing are key predictors of DON, with apical crowding being the most influential.

PMID:40788673 | DOI:10.1097/IOP.0000000000003007