Nevin Manimala

Eur J Radiol. 2025 Apr 23;188:112132. doi: 10.1016/j.ejrad.2025.112132. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to investigate the impact of adaptive statistical iterative reconstruction-Veo (ASIR-V) and deep learning image reconstruction (DLIR) algorithms on the quantification of pericoronary adipose tissue (PCAT) and epicardial adipose tissue (EAT). Furthermore, we propose to explore the feasibility of correcting the effects through fat threshold adjustment.

METHODS: A retrospective analysis was conducted on the imaging data of 134 patients who underwent coronary CT angiography (CCTA) between December 2023 and January 2024. These data were reconstructed into seven datasets using filtered back projection (FBP), ASIR-V at three different intensities (ASIR-V 30%, ASIR-V 50%, ASIR-V 70%), and DLIR at three different intensities (DLIR-L, DLIR-M, DLIR-H). Repeated-measures ANOVA was used to compare differences in fat, PCAT and EAT attenuation values among the reconstruction algorithms, and Bland-Altman plots were used to analyze the agreement between ASIR-V or DLIR and FBP algorithms in PCAT attenuation values.

RESULTS: Compared to FBP, ASIR-V 30 %, ASIR-V 50 %, ASIR-V 70 %, DLIR-L, DLIR-M, and DLIR-H significantly increased fat attenuation values (-103.91 ± 12.99 HU, -102.53 ± 12.68 HU, -101.14 ± 12.78 HU, -101.81 ± 12.41 HU, -100.87 ± 12.25 HU, -99.08 ± 12.00 HU vs. -105.95 ± 13.01 HU, all p < 0.001). When the fat threshold was set at -190 to -30 HU, ASIR-V and DLIR algorithms significantly increased PCAT and EAT attenuation values compared to FBP algorithm (all p < 0.05), with these values increasing as the reconstruction intensity level increased. After correction with a fat threshold of -200 to -35 HU for ASIR-V 30 %, -200 to -40 HU for ASIR-V 50 % and DLIR-L, and -200 to -45 HU for ASIR-V 70 %, DLIR-M, and DLIR-H, the mean differences in PCAT attenuation values between ASIR-V or DLIR and FBP algorithms decreased (-0.03 to 1.68 HU vs. 2.35 to 8.69 HU), and no significant difference was found in PCAT attenuation values between FBP and ASIR-V 30 %, ASIR-V 50 %, ASIR-V 70 %, DLIR-L, and DLIR-M (all p > 0.05).

CONCLUSION: Compared to the FBP algorithm, ASIR-V and DLIR algorithms increase PCAT and EAT attenuation values. Adjusting the fat threshold can mitigate the impact of ASIR-V and DLIR algorithms on PCAT attenuation values.

PMID:40344712 | DOI:10.1016/j.ejrad.2025.112132

Int Orthod. 2025 May 8;23(4):101015. doi: 10.1016/j.ortho.2025.101015. Online ahead of print.

ABSTRACT

OBJECTIVES: To validate the accuracy of integration of intraoral scan to the facial scan acquired by the EM3D application, utilising the Blue Sky Plan 4 software, creating a digital model of an orthodontic patient, by comparing the same linear measurements on real photographs and images from the digital model of the patient.

MATERIAL AND METHODS: Thirty patients (20 females and 10 males; age range 12-30years) undergoing orthodontic treatment with fixed appliances were recruited in this prospective cross-sectional study from December 2024 to February 2025. Five facial landmarks were marked on each patient: Tragion right, Cheilion right and left, Subnasale and Pronasale. Intraoral scan and facial scan were performed at the same appointment. Facial scan was conducted using an iPhone 13 Pro with the EM3D face scanning application which utilizes the iPhone’s TrueDepth camera technology while the patient was smiling. The STL (Stereolithography) and OBG (Object) files (acquired from intraoral and facial scan respectively) were combined in a digital model using the Blue Sky Plan 4 software. Lateral and frontal photographs of the patient’s face, while smiling, were also acquired. Eight linear measurements (Tragion right – bracket #11, Tragion right – incisal #11, Cheilion right – #13, Cheilion left – #13, Subnasale – #11, Subnasale – #21, Pronasale – #11, Pronasale – #21) were digitally performed on the real and digital photographs of the patients using the facial landmarks and certain points on teeth and braces. Paired sample t-test and Wilcoxon signed-rank test were used for statistical analysis.

RESULTS: Significantly statistical difference was detected only in one (Cheilion right – #13) measurement (P=0.004).

CONCLUSION: Combining intraoral and facial scan using a special software provides a clinically useful digital model of an orthodontic patient for diagnosis, treatment planning and outcome assessment.

PMID:40344702 | DOI:10.1016/j.ortho.2025.101015

Int Orthod. 2025 May 8;23(4):101014. doi: 10.1016/j.ortho.2025.101014. Online ahead of print.

ABSTRACT

AIM: The study aimed to evaluate the impact of incorporating 2.5%, 5%, and 7% arginine on the hardness, roughness, and cytotoxicity of 3M™ Transbond™ XT.

MATERIAL AND METHODS: A total of 48 samples were divided into four groups (n=12): G1 – commercial resin 3M™ Transbond™ XT (TXT); G2 – TXT+2.5% arginine; G3 – TXT+5% arginine; and G4 – TXT+7% arginine. The hardness analysis was performed by a microhardness tester. The measurements of roughness were performed by a surface roughness measuring instrument. The surface morphology analysis was analyzed by digital images obtained with a scanning electron microscope (SEM). For the in vitro cytotoxicity test, dental pulp mesenchymal cells underwent a cell viability reduction assay. For statistical analysis, ANOVA (one-way/two-way) was used, followed by Tukey’s test post hoc (P<0.05).

RESULTS: There was a reduction in the hardness of experimental resins compared to 3M™ Transbond™ XT commercial resin (P < 0.05). There was no difference between concentrations of 2.5% and 5%, but there was the largest reduction in resin with 7% arginine (P < 0.05). Surface roughness analysis showed there was no statistical difference between the samples (P ≥ 0.05). SEM also did not demonstrate changes in the surface roughness of the resins. All groups exhibited good cell viability at each timepoint. After 48h, an increase was observed for groups contaning arginine (P < 0.05).

CONCLUSION: Surface hardness was modified with when arginine incorporation – to the Transbond™ XT resin formulation. No differences were observed for surface roughness. Due to the initial cytotoxicity of the resins, precautions regarding satisfactory photopolymerization and the distance of application in relation to the gingival tissues must be adopted.

PMID:40344701 | DOI:10.1016/j.ortho.2025.101014

Medwave. 2025 May 9;25(4):e3032. doi: 10.5867/medwave.2025.04.3032.

ABSTRACT

INTRODUCTION: There is a need for a validated instrument that assesses the perception of competencies and the level of preparedness of professionals and technicians who perform telehealth care in Chile.

OBJECTIVE: To develop and evaluate the reliability and validity of an instrument designed to measure the perception of competencies and the level of preparedness in telehealth.

METHODS: An instrument on telehealth competencies and level of preparedness was designed, obtaining content validity through expert judgement. The instrument was then administered in 2023 to a total of 83 healthcare professionals and technicians with telehealth experience. To determine construct validity, exploratory factor analysis was conducted, extracting factors using Principal Axes and estimating the number of factors by combining Horn’s Parallel Analysis and scree plot. Rotation was performed using the Oblimin method. To estimate reliability, Cronbach’s Alpha statistic was calculated.

RESULTS: The factor analysis identified items with loadings over 0.6, resulting in a final scale of two factors with a total of 31 items. This factorial model explained 75.5% of the total variance. The first factor brings together items assessing perceptions of telehealth competencies, and the second factor assesses perceptions of the level of telehealth preparedness. Both factors show adequate reliability indicators, with Cronbach’s Alpha of 0.98 and 0.97 respectively, and present correlations considered adequate.

CONCLUSIONS: The instrument has adequate psychometric indicators, even considering the sample size, to measure the perception of competencies and level of preparation in telehealth in health professionals and technicians in the Biobío region. The two factors that make up the instrument help identify training and education needs. It is suggested to extend the validation to samples from other regions and to increase the diversity of clinical disciplines.

PMID:40344684 | DOI:10.5867/medwave.2025.04.3032

Alcohol Alcohol. 2025 Mar 25;60(3):agaf022. doi: 10.1093/alcalc/agaf022.

ABSTRACT

AIMS: To examine predictors of 30-day readmissions to acute hospitals in England for patients treated for alcohol withdrawal (AW).

METHODS: Retrospective cross-sectional analysis of routine hospital administrative data (i.e. Hospital Episode Statistics-Admitted Patient Care records) for adults admitted to non-specialist hospitals in England 2017-18.

RESULTS: AW admissions were associated with digestive, circulatory, respiratory, and endocrine disorders and were of short duration (median 3 days). Of the 19 588 completed AW admissions examined in 2017-18, 3957 (20.2%) resulted in readmission within 30 days. The strongest predictors of 30-day readmission were being no fixed abode (Adjusted Odds Ratio (AOR) 1.81, 95%CI 1.44-2.26), prior discharge against medical advice (AOR 1.57, 95%CI 1.40-1.77), and greater Charlson comorbidity index total score (AOR 1.02, 95%CI 1.02-1.03).

DISCUSSION: AW 30-day admissions are common and associated to complex case presentations that require high levels of community support on discharge. Hospital-based alcohol teams should prioritize strategies, which maximize medically managed AW, effective transitions to specialist community care including outreach teams and strong collaborations with physical and mental health outpatient services. Together with specialist initiatives within community mental health teams, assertive outreach, and homeless services 30-day readmissions may be minimized.

PMID:40344682 | DOI:10.1093/alcalc/agaf022

JMIR Res Protoc. 2025 May 9;14:e62951. doi: 10.2196/62951.

ABSTRACT

BACKGROUND: Individuals with poststroke hemiplegia often develop spasticity, which increases disability. Antispastic treatments such as baclofen and botulinum toxin are commonly prescribed in poststroke recovery. However, their impact on motor recovery, especially when administered within the first 2 months after stroke, remains unclear.

OBJECTIVE: This study aims to compare the motor recovery effects of botulinum toxin versus oral baclofen. The hypothesis is that botulinum toxin is more supportive of motor recovery than baclofen and enhances functional recovery.

METHODS: The study is a multicenter, controlled phase IV, comparative, prospective, randomized, double-blind, double-dummy, superiority trial to compare the toxin and baclofen, and a noninferiority trial to compare the toxin and the placebo. It focuses on the time course of the Fugl-Meyer Motor Assessment (FMA) as the primary outcome. The main inclusion criterion is patients with a single stroke in the past 2 months. Treatment comprises 1 intramuscular injection at treatment initiation and oral tablets for 4 months. Randomized patients are allocated to 3 arms: botulinum toxin with placebo baclofen, baclofen with placebo botulinum toxin, and placebo baclofen with placebo botulinum toxin. FMA scores are assessed at pretreatment, 1 month, and 3 months later. Spasticity, functional abilities, activities of daily living, pain, and quality of life are also evaluated. Adverse effects are monitored. A positive difference of 13 points in the FMA time course between the botulinum toxin and baclofen groups is considered a relevant effect. The data analysis plan involves linear regression models to compare primary and secondary outcomes, with adjustments for covariates such as age, center, and associated treatments. Subgroup analyses will examine proportional recovery profiles, and missing data in Fugl-Meyer scores will be addressed using imputation methods.

RESULTS: A total of 179 participants were randomized across 18 centers, with inclusions delayed due to the COVID-19 pandemic. As of December 2024, the data manager currently has all the data, and a review of data quality is in progress. No statistical analysis has been conducted so far, and the blind will be lifted after the analysis.

CONCLUSIONS: This study identifies the most suitable spasticity treatment, considering the specificities of the stroke and constraints during the recovery phase. It will provide recommendations for the primary treatment of early spasticity post stroke.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02462317; https://clinicaltrials.gov/study/NCT02462317; European clinical trials (EudraCT) 2010-022881-28; https://www.clinicaltrialsregister.eu/ctr-search/trial/2010-022881-28/FR.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/62951.

PMID:40344664 | DOI:10.2196/62951

J Med Internet Res. 2025 May 9;27:e68648. doi: 10.2196/68648.

ABSTRACT

BACKGROUND: Effective diabetes management requires a multimodal approach involving lifestyle changes, pharmacological treatment, and continuous patient education. Self-management demands can be overwhelming for patients, leading to lowered motivation, poor adherence, and compromised therapeutic outcomes. In this context, digital health apps are emerging as vital tools to provide personalized support and enhance diabetes management and clinical outcomes.

OBJECTIVE: This study evaluated the impact of the digital health application Vitadio on glycemic control in patients with type 2 diabetes mellitus (T2DM). Secondary objectives included evaluating its effects on cardiometabolic parameters (weight, BMI, waist circumference, blood pressure, and heart rate) and self-reported measures of diabetes distress and self-management.

METHODS: In this 6-month, 2-arm, multicenter, unblinded randomized controlled trial, patients aged 18 years or older diagnosed with T2DM were randomly assigned (1:1) to an intervention group (IG) receiving standard diabetes care reinforced by the digital health app Vitadio or to a control group (CG) provided solely with standard diabetes care. Vitadio provided a mobile-based self-management support tool featuring educational modules, motivational messages, peer support, personalized goal setting, and health monitoring. The personal consultant was available in the app to provide technical support for app-related issues. The primary outcome, assessed in the intention-to-treat population, was a change in glycated hemoglobin (HbA_1c) levels at 6 months. Secondary outcomes included changes in cardiometabolic measures and self-reported outcomes. Data were collected in 2 study centers: diabetologist practice in Dessau-Roßlau and the University of Dresden.

RESULTS: Between November 2022 and June 2023, a total of 276 patients were screened for eligibility, with 149 randomized to in intervention group (IG; n=73) and a control group (CG; n=76). The majority of participants were male (91/149, 61%). The dropout rate at month 6 was 19% (121/149). While both groups achieved significant HbA_1c reduction at 6 months (IG: mean -0.8, SD 0.9%, P<.001; CG: mean -0.3, SD 0.7%, P=.001), the primary confirmatory analysis revealed statistically significant advantage of the IG (adjusted mean difference: -0.53%, SD 0.15, 95% CI -0.24 to -0.82; P<.001; effect size [Cohen d]=0.67, 95% CI 0.33-1). Significant between-group differences in favor of the IG were also observed for weight loss (P=.002), BMI (P=.001) and systolic blood pressure (P<.03). In addition, Vitadio users experienced greater reduction in diabetes-related distress (P<.03) and obtained more pronounced improvements in self-care practices in the areas of general diet (P<.001), specific diet (P<.03), and exercise (P<.03).

CONCLUSIONS: This trial provides evidence for the superior efficacy of Vitadio in lowering the HbA_1c levels in T2DM patients compared to standard care. In addition, Vitadio contributed to improvements in cardiometabolic health, reduced diabetes-related distress, and enhanced self-management, highlighting its potential as an accessible digital tool for comprehensive diabetes management.

TRIAL REGISTRATION: German Clinical Trials Registry DRKS00027405; https://drks.de/search/de/trial/DRKS00027405.

PMID:40344662 | DOI:10.2196/68648

J Am Acad Orthop Surg. 2025 May 6. doi: 10.5435/JAAOS-D-24-01352. Online ahead of print.

ABSTRACT

PURPOSE: Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis pose notable financial and symptomatic burdens on the aging population. This study aims to determine how social determinants of health affect patient-reported outcomes following reverse total shoulder arthroplasty (rTSA), the surgical treatment for cuff tear arthropathy and glenohumeral osteoarthritis.

METHODS: A single-center retrospective review was conducted for patients who underwent rTSA between 2017 and 2022. Zip codes were used to determine income levels, as defined by the U.S. Department of Housing and Urban Development (HUD) and the Federal Reserve (FED). Social disadvantage was quantified using Social Deprivation Index (SDI). The American Shoulder and Elbow Score (ASES) was obtained by chart review or calls at a minimum 2-year follow-up. Statistical analysis was notable done using analysis of variance, Kruskal-Wallis, and Pearson chi-square tests.

RESULTS: A total of 121 patients met inclusion criteria. Of those included, 101 patients (83%) had 2-year ASES scores. Patients were divided into three cohorts based on HUD income status, FED income status, and SDI score. A difference was observed in 2-year ASES scores when stratified by HUD subgroups (P = 0.011); however, no difference was observed in 2-year ASES scores between FED or SDI subgroups. Analysis yielded no differences in pain scores, range of motion, total length of hospital stay, complications, or revision rates between all subgroups (all, P > 0.05).

DISCUSSION: The results of this study yielded no notable difference in postoperative ASES scores between FED classes or SDI subgroups. Although a difference was observed in ASES scores between HUD classes, it may be clinically negligible. Contrary to previous literature, socioeconomic status and social deprivation did not affect postoperative outcomes within our patient population.

CONCLUSION: Social determinants of health did not affect outcomes of patients undergoing a rTSA within the first 2 years after surgery.

LEVEL OF EVIDENCE: III.

PMID:40344656 | DOI:10.5435/JAAOS-D-24-01352

J Am Acad Orthop Surg. 2025 May 6. doi: 10.5435/JAAOS-D-24-01297. Online ahead of print.

ABSTRACT

INTRODUCTION: Compensation based on work relative value unit (wRVU) production is common among orthopaedic surgeons. With increased adoption of value-based payments, a greater portion of surgeon compensation will be linked to quality and outcome measures-including patient-reported outcomes. Therefore, we aimed to evaluate the relationship between wRVUs and changes in Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) scores to assess whether wRVUs could serve as a marker of patient-reported functional improvements.

METHODS: A retrospective review of 2,996 orthopaedic surgeries at a single institution was done. Patient characteristics, total wRVUs billed by the surgeon for the case, operating room (OR) time, and change in PROMIS-PF scores from baseline to 6 months postoperatively were compared across subspecialties. Pearson correlation and multivariable linear regression were used to assess the relationship between wRVUs, OR time, and PROMIS-PF change.

RESULTS: Statistically significant differences in average wRVUs, OR times, and PROMIS-PF scores were observed across subspecialties. A strong positive correlation between wRVUs and OR time existed (r = 0.732, P < 0.001) that explained approximately 54% of OR-time variability. A weak positive correlation between wRVUs and change in PROMIS-PF scores was observed (r = 0.058, P = 0.002) that explained <1% of the variation. Each 1-point increase in wRVU was associated with a 3-minute increase in surgical duration (β = 3.04, P < 0.001) after controlling for demographics, comorbidities, and subspecialty, accounting for approximately 63% of OR-time variation. Each 1-point increase in wRVU was independently associated with a 0.02-point increase in PROMIS-PF change (β = 0.02, P = 0.036), explaining approximately 7% of the variation.

CONCLUSION: Across orthopaedic subspecialties, notable variability in both wRVUs and physical function improvements at 6 months postoperatively exists. Although highly correlated with surgical time, wRVUs show little association with functional improvement across subspecialties. As the transition toward value-based payment models continues, measurement of and compensation for work complexity and functional outcomes must remain separate and distinct.

PMID:40344652 | DOI:10.5435/JAAOS-D-24-01297

J Dtsch Dermatol Ges. 2025 May 9. doi: 10.1111/ddg.15730. Online ahead of print.

NO ABSTRACT

PMID:40344645 | DOI:10.1111/ddg.15730