Nevin Manimala

Acta Orthop. 2025 Dec 11;96:897-903. doi: 10.2340/17453674.2025.44923.

ABSTRACT

BACKGROUND AND PURPOSE: Both cemented and uncemented stem fixation is used in 2-stage hip revision arthroplasty addressing periprosthetic joint infection (PJI). We aimed to compare the risk of infection relapse and the risk of reoperation for any reason between uncemented and cemented stem fixation.

METHODS: Patients who underwent 2-stage hip revision arthroplasty for PJI between 2005 and 2020 were included. Data on baseline demographics, implant type, and microbiological and antibiotic treatment data was obtained from a local registry and medical records. Kaplan-Meier analysis compared relapse-free survival and reoperation-free survival between uncemented (n = 60) and cemented (n = 34) stems. Cox regression models were fitted to assess adjusted hazard ratios (aHR) for the risk of relapse or reoperation with 95% confidence intervals (CIs).

RESULTS: 94 patients underwent 2-stage revision hip arthroplasty for PJI. Unadjusted 2-year relapse-free survival rates were 95% (CI 89-100) for patients with uncemented stem fixation and 97% (CI 90-100) for those with cemented fixation. Reoperation-free survival at 10 years was 82% (CI 70-95) for patients with uncemented fixation and 61% (CI 43-85) for those with cemented fixation. Using cemented fixation as the reference, the aHR for infection relapse was 2.0 (CI 0.2-20.1, P = 0.6) for uncemented fixation, whereas the aHR for reoperation was 0.3 (CI 0.1-0.9, P = 0.03).

CONCLUSION: We showed no statistical difference in the risk of infection relapse, but uncemented stem fixation in 2-stage revision arthroplasty for PJI was associated with a reduced risk of reoperation for any reason. Uncemented stems may thus be a suitable choice in 2-stage revisions for PJI when this concept is believed to provide better fixation.

PMID:41379462 | DOI:10.2340/17453674.2025.44923

JAMA Oncol. 2025 Dec 11. doi: 10.1001/jamaoncol.2025.5220. Online ahead of print.

ABSTRACT

IMPORTANCE: Breast cancer treatment is associated with cancer-related cognitive impairment (CRCI). However, the association of endocrine therapy (ET) vs chemotherapy plus endocrine therapy (CET) with CRCI is poorly understood.

OBJECTIVE: To compare patient-reported CRCI between women with breast cancer treated with ET vs CET and to consider whether menopausal status may be associated.

DESIGN, SETTINGS, AND PARTICIPANTS: This was a prespecified secondary analysis of RxPONDER (SWOG S1007), a multinational phase 3 randomized clinical trial of more than 5000 women with hormone receptor-positive ERBB2-negative (formerly HER2-negative) breast cancer with 1 to 3 involved lymph nodes and Oncotype DX (21-gene recurrence score) of 25 or less. Participants were enrolled from February 2011 to September 2017, with results first reported in December 2020. Participants were randomly assigned to CET or ET, with ongoing follow-up. This secondary analysis assessed cognitive function using the Patient-Reported Outcomes Measurement Information System Perceived Cognitive Function Concerns (PCF) questionnaire at baseline, 6, 12, and 36 months. Data were analyzed from July 2022 to August 2025.

INTERVENTION: Random assignment to CET or ET.

MAIN OUTCOMES AND MEASURES: Mean PCF standardized (T) scores by menopausal status over time using generalized estimating equations analysis for continuous outcomes.

RESULTS: Of the 568 patients who completed the baseline questionnaire and were included in the analysis, 139 (24%) were premenopausal (median [range] age, 47.8 [28.0-56.3] years) and 429 (76%) were postmenopausal (median [range] age, 62.3 [37.3-87.6] years). Among the 274 (48%) who received CET and the 294 (52%) who received ET alone, CET was determined to have a greater negative association with patient-reported CRCI in both the pre- and postmenopausal participants during the 36-month follow-up. In the ET alone group, PCF scores for premenopausal participants decreased from baseline to 6 and 12 months (53.53, 51.51, and 51.72, respectively) but recovered to baseline (54.36) at 36 months. For postmenopausal participants, mean PCF scores were essentially stable (51.72, 51.13, 51.11, and 51.70, respectively); however, in the CET group, PCF scores for both pre- and postmenopausal participants decreased from baseline to 6 and 12 months (premenopausal, 52.84, 49.27, 48.04; postmenopausal, 50.65, 48.39, 47.13, respectively) and did not return to baseline at 36 months (premenopausal, 49.25; postmenopausal, 48.44). The difference in longitudinal mean PCF scores over time between CET and ET groups was -3.02 (95% CI, -5.33 to -0.72; P = .01) for premenopausal and -2.37 (95% CI, -3.92 to -0.82; P = .003) for postmenopausal participants.

CONCLUSIONS AND RELEVANCE: This secondary analysis of the RxPONDER found that CET had a greater negative association with patient-reported CRCI compared to ET alone in both pre- and postmenopausal participants over a 36-month follow-up period. Interventions to prevent or treat CRCI are needed to improve the long-term quality of life of these patients treated with chemotherapy.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01272037.

PMID:41379459 | DOI:10.1001/jamaoncol.2025.5220

JAMA Otolaryngol Head Neck Surg. 2025 Dec 11. doi: 10.1001/jamaoto.2025.4542. Online ahead of print.

ABSTRACT

IMPORTANCE: Inducible laryngeal obstruction (ILO) presents as episodic shortness of breath that can range in severity and may greatly impact daily life. Respiratory retraining therapy (RRT) provided by speech-language pathologists is the standard of care. Limited data exist on treatment effectiveness, with no published randomized clinical trials comparing treatments.

OBJECTIVE: To evaluate the effectiveness of video biofeedback (directly showing participants their laryngeal anatomy as they perform breathing exercises) compared with RRT in the treatment of episodic, inhalational dyspnea attributed to ILO.

DESIGN, SETTING, AND PARTICIPANTS: This pilot randomized clinical trial was conducted at a single-institution laryngology clinic. Patients with inhalational dyspnea attributed to ILO were included. Data were collected from March 2023 to July 2024, and data were analyzed from July 2024 to March 2025.

INTERVENTIONS: Video biofeedback and RRT.

MAIN OUTCOMES AND MEASURES: The primary end point was the difference in the Dyspnea Index (DI) score at 1 month posttreatment compared with pretreatment. The Clinical Global Impressions-Improvement scale was also used to assess patients’ perceived response to treatment.

RESULTS: A total of 54 patients newly diagnosed with episodic shortness of breath attributed to ILO were evenly randomized to biofeedback or RRT. Of these, 25 participants in the biofeedback group, and 20 in the RRT group completed the full assigned intervention. The mean (SD) age was 46.4 (16.2) years in the biofeedback group and 49.4 (20.0) years in the RRT group. A total of 42 patients (78%) were female. DI score was reduced by a mean (SD) of 3.54 (4.75) points in the biofeedback group and 4.15 (4.44) points in the RRT group, representing a mean difference of 0.61 (95% CI, -2.21 to 3.43) between the 2 groups. Most patients in both groups (14 of 22 [64%] in the biofeedback group and 12 of 19 [63%] in the RRT group) self-reported at least some improvement.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, video biofeedback and RRT were not different in the treatment of ILO. Biofeedback presents potential advantages, as it is easily accessible and imposes no additional cost to patients. Physicians should be thoughtful in selection of which treatment they recommend to patients, taking individual patient factors, such as comorbidities and access to care, into account.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05770518.

PMID:41379457 | DOI:10.1001/jamaoto.2025.4542

JAMA Netw Open. 2025 Dec 1;8(12):e2547584. doi: 10.1001/jamanetworkopen.2025.47584.

ABSTRACT

IMPORTANCE: Intraventricular hemorrhage (IVH) is a significant complication of preterm birth, affecting approximately 20% of preterm infants. Despite its prevalence, the effect of IVH beyond the impact of prematurity alone has been scarcely studied beyond early childhood, posing an important knowledge gap.

OBJECTIVE: To investigate the association of IVH with national school performance throughout childhood to adolescence.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included all very preterm infants (<32 weeks’ gestation) and full-term infants (≥37 weeks’ gestation) born in New South Wales, Australia, between January 1, 2007, and December 31, 2013. Cohorts were very preterm children with low-grade (grades 1-2) or high-grade (grades 3-4) IVH, very preterm controls without IVH, and full-term controls. Analyses were conducted from January 30 to September 18, 2024.

EXPOSURE: IVH grade 1 to 4.

MAIN OUTCOMES AND MEASURES: The primary outcome was overall performance on standardized national school assessments at age 8 to 9, 10 to 11, and 12 to 13 years, including adjusted mean differences (AMDs) in z scores between children with IVH and very preterm controls. Secondary outcomes were domain-specific performance in reading, writing, spelling, grammar, and numeracy and whether children met the national minimum standards overall and for each domain. Academic trajectories were also compared by group.

RESULTS: This study included 408 189 children: 557 with low-grade IVH, 85 with high-grade IVH, 2557 very preterm controls without IVH, and 404 990 full-term controls. Children with low-grade IVH performed similarly to preterm controls at age 8 to 9 years (AMD in overall academic z score, -0.06; 95% CI, -0.14 to 0.03), 10 to 11 years (AMD, -0.09; 95% CI, -0.21 to 0.03), and 12 to 13 years (AMD, -0.04; 95% CI, -0.24 to 0.16). Children with grade 2 IVH (n = 145), however, performed significantly worse than very preterm controls at age 8 to 9 years (AMD, -0.20; 95% CI, -0.36 to -0.04). Children with high-grade IVH performed significantly worse than very preterm controls at age 8 to 9 years (AMD, -0.50; 95% CI, -0.71 to -0.30), 10 to 11 years (AMD, -0.59; 95% CI, -0.85 to -0.34), and 12 to 13 years (AMD, -0.61; 95% CI, -1.05 to -0.17). Numeracy was a consistently weak domain for children with high-grade IVH throughout school age (eg, at age 8 to 9 years, AMD in the numeracy z score compared with very preterm controls was -0.49 [95% CI, -0.70 to -0.28]). Differences in academic trajectories between groups remained fixed with increasing age; however, all groups showed improvement over time (eg, adjusted β for very preterm children, 32.3 [95% CI, 31.2-33.5]; children with low-grade IVH, 31.5 [95% CI, 29.0-34.0]; high-grade IVH, 30.2 [95% CI, 24.1-36.4]).

CONCLUSIONS AND RELEVANCE: In this cohort study, the association of low-grade IVH with worse school performance appeared limited to children with grade 2 IVH. Children with high-grade IVH consistently showed poorer academic performance into adolescence than their peers born very preterm without IVH. Nevertheless, very preterm children, regardless of IVH grade, demonstrated academic progress over time, underscoring the need for ongoing educational support to help them to realize their full potential.

PMID:41379448 | DOI:10.1001/jamanetworkopen.2025.47584

JAMA Netw Open. 2025 Dec 1;8(12):e2548617. doi: 10.1001/jamanetworkopen.2025.48617.

ABSTRACT

IMPORTANCE: Corticosteroids are frequently used to manage symptoms in patients with diffuse large B-cell lymphoma (DLBCL), but longstanding clinical caution suggests that prebiopsy administration may reduce diagnostic accuracy. The association between steroids and biopsy outcomes in patients with systemic DLBCL remains unexamined.

OBJECTIVE: To determine whether corticosteroid use before biopsy is associated with diagnostic yield in patients with newly diagnosed DLBCL.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series of adult patients newly diagnosed with DLBCL at a single institution tertiary academic medical system affiliated with Brown University between 2015 and 2024. Patients were identified through institutional hematology and pathology databases. Patients with relapsed or refractory DLBCL or primary central nervous system lymphoma were excluded. Logistic regression was used to assess the association between steroid exposure (dose, duration, and withdrawal) and diagnostic yield.

EXPOSURE: Corticosteroid administration within 30 days before tissue biopsy.

MAIN OUTCOMES AND MEASURES: Diagnostic yield of initial biopsy for DLBCL, repeat biopsy rates, and time from first negative biopsy to chemotherapy initiation.

RESULTS: Of 320 patients (mean [SD] age, 68 [14] years and 164 [51%] female), 48 (15%) received corticosteroids prebiopsy. Diagnostic yield was 83% (40 of 48 patients) in the steroid group and 81% (221 of 272 patients) in the nonsteroid group, with no statistically significant difference between the groups (prevalence ratio [PR], 1.03; 95% CI, 0.89-1.18). Among patients with negative first biopsies, time to treatment initiation did not differ significantly between groups. No significant associations were observed between diagnostic yield and total steroid dose, duration, or days off steroids before biopsy. Biopsy type was significantly associated with diagnostic yield. Compared with excisional and incisional biopsies, core needle and fine needle aspiration were 12% (PR, 0.88; 95% CI, 0.81-0.96; P = .01) and 69% (OR, 0.31; 95% CI, 0.18-0.63; P < .001) less likely to be diagnostic, respectively.

CONCLUSIONS AND RELEVANCE: In this case series of 320 patients with DLBCL, prebiopsy corticosteroid administration was not associated with reduced diagnostic yield or delay in treatment in patients with newly diagnosed DLBCL. Biopsy technique was most associated with diagnostic success. These findings support a clinically pragmatic approach to steroid use during lymphoma evaluation.

PMID:41379445 | DOI:10.1001/jamanetworkopen.2025.48617

JAMA Netw Open. 2025 Dec 1;8(12):e2548715. doi: 10.1001/jamanetworkopen.2025.48715.

ABSTRACT

IMPORTANCE: Associations with chemotherapy, occurrence of multiple meningiomas, and mortality after subsequent meningioma diagnosis among survivors of childhood cancer remain unclear.

OBJECTIVES: To report the incidence of meningioma among childhood cancer survivors, identify novel risk factors for meningiomas, characterize survivors with multiple meningiomas, and describe cause-specific mortality following meningioma occurrence.

DESIGN, SETTING, AND PARTICIPANTS: The Childhood Cancer Survivor Study is a retrospective cohort study with longitudinal prospective follow-up of childhood cancer survivors diagnosed between 1970 to 1999 in the US and Canada. Eligibility included diagnosis of cancer before age 21 years and surviving more than 5 years after diagnosis. Meningiomas were self-reported and confirmed by review of pathology reports. Childhood cancer diagnosis, chemotherapy details, and radiation therapy exposures from up to 5 years from diagnosis were abstracted from medical records.

MAIN OUTCOMES AND MEASURES: Cumulative incidence of meningioma was calculated starting from 5 years from the diagnosis. Overall survival (OS) from diagnosis of the first subsequent meningioma was estimated using Kaplan-Meier methods.

RESULTS: The CCSS cohort included 24 886 survivors initially diagnosed from 1970 to 1999, including 471 survivors (263 female [56%]; median [range] age at last follow-up, 42.5 [19.7-66.3] years; median [range] age at primary cancer diagnosis, 5.6 [0-20.9] years) who were diagnosed with 710 meningiomas. Thirty-five years after primary cancer diagnosis, the cumulative incidence of a subsequent meningioma was 2.3% (95% CI, 2.1%-2.6%). Of the 471 survivors who developed meningioma, 137 (29.0%) had at least 2 meningiomas, and 80 (16%) met criteria for meningiomatosis. An increased risk of meningioma was associated with higher doses of cranial radiation therapy (eg, HR, 125.3 [95% CI, 58.1-270.5]), younger age at primary cancer diagnosis (eg, 0 to 4 years: HR, 4.0 [95% CI, 2.4-6.1]), female sex (HR, 1.6 [95% CI, 1.3-1.9]), and exposure to platinum, 6-mercaptopurine, and intrathecal chemotherapy, and a lower risk was associated with non-Hispanic Black race (HR, 0.5 [95% CI, 0.3-1.0]) and exposure to alkylating agents (HR, 0.6 [95% CI, 0.5-0.8]). The all-cause cumulative mortality was 4.9%, 10.5% and 18.4% at 5, 10, and 15 years from the first subsequent meningioma diagnosis.

CONCLUSIONS AND RELEVANCE: Meningiomas have a relatively high incidence and mortality for childhood cancer survivors. Results from this study could justify screening for meningiomas in high-risk populations.

PMID:41379444 | DOI:10.1001/jamanetworkopen.2025.48715

JAMA Netw Open. 2025 Dec 1;8(12):e2548809. doi: 10.1001/jamanetworkopen.2025.48809.

ABSTRACT

IMPORTANCE: Substance use disorders (SUDs) affect millions of of people worldwide and are marked by high relapse rates. Cue-elicited brain activity may correlate with treatment success, but no meta-analysis has identified which brain regions are consistently associated with outcomes.

OBJECTIVE: To evaluate, across the existing literature, whether functional magnetic resonance imaging (fMRI)-based cue reactivity is associated with SUD treatment response (eg, predictive biomarker) or posttreatment neural changes (eg, response biomarker).

DATA SOURCES: A systematic search of PubMed, PsycINFO, Embase, and Cochrane databases covered studies published from database inception through May 2023.

STUDY SELECTION: Studies were included if they reported fMRI-based cue reactivity and treatment outcomes for adults undergoing SUD treatment.

DATA EXTRACTION AND SYNTHESIS: Data extraction followed PRISMA guidelines. Analyses were conducted from October 2024 to January 2025 using Seed-Based d Mapping With Permutation of Subject Images to quantify the magnitude and extent of activation to substance-related cues across studies. Random-effects models were used to generate statistical activation maps.

MAIN OUTCOMES AND MEASURES: Statistical maps of cue-induced activation during drug cue presentation at baseline correlating with a treatment outcome (for predictive biomarkers) as well as in brain regions exhibiting a significant change after treatment (for response biomarkers). Statistical inference used permutation statistics, with thresholds set at P < .005 and cluster extent of 10 voxels.

RESULTS: Fifty-one studies (1787 participants) were included. Cue-elicited activation was observed across studies in the cingulate gyrus, middle frontal gyrus, caudate, and insula. Predictive biomarker regions (n = 14 studies, 456 participants) included the bilateral insula and cingulate, in which lower baseline cue reactivity was associated with better treatment outcomes. Response biomarkers (pretreatment to posttreatment analyses; n = 25 studies, 609 participants) indicated significant reductions in cue reactivity in the anterior cingulate, caudate, accumbens, and insula. Cue-elicited activation in the insula emerged as both predictive and response biomarkers.

CONCLUSIONS AND RELEVANCE: This meta-analysis of cue-induced brain activation in adults with SUDs identified specific regions consistently engaged during cue exposure that may serve as candidate predictive and response biomarkers for treatment outcomes, highlighting the potential role of brain-based biomarkers in informing interventions for SUD.

PMID:41379443 | DOI:10.1001/jamanetworkopen.2025.48809

Stomatologiia (Mosk). 2025;104(6. Vyp. 2):51-55. doi: 10.17116/stomat202510406251.

ABSTRACT

In certain clinical cases where orthograde treatment of chronic apical periodontitis is either impossible or ineffective, apical surgery with retrograde filling is considered the preferred method. When selecting a retrograde filling material, key factors such as biocompatibility, ability to provide a reliable seal, ease of use, and availability are taken into account. Despite numerous studies investigating the influence of various retrograde filling materials on the outcomes of apical surgery, there is still no consensus on the most effective material. Therefore, further research in this area remains an important and relevant task. The aim of this study was to evaluate the effectiveness of mineral trioxide aggregate (MTA) and glass ionomer cement as retrograde filling materials. The study included 40 patients diagnosed with chronic apical periodontitis (ICD-10 code K04.5). Patients were randomly assigned to two groups: the first group (24 patients) received retrograde filling with the new material Dia-Root BioMTA, while the second group (16 patients) was treated with glass ionomer cement Ketac Cem. Healing dynamics were assessed using the periapical index (PAI) before surgery and at 3, 6, and 12 months postoperatively. The results demonstrated a significant and sustained reduction of inflammation in both groups, with no statistically significant differences between them, indicating comparable effectiveness of the materials used.

PMID:41379411 | DOI:10.17116/stomat202510406251

Stomatologiia (Mosk). 2025;104(6. Vyp. 2):32-37. doi: 10.17116/stomat202510406232.

ABSTRACT

OBJECTIVE: Study of cytocompatibility of hydroxyapatite coating for titanium implants applied by high-frequency magnetron sputtering at low pressures in an inert gas atmosphere.

MATERIALS AND METHODS: Hydroxyapatite was deposited on titanium substrates using the HF magnetron sputtering method. The cytocompatibility of the materials was assessed by incubating with multipotent mesenchymal stromal cells (MSCs) using the MTT assay. Adhesion properties were studied by staining cells with fluorescent dyes and using scanning electron microscopy.

RESULTS: The studied titanium materials possess high cytocompatibility. The number of living cells on the 7th day was 100.0±5.6% and 108.5±8.7% for materials with and without coating, respectively. Furthermore, coating titanium substrates with hydroxyapatite resulted in a statistically significant 1.7±0.4-fold increase in the number of adhered MSCs compared to uncoated materials.

CONCLUSION: The hydroxyapatite coating applied using HF magnetron sputtering significantly improves cell adhesion to titanium materials. Thus, the obtained results provide a basis for the development of new implants with functionalized surfaces.

PMID:41379408 | DOI:10.17116/stomat202510406232

Environ Geochem Health. 2025 Dec 11;48(1):43. doi: 10.1007/s10653-025-02930-x.

ABSTRACT

River water quality in agricultural areas is crucial for human health, ecological well-being, and productivity. Pollution and high concentrations of ions, particularly in developing countries, are caused by both natural and human-induced factors, including the use of chemical fertilizers and pesticides, making prompt action necessary to address pollution. Thus, this work evaluated the hydrogeochemistry and water quality of the Duero River, located in the northwest part of Michoacán State, México. Twelve sites were selected to cover its entire course, from its source to its mouth, passing through the Zamora Valley, known for its high agricultural productivity. Three sample collections were conducted to cover both the dry and rainy seasons. Physicochemical parameters (temperature, pH, electrical conductivity, redox potential, solids, total hardness, total alkalinity, BOD₅, COD, total phosphorus (TP), N-NH₃, NO₃^–), major ions (Ca²⁺, Mg²⁺, Na⁺, HCO₃^–, SO₄^2-, Cl^–), and fecal coliforms (FC) were analyzed. The results indicated that the river water had a slightly alkaline pH. Water from the first part of the river is suitable for agricultural irrigation, and only the water from the first site, which corresponds to the source of the river, is suitable for human use and consumption. The analysis revealed that most of the sites examined are contaminated with fecal matter. Statistical analysis indicates similarities between COD, total phosphorus, TDS, alkalinity, total hardness, N-NH₃, and electrical conductivity (EC). These findings suggest that agricultural activities in the area likely influence the contamination of the Duero River. The chemistry of river water is mainly controlled by the weathering of rocks, dissolution of carbonates, and ion exchange reactions.

PMID:41379371 | DOI:10.1007/s10653-025-02930-x