Tag: pubmed

Pediatr Surg Int. 2025 Jun 26;41(1):194. doi: 10.1007/s00383-025-06103-w.

ABSTRACT

PURPOSE: Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. The purpose of this study was to retrospectively investigate the management strategies of the appendiceal stump during transumbilical laparoscopic-assisted appendectomy for acute appendicitis in terms of surgical time, hospital length of stay, and postoperative complications.

METHODS: The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed.

RESULTS: The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. Appendiceal stump invagination was performed in 208 patients (74.8%), comprising 106 females (51.0%) and 102 males (49.0%), with a median age of 11 years (IQR 8-15) and a median weight of 36.5 kg (IQR 28-54). Twenty-six (12.5%) patients had associated conditions. The appendiceal stump was not invaginated in 70 children (25.2%), consisting of 26 females (37.1%) and 44 males (62.9%), with a median age of 11 years (IQR 8-14) and a median weight of 38.3 kg (IQR 29.5-47). Fourteen patients (20%) had associated pathologies. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, stump invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P = 0.03). In addition, the median surgical duration was 63.5 min (IQR 46-90) for patients undergoing stump inversion and 69 min (IQR 60-115) for patients undergoing simple ligation respectively (P = 0.02). Interestingly, statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15).

CONCLUSION: Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay.

PMID:40569465 | DOI:10.1007/s00383-025-06103-w

World J Urol. 2025 Jun 26;43(1):399. doi: 10.1007/s00345-025-05769-0.

ABSTRACT

OBJECTIVE: This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).

METHODS: A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, n = 263) and those with reusable fURS (Group 2, n = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with p < 0.05 considered significant.

RESULTS: After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD < 0.1). Group 1 was associated with shorter laser (p = 0.001) and operative times (p = 0.048), and more frequent use of larger sheaths (p < 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, p = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups. On multivariate analysis, single-use scope use (OR 1.659, p = 0.018) and 10-12 Fr UAS (OR 1.749, p = 0.043) were significantly associated with complete stone clearance.

CONCLUSION: Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.

PMID:40569462 | DOI:10.1007/s00345-025-05769-0

Rheumatol Int. 2025 Jun 26;45(7):158. doi: 10.1007/s00296-025-05916-1.

ABSTRACT

INTRODUCTION: Patients with rheumatoid arthritis (RA) have an elevated risk of developing cardiovascular disease (CVD). Despite European guidelines recommending routine CVD risk assessment, implementation in clinical practice is challenging. The objectives of this review were to determine if patients attending an Irish tertiary rheumatology centre received CVD risk assessments in line with European guidelines and assess the extent of CVD risk factor screening over five years of routine rheumatology care.

METHODS: A retrospective chart review was conducted for patients newly diagnosed with RA in 2018, with five-year follow-up. Data were extracted to determine if CVD risk assessments were performed, and where absent, risk was retrospectively calculated. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for cohort studies was used to guide the reporting of this study.

RESULTS: Among 21 patients, no documented CVD risk assessments were identified. CVD risk factor screening was consistently insufficient. There was a lack of documented clinical data necessary to conduct a CVD risk assessment on more than half of patients at study entry, and one quarter of patients at five-year follow up. Of those with data available (n = 10), retrospective calculations showed 80% had an undetected moderate or higher CVD risk at diagnosis. There was no documented referral to primary care for CVD risk assessment.

CONCLUSION: Implementation of CVD risk management guidelines in the routine care of patients with RA is challenging. The interpretation and operationalisation of guideline recommendations by rheumatology healthcare professionals in relation to implementation barriers needs to be explored.

PMID:40569458 | DOI:10.1007/s00296-025-05916-1

Int J Offender Ther Comp Criminol. 2025 Jun 26:306624X251345511. doi: 10.1177/0306624X251345511. Online ahead of print.

ABSTRACT

There has been a considerable amount of research examining the role that poverty might play in the development of crime and with being processed through the criminal justice system. Despite this research, there still remain some important gaps in the knowledge base, including whether poverty differentially moderates the effects of criminal behavior and criminogenic influences on being processed through the criminal justice system. The current study addressed this gap by examining whether poverty in adolescence moderated the influence of antisocial behavior and criminogenic influences on being arrested, convicted, and incarcerated in adulthood. Findings revealed little evidence of poverty as a moderating influence on criminal justice processing. The one exception, however, was that poverty moderated the association between antisocial behavior and incarceration such that antisocial behavior had no association on incarceration for persons living in poverty, but that it had a statistically significant and positive association with incarceration for persons not living in poverty. The results of this study are discussed in relation to the existing literature on the poverty-crime nexus.

PMID:40568765 | DOI:10.1177/0306624X251345511

Front Cell Infect Microbiol. 2025 Jun 11;15:1571291. doi: 10.3389/fcimb.2025.1571291. eCollection 2025.

ABSTRACT

OBJECTIVES: This study aimed to investigate the prevalence of TB/HIV co-infection in pediatric TB patients in southwest China and its associated variables.

METHODS: Pediatric TB patients were recruited from January 2014 to September 2024 in southwest China, based on etiology or clinical confirmation. Hospitalization records were extracted for each patient.

RESULTS: Among 2,607 pediatric TB patients with an average age of 9.58 ± 4.08 years, 39 (1.5%) were HIV-positive. The TB/HIV co-infection group male-to-female ratio was 2:1, higher than the TB-only group 1.19:1. The highest proportion of TB/HIV co-infection was in the 5-9 years age group (43.6%), while the 10-14 years age group accounted for the highest proportion of TB-alone cases (57.5%). In terms of population distribution, the Yi ethnic group had the highest proportion of TB/HIV co-infection cases (43.6%), while the Tibetan group had the highest proportion of TB-alone cases (51.1%). Extrapulmonary TB in the TB/HIV co-infection group primarily involved abdominal and pericardial sites, whereas the TB-alone infection group had more cases of lymphadenitis and pleural TB. The length of hospitalization (>14 days) in the TB/HIV co-infection group (74.4%) was significantly longer than in the TB-alone infection group (51.7%). Over the past 11 years, most pediatric TB/HIV co-infection cases were from the eastern-central and southern-central regions of Sichuan, particularly the southern Liangshan Yi Autonomous Prefecture. The number of children with TB-alone infections increased gradually during this period. No significant difference in the number of pediatric TB/HIV co-infection cases was observed over the 11 years.

CONCLUSION: Pediatric TB/HIV co-infection in southwest China predominantly affects middle-aged and young boys, with a higher co-infection rate than the national average. The central and southern regions of Sichuan have a relatively high proportion of cases. Public health efforts should focus on strengthening awareness, screening, and early diagnosis of TB and HIV in children in high-risk areas to prevent further infections.

PMID:40568707 | PMC:PMC12187718 | DOI:10.3389/fcimb.2025.1571291

medRxiv [Preprint]. 2025 Jan 15:2025.01.14.25320574. doi: 10.1101/2025.01.14.25320574.

ABSTRACT

Psychiatric disorders display high levels of comorbidity and genetic overlap ^1,2 . Genomic methods have shown that even for schizophrenia and bipolar disorder, two disorders long-thought to be etiologically distinct ³ , the majority of genetic signal is shared ⁴ . Furthermore, recent cross-disorder analyses have uncovered over a hundred pleiotropic loci shared across eight disorders ⁵ . However, the full scope of shared and disorder-specific genetic basis of psychopathology remains largely uncharted. Here, we address this gap by triangulating across a suite of cutting-edge statistical genetic and functional genomic analyses applied to 14 childhood- and adult-onset psychiatric disorders (1,056,201 cases). Our analyses identify and characterize five underlying genomic factors ⁶ that explain the majority of the genetic variance of the individual disorders (∼66% on average) and are associated with 268 pleiotropic loci. We observed particularly high levels of polygenic overlap ⁷ and local genetic correlation ⁸ and very few disorder-specific loci ⁹ for two factors defined by: ( i ) schizophrenia and bipolar disorder (“SB factor”), and by ( ii ) major depression, PTSD, and anxiety (“internalizing factor”). At the functional level, we applied multiple methods ^10-12 which demonstrated that the shared genetic signal across the SB factor was substantially enriched in genes expressed in excitatory neurons, whereas the internalizing factor was associated with oligodendrocyte biology. By comparison, the genetic signal shared across all 14 disorders was enriched for broad biological processes (e.g., transcriptional regulation). These results indicate increasing differentiation of biological function at different levels of shared cross-disorder risk, from quite general vulnerability to more specific pathways associated with subsets of disorders. These observations may inform a more neurobiologically valid psychiatric nosology and implicate novel targets for therapeutic developments designed to treat commonly occurring comorbid presentations.

PMID:40568675 | PMC:PMC12191084 | DOI:10.1101/2025.01.14.25320574

medRxiv [Preprint]. 2025 Jan 20:2025.01.19.25320798. doi: 10.1101/2025.01.19.25320798.

ABSTRACT

Unlike some health conditions that have been extensively delineated throughout the lifespan, many genetic conditions are largely described in pediatric populations, with a focus on early manifestations like congenital anomalies and developmental delay. An apparent gap exists in understanding clinical features and optimal management as patients age. Generative artificial intelligence is transforming biomedical disciplines including through the introduction of large language models (LLMs). Motivated by these advances, we explored how LLMs handle age with respect to 282 genetic conditions selected based on prevalence. We divided these conditions into five categories: Disorders limited to childhood; Disorders limited to adulthood; Disorders with changes in presentation across ages; Disorders with changes in management across ages; Disorders with no changes across ages. We evaluated Llama-2-70b-chat (70b) and GPT-3.5 (GPT) capabilities at generating accurate medical vignettes for these conditions based on Correctness, Completeness, and Conciseness as graded by 3 clinicians. Using accurately generated vignettes as in-context prompts, we further generated and evaluated patient-geneticist dialogues and assessed LLM performance in answering specific questions regarding age-based management plans for a subset of conditions. Results revealed impressive performances of 70b with in-context prompting and GPT in generating vignettes. We overall did not observe age-based biases, though our experiments identified statistically significant differences in some areas related to LLM output. Despite impressive capabilities, LLMs still have limitations in clinical applications.

PMID:40568663 | PMC:PMC12191088 | DOI:10.1101/2025.01.19.25320798

medRxiv [Preprint]. 2025 Jan 15:2025.01.15.25320592. doi: 10.1101/2025.01.15.25320592.

ABSTRACT

PURPOSE: Poor quality prostate MRI images, especially ADC maps, can lead to missed lesions and unnecessary repeat scans. To address this issue, we aimed to develop an automated method to predict ADC map quality from T2 images acquired earlier in the scanning process.

MATERIALS AND METHODS: A paired multi-site image corpus of T2-weighted images and ADC maps was constructed from 486 patients imaged in-house and at 62 external clinics. A senior radiologist assigned 1-3 quality ratings to each image set, later converted to a binary “non-diagnostic” or “diagnostic” scale. A deep learning model and a rectal cross-sectional area measurement approach were developed to predict ADC image quality from T2 images. Model performance was evaluated retrospectively by accuracy, sensitivity, negative and positive predictive value, and AUC.

RESULTS: No single acquisition parameter in the metadata was statistically associated with image quality for either T2 or ADC maps. Quality scores of the same modality showed low correlation across sites (r∼0.2). In the challenging task of predicting ADC quality from prior T2 images, our model achieved performance comparable to current single-site models directly using ADC maps, with 83% sensitivity and 90% negative predictive value. The model showed stronger performance on in-house data (94±2% accuracy) despite being trained exclusively on multicenter external data. Rectal cross-sectional area on T2 images provided an interpretable quality metric (AUC 0.65).

CONCLUSION: The probability of low quality, uninterpretable ADC maps can be inferred early in the imaging process by neural network approach, allowing corrective action to be employed.

PMID:40568662 | PMC:PMC12191087 | DOI:10.1101/2025.01.15.25320592

medRxiv [Preprint]. 2025 May 23:2025.05.22.25328175. doi: 10.1101/2025.05.22.25328175.

ABSTRACT

BACKGROUND: Recent genome-wide association studies (GWAS) for Alzheimer’s Disease and related dementias (ADRD) have increased statistical power via larger analysis datasets from biobanks by 1) including non-age-matched controls and prevalent cases, and/or 2) including individuals who report a family history of ADRD as proxy cases. However, these methods have the potential to increase noise and distort genetic associations which are important for genomic-informed prevention and treatment of ADRD. Here, we sought to understand how the effect sizes of genetic associations in ADRD could be sensitive to these methodological choices, using APOE genotypes as an example.

METHODS: Participants in the All of Us Research Program over the age of 49 at enrollment (n=258,693) were assigned one of four categories: incident ADRD (developed after enrollment in All of Us ), prevalent ADRD (present on enrollment), proxy ADRD (participant noted a family history of ADRD), and control (no history or diagnosis of ADRD). Dementia diagnoses were determined using available Electronic Health Records (EHR) and APOE genotype was determined using whole-genome sequencing. Effect sizes for the associations between APOE risk alleles and ADRD diagnoses were compared using polychotomous logistic regression.

RESULTS: The mean age of the cohort was 67±10 years, and it was 58% female; 63% clustered predominantly with European genetic reference populations. Among the participants, 3,107 (1.2%) had prevalent ADRD, 301 (0.1%) had incident ADRD, and 19,910 (7.7%) reported a family history of ADRD (proxy ADRD). Both prevalent and proxy ADRD had attenuated associations with APOE genotype compared to incident ADRD. The adjusted generalized ratio (95% CI) (AGR) for incident ADRD for APOE ε4 heterozygotes was 2.95 (2.31-3.74) compared to 2.10 (1.96-2.24) and 1.42 (1.32-1.55) for proxy and prevalent ADRD, respectively. For APOE ε4 homozygotes, the effect sizes were even more different. Furthermore, APOE association effect sizes increased when restricting the control (no ADRD) group to older age brackets.

CONCLUSIONS: Our study highlights how genetic associations with ADRD can be sensitive to how cases are defined in biobanks like All of Us , with effect sizes downwardly biased when using prevalent or by-proxy cases compared to incident cases.

PMID:40568661 | PMC:PMC12191090 | DOI:10.1101/2025.05.22.25328175

Rwanda J Med Health Sci. 2023 Nov 30;6(3):389-397. doi: 10.4314/rjmhs.v6i3.12. eCollection 2023 Nov.

ABSTRACT

BACKGROUND: Exposure to polluted air is a significant cause of negative health effects. Air quality is crucial in hospital environments as patients and healthcare workers spend more time in such settings for treatment where they experience prolonged and repetitive exposure; however, comprehensive studies on air quality in hospital environments in Rwanda are scarce.

OBJECTIVE: This study aimed to determine the indoor and outdoor air quality concentration levels in selected hospitals and investigate potential sources of air pollution.

METHODS: This descriptive cross-sectional study was conducted in two public and two private hospitals in Kigali that were randomly selected using a simple random sampling technique. Real-time particulate matter (PM), PM_2.5 and PM₁₀ were measured using calibrated Purple Air PA-II sensors. An observation checklist was used to identify potential sources of air pollution. One way ANOVA and t-tests were performed.

RESULTS: Air quality levels in selected hospitals exceeded acceptable limits. The daily average indoor PM_2.5 concentration ranged from 23.52 µg/m³ to 121.60 µg/m³, and the PM₁₀ levels varied from 25.98 µg/m³ to 131.17 µg/m³. In all hospitals, the difference in average indoor and outdoor PM_2.5 and PM₁₀ concentrations were not statistically significant.

CONCLUSION: All recorded concentrations exceeded the WHO air quality guidelines. The study calls for strategies to improve air quality in hospitals.

PMID:40568653 | PMC:PMC12110502 | DOI:10.4314/rjmhs.v6i3.12