Category: Nevin Manimala

Oral Surg Oral Med Oral Pathol Oral Radiol. 2025 Sep 2:S2212-4403(25)01196-4. doi: 10.1016/j.oooo.2025.08.018. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical and radiographic outcomes of temporomandibular joint (TMJ) total joint replacement (TJR) in osteoporotic patients receiving preoperative antiresorptive therapy.

STUDY DESIGN: This retrospective chart review included osteoporotic patients who underwent TMJ TJR at a single institution. Data collected included demographics, medical history, type and duration of antiresorptive therapy, surgical details, and postoperative outcomes. Clinical parameters included range of motion (ROM), joint noise, and dietary limitations. Radiographic assessment evaluated periprosthetic bone changes and implant stability. Descriptive statistics summarized outcomes.

RESULTS: Eight patients (62.5% female; mean age 61.5 ± 11.4 years) with osteoporosis and history of antiresorptive therapy were analyzed. The average therapy duration was 3.75 ± 3 years. Mean clinical and CBCT follow-up was 16 ± 9.6, and 6.5 ± 3.6 months respectively. No patients developed medication-related osteonecrosis of the jaw (MRONJ), prosthetic failure, hardware loosening, or periprosthetic osteolysis. Functional outcomes were favorable, with mean postoperative ROM of 35.1 ± 4.8 mm and no joint noise.

CONCLUSION: Preoperative antiresorptive therapy in osteoporotic patients does not appear to increase the risk of complications or impair functional outcomes following TMJ TJR. Larger sample sizes, possibly through multicenter investigations, are critical to establishing high-level evidence regarding its safety and efficacy.

PMID:41047323 | DOI:10.1016/j.oooo.2025.08.018

BMJ Open. 2025 Oct 5;15(10):e099692. doi: 10.1136/bmjopen-2025-099692.

ABSTRACT

INTRODUCTION: Achieving universal health coverage requires the use of health research evidence in decision-making; however, this remains understudied in lower and middle-income countries (LMICs) such as Tanzania. Despite several health sector reforms and the availability of locally generated research, evidence indicates that the use of such research in health planning and decision-making remains limited in Tanzania, creating a gap between research production and its practical application. This study examined the extent of research evidence used in health planning and the factors influencing its use among health planning teams.

METHODS AND ANALYSIS: A sequential exploratory mixed-methods design was employed, starting with qualitative data from focus group discussions (N=6) and KIIs (N=34) with health planners from selected regions in Tanzania, recruited based on their direct involvement in health planning, using semistructured guides informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model. This was followed by a quantitative survey of 422 participants meeting the same inclusion criteria, administered with a structured questionnaire derived from the model. The COM-B framework guided both tool development and analysis. Qualitative data were thematically analysed using a framework approach, yielding three themes, while quantitative data were analysed using descriptive statistics and binary logistic regression.

RESULTS: Qualitative findings revealed barriers such as limited knowledge and skills, inadequate access to knowledge translation tools, poor dissemination processes, financial and technical constraints, and lack of training. Opportunities included supportive guidelines, research coordinators, collaborations, dedicated budgets and improved internet access. Motivators such as job promotions, professional development, allowances and targeted training were also identified. Quantitative results showed moderate evidence use (66.2%), slightly higher than in other LMICs. Barriers included suboptimal dissemination (74.5%; OR=2.035, p=0.0008), inadequate resources (70.0%; OR=0.965, p=0.8759) and lack of training (63.7%; OR=1.361, p=0.1806). Integrated findings highlighted convergence on dissemination, resource and training challenges, with divergence in statistical significance between methods.

CONCLUSIONS: Barriers related to dissemination, resources and training hinder evidence use. Interventions such as digital repositories, guideline development and capacity building, alongside institutionalised frameworks, resource allocation and accountability mechanisms, are essential to strengthen evidence-based health planning in Tanzania.

PMID:41047277 | DOI:10.1136/bmjopen-2025-099692

BMJ Open. 2025 Oct 5;15(10):e103724. doi: 10.1136/bmjopen-2025-103724.

ABSTRACT

OBJECTIVE: This study aims to develop a methodology to retrieve, harmonise and evaluate the completeness of national body mass index (BMI) data from linked electronic health record (EHR) sources to build a longitudinal research-ready data asset (RRDA).

DESIGN: A longitudinal study of BMI records spanning 23 years (1 January 2000 to 31 December 2022) from four data sources.

SETTING: The national BMI RRDA is created within the Secure Anonymised Information Linkage (Databank), encompassing the entire population of Wales, UK.

PROCEDURE AND PARTICIPANTS: We built a methodology that provides a reproducible framework for extracting and harmonising BMI data from four major linked EHRs across two age groups: children and young people (CYP; 2-18 years old) and adults (19 years and older). The methodology is adaptable across different trusted research environments. We evaluated the completeness and retention of records over 1-, 5- and 23-year periods by calculating the proportion of missing data relative to each year’s population.

RESULTS: We retrieved 53.4 million records for 3.2 million individuals across Wales from 1st January 2000 to 31 December 2022. Among these, 3% of CYP and 34% of adults had repeat BMI measurements recorded over periods ranging from 5 to 23 years. Throughout the entire population of Wales during this period, 49% of CYP and 26% of adults had at least one BMI reading recorded, resulting in a missingness rate of 51% for CYP and 74% for adults. Preserving BMI information by retaining the most recently recorded BMI over 1-, 5- and 23-year intervals from 2022 showed coverage rates of 10%, 33% and 68%, respectively, for CYP, and 25%, 51% and 73%, respectively, for adults.

CONCLUSIONS: Our findings highlight substantial variations in BMI data availability and retention across CYP and adults, as well as time periods within EHR in Wales. Wider adoption of this approach can enhance standardised approaches in using accessible measures like BMI to assess disease risk in population-based studies, strengthening public health initiatives and research efforts.

PMID:41047276 | DOI:10.1136/bmjopen-2025-103724

BMJ Open. 2025 Oct 5;15(10):e096130. doi: 10.1136/bmjopen-2024-096130.

ABSTRACT

OBJECTIVES: To evaluate temporal trends in the epidemiology of hip osteoarthritis (OA) in the USA from 1990 to 2019, with stratification by sex and geographic region.

DESIGN: Cross-sectional time-series analysis using secondary data from the Global Burden of Disease (GBD) study.

SETTING: US population-based analysis, stratified by the four US Census Bureau regions: Northeast, Midwest, South and West.

PARTICIPANTS: De-identified, aggregate population-level data representing all adults in the USA from 1990 to 2019, drawn from the GBD database.

PRIMARY AND SECONDARY OUTCOME MEASURES: Age-standardised rates per 100 000 population for years lived with disability (YLDs), prevalence and incidence of hip OA. Outcomes were stratified by sex and region. Statistical significance was defined as p<0.05.

RESULTS: Between 1990 and 2019, hip OA in the USA increased by 23.91% in YLDs, 24.67% in prevalence and 25.22% in incidence. In 2019, the mean YLDs were 28.30 in women versus 25.48 in men; prevalence was 49.55 versus 41.08; and incidence was 919.29 versus 818.10 (all p<0.001). Regionally, the Northeast had the highest mean YLDs (30.1), prevalence (52.4) and incidence (950.5), while the South had the lowest (YLDs: 24.5, prevalence: 40.7, incidence: 805.2). These sex-based and region-based disparities were statistically significant (p<0.05).

CONCLUSIONS: There has been a substantial rise in the burden of hip OA in the USA over the past three decades. Women and residents of the Northeastern USA are disproportionately affected. These findings underscore the need for targeted public health strategies that account for geographic and sex-based disparities in hip OA burden.

PMID:41047275 | DOI:10.1136/bmjopen-2024-096130

Inflammopharmacology. 2025 Oct 5. doi: 10.1007/s10787-025-01995-5. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic low-grade inflammation plays a central role in the pathophysiology of both type 2 diabetes mellitus (T2DM) and hypertension, contributing to increased cardiovascular risk. Telmisartan, an angiotensin receptor blocker with partial peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist activity, may offer anti-inflammatory benefits in addition to its antihypertensive effects.

AIMS: This study compares the effects of telmisartan versus other standard antihypertensive agents on inflammatory biomarkers, including high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), in patients with diabetes and newly diagnosed hypertension.

METHODS: This is a randomized, open-label, parallel-group, active-controlled trial. Seventy eligible patients were randomized to receive telmisartan (N = 34) or another antihypertensive agent [amlodipine (n = 22), cilnidipine (n = 12), or ramipril (n = 2)] (N = 36). Secondary outcome parameters included inflammatory biomarkers such as highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-α) measured at baseline and 12 weeks following treatment. Data are presented as median and interquartile range (IQR). Between-group comparisons at 12 weeks were performed using the Mann-Whitney U test. The trial is registered with the Clinical Trial Registry of India (CTRI/2023/04/051878).

RESULTS: At baseline, hsCRP, IL-6, and TNF-α levels were comparable between groups. In the telmisartan group, hsCRP declined from 3.4 mg/L (IQR: 2.0, 13.7) to 1.8 mg/L (IQR: 1.2, 5.0), IL-6 from 4.3 pg/mL (IQR: 2.9,9.5) to 3.4 pg/ml (IQR: 2.2, 6.8), and TNF-α from 19.4 pg/ml (IQR: 8.9, 43.7) to 13.8 pg/ml (IQR: 3.5, 32.4). In the active control group, hsCRP changed from 3.1 mg/L (IQR: 1.7, 8.0) to 2.9 mg/L (IQR: 1.7, 4.9), IL-6 from 4.1 pg/ml (IQR: 3.0,7.6) to 4.2 pg/ml (IQR: 2.9, 7.8), and TNF-α from 20.2 pg/ml (IQR: 10.4, 48.6) to 16.9 pg/ml (IQR: 3.3, 30.3). The differences between groups at 12 weeks were not statistically significant for hsCRP (P = 0.07), IL-6 (P = 0.24), or TNF-α (P = 0.93).

CONCLUSION: The anti-inflammatory markers were reduced in both groups at 12 weeks without any statistically significant difference across groups. However, telmisartan was associated with greater reductions in hsCRP, IL-6, and TNF-α in patients with T2DM and hypertension following 12 weeks of treatment. These findings may indicate a potential anti-inflammatory effect of telmisartan that requires confirmation in adequately powered trials.

PMID:41046489 | DOI:10.1007/s10787-025-01995-5

J Robot Surg. 2025 Oct 5;19(1):663. doi: 10.1007/s11701-025-02752-0.

ABSTRACT

Accurate flexion-extension gap balancing is critical in total knee arthroplasty (TKA), influencing postoperative stability and longevity. Femoral component flexion in the sagittal plane has been suggested as a means to adjust gap balance; however, its impact across different implant designs remains unclear. This study compares the influence of femoral component flexion on gap balancing between single-radius and multi-radius femoral components using robotic-assisted TKA. A prospective observational cohort study was conducted on 200 patients (100 in each cohort) undergoing primary robotic-assisted TKA for varus deformity with end-stage osteoarthritis. Patients were randomized to receive either single-radius (Stryker MAKO with Stryker Triathlon implants) or multi-radius (Meril CUVIS with Maxx-Freedom implants) femoral components. Intraoperative medial and lateral flexion-extension gaps were assessed at femoral flexion increments from 0° to 6° using robotic measurement software, and statistical analyses were done. Femoral component flexion had distinct impacts on gap balancing depending on implant design. Multi-radius implants showed significant variability with extension medial gaps progressively loosened (mean Change 0.19 mm/degree of flexion, p < 0.001), and flexion medial and lateral gaps progressively tightened (mean Changes 0.21 mm/degree, p < 0.001 and 0.24 mm/degree, p < 0.05, respectively). Conversely, single-radius implants demonstrated minimal variability in all gap measurements across degrees of femoral flexion (p > 0.05). Femoral component flexion significantly affects gap balancing during robotic-assisted TKA, particularly in multi-radius femoral components. Multi-radius designs require careful sagittal alignment to prevent undesirable gap variations, whereas single-radius implants exhibit more predictable gap balancing profiles, potentially simplifying intraoperative adjustments. Future research should evaluate long-term clinical outcomes related to these findings.

PMID:41046480 | DOI:10.1007/s11701-025-02752-0

J Esthet Restor Dent. 2025 Oct 5. doi: 10.1111/jerd.70043. Online ahead of print.

ABSTRACT

INTRODUCTION: Cervical lesions often demand specialized approaches due to their anatomical position, and the effectiveness of these techniques may vary among clinicians.

OBJECTIVES: To assess the clinical effectiveness of various adhesive strategies combined with different restorative materials for managing cavitated cervical carious lesions in adults, with a specific focus on restoration retention. The study also aimed to rank these combinations through network meta-analysis.

METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Randomized controlled trials comparing at least two restorative protocols in adult populations were included. Pairwise and network meta-analyses were performed using random-effects models. The certainty of the evidence was evaluated using the CINeMA framework.

RESULTS: Seventeen RCTs met the inclusion criteria. Conventional composites applied with two-step etch and rinse adhesives and compomers demonstrated the highest retention rates in pairwise comparisons. Glass ionomer cement showed the most stable long-term performance. However, the network meta-analysis revealed no statistically significant differences among treatments. Notably, compomers ranked highest in overall performance but were supported by studies with substantial heterogeneity and a high risk of bias.

CONCLUSIONS: Although compomers achieved the highest retention rates in direct comparisons, the underlying evidence is limited by methodological concerns, reducing confidence in their clinical reliability. In contrast, conventional composites bonded with two-step etch-and-rinse adhesives emerged as the most robust and evidence-based option for restoring cervical carious lesions. The optimization of adhesive protocols, particularly the incorporation of selective enamel etching, remains a key determinant for long-term restoration success.

CLINICAL SIGNIFICANCE: This systematic review and network meta-analysis provides robust, evidence-based guidance for the restoration of cavitated cervical carious lesions in adults. Optimizing adhesive protocols, especially with selective enamel etching, significantly enhances the longevity of cervical carious lesion restorations. Evidence supports two-step etch-and-rinse adhesives with conventional composites as a dependable choice, ensuring durable retention, favorable esthetic integration, and long-term performance in this highly visible and esthetically sensitive region of the dentition.

PROSPERO: Registration number: CRD420251083691.

PMID:41046479 | DOI:10.1111/jerd.70043

Clin Transl Sci. 2025 Oct;18(10):e70365. doi: 10.1111/cts.70365.

ABSTRACT

Rare diseases affect a small population of patients, resulting in low incentives for developing orphan drug products (ODPs). The United States Congress passed the Orphan Drug Act of 1983 to incentivize pharmaceutical manufacturers to develop drugs to treat rare diseases. However, ODPs generally have higher treatment costs than non-ODP treatments. Developing generic ODPs can benefit patients by increasing market competition and providing alternate treatment options. This research aims to identify factors influencing the first submission of abbreviated new drug applications (ANDAs) for generic orphan drugs. Data were collected from the U.S. Food and Drug Administration (FDA) databases (including but not limited to the FDA Orphan Drug Designations and Approvals database, Orange Book, and the internal drug product complexity designation) and the IQVIA sales database to inform the drug product information, regulatory factors, and pharmacoeconomic factors. The Random Survival Forest (RSF) machine learning method was employed to conduct the analysis for New Chemical Entities (NCEs) and non-NCEs. The modeling analysis was adequately assessed through both internal and external validations. For NCEs and non-NCEs, the RSF was able to predict ANDA submission with a repeated cross-validation C-index of 0.675 ± 0.0261 (C-index of full training dataset: 0.915) and 0.754 ± 0.0441 (C-index of full training dataset: 0.838), respectively. The variables with the highest importance in the RSF model to predict ANDA submission of NCE ODPs were sales data, while for non-NCEs, regulatory data was the most important (i.e., availability of product-specific guidances (PSGs)). As more data becomes available in the future, the RSF methodology will likely be able to predict ANDA submissions of ODPs more effectively. The model-informed results may be utilized in future intervention strategies to promote ANDA submissions for orphan drugs and to increase the availability of generic ODPs.

PMID:41046470 | DOI:10.1111/cts.70365

Clin Transl Sci. 2025 Oct;18(10):e70372. doi: 10.1111/cts.70372.

ABSTRACT

Although extensive research has linked education to the Stroop effect, the neural mechanisms by which higher education influences Stroop performance in non-demented older adults remain unclear. This study investigated this relationship in 126 older adults from Qingdao, stratified into higher education (> 12 years) and non-higher education (≤ 12 years) groups. Demographic data and Stroop performance were collected using a 50-item Stroop Color-Word Test (SCWT), yielding measures of completion time, correct responses, score-time ratio (efficiency), and time interference score (TI). Resting-state fMRI (rs-fMRI) was performed, and neural activity was assessed via amplitude of low-frequency fluctuations (ALFF) to identify regions of interest (ROIs). Multivariable regression models examined associations between education and Stroop outcomes, followed by correlation analyses between ROIs and performance. Bootstrap mediation analysis (5000 resamples) tested whether ROIs mediated the education-Stroop relationship. Results showed that higher education was significantly associated with better Stroop performance-shorter completion time, higher efficiency, and lower TI-after full adjustment (all p < 0.05). Rs-fMRI revealed greater ALFF in the right frontal eye field (FEF), right dorsolateral prefrontal cortex (DLPFC), and left dorsal anterior cingulate cortex (dACC) in the higher education group. These regions correlated negatively with completion time and TI, and positively with efficiency. Mediation analyses confirmed that right FEF, right DLPFC, and the combined ROIs significantly mediated the effects of higher education on Stroop performance. In conclusion, higher education may enhance Stroop performance in non-demented older adults by modulating resting-state neural activity in key cognitive control regions.

PMID:41046460 | DOI:10.1111/cts.70372

Phys Rev Lett. 2025 Sep 19;135(12):126503. doi: 10.1103/tp8x-dscx.

ABSTRACT

The quantum loop and dimer models are archetypal correlated systems with local constraints. With natural foundations in statistical mechanics, they are of direct relevance to various important physical concepts and systems, such as topological order, lattice gauge theories, geometric frustrations, or more recently Rydberg array quantum simulators. However, how the thermal fluctuations interact with constraints has not been explored in the important class of nonbipartite geometries. Here we study, via unbiased quantum Monte Carlo simulations and field theoretical analysis, the finite-temperature phase diagram of the quantum loop model on the triangular lattice. We discover that the recently identified, “hidden” vison plaquette (VP) quantum crystal [X. Ran et al., Hidden orders and phase transitions for the fully packed quantum loop model on the triangular lattice, Commun. Phys. 7, 207 (2024)CMPYEL0868-316610.1038/s42005-024-01680-z] experiences a finite-temperature continuous transition, which smoothly connects to the (2+1)d Cubic* quantum critical point separating the VP and Z_{2} quantum spin liquid phases. This finite-temperature phase transition acquires a unique property of “remnants of fractionalization” at finite temperature, in that, both the cubic order parameter-the plaquette loop resonance-and its constituent-the vison field-exhibit independent criticality signatures. This phase transition is connected to a three-state Potts transition between the lattice nematic phase and the high-temperature disordered phase. We discuss the relevance of our results for current experiments on quantum simulation platforms.

PMID:41046441 | DOI:10.1103/tp8x-dscx