Category: Nevin Manimala

J Forensic Sci. 2025 Mar 21. doi: 10.1111/1556-4029.70021. Online ahead of print.

ABSTRACT

Strangulation-related homicides represent a complex and under-researched form of violent crime, characterized by distinct behavioral and situational elements. The aim of the research was to identify perpetrator typologies in strangulation homicides and to analyze their relationships with victim characteristics and crime scene factors. A retrospective analysis of 200 systematically sampled cases from the Radford/Florida Gulf Coast University Serial Killer Database employed Smallest Space Analysis (SSA) to examine 42 behavioral variables. The analysis revealed four primary typologies: Excessive (characterized by severe violence beyond lethality, including mutilation and torture), intended (marked by premeditation and organizational elements), personal (distinguished by intimate engagement and direct manual methods), and sexual (defined by sexual assault and sadistic behaviors). Statistical analysis demonstrated significant correlations between offender-victim relationships, crime scene characteristics, and degrees of violence within each typological category, with 97% of cases fitting distinctly into one category and 3% showing hybrid characteristics. The findings provide empirically based frameworks for forensic profiling and inform specific investigative strategies aligned with each typological pattern. These results equip law enforcement with targeted investigation and risk assessment approaches, potentially leading to more accurate offender identification and prevention efforts. The research advances the understanding of psychological and situational factors in strangulation-related homicides, contributing to both forensic literature and practical applications in criminal investigations.

PMID:40116021 | DOI:10.1111/1556-4029.70021

Cardiol Young. 2025 Mar 21:1-6. doi: 10.1017/S1047951125001386. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the outcomes of patients with single ventricle physiology supported with extracorporeal membrane oxygenation as a bridge to first-stage palliation.

METHODS: This was a retrospective registry-based study. Data from the Extracorporeal Life Support Organization registry were used to identify single ventricle physiology patients supported with extracorporeal membrane oxygenation prior to palliation from 2016 to 2021. Descriptive statistics and multivariate analyses for associations with mortality were conducted.

RESULTS: Primary outcome was death before hospital discharge. Patient characteristics including demographics and associated complications were evaluated as secondary outcomes. Sixty-five patients met inclusion criteria. Survival to discharge was 42%. Twenty-four (37%) patients died while on extracorporeal membrane oxygenation. There was no significant difference in demographics between survivors and non-survivors. Non-survivors had a significantly longer median duration on extracorporeal membrane oxygenation compared to survivors, 99-hrs [IQR (Interquartile Range), 160, 300] vs. 59-hrs [43, 124] (p<0.001). Multivariate analysis demonstrated extracorporeal membrane oxygenation duration (adjusted-OR [Odds Ratio] 1.01, 95% CI [Confidence Interval] 0.98, 0.99; p = 0.03) and requiring renal replacement therapy (42% vs. 19%; p = 0.04) were associated with mortality prior to discharge.

CONCLUSIONS: Clinicians managing decompensated patients with single ventricle physiology may consider extracorporeal membrane oxygenation as a bridge to palliation. Survival to discharge was 42%. Evidence of renal injury and longer extracorporeal membrane oxygenation durations were associated with mortality. These data may be used to guide providers and to counsel families. However, more data are needed to refine indications and assess associations related to outcomes and decision-making.

PMID:40116014 | DOI:10.1017/S1047951125001386

J Endovasc Ther. 2025 Mar 21:15266028251326767. doi: 10.1177/15266028251326767. Online ahead of print.

ABSTRACT

PURPOSE: To describe a novel endovascular technique to treat ilio-femoral reflux in post-thrombotic syndrome (PTS). It consists of regulated exclusion of a femoral vein (FV) segment with indication based on Doppler ultrasound (DUS) scan and ascending and descending venogram.

TECHNIQUE: Through lower limb venous DUS, we identify a post-thrombotic refluxing FV, characterized by a duplicated FV and/or ascending collateral veins draining into a common trunk with a re-entry point into the refluxing FV itself. The above findings indicate a second-level venogram. If the descending phase confirms the FV reflux pattern, we perform an ascending venogram to confidently locate where the draining blood is shunted into the FV. We proceed with the scleroembolization of the segment below the shunt. The postoperative venogram documents the treated segment occlusion and the elimination of the reflux. We described 4 cases: 3 successful reflux eliminations and 1 case where we decided not to treat. Mean follow-up lasts 6.5 months with DUS showing the abolition of the reflux; the overall Villalta score, performed at the baseline and last follow-up visit, resulted statistically significant (p = 0.0087).

CONCLUSION: Performing an endovascular regulated exclusion of FV refluxing segment opens a great scenario for PTS treatment; multicenter randomized trials are warranted.Clinical ImpactRecanalized post-thrombotic syndrome, with reflux involving the ilio-popliteal segments, affects the patient’s life without any clear surgical indication. The proposed protocol and technique are based on performing a descending and ascending venogram to identify the point of femoral vein duplication. The regulated exclusion of the refluxing FV segment, below the duplication, by means of scleroembolization, allowed to permanent abolish the reflux. This novel technique is minimally invasive and presents great potential for treating a significant proportion of patients currently managed exclusively with conservative approaches.

PMID:40116011 | DOI:10.1177/15266028251326767

Eur J Neurol. 2025 Mar;32(3):e16510. doi: 10.1111/ene.16510.

ABSTRACT

BACKGROUND AND PURPOSE: Neurological involvement in long COVID (coronavirus disease 2019) is well known. In a previous study we identified two subtypes of neurological long COVID, one characterized by memory disturbances, psychological impairment, headache, anosmia and ageusia, and the other characterized by peripheral nervous system involvement, each of which present a different risk factor profile. In this study, we aimed to clarify the persistence of neurological long COVID symptoms with a significantly longer term follow-up.

METHODS: We prospectively collected data from patients with prior COVID-19 infection who showed symptoms of neurological long COVID. We conducted a descriptive analysis to investigate the progression of neurological symptoms over time at 3-, 6-, 12-, and 18-month follow-ups. We performed a k-means clustering analysis on the temporal evolution of the symptoms at 6, 12, and 18 months. Finally, we assessed the difference between the recovery course of vaccinated and non-vaccinated patients by computing the cumulative recovery rate of symptoms in the two groups.

RESULTS: The study confirmed the presence of two subtypes of neurological long COVID. Further, 50% of patients presented a complete resolution of symptoms at 18 months of follow-up, regardless of which subtype of neurological long COVID they had. Vaccination against SARS-Cov-2 appeared to imply a higher overall recovery rate for all neurological symptoms, although the statistical reliability of this finding is hampered by the limited sample size of the unvaccinated patients included in this study.

CONCLUSIONS: Neurological long COVID can undergo complete resolution after 18 months of follow-up in 50% of patients and vaccination can accelerate the recovery.

PMID:40115993 | DOI:10.1111/ene.16510

Stroke. 2025 Mar 21. doi: 10.1161/STROKEAHA.124.048183. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic rehabilitation, which provides a high-intensity, high-frequency therapy to improve neuroplasticity, is gaining traction. However, its effectiveness for upper extremity stroke rehabilitation remains uncertain. This study comprehensively reviewed meta-analyses on the effectiveness of upper extremity robot-assisted therapy in patients with stroke.

METHODS: We combined results from 396 randomized controlled trials (RCTs) in 16 meta-analyses and conducted a new meta-analysis using nonoverlapping RCTs and 6 additional RCTs published after 2024. Duplicate studies were removed, all data were from RCTs, and a random-effects model resolved heterogeneity. Effects were analyzed by comparing robot-assisted therapy with conventional therapy at the same dose and as an add-on to conventional therapy.

RESULTS: Compared with conventional therapy, the effect of robot-assisted therapy on the Fugl-Meyer assessment was summarized as a significant standardized mean difference (SMD) of 0.29 (95% CI, 0.14-0.44; number of individual RCTs reanalyzed, 100 RCTs), and the additional effect of robot-assisted therapy was an SMD of 0.42 (95% CI, 0.23-0.61; 16 RCTs). However, these Fugl-Meyer assessment improvements did not meet the minimum clinically important difference thresholds identified in previous studies: 12.4 for subacute and 3.5 for chronic stroke. For activities of daily living, only the additional effect was significant by SMD of 0.35 (95% CI, 0.17-0.54; 26 RCTs), muscle strength was significant by SMD of 0.46 (95% CI, 0.22-0.70; 31 RCTs), and spasticity was not significant by SMD of -0.25 (95% CI, -0.55 to 0.06; 25 RCTs).

CONCLUSIONS: Robot-assisted therapy shows statistically significant improvements in motor recovery as measured by the Fugl-Meyer assessment in patients with stroke, both at the same dose and as an add-on to conventional therapy; however, these improvements do not meet the minimum clinically important difference. These benefits are consistent across different stages of stroke recovery, different types of robotic devices, duration of intervention, and training sites. However, the heterogeneity of included studies in patient population, stroke severity, intervention protocol, and robot type limits generalizability. High-quality trials are needed to better define the value of robot-assisted therapy across various devices and strategies.

PMID:40115991 | DOI:10.1161/STROKEAHA.124.048183

Psychophysiology. 2025 Mar;62(3):e70045. doi: 10.1111/psyp.70045.

ABSTRACT

Facial expressions provide critical details about social partners’ inner states. We investigated whether event-related potentials (ERP) related to the visual processing of facial expressions are modulated by participants’ perceived arousal and valence at the stimulus level. ERPs were recorded while participants (N = 80) categorized the gender of faces expressing fear, anger, happiness, and no emotion. Participants then viewed each face again and rated them on arousal and valence using 1-9 Likert scales. For each participant, ratings of each unique face were linked back to corresponding ERP trials. ERPs were analyzed at all time points and electrodes using hierarchical mass univariate statistics. Three different ANOVA models were employed: the original emotion model, and models with valence or arousal ratings as trial-level regressors. Results from models with ratings highly overlapped with the original model, although they were more temporally restricted. The N170 component was the most impacted by arousal and valence ratings, with four out of six emotion contrasts revealing significant valence or arousal interactions. Emotion effects on the P2 component were mostly unrelated to ratings. On the EPN component, only two contrasts related to both arousal and valence ratings. Thus, ERP emotion effects are related to participants’ perceived arousal and valence of the stimuli, although this association depends on the contrast analyzed. These findings, their limitations, and generalizability are discussed in reference to existing theories and literature.

PMID:40115983 | DOI:10.1111/psyp.70045

J Gastrointest Oncol. 2025 Feb 28;16(1):17-26. doi: 10.21037/jgo-24-807. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: The prognosis of patients with gastric cancer with peritoneal metastasis (GCPM) is exceedingly poor. This study evaluated the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) with paclitaxel combined with S-1 and oxaliplatin (SOX) in the treatment of GCPM.

METHODS: Patients with pathologically confirmed primary gastric adenocarcinoma and laparoscopy-confirmed peritoneal metastasis were enrolled and randomized to receive either HIPEC plus SOX (HIPEC group) or SOX alone (SOX group). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were 1-year survival rate, overall survival (OS), and safety.

RESULTS: Among the included patients, 30 were assigned to the HIPEC group and 29 to the SOX group. Compared to the HIPEC group, the SOX group had a significantly higher median PFS (SOX: median 8.5 months, IQR, 3.8-21.8 months; HIPEC: median 6.1 months, IQR, 3.3-10.8 months; P=0.004) and OS (SOX: median 13.0 months, IQR, 6.3-16.6 months; HIPEC: median 10.0 months, IQR, 5.2-24.0 months; P=0.02). The 1-year survival rate was 50.0% in the SOX group and 37.9% in HIPEC group, but the difference was not statistically significant. No serious adverse events related to the protocol treatment occurred in any patients.

CONCLUSIONS: This trial failed to show the superiority of HIPEC with SOX over SOX alone. Further research into this regimen is needed.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03604614.

PMID:40115934 | PMC:PMC11921333 | DOI:10.21037/jgo-24-807

Rev Cuid. 2024 May 27;15(1):e3220. doi: 10.15649/cuidarte.3220. eCollection 2024 Jan-Apr.

ABSTRACT

INTRODUCTION: Family members of patients admitted to an Intensive Care Unit present high uncertainty level due to not knowing what is happening and to not having clear details about the related events; therefore, interventions are required to allow modulating those levels.

OBJECTIVE: To evaluate the effect of an educational Nursing intervention compared to conventional care on the uncertainty of family members of patients hospitalized in an ICU.

MATERIALS AND METHODS: An experimental study with a sample comprised by 132 relatives of patients admitted to an ICU, randomly distributed in four Solomon groups (33 in each group). The Nursing intervention based on the concepts of the Uncertainty in Illness Theory was applied to both experimental groups and devised under the Whittemore and Grey parameters with three moments: assessment; education about the relative’s hospitalization in the ICU; and accompaniment. This was done with pre-assessments for two groups and post-assessments for the four groups, using the PPUS-FM Uncertainty Scale. The data were analyzed by means of descriptive statistics and respective non-parametric analyses. The study took into account the ethical principles in research.

RESULTS: The family members in the experimental groups presented a lower final uncertainty level when compared to the control groups, with a difference of 73.04 points and a p-value of 0.001.

DISCUSSION: Standardized interventions and under a theoretical model allow reducing uncertainty in relatives of patients in ICUs.

CONCLUSIONS: The Nursing intervention based on the Uncertainty theory allows reducing uncertainty in relatives of patients hospitalized in an Intensive Care Unit.

PMID:40115899 | PMC:PMC11560101 | DOI:10.15649/cuidarte.3220

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:292-299. doi: 10.3760/cma.j.cn115330-20240812-00471. Online ahead of print.

ABSTRACT

Objective: To evaluate the safety, and feasibility of transoral robot-assisted retropharyngeal lymph node (RPLN) dissection. Methods: Clinical data of head and neck cancer patients who underwent transoral robot-assisted RPLN dissection from December 2017 to March 2024 at the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and Sun Yat-sen University Cancer Centre were retrospectively analyzed. A total of 35 patients(22 males, 13 females, aged 47.4±13.4 years old) with retropharyngeal lymph node metastases from head and neck cancer, including 20 cases of nasopharyngeal cancer, 9 cases of thyroid cancer, 2 cases of salivary adenocarcinoma, 2 cases of tonsil cancer and 2 cases of hypopharyngeal cancer. Operation time, intraoperative bleeding and complications, postoperative nasogastric tube retention time, hospital stay and complications were evaluated. Statistical analysis was performed using SPSS 22.0 software. Results: All patients successfully received transoral robot-assisted RPLN dissection without intermediate open surgery, with removals of 2 (1, 3) RPLNs. The total operation time was 130 (102, 210) minutes. The intraoperative bleeding was 50 (20, 100) ml, and there was no major bleeding or organ damage during the operation. Prophylactic tracheotomy was performed in 8 cases, and postoperatively nasogastric tubes were left in 22 patients, with retention time of 10.5 (7.5, 14.0) days. Postoperative hospital stay was 5 (4, 9) days. Postoperative complications included incision dehiscence in 4 cases and dysphagia in 4 cases. The median postoperative follow-up was 23.4 months, with progression or recurrence in 5 patients, including regional recurrence in 3 patients, lung metastasis in 1 patient, and bone metastasis in 1 patient. The 2-year regional failure-free survival and disease-free survival rates were 91.43% and 85.71%, respectively. Conclusion: Transoral robot-assisted RPLN dissection is a safe and feasible surgical method with less trauma, fewer complications, and higher safety. Patients need to be carefully selected at the initial stage of application.

PMID:40113568 | DOI:10.3760/cma.j.cn115330-20240812-00471

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:266-271. doi: 10.3760/cma.j.cn115330-20240807-00466. Online ahead of print.

ABSTRACT

Objective: To explore the safety, effectiveness, and short-term outcomes of transoral robotic surgery (TORS) for supraglottic laryngeal cancer. Methods: A retrospective analysis was conducted on patients with supraglottic laryngeal cancer who underwent TORS at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Eye Ear Nose and Throat Hospital of Fudan University, and the First Affiliated Hospital of China Medical University between January 2018 and April 2024. Data on operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheostomy, nasogastric feeding, complications, and short-term follow-up were analyzed. Statistical analysis was performed using Python. Results: A total of 27 patients with supraglottic laryngeal cancer were included from the four centers, including 24 males and 3 females, with a median age of 66 (65, 68) years [M(Q₁, Q₃), same below]. There were 26 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma.The TNM staging included T1 in 10 cases (37.04%), T2 in 13 cases (48.15%), and T3 in 4 cases (14.81%); N0 in 14 cases (51.85%), N1 in 7 cases (25.93%), and N2 in 6 cases (22.22%). The Da Vinci Si system was used in 23 cases, and the Da Vinci Xi in 4 cases. The robotic surgical time was 53 (30, 58) min. Concurrent neck dissection was performed in 25 cases, neoadjuvant therapy was given preoperatively in 8 cases (29.63%), and postoperative radiotherapy was administered in 13 cases (48.15%). Tracheostomy was performed in 11 cases (40.74%). Nasogastric tube placement was required in 23 cases (85.19%), with a median duration of 16 (12, 21) days. The postoperative hospital stay was 9.19±4.07 days. The median follow-up time was 12 (3, 30) months. Local recurrence occurred in 2 cases. The 3-year overall survival rate was 100%, and the 3-year disease-free survival rate was 94.1%. Conclusion: With appropriate patient selection, TORS for supraglottic laryngeal cancer demonstrates satisfactory short-term outcomes, offering advantages in safety, efficacy, and minimal invasiveness. It can be considered a new treatment option for this condition.

PMID:40113567 | DOI:10.3760/cma.j.cn115330-20240807-00466