Tag: pubmed

Sports Med. 2025 Jun 16. doi: 10.1007/s40279-025-02258-7. Online ahead of print.

ABSTRACT

BACKGROUND: In the pursuit of sporting success, some elite athletes prioritise peak performance over long-term health, frequently resulting in significant and enduring health consequences. The Enhanced Games (TEG) position themselves as a bold experiment in transhumanism, advocating for the use of performance-enhancing drugs (PEDs), including methods banned by World Anti-Doping Agency (WADA), to push the boundaries of human athletic potential.

OBJECTIVES: The aim of this study is to explore the perspectives of sport physicians, sport scientists, physiotherapists and other allied healthcare professionals on treating and supporting “enhanced athletes”, with the view of informing future guidelines.

METHODS: Participants were invited via email and personal contacts within sport medicine communities to complete a brief anonymous survey via QuestionPro™. Descriptive statistics were performed using Excel™ and RStudio™.

RESULTS: A total of 323 healthcare professionals responded (82% were sport physicians), among whom 74% expressed a willingness to treat acute lesions and/or chronic diseases in “enhanced athletes”. In comparison, a considerable minority (30%) expressed support for assisting athletes in their use of PEDs and methods under medically supervised conditions, with high consistency across professional roles. A relatively high readiness was observed in sport physicians treating acute (77% versus 58%; p < 0.01) and chronic (75% versus 63%; p = 0.11) diseases for “enhanced athletes”. As far as WADA rules and/or national anti-doping laws apply, this support presupposes compliance with the code and the respective national laws to protect physicians from serious professional, legal and personal consequences.

CONCLUSION: The preliminary findings align with the broader goal of fostering a sport culture that values both peak performance and the short- and long-term health of all participants. These results emphasise the necessity of implementing professional guidelines and comprehensive support systems designed to safeguard the long-term well-being of all athletes and underscore the urgent need for further research into the impact of TEG on sport and its community.

PMID:40522609 | DOI:10.1007/s40279-025-02258-7

Ann Surg Oncol. 2025 Jun 16. doi: 10.1245/s10434-025-17663-5. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate preoperative imaging of breast tumor size is essential, as small measurement differences can influence the treatment strategy. This study evaluates the accuracy of tumor size estimation by mammography, ultrasound, and magnetic resonance imaging (MRI) compared with pathology and examines factors influencing imaging performance.

PATIENTS AND METHODS: We retrospectively analyzed patients with breast cancer treated from 2019 to 2024. Measurements were considered concordant if they fell within ±20% of the pathological size. Statistical analyses performed include paired t-tests, chi-squared tests, Lin’s concordance correlation coefficient (CCC), and logistic regression. Python-based framework was used to identify the most accurate weighted formula.

RESULTS: We included 460 patients with a median age of 57 (26-90) years. MRI had the highest concordance (62%), outperforming mammography (57%) and ultrasound (53%) (p = 0.004). Our alternative weighted average formula (0.66 × MRI size + 0.35 × US size) yielded the highest concordance rate (65.2%, CCC = 0.785). Average tumor size on pathology was 17.31 mm. MRI slightly overestimated the size (18.38 mm, p = 0.482), while mammography (14.8 mm, p = 0.06) and ultrasound (14.31 mm, p = 0.019) underestimated. MRI demonstrated the highest accuracy in T-stage classification (89%). Concordance was highest for masses without non-mass enhancement (NME) (CCC = 0.834) and declined with NME (CCC = 0.635). MRI accuracy improved in tumors > 15 mm (OR 2.47) and high-grade tumors (OR 1.75) but declined in extremely dense breasts (OR 0.42) and lobular histology (OR 0.46).

CONCLUSIONS: MRI demonstrated the highest concordance with tumor size and T stage. Its accuracy improved in larger and high-grade tumors but decreased with dense breasts, NME, and lobular histology. A combined imaging approach using MRI and ultrasound may enhance preoperative size estimation.

PMID:40522576 | DOI:10.1245/s10434-025-17663-5

J Neurooncol. 2025 Jun 16. doi: 10.1007/s11060-025-05101-1. Online ahead of print.

ABSTRACT

PURPOSE: Laser interstitial thermal therapy (LITT) offers a minimally invasive approach for treating intracranial pathologies while offering shorter length of stays (LOS) as compared to traditional craniotomies. Yet, some patients still face prolonged LOS (pLOS), highlighting the need to identify factors contributing to pLOS to improve outcomes.

METHODS: We retrospectively reviewed patients who underwent LITT for intracranial pathologies at our institution from 2012 to 2023. Patients with LOS ≥ 75th percentile formed the study group, while those with LOS < 75th percentile formed control group. Patient demographics and perioperative factors were analyzed. Bivariate statistical analyses included Fisher’s exact test, chi-square test, and t-tests. Univariate and multivariate logistic regression identified significant predictors of pLOS.

RESULTS: Of 294 patients in this study, 73 patients in the study group (mean age 62.14 ± 11.63 years, 54.8% males) with a median LOS of 4.12 [IQR: 3.01-6.67] days were compared to 221 controls (mean age 59.50 ± 14.01 years, 40.3% males) with a median LOS of 1.92 [IQR: 1.86-2.01] days. Upon multivariate analysis, higher mFI-5 scores (OR 1.80; 95% CI [1.31-2.47]; p < 0.001), preoperative neurologic deficits (OR 2.27; 95% CI [1.09-4.76]; p = 0.029), and preoperative tumor volume (OR 2.03; 95% CI [1.46-2.83]; p < 0.001) were significantly associated with pLOS. Operative time, number of pullbacks, and extent of ablation were not significantly associated with pLOS (p > 0.05).

CONCLUSION: To our knowledge, this is the first study to identify preoperative mFI-5 score, neurological deficit, and tumor volume as independent predictors of pLOS in patients undergoing LITT for intracranial pathologies.

PMID:40522561 | DOI:10.1007/s11060-025-05101-1

J Neurooncol. 2025 Jun 16. doi: 10.1007/s11060-025-05099-6. Online ahead of print.

ABSTRACT

OBJECTIVE: WHO grade 4 glioma is the most common primary malignant brain tumor, with a median survival of only 14.6 months. Predicting survival outcomes remains challenging due to the tumor’s heterogeneity and the influence of multiple clinical factors. Machine learning (ML) techniques have demonstrated superior predictive performance compared to traditional statistical models. Embedded feature-selection techniques such as Lasso shrinkage or Random-Forest importance scores are widely used, yet grade-4-glioma prognostic models still rely on an initial clinician-curated variable list and on ad-hoc cut-offs (e.g., “top X features” or “above certain threshold”) when deciding how many ranked features to keep-choices that markedly influence model accuracy. We therefore developed a fully data-driven pipeline that begins with an unrestricted pool of clinical, functional, and biomarker variables, employs SHAP values for global importance ranking, and uses automated feature-subset optimization to identify the most optimal combination of predictors that maximizes survival-prediction performance in grade-4 glioma.

METHOD: We retrospectively analyzed clinical data from 764 patients who underwent grade 4 glioma resection at a single institution. Five ML models (XGBoost, AdaBoost, Random Forest, Decision Tree, and Neural Networks) were trained to predict survival time and classify into longer-term survival (≥ 12 months) and short-term survival (< 12 months). Feature selection was performed in two steps: (1) Shapley Additive Explanations (SHAPs) were used to identify the most important prognostic features influencing survival outcomes, and (2) feature-subset optimization was applied to determine the optimal number of top features to be included in each model. 5-fold cross-validation (CV) and holdout testing were performed to evaluate the models’ performance on unseen testing data. Model evaluation was conducted using root mean square error (RMSE) for regression and area under the receiver operating characteristic curve (AUROC) for classification. Decision Curve Analysis (DCA) was performed to evaluate the clinical utility of the models.

RESULTS: Feature selection and model optimization significantly enhanced predictive accuracy across both regression and classification tasks. In regression, AdaBoost achieved the lowest RMSE of 1.69 months after feature selection, outperforming other models. In classification, XGBoost demonstrated the highest AUROC (0.85) on holdout testing, though all ensemble models (XGBoost, Random Forest, and AdaBoost) achieved comparable performance with no statistical significance. DCA revealed that XGBoost and Random Forest achieved the most net benefit of 0.24 and 0.22, respectively. Key prognostic features consistently identified included patient age, tumor location, radiation dose, extent of resection, Karnofsky Performance Score, and MGMT promoter methylation status. Biomarkers such as Ki-67, ATRX, and TP53 also emerged as important predictors of survival outcomes. The model also uncovered several cognitive and functional deficits-including preoperative and postoperative language deficits, permanent motor deficits, and perioperative seizures-that were previously underutilized in survival prediction models.

CONCLUSION: ML-based feature selection enhances survival prediction in grade 4 glioma by systematically identifying the most relevant prognostic factors while minimizing human bias. Our findings suggest that ensemble models, and particularly AdaBoost, offer robust prognostic capabilities. These insights can aid clinicians in personalized treatment planning and patient counseling.

PMID:40522559 | DOI:10.1007/s11060-025-05099-6

J Robot Surg. 2025 Jun 16;19(1):295. doi: 10.1007/s11701-025-02446-7.

ABSTRACT

Pancreatic resection is necessary to treat pancreatic diseases, especially malignancy. Minimally invasive procedures, including robotic (RPR) and laparoscopic (LPR) pancreatic resections, have grown in popularity due to their potential to improve recovery and lower morbidity. The aim of this study is to provide evidence-based data for clinical decision-making by systematically comparing RPR and LPR with respect to postoperative recovery, perioperative safety, and oncological outcomes. A systematic review and meta-analysis following PRISMA guidelines was conducted using PubMed, Google Scholar, Cochrane, and Web of Science. Two independent reviewers extracted data, and pooled prevalence was analyzed using a random-effects model. Heterogeneity was assessed with Higgins I² and Cochran’s Q test. A sensitivity analysis was done using R. Forty-six peer-reviewed articles with follow-up periods ranging from 3 to 288 months were included in this review. Robotic surgery was performed in 4.8%-67.6% of cases, with patient ages ranging from 30 to 70 years. A considerably shorter hospital stay (MD: – 0.72, P = 0.004) and a higher rate of conversion to open surgery (OR: 0.52, P < 0.00001) were associated with RPR. However, no significant differences were observed between RPR.and LPR in important outcomes, including resection rate, lymph node yield, overall complications, operating time, 90-day mortality, and postoperative complications. While RPR outperforms LPR in terms of conversion and hospital stay rates, it is not significantly superior in terms of oncological outcomes and morbidity rate. The high heterogeneity in the studies suggests the need for more research to determine the optimal minimally invasive technique for pancreatic surgery.

PMID:40522553 | DOI:10.1007/s11701-025-02446-7

Bull Math Biol. 2025 Jun 16;87(7):96. doi: 10.1007/s11538-025-01478-2.

ABSTRACT

Pseudomonas aeruginosa is an opportunistically pathogenic bacteria that causes fatal infections and outbreaks in hospital environments. Due to the increasing prevalence of antibiotic-resistant strains of P. aeruginosa, the need for alternative therapies is critical. Bacteriophage therapy is emerging as a promising approach; however, it remains unapproved for clinical use and is hindered by limited understanding of the complex interactions between bacterial cells and phage virions. Mathematical models provide insight into these interactions. Through a system of ordinary differential equations, we successfully capture the dynamics observed between susceptible, infected, and mutated bacterial cells and bacteriophage virions in a microwell setting. Data fitting based on this model produced a set of parameter estimates unique to our experimental observations of a specific phage and P. aeruginosa strain. In translating observed optical density readings into bacterial concentrations, we also found that bacterial debris has a significant impact on optical density, with a lysed bacterium contributing roughly $31\%$ as much to optical density readings as a living cell.

PMID:40522533 | DOI:10.1007/s11538-025-01478-2

Hernia. 2025 Jun 16;29(1):204. doi: 10.1007/s10029-025-03367-y.

ABSTRACT

BACKGROUND: The rate of incisional hernia (IH) at stoma site after ileostomy closure is controversial in the literature. We aimed to estimate the prevalence of IH at stoma site after ileostomy reversal and to determine its risk factors.

MATERIAL AND METHODS: We performed a systematic review according to PRISMA standards to identify studies reporting prevalence of IH after ileostomy closure. Meta-analysis was performed to estimate its rate. Heterogeneity was explained by meta-regression and subgroup analysis.

RESULTS: Twenty studies were included with 2629 patients. The pooled estimated rate was 13,7% with a 95% confidence interval (11-17%). The 95% prediction interval varied between 5,3% and 31,1%, which showed substantial heterogeneity. Meta-regression showed that ASA score III and IV increases IH rate (p = 0,02). Obese and elderly patients have a tendency for developing IH with substantial heterogeneity. Subgroup analysis for COPD, diabetes mellitus, smoking, laparotomy approach for the initial surgery, did not show statistically significant differences.

CONCLUSION: Prevalence of IH is higher than previously estimated in the literature. ASA score III and IV increases its rate. Prospective randomized studies focusing on the impact of prophylactic mesh implementation are necessary.

PMID:40522527 | DOI:10.1007/s10029-025-03367-y

Schizophr Bull. 2025 Jun 16:sbaf067. doi: 10.1093/schbul/sbaf067. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: To determine whether a tele-mentoring program increases clozapine utilization by improving prescriber knowledge and perceived competence in clozapine management.

STUDY DESIGN: In a cluster-randomized controlled design, we tested the effectiveness of an Extension for Community Healthcare Outcomes (ECHO) model-based intervention, consisting of 26 biweekly didactic and case-based tele-mentoring sessions, vs enhanced treatment as usual (eTAU), in which both conditions received access to a consultation phone line and a point of care device for on-site hematologic monitoring. Prescribers completed baseline and 12-month assessments of clozapine knowledge and competence, and prescription records were used to evaluate the effects of ECHO on prescribing and treatment persistence.

STUDY RESULTS: 266 prescribers from 43 mental health treatment settings throughout Maryland were enrolled. Prescribers randomized to ECHO demonstrated a significant increase in clozapine knowledge compared to eTAU (P < .001), and competence increased significantly in those who attended 14 or more tele-mentoring sessions (P = .017). ECHO did not increase the likelihood of clozapine prescribing during follow-up (P = .70). While there was a 17% lower hazard of clozapine discontinuation among patients of prescribers randomized to ECHO, this did not reach statistical significance (P = .72).

CONCLUSIONS: A statewide tele-mentoring program increased prescriber knowledge and competence in clozapine prescribing among those attending most ECHO sessions. Median time to clozapine discontinuation was double in the ECHO group, however, neither this nor rates of prescribing were statistically significantly different from control. Additional support is needed to motivate clozapine prescribing beyond providing education and increasing confidence in clozapine management.

PMID:40518551 | DOI:10.1093/schbul/sbaf067

Malar J. 2025 Jun 15;24(1):192. doi: 10.1186/s12936-025-05446-y.

ABSTRACT

BACKGROUND: The declining efficacy and widespread resistance to antimalarial drugs (AMD) pose significant challenges to global malaria control and elimination efforts. To enhance treatment efficacy, the World Health Organization (WHO) recommends the use of combination therapies. This study aimed to evaluate the therapeutic efficacy of chloroquine with primaquine (CQ-PQ) for the treatment of uncomplicated Plasmodium vivax malaria in the study area.

METHODS: The study utilized a single-arm, 42-day follow-up design to assess the therapeutic efficacy and safety of a treatment regimen in Northwest Ethiopia. Participants, all diagnosed with uncomplicated vivax malaria, received a 3-day course of chloroquine (CQ) at 25 mg/kg, followed by a 14-day course of primaquine (PQ) at 0.25 mg/kg. Participants were monitored with follow-up visits on days 1, 2, 3, 7, 14, 21, 28, 35, and 42. Data were double-entered into a standard Excel sheet by the WHO and analysed using SPSS v.26. Statistical analyses included Kaplan-Meier survival analysis, t-tests, and ANOVA, with statistical significance set at p < 0.05.

RESULTS: Of the 100 participants enrolled, 92% completed the study. The cumulative treatment success rate for CQ-PQ was 93.7% (95% CI 0.86-0.97) on day 42, with a 6.3% (95% CI 0.03-0.14) treatment failure rate. Asexual parasite clearance was rapid, with 97% achieving clearance by day 2 and full clearance by day 3 in all but one participant. Haemoglobin levels increased significantly from 12.3 g/dL at baseline to 13.5 g/dL by day 42, with 84.2% of mild anaemic patients and 85.7% of moderate anaemic patients showing recovery. Common adverse events included abdominal pain (8%) and diarrhea (5%), all of which resolved by day 7.

CONCLUSION: CQ-PQ therapy demonstrated high efficacy in clearing parasitaemia and improving haemoglobin levels in patients with vivax malaria. These results highlight the potential of CQ-PQ as an effective treatment option, with a favourable safety profile. Further studies are needed to explore long-term outcomes and the impact of this treatment on malaria control in different settings.

PMID:40518540 | DOI:10.1186/s12936-025-05446-y

Diabetol Metab Syndr. 2025 Jun 16;17(1):215. doi: 10.1186/s13098-025-01784-8.

ABSTRACT

BACKGROUND: The relationship between mixed metal exposure and metabolic syndrome (MetS) remains controversial, and the underlying mechanisms of this relationship are not yet fully understood.

OBJECTIVE: We evaluated the association between urinary metals and MetS and investigated the potential mediating effect of ageing.

METHODS: This study utilized National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 and included 11,541 adults aged 20 years and above. We explored the association between urinary concentrations of nine metals and MetS using weighted quantile sum (WQS) regression, grouped weighted quantile sum (GWQS) regression, and Bayesian kernel machine regression (BKMR). In addition, various methodologies have been used to assess biological ageing, encompassing the examination of cellular senescence through the evaluation of telomere length, as well as a comprehensive evaluation of overall body ageing through the determination of biological age. The contribution of biological ageing to the association between urinary metals and MetS was investigated in a mediation analysis.

RESULTS: After adjusting for confounders, the WQS and GWQS analyses found positive and negative correlations between metal exposure and MetS, and the main metals affecting MetS risk were cadmium (Cd) and lead (Pb), respectively. A positive relationship was found between exposure to mixed metals and the risk of MetS in the BKMR results. Mediation analysis showed that ageing biomarkers, including biological age and telomere length, mediated 68.43% and 12.05% of the association between metal exposure and MetS, respectively. Biological ageing may play a major role in the association between mixed metal exposure and MetS. Cd contributed the most to the positive association, indicating that priority control measures may be necessary to reduce the risk of MetS related to Cd exposure.

SIGNIFICANCE: The findings of this study could contribute to the advancement of targeted measures for metal precautions, ultimately mitigating the incidence of metabolic syndrome.

IMPACT STATEMENT: This research employed multipollutant models including WQS regression, GWQS and BKMR to evaluate the combined effects of various metal exposures on the risk of developing MetS based on a nationally representative large cross-sectional study. In addition, this research investigated biological aging by conducting a comprehensive assessment of biological age and telomere length. Our goal is to understand its potential mediating effect on metal exposure and the occurrence of metabolic syndrome. The insights gained from this study could provide valuable hints for future mechanistic research in this field.

PMID:40518538 | DOI:10.1186/s13098-025-01784-8