Category: Nevin Manimala

Arch Orthop Trauma Surg. 2025 May 15;145(1):296. doi: 10.1007/s00402-025-05915-8.

ABSTRACT

INTRODUCTION: In humeral shaft fractures, the presence of a free bone fragment, called the third fragment or butterfly fragment, is thought to induce non-union. We hypothesised that non-union and subsequent reoperations could be reduced by performing cerclage wiring for fragments, in addition to intramedullary nailing for fractures with the third fragment. This study aimed to examine the effectiveness of cerclage wiring for the third fragments associated with humeral shaft fractures.

MATERIALS AND METHODS: This study included patients with humeral shaft fractures involving the third fragment, who underwent osteosynthesis with intramedullary nailing at our institution between April 2013 and June 2024. The patients were divided into two groups: those who underwent osteosynthesis using an intramedullary nail alone (Group1) and those who underwent osteosynthesis using an intramedullary nail with cerclage wiring (Group2). Patient and injury characteristics, surgical time, intraoperative blood loss, postoperative complications, fracture healing, time to bone union, and reoperation were investigated and compared between the two groups.

RESULTS: Sixteen patients were included in Group1 and 27 patients were included in Group2. There were no significant differences in patient characteristics or injuries. Surgical time was significantly longer (p = 0.01) and intraoperative blood loss was significantly greater (p = 0.01) in Group2. There were no significant differences in the rates of infection and postoperative nerve paralysis (p = 1, 0.522). The rates in non-union was significantly higher in Group1 (p = 0.05). There were no significant differences in reoperation rate (p = 0.137). In cases where fracture healing was achieved, the time to bone union was significantly longer in Group1 (p < 0.001).

CONCLUSION: Cerclage wiring, in addition to intramedullary nailing for fractures with a third fragment, may prevent non-union. Although the addition of cerclage wiring significantly increased the surgical time and intraoperative blood loss, there was no increase in postoperative complications.

PMID:40372626 | DOI:10.1007/s00402-025-05915-8

Neuropsychol Rev. 2025 May 15. doi: 10.1007/s11065-025-09661-x. Online ahead of print.

ABSTRACT

The purpose of this systematic review was to synthesize the current evidence on motor learning in mild cognitive impairment (MCI). A search of five databases returned a total of 6058 references, 10 of which met criteria for inclusion in this review. The existing evidence was notably variable with an overall moderate risk of bias. Eight articles compared behavioral motor learning outcomes in MCI and age matched, non-cognitively impaired (NCI) samples. In 37.5% of these studies, the degree of motor skill acquisition in the MCI group was statistically significantly less than in the NCI group. Skill retention was only compared between MCI and NCI samples in one article, which reported a relative reduction in MCI group performance following a 24-h, no-practice delay. Importantly, none of the included articles examined motor skill transfer. We discuss possible sources of heterogeneity among collective findings including variability in motor tasks, outcome measurement, and research design. Further research is needed to support a comprehensive understanding of motor learning in the early stages of age-related cognitive decline. Future investigations should emphasize functional motor tasks and clinically relevant learning outcomes, including retention and transfer of motor skills, while controlling for potentially confounding factors such as motivation and sleep performance. This systematic review was registered with PROSPERO international prospective register of systematic reviews (registration ID CRD42023417329).

PMID:40372622 | DOI:10.1007/s11065-025-09661-x

Drugs Real World Outcomes. 2025 May 15. doi: 10.1007/s40801-025-00494-x. Online ahead of print.

ABSTRACT

BACKGROUND: In early 2022, new treatment recommendations for heart failure (HF) were introduced in Sweden.

OBJECTIVE: This study aims to evaluate and analyze the pharmaceutical treatment patterns of HF patients over time in Sweden, in relation to the updated treatment recommendations.

METHODS: This observational study is based on registry data. The study population consisted of patients ≥18 years old who, at any time between 2017 and 2023, had an HF diagnosis, defined using ICD-10 code I50 (n = 212,757). Descriptive statistics were presented for the study population. Based on data from the national drug prescription registry, the treatment patterns between 2021 and 2023 were analyzed using biannual datasets before and after the introduction of treatment recommendations.

RESULTS: The mean age of the study population was 79 years and 56% were men. The utilization of quadruple therapy and SGLT2 inhibitors, both as monotherapy and in combination, increased over time, with a rising trend already apparent prior to the introduction of the updated treatment recommendations. At the end of 2023, about 30% of the incident HF population had at least tried quadruple therapy. Furthermore, a growing number of diverse treatment pathways among HF patients was observed over time, which may indicate an increased consideration for individualized treatment.

CONCLUSIONS: Even though the implementation of the treatment recommendations for HF is not yet optimal, this study found a notable adoption of quadruple therapy in Sweden. There was an increased use of SGLT2 inhibitors and quadruple therapy, beginning even before the introduction of the updated Swedish treatment recommendations.

PMID:40372621 | DOI:10.1007/s40801-025-00494-x

J Cancer Educ. 2025 May 15. doi: 10.1007/s13187-025-02648-5. Online ahead of print.

ABSTRACT

Symptom management is one of the major concerns of cancer survivors, including Asian American breast cancer survivors (ABS) during their survivorship process. The purpose of this randomized intervention study was to determine the efficacy of a technology-based educational intervention in decreasing multiple domains of symptom experience among ABS. This was a part of a randomized clinical trial with repeated measures among 199 ABS recruited through online and offline groups/communities for Asian Americans. The intervention was a technology-based educational (information and coaching/support) program using computers and mobile devices to change health behaviors to improve the women’s survivorship experience. The data were collected using multiple items on background and disease factors, and the Memorial Symptom Assessment Scale-Short Form (MSAS-SF). The data analysis was conducted using an intent-to-treat approach. Although the differences were not statistically significant, all multiple domain symptom scores of the intervention group decreased from pre-test to post 3 months, while only psychological symptom distress scores of the control group decreased from pre-test to post 3 months. Depending on the domain of symptoms, the significant mediators, with total, direct, or indirect effects, were different at different time points. For instance, attitudes, perceived barriers, social influences, social support, and self-efficacy showed significant total mediation effects on the total symptom distress scores only at pre-test (p < 0.05). The efficacy of a technology-based education intervention was supported in decreasing symptoms among ABS. Health educators need to consider that culturally tailored technology-based educational interventions could help improve the symptom experience of ABS.

PMID:40372611 | DOI:10.1007/s13187-025-02648-5

Photochem Photobiol Sci. 2025 May 15. doi: 10.1007/s43630-025-00733-8. Online ahead of print.

ABSTRACT

Understanding the relationship between molecular structure and bioactivity is crucial for optimizing porphyrin-based therapeutics. By integrating cheminformatics techniques with machine learning models, our work enables the efficient classification of compounds based on their molecular structures and their growth inhibition capabilities (IC₅₀). A dataset of 317 porphyrin derivatives was compiled, incorporating molecular descriptors and biological activity data. Descriptive statistical analysis was performed to examine compound distribution and key features. Clustering analysis was conducted using hierarchical clustering and fingerprint similarity matrices to classify compounds based on structural similarity. Lipinski’s Rule of Five was applied to assess drug-likeness, while Murcko scaffold analysis identified core structural patterns. Tumor response data were analyzed to evaluate therapeutic efficacy. Machine learning models were implemented to predict bioactivity. Descriptive statistics highlighted bioactive compounds, with TMPyP4 and Temaporfin being the most studied. Quantitative estimation of drug-likeness and the number of aliphatic carboxylic acids were identified as the most influential descriptors among others for bioactivity. Hierarchical clustering segmented porphyrins into nine structural groups. The analysis identified 168 pIC₅₀ active compounds, with 31 meeting Lipinski’s criteria, and 11 overlapping as both effective and bioavailable. Tumor response analysis revealed three porphyrins achieving 100% response. Logistic Regression emerged as the best-performing model, achieving 83% accuracy, demonstrating robust predictive capabilities. This study successfully characterized porphyrin derivatives, reviewing key molecular features influencing bioactivity and evaluating their therapeutic potential. It highlights the potential of machine learning in predicting the biological activity status of porphyrin derivatives.

PMID:40372610 | DOI:10.1007/s43630-025-00733-8

Eur J Clin Invest. 2025 May 15:e70068. doi: 10.1111/eci.70068. Online ahead of print.

ABSTRACT

BACKGROUND: Torque teno virus (TTV) is not known to cause disease in humans; however, chronic inflammatory conditions and immunosuppression states can favour TTV replication. This study aimed to verify the effectiveness of TTV as an immune biomarker.

METHODS: The protocol of this review was registered in PROSPERO (CRD42022331049) and performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS: Thirty-three articles were selected and different groups of patients were assessed. In the solid organ and hematopoietic stem cell transplant groups, most studies reported that TTV viral load (VL) was highly detectable after transplantation and compared to controls, but the association with immune parameters showed conflicting results. In melanoma patients, no statistical difference in TTV VL was identified between susceptible and treatment-resistant patients. In lung cancer patients, viral load increases significantly with disease progression but decreases after chemotherapy. HIV-positive patients showed a higher VL than controls, but an inverse correlation with CD4+ was observed in half of the studies. Although 57.14% of all studies presented a low risk of bias, significant differences were observed between studies, particularly in the choice of the analyzed outcome, the parameter used to evaluate the patient’s immune status, the presence of a control group, and the sample collection time points.

CONCLUSIONS: Although TTV seems to have the potential to be a promising biomarker of immunosuppression, further high-quality prospective clinical studies are still needed.

PMID:40371633 | DOI:10.1111/eci.70068

J Am Heart Assoc. 2025 May 15:e038687. doi: 10.1161/JAHA.124.038687. Online ahead of print.

ABSTRACT

BACKGROUND: The LoDoCo2 (Low-Dose Colchicine 2) trial showed that colchicine reduced the risk for cardiovascular events in patients with chronic coronary syndrome. Current guidelines recommend colchicine use in selected high-risk patients. The aim of this secondary analysis was to explore the relative and absolute benefits of colchicine according to baseline risk.

METHODS: The LoDoCo2 trial randomized 5522 patients to colchicine 0.5 mg or placebo. The primary end point was a composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. First, a LoDoCo2 risk score was developed by Cox regression to identify high-risk features for the primary end point. Second, the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was applied to explore robustness of findings.

RESULTS: In the LoDoCo2 risk score, high-risk features were age ≥75, diabetes, and current smoker. In high-risk (≥1 high-risk feature), compared with low-risk (0 high-risk features) patients, colchicine was associated with consistent relative (high risk: hazard ratio [HR], 0.72 [95% CI, 0.56-0.94] versus low risk: HR, 0.67 [95% CI, 0.52-0.88]; P for interaction=0.73) and absolute benefits (high risk: HR, -1.33 [95% CI, -2.38 to -0.27] versus low risk: HR, -0.93 [95% CI -1.57 to -0.30] events per 100 person-years). Using the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, consistent relative and absolute benefits were found in high-, intermediate-, and low-risk patients.

CONCLUSIONS: In patients with chronic coronary syndrome, the relative and absolute benefits of colchicine were consistent in those at high, intermediate, and low risk for cardiovascular events. These findings support the use of colchicine across the spectrum of baseline risk.

REGISTRATION: URL: https://www.anzctr.org.au; Unique identifier: 12614000093684.

PMID:40371626 | DOI:10.1161/JAHA.124.038687

Minerva Med. 2025 May 15. doi: 10.23736/S0026-4806.25.09633-8. Online ahead of print.

ABSTRACT

BACKGROUND: The role of Transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) in the diagnosis of malignant pulmonary lesions adjacent to the esophagus is a well-known procedure with high diagnostic yield. Moreover, it is indicated for lung cancer staging. Franseen needle tip is a crown-cut needle that allow to obtain tissue cores and provide huge amount of tissue for pathologist’s evaluation, moving from fine needle aspiration (FNA) to fine needle biopsy (FNB). Few data about EUS-B-FNB and Franseen needle tip are available in Literature.

METHODS: Between May 2022 and June 2024, 33 patients with lymphadenopathy who underwent EUS-B with Franseen needle tip were consecutively enrolled. Chest CT scan was performed prior procedure. Lymphnodes’ dimension at imaging and EUS-B were recorded. EUS-B-TBNB was performed with 22G or 25G needle size. Diagnostic yield and specimen adequacy (SA) for predictive markers were evaluated.

RESULTS: 22G needle was used in 18 patients and 25G in 15, and no statistically significant differences were observed between sex and age in the two groups. Overall Diagnostic Yield was 91% (30/33), with no statistically significant differences between 22G and 25G needle group (89% and 93%, respectively). SA for predictive markers was achieved in 20 of 23 patients (87%) with cancer diagnosis, with no significant differences between 22G and 25G group (P=0.59). No adverse events were observed.

CONCLUSIONS: EUS-B-FNB is a safe and an effective diagnostic method that should be performed in every bronchoscopy suite. Franseen needle tip provides high quality samples for pathologists, avoiding procedure repetition and/or more invasive procedures.

PMID:40371614 | DOI:10.23736/S0026-4806.25.09633-8

Clin Pharmacol Ther. 2025 May 15. doi: 10.1002/cpt.3715. Online ahead of print.

ABSTRACT

Autosomal dominant polycystic kidney disease is the most prevalent inherited kidney disease and leads to bilateral kidney enlargement and progressive loss of renal function, often over decades. Comorbidities include hypertension, flank pain, and bacterial infections. The condition often necessitates prolonged multidrug therapy. Given the kidneys’ critical role in drug excretion, the progressive functional impairment in the disease can lead to complications such as drug overdosing and unexpected levels of drug-drug interactions. Studies of drug-metabolizing enzyme and transporter expression in this patient group remain scarce. We conducted comprehensive global liquid chromatography-tandem mass spectrometry proteomic analyses of microsomal and cytosolic fractions from early-stage (chronic kidney disease stage: 13, n = 16) and end-stage autosomal dominant polycystic kidney disease patients (chronic kidney disease stage: 5, n = 14), comparing them with age-matched healthy controls (n = 11). In the early-stage ADPKD samples, most drug-metabolizing enzymes and drug transporters did not differ significantly from the healthy controls. Exceptions were EPHX2 and SULT1C2 in the cytosolic fraction, which showed a more than 2-fold decrease in abundance (P < 0.05). In contrast, the end-stage ADPKD kidney samples showed a decrease in the abundance of most measured proteins. Several drug-metabolizing enzymes, including CYP4F2, UGT1A6, UGT1A9, and UGT2B7, exhibited statistically significant reductions (P < 0.05). Among the drug transporters, OAT1, OAT3, and OCT2 were below the limit of quantification in most ES-ADPKD samples. MDR1 was the only efflux drug transporter consistently measured, with an average abundance of 1.24 pmol/mg microsomal protein across all samples.

PMID:40371605 | DOI:10.1002/cpt.3715

Lasers Surg Med. 2025 May 15. doi: 10.1002/lsm.70026. Online ahead of print.

ABSTRACT

BACKGROUND: Moderate-to-severe acne vulgaris (AV) remains a therapeutic challenge, often demonstrating resistance to standard interventions, including topical agents, oral antibiotics, and systemic retinoids. Nonablative monopolar radiofrequency (NMRF) offers a promising alternative by delivering controlled dermal heating without epidermal disruption. Initial findings from the authors demonstrated significant reductions in inflammatory lesion counts and sebum production following two NMRF sessions administered 4 weeks apart, with results sustained up to 6 months. This updated study extends the evaluation to include additional clinical assessments at 9- and 12-month posttreatment, providing further insights into the long-term efficacy and safety of this modality.

OBJECTIVE: To evaluate the extended efficacy and safety of NMRF therapy in the management of moderate-to-severe AV, incorporating follow-up assessments at 9- and 12-month posttreatment.

METHODS: The study included 20 participants with moderate-to-severe AV who had been previously enrolled in the authors’ initial investigation. All participants underwent two NMRF sessions, spaced 4 weeks apart, as per the original protocol. Follow-up assessments were conducted at 9- and 12-month posttreatment. Lesions were categorized as inflammatory (papules, pustules, nodules, cysts) or noninflammatory (comedones). Sebum production was measured quantitatively using a Sebumeter at each follow-up visit. Patient-reported outcomes, including perceived improvement and satisfaction, were also documented.

RESULTS: Of the initial 20 participants, 11 completed the 12-month follow-up. Clinical assessments revealed statistically significant reductions in both inflammatory and noninflammatory lesion counts, with the most substantial decreases observed in papules, pustules, nodules, and cysts. Sebum levels continued to decline consistently over the extended follow-up period. Patient satisfaction scores remained high at both time points, and no significant adverse effects were reported, reinforcing the favorable safety and tolerability profile of NMRF therapy.

CONCLUSION: NMRF is a safe, effective, and minimally invasive treatment for moderate-to-severe AV. The 1-year follow-up data highlight its potential as a long-term treatment option, demonstrating sustained reductions in lesion counts and sebum production following a two-session course.

PMID:40371601 | DOI:10.1002/lsm.70026