Category: Nevin Manimala

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06620-2. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a highly effective procedure for end-stage knee osteoarthritis, but postoperative instability remains a major concern, impacting patient satisfaction and leading to potential revision surgeries. Understanding patient-related risk factors for instability is crucial for optimizing outcomes and minimizing complications.

METHODS: We conducted a retrospective cohort study of patients who underwent revision TKA at our clinic between 1996 and 2021, focusing on those who required revision specifically due to instability. We analyzed a dataset of 39,572 primary TKA patients without documented revisions and 859 revision patients. Data extraction included age, gender, body mass index (BMI), age-adjusted Charlson Comorbidity Index (CCI) score, and comorbidities. Statistical analyses, including binary logistic regression, were performed to identify independent risk factors for instability.

RESULTS: The instability group (n = 859) had a mean age of 65.7 years and a significantly lower proportion of males compared to the control group (mean age 67.5 years, p < 0.001; males 30.7% vs. 38.1%, p < 0.001). Notable risk factors included younger age, female gender, stroke, deep vein thrombosis (DVT), and scleroderma. Specifically, scleroderma was associated with a high risk of instability (P < 0.01 OR [odds ratio] 9.27, CI [confidence interval] 2.01 to 42.7), stroke (P = 0.01 OR 1.8, CI: 1.1 to 3.1), and DVT (p < 0.01 OR: 2.0, CI: 1.4 to 2.8).

CONCLUSION: Patient-related factors such as younger age, female gender, stroke, DVT, and scleroderma significantly influence the risk of instability following primary TKA. These findings highlight the multifactorial nature of TKA instability and underscore the importance of tailored preoperative assessment and postoperative care. Addressing these risk factors can improve patient outcomes and reduce the incidence of instability following TKA.

PMID:40715844 | DOI:10.1007/s00264-025-06620-2

Environ Geochem Health. 2025 Jul 26;47(9):339. doi: 10.1007/s10653-025-02585-8.

ABSTRACT

Urban air pollution caused by car emissions and industrial activities is one of the most salient causes of health threat in urban areas. Considering that taxi drivers are exposed to such pollutants all the time for several hours, the present study sought to determine the level of metal elements in the hair of this working population and to examine the determining factors.In this study, hair samples from 88 taxi drivers in Kerman city were analyzed for concentrations of iron, copper, chromium, cadmium, zinc, lead, aluminum, cobalt, and nickel using ICP-OES instrument. The relationship between metal elements (MEs) and influencing factors was investigated using Spearman’s test. Mean group differences were evaluated with Kruskal-Wallis and Mann-Whitney tests. Nickel had no strong correlation with chromium, cadmium and aluminum (rho = 0.2; Sig < 0.05). Other MEs exhibited strong positive correlations with each other, with iron showing the strongest correlation (rho = 0.34 to 0.84; Sig < 0.05), indicating that the elements may have originated from common sources. Age exhibited a significant positive correlation with nickel levels (rho = 0.47; Sig < 0.01). Using the Mann-Whitney U test, a significant difference was observed in the average nickel concentration between the hair of young and middle-aged drivers (Sig = 0.006). In addition, hair nickel levels were significantly different among drivers in the northern, western and eastern regions of the city (Sig < 0.03). However, there was no significant difference in nickel levels between drivers with less than a decade of work experience and those with over a decade (Sig > 0.05). About 75% of samples had lead concentrations below 18 mg/kg, while 25% had levels exceeding this.

PMID:40715843 | DOI:10.1007/s10653-025-02585-8

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11839-z. Online ahead of print.

ABSTRACT

OBJECTIVES: Accurately quantify pulmonary iron oxide by dual-energy CT (DECT) and evaluate its diagnostic potential in arc-welders’ pneumoconiosis (AWP).

MATERIALS AND METHODS: This prospective, single‑center diagnostic accuracy study (April 2024 to October 2024) included three groups: welders, mimic-imaging, and healthy controls. DECT quantified whole-lung Fe₂O₃ density (mg/cm³) [D_Fe2O3] and total Fe₂O₃ mass (mg) [Total-Fe₂O₃]. Maximal diameter and D_Fe2O3 for the largest nodule and the subjective grading on imaging features were also collected. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic performance. In vitro experiments, ten 30 mL tubes containing Fe₂O₃ solutions (0-12 mg/mL, in triplicate) were scanned immediately after preparation. ROIs were analyzed, and averaged values were linearly regressed with actual concentrations.

RESULTS: In vitro experiments showed a strong correlation between measured and actual Fe₂O₃ concentrations (r = 1.00, p < 0.01). One hundred forty participants were included: 50 welders (mean age, 44.5 years ± 20.25；47 male), 35 mimic-imaging controls (mean age, 51.0 years ± 10.0; 34 male), and 55 healthy controls (mean age, 48.0 years ± 19.0; 41 male). Welders had higher D_Fe₂O₃ (0.934 ± 0.50 mg/cm³) and Total-Fe₂O₃ (4082.6 ± 2503.1 mg) than mimic (0.346 ± 0.28 mg/cm³; 1376.1 ± 1514.9 mg) and healthy controls (0.371 ± 0.24 mg/cm³; 1374.1 ± 896.2 mg) (all p < 0.001). D_Fe2O3 distinguished welders from healthy controls with AUC 0.911 [95% CI: 0.840-0.958], sensitivity 82.0%, specificity 92.7%, and from mimic controls with AUC 0.900 [95% CI: 0.816-0.954], sensitivity 84.0%, specificity 82.9%. In vitro experiments showed a strong correlation (r = 1.00, p < 0.01) between actual and measured concentrations.

CONCLUSION: Quantification of pulmonary iron oxide deposition using DECT can aid in the differential diagnosis of AWP.

KEY POINTS: Question Due to overlapping imaging features between AWP and other diffuse pulmonary diseases, a definitive diagnosis is difficult based solely on imaging. Findings Pulmonary D_Fe2O3 and Total-Fe₂O₃ by DECT showed high diagnostic accuracy (AUCs > 0.90) for distinguishing welders’ pneumoconiosis from both mimic-imaging and healthy controls. Clinical relevance Non-invasive DECT Fe₂O₃ quantification improves the differential diagnosis of AWP, and enables targeted monitoring of occupational exposure, enhancing patient outcomes and occupational health management.

PMID:40715825 | DOI:10.1007/s00330-025-11839-z

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11806-8. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to establish normal knee cartilage T2-values at 1.5-Tesla, assess the influence of age and sex on T2-values, and compares T2-times between subjects with and without morphological cartilage changes.

MATERIALS AND METHODS: A sagittal 2D T2-weighted multi-slice multi-echo sequence (MSME) sequence with automatic generation of a color-coded T2-map was acquired at 1.5-Tesla in 929 volunteers (ages 28-89) from the Study-of-Health-in-Pomerania TREND-1 cohort. Knee morphology was assessed with the modified Noyes Score in eight cartilage regions. T2 measurements were performed manually in seven cartilage regions, including superficial and deep cartilage layers.

RESULTS: Subjects with normal cartilage morphology (300 subjects) showed significant T2-value differences across cartilage regions (p ≤ 0.001), with higher values in femoral cartilage and superficial layers. T2-values increased with age (p ≤ 0.001), and women had higher T2-values in the femoral, tibial, and medial femorotibial compartments. The subjects with evidence of pathological cartilage morphology changes (629 subjects) had higher T2-values compared to the subjects with structurally normal knee cartilage in MRI (p ≤ 0.001).

CONCLUSIONS: This study provides population-based 1.5-Tesla knee cartilage T2-values, showing age-related increases and higher values in superficial and femoral layers. Pathological cartilage morphology was associated with elevated T2-values.

KEY POINTS: Question This study examines early cartilage degeneration by establishing normal T2-values and analyzing how demographics and morphological cartilage changes impact these values. Findings T2-times were higher in superficial femoral cartilage but lower in retropatellar, tibial cartilage, and deep layers, increasing with age and pathological cartilage changes. Clinical relevance This study establishes normal T2-values for knee cartilage at 1.5-Tesla, identifies age- and sex-related variations, and associates elevated T2-values to morphological cartilage changes, enhancing cartilage health understanding and early diagnostic precision.

PMID:40715824 | DOI:10.1007/s00330-025-11806-8

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11860-2. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the efficacy, safety, and factors influencing the response to radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT) in a prospective multicenter trial.

MATERIALS AND METHODS: Between September 2022 and June 2024, 34 patients with 35 parathyroid lesions who either refused surgery or were ineligible for it underwent RFA for treatment of PHPT across three hospitals. Nodule size, volume, and biochemical data were compared before and after treatment (at 2 h, 1 week, and 1, 3, 6, and 12 months). Complications were assessed during and after treatment. Factors influencing the treatment response to RFA for PHPT were analyzed.

RESULTS: Significant reductions in nodule size and volume, as well as improvements in serum parathyroid hormone (PTH) and total calcium levels, were noted at the 3-, 6-, and 12-month follow-ups after RFA (all p < 0.05). Out of the 34 patients, 17 experienced a complete response with normalized serum PTH and calcium levels (50.0%), whereas 17 showed a partial response (50.0%) (median number of sessions 1). The initial serum PTH level was a key factor associated with the treatment response to RFA, with an area under the receiver operating characteristic curve of 0.853 using a PTH cutoff value of ≥ 118 pg/mL. Transient voice change (n = 1) and hypocalcemia (n = 1) were reported after the procedure.

CONCLUSION: In selected cases, RFA is a safe and effective treatment option for patients with PHPT. The initial PTH level of < 118 pg/mL is associated with achieving a biochemical cure after a single treatment.

KEY POINTS: Question The efficacy of radiofrequency ablation in treating primary hyperparathyroidism remains unclear due to limited evidence, highlighting the need for further study. Findings In this prospective multicenter study, the complete response rate was 50.0%, with 79.4% achieving normocalcemia. Baseline serum parathyroid hormone levels significantly influenced treatment response. Clinical relevance Radiofrequency ablation is a safe and effective treatment for selected patients with primary hyperparathyroidism, especially those who are ineligible for surgery. Initial serum parathyroid hormone levels predict the likelihood of achieving a biochemical cure after a single treatment.

PMID:40715823 | DOI:10.1007/s00330-025-11860-2

Eur Radiol. 2025 Jul 25. doi: 10.1007/s00330-025-11845-1. Online ahead of print.

ABSTRACT

OBJECTIVES: Lung cancer is the leading cause of cancer-related mortality. While early detection improves survival, distinguishing malignant from benign pulmonary nodules remains challenging. Artificial intelligence (AI) has been proposed to enhance diagnostic accuracy, but its clinical reliability is still under investigation. Here, we aimed to evaluate the diagnostic performance of AI models in classifying pulmonary nodules.

MATERIALS AND METHODS: This single-center retrospective study analyzed pulmonary nodules (4-30 mm) detected on CT scans, using three AI software models. Sensitivity, specificity, false-positive and false-negative rates were calculated. The diagnostic accuracy was assessed using the area under the receiver operating characteristic (ROC) curve (AUC), with histopathology serving as the gold standard. Subgroup analyses were based on nodule size and histopathological classification. The impact of imaging parameters was evaluated using regression analysis.

RESULTS: A total of 158 nodules (n = 30 benign, n = 128 malignant) were analyzed. One AI model classified most nodules as intermediate risk, preventing further accuracy assessment. The other models demonstrated moderate sensitivity (53.1-70.3%) but low specificity (46.7-66.7%), leading to a high false-positive rate (45.5-52.4%). AUC values were between 0.5 and 0.6 (95% CI). Subgroup analyses revealed decreased sensitivity (47.8-61.5%) but increased specificity (100%), highlighting inconsistencies. In total, up to 49.0% of the pulmonary nodules were classified as intermediate risk. CT scan type influenced performance (p = 0.03), with better classification accuracy on breath-held CT scans.

CONCLUSION: AI-based software models are not ready for standalone clinical use in pulmonary nodule classification due to low specificity, a high false-negative rate and a high proportion of intermediate-risk classifications.

KEY POINTS: Question How accurate are commercially available AI models for the classification of pulmonary nodules compared to the gold standard of histopathology? Findings The evaluated AI models demonstrated moderate sensitivity, low specificity and high false-negative rates. Up to 49% of pulmonary nodules were classified as intermediate risk. Clinical relevance The high false-negative rates could influence radiologists’ decision-making, leading to an increased number of interventions or unnecessary surgical procedures.

PMID:40715822 | DOI:10.1007/s00330-025-11845-1

Int J Impot Res. 2025 Jul 25. doi: 10.1038/s41443-025-01131-5. Online ahead of print.

ABSTRACT

Delayed ejaculation (DE) is among the most challenging male sexual dysfunctions. We aim to explore and compare socio-demographic and clinical characteristics of men with self-reported DE and primary premature ejaculation (PE). Data from 555 consecutive men seeking first medical help for DE or primary PE were retrospectively analyzed. Socio-demographic, clinical, laboratory data, and self-reported symptoms of anxiety and depression were collected. Patients completed International Index of Erectile Function (IIEF) and Beck Depression Inventory (BDI). We excluded men who had undergone pelvic surgery. Descriptive statistics compared clinical and socio-demographic characteristics. Linear regression models tested the association between depressive symptoms and baseline IIEF domain scores among men with DE. Of 555 patients, 479(86.3%) and 76(13.7%) had PE and DE, respectively. Men with DE were significantly older than those with PE [47(34-63.5) vs. 44(33-53), P = 0.01]. Conversely, men with PE depicted a CCI ≥ 1 more frequently compared to those with DE [17(22.4%) vs. 53(11.1%); P = 0.01]. The two groups did not differ regarding relational status, BMI, waist circumference, and hormonal milieu. Men with DE reported more frequently symptoms referable to anxiety and depression (P = 0.001) along with higher median (IQR) baseline BDI scores [8(4.8-14.3) vs. 6(2-10); P = 0.01], lower median IIEF-orgasmic function (OF) [6(5-9) vs. 9(6-10); P = 0.003] and IIEF-sexual desire (SD) [7(5.8-8) vs. 8(6-9); P = 0.001] domain scores compared to men with PE. At linear regression analysis, in men with DE, the higher the BDI score the lower the IIEF-overall satisfaction [β = -1.57, CI(-2.60, -0.53), P = 0.004], and the lower the IIEF-intercourse satisfaction [β = -0.76, CI(-1.29, -0.16), P = 0.01] domain scores. Conversely, no association between BDI and IIEF-OF, -SD, and -erectile function domain scores were found. Of men complaining of ejaculatory disorders, one out of ten reports DE. Patients with DE have higher chances to report clinically significant depression which can significantly impact their overall sexual satisfaction.

PMID:40715810 | DOI:10.1038/s41443-025-01131-5

Pediatr Cardiol. 2025 Jul 25. doi: 10.1007/s00246-025-03970-x. Online ahead of print.

ABSTRACT

The pulmonary artery pulsatility index (PAPi), calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure)/mean right atrial pressure). This study aimed to assess the clinical utility of PAPi in risk stratification for pediatric idiopathic pulmonary arterial hypertension (IPAH) and its performance in predicting the need for invasive intervention due to severe right heart failure. We analyzed clinical, echocardiographic, and right heart catheterization findings of 24 IPAH patients between April 2019 and November 2024. Statistical analyses included ROC curve analysis for PAPi’s diagnostic performance, Kaplan-Meier survival analysis, and Cox regression for identifying independent predictors of intervention. The study included 24 patients (mean age 8.2 ± 4.7 years, 66.7% female). Based on pediatric risk classification, 45.8% were lower-risk, and 54.2% were high-risk, with PAPi significantly lower in high-risk patients (p < 0.001). ROC analysis identified PAPi < 3.24 as a strong predictor of high-risk status (sensitivity = 92%, specificity = 82%). PAPi correlated positively with 6MWT (r = 0.802) and TAPSE (r = 0.812) and negatively with WHO-FC (r = – 0.692) and NT-proBNP (r = – 0.713) (p < 0.001). Over 22 ± 15.9 months, 37.5% (n = 9) required invasive interventions for syncope, WHO-FC III/IV symptoms, or right ventricular failure, including atrial septostomy (77.8%), partial ASD closure (11.1%), and reverse Potts shunt (11.1%). Post-intervention, all but one patient improved. Patients requiring intervention had lower PAPi (1.88 ± 0.71 vs. 3.95 ± 1.27, p < 0.001). Kaplan-Meier analysis confirmed PAPi > 3.24 was associated with longer event-free survival (p = 0.002). Cox regression showed higher PAPi independently predicted lower intervention risk (HR 0.36, p = 0.042). In conclusion, this study suggests that PAPi is a reliable prognostic marker for risk stratification and predicting the need for invasive intervention in pediatric IPAH.

PMID:40715799 | DOI:10.1007/s00246-025-03970-x

Braz J Microbiol. 2025 Jul 27. doi: 10.1007/s42770-025-01730-w. Online ahead of print.

ABSTRACT

Glanders, caused by Burkholderia mallei, is a zoonotic disease with profound socioeconomic and public health implications, affecting equines and humans. This study investigated glanders cases in Brazil from 2006 to 2023 to identify persistent clusters and analyze temporal trends, providing a foundation for the formulation of effective control policies. Official data were obtained from the National Animal Health Information System (SIZ) and Brazilian Institute of Geography and Statistics (IBGE), encompassing case notifications and equine population statistics by state and year. The incidence risk (IR) was calculated, and prospective spatiotemporal analyses were performed using the discrete Poisson model in SatScan software. Temporal trends were assessed through segmented regression in Joinpoint software. A total of 2,654 glanders cases were reported, with the Northeast region accounting for 52.19% of cases and Pernambuco presenting the highest IR (342.58/100,000). Primary clusters were detected in the Northeast (RR = 5.16), while secondary clusters were identified in the North, South, Central-West, and Southeast regions, with the most notable cluster in Amazonas (RR = 60.32). Temporal trend analysis revealed overall stability in Brazil but demonstrated increasing trends in the North, South, and Central-West regions. These results underscore the critical need for integrated epidemiological surveillance, stricter health regulations, and improved control of equine movement, particularly in regions at higher risk. Strengthening early diagnostic capabilities and implementing targeted educational initiatives are essential to curbing the spread of B. mallei and mitigating the socioeconomic and public health impacts of glanders in Brazil.

PMID:40715785 | DOI:10.1007/s42770-025-01730-w

Int J Gynaecol Obstet. 2025 Jul 26. doi: 10.1002/ijgo.70415. Online ahead of print.

ABSTRACT

Obstetric anal sphincter injuries (OASIs) constitute a significant complication in vaginal childbirth, affecting up to 26% of deliveries and representing the leading cause of anal incontinence among women. Despite their prevalence and serious long-term consequences, OASIs remain widely underreported, partly because of clinicians’ hesitancy linked to fear of litigation, peer criticism, and a pervasive culture that discourages disclosure of adverse events. Recent evidence emphasizes that underreporting exacerbates rather than mitigates legal risks and patient harm, underscoring the urgent need for systemic changes. This article reviews critical factors contributing to OASI underreporting, including inadequate clinical training, inconsistent national guidelines, variable litigation landscapes, and differing diagnostic practices across European healthcare systems. Examples from the UK, Poland, Sweden, Norway, France, Italy, the Czech Republic, and Belgium demonstrate significant variations in prevention strategies, diagnostic accuracy, and management protocols, reflecting uneven progress and highlighting opportunities for standardized care improvements. These national discrepancies in OASI definitions, classification, and reporting thresholds may lead to significant inconsistencies in both clinical outcomes and statistical comparisons across healthcare systems. Implementing structured training, standardized protocols, multidisciplinary collaboration, and transparent reporting systems are essential for improving maternal outcomes and reducing litigation risks. Encouraging an institutional culture of accountability and openness will support continuous improvement, ensuring enhanced patient safety and quality care across global healthcare systems.

PMID:40715780 | DOI:10.1002/ijgo.70415