Category: Nevin Manimala

J Robot Surg. 2025 Aug 21;19(1):503. doi: 10.1007/s11701-025-02666-x.

ABSTRACT

While robotic surgery has been dominated by a single platform in the United States for over 25 years, the introduction of new robotic systems may have an impact on subjective workload. Therefore, we aimed to establish baseline workload measurements for operating room team members using the DaVinci surgical robot during robotic hernia procedures, providing reference points for evaluating team adaptation as new robotic platforms are introduced. Within the operating room, subjective workload refers to the physical, cognitive, and temporal demands experienced during surgical procedures. We prospectively collected NASA-TLX surveys from surgeons, circulators, and scrub staff performing robotic hernia repairs between February-December 2024. Baseline demographics and prior robotic experience were collected for each participant. Surveys assessed subjective workload across six NASA-TLX domains and surgeon assessment of case complexity relative to other procedures (Easiest 1/3, Average, Hardest 1/3). Case-specific information was extracted from the electronic medical record. We used linear mixed-effects models (LMMs) to analyze role-based and complexity-related workload, which accounts for within-subject correlation from repeated measurements collected from the same individuals across different surgical cases. A total of 131 post-operative surveys were analyzed from 14 participants across 72 robotic hernia cases. Robotic OR team members reported similar baseline workload with the highest overall workload reported by circulators (mean 30.6, 95% CI 22.1-39.2), followed by scrub staff (mean 25.1, 95% CI 16.5-33.7). Surgeons experienced the lowest overall workload (mean 24.4, 95% CI 10.2-38.6), however, demonstrated a significant stepwise increase in workload with increasing case complexity (mean 11.4 to 41.5, Cohen’s d = 3.41, 95% CI [2.31, 4.51], p < 0.0001), while circulators and scrub staff were unaffected. Comparisons across NASA-TLX domains showed that circulators reported significantly worse self-assessed performance (mean difference vs. surgeons: 14.97, 95% CI [8.84, 21.10], p = 0.001; vs. scrub staff: 9.60, 95% CI [4.21, 14.99], p = 0.002) and higher effort compared to other team members (mean difference vs scrub staff: 11.07, 95% CI [3.20, 18.94], p = 0.017). These findings provide one of the first role-specific benchmarks for intraoperative workload in robotic hernia surgery, representing essential reference metrics against which new robotic platforms can be evaluated. Further exploration of these role-specific challenges is needed to determine if there are opportunities to optimize workload to improve patient safety, team efficiency, and staff well-being as new platforms are adopted.

PMID:40839192 | DOI:10.1007/s11701-025-02666-x

Curr Opin Oncol. 2025 Aug 12. doi: 10.1097/CCO.0000000000001184. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Immunotherapy has transformed the management of several malignancies, yet its role in rare breast cancer histologies remains poorly defined due to limited research and few dedicated clinical trials. This review critically assesses current knowledge and emerging opportunities for immunotherapy in these uncommon breast cancer subtypes.

RECENT FINDINGS: Rare breast cancer histologies exhibit heterogeneous immunogenicity, including variable expression of programmed death-ligand 1 (PD-L1), differing levels of tumor-infiltrating lymphocytes (TILs), and distinct mutational burdens. Recent studies highlight potential immunotherapy responsiveness in metaplastic, invasive lobular, apocrine, and other rare breast cancer types, though predictive biomarkers like PD-L1 and tumor mutational burden (TMB) alone appear insufficient. Currently, only two clinical trials specifically target rare breast cancer histologies, emphasizing significant knowledge gaps.

SUMMARY: The effectiveness of immunotherapy in rare breast cancer histologies remains limited, likely due to inadequate patient selection using current biomarkers such as PD-L1 and TMB. Further research must focus on refining predictive biomarkers to better identify patients likely to from immunotherapy and enhance outcomes in these challenging clinical settings.

PMID:40838334 | DOI:10.1097/CCO.0000000000001184

J Periodontol. 2025 Aug 21. doi: 10.1002/JPER.24-0735. Online ahead of print.

ABSTRACT

BACKGROUND: Inflammatory cytokines play a significant role in the pathogenesis of both autoimmune hypothyroidism and periodontal disease. The cumulative effect of these inflammatory markers may lead to extensive periodontal breakdown. This study was undertaken to assess the prevalence and severity of periodontitis, to correlate clinical attachment loss (CAL), and periodontal inflamed surface area (PISA) with anti-thyroid peroxidase (anti-TPO) antibody, triiodothyronine (T3), thyroxine (T4), thyroid- stimulating hormone (TSH), and C-reactive protein (CRP) in autoimmune hypothyroid patients and systemically healthy subjects.

METHODS: This cross-sectional study comprised of 65 autoimmune hypothyroid patients under treatment and 75 systemically healthy subjects. All participants were evaluated for periodontal parameters (bleeding on probing (BoP), probing pocket depth (PPD), CAL, oral hygiene index-simplified (OHI-S Index), Plaque Index (PI) and PISA) and systemic parameters (T3, T4, TSH, anti-TPO antibody, and CRP). Analysis of quantitative and qualitative data was done by unpaired t-test and Chi-Square test, respectively.

RESULTS: Prevalence and severity of periodontitis in the autoimmune hypothyroid group were significantly higher compared with the systemically healthy group (p < 0.001). CAL, PISA, T3, TSH, and anti-TPO antibody were significantly higher in the autoimmune hypothyroid group as compared with the systemically healthy group. Mean CAL and PISA were positively correlated with anti-TPO antibody, T3, T4, TSH, and CRP. The multivariate linear regression model with dependent variable mean CAL showed that anti-TPO antibody was significantly associated with mean CAL (β = 0.001, p = 0.02).

CONCLUSIONS: Autoimmune hypothyroid subjects exhibited a higher prevalence and severity of periodontitis compared with the systemically healthy group. BoP, PPD, CAL and PISA were also higher in autoimmune hypothyroid group as compared with the systemically healthy group. A statistically significant positive correlation of CAL, and PISA with anti-TPO antibody, T3, TSH, and CRP was observed.

PLAIN LANGUAGE SUMMARY: This study assessed the link between autoimmune hypothyroidism (a condition characterized by decreased thyroid function) and periodontitis by comparing 65 individuals with autoimmune hypothyroidism undergoing treatment to 75 healthy subjects. This research measured periodontal health indicators, thyroid hormone levels, and inflammatory markers. Results indicated that those with autoimmune hypothyroidism experienced more severe periodontal disease and increased periodontal tissue loss. They also showed elevated levels of specific thyroid antibodies and thyroid hormonal imbalances. Importantly, a significant positive association was found between the extent of periodontal tissue loss and these thyroid-related markers, especially the anti-TPO antibody. In conclusion, individuals with autoimmune hypothyroidism are at a higher risk for severe periodontal disease, suggesting a relationship between thyroid dysfunction and periodontal health. Therefore, it is crucial for both periodontists and endocrinologists to recognize this association when planning appropriate treatments.

PMID:40838332 | DOI:10.1002/JPER.24-0735

Phys Chem Chem Phys. 2025 Aug 21. doi: 10.1039/d5cp01466b. Online ahead of print.

ABSTRACT

The bimolecular reactions between CH₃F and H₂⁺, HD⁺ and D₂⁺ have been studied in the range of collision energies between ∼0 and k_B × 30 K using a merged-beam approach. The ion-molecule reactions were investigated following photoexciting of H₂ (HD, D₂) to high Rydberg states in a supersonic beam, merging the Rydberg-molecule beam with a cold supersonic beam of CH₃F using a surface-electrode Rydberg-Stark deflector and monitoring the CH₃⁺, CH₂F⁺ and CH₃F⁺ ions generated by the reactions of H₂⁺ (HD⁺, D₂⁺) with CH₃F within the distant orbit of the Rydberg electron. In all three reaction systems, a strong increase of the rate coefficients was observed at collision energies below k_B × 4 K. Branching ratios for the formation of CH₃⁺, CH₂F⁺ and CH₃F⁺ were measured for all three reactions as a function of the collision energy. The branching ratio for the formation of CH₃⁺ was found to decrease with increasing deuteration of the hydrogen molecular ion and to increase at collision energies below k_B × 4 K. The experimental results were interpreted using model calculations based on a rotationally adiabatic capture model as well as using classical trajectory simulations. The reaction products are shown to be generated in two distinct mechanisms: electron transfer leading to a dominant CH₂F⁺ and a weaker CH₃F⁺ product channel, and short-range complex formation leading predominantly to CH₃⁺ by F^– transfer, with a weaker contribution of CH₂F⁺ by H^– transfer. The model calculations highlight the role played by quantum-statistical and stereodynamical effects associated with the J = 1, |K| = 1 ground state of para-CH₃F and by the reduced mass of the colliding partners: the orientation of CH₃F molecules induced by the electric field of the ion favours the production of CH₃⁺ by F^– transfer at low collision energies and the slower approach of the reaction partners with increasing reduced mass favours electron transfer at intermediate distances.

PMID:40838331 | DOI:10.1039/d5cp01466b

Vasa. 2025 Aug 21. doi: 10.1024/0301-1526/a001225. Online ahead of print.

ABSTRACT

Background: We investigated the safety and efficacy of antiplatelet therapy in preventing native arteriovenous fistula (AVF) dysfunction. Patients and methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating the effects of antiplatelet therapy following native AVF creation were eligible for inclusion. The primary endpoint was AVF primary patency. Secondary endpoints included AVF maturation, abandonment, and overall bleeding. Results: Twelve RCTs, comprising 2,491 patients, were incorporated in the analysis. The included studies assessed aspirin, clopidogrel, ticlopidine, and dypiridamole across various dosing regimens. The postoperative administration of antiplatelets, regardless of the specific drug or dose, was associated with improved AVF primary patency compared to controls or placebo, odds ratio (OR) 2.28 (95% CI: 1.42-3.65). Subgroup analysis showed no significant differences for aspirin 100mg daily or clopidogrel 75mg daily compared to controls/placebo, with ORs of 1.08 (95% CI: 0.76-1.54) and 2.16 (95% CI: 0.95-4.91), respectively. In contrast, ticlopidine 250mg twice daily significantly improved patency, OR 3.48 (95% CI: 1.46-8.26). Additionally non-statistically significant differences were identified between the antiplatelet and control/placebo groups in terms of maturation, OR 1.58 (95% CI: 0.81-3.09), AVF abandonment, risk ratio (RR) 0.93 (95% CI: 0.58-1.50), or overall bleeding RR 1.18 (95% CI: 0.77-1.81). Finally, meta-regression analysis of the antiplatelet groups pooled estimates revealed a negative association between maturation and follow-up duration (β =-0.1235, p<.01), and treatment duration and abandonment outcomes (β =-0.065, p<.01). Conclusions: This review demonstrated the safety and efficacy of antiplatelet therapy in preserving AVF patency, with ticlopidine and clopidogrel emerging as the primary contributors to this outcome. These findings suggest the potentially beneficial role of adenosine diphosphate (ADP) receptor antagonists in maintaining AVF patency.

PMID:40838310 | DOI:10.1024/0301-1526/a001225

ANZ J Surg. 2025 Aug 21. doi: 10.1111/ans.70279. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic exenteration (PE) including en-block resection of two or more adjacent pelvic organs, regional lymph nodes, and pelvic side wall is a major surgical undertaking with associated morbidity. This study aims to assess the rate of urological intervention and complications of PE at an Australian quaternary centre.

METHODS: Patients undergoing PE with a genitourinary component between January 2003 and July 2021 were included. Data were collected prospectively and analyzed retrospectively. Complications were defined as early (< 30 days) or late (≥ 30 days) using the Clavien-Dindo classification.

RESULTS: A total of 424 patients underwent PE, of whom 213 (50.2%) had a genitourinary component. Early post-operative (30-day) mortality was 0.5% and overall survival was 59.6%. Early urological complications occurred in 106 (49.8%) patients, with 11 (5.2%) experiencing an early urine leak and five (2.3%) sustaining ureteric injury. A late urological complication eventuated in 56 (26.3%) patients, with 19 (8.9%) patients developing non-malignant ureteric stricture requiring upper tract intervention. Chronic kidney disease developed post-operatively in 39 (18.3%) patients at the completion of patient follow-up. Female sex and primary (versus recurrent) malignancy were the only statistically significant predictors of new chronic renal impairment (OR [95% CI] 2.86 (1.33-6.16) and 2.18 (1.09-4.34), respectively). No pre-operative clinicopathological factors predicted urine leak.

CONCLUSIONS: Our experience with PE over a long follow-up period demonstrates urological complication rates consistent with the literature associated with urinary diversion and anastomosis, with expected rates of urine leak and ureteric stricture. Further research is required to better delineate and mitigate risk factors for genitourinary complications.

PMID:40838304 | DOI:10.1111/ans.70279

Int J Environ Res Public Health. 2025 Jul 23;22(8):1165. doi: 10.3390/ijerph22081165.

ABSTRACT

In the original publication […].

PMID:40838296 | DOI:10.3390/ijerph22081165

An Sist Sanit Navar. 2025 Aug 21;48(2):e1109. doi: 10.23938/ASSN.1109.

ABSTRACT

BACKGROUND: This study aimed to evaluate the effects of nursing quality control combined with intensified psychological care on negative emotions and health outcomes in patients undergoing blood purification.

METHODS: Patients who underwent blood purification at the Affiliated Hospital of Jiangnan University (China) from January 2021 to December 2023 were enrolled and assigned to either a control or an intervention group using a random number table. Both groups received standard care, while the intervention group additionally received nursing quality control and intensified psychological care. Outcomes compared between groups included negative emotions (assessed by the Hamilton Anxiety Scale and Hamilton Depression Scale scores), quality of life (SF-36), treatment adherence, and complication rates.

RESULTS: Prior to the treatment, both groups (150 patients in each) were comparable in the Hamilton Anxiety Scale, the Hamilton Depression Scale, and SF-36 scores. After the treatment, the intervention group showed significantly greater reduction in the Hamilton Anxiety Scale (15.89 vs. 7.19) and Hamilton Depression Scale (12.22 vs. 4.74) scores, and greater improvements in SF-36 scores, particularly in physical functioning (37.99 vs. 22.61and) and mental health (34.48 vs. 18.95). Moreover, treatment adherence was significantly higher in the intervention group (98.67% vs 70%), while the complication rate was markedly lower (10% vs. 35.33%). All differences were statistically significant (p < 0.001).

CONCLUSIONS: Nursing quality control combined with intensified psychological care significantly improves negative emotional states and quality of life in patients undergoing blood purification, while also enhancing treatment adherence and reducing the incidence of complications.

PMID:40838287 | DOI:10.23938/ASSN.1109

Spine (Phila Pa 1976). 2025 Aug 21. doi: 10.1097/BRS.0000000000005464. Online ahead of print.

ABSTRACT

STUDY DESIGN: Modified Delphi consensus survey.

OBJECTIVE: To survey expert opinion on postoperative return-to-sport (RTS) decisions in athletes requiring cervical spine surgery.

SUMMARY OF BACKGROUND DATA: Postoperative sport participation recommendations for athletes requiring cervical spine surgery are lacking, and management of these athletes remains challenging.

METHODS: A cross-sectional, modified Delphi consensus survey investigating RTS decisions in athletes requiring various cervical spine operations was undertaken. A panel of neurosurgery/orthopedic spine surgeons with sport expertise was identified from the United States and Australia. Single and multi-level cervical spine surgical conditions studied included: anterior cervical discectomy and fusion (ACDF), cervical laminectomy and laminoplasty, posterior cervical fusion, occipito-cervical fusion, C1 fracture, and C1-C2 fusion. A 2×2 scheme was used to classify sport risk based on impact forces and frequency: low impact/low frequency, low impact/high frequency, high impact/low frequency, and high impact/high frequency. Consensus was a-priori defined at ≥70%. Descriptive statistics were performed.

RESULTS: Of the 34 sports spine surgeons invited (56% neurosurgeons and 44% orthopedic surgeons), survey completion was 100%. Consensus was achieved to recommend return to high impact/high frequency sport for individuals with 1-level ACDF, 1-level cervical laminectomy, 1-level posterior cervical fusion, and for a healed C1 fracture treated with open reduction and internal fixation. For individuals with a healed occipito-cervical fusion, consensus was achieved to recommend return to low impact/low frequency sport.

CONCLUSIONS: Consensus was achieved to recommend return to high impact/high frequency sport after surgical treatment of a variety of cervical pathologies in athletes. Certain situations received consensus recommendations to return to low impact/low frequency sport, while many others did not reach a consensus. These results provide useful data that can help spine surgeons navigate challenging postoperative RTS decisions.

PMID:40838273 | DOI:10.1097/BRS.0000000000005464

Front Psychiatry. 2025 Aug 5;16:1636838. doi: 10.3389/fpsyt.2025.1636838. eCollection 2025.

ABSTRACT

BACKGROUND: The prevalence of late-life depression (LLD) is high, and its most dangerous, serious, and fatal comorbidity is suicide. Therefore, the present study systematically investigates the risk factors for suicide in individuals with LLD, offering empirical support for the development of preventive interventions against suicidal behavior.

METHODS: PubMed, Web of Science, the Cochrane Library, PsycInfo, CNKI, Wan Fang Data, VIP, and CBM databases were searched from the inception of each database to February 2025 to identify observational studies of risk factors for suicide in LLD patients. The Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) were used to ensure study quality. Stata 18.0 software was used to perform a meta-analysis and sensitivity analysis to compute the pooled odds ratio.

RESULTS: A total of 12 studies (eight case-control, two cross-sectional, and two longitudinal studies), with a quality level of medium or above, were included in the analysis. Depression severity (OR = 3.485, 95% CI: 1.385 to 8.769, P = 0.008) was identified as a significant risk factor for suicide in LLD. The age of onset (OR = 0.969, 95% CI: 0.905 to 1.039, P = 0.378) was not statistically significant for the risk of suicide in LLD. The descriptive analysis revealed that suicidal ideation, educational level, N3 sleep duration, odor identification dysfunction, alcohol drinking history, cognitive function, history of major trauma, history of suicide attempts, and high-density lipoprotein were associated with an increased suicide risk in LLD.

CONCLUSION: Our meta-analysis has revealed a variety of factors influencing suicide risk in LLD patients. Clinical staff should strengthen the assessment and screening of risk factors and take timely intervention and targeted treatment to reduce the risk of suicide in LLD.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251040029.

PMID:40838257 | PMC:PMC12362716 | DOI:10.3389/fpsyt.2025.1636838