Category: Nevin Manimala

Endocrine. 2025 Jan 26. doi: 10.1007/s12020-025-04170-6. Online ahead of print.

ABSTRACT

PURPOSE: Our study evaluated skeletal muscle mass, function and quality among mild autonomous cortisol secretion (MACS) patients and non-functioning adrenal incidentaloma (NFAI) patients in comparison with the control group without adrenal mass.

METHODS: 63 NFAI (49 female, 14 male) and 31 MACS (24 female, 7 male) patients were included in the study. As the control group, 44 patients (31 women, 13 men) who were known to have no radiological adrenal pathology on computed tomography or magnetic resonance imaging performed for other reasons were selected. After recording the laboratory parameters of the patients, anthropometric measurements, handgrip strength test with dynamometer, SARC-F survey and bioelectrical impedance analysis (BIA) measurements were performed.

RESULTS: There was no statistical difference among the groups in terms of age, gender, and BMI parameters. Handgrip strength (HGS), skeletal muscle mass (SMM) index (SMM/BMI), and skeletal muscle quality (HGS/SMM), values used to evaluate muscle strength and quality, were found to be significantly lower in both the MACS and NFAI groups compared to the control group (p = 0.004, p = 0.012 and p = 0.034 respectively). This significance was also present in women subgroup analyses (p = 0.002, p = 0.037 and p = 0.039 respectively), but these parameters lost their statistical significance in men. In the correlation analysis of the female subgroup, 24-h free urine cortisol value was inversely proportional to skeletal muscle quality (r_s = -0.417, p = 0.008).

CONCLUSION: Our study showed that there is a decrease in muscle mass and function in female AI patients, and this decrease is more severe in MACS patients. These results may suggest that mild cortisol excess also has negative effects on skeletal muscle metabolism.

PMID:39864048 | DOI:10.1007/s12020-025-04170-6

Pediatr Surg Int. 2025 Jan 26;41(1):73. doi: 10.1007/s00383-024-05948-x.

ABSTRACT

OBJECTIVE: To review and compare robot-assisted ipsilateral ureteroureterostomy (RALUU) and laparoscopic ipsilateral uretero-ureterostomy (LUU) in terms of efficacy and outcomes.

METHODS: Clinical data of 65 children with complete renal ureteral duplication deformity admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2022 were collected. Among these, 42 patients underwent laparoscopic ureteroureterostomy (LUU), designated as the LUU group, while 23 patients received robot-assisted laparoscopic ureteroureterostomy (RALUU), designated as the RALUU group. We compared the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage duration, length of hospital stay, changes in anterior-posterior diameter (APD) of the affected renal pelvis pre- and postoperatively, changes in ureteral diameter, and alterations in renal function.

RESULTS: The postoperative drainage duration (Z = 2.375, P = 0.024) and length of hospital stay (t = 2.142, P = 0.038) were shorter in the RALUU group compared to the LUU group, with statistically significant differences. However, there were no statistically significant differences in surgical duration (t = – 1.465, P = 0.153) and intraoperative blood loss (Z = 1.679, P = 0.097) between the two groups. Complications occurred in three patients in the LUU group (two cases of anastomotic stricture and one case of stump syndrome), while no long-term complications were reported in the RALUU group, with no significant difference between the groups (χ² = 0.482, P = 0.488). Both groups exhibited a tendency for improvement in APD, ureteral diameter (UD), and differential renal function (DRF) pre- and postoperatively. However, further analysis revealed that changes in APD (ΔAPD, t = – 1.132, P = 0.284), DRF (ΔDRF, Z = 1.865, P = 0.073), and UD (ΔUD, t = 1.562, P = 0.064) did not show statistically significant differences between the two groups.

CONCLUSION: Both RALUU and LUU are safe and effective treatments for children with complete renal ureteral duplication anomalies. Compared to LUU, RALUU is associated with shorter postoperative drainage duration and hospital stay.

PMID:39864036 | DOI:10.1007/s00383-024-05948-x

Radiol Med. 2025 Jan 26. doi: 10.1007/s11547-025-01957-5. Online ahead of print.

ABSTRACT

PURPOSE: To develop an artificial intelligence (AI) algorithm for automated measurements of spinopelvic parameters on lateral radiographs and compare its performance to multiple experienced radiologists and surgeons.

METHODS: On lateral full-spine radiographs of 295 consecutive patients, a two-staged region-based convolutional neural network (R-CNN) was trained to detect anatomical landmarks and calculate thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), and sagittal vertical axis (SVA). Performance was evaluated on 65 radiographs not used for training, which were measured independently by 6 readers (3 radiologists, 3 surgeons), and the median per measurement was set as the reference standard. Intraclass correlation coefficient (ICC), mean absolute error (MAE), and standard deviation (SD) were used for statistical analysis; while, ANOVA was used to search for significant differences between the AI and human readers.

RESULTS: Automatic measurements (AI) showed excellent correlation with the reference standard, with all ICCs within the range of the readers (TK: 0.92 [AI] vs. 0.85-0.96 [readers]; LL: 0.95 vs. 0.87-0.98; SS: 0.93 vs. 0.89-0.98; SVA: 1.00 vs. 0.99-1.00; all p < 0.001). Analysis of the MAE (± SD) revealed comparable results to the six readers (TK: 3.71° (± 4.24) [AI] v.s 1.86-5.88° (± 3.48-6.17) [readers]; LL: 4.53° ± 4.68 vs. 2.21-5.34° (± 2.60-7.38); SS: 4.56° (± 6.10) vs. 2.20-4.76° (± 3.15-7.37); SVA: 2.44 mm (± 3.93) vs. 1.22-2.79 mm (± 2.42-7.11)); while, ANOVA confirmed no significant difference between the errors of the AI and any human reader (all p > 0.05). Human reading time was on average 139 s per case (range: 86-231 s).

CONCLUSION: Our AI algorithm provides spinopelvic measurements accurate within the variability of experienced readers, but with the potential to save time and increase reproducibility.

PMID:39864034 | DOI:10.1007/s11547-025-01957-5

Pediatr Surg Int. 2025 Jan 26;41(1):74. doi: 10.1007/s00383-025-05972-5.

ABSTRACT

PURPOSE: Initial recommendations for ECMO had relative contraindications for low birth weight (BW) or low gestational age (GA) babies. However, more recent literature has demonstrated improved and acceptable outcomes of ECMO in smaller neonates. The purpose of this study was to understand both utilization and survival in patients with lower GA and BW.

METHODS: All neonates captured in the Extracorporeal Life Support Organization (ELSO) registry who underwent a single ECMO run from 2009 to 2019 were included. The primary outcome measure was mortality and the secondary outcome measure was major adverse outcomes, defined as a composite outcome variable any severe ECMO complications. Univariate and multivariable statistical tests were performed to estimate the association between GA and BW with both outcome variables.

RESULTS: A total of 14,167 cases met inclusion criteria. Univariate analysis noted that birth weight, gestational age, ECMO mode, pulmonary support type, pH and ventilator settings were highly significant predictors of survival. Multivariable assessment noted significant linear relationship of mortality rates with increasing GA and BW (p < 0.001, OR = 0.82 GA, 0.51 BW). The highest ECMO-related mortality was observed in neonates with GA 30-31 weeks and BW 1.5-2.0 kg, with a 70-75% in-hospital mortality rate.

CONCLUSIONS: Decreasing GA and BW were strongly correlated with increasing odds of mortality and/or ECMO-related complications. However, even in low GA or BW neonates, survival may be possible in up to a quarter of patients put on ECMO.

PMID:39864029 | DOI:10.1007/s00383-025-05972-5

Orv Hetil. 2025 Jan 26;166(4):146-153. doi: 10.1556/650.2025.33211. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A szuicid viselkedés megelőzése szempontjából kiemelt jelentőséggel bír az akut szuicid veszély felismerése. Ugyanakkor kevés olyan adattal rendelkezünk, amelynek segítségével megbízhatóan felismerhető lenne a preszuicidális lelkiállapot. Célkitűzés: A Galynker és munkacsoportja által kidolgozott szuicid krízis szindróma alapján kifejlesztett szűrőteszt és kérdőív magyar adaptálása. Módszer: Az általános pszichiátriai vizsgálat mellett a szuicid krízis szindróma szűrésére alkalmas rövid Akut Szuicid Rizikó Teszt és a Rihmer-féle rizikóbecslő Rövid Szuicid Kérdőív felvételére került sor konszekutív módon minden olyan pácienssel, aki a vizsgálati időszakban klinikánk ambuláns vagy osztályos ellátásában részesült. A rövid szűrőtesztek pozitivitása esetén a szuicid krízis szindróma tüneteit felmérő részletes skála is kitöltésre került. Eredmények: 99 páciens 150 kérdőívének kitöltésére került sor, egyharmaduk (n = 35) ambuláns, kétharmaduk (n = 64) osztályos ellátásban részesült. A klinikai diagnózisok között a leggyakoribbak a depressziós (44,7%), az alkalmazkodási (34%), a pszichotikus (33,3%) és a szerhasználati (33,3%) zavarok voltak, és nagy volt a komorbiditás aránya. Az ambuláns ellátásban részesülők felében (n = 19; 54,3%), míg az osztályos felvételre kerülők háromnegyedében (n = 49; 76,6%) igazoltak a szűrőtesztek szuicid rizikót. Az osztályos kezelést követően ez az arány egyharmadra csökkent (n = 17; 33,3%). A szuicid krízis szindróma teljes diagnosztikai kritériumai azoknál teljesültek a leggyakrabban, akiknél az Akut Szuicid Rizikó Teszt pozitív volt, akár önmagában (74,2%), akár a Rövid Szuicid Kérdőívvel együtt (87,1%). E két kérdőív együttes pozitivitása esetén fordult elő a leggyakrabban súlyos szuicid krízis szindróma (29%). Megbeszélés: A szuicid krízis szindrómán alapuló rövid szűrőteszt jelentős arányban azonosítja az aktuális szuicid rizikót. A szuicid krízis szindróma koncepció és a módszer előnye, hogy akkor is lehetővé teszi az öngyilkossági veszély felismerését, amikor direkt szuicid szándékok nem kerülnek felszínre. Az akut szűrőteszt értékét tovább növeli az elsősorban az élettartamra vonatkozó szuicid rizikót felmérő Rihmer-féle Rövid Szuicid Kérdőív. Következtetés: Ezeknek a teszteknek az együttes alkalmazása támogatja az akut pszichiátriai osztályos felvételt megalapozó klinikai döntéshozatalt, és megelőzi a páciensek kezelésének korai lezárását, így szűrőmódszerünk fontos szuicidprevenciós jelentőséggel bír. Orv Hetil. 2025; 166(4): 146–153.

PMID:39864028 | DOI:10.1556/650.2025.33211

Orv Hetil. 2025 Jan 26;166(4):139-145. doi: 10.1556/650.2025.33221. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A minimálinvazív műtéteknek és a hatékony perioperatív protokolloknak köszönhetően a colorectalis műtétek utáni morbiditás és kórházi tartózkodás csökkenthető, elektív colorectalis műtétek után a betegek egy része 72 órán belül elbocsátható. A korai emisszió nem rutingyakorlat, kritériumai nem egyértelműek. Módszer: Retrospektív kohorszvizsgálatot végeztünk 2022. 03. 01. és 2024. 05. 01. között anastomosissal járó elektív colorectalis műtéten átesett páciensek körében. Elemeztük a korai elbocsátás (<72 óra) összefüggését a 30 napos morbiditással és nem tervezett kórházi újrafelvétellel. A sikeres korai emissziót befolyásoló tényezők azonosítására demográfiai, anamnesztikus, intraoperatív és posztoperatív adatokat elemeztünk. Eredmények: Összesen 109 betegen végeztünk elektív colorectalis műtétet. A beavatkozások közül 85 laparoszkópos, 8 robotasszisztált és 4 nyitott műtét volt, 12 stomazárás történt. A 30 napos morbiditás 8,25% (n = 9), ebből súlyos (Clavien–Dindo 3b) morbiditás 4,6% (n = 5) volt. A 72 órán belül komplikációval járó eseteket (n = 9) kizártuk. Eseménytelen posztoperatív szak mellett korai elbocsátás 30, ennél hosszabb tartózkodás 70 betegnél történt (ápolási idő: 67,5 ± 4,13 vs. 99,8 ± 2,06 óra; p = 0,0001). A csoportok homogének voltak az életkor (57,17 ± 5,27 vs. 61,94 ± 2,75 év; p = 0,09), a nem (p = 0,83), a testtömegindex (p = 0,13) és a kísérő betegség (p = 0,85) tekintetében. A bélműködés helyreállása sem különbözött a csoportok között (31,0 ± 3,84 vs. 34,5 ± 3,49 óra; p = 0,26). A korai és a normál csoportban azonos arányban voltak jobb és bal oldali resectiók (p = 0,28), több stomazárás történt a korai csoportban (11 vs. 1; p<0,00001). Egyik csoportban sem volt 30 napon belül újrafelvétel, morbiditás vagy mortalitás. Következtetés: Nem szövődményes elektív colorectalis resectio és stomazárás után a korai (72 órán belüli) elbocsátás biztonságos. Orv Hetil 2025; 166(4): 139–145.

PMID:39864024 | DOI:10.1556/650.2025.33221

EJNMMI Phys. 2025 Jan 26;12(1):8. doi: 10.1186/s40658-025-00718-7.

ABSTRACT

BACKGROUND: System calibration is essential for accurate SPECT/CT dosimetry. However, count losses due to dead time and pulse pileup may cause calibration errors, in particular for ¹³¹I, where high count rates may be encountered. Calibration at low count rates should also be avoided to minimise detrimental effects from e.g. background counts and statistical fluctuations. This paper aims to present experimental data illustrating count-rate dependencies and to propose practical routines to mitigate errors in the ¹³¹I calibration procedure without needing advanced analysis tools.

RESULTS: The sensitivities of two General Electric (GE) Discovery 670 Pro systems were assessed using two Jaszczak phantom geometries. SPECT/CT data were collected over two months, starting with an initial ¹³¹I content of > 2 GBq, decaying to approximately 20 MBq. This allowed for a detailed analysis of count losses due to dead time and pulse pileup. From the sensitivity analysis, it was shown that robust calibration was obtained for ¹³¹I phantom activities ranging between 250 and 1500 MBq.

CONCLUSIONS: The results show that adequate corrections for dead-time and pulse-pileup counting losses are essential for accurate calibration. It is argued that loss corrections should be based on total spectrum count rates in projections and not only on the 364.5 keV energy window data. The measurement campaigns presented in this paper, using basic tools and equipment, may serve as a model for establishing routines for count-loss corrections as well as for system calibration and regular control of system sensitivity. The data suggest that analysis of source and count concentration in a homogeneous Jaszczak phantom offers robust calibration, whereas analysis of source strength and counts in a delineated phantom insert offers a practical and robust method for regular quality control.

PMID:39864022 | DOI:10.1186/s40658-025-00718-7

Int J Radiat Oncol Biol Phys. 2025 Jan 24:S0360-3016(24)03705-2. doi: 10.1016/j.ijrobp.2024.11.098. Online ahead of print.

ABSTRACT

PURPOSE: Standard therapy for breast cancer after breast-conserving surgery is radiation therapy (RT) plus hormone therapy (HT). For patients with a low-risk of recurrence, there is an interest in deescalating therapy.

METHODS AND MATERIALS: A retrospective study was carried out for patients treated at the Swedish Cancer Institute from 2000 to 2015, aged 70 years or older, with pT1N0 or pT1NX estrogen receptor-positive and ERBB2-negative unifocal breast cancer without positive surgical margins, high nuclear grade, or lymphovascular invasion.

RESULTS: Patient numbers were sufficient to carry out analyses for RT + HT (n = 307) and RT alone (n = 148). The median follow-up was 9.6 years. There were no statistically significant differences in adjusted overall survival (OS), disease-specific death, progression-free survival (PFS), distant recurrence, and second primary cancers with RT monotherapy compared with RT + HT. Cumulative rates of all of these outcomes were <5%, even at 15 years of follow-up, regardless of treatment, greatly outweighed by the incidence of death from other causes in this elderly population. In matched analysis, we calculated a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for OS and a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for PFS.

CONCLUSIONS: Our data suggest that elderly, low-risk breast cancer patients have similarly high OS and PFS with low rates of local recurrence, distant recurrence, and death from breast cancer with much higher rates of death from competing causes, whether treated with RT or HT + RT. These patients are likely to die of other causes without disease recurrence, regardless of which of these treatments is used. Thus, they may benefit from the administration of more modern forms of breast irradiation without the need for adjuvant systemic hormone therapy. A detailed analysis of which clinical, pathologic, genomic, and comorbidity variables are needed to select these patients.

PMID:39864014 | DOI:10.1016/j.ijrobp.2024.11.098

J Hand Surg Am. 2025 Jan 24:S0363-5023(24)00608-7. doi: 10.1016/j.jhsa.2024.11.022. Online ahead of print.

ABSTRACT

PURPOSE: We compared the radiographic union and magnitude of humpback deformity correction when using different vascularized bone grafts (VBGs) and nonvascularized bone grafts (NVBGs) in the treatment of unstable scaphoid nonunions (USNUs).

METHODS: This was a retrospective radiographic review of 93 patients with an USNU treated between 2013 and 2022 at a single center by a single surgeon. Inclusion criteria included skeletally mature patients with radiographic evidence of an USNU resulting from failure of either nonsurgical or operative treatment. There were three treatment groups. Two groups were treated with either a palmar radiocarpal artery (PRCA) VBG or a 1,2 intercompartmental supraretinacular (1,2 IC-SRA) VBG. The third group comprised patients who were treated with a heterogeneous mix of NVBGs. Patients were followed radiographically at regular intervals until they were deemed healed or underwent a salvage procedure because of treatment failure. Measurements of carpal and scaphoid alignment were then repeated on the final imaging series and compared to preoperative measurements.

RESULTS: Ninety patients were included in the final analysis. PRCA VBG had the highest radiographic union rate, followed by 1,2 IC-SRA VBG and finally NVBGs. PRCA VBG had a significantly higher rate of union than NVBGs. Scapholunate angle change and scaphoid length change were greatest with PRCA VBG. These differences were statistically significant for the former when compared with 1,2 IC-SRA VBG and NVBGs and for the latter when compared with the 1,2 IC-SRA VBG in both univariate and multivariable analyses.

CONCLUSIONS: PRCA VBG had the highest radiographic union rate compared with alternative grafts as well as providing the greatest degree of humpback deformity correction in the treatment of USNUs.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:39864012 | DOI:10.1016/j.jhsa.2024.11.022

J Adolesc Health. 2025 Jan 23:S1054-139X(24)00447-6. doi: 10.1016/j.jadohealth.2024.09.017. Online ahead of print.

NO ABSTRACT

PMID:39864002 | DOI:10.1016/j.jadohealth.2024.09.017