Category: Nevin Manimala

Esophagus. 2025 Sep 29. doi: 10.1007/s10388-025-01157-0. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with esophageal cancer (EC) usually have multiple comorbidities, particularly, high cachexia incidence, which may lead to increased postoperative complications. A novel inflammatory marker, growth differentiation factor 15 (GDF15), was recently reported to be associated with cancer cachexia. This study evaluated the correlation between clinical data suggestive of cachexia in patients with EC and circulating GDF15 levels.

METHODS: Eighty patients with EC were enrolled in this study. Plasma samples were collected before initiating any cancer treatment. GDF15 was quantified using ELISA. Clinical information, including age, comorbidities, biochemical data, Controlling Nutritional Status score, and Psoas muscle index (PMI), was collected from the clinical records. Clinical impact of GDF15 was then evaluated and compared with cachectic indicators or postoperative results.

RESULTS: The median value of GDF15 was 1168 pg/mL (range 298-9100 pg/mL). GDF15 values statistically correlated with age, prevalence of diabetes, serum level of aspartate aminotransferase/γ-glutamyltransferase/creatinine/blood sugar/albumin, and PMI. Sixty-three patients finally underwent curative esophagectomy with right thoracic approach and gastric tube reconstruction. Patients with infectious complications had a statistically higher GDF15 than those without. The cut-off value was 930 pg/mL for detecting infectious complications, with an area under the receiver operating characteristic curve value of 0.685, and high GDF15 was detected as an independent risk factor for postoperative infectious complications.

CONCLUSIONS: GDF15 is potentially suggestive of general condition deterioration from aging, organ dysfunction, and decreased muscle mass, which may lead to cachexia in patients with EC. Moreover, patients with higher GDF15 are at a risk of postoperative infectious complications.

PMID:41016991 | DOI:10.1007/s10388-025-01157-0

Ophthalmol Ther. 2025 Sep 29. doi: 10.1007/s40123-025-01245-5. Online ahead of print.

ABSTRACT

INTRODUCTION: To compare the U.S. Food and Drug Administration (FDA) premarket approval (PMA) trials of topography-guided laser in situ keratomileusis (TG-LASIK) and ray tracing-guided LASIK (RT-LASIK) for the treatment of myopia and myopic astigmatism.

METHODS: This comparative study was conducted between TG-LASIK (P020050/S012; Alcon Laboratories, Inc., Fort Worth, TX, USA) with Allegretto Wave Eye-Q laser and topography-guided custom ablation treatment planning software, and “WaveLight Plus” RT-LASIK (P020050/S043; Alcon Laboratories, Inc.) using the WaveLight EX500 excimer laser and InnovEyes Sightmap. Clinical outcomes were compared, including visual and refractive measures, astigmatic correction, mesopic contrast sensitivity, higher-order aberrations, and patient-reported outcomes.

RESULTS: This analysis included 249 eyes (212 patients) that underwent TG-LASIK and 336 eyes (168 patients) that underwent RT-LASIK. At 12 months, uncorrected distance visual acuity of 20/16 or better (64.8% TG-LASIK vs. 70.2% RT-LASIK) and 20/20 or better (92.6% TG-LASIK vs. 94.4% RT-LASIK) did not differ statistically between platforms. However, more TG-LASIK eyes had 20/10 or better (15.7% vs. 2.5%, P < 0.001) and 20/12.5 or better (34.4% vs. 26.4%, P = 0.044) than RT-LASIK eyes. Both platforms demonstrated comparable refractive predictability and stability (P > 0.05). For preoperative cylinder between – 1.00 to – 4.00 D, RT-LASIK showed greater astigmatic overcorrection (P < 0.05). At 3 months, RT-LASIK showed higher mesopic contrast sensitivity at 3, 6, and 12 cycles per degree under glare, with more eyes achieving clinically significant gains compared to TG-LASIK (P < 0.001). Both platforms induced changes in total higher-order aberrations, although not clinically significant. RT-LASIK also reduced spherical aberration from baseline. Both procedures showed a reduction in symptom severity for glare, halos, starburst, double vision, and dry eye.

CONCLUSIONS: While TG-LASIK showed superior visual acuity outcomes, RT-LASIK was associated with higher contrast sensitivity; however, both platforms demonstrate excellent visual and refractive outcomes. The majority of published studies are consistent with FDA PMA trends, showing potential reductions in spherical aberration and higher rates of 20/20 or better visual acuity with RT-LASIK.

PMID:41016970 | DOI:10.1007/s40123-025-01245-5

Glob Health Res Policy. 2025 Sep 29;10(1):48. doi: 10.1186/s41256-025-00447-5.

ABSTRACT

BACKGROUND: Routine childhood vaccination coverage under the National Immunization Program of the Philippines is well below the target of 95% with a high number of zero-dose children. Declining immunization rates led to outbreaks of vaccine-preventable diseases such as measles, polio, and pertussis. This study aimed to identify the factors affecting childhood vaccine uptake by exploring the perspectives of community members, program managers, and coordinators.

METHODS: Three regions with low vaccine coverage in the Philippines were selected as study sites. We conducted focus groups with adult caregivers of vaccinated and unvaccinated children aged 0-11 years recruited by barangay (community) health workers. Key informant interviews were also conducted with immunization program managers and coordinators from different administrative levels. Focus group and interview guides were informed by the World Health Organization’s Behavioural and Social Drivers (BeSD) of Vaccination framework. Transcripts were analysed by themes and deductive axial coding was used to categorize themes into BeSD domains and socioecological levels.

RESULTS: Twelve focus groups (n = 143) and 57 key informant interviews were done. Various behavioural and social drivers of vaccination present at different levels of the socioecological model affect vaccine decisions both positively and negatively. Under the ‘Thinking and feeling’ domain of the BeSD, at the intrapersonal level, the perception of benefits and negative side effects of routine vaccines were clear drivers of vaccination. In the ‘Social processes’ domain, factors at multiple socioecological levels such as the influence of family, barangay health workers, and community leaders were identified. Practical issues such as the availability of vaccines and accessibility of vaccination sites remain a barrier to vaccination.

CONCLUSIONS: Availability of routine vaccines and accessibility to vaccination sites are major challenges in the Philippines. Acceptability of routine vaccines continue to be affected by previous controversies around the Dengue vaccine and the recent COVID-19 pandemic. Findings suggest that enhancing advocacy for immunization through continuing communication training for health care workers on health promotion and education regarding vaccination may contribute to increased vaccine uptake. Integration of immunization with other population-based health programs could be explored.

PMID:41016961 | DOI:10.1186/s41256-025-00447-5

Lasers Med Sci. 2025 Sep 29;40(1):391. doi: 10.1007/s10103-025-04596-4.

ABSTRACT

Photobiomodulation therapy (PBMT), which involves both stimulatory and inhibitory biological responses to light, represents a critical area of research requiring further in-depth exploration. This study aimed to evaluate and compare the effects of 650 nm and 450 nm diode lasers on wound healing following tooth extraction in a rabbit model. Local anesthesia was used. A continuous-wave (CW) diode laser with wavelengths of 650 then 450 were used on wound after tooth extraction in 30 rabbits divided into three groups randomly and equally separated groups: control group (G1), 650 nm group (G2) and 450 nm group (G3), with laser parameters determined based on a prior pilot study in rabbits. The energy density for a 30-second exposure was 7.64 J/cm². The power output and the power density were 200 mW and 254 mW per cm², respectively. By day 7, 70% of rabbits in the G2 exhibited pink gingival tissue, compared to only 40% in the G3.Healing outcomes demonstrated statistically significant (p < 0.05) in G2in the gingival color and thickness relative to those G1 and G3.By day 14, none of theG1 displayed severe congestion, whereas G2 showed normal tissue recovery without pathological secretion(only two rabbits in G3 showed suppuration).Histopathological analysis revealed that 650 nm PBMT stimulated partial epithelialization and collagen deposition by day 7, with further enhancement by day 14. The 650 nm wavelength demonstrated superior healing effects, characterized by increased pink gingival tissue, reduced bleeding, and absence of inflammation. Photobiomodulation therapy (PBM) accelerates wound healing and is effective in reducing inflammation. Further research is needed to optimize wavelength selection.Clinical trial number Not applicable.

PMID:41016952 | DOI:10.1007/s10103-025-04596-4

Clin Oral Investig. 2025 Sep 29;29(10):478. doi: 10.1007/s00784-025-06572-2.

ABSTRACT

OBJECTIVES: An in vitro study to verify the potential effectiveness of an orthodontic adhesive incorporating a polybetaine zwitterionic mixture in preventing biofilm formation.

MATERIALS AND METHODS: 2-methacryloyloxyethyl phosphorylcholine (MPC) and sulfobetaine methacrylate (SBMA), were added to An adhesive at 1 wt% (MS1) And 3 wt% (MS3). The MS0 group had no zwitterions. Flowability measurement, shear bond strength (SBS), the adhesive remnant index (ARI), and the contact angle were assessed. Bracket bonding was performed, and cross-sections were examined using scanning electron microscopy (SEM). Biofilm formation was analyzed using confocal laser scanning microscopy. Statistical analyses were conducted using R software. Wilcoxon tests with the Holm correction were used for non-parametric data, and pairwise t-tests with the Bonferroni correction were used for parametric data. Significance was set at P < 0.0001.

RESULTS: Flow analysis showed no significant differences in the experimental groups compared to the MS0 group (P > 0.05). The SEM images confirmed uniform bonding in all groups. SBS decreased significantly with higher MS content (P < 0.0001), And ARI scores shifted with the addition of zwitterionic mixtures, increasing scores to 1 And 2. MS3 showed a significantly lower contact angle compared to MS0 (P < 0.05). MS3 exhibited reduced biofilm formation and lower fluorescence intensity (P < 0.05).

CONCLUSIONS: Despite reductions in SBS, all adhesives remained at minimum acceptable levels. The 3 wt% zwitterionic adhesive effectively suppressed biofilm formation and may help prevent demineralization.

CLINICAL RELEVANCE: An orthodontic adhesive containing a zwitterionic mixture can satisfy clinical properties and prevent side effects due to biofilm formation.

PMID:41016948 | DOI:10.1007/s00784-025-06572-2

J Neurol. 2025 Sep 29;272(10):659. doi: 10.1007/s00415-025-13383-8.

ABSTRACT

OBJECTIVE: About 30% of patients with isolated adult-onset dystonia report an improvement of their motor symptoms after the consumption of alcohol. In this cross-sectional study, we sought to investigate whether the observed improvement is attributable to the anxiolytic, euphoric, and analgesic properties of alcohol, rather than or in addition to its effect on dystonic movements, as psychiatric symptoms and pain frequently occur in dystonia patients and as emotional stress is a well-established trigger for symptom exacerbation.

METHODS: We analyzed data from 339 prospectively enrolled participants with recently diagnosed isolated dystonia (mean age: 55.2 ± 12.5 years, 228 female) of the Natural History Project of the Dystonia Coalition, a large international multicenter study. Alcohol responsiveness was determined by patients´ self-report. Symptoms of depression, as well as generalized and social anxiety, were assessed using the Hospital Anxiety and Depression Scale and the Liebowitz Social Anxiety Scale. Severity of pain was measured using question 21 of the RAND 36-Item Health Survey.

RESULTS: Participants with more severe pain reported greater response to alcohol than those with less severe pain (p = .004), whereas symptoms of depression (p = .986), generalized anxiety (p = .395) and social anxiety (p = .953) were not associated.

CONCLUSION: Alcohol responsiveness in isolated dystonia is associated with higher levels of pain, whereas self-reported alcohol-related improvements in dystonic movements or tremor do not depend on the euphoric or anxiolytic effects of alcohol. This finding underscores the potential role of pain management in alleviating motor symptoms in dystonia.

PMID:41016940 | DOI:10.1007/s00415-025-13383-8

Oral Maxillofac Surg. 2025 Sep 29;29(1):162. doi: 10.1007/s10006-025-01449-w.

ABSTRACT

PURPOSE: This study aimed to compare the postoperative clinical outcomes between the conservative bone trocar and open conventional techniques for iliac crest bone harvesting for alveolar bone grafting.

METHODS: The study included 20 unilateral cleft patients aged between 8 and 11 years, just before canine eruption, who suffered from oro-nasal communication, and were divided into two groups. Group A: ten patients using the open technique with a 4 cm incision at the anterior superior iliac crest for harvesting bone chips. Group B: ten patients using a conservative technique with a 1 cm incision at the anterior superior iliac crest using a special bone trocar extractor and curette. Postoperative evaluation included the Visual Analogue Scale (VAS) for pain assessment to compare the level of pain postoperatively. Also Vancouver scale was used for scar wound evaluation through clinical examination of wound size and concerning tissue vascularity, pigmentation, pliability, and height.

RESULTS: There were no postoperative complications observed, including infection, dehiscence, and graft resorption in both groups. Two weeks postoperative: Group A reported significantly higher pain (7.8 ± 0.79) compared to Group B (3.6 ± 0.97) & p < 0.001, indicating statistically significant lower pain levels in Group B. Regarding the Vancouver Scar Scale, two weeks postoperative: Group A had significantly higher scar severity (9.1 ± 0.88) compared to Group B (3.0 ± 0.82) and p < 0.001, suggesting better scar satisfaction in Group B. One month postoperatively, Group B over time confirmed better scar appearance.

CONCLUSION: Autogenous iliac crest using a conservative technique with a bone trocar is significantly more beneficial, less painful, and provides better wound scar healing satisfaction than the standard open approach in terms of VAS pain scale and Vancouver scar scale.

PMID:41016933 | DOI:10.1007/s10006-025-01449-w

J Pediatr Urol. 2025 Sep 16:S1477-5131(25)00486-3. doi: 10.1016/j.jpurol.2025.09.012. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of overactive bladder (OAB) in children by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS: A systematic search of PubMed, Embase and the Cochrane Library was conducted to identify RCTs comparing TENS with standard therapies (urotherapy, sham TENS, or oxybutynin) in children with OAB. Inclusion criteria encompassed RCTs published between 2004 and 2024, reporting TENS as a primary intervention. Data were pooled using a meta-analysis framework, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the ROBVIS tool.

RESULTS: Nine RCTs involving 382 children were included. Five studies compared active TENS with sham TENS, of which three reported superior efficacy for TENS, while two found no difference. Two studies compared TENS with oxybutynin; one demonstrated TENS superiority, while the other found comparable efficacy. One study showed TENS to be as effective as urotherapy, and another found that TENS combined with oxybutynin was superior to either treatment alone. The meta-analysis revealed that TENS significantly increased the likelihood of a full response compared to other treatments (OR 3.96, 95 % CI 2.46-6.38, p < 0.001). TENS was effective both as a standalone therapy (OR 4.34) and as an adjunct (OR 3.27). Parasacral TENS demonstrated a higher response rate than posterior tibial TENS.

CONCLUSION: TENS is an effective, non-invasive therapy for pediatric OAB, either as monotherapy or in combination with urotherapy or medication. However, variability in study protocols and limited long-term follow-up data highlight the need for standardized treatment protocols and larger RCTs to assess long-term outcomes, including relapse rates.

PROSPERO REGISTRATION NUMBER: CRD420251114932.

PMID:41016899 | DOI:10.1016/j.jpurol.2025.09.012

Urol Oncol. 2025 Sep 27:S1078-1439(25)00351-5. doi: 10.1016/j.urolonc.2025.08.029. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide an updated analysis of trends and outcomes for these approaches using data from the SEER database (2000-2021).

METHODS: Patients diagnosed with localized T1a renal cell carcinoma (RCC) were identified from the SEER database. Management strategies were categorized as PN, RN, AT, or non-surgical management (NSM), including AS. Descriptive statistics assessed patient demographics and tumor characteristics. Logistic regression models identified predictors of NSM, adjusting for age, race, tumor grade, histology, and socioeconomic factors. Kaplan-Meier survival analysis and Cox proportional hazards regression evaluated associations between management type and 5-year overall survival.

RESULTS: RN usage declined sharply from ∼75% in 2000 to ∼14% in 2021, while PN steadily increased, surpassing RN around 2017 and reaching ∼50% by 2021. Notably, younger patients (<60 years) demonstrated a more rapid shift toward partial nephrectomy over time, whereas the oldest patients (>75 years) showed a slower uptake of partial nephrectomy and a higher ongoing utilization of non-surgical management. AT and NSM showed gradual adoption, peaking at ∼10% and ∼15% to 20%, respectively, by 2021. PN was associated with the best overall survival, followed by RN and AT, while NSM had the poorest outcomes. Predictors of NSM included advanced age (>75 years, OR = 3.54) and black race (OR = 1.63).

CONCLUSION: PN has become the most widely used management for SRMs, aligned with AUA and EAU guidelines. AS remains a viable and guideline-recommended option for select patients with SRMs <2 cm. The variable use of AT and NSM, coupled with the poorer prognosis of NSM, underscores the importance of individualized patient selection and close follow-up to ensure optimal outcomes.

PMID:41016894 | DOI:10.1016/j.urolonc.2025.08.029

Pain Manag Nurs. 2025 Sep 27:S1524-9042(25)00271-1. doi: 10.1016/j.pmn.2025.09.002. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the effect of auditory distraction and virtual reality (VR) on pain severity and physiological indicators during burn dressing changes among adult patients.

DESIGN: A single-center, randomized controlled trial.

METHODS: A total of 60 patients were randomly assigned to the auditory distraction (n = 20), VR (n = 20), and control (n = 20) groups. All patients in the three groups received intravenous morphine at a dose of 0.05 mg/kg body weight, 15 minutes prior to the dressing change. The auditory distraction group listened to music during the dressing, while the VR group used a headset to view nature images throughout the dressing procedure. Data collection tools were the numeric pain scale, a checklist form of the physiological Indicators, and a pulse oximetry device.

RESULT: Statistically significant differences in pain severity were observed among the VR, auditory distraction, and control groups during dressing changes (p < .05). Despite all patients receiving intravenous morphine (0.05 mg/kg), both interventions led to greater pain reduction. Oxygen saturation and respiratory rates also differed significantly across groups (p < .05), with posthoc analysis confirming that both interventions were equally effective and superior to standard care.

CONCLUSIONS: This study’s findings demonstrated that auditory distraction was as effective as VR techniques in reducing fluctuations in physiological indicators and pain severity during dressing changes in adult patients.

CLINICAL IMPLICATIONS: Nonpharmacological interventions can serve as effective adjuncts alongside pharmacological treatments in pain management nursing.

PMID:41016886 | DOI:10.1016/j.pmn.2025.09.002