Category: Nevin Manimala

Vascular. 2026 Mar 2:17085381261425712. doi: 10.1177/17085381261425712. Online ahead of print.

ABSTRACT

ObjectivesPelvic congestion syndrome (PCS), often underdiagnosed, is a cause of chronic pelvic pain in women and is frequently associated with pelvic varicose veins. Endovascular embolization is an established treatment, traditionally performed via femoral or jugular access. However, these approaches may carry higher risks of complications. This study aimed to evaluate the safety, feasibility, and clinical outcomes of using basilic vein percutaneous access for pelvic vein embolization in patients with PCS.MethodsA retrospective cohort study was conducted on 292 women of reproductive age with symptomatic PCS who underwent pelvic varicose vein embolization using percutaneous access via the distal third of the right basilic vein. The study spanned from 2018 to 2023 and was carried out at two hospitals in Bogotá, Colombia. Inclusion criteria comprised chronic pelvic postcoital pain and Doppler-confirmed pelvic varicosities with reflux diameters >6 mm. Data collected included demographics, CEAP and Symptoms-Varices-Pathophysiology classifications, intraoperative details (access approach, duration, coil usage, complications), and postoperative outcomes (symptom resolution, complications, reintervention, ICU/hospital stay, and mortality). Follow-up evaluations were conducted at 15 days, 3 months, and 6 months post-procedure. Descriptive statistics were used for analysis. A detailed description of the surgical technique used for basilic vein access and embolization was included.ResultsAll 292 procedures were successfully performed using basilic vein access with no access-related complications such as bleeding, thrombosis, or hematoma. The average surgical duration was 41.1 min (SD = 4.1), and a mean of 2.6 coils (SD = 0.7) was used per case. The left gonadal vein was embolized in all patients, with additional embolization of the right gonadal (68.8%) and hypogastric veins (6.8%) when indicated. Only one patient (0.3%) experienced a coil migration resulting in pulmonary embolism, requiring reintervention and a short ICU stay. No mortalities were reported. Symptom resolution was achieved in 278 patients (95.2%), indicating high procedural effectiveness.ConclusionsBasilic vein access is a feasible and safe alternative for pelvic vein embolization in patients with PCS. This approach demonstrated excellent technical success, a low complication rate, and high symptom resolution, with the added benefits of shorter procedure time and reduced coil usage compared to traditional access routes. These findings suggest potential procedural and resource efficiency advantages. However, due to the study’s retrospective nature and lack of comparative controls, prospective studies are necessary to further assess the long-term efficacy and cost-effectiveness of basilic access in comparison to femoral and jugular approaches. Establishing standardized guidelines for vascular access in PCS treatment could enhance outcomes and procedural safety.

PMID:41766632 | DOI:10.1177/17085381261425712

Acta Orthop Belg. 2025 Sep;91(3):387-398. doi: 10.52628/91.3.14701.

ABSTRACT

Pathological femoral fractures resulting from primary or metastatic tumors represent a complex clinical challenge for orthopedic surgeons, often requiring individualized treatment strategies. This retrospective study aimed to evaluate and compare the outcomes of different surgical approaches used in the management of pathological femoral fractures secondary to metastatic disease. A total of 46 patients (52 femoral fractures) who underwent surgical treatment between 2020 and 2023 were included in the study. Data collected encompassed demographic characteristics, tumor histology, surgical techniques employed, and clinical outcomes. Statistical analysis was conducted using appropriate parametric and non-parametric tests, depending on data distribution. Of the patients included, 51% underwent tumor resection followed by endoprosthetic reconstruction, 40% were treated with intramedullary nailing, and 9.4% underwent plate osteosynthesis. The highest postoperative mortality rate was observed among patients with lung cancer metastases. Blood transfusions were necessary in 66% of cases. The overall mean survival time following surgery was 4.5 months, with significant variation according to tumor type and metastatic burden. The findings of this study underscore the importance of a multidisciplinary approach in the surgical management of pathological femoral fractures caused by metastatic tumors. Surgical interventions such as intramedullary nailing, plate fixation, and endoprosthetic reconstruction can effectively restore mechanical stability and contribute to improved patient quality of life. Selection of the optimal surgical technique should be guided by tumor histopathology, anatomical location and extent of bone involvement, number of metastatic lesions, and overall patient prognosis. Timely and appropriate surgical intervention remains critical to minimizing complications and enhancing survival outcomes in this patient population.

PMID:41766554 | DOI:10.52628/91.3.14701

Acta Orthop Belg. 2025 Sep;91(3):365-374. doi: 10.52628/91.3.12985.

ABSTRACT

BACKGROUND AND STUDY AIMS: The exact cause of spontaneously healing idiopathic osteonecrosis in the Legg-Calvé-Perthes disease (LCPD) is still unknown. Although it is postulated that thrombotic processes that occur as a result of genetic, epigenetic and environmental factors are at the forefront, the root cause cannot be fully elucidated. The aim of this study is to investigate underlying endothelial inflammation as a trigger of these pathophysiological mechanisms leading to LCPD.

MATERIALS: The levels of ICAM-1 and E-selectin in the local blood vessels around the femoral neck and peripheral veins of seven surgically treated LCPD patients and similar age controls were compared. These were reviewed together with the clinical and histopathological findings of the LCPD patients.

RESULTS: There were no statistically significant differences between each group’s ICAM-1 and E-selectin levels in the femoral neck region or the peripheral vessels (p>0.05). Histopathological examination revealed arterioles with thickened walls and luminal obliteration. Chronic synovitis with plasma cell and lymphocyte infiltration of different severity was detected in more than half of the patients. Proliferative synovitis with papillary proliferations was seen in two patients. The patients who had these histological findings also had endothelial marker levels above the cohort mean.

CONCLUSIONS: In summary, this study provided a comprehensive examination of LCPD patients. We observed arteriolar involvement and proliferative synovitis in multiple patients in the group.

CLINICAL RELEVANCE: This study provides important information about the pathophysiological basis of LCPD by combining clinical, molecular, and histopathological data. It is a comprehensive study in an uncommon population of surgically treated LCPD patients and similar age controls. To our knowledge, the findings of proliferative synovitis and arteriolar wall thickening have not been previously reported in the LCPD literature.

PMID:41766552 | DOI:10.52628/91.3.12985

Acta Orthop Belg. 2025 Sep;91(3):309-317. doi: 10.52628/91.3.14109.

ABSTRACT

Since its invention, the ball-and-socket prosthesis has played a significant role in treating carpometacarpal osteoarthritis of the thumb. One of the main postoperative complications remains prosthetic dislocation. To reduce this risk, engineers developed new designs – primarily the retentive cup and the dual-mobility cup. The aim of this study was to compare the stability and outcomes of these two designs, focusing specifically on dislocation as the primary variable. All Maia prostheses (n=118) implanted between 2019 and 2023 at a single institution by two surgeons using the same surgical technique were retrospectively reviewed. The type of implant, dislocation and complication rates, functional outcomes, and patient satisfaction were analyzed. Although the overall complication rates did not differ significantly between groups, the retentive cup group had a slightly higher rate of dislocation (n=2; 3%) compared to the dual-mobility group (n=0; 0%) (p = 0.55). Satisfaction rates, functional scores, QuickDASH results, and range of motion were similar between the two groups and comparable to those of the general age-matched population at midterm follow-up. This study found a low postoperative dislocation rate in both groups, with no dislocations in the dual-mobility group. Although the difference was not statistically significant, the dual-mobility design may demonstrate superior stability in larger cohorts. Both implant types showed reliable performance and high survival rates at midterm follow-up.

PMID:41766546 | DOI:10.52628/91.3.14109

Acta Orthop Belg. 2025 Sep;91(3):257-264. doi: 10.52628/91.3.10897.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the effectiveness of Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy in patients diagnosed with knee osteoarthritis and to compare its effectiveness in patients with grade 2 and grade 3 osteoarthritis.

MATERIAL AND METHOD: The study group comprised 48 patients over the age of 18 that were diagnosed with Grade II or Grade III (Kellgren-Lawrence) primary knee osteoarthritis. Two-way comparative knee radiography was performed for all patients before the procedure. Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy was applied to all patients. The patients were evaluated with the VAS and WOMAC index before the treatment and 3 months and 6 months after the treatment.

RESULTS: A statistically significant decrease was found in the six-month follow-up WOMAC and VAS scores compared to the pre-treatment scores regardless of the grade of their osteoarthritis (p <0.001).

CONCLUSION: In conclusion, it was observed that the intra-articular injection of the AD-MSCs provided satisfactory functional recovery and pain relief for patients with knee osteoarthritis at six-month follow-up. No procedure-related adverse events were observed during the follow-up period.

PMID:41766540 | DOI:10.52628/91.3.10897

Stroke. 2026 Mar 2. doi: 10.1161/STROKEAHA.125.053747. Online ahead of print.

ABSTRACT

BACKGROUND: Moyamoya disease (MMD) has a strong genetic basis, with the rare RNF213 variant (rs112735431) representing a major risk factor, while the broader genetic architecture and disease-relevant vascular cell types remain incompletely understood.

METHODS: We conducted a genome-wide association study in Japanese individuals (n=47 656; 401 MMD cases and 47 255 controls). Population-level features at MMD risk loci were examined by regional allele frequency and haplotype analyses. We performed single-nucleus RNA-seq of superficial temporal arteries from patients with MMD (n=3). Cell type-specific enrichment of genome-wide association study signals was assessed using the Single-Cell Disease Relevance Score. Endothelial signatures were validated by integration with publicly available single-cell data sets from controls (n=5) and immunohistochemistry for candidate markers (n=1).

RESULTS: Beyond rs112735431, we identified a genome-wide significant signal in the HDAC9-TWIST1 region (P=3.3×10^-14; odds ratio, 1.77). Conditional analysis on rs112735431 revealed a protective RNF213 missense variant, p.Asn1331Gly (rs8074015; P=3.7×10^–9; odds ratio, 0.53), whose minor allele was mutually exclusive with rs112735431-A on haplotypes. Population analysis revealed geographic variation and extended haplotype structure of the rs112735431-A allele in Japan. Single-nucleus RNA-seq identified a mesenchymal-like endothelial cell (MEC) population with selective FN1 expression. Genome-wide association study-prioritized disease genes were strongly enriched in MECs. MECs showed mesenchymal pathway activation with a regulatory program distinct from canonical endothelial states. The proportion of MECs was markedly increased in MMD (72% versus 28% in controls), and FN1 expression in endothelial regions was confirmed by immunohistochemistry.

CONCLUSIONS: Our findings identify a protective RNF213 variant that is mutually exclusive with the known rs112735431-A allele. Genetic risk converges on an MEC state markedly expanded in MMD.

PMID:41766532 | DOI:10.1161/STROKEAHA.125.053747

Int J Inj Contr Saf Promot. 2026 Mar 2:1-7. doi: 10.1080/17457300.2026.2635094. Online ahead of print.

ABSTRACT

The growing number of road accidents in India has been a concern over the years. Alcohol and mobile phone use while driving have been found to be important factors in road injuries. Although legislative changes, like ‘The Motor Vehicle (Amendement) Act, 2019’, introduced stricter penalties to control dangerous driving behavior, limited evidence exists regarding their real-world impact in low and middle-income countries (LMICs) like India. This study examines the impact of increased penalties on alcohol and mobile-related accidents in India using “Road Accidents in India” reports. Accident trends were assessed before and after the implementation of stricter penalties using year-on-year statistical testing for proportion differences. Drunk driving and mobile phone-related violations increased until 2019 but showed a significant decline following the introduction of higher penalties, sustained up until 2021. Findings show that while stricter penalties help, lasting impact depends on consistent enforcement, public awareness, and attitudinal changes toward road safety.

PMID:41766491 | DOI:10.1080/17457300.2026.2635094

Risk Anal. 2026 Mar;46(3):e70213. doi: 10.1111/risa.70213.

ABSTRACT

People’s risk perceptions are crucial for climate change adaptation, influencing individual decisions and policy effectiveness. Although many studies highlight the importance of social influences and social norms in this context, the mechanisms through which they shape individual risk perceptions and adaptation behavior remain unclear. To address this gap, we analyze cross-country survey data (N = 1612) from coastal areas in the Netherlands, United Kingdom, and the USA with a focus on flood risk and adaptation behavior. Our statistical analysis reveals several important patterns in social interactions, and the ways in which these social interactions influence individual risk perceptions. First, we find limited social engagement regarding risks and adaptation, with a significant portion of respondents (50%) reporting no interactions with peers on these topics. Among those who do engage, social interactions on flood risk and adaptation appear infrequent (fewer than five times per year). Second, contrary to common assumptions, individuals who discuss flood risk and adaptation, rarely do so with neighbors. Moreover, homophily-shared socio-demographic characteristics-is not the primary determinant of who interacts on the topic. Third, we see that those with hazard experience and those with higher risk perceptions are more likely to interact with others on the topics of these risks and climate adaptation, confirming that social amplifications might be in place. These findings provide unique insights into the social dynamics underlying the evolution of individual risk perceptions, offering the potential to refine models of social influence in climate change and social tipping points. They also highlight potential synergies between communication strategies and policy tools to support timely and, possibly transformational, adaptation.

PMID:41766472 | DOI:10.1111/risa.70213

Child Maltreat. 2026 Mar 2:10775595261430083. doi: 10.1177/10775595261430083. Online ahead of print.

ABSTRACT

School social workers (SSWers) play a central role in child abuse and neglect (CAN) reporting, yet few empirical studies have examined factors that influence SSWers’ reporting practices. Using data from a national survey of 455 SSWers, this study examined how training, bias awareness, and beliefs about child protective services (CPS) influence SSWers’ CAN reporting behavior. The role of individual-level and school-level demographic factors was also considered. Findings indicated that SSWers who were White (OR = 1.61, p = .034), OR = 0.77, p = .004), worked in a school serving higher proportions of low-income students (OR = 1.2, p = .002), and had higher levels of satisfaction with CPS (OR = 1.26, p = .013) and mandated reporting (OR = 0.74, p = .003) had significantly higher CAN reporting frequency. No statistically significant association was found between participants’ self-report that their prior mandated reporter (MR) trainings included some form of anti-bias content and participants’ awareness of their own biases. Results suggest individual-level factors impact reporting decisions; implications for research and training are addressed.

PMID:41766464 | DOI:10.1177/10775595261430083

Rural Remote Health. 2026 Mar;26(1):10113. doi: 10.22605/RRH10113. Epub 2026 Mar 2.

ABSTRACT

INTRODUCTION: End-stage kidney disease (ESKD) imposes a significant financial burden due to its long-term treatment and represents a growing health issue worldwide. Health inequalities arising from urban and rural geographic disparities remain pressing global issues. South Korea operates a universal and inclusive healthcare system aimed at achieving health equity, with catastrophic health expenditure (CHE) widely recognised as a key indicator for measuring the financial burden associated with diseases. This study aims to assess health equity between urban and rural individuals with ESKD by identifying health status, healthcare accessibility, household finances, financial burden, and CHE factors.

METHODS: This study utilised longitudinal data comprising 421 observations of ESKD from 105 individuals in the 7-year dataset of the Korea Health Panel (2012-2018). Non-parametric statistics were used for cross-sectional analyses to determine subject characteristics at baseline, and mixed-effects panel logistic regression and linear regression for longitudinal studies accounting for time-varying effects. Additionally, population-weighted analyses were conducted to address potential sampling bias in the panel data.

RESULTS: Among those with ESKD, 34.3% resided in rural areas. Over a 7-year period, the cumulative prevalence of CHE was 24.6% in urban areas, 30.6% in rural areas, and 26.7% overall. Over the 7-year panel data, no significant differences in health status or household financial indicators were identified between urban and rural areas. However, regarding healthcare accessibility, the adjusted odds ratio (AOR) for inpatient utilisation in rural compared to urban areas was 2.72 (95%CI 1.41-5.25). Conversely, the AOR for outpatient use was 0.14 (95%CI 0.02-0.80). After population weighting, the prevalence of CHE (AOR 1.40, 95%CI 1.39-1.42) and the prevalence of impoverishment (AOR 1.56, 95%CI 1.54-1.57) were significantly elevated in rural compared to urban areas. Factors associated with higher CHE prevalence included being female (AOR 1.83, 95%CI 1.02-3.16), lowest household income (AOR 6.55, 95%CI 1.67-25.72), inpatient utilisation (AOR 5.36, 95%CI 2.86-10.03), and being aged 65 years or older (AOR 1.71, 95%CI 0.88-3.31). In the population-weighted analysis, CHE was higher in rural areas than in urban areas (AOR 1.22, 95%CI 1.20-1.23).

CONCLUSION: Health status and household financial equity between urban and rural individuals with ESKD in South Korea demonstrate positive outcomes of a universal and inclusive healthcare coverage system. Nevertheless, regarding healthcare accessibility, living rurally exhibited lower outpatient and emergency room visits alongside higher inpatient utilisation, indicating greater challenges in CHE. Tailored adjustments to the healthcare system are needed to address the vulnerabilities of rural place.

PMID:41766405 | DOI:10.22605/RRH10113