Five-year outcomes similar for low-risk patients receiving transcatheter, surgical aortic valve replacement: Study

Patients with severe aortic stenosis at low surgical risk who underwent supra-annular, self-expanding Evolut transcatheter aortic valve replacement (TAVR) had similar rates of death or disabling stroke at five years compared with those whose valves were replaced through standard open heart surgery, based on new follow-up data from the Evolut Low Risk trial presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).

Evolut Low Risk is a large, prospective trial that initially enrolled 1,478 patients at 86 centers in the United States, Canada, Europe, Japan, Australia and New Zealand to compare the safety and efficacy of Evolut TAVR to surgery. Patients were randomized to TAVR (n=737) or surgical aortic valve replacement (SAVR) (n=741). Both groups were well-matched in terms of baseline characteristics such as hypertension, coronary disease and lung disease; patients were 74 years old, on average, and one-third were women.

Follow-up data was available for 91% of TAVR patients and 87.4% of SAVR patients for the five-year analysis. Of these patients, the primary endpoint of death or disabling stroke occurred in 15.5% of those receiving Evolut TAVR and 16.4% of those undergoing SAVR.

“The outcomes of all-cause mortality and disabling stroke remain similar between TAVR and surgery, though numerically TAVR remains better,” said Michael J. Reardon, MD, professor and Allison Family Distinguished Chair of Cardiovascular Research at Houston Methodist Hospital and the study’s senior author. “TAVR has also shown similar improvements in terms of symptom and functional class and there’s no difference in the rate of reinterventions, so the supra-annular, self-expanding Evolut TAVR looks really good at five years in this group of patients.”

In addition to the combined rates of death and disabling stroke being similar between the two groups, the rates of disabling stroke were also comparable at five years (3.6% for TAVR and 4% for surgery) with no difference between year four and year five. All-cause mortality widened slightly during this period, though deaths remained similar between the two groups (13.5% for TAVR and 14.9% for surgery), Reardon said. Cardiovascular-related deaths were similar from two years to five years post-intervention and there was also no difference in reintervention rates between the groups at five years.

When examining all-cause mortality between the groups, Reardon said the deaths were primarily driven by non-cardiovascular events, including cancer-related deaths (seven in the TAVR group and one in SAVR), sepsis (three in TAVR) and COVID-19 (three in TAVR and two in SAVR).

“The difference in cardiovascular deaths is maintained over the five years of the trial, which is reassuring as these deaths are related to how well the aortic valve works,” Reardon said. “In looking at cardiovascular deaths alone, they occurred in 7.2% of people with TAVR at 9.3% at five years—the curves looked similar, the delta was 1.1% at two years and now at five years is 2.1%, which gives us strong confidence that the performance of the valve compared with surgery remains very good.”

Quality of life, measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), which allows patients to report their functional ability and wellness, stayed high through five years for both Evolut TAVR and surgery. Based on the scores, researchers report that approximately 70% of patients in both groups are alive and well at five years.

As shown previously, patients receiving TAVR had significantly fewer cases of atrial fibrillation, superior hemodynamics (blood flow through the heart), more pacemakers and more paravalvular regurgitation (leakage around the valve), which decreased over time.

TAVR, which involves threading a replacement valve through a catheter in the groin or chest, has emerged as the leading procedure for treating symptomatic severe aortic stenosis in the U.S., irrespective of the patient’s surgical risk. With TAVR, most patients are out of the hospital within a few days and back to their normal activities within a week versus more extended recovery time with surgery. Patients randomized to TAVR in this study received the Medtronic Evolut R, PRO or CoreValve bioprosthesis as new generation valves became available during the study.

Aortic stenosis-when the valve in the heart’s main artery doesn’t open fully-forces the heart to work harder to pump blood and can be life-threatening. TAVR is now FDA approved for use in high, intermediate and low surgical risk patients with severe aortic stenosis. Low risk was defined as a predicted 30-day mortality of 3% or less for 30 days post-surgery and was based on a combination of clinical judgment from the local heart team and an independent screening committee.

Reardon and team plan to follow patients for 10 years, which should yield important long-term data about TAVR’s durability compared with surgically implanted valves, as well as the life of the valves themselves.  

Reference:

Five-year outcomes similar for low-risk patients receiving transcatheter, surgical aortic valve replacement, American College of Cardiology, Meeting:American College of Cardiology’s Annual Scientific Session.

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Study Finds Adulting hard on heart: Teen to young adulthood a critical time to address risk

Many teenagers enter adulthood with significant risk factors for cardiovascular disease, and the transition from adolescence to adulthood is a key time to address these risk factors and reduce the risk of developing future cardiovascular disease, according to a new American Heart Association scientific statement published today in the Journal of the American Heart Association.

According to the scientific statement, “Cardiovascular Health in the Transition from Adolescence to Emerging Adulthood,” emerging adulthood is the period between age 18 and the mid- to late-twenties, when the brain and decision-making ability are still maturing to adult levels. Greater independence and many changes in life circumstances are occurring simultaneously during this time.

“Emerging adulthood is a time of significant planning, often centered around career development and forming close personal relationships. This pivotal phase is also an ideal time to establish health practices that support lifelong heart health,” said Chair of theJournal of the American Heart Association scientific statement writing group Jewel Scott, Ph.D., R.N., FNP-C, an assistant professor of biobehavioral health and nursing science in the College of Nursing at the University of South Carolina in Columbia, South Carolina.

The scientific statement reviews many of the individual and social challenges to protecting heart health in emerging adults, and it identifies types of interventions that may help.

Transitions in health care and lifestyle changes

In childhood and adolescence, there are typically standard occasions to see health care professionals, such as scheduled vaccinations and school or sports check-ups. These visits provide an opportunity to measure weight and blood pressure and check cholesterol and blood sugar levels. They can also open the door to a discussion about maintaining heart health and addressing any concerns before a risk factor is apparent.

“In the transition from high school to young adulthood, the built-in checkpoints fall off, and young adults may not reengage with care until after they’ve developed a heart disease risk factor,” said Scott.

Life’s Essential 8, the American Heart Association’s key measures for improving and maintaining cardiovascular health, include several health behaviors (such as eating a healthy diet and getting enough physical activity) that may worsen in emerging adulthood. This period of life usually brings greater responsibilities along with a loss of structures that were in place during adolescence. Becoming more sedentary is common, as is gaining weight.

“Lots of youth who were very active in high school become less active once the recreational sport or team sport they loved goes away. How to cook is not often taught in high school these days, and we know that people who have more cooking skills are more likely to prepare food at home — and meals at home tend to have less sodium and to be more balanced than meals at fast food or sit-down restaurants,” said Scott.

Responsibilities related to school, work, commuting and parenting may also make it difficult for young adults to get sufficient sleep, another important factor for optimal heart health.

While, historically, young people often started smoking tobacco in middle school and high school, the percentage of people who started using tobacco between 18 and 23 years of age doubled between 2002 to 2018, with electronic cigarettes as the most frequently used product. The authors emphasize that more research is needed to learn about the long-term cardiovascular effects of vaping.

Barriers to health care access

The ability to pay for health care may also become a challenge during the transition from adolescence to adulthood. Emerging adults make up the largest group of the 27 million uninsured adults in the United States. In some states without expanded Medicaid access, individuals can lose their Medicaid coverage when they turn 19. If their parents are insured through the Affordable Care Act, emerging adults age out of coverage after age 26.

While college health services can be important in providing care, 40% of all college students attend two-year community colleges. These students are less likely to have access to health care, which is often not available at community colleges. Young adults pursuing a trade pathway or apprenticeship are also less likely to have health insurance coverage.

To improve health care access for emerging adults, the statement suggests supporting policies that expand insurance access across the lifespan and eliminate gaps in coverage. However, the statement points out that barriers to obtaining health care go beyond insurance status, since health care utilization is less than 40% among insured emerging adults. Barriers may include a lack of knowledge of health care services, past negative experiences with care or other issues, such as long wait times and poorly coordinated care.

Other social determinants of health

Social determinants of health have a significant impact on cardiovascular health outcomes during emerging adulthood. Factors such as education, neighborhood environment and economic stability play a crucial role in mediating health inequities:

  • Higher education is strongly correlated with better cardiovascular health. Principles of cardiovascular health should be integrated into educational settings from early in life and continue through post-secondary and vocational education.
  • Neighborhoods that are segregated, have fewer resources, have less access to clean air and water and lack safe spaces for physical activity, are associated with poorer cardiovascular health beginning at a young age. The statement advocates for policies addressing social and economic inequities that contribute to residential segregation, and for greater access to and utilization of green spaces and safe spaces for physical activity.
  • As friendships and intimate partner relationships become more central in the lives of emerging adults, a lack of positive social connection and support is related to poorer cardiovascular health. Enhancing peer relationships and social networks could have a positive impact on heart-related behaviors in young adults, such as promoting tobacco cessation or encouraging more physical activity. The statement calls for exploring opportunities to reduce isolation, especially for those who may have experienced serious isolation during the COVID-19 pandemic, and to identify and intervene with at-risk individuals, such as those with a history of intimate partner violence, adverse childhood experiences or social isolation.
  • Economic instability creates barriers to health care access and nutritious foods. The statement calls for supporting policies that remove financial barriers to health care, identifying disconnected young people — those not employed or pursuing further education — and designing programs to promote vocational training and improve financial stability.

“We highlight some of the populations that need extra effort or attention tailored to their unique circumstances, such as those moving out of the foster care system and others who have barriers engaging with the health care system. One size may seem to fit all, however, it doesn’t usually work,” said Scott.

Opportunities for engagement

When young adults visit their health care professionals, there may be missed opportunities to discuss how to protect heart health.

“Clinicians have limited time with each patient. We may see their blood pressure is a little high, but we don’t address it because they came in with an ear infection or sprained ankle or something else that needs immediate attention. We may miss the opportunity to let them know that they are in the elevated blood pressure range and ways they can take action. We need to have these conversations and make sure that heart health is at the front of their minds,” said Scott.

Health care engagement also provides an important opportunity to address cardiovascular health before pregnancy, since suboptimal cardiovascular health increases the risk of adverse pregnancy outcomes, such as gestational diabetes, preeclampsia and pre-term birth. Adverse pregnancy outcomes are strongly associated with poorer cardiovascular health later in life.

The statement also suggests leveraging telehealth and mobile technology to increase health care use among emerging adults. With young adults increasingly living in a digital world, there is a need to explore how social media can be harnessed to deliver tailored cardiovascular prevention messages and track whether they are effective in resulting in behavioral changes.

In addition, researchers, clinicians and the public health community are encouraged to think about other avenues for reaching emerging adults, such as community colleges and universities, the military and veterans administration, and industries such as hospitality that employ a disproportionate number of young adults.

Reference:

Jewel Scott, Anandita Agarwala, Carissa M. Baker‐Smith, Matthew J. Feinstein, Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association, Journal of the American Heart Association, https://doi.org/10.1161/JAHA.124.039239

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Individuals living Alone with anxiety or depression at high risk of Suicide: JAMA

Researchers have found in a new study that individuals who live alone and experience depression or anxiety have a higher risk of suicide. The findings emphasize the need for targeted mental health interventions and suicide-prevention strategies to support vulnerable individuals. Living alone and mental health disorders, including depression and anxiety, are associated with high suicide risk, but their combined impact remains underexplored. A study was done to examine the association of living arrangements and depression or anxiety with suicide risk. This population-based cohort study used data from the Korean National Health Insurance Service database from January 1, 2009, to December 31, 2021, that included adults aged 20 years or older who participated in the General Health Screening Program in Korea in 2009. Individuals with incomplete data and those who died by suicide within the first year were excluded to minimize the possibility of reverse causation. Data were analyzed from December 28, 2023, to December 27, 2024. Living arrangements, categorized as living alone (≥5 years) or living with others, and depression and anxiety, determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The primary outcome was death by suicide, identified through national death records. Multivariable Cox proportional hazards regression models were used to estimate adjusted hazard ratios (AHRs) and 95% CIs for suicide risk. Results The study included 3 764 279 adults (mean [SD] age, 47.2 [14.0] years; 55.8% male). Of these individuals, 112 460 (3.0%) had depression, 232 305 (6.2%) had anxiety, and 319 993 (8.5%) lived alone. Compared with individuals who had neither depression nor anxiety nor lived alone, individuals living alone with both depression and anxiety exhibited a 558% increased risk of suicide (AHR, 6.58 [95% CI, 4.86-8.92]). Living alone with depression was associated with a 290% increased risk (AHR, 3.91 [95% CI, 2.96-5.16]), and living alone with anxiety was associated with a 90% increased risk (AHR, 1.90 [95% CI, 1.48-2.43]). The AHRs were higher for the association between living alone and suicide among middle-aged individuals (aged 40 to 64 years) and men compared with other demographic groups. In this cohort study of 3 764 279 individuals, living alone with depression or anxiety was associated with an increased risk of suicide, particularly among middle-aged individuals and men. These findings underscore the importance of preventing mental illness, such as depression and anxiety, while addressing living arrangements as a critical factor in suicide risk assessments for individuals with these conditions.

Reference:

Moon DU, Kim H, Jung J, Han K, Jeon HJ. Suicide Risk and Living Alone With Depression or Anxiety. JAMA Netw Open. 2025;8(3):e251227. doi:10.1001/jamanetworkopen.2025.1227

Keywords:

Individuals, living, Alone, anxiety, depression, high risk, Suicide, JAMA, Moon DU, Kim H, Jung J, Han K, Jeon HJ.

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AI dental assistant reads X-rays with near-perfect accuracy, reports research

The Ateneo Laboratory for Intelligent Visual Environments (ALIVE) and international researchers have developed a deep learning model that aims to revolutionize dentistry, with the capability to identify tooth and sinus structures in dental X-rays with an accuracy of 98.2%.

Using a sophisticated object detection algorithm, the system was specifically trained to help quickly and more accurately detect odontogenic sinusitis-a condition that is often misdiagnosed as general sinusitis and, if left unchecked, could spread infection to the face, eyes, and even the brain.

Odontogenic sinusitis, caused by infections or complications related to the upper teeth, is notoriously difficult to diagnose. Its symptoms-nasal congestion, foul-smelling nasal discharge, and occasional tooth pain-are nearly identical to those of ordinary general sinusitis. To make matters worse, only about a third of patients experience noticeable dental pain, meaning the condition is frequently overlooked by general practitioners. Traditional diagnosis requires collaboration between dentists and otolaryngologists, often leading to delayed treatment.

By training deep learning models on dental panoramic radiograph (DPR) images, the researchers found a way to detect key anatomical relationships0such as the proximity of tooth roots to sinuses-with unprecedented accuracy. The study used the YOLO 11n deep learning model, achieving an impressive 98.2% accuracy, outperforming traditional detection methods.

YOLO (You Only Look Once) is a state-of-the-art object detection algorithm known for its speed and accuracy. The YOLO 11n model, an improved version, is optimized for medical imaging tasks, enabling it to identify teeth and sinus structures with high precision in a single pass through the image. Unlike conventional diagnostic methods, which require multiple steps and expert interpretation, YOLO 11n rapidly pinpoints the affected areas in real time, making it an invaluable tool for dental professionals.

Beyond accuracy, this AI-driven approach also offers practical benefits. It minimizes patient exposure to radiation by reducing the need for CT scans, which are currently the gold standard for diagnosing odontogenic sinusitis. It also provides a cost-effective screening tool, particularly useful in resource-limited areas where advanced imaging technology may not be available. And by flagging potential cases early, the system allows for prompt intervention, preventing complications and reducing the burden on healthcare providers.

This breakthrough highlights AI’s growing role in medical diagnostics, bridging gaps where human expertise alone may fall short. With further validation, this technology could become a standard tool in dental and ENT clinics, ensuring that more patients receive timely and accurate diagnoses.

Reference:

Wu, P.-Y.; Lin, Y.-J.; Chang, Y.-J.; Wei, S.-T.; Chen, C.-A.; Li, K.-C.; Tu, W.-C.; Abu, P.A.R. Deep Learning-Assisted Diagnostic System: Apices and Odontogenic Sinus Floor Level Analysis in Dental Panoramic Radiographs. Bioengineering 2025, 12, 134. https://doi.org/10.3390/bioengineering12020134

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Menthol in E-Cigarettes during pregnancy May Harm Developing Babies, suggests study

Research suggests that menthol, a common flavor chemical in electronic cigarettes, could pose risks to fetal development. Exposure during pregnancy may impact a baby’s growth and health, raising concerns about vaping while expecting.

Vaping during pregnancy is becoming more common, but its impact on early human development is not well understood. A new study by scientists at the University of California, Riverside, now reports that the flavor chemical menthol used in electronic cigarettes could pose risks to a developing baby.

The study, published in STEM CELLS Translational Medicine, used human embryonic stem cells, or hESCs, to characterize early stages of embryonic development and examined how low concentrations of menthol affect important cellular processes.

The researchers found the concentration of menthol in the blood of pregnant women who vape is enough to activate stress-related channels called Transient Receptor Potential channels in the hESCs.

“This activation led to inhibition of cell growth, increased cell death, and abnormal cell movement in the hESCs,” said Shabnam Etemadi, first author of the research paper and a bioengineering graduate student who works with Prue Talbot, a professor of the graduate division. “These changes could interfere with a critical stage of development called gastrulation, potentially increasing the risk of birth defects.”

Transient Receptor Potential channels are a large family of ion channels located in the membranes of many different cell types, including in reproductive tissues and embryos. They are involved in a wide range of sensory and physiological processes, including detecting heat, cold, pain, pressure, taste, and smell.

The researchers found that one of the channels, the TRPA1 channel, was activated by nanomolar concentrations of menthol, which their exposure model predicts would be in the blood of pregnant women who vape and would reach the embryo.

Etemadi explained that gastrulation involves movement of epiblast cells-cells that can differentiate into any cell type in the body-to form the definitive endoderm and the mesoderm. Gastrulation is considered a critical stage of development because it is the process where the three primary germ layers-the ectoderm, mesoderm, and endoderm-are formed during the third or fourth week of development, she said.

“These germ layers serve as the building blocks for all future organs and tissues in the embryo; any disruption during this stage can lead to significant structural birth defects due to the misallocation of cells destined for specific tissues and organs,” she added.

Talbot, the senior author of the research paper, said the findings highlight the need for more research on how vaping during pregnancy may harm embryonic and fetal development and point to possible dangers of using mentholated electronic cigarettes.

“The use of e-cigarettes by pregnant women should be discourag.ed until the effects on their embryos of flavor chemicals, such as menthol, are fully understood,” she said.

Reference:

Shabnam Etemadi, Menthol, a Consumer Product Additive, Adversely Effects Human Embryonic Cells via Activation of TRPM8 and TRPA1 Channels, Stem Cells Translational Medicine, https://doi.org/10.1093/stcltm/szae099 

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Embolic protection device shows no effect on stroke risk with TAVR: Study

A device designed to remove embolic material-fragments of tissue that can be released into the bloodstream during transcatheter aortic valve replacement (TAVR)—did not result in a reduction in the rate of stroke, according to a randomized trial presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).

The BHF PROTECT-TAVI trial is the largest randomized trial assessing the use of a cerebral embolic protection device during TAVR, also known as transcatheter aortic valve implantation or TAVI.

“This large, well-conducted, appropriately powered clinical trial has addressed the question of whether the SENTINEL Cerebral Protection System is effective in an unselected cohort of TAVI patients,” said Rajesh Kharbanda, MD, associate professor of cardiovascular medicine at the University of Oxford, United Kingdom, and the study’s first author. “In our population, a routine strategy of cerebral embolic protection did not reduce the rate of stroke. Our study provides convincing evidence that there is no value in the routine use of this device during TAVI.”

TAVR is a common procedure carried out to treat patients with aortic stenosis, a condition in which the aortic valve becomes narrowed, preventing blood from flowing properly. During TAVR a prosthetic valve is implanted in the diseased valve between the aorta and the heart’s left ventricle. While TAVR carries a good safety record overall, around 2% to 4% of patients have a stroke during or shortly after the procedure, sometimes because calcium or tissue fragments are released when the replacement valve is deployed. About half of such strokes result in permanent disabilities.

Cerebral embolic protection devices are designed to capture embolic material that enters the bloodstream during TAVR, preventing it from reaching the brain and causing a stroke. SENTINEL, the device used in the trial, is the most frequently used embolic protection device in TAVR procedures.

The BHF PROTECT-TAVI trial enrolled 7,635 patients undergoing TAVR for aortic stenosis at 33 centers in the United Kingdom between 2020-2024, representing about 30% of all UK patients who received the procedure in those years. Participants had an average age of 81 years and just under 40% were female. Participants were randomized 1:1 to undergo TAVR with the SENTINEL device or TAVR without cerebral embolic protection.

In a third planned interim analysis, the trial’s primary endpoint-the incidence of stroke at 72 hours post-TAVR or at the time of hospital discharge, if sooner-occurred in 2.1% of patients assigned to the SENTINEL device and in 2.2% of patients assigned to the control group, showing no evidence of a difference between the two study arms. Results for secondary endpoints including all-cause mortality, stroke severity, disabling stroke and cognitive outcomes were also similar between groups. Recruitment for the trial was stopped after the interim analysis based on these findings.

No differences in outcomes were seen in any subgroups that were analyzed.

Researchers said the stroke risk associated with TAVR has decreased over the past decade due to improvements in TAVR devices, implantation techniques and procedural protocols and as operators have become more experienced with the procedure. Although the trial showed current cerebral embolic protection devices do not improve outcomes, Kharbanda said it is possible that next-generation embolic protection devices could potentially reduce stroke risk for certain groups, but further trials would be needed to demonstrate this.

“We need to understand which patients are at higher risk of stroke during TAVR and whether a more stratified approach to delivering therapy to those people is beneficial,” Kharbanda said.

Although the study was limited to the UK, researchers said the broad, national rollout of the trial and its representative patient population likely make the results generalizable to other countries.

Reference:

Embolic protection device shows no effect on stroke risk with TAVR, American College of Cardiology, Meeting: American College of Cardiology’s Annual Scientific Session.

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Laparoscopic Supracervical Hysterectomy safer than total Laparoscopic Hysterectomy among patients with uterine fibroids: Study

Researchers have found in a new research that Laparoscopic supracervical hysterectomy (LSH) has a lower risk of short-term postoperative complications compared to total laparoscopic hysterectomy (TLH) in patients with uterine fibroids. Therefore these findings support informed, shared decision-making when considering minimally invasive hysterectomy for uterine fibroids. Hysterectomy is the standard surgical treatment for uterine fibroids in the United States, but there has been limited information on how the two most common minimally invasive surgical methods impact patient outcomes. The study was conducted by Raanan M. and published in the American Journal of Obstetrics and Gynecology.

This cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program database of cases from 2012 to 2020. The analysis involved 50,796 women who had total laparoscopic hysterectomy (44,413 patients) or laparoscopic supracervical hysterectomy (6383 patients) performed for the purpose of uterine fibroids. Researchers compared 30-day postoperative complications, classified based on the Clavien-Dindo classification. Variables like age, body mass index, race, comorbidities, American Society of Anesthesiologists classification, uterine weight, and other surgical procedures were compared using multivariate regression to identify their role in postoperative results.

Key Findings

Operative Time:

  • Mean operative time was considerably less for total laparoscopic hysterectomy (143.0 minutes) than for laparoscopic supracervical hysterectomy (150.6 minutes, p<.001).

Uterine Weight

  • The rate of patients with uterine weights over 250 g was lower in the total laparoscopic hysterectomy group (39.4%) than in the laparoscopic supracervical hysterectomy group (45.1%, p<0.001).

Overall Complication Rates:

  • Any complications after the operation were more in the group that underwent total laparoscopic hysterectomy (6.6%) than in the group that underwent laparoscopic supracervical hysterectomy (5.3%, p<0.001).

Major Complications:

  • Major complications were also more with total laparoscopic hysterectomy (2.7%) than with laparoscopic supracervical hysterectomy (1.6%, p<0.001).

Minor Complications:

  • Rates of minor complications did not significantly differ between both groups (total laparoscopic hysterectomy: 4.4%, laparoscopic supracervical hysterectomy: 4.1%, p=0.309).

Adjusted Odds Ratios:

  • Laparoscopic supracervical hysterectomy was independently linked with lower risk of any postoperative complication (adjusted OR: 0.79; 95% CI: 0.70–0.88).

  • It also carried a much lower risk of major complications (adjusted OR: 0.55; 95% CI: 0.44–0.69).

This research concludes that laparoscopic supracervical hysterectomy has a reduced risk of short-term postoperative complications when compared to total laparoscopic hysterectomy in uterine fibroid patients. These findings reinforce the importance of personalized surgical planning and can aid patients and surgeons to select the ideal minimally invasive hysterectomy method.

Reference:

Meyer R, Hamilton KM, Schneyer RJ, Levin G, Truong MD, Wright KN, Siedhoff MT. Short-term outcomes of minimally invasive total vs supracervical hysterectomy for uterine fibroids: a National Surgical Quality Improvement Program study. Am J Obstet Gynecol. 2025 Apr;232(4):377.e1-377.e10. doi: 10.1016/j.ajog.2024.10.006. Epub 2024 Oct 14. PMID: 39413898.

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High SII and Low PNI Linked to Prolonged ICU Stay in Pneumonia Patients with Respiratory Failure: Study

China: A recent study published in the International Journal of General Medicine has explored the prognostic value of the Systemic Immune Inflammation Index (SII) and the Prognostic Nutritional Index (PNI) in predicting prolonged Intensive Care Unit (ICU) stays in patients with pneumonia complicated by respiratory failure.

In patients with pneumonia complicated by respiratory failure, both the SII and PNI were associated with prolonged ICU stays. The study of 3,425 patients found that high SII (OR: 2.115) was a significant factor contributing to longer ICU stays in patients who received blood transfusions, while low PNI (OR: 1.378) was linked to extended ICU stays in those who did not receive transfusions. Additionally, invasive mechanical ventilation strongly predicted prolonged ICU stays in both groups.

The length of intensive care unit stay is a crucial indicator of prognosis in patients with severe pneumonia (SP) complicated by respiratory failure (RF). While blood transfusion can help alleviate tissue hypoxia in ICU patients, its impact on patient outcomes, including prognosis, remains a significant concern. In this context, the study aimed to evaluate how immune-nutritional indices—such as the pan-immune inflammation value (PIV), systemic immune inflammation index (SII), system inflammation response index (SIRI), neutrophil-to-albumin ratio (NAR), and prognostic nutritional index (PNI)—influence the duration of ICU stay in patients treated with and without blood transfusion.

By exploring these indices, Zhijuan Zheng, Intensive Care Unit, Meizhou People’s Hospital, Meizhou, People’s Republic of China, and colleagues sought to understand their role in predicting the length of ICU care and their potential to guide better management strategies for patients in critical condition.

For this purpose, the researchers retrospectively analyzed the medical records of 3,425 patients with pneumonia complicated by respiratory failure. They collected data on various factors, including age, gender, body mass index, smoking and alcohol consumption history, hypertension, diabetes mellitus, lung diseases, invasive mechanical ventilation, blood transfusion, APACHE II score, and laboratory test results. The relationship between these factors and the length of ICU stay was then analyzed to identify key predictors of prolonged ICU hospitalization in these critically ill patients.

The study led to the following findings:

  • The average length of ICU stay was 5.32 days. 2,521 patients (73.6%) had a non-prolonged ICU stay (less than 9 days), while 904 patients (26.4%) had a prolonged ICU stay (9 days or more).
  • Patients with prolonged ICU stays had higher levels of PIV, SII, and SIRI compared to those with non-prolonged ICU stays, both in patients with and without blood transfusion.
  • Multivariate logistic regression analysis revealed that high SII (OR: 2.115) and invasive mechanical ventilation (OR: 10.205) were associated with prolonged ICU stays in patients who received blood transfusions.
  • Low PNI (OR: 1.378) and invasive mechanical ventilation (OR: 3.566) were independently associated with prolonged ICU stays in patients without blood transfusion.

The study concluded that high levels of the systemic immune inflammation index and the use of invasive mechanical ventilation were independently associated with prolonged ICU stays in patients who received blood transfusions. Conversely, in patients who did not receive blood transfusions, low levels of the prognostic nutritional index and invasive mechanical ventilation were independently linked to extended ICU stays.

“These findings offer a novel approach for personalized medicine, providing valuable insights to guide ICU management of severe pneumonia complicated by respiratory failure. However, the researchers emphasize the need for further prospective cohort studies to better understand the relationship between these composite indices and patient prognosis in this critical condition,” the authors concluded.

Reference:

Zheng Z, Yu M, Peng G, Xiao Y. Systemic Immune Inflammation Index (SII) and Prognostic Nutritional Index (PNI) Associated with Prolonged Intensive Care Unit (ICU) Stay in Patients with Pneumonia Complicated with Respiratory Failure. Int J Gen Med. 2025;18:1765-1776 https://doi.org/10.2147/IJGM.S510659

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Surgery may improve neck disability index in cervical radiculopathy patients, suggests study

A new study published in The New England Journal of Medicine Evidence showed that surgery significantly improved the Neck Disability Index (NDI) after 12 months in individuals with cervical radiculopathy when compared to nonsurgical therapy for disc herniation.

Cervical radicular syndrome (CRS) may result in sensory and motor impairments as well as invalidating radicular discomfort. Most patients have a gradual reduction in symptoms over the course of a few weeks, allowing them to resume their regular daily activities. There are several disagreements on whether to do diagnostic tests, when to refer specialists, and when to perform surgery for a cervical cervical hernia nuclei pulposus (HNP).

The majority of cervical disc protrusions resolve on their own without surgery, according to indirect data. Surgery may be considered if the problems do not go away on their own in a fair amount of time. An anterior discectomy followed by anterior spinal nerve decompression is the standard surgical procedure.

A total of 180 patients with incapacitating radicular arm pain and cervical disc herniation (trial 1; n = 89) or spondylosis (trial 2; n = 91) confirmed by magnetic resonance imaging or computed tomography participated in 2 randomized clinical trials at Oslo University Hospital in Norway. A 1:1 random assignment system was used to allocate patients to either surgery or nonsurgical therapy.

Anterior cervical discectomy and fusion were the surgical procedures. 3 appointments with physical medicine/rehabilitation doctors and three sessions with physiotherapists for cognitive behavioral and functional assistance comprised the nonsurgical therapy. The NDI score, which patients self-reported at 12 months and ranged from 0 to 100 (higher scores indicate greater impairment; the smallest meaningful difference is 15), was the main endpoint in both studies.

The average difference in NDI adjusted for baseline was 7.4 in favor of surgical therapy among the 87 participants in the 12-month data disc herniation study. The mean difference in NDI corrected for baseline was 2.3 among the 88 participants in the 12-month data set of the spondylosis experiment.

2 patients from the nonsurgical group switched to surgery in the disc herniation experiment. 11 individuals in the nonsurgical group switched to surgery in the spondylosis study. No significant adverse effects occurred. Overall, this study observed a statistically significant difference in NDI at 12 months between surgical and nonsurgical therapy for patients with cervical radiculopathy.

Reference: 

Taso, M., Sommernes, J. H., Sundseth, J., Pripp, A. H., Bjorland, S., Engebretsen, K. B., Kolstad, F., Zwart, J. A., & Brox, J. I. (2025). Surgical versus nonsurgical treatment for cervical radiculopathy. NEJM Evidence, 4(4), EVIDoa2400404. https://doi.org/10.1056/EVIDoa2400404

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Children of moms who smoked or were obese are more likely to become obese adults, reports research

A study finds that factors beyond a person’s control, like socioeconomic status and whether their mom smoked or was obese, can influence whether they are overweight or obese as teenagers or adults. Glenna Nightingale of the University of Edinburgh, UK and colleagues report these findings on March 26, 2025 in the open-access journal PLOS One.

Obesity is considered to be a global public health concern, but experts still disagree about the precise origins and causes of rising obesity rates. One topic under debate is whether a person’s individual genetics and behaviors are more or less important than environmental factors, like socioeconomic status, in developing obesity.

In the new study, researchers estimated the impact of several factors on a person’s weight, including societal factors, like a person’s job type, as well as early life factors, like a person’s birth order, how they were delivered and whether their mother smoked or was obese. They looked specifically at whether a person was overweight, obese or severely obese at age 16 and age 42. They also looked at participants’ weight between ages 16 to 42, a range that spans the rise in obesity rates in the United Kingdom. The data came from the 1958 National Child Development Study, a long-term study that followed the lives of more than 17,000 people born in a single week in March 1958 across England, Scotland and Wales.

The analysis showed that if a mother was obese or if she smoked, her child was more likely to be obese or severely obese at each of the ages examined. The findings demonstrate that these early life factors can have a persistent effect on a person’s weight. Notably, these factors were just as powerful before and after the start of the rise in obesity rates in the UK, suggesting that the impact of individual factors, like behaviors, likely did not change during that time.

The results suggest that societal and early-life risk factors could be used to target obesity prevention programs for children and adults. The researchers also conclude that, since individual risk factors have not changed as obesity rates have risen, new studies are needed to identify societal factors that may have caused the current obesity pandemic.

The authors add: “Our research shows that the effect of maternal influences persists through to age 42 and that strikingly, those predictors were just as powerful (and prevalent) in the era before the current obesity pandemic began. This suggests that, as Geoffrey Rose pointed out, novel studies are needed of factors at the community/societal level that may have caused the current obesity pandemic, since individual-level risk factors appear not to have changed over the time period spanning the pandemic’s onset and growth.”

Reference:

Glenna Nightingale ,Karthik Mohan,John Frank,Sarah Wild,Sohan Seth, Sociodemographic and early-life predictors of being overweight or obese in a middle-aged UK population– A retrospective cohort study of the 1958 National Child Development Survey participants, PLOS One, https://doi.org/10.1371/journal.pone.0320450

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