Category: Nevin Manimala

AJNR Am J Neuroradiol. 2025 Aug 14. doi: 10.3174/ajnr.A8849. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Upper cervical spine trauma (UCST) can lead to severe morbidity and mortality, particularly when associated with craniocervical junction (CCJ) injuries. Previous studies suggest that identifying prevertebral hematomas in patients with cervical trauma may have clinical significance. However, the association between prevertebral hematomas and clinical outcomes in patients with UCST has not yet been firmly established. The purpose of this study is to investigate the association of prevertebral hematomas with the severity of upper cervical spine injury, and clinical outcomes in patients with UCST.

MATERIALS AND METHODS: This retrospective study analyzed patients with UCST admitted to a level I trauma center in a 3-year period. Inclusion criteria included cervical spine trauma confirmed via imaging and MRI performed within 7 days of admission. Prevertebral hematomas were assessed for size and location and correlated with injury patterns and clinical outcomes. Statistical analysis was performed by using χ² tests and logistic regression models.

RESULTS: One hundred sixty-five patients (mean age, 40.6 ± 19.9 years; 103 men) were evaluated. Prevertebral hematomas were identified in 88 of 165 patients (53.3%). Hematomas were significantly associated with CCJ dislocations (17/23 patients; 73.9%, P = .03) and subaxial disco-ligamentous injuries (48/71 patients; 67.6%, P = .001). Surgical intervention was more likely in patients with prevertebral hematomas (39/60 patients; 65%, P = .02), with an OR of 2.08 (95% CI, 1.08-4.01). While 75 of 148 patients with neurologic disability at discharge had prevertebral hematomas (50.6%, P = .06), this association did not reach statistical significance.

CONCLUSIONS: Prevertebral hematomas were significantly associated with CCJ dislocations, subaxial disco-ligamentous injuries, and an increased likelihood of surgical intervention in patients with UCST. These findings suggest that prevertebral hematomas can serve as a useful marker for identifying patients with more severe injury patterns.

PMID:40813212 | DOI:10.3174/ajnr.A8849

AJNR Am J Neuroradiol. 2025 Aug 14. doi: 10.3174/ajnr.A8864. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: 3D-FLAIR sequence has an important contribution to the display of endolymphatic hydrops (EH) in Meniere disease (MD), but its clinical application is limited because of the long acquisition time. We investigated whether 3D-FLAIR combined with compressed sensing (CS) technology (3D-FLAIR-CS) can shorten the scan time while maintaining the image quality and diagnostic efficiency for EH.

MATERIALS AND METHODS: This prospective study included 50 patients with unilateral definite MD who underwent 3T MR imaging 4 hours after gadolinium injection using traditional 3D-FLAIR (10 minutes 35 seconds) and 3D-FLAIR-CS (5 minutes 25 seconds). Image quality was assessed using quantitative (the contrast-to-noise ratio [CNR], SNR, and signal intensity ratio [SIR]) and qualitative methods. The chi-square test compared the diagnostic efficacy of the sequences, paired t tests analyzed quantitative differences, and intra-/interobserver agreement was evaluated using the weighted kappa statistic.

RESULTS: Among 50 patients (23 men, 27 women; 27 left ears, 23 right ears), no significant differences were found between the 2 sequences in image quality or diagnosing EH (P >.05). There were no statistically significant differences in CNR (affected side: P = .09; asymptomatic side: P = .07), SNR (affected side: P = .12; asymptomatic side: P = .10), and SIR (affected side: P = .13; asymptomatic side: P = .45) between traditional 3D-FLAIR and 3D-FLAIR-CS, and both sequences exhibited excellent intra- and interobserver agreement (kappa >0.80).

CONCLUSIONS: Acquisition time for the 3D-FLAIR-CS sequence is reduced by a factor of about 2 compared to traditional 3D-FLAIR, while image quality and diagnostic efficacy in the assessment of EH are the same.

PMID:40813211 | DOI:10.3174/ajnr.A8864

HPB (Oxford). 2025 Jul 12:S1365-182X(25)00664-1. doi: 10.1016/j.hpb.2025.07.005. Online ahead of print.

ABSTRACT

BACKGROUND: Resected early-stage (T1) ampullary carcinomas (ACs) have the best overall survival (OS) but can have higher postoperative morbidity compared to higher-stage ACs and other periampullary cancers.

METHOD: A retrospective analysis of resected T1-ACs at Tata Memorial Centre, Mumbai, from January 2012 to December 2022 was performed. Perioperative and long-term outcomes were assessed.

RESULTS: A total of 92 patients underwent resection for T1-ACs, with a significant morbidity rate (Clavien-Dindo ≥3) of 38%, and a clinically relevant postoperative pancreatic fistula rate of 22.5%. The node positivity rate in resected T1-ACs was 25%. The 3- and 5-year OS rates were 77.9% and 74.5%, while recurrence-free survival (RFS) rates were 81.8% and 78.4%, respectively. There were 18 (19.6%) recurrences (2 local, 16 distant) during a median follow-up of 66.7 months. The 3- and 5-year OS after recurrence was 29.6% and 14.8% respectively. Lymph node metastasis was the sole significant factor affecting OS (HR 2.815, 95% CI: 1.114-7.112, p = 0.029) and RFS (HR 2.54, 95% CI: 0.978-6.595, p = 0.056).

CONCLUSION: T1-ACs have excellent survival after resection; however, about 20% of patients develop recurrence. Lymph node metastasis remains the most important factor affecting long-term survival.

PMID:40813200 | DOI:10.1016/j.hpb.2025.07.005

HPB (Oxford). 2025 Jul 30:S1365-182X(25)00675-6. doi: 10.1016/j.hpb.2025.07.016. Online ahead of print.

ABSTRACT

BACKGROUND: Morbidity and mortality following pancreaticoduodenectomy (PD) have improved; however, the population is aging, and the use of robotic surgery is expanding. This study compares the selection of octogenarians who underwent PD, their outcomes, and whether robotic surgery provides an advantage.

METHODS: This is a multi-institutional retrospective review from 2007 to 2023 of patients who underwent PD, including open and robotic approach. Pre-, intra-, and post-operative outcomes were analyzed; multivariable analysis (MVA) and propensity score matching (PSM) were performed.

RESULTS: 2175 patients underwent PD for all causes; <80 years: n=1,952, >80 (octogenarians): n=223. Octogenarians had higher age unadjusted Charlson Comorbidity Index (2.8 vs 2.6, p<0.001), and more prior surgeries (67.9 % vs 56.1 %, p<0.001). On univariate analysis, octogenarians had higher average Clavien-Dindo grade (2.0 vs 1.7, p=0.002) and higher 90-day mortality (9.9 % vs 3.1 %, p<0.001). On MVA, age >80 was associated with increased risk of major morbidity (OR 1.50 [1.10-2.04], p=0.011) and 90-day mortality (OR 3.20 [1.85-5.54], p<0.001). Robotic PD (RPD) was associated with decreased risk of major morbidity (OR 0.69 [0.56-0.86], p<0.001). After PSM of octogenarians who underwent RPD, there was no statistically significant difference in mortality.

CONCLUSION: Pancreaticoduodenectomy has increased but acceptable morbidity in octogenarians. The increased risk may be mitigated by RPD.

PMID:40813199 | DOI:10.1016/j.hpb.2025.07.016

J Orthop Sci. 2025 Aug 13:S0949-2658(25)00207-6. doi: 10.1016/j.jos.2025.07.007. Online ahead of print.

ABSTRACT

OBJECTIVES: Prosthetic feet are designed to fulfil the function of the ankle-foot part. It is an important part of lower extremity prostheses. Although there are many different types of prosthetic feet, it is difficult to determine the most suitable prosthetic foot for each amputee. The aim of this study was to determine the experiences of patients with unilateral transtibial amputation (TTA) regarding different types of prosthetic feet [non-articulating ankle (NAA), articulating hydraulic ankle (AHA) or microprocessor-controlled foot (MPC)].

METHODS: Seventeen patients with unilateral traumatic TTA who had experience with all three prosthetic foot types were included. Patients were asked to rate 14 features of the different types of prosthetic feet they had used using a numeric rating scale.

RESULTS: There were statistically significant differences between the prosthetic feet in walking on flat roads, walking on uneven roads, walking fast, running, descending and ascending stairs, descending and ascending ramps, using with different shoes, using at home, maintenance need, and general satisfaction (p < 0.001, p < 0.001, p < 0.001, p:0.005, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p:0.042, p < 0.001, respectively). No statistically significant difference was found in the frequency of malfunction and weight of prosthetic foot types (p:0.929, p:0.114, respectively).

CONCLUSIONS: From the patient perspective, MPC was better than AHA and NAA in most activities of daily living and general satisfaction. AHA was better than NAA in these activities. There was no difference in the frequency of malfunction and the weight of the prosthetic foot.

CLINICALTRIAL: Registry name: Comparison of Different Types of Prosthetic Feet; Patient Perspective, Registry number: NCT05691998.

PMID:40813189 | DOI:10.1016/j.jos.2025.07.007

Neurol Res. 2025 Aug 14:1-9. doi: 10.1080/01616412.2025.2541908. Online ahead of print.

ABSTRACT

OBJECTIVE: Based on the principles of Predictive, Preventive, and Personalized Medicine (PPPM), this study aimed to identify ferroptosis-related genes associated with multiple sclerosis (MS) and to explore the underlying mechanisms through genetic approaches.

MATERIALS AND METHODS: Summary statistics of circulating proteins were obtained from the UK Biobank Pharma Proteomics Project (UKB-PPP), ferroptosis-related genes were curated from the FerrDb database, and MS genome-wide association study (GWAS) data were sourced from the International Multiple Sclerosis Genetics Consortium (IMSGC). Two-sample Mendelian randomization (MR) analyses were performed to assess the causal relationships between proteins, ferroptosis-related genes, and MS risk. Mediation MR analysis was conducted to explore the potential mediating role of ferroptosis-related genes. The primary analytical method was inverse variance weighting (IVW), supplemented by MR-Egger and weighted median approaches.

RESULTS: After Bonferroni correction, one ferroptosis-related gene (Ferritin Mitochondrial, FTMT) and 21 circulating proteins were significantly associated with MS. Eleven protein-gene pairs were identified. Mediation analysis further revealed that FTMT mediated the effects of several proteins on MS risk, including CD8A (17.6%), CFB (9.0%), ENPP6 (9.5%), GZMA (22.9%), KIR2DL2 (17.4%), KIR2DL3 (16.9%), and TNXB (13.2%).

CONCLUSIONS: This study highlights the critical role of FTMT in linking circulating proteins to MS pathogenesis through ferroptosis regulation, providing novel insights into predictive, preventive, and personalized medicine strategies for MS management.

PMID:40813130 | DOI:10.1080/01616412.2025.2541908

Zhonghua Zhong Liu Za Zhi. 2025 Aug 23;47(8):750-755. doi: 10.3760/cma.j.cn112152-20240922-00409.

ABSTRACT

Objective: To detect the association of tumor circumferential involvement range (CIR) with neoadjuvant chemoradiotherapy (NCRT) efficacy and long-term survival outcomes in locally advanced rectal cancer (LARC) patients. Methods: Clinical data of 451 patients admitted to our hospital from January, 2018 to January, 2022 were retrospectively collected. According to the CIRs as determined by rectal magnetic resonance imaging, patients were divided into the High group (≥2/3 cycle, 270 patients) and the Low group (＜2/3 cycle, 181 patients). The primary outcome was three-year disease-free survival. The baseline characteristics, pathological features, and survival outcomes were compared. Results: Compared to patients in the Low group, patients in the High group exhibited significantly larger tumor vertical diameters [(4.7±1.7) vs. (3.6±1.4)cm, P＜0.001], higher rates of mrT4 stage (37.8% vs. 13.2%, P＜0.001), and higher rates of positive mesorectal fascia (54.1% vs. 29.8%, P＜0.001) and extramural vascular invasion (55.6% vs. 38.1%, P＜0.001). Patients in the High group were mainly pT3-4 stages (46.7% vs. 30.9%, P=0.002), with significantly lower rates of pathological complete response (22.2% vs. 33.1%, P=0.010) , poorer tumor regression grades (48.9% vs. 60.8%, P=0.013), and higher rates of positive peripheral nerve invasion (11.5% vs. 5.5%, P=0.031), as compared to patients in the Low group. The median follow-up time was 40 months. About 11 (2.4%) and 48 patients (10.6%) experienced tumor local recurrence and distant metastasis, respectively. The recurrence rates were 2.2% and 2.6%, and the distant metastasis rates were 7.7% and 12.6%, respectively, in the Low group and the High group, with no statistical significance (P=0.957, P=0.096). The three-year disease-free survival in the High group was significantly lower than that in the Low group (84.4% vs. 92.4%, P=0.014). Conclusions: The CIR is closely related to tumor burden, which can judge tumor response to NCRT, and is negatively related to survival prognosis. For patients who have more than a 2/3 cycle of CIR, intensified or consolidated treatments may be required to improve survival outcomes.

PMID:40813119 | DOI:10.3760/cma.j.cn112152-20240922-00409

Zhonghua Zhong Liu Za Zhi. 2025 Aug 23;47(8):734-744. doi: 10.3760/cma.j.cn112152-20231006-00164.

ABSTRACT

Objective: To investigate the survival outcomes and prognostic factors of patients with double primary breast cancer (BC) and endometrial cancer (EC). Methods: A retrospective cohort study was conducted using data for the period 1992-2018 from the Surveillance, Epidemiology, and End Results (SEER) database. There were 3 465 patients with BC as the first primary cancer (BC-EC group) and 2 804 patients with EC as the first primary cancer (EC-BC group). Kaplan-Meier analysis and cumulative incidence function were used to estimate overall mortality, breast cancer-specific mortality, and endometrial cancer-specific mortality, respectively. Cox regression and Fine-Gray regression were used to analyze the prognostic factors of overall mortality, breast cancer-specific mortality, and endometrial cancer-specific mortality, respectively. Results: During a median follow-up of 160 months, 1 616 deaths occurred in the BC-EC group, with EC being the leading cause of death (37.69%); 994 deaths occurred in the EC-BC group, with BC being the leading cause of death (28.77%). Cox regression identified patients with older ages at first primary cancer diagnosis (54-61 years: HR=1.46, 95% CI: 1.26-1.69; 62-68 years: HR=2.64, 95% CI: 2.29-3.03; ≥69 years: HR=4.89, 95% CI: 4.27-5.60), shorter time interval between the diagnoses (0-5 months: HR=6.13, 95% CI: 5.21-7.21; 6-23 months: HR=5.69, 95% CI: 4.95-6.55; 24-59 months: HR=3.44, 95% CI: 3.04-3.89; 60-119 months: HR=2.32, 95% CI: 2.07-2.59), mixed ductal-lobular BC (HR=1.29, 95% CI: 1.11-1.48), endometrial mixed cell adenocarcinoma (HR=1.23, 95% CI: 1.01-1.50), advanced tumor grade (grade Ⅱ BC: HR=1.13, 95% CI: 1.01-1.27; grade Ⅲ BC: HR=1.24, 95% CI: 1.10-1.41; grade Ⅱ EC: HR=1.19, 95% CI: 1.06-1.33; grade Ⅲ EC: HR=1.68, 95% CI: 1.48-1.90), advanced tumor stage of the two cancers (distant BC: HR=3.14, 95% CI: 2.50-3.94; regional EC: HR=1.53, 95% CI: 1.36-1.71; distant EC: HR=3.00, 95% CI: 2.59-3.47) had increased risk of overall mortality. Fine-Gray regression showed that compared with BC-EC patients, EC-BC patients had a higher risk of breast cancer-specific mortality [sub-distribution hazard ratio (sHR=1.24, 95% CI: 1.04-1.47], but a lower risk of endometrial cancer-specific mortality (sHR=0.37, 95% CI: 0.30-0.46). Older ages at first cancer diagnosis, shorter intervals between the diagnoses, negative ER and PR status, and advanced BC grades/stages were associated with increased breast cancer-specific mortality (P＜0.05). Similarly, older ages, shorter intervals, endometrial serous carcinoma/mixed cell adenocarcinoma, and advanced EC grades/stages correlated with elevated endometrial cancer-specific mortality (P＜0.05). Conclusion: The management of double primary BC and EC patients requires multidisciplinary strategies, with particular attention to patients presenting older ages at first cancer diagnosis, shorter intervals between the diagnoses, and unfavorable tumor characteristics.

PMID:40813117 | DOI:10.3760/cma.j.cn112152-20231006-00164

Zhonghua Zhong Liu Za Zhi. 2025 Aug 23;47(8):726-733. doi: 10.3760/cma.j.cn112152-20231007-00168.

ABSTRACT

Objective: To investigate the differences in the clinicopathological and magnetic resonance imaging (MRI) imaging features between ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinfiltration (DCIS-MI) of the breast, and to clarify the risk factors for the development of DCIS-MI. Methods: Forty-four patients diagnosed with DCIS and 21 patients diagnosed with DCIS-MI by postoperative pathology at Guangdong Maternal and Child Health Hospital from November 2017 to November 2022 were included, and the clinicopathological and preoperative breast MRI data of these patients were retrospectively collected. The patients’ MRI images were categorized and diagnosed with reference to the Breast Imaging Reporting and Data System (BI-RADS) criteria. The χ² test or Fisher exact probability method was used to compare the differences in the clinicopathological and MRI imaging characteristics between the two groups of patients, and generalized linear model analysis was used to clarify the influencing factors of DCIS-MI. Results: The differences in the histologic grading, estrogen receptor (ER) expression, progesterone receptor (PR) expression, human epidermal growth factor receptor 2 (HER-2) expression, Ki-67, and molecular typing between patients in the DCIS and DCIS-MI groups were statistically significant (all P＜0.05). The results of generalized linear model analysis showed that Ki-67 expression and specific molecular typing (Luminal B and triple-negative types) were significantly associated with the risk of developing DCIS-MI (P＜0.05). Breast fibroglandular tissue density, lesion type, background parenchymal enhancement, type of time-intensity curves (TICs), distribution of non-mass enhancement, non-mass enhancement internal enhancement characteristics, mass morphology, mass boundary, mass enhancement mode, and other MRI imaging features were not statistically significant (all P＞0.05).The MRI diagnostic accuracy of the DCIS group and the DCIS-MI group was 77.3% (34/44) and 95.2% (20/21), respectively, and the difference in the MRI BI-RADS classification of the patients in the two groups was not statistically significant (P=0.227). Conclusions: There was no significant difference in the breast MRI imaging characteristics between patients in the DCIS and DCIS-MI groups. Patients in the DCIS-MI group were more likely to present with high histologic grades, negative ER, negative PR, positive HER-2, high Ki-67 expression, HER-2 overexpression, and triple-negative phenotypes. The association between Ki-67 expression and specific molecular typing (Luminal B and triple-negative phenotypes) and the risk of developing DCIS-MI risk were correlated.

PMID:40813116 | DOI:10.3760/cma.j.cn112152-20231007-00168

J Oral Pathol Med. 2025 Aug 14. doi: 10.1111/jop.70034. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the interaction between fluconazole-resistant (Flu-R) and -susceptible dose-dependent (Flu-SDD) isolates of Candida albicans and Candida glabrata with oral streptococci, exploring autoaggregation, coaggregation, and the impact of streptococcal biofilm-secreted components on Candida biofilms.

METHODS: Autoaggregation and coaggregation of Candida Flu-R and Flu-SDD isolates with streptococci (S. mutans, S. gordonii, and S. sanguinis) were assessed using an optical density assay. The inhibitory effects of streptococcal biofilm-secreted components on Candida biofilms were examined, quantifying biofilm inhibition by crystal violet staining and assessing viability through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Statistical analysis of the data was done by one-way ANOVA, considering a p-value of < 0.05 as significant.

RESULTS: Flu-R C. albicans exhibited higher autoaggregation (71%) than Flu-SDD (62%), both surpassing Streptococcus spp. (32%-49%). Flu-R and Flu-SDD C. glabrata had less autoaggregation ability than C. albicans (p < 0.05). Coaggregation increased steadily, with Flu-SDD C. albicans exhibiting the highest coaggregation with S. mutans (69% ± 8% at 2 h). Flu-R strains showed significant coaggregation differences with streptococcal species (p-values 0.05-< 0.001). Biofilm inhibition was significant in Candida Flu-R and Flu-SDD isolates treated with streptococcal biofilm supernatants. Supernatants of all three streptococcal species decreased Flu-R C. albicans viability (1.15-2.15-fold).

CONCLUSIONS: Fluconazole susceptibility/resistance significantly influences aggregation and biofilm formation with oral streptococci. Streptococcal biofilm supernatants hinder Candida strains’ growth and viability, suggesting implications for colonization, biofilm formation, and oral infections.

PMID:40813110 | DOI:10.1111/jop.70034