Category: Nevin Manimala

Wien Klin Wochenschr. 2025 Dec 6. doi: 10.1007/s00508-025-02666-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of the study was to investigate the performance of endovascular aortic aneurysm repair (EVAR) with suprarenal fixation endografts in wide necks for intact abdominal aortic aneurysms (iAAA).

METHODS: Anatomical data of the treated iAAAs, acquired from a thin slice computed tomography angiography (CTA) of the abdomen with 3‑dimentional reconstructions preoperatively and postoperatively, were evaluated. A statistical analysis comparing the anatomical characteristics of the aneurysm neck according to the presence of an endoleak was conducted using the SPSS Statistics package version 29.

RESULTS: Between January 2020 and October 2024, 114 patients (105, 92.1% males, median age 75 years) with iAAAs underwent EVAR, most of them (83) with Endurant II/IIs stent-graft (Medtronic, Santa Rosa, US) and of them 15 had a wide neck (28 mm or more). In a multivariate logistic regression analysis the presence of a wide neck had a statistically significant association with the development of a type Ia endoleak (odds ratio, OR 12.961, p = 0.025). A type Ia endoleak was present in 2 of these patients in the first 30 postoperative days. In these 2 patients the oversizing percentage of the proximal landing zone was significantly lower compared to the patients with a wide neck without type Ia endoleak (median oversizing 11.3%, range 6.6-16% vs. 20%, range 15-25%, p = 0.019). The endoleak was persistent in a follow-up period of 18 months.

CONCLUSION: The use of EVAR with suprarenal fixation endografts in wide infrarenal necks is safe but in the case of poor oversizing, there is a significant risk for development of a persistent type Ia endoleak.

PMID:41351797 | DOI:10.1007/s00508-025-02666-9

Naunyn Schmiedebergs Arch Pharmacol. 2025 Dec 6. doi: 10.1007/s00210-025-04552-7. Online ahead of print.

ABSTRACT

Current treatments for pregnancy-associated genital warts (PGW) often fail to balance safety and efficacy, especially during gestation. In this study, we introduce GelPV-5-ALA-Matrine, a smart, photoresponsive hydrogel designed for localized photodynamic therapy (PDT) targeting HPV-infected tissues. Co-delivery of 5-ALA and matrine facilitates mitochondrial autophagy through reactive oxygen species (ROS) elevation and MAPK8 activation. Using Mendelian randomization, we identified mitochondrial DNA copy number as a risk factor for sexually transmitted infections, supporting mitochondrial pathways as viable therapeutic targets. The hydrogel demonstrated strong in vitro efficacy in HPV-positive HeLa cells and significantly reduced wart burden and viral load in vivo under near-infrared (NIR) light. Molecular docking and functional validation highlighted MAPK8’s key role in mediating ROS-induced mitochondrial clearance and apoptosis. Importantly, no systemic toxicity or adverse biochemical responses were observed. This innovative hydrogel system provides a blueprint for next-generation, patient-safe therapies for PGW and may be adaptable to other HPV-related pathologies in reproductive health.

PMID:41351796 | DOI:10.1007/s00210-025-04552-7

J Autism Dev Disord. 2025 Dec 6. doi: 10.1007/s10803-025-07111-4. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess type 2 diabetes mellitus (T2DM)-related avoidable mortality in individuals with developmental disabilities using national claims data, comparing outcomes with those of other disabilities and non-disabled controls.

METHODS: We used de-identified national claims data from the National Health Insurance Service merged with Causes of Death Statistics. The cohort included individuals over 30 years old with developmental disabilities who were newly diagnosed with T2DM between 2012 and 2016. Matched controls (non-disabled, mild, and severe disabilities) were selected based on sex, age, income proxy, and region. T2DM-related avoidable mortality (ICD-10 code “E11”) within 1, 3, and 5 years was assessed using multiple logistic regression, adjusted for sociodemographic factors and comorbidities.

RESULTS: T2DM-related avoidable mortality rates in the developmental disability group were 0.05%, 0.23%, and 0.55% at 1, 3, and 5 years post-diagnosis, respectively-lower than those in individuals with severe disabilities but higher than those of individuals without disabilities. Multiple logistic regression revealed no significant difference in 1-year mortality between individuals with developmental disabilities and those without disabilities; however, the risk was significantly higher at 3 years (OR = 4.84; 95% CI: 1.80-13.00) and 5 years (OR = 3.82; 95% CI: 2.14-6.81). Compared with individuals with mild disabilities, the 5-year mortality risk was also higher (OR = 2.41; 95% CI: 1.38-4.21).

CONCLUSION: Individuals with developmental disabilities exhibit significantly higher T2DM-related avoidable mortality than non-disabled and mild disability groups, highlighting critical gaps in healthcare accessibility. Strengthening targeted interventions and support services is essential to reducing avoidable deaths and improving health outcomes in this population.

PMID:41351782 | DOI:10.1007/s10803-025-07111-4

Int Orthop. 2025 Dec 6. doi: 10.1007/s00264-025-06705-y. Online ahead of print.

ABSTRACT

PURPOSE: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a devastating complication, and the optimal surgical approach is still debated. This study aimed to compare the outcomes of single-stage versus two-stage revision and to identify clinical or demographic factors associated with treatment failure.

METHODS: A retrospective observational study was conducted at a single tertiary hospital including 29 patients treated for shoulder PJI between 2010 and 2023. Patients underwent either one-stage (n = 15) or two-stage (n = 14) revision according to clinical and microbiological criteria, and the final choice of surgical strategy (one-stage vs. two-stage revision) was made at the discretion of the attending surgeon. The primary outcome was treatment success, defined as infection eradication without further surgery or suppressive antibiotics. Secondary outcomes were pain and functional results measured with the Constant-Murley Score (CMS), the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS). A standard statistical analysis was performed comparing baseline data of both groups and finding factors related to the primary outcome.

RESULTS: Baseline characteristics of both groups were comparable. Overall infection control was achieved in 83% of patients, nonetheless, the one-stage group showed a higher success rate compared with the two-stage group (93% vs. 71%), although this difference did not reach statistical significance (p = 0.169; OR:0.19(0.003,2.29)). Functional outcomes assessed by CMS and VAS did not differ significantly between groups, whereas SST scores were significantly better following one-stage revision (p = 0.006). Increased BMI and a higher number of previous surgeries tended to be associated with treatment failure.

CONCLUSION: Single-stage revision achieved comparable infection control and better functional outcomes than two-stage revision, supporting its role as a reliable surgical option for shoulder PJI in appropriately selected patients, although it could be influenced by bias selection.

PMID:41351768 | DOI:10.1007/s00264-025-06705-y

Drug Saf. 2025 Dec 6. doi: 10.1007/s40264-025-01632-8. Online ahead of print.

ABSTRACT

BACKGROUND: Databases for safety monitoring of medicinal products contain records of a huge number of pairings of drugs and adverse events (AEs). Existing disproportionality methods for safety monitoring in such databases estimate background rates of AE occurrence in ways that may be susceptible to masking effects that can hinder signal detection, particularly in the context of large overall counts of AE or drug occurrence in the data.

OBJECTIVES: To develop a new statistical model for determining the background rate against which individual drug-AE pairs are to be evaluated, which is robust against masking effects, and to incorporate this into an algorithm which simultaneously estimates background rates and detects drug-AE pair counts that deviate significantly from these rates.

METHODS: We constructed a hierarchical Bayesian model for background rates, and background rate samples were drawn from the model parameters using an iterative Markov Chain Monte Carlo (MCMC) method. At each iteration, any counts whose probability is low given current background rate estimation were removed from the computation that sampled the next set of background rates. The algorithm, called Markov Chain Signal Generation (MCSG), was implemented using a combination of Python and the probabilistic programming language Stan.

RESULTS: The MCSG algorithm outperformed routinely used quantitative approaches for signal detection on both synthetic data designed to include a drug-AE pair with very strong masking effects and a reference set featuring 69 unique active substances and 792 unique AEs. On a synthetic dataset where selected pairs occurred at rates deviating from a constant background, MCSG accurately identified these pairs in the presence of strong masking signals. On a subset of some real data from the FDA Adverse Event Report System (FAERS), it effectively identified a reference set of positive and negative controls and was able to identify drug-AE pairs suggested in the literature.

CONCLUSION: We have demonstrated a new approach to signal generation, which avoids the confounding effect of masking more effectively than currently used methods. The algorithm is best used in a setting of multiple drug-AE pairs, the majority of which are expected to have counts at background rate, although with substantial datasets the algorithm can take minutes or hours to run. It is therefore particularly suitable for infrequent, large-scale analysis (for example, quarterly analysis of the entirety of a pharmacovigilance database).

PMID:41351764 | DOI:10.1007/s40264-025-01632-8

J Interv Card Electrophysiol. 2025 Dec 6. doi: 10.1007/s10840-025-02190-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Cardiovascular disease is one of the leading causes of death in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have proven to be beneficial in improving cardiovascular outcomes and reducing all-cause mortality in patients with T2DM. We aimed to investigate the effect SGLT2i use on cardiovascular outcomes inpatients with T2DM who underwent VT ablation.

METHODS: A retrospective cohort study was conducted using the TriNetX US Collaborative Network, a federated network of healthcare organizations across the United States. Adults (aged 18-80 years) with T2DM who underwent catheter ablation for ventricular tachycardia were included. Patients were stratified based on exposure to SGLT2i. Propensity score matching (1:1) was used to balance baseline characteristics. Outcomes were assessed within 3 years following the index ablation procedure. Patients with a recorded occurrence of the outcome prior to the index event were excluded from each respective outcome analysis. Kaplan-Meier analysis and log-rank tests were used for statistical comparisons with significance set at p < 0.05.

RESULTS: SGLT2 inhibitor non-users exhibited significantly higher hazard ratios (HR) for various adverse outcomes. The HR for all-cause mortality was 1.422 (95% CI: 1.279-1.581), while the HR for cardiac arrest was 1.409 (95% CI: 1.135-1.750). Additionally, the HR for post-ablation cardioversion was 1.188 (95% CI: 1.042-1.355), and the utilization of amiodarone after ablation had an HR of 1.240 (95% CI: 1.106-1.391). In contrast, the hazard ratios for redo ablation (1.039, 95% CI: 0.956-1.128), visits for ICD adjustments (0.916, 95% CI: 0.766-1.096), post-ablation use of any class of antiarrhythmics (1.139, 95% CI: 0.906-1.431), and lidocaine (0.911, 95% CI: 0.775-1.070) were less definitive.

CONCLUSION: SGLT2i non-user group was associated with significantly higher risks of several adverse outcomes following ablation, including a 42% increase in all-cause mortality and a 41% increase in cardiac arrest. Non-users also had higher rates of post-ablation cardioversion and amiodarone use. However, no significant differences were found in redo ablation, ICD adjustments, or the use of other antiarrhythmics. These findings suggest a potential protective role of SGLT2 inhibitors in selective cardiovascular outcomes. Further studies are warranted to confirm these associations and investigate the underlying mechanisms.

PMID:41351762 | DOI:10.1007/s10840-025-02190-w

J Occup Rehabil. 2025 Dec 6. doi: 10.1007/s10926-025-10349-5. Online ahead of print.

ABSTRACT

PURPOSE: To compare employment status 5 years post-diagnosis among native Norwegian, Western immigrant, and non-Western immigrant female cancer survivors (CSs) and their matched controls without cancer, who were employed at the time of diagnosis.

METHODS: Participants were categorized into three groups based on data from Statistics Norway: Natives (CSs = 6587, control = 6587), Western immigrants (CSs = 209, control = 209), and non-Western immigrants (CSs = 105, control = 105). Women were aged 30-55 at diagnosis, employed (salaried/self-employed) at baseline, and alive at 5-year follow-up. CSs and controls were matched on age, education, and employment at diagnosis. Associations between cancer status, immigrant background, and employment were analyzed using binary logistic regressions and Firth penalized logistic regression to account for potential bias from small subgroup sizes.

RESULTS: At 5 years, female CSs had lower odds of employment compared with controls. Western immigrants did not differ from natives, whereas non-Western immigrants showed reduced employment. Higher income was positively associated with employment, while being married or cohabiting and working in the public sector were linked to higher odds. Interaction terms between cancer survivorship and immigrant background were not significant.

CONCLUSION: Among women employed at baseline, cancer survivorship and non-Western immigrant background were independently associated with lower odds of employment five years later. Tailored employment support is needed for non-Western immigrants to improve long-term outcomes. Interventions should also target employers and workplaces to support employment maintenance among CSs.

PMID:41351748 | DOI:10.1007/s10926-025-10349-5

J Robot Surg. 2025 Dec 6;20(1):57. doi: 10.1007/s11701-025-03011-y.

ABSTRACT

As robotic-assisted total knee arthroplasty (TKA) continues to evolve, a key clinical question is whether the learning curve and clinical outcomes differ between CT-dependent and image-independent robotic systems. This retrospective study compared the learning curves and early clinical outcomes of 101 patients undergoing TKA with either a CT-dependent robotic system (Beijing HURWA, Group A) or an image-independent system (Smith & Nephew CORI, Group B). A statistically significant intergroup disparity (P < 0.05) was noted in the rates of transition to conventional treatment, with Group A exhibiting a higher frequency during the learning phase. However, this phase did not witness a significant difference between the groups for other outcomes (p > 0.05). Cumulative sum (CUSUM) analysis was employed to chart the learning curve., peaked at the 15th case for Group A and the 14th for Group B, indicating a similar number of cases to achieve proficiency. During both learning and proficiency phases, the HURWA system demonstrated a shorter bone resection time but longer reference array mounting and registration times. Radiographically, the CT-dependent HURWA system showed superior performance in achieving optimal frontal and lateral femoral component (FFC, LFC) angles. In the early learning phase, Group A reported higher pain scores (VAS) at postoperative day 7, but this difference resolved by day 180. A comparison of the groups demonstrated comparable final knee function (KSS, ROM) and complication rates at all assessment points. The findings indicate that while the two robotic systems exhibit distinct operational time profiles and early radiographic advantages for the CT-dependent system in femoral positioning, both facilitate comparable and satisfactory early clinical outcomes after the initial learning period.

PMID:41351741 | DOI:10.1007/s11701-025-03011-y

Geroscience. 2025 Dec 6. doi: 10.1007/s11357-025-02008-7. Online ahead of print.

ABSTRACT

The rising prevalence of cognitive disorders highlights the urgent need for effective prevention strategies and therapeutic interventions. While adherence to a balanced diet has been associated with a reduced risk of cognitive decline, emerging evidence underscores the potential role of plant-derived bioactive compounds, such as (poly)phenols, with anthocyanins receiving increasing attention. This meta-analysis aimed to evaluate the effect of anthocyanin-rich interventions on cognitive performance. A systematic search of randomized controlled trials (RCTs) assessing the effects of anthocyanin supplementation and cognitive outcomes identified 59 eligible studies. Overall, anthocyanin intervention significantly improved global cognition (standardized mean difference (SMD) = 0.46, 95% CI = 0.30 to 0.63, I² = 0.0%) compared with controls. Domain-specific analyses further revealed significant benefits for visuospatial processing/reasoning and attention (SMD = 0.37, 95% CI = 0.18 to 0.55, I² = 76.3%), processing and psychomotor speed (SMD = 0.19, 95% CI = 0.05 to 0.34, I² = 64.0%), verbal speed and fluency (SMD = 0.21, 95% CI = 0.03 to 0.39, I² = 30.5%), episodic memory (SMD = 0.30, 95% CI = 0.10 to 0.50, I² = 75.9%), and working memory (SMD = 0.24, 95% CI = 0.12 to 0.36, I² = 46.5%). Collectively, these findings suggest that anthocyanin supplementation may improve multiple cognitive domains. Although these results are promising, further well-designed RCTs are needed to validate these outcomes and consolidate the current evidence base.

PMID:41351717 | DOI:10.1007/s11357-025-02008-7

Eur J Orthop Surg Traumatol. 2025 Dec 6;36(1):37. doi: 10.1007/s00590-025-04604-x.

ABSTRACT

INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have recently garnered increased attention due to their effectiveness in inducing marked weight loss among overweight and obese adults. Recent evidence, however, has raised concerns about a potential link between GLP-1 receptor agonist therapy and perioperative pulmonary aspiration. In this single-institution retrospective series, we aimed to quantify the incidence of intraoperative and early postoperative complications among patients taking GLP-1 RA before elective total joint arthroplasty (TJA).

METHODS: All patients who underwent primary TJA at our institution between April 2014 and October 2023 were initially screened. Patients were considered eligible for inclusion if they demonstrated consistent preoperative GLP-1 RA utilization. GLP-1 RA medication type, dosage, administration method, and treatment duration were tabulated for each patient. The primary outcomes of interest wereintraoperative anesthesia-related complications, particularly pulmonary aspiration, postoperative medical and surgical complications, and 90-day reoperation.

RESULTS: In total, 83 patients demonstrated consistent GLP-1 RA usage before primary TJA. Of these patients, 63 (75.9%) received semaglutide, 19 (22.9%) liraglutide, and 1 (1.2%) tirzepatide. No cases of acute intraoperative pulmonary aspiration were identified. Intraoperative assessment of gastric contents was not routinely performed; however, one patient was noted to have a full stomach requiring nasogastric decompression. This individual was in the dose-escalation phase of treatment, having self-administered 1 mg of semaglutide five days before surgery. Four patients (4.8%) experienced 90-day medical complications, none of which were attributed to GLP-1 RA use, and one patient (1.2%) required reoperation.

CONCLUSION: Despite recent studies suggesting an elevated risk of acute intraoperative pulmonary aspiration, our findings underscore the rare nature of intraoperative anesthesia-related adverse events in TJA patients taking GLP-1 RA.

PMID:41351714 | DOI:10.1007/s00590-025-04604-x