Category: Nevin Manimala

J Med Internet Res. 2025 Apr 25;27:e66037. doi: 10.2196/66037.

ABSTRACT

BACKGROUND: Osteoarthritis (OA) is a chronic degenerative bone and joint disease that significantly impacts patients’ quality of life and mental health, while also imposing a substantial economic burden on society. However, access to rehabilitation for patients with OA is challenging upon hospital discharge. Digital exercise therapy represents a promising telemedicine strategy for enhancing the management of OA, but its effect on OA is not yet clear.

OBJECTIVE: This study aimed to systematically evaluate the therapeutic effects of digital exercise therapy on pain and physical function in patients with OA.

METHODS: Databases including PubMed, Embase, Cochrane Library, Web of Science, and SPORTDiscus were searched for randomized controlled trials on using digital exercise therapy for OA until October 25, 2023. The primary outcomes included the measures of pain scores or physical function scores immediately after the intervention and at full follow-up. The risk of bias was evaluated using the Physiotherapy Evidence Database scale. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software (Cochrane Collaboration).

RESULTS: A total of 9 studies with 1604 patients were included in the final meta-analysis. Compared with the conventional treatment group, digital exercise therapy significantly reduced numerical rating scale pain scores (mean difference [MD]=-1.07, 95% CI -1.35 to -0.78; P<.001) and Western Ontario and McMaster Universities Osteoarthritis Index physical function scores (MD=-2.39, 95% CI -3.68 to -1.10; P<.001) in patients with OA immediately after the intervention. However, follow-up results revealed no statistically significant difference in numerical rating scale pain scores (MD=-0.20, 95% CI -0.59 to 0.20; P=.34), while Western Ontario and McMaster Universities Osteoarthritis Index physical function scores showed a significant improvement in the digital exercise therapy group compared with the control group (MD=-1.89, 95% CI -3.52 to -0.26; P=.02). These findings suggest that digital exercise therapy provides immediate benefits for both pain and physical function in patients with OA, with sustained improvements in physical function observed during follow-up, though pain relief may not persist long term.

CONCLUSIONS: Digital exercise therapy can alleviate the pain and improve the physical function in patients with OA and can be used as an auxiliary means in the rehabilitation treatment of OA. It provides great convenience for patients with OA who need long-term treatment, allowing them to exercise at home for rehabilitation training.

TRIAL REGISTRATION: PROSPERO CRD42023484819; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023484819.

PMID:40279572 | DOI:10.2196/66037

Retina. 2025 Apr 24. doi: 10.1097/IAE.0000000000004496. Online ahead of print.

ABSTRACT

PURPOSE: Outcomes of sutureless scleral-fixated intraocular lens (SSFIOL) have primarily focused upon short-term results. This retrospective, observational clinical study focuses upon the long-term visual acuity and anatomic outcomes of SSFIOLs.

METHODS: A comprehensive medical record review of patients that underwent SSFIOL placement by a single surgeon from 2015 through 2024 was performed. Pre- and postoperative BCVA, anatomic outcomes, and complications were documented. Statistical analysis was performed.

RESULTS: Forty-three patients (ages 18 to 91 years, mean = 63) with follow-up ranging from 1 to 100.5 months (mean = 27.5, median = 14.67) met inclusion criteria. Mean preoperative BCVA was 1.11 logMAR units (Snellen ratio: 20/250) ± 0.59 SD. Mean postoperative BCVA improvement was statistically significant at 1, 3, 6, 9 months, and 1, 2, 3 years. Postoperative complications included hyphema (n=3), vitreous hemorrhage (n=14), transient ocular hypertension (n=8) and hypotony (n=5), haptic erosion (n=3), IOL dislocation or damage (n=4), cystoid macular edema (CME, n=8). All complications were identified within 1.25 years of follow-up excluding 2 cases of CME.

CONCLUSION: SSFIOL patients demonstrated statistically significant and gradual BCVA improvement up to 3 years postoperatively. Cases of CME were identified up to 3 years postoperatively.

PMID:40279564 | DOI:10.1097/IAE.0000000000004496

J Healthc Qual. 2025 Apr 25. doi: 10.1097/JHQ.0000000000000477. Online ahead of print.

ABSTRACT

INTRODUCTION: Catheter-associated urinary tract infections (CAUTIs) are common complications in patients with traumatic brain injury (TBI) who require indwelling bladder catheters (IBCs). This study examined the impact of an Acute Urinary Retention Algorithm (AURA) nursing protocol that incorporates intermittent catheterization (IC) on CAUTI incidence.

METHODS: A retrospective analysis was conducted on TBI patients with IBCs placed between 2018 and 2022 at a Level I trauma center in Southern California. Catheter-associated urinary tract infection incidence and catheter-associated complications were compared between patients treated with and without the AURA protocol.

RESULTS: Among 73,005 patients with IBC, 255 had TBI and were admitted to the intensive care unit. Only 27 (10.6%) patients had catheters removed through the AURA protocol and had longer dwell times than the nonprotocol patients (2.59 vs. 2.44 days, p < .001). Catheter-associated urinary tract infection incidence was statistically similar between the protocol (7.4%) and nonprotocol groups (3.5%) (p = .327). However, patients who developed CAUTI were more likely to have undergone more than one IC.

CONCLUSIONS: Timely removal of IBCs is crucial to minimizing the risk of CAUTI. This study highlights the underutilization of nurse-driven protocols such as AURA and suggests a careful application of IC in such protocols because of its potential association with increased CAUTI risk.

PMID:40279521 | DOI:10.1097/JHQ.0000000000000477

Eur J Dent Educ. 2025 Apr 25. doi: 10.1111/eje.13104. Online ahead of print.

ABSTRACT

INTRODUCTION: The literature has established burnout syndrome as a modern epidemic with adverse consequences. Burnout data for dental students training in the United States is lacking. This study aimed to examine differences in the dimensions of burnout between traditional standing (TS) and advanced standing (AS) dental students.

MATERIALS AND METHODS: TS and AS predoctoral dental students transitioning from didactic course work to preclinical and clinical education completed an informed consent, a demographic survey, and the Maslach Burnout Inventory-General Survey for Students. Statistical analyses included descriptive statistics, assumptions testing, independent samples t-test analysis, and Cronbach’s alpha analysis.

RESULTS: Significant differences in the burnout dimension of exhaustion, M = 0.82, 95% CI (0.41, 1.22), t (108) = 3.97, p < 0.001, and the burnout dimension of cynicism, M = 0.96, 95% CI (0.50, 1.42), t (182) = 4.11, p < 0.001, existed between TS and AS dental students. TS dental students demonstrated significantly higher exhaustion (M = 4.61) and cynicism (M = 3.43) compared to AS dental students (M = 3.79 exhaustion and M = 2.47 cynicism). No significant difference in professional efficacy, M = -0.096, 95% CI [-0.38, 0.18], t (182) = 0.68, p = 0.50, was observed between the TS dental students (M = 4.38) and AS dental students (M = 4.47).

CONCLUSION: While both groups of dental students experienced burnout, TS dental students experienced significantly more burnout along the dimensions of exhaustion and cynicism. The presence of burnout in both groups of students suggests the need to develop programme-based strategies that aim to alleviate academic burnout and promote the wellbeing of the future dental workforce.

PMID:40279476 | DOI:10.1111/eje.13104

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251330091. doi: 10.1177/21501319251330091. Epub 2025 Apr 25.

ABSTRACT

INTRODUCTION: Continuous Glucose Monitors (CGMs) offer critical insight into glucose trends, aiding significantly in overall type 2 diabetes (T2DM) management. Few studies have evaluated pharmacist involvement in CGM management.

METHODS: This was a retrospective study, conducted at two primary care offices within a community health system. The aim of this study was to assess pharmacist impact on the deprescribing of high-risk medications in patients with T2DM utilizing CGM data. The primary outcome was the percentage of patients that experienced deprescribing of a high-risk medication (defined as reduction or discontinuation in total daily dosage of insulin, sulfonylureas, and thiazolidinediones). The secondary outcomes were rate of hospitalizations and changes in total daily insulin dose. Chi-square tests and t-tests were utilized to analyze primary and secondary outcomes.

RESULTS: Among 317 participants, 58% of patients on CGMs had pharmacists involved in their care. Of patients in the pharmacist-led group, 11.4% experienced deprescribing of a high-risk medication compared to about 8.3% in the usual care group. Overall, hospitalizations were 3.2% lower in the pharmacist-led group compared to the usual care group during the study period. In addition, patients in the pharmacist-led group experienced a reduction in total daily insulin dose, while an increase in total daily insulin dosage for the usual care group was observed.

CONCLUSION: While our study did not find a statistically significant difference in pharmacist-led deprescribing, there was a trend towards reduction in high-risk medication use. This suggests potential clinical significance, emphasizing the role of pharmacist involvement in prescribing practices of medications used to treat T2DM, including deprescribing high-risk medications and initiating non-high-risk medications with additional benefits. Further studies are needed to determine a difference in prescribing practice in pharmacist-led management of T2DM.

PMID:40279452 | DOI:10.1177/21501319251330091

J Bone Joint Surg Am. 2025 Apr 25. doi: 10.2106/JBJS.24.00048. Online ahead of print.

ABSTRACT

BACKGROUND: For patients with rheumatoid arthritis (RA) undergoing total ankle arthroplasty (TAA), conflicting data have been reported regarding complications and patient-reported outcome (PRO) improvement when compared with patients with osteoarthritis (OA). The purpose of this study was to compare complication rates and PROs among patients with RA, primary OA, or posttraumatic arthritis.

METHODS: This was a retrospective study of 1,071 primary TAAs performed at a single institution between March 2000 and October 2020. Minimum follow-up was 2 years. Patients were stratified by indication for TAA (OA, n = 372; posttraumatic arthritis, n = 642; RA, n = 57). Patient demographics, intraoperative variables, postoperative complications, and PRO measures were compared among the groups using univariable statistics. Cox regression was performed to assess the risk of implant failure. The overall cohort had a mean age of 63.4 years, 51.3% were male, and 94.8% were White. The mean duration of follow-up (and standard deviation) was 5.7 ± 3.1 years.

RESULTS: Compared with the OA and posttraumatic arthritis groups, the RA cohort had the lowest mean age (p < 0.001), lowest percentage of males (p < 0.001), and highest American Society of Anesthesiologists (ASA) score (p < 0.001). Univariable analysis showed no significant difference in the infection rate among the groups (p = 1.0). The RA cohort had the highest rate of heterotopic ossification postoperatively (2 of 57, 3.5%; p < 0.040). Cox regression analysis showed no increased risk of implant failure for the RA cohort (p = 0.08 versus the OA cohort, 0.14 versus the posttraumatic arthritis cohort). For the Short Musculoskeletal Function Assessment (SMFA), Short Form (SF)-36, Foot and Ankle Outcome Score (FAOS)-symptoms subscale, and FAOS-activities of daily living subscale, the RA group reported significantly worse scores in the postoperative period (p < 0.001). However, the RA cohort demonstrated improvements in all PROs.

CONCLUSIONS: In the largest single-institution study to date, patients with RA reported poorer PRO scores compared with the OA and posttraumatic arthritis groups but experienced functional outcome improvement from the preoperative baseline.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40279451 | DOI:10.2106/JBJS.24.00048

Sci Adv. 2025 Apr 25;11(17):eadu5799. doi: 10.1126/sciadv.adu5799. Epub 2025 Apr 25.

ABSTRACT

Driven-dissipative many-body systems are ubiquitous in nature and a fundamental resource for quantum technologies. However, they are also complex and hard to model because they cannot be described by the standard tools in equilibrium statistical mechanics. Probing nonequilibrium critical phenomena in pristine setups can illuminate fresh perspectives on these systems. Here, we use an ensemble of cold ⁸⁸Sr atoms coupled to a driven high-finesse cavity to study the cooperative resonance fluorescence (CRF) model, a classic driven-dissipative model describing coherently driven dipoles superradiantly emitting light. We observe its nonequilibrium phase diagram characterized by a second-order phase transition. Below a critical drive strength, the atoms quickly reach the so-called superradiant steady state featuring a macroscopic dipole moment; above the critical point, the atoms undergo persistent Rabi-like oscillations. At longer times, spontaneous emission transforms the second-order transition into a discontinuous first-order transition. Our observations pave the way for harnessing robust entangled states and exploring boundary time crystals in driven-dissipative systems.

PMID:40279431 | DOI:10.1126/sciadv.adu5799

Sci Adv. 2025 Apr 25;11(17):eadv3491. doi: 10.1126/sciadv.adv3491. Epub 2025 Apr 25.

ABSTRACT

Activation-induced marker (AIM) assays identify antigen (Ag)-specific T cells, but recent studies revealed AIM⁺ T helper cell 17 (T_H17)-like (CCR6⁺) and circulating T follicular helper cells (cTfh) were not associated with peptide/HLA tetramer staining. We show that CD39⁺ regulatory T cell (T_reg)-like and CD26^hi T_H22-like cells undergo T cell receptor (TCR)-independent activation by cytokines during Ag stimulation, leading to nonspecific up-regulation of AIM readouts. Transcriptional analysis enabled discrimination of bona fide Ag-specific T cells from cytokine-activated T_reg and T_H22 cells. CXCR4 down-regulation emerged as a hallmark of clonotypic expansion and TCR-dependent activation in memory CD4⁺ T cells and cTfh. By tracking tetramer-binding cells upon Ag restimulation, we demonstrated that CXCR4-CD137⁺ cells provided a more accurate measure of Ag-specificity than standard AIM readouts. This modified assay excluded the predominantly CCR6⁺ cytokine-activated T cells that contributed to an average 12-fold overestimation of the Ag-specific population. Our findings provide an accurate approach to characterize genuine Ag-specific T cells.

PMID:40279430 | DOI:10.1126/sciadv.adv3491

Proc Natl Acad Sci U S A. 2025 Apr 29;122(17):e2420288122. doi: 10.1073/pnas.2420288122. Epub 2025 Apr 25.

ABSTRACT

Regional high-resolution climate projections are crucial for many applications, such as agriculture, hydrology, and natural hazard risk assessment. Dynamical downscaling, the state-of-the-art method to produce localized future climate information, involves running a regional climate model (RCM) driven by an Earth System Model (ESM), but it is too computationally expensive to apply to large climate projection ensembles. We propose an approach combining dynamical downscaling with generative AI to reduce the cost and improve the uncertainty estimates of downscaled climate projections. In our framework, an RCM dynamically downscales ESM output to an intermediate resolution, followed by a generative diffusion model that further refines the resolution to the target scale. This approach leverages the generalizability of physics-based models and the sampling efficiency of diffusion models, enabling the downscaling of large multimodel ensembles. We evaluate our method against dynamically downscaled climate projections from the Coupled Model Intercomparison Project 6 (CMIP6) ensemble. Our results demonstrate its ability to provide more accurate uncertainty bounds on future regional climate than alternatives such as dynamical downscaling of smaller ensembles, or traditional empirical statistical downscaling methods. We also show that dynamical-generative downscaling results in significantly lower errors than popular statistical downscaling techniques, and captures more accurately the spectra, tail dependence, and multivariate correlations of meteorological fields. These characteristics make the dynamical-generative framework a flexible, accurate, and efficient way to downscale large ensembles of climate projections, currently out of reach for pure dynamical downscaling.

PMID:40279391 | DOI:10.1073/pnas.2420288122

Aesthet Surg J. 2025 Apr 25:sjaf064. doi: 10.1093/asj/sjaf064. Online ahead of print.

ABSTRACT

BACKGROUND: Double-eyelid blepharoplasty is a common cosmetic surgery. However, blepharoplasty can lead to poor results, necessitating repair surgery. One of the most frequent poor results after double-eyelid blepharoplasty is an excessively wide double-eyelid fold.

OBJECTIVES: To evaluate the clinical efficacy of wide double-eyelid repair using orbital septum and suborbicularis oculi fascial-fat flap in cases requiring preservation of the original incision scar.

METHODS: From June 2019 to June 2022, This retrospective study included 35 patients who underwent wide double-eyelid repair. The orbital septum and suborbicularis oculi fascial-fat flap were prepared. Deep and superficial scar adhesions were fully released to correct the uneven contour at the original incision scar site. The orbital septum flap was turned downward and sutured to the inferior orbicularis oculi muscle and pretarsal fascia. Thereafter, a postoperative follow-up was conducted to observe the results in terms of width of double eyelid, postoperative scars, and patients’ satisfaction.

RESULTS: The difference of double eyelid width before operationat and the last follow-up after operation was statistically significant. No visible scars were seen in patients after the operation, and The width of double eyelid was corrected. The operation was effective, the surgical results were rated as satisfactory in 21 patients and basically satisfactory by 10 patients. The satisfaction rate was 88.57%.

CONCLUSIONS: For wide double-eyelid fold repair in cases requiring preservation of the original incision scar, the use of the orbital septum flap and suborbicularis oculi fascial-fat flap achieves good effects in releasing adhesions, preventing abnormal re-adhesions, and reconstructing natural-looking double-eyelid folds.

PMID:40279382 | DOI:10.1093/asj/sjaf064