Nevin Manimala

Plast Reconstr Surg. 2025 Dec 9. doi: 10.1097/PRS.0000000000012703. Online ahead of print.

ABSTRACT

PURPOSE: GLP-1 agonists have gained FDA approval for managing type 2 diabetes. However, they have been increasingly utilized for their weight loss side effect profile. Although of low incidence rate, surgical site wound complications have been observed in patients using these medications. Given the paucity of literature on weight loss medications and its implications in plastic surgery, this study aims to evaluate the impact of weight loss medication on postoperative surgical site outcomes in patients undergoing common plastic and reconstructive procedures.

METHODS: The TriNetX National Health Research database was queried to identify patients undergoing panniculectomy, abdominoplasty, and breast reduction. Patients with diabetes, peripheral vascular diseases, nutritional/metabolic/endocrine diseases, history of cancer, and smokers were excluded. Propensity matching analysis was performed to balance the cohorts. Postoperative outcomes, specifically surgical wound infections, breakdown, or dehiscence within 30 days post-procedure were assessed based on patients’ GLP-1 agonist use status.

RESULTS: The risk of surgical site wound healing complications in patients taking GLP-1 agonists compared to those not on these medications was statistically significantly higher before cohort matching as well as after matching. Matched cohorts: 4.7% vs. 2.7% for panniculectomy (p = 0.05), 9.8% vs. 3.6% for abdominoplasty (p=0.001), and 2.6 % vs. 1.3% for breast reduction (p=.035), respectively.

CONCLUSIONS: Patients using GLP-1 agonists were associated with higher rates of surgical site complications across all evaluated procedures. This underscores the necessity of patient counseling regarding the implications of these weight loss medications prior to surgery, along with the potential need for a strategic perioperative management plan to enhance surgical outcomes.

PMID:41364427 | DOI:10.1097/PRS.0000000000012703

Obes Surg. 2025 Dec 9. doi: 10.1007/s11695-025-08278-6. Online ahead of print.

ABSTRACT

Obesity is a chronic, systemic disease that alters the function of tissues, organs, and overall health, requiring prompt recognition and treatment by qualified professionals. IFSO recognizes the need to provide a new methodology for developing IFSO position statements. All new official position statements should be developed using a GRADE-based methodology, systematically reviewing all available evidence relevant to Metabolic and Bariatric Surgery (MBS). The present Position Statement was developed using results coming from a systematic review and meta-analysis, reported herein, following the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Fourteen Randomized controlled trials (RCTs) were included in this meta-analysis, 13 and 1 of them assessing outcomes of OAGB in primary and revisional setting respectively, with a total of 1288 patients. In the short term, OAGB exhibited a significantly higher excess weight loss percentage (EWL%) compared to RYGB. Regarding weight loss and metabolic outcomes, OAGB was not reported to be inferior in terms of weight loss and T2DM resolution when compared to RYGB. Further RCTs comparing OAGB to other MBS procedures are needed to reach a definitive recommendation regarding OAGB in revisional surgery setting. Regarding safety profile, no statistically significant differences between OAGB and other MBS were reported. This position statement was issued by the IFSO OAGB task force and approved by IFSO Scientific Committee aims to provide evidence on the effectiveness of One Anastomosis Gastric Bypass in both primary and revisional settings.

PMID:41364417 | DOI:10.1007/s11695-025-08278-6

J Robot Surg. 2025 Dec 9;20(1):71. doi: 10.1007/s11701-025-03037-2.

ABSTRACT

To evaluate trifecta achievement and identify predictors of successful outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN) for stage I renal cell carcinoma (RCC) using the Medtronic Hugo™ robotic-assisted surgery (RAS) system, and to compare findings with contemporary literature using the da Vinci and other robotic platforms. This prospective observational study enrolled 77 patients with clinically staged T1 RCC undergoing RAPN using the Hugo™ RAS system at a single tertiary institution between August 2023 and March 2025. The primary endpoint was attainment of trifecta outcome. The trifecta outcome was defined as negative surgical margins, warm ischaemia time (WIT) ≤25 min, and absence of complications (Clavien-Dindo grade ≥ III) within 3 months. Patient demographics, tumour characteristics (including R.E.N.A.L. nephrometry score (RNS)), intraoperative variables, and perioperative outcomes were systematically recorded. Univariate and multivariate logistic regression analyses identified independent predictors of trifecta success using the new robotic system. Contemporary literature was reviewed for comparative analysis. Trifecta was achieved in 62 of 77 patients (80.5%; 95% CI: 69.9-88.1%). Mean patient age was 52.2 ± 13.5 years (81% male); mean tumor size was 3.6 ± 1.3 cm. The majority of tumors were T1a (67.5%) with intermediate complexity (50.6%). Median WIT was 22 (range 12-35) minutes; median R.E.N.A.L. nephrometry score (RNS) was 7 (4-10). All 36 patients with low RNS complexity achieved trifecta, whereas none of the 2 patients with high complexity did (p < 0.001). RNS was the only independent predictor of trifecta achievement on multivariate analysis (OR: 0.35; 95% CI: 0.18-0.68; p = 0.002). No positive surgical margins were identified. Two patients experienced Clavien-Dindo grade III complications (hematuria with clot retention), both managed endoscopically. No intraoperative conversions or perioperative deaths occurred. Postoperative creatinine changes were significantly lower in trifecta-achieved patients (0.12 ± 0.22 mg/dL, 14.1% increase) compared to non-trifecta patients (0.38 ± 0.39 mg/dL, 40.5% increase; p = 0.018), demonstrating enhanced renal functional preservation with successful trifecta achievement. The 80.5% trifecta rate with Hugo™ RAS compares favorably to published da Vinci RAPN series (60-70%) and approaches the 92.6% rate reported in the initial Hugo™ LPN vs. RAPN comparative study. RNS and complexity stratification emerged as the only significant independent predictor, consistent with findings from da Vinci series (Sharma et al.: 60.9%; Furukawa et al.: 62.1%; Kim et al.: 65% in T1a subset) but superior to some published cohorts. RAPN using the Hugo™ RAS system demonstrates high trifecta achievement rates (80.5%) in stage I RCC, with tumor complexity as assessed by R.E.N.A.L. nephrometry score emerging as the critical independent predictor of surgical success. These outcomes compare favorably with, or exceed, published da Vinci series and support the feasibility and safety of the Hugo™ RAS system in the Indian surgical setting. The consistency of RNS as a predictor across multiple robotic platforms suggests that preoperative anatomical assessment should guide patient selection and surgical planning. Multi-institutional studies with extended follow-up and direct head-to-head comparisons are warranted.

PMID:41364415 | DOI:10.1007/s11701-025-03037-2

Ir J Med Sci. 2025 Dec 9. doi: 10.1007/s11845-025-04193-y. Online ahead of print.

ABSTRACT

PURPOSE: Thirst is common and distressing symptom among critically ill patients, yet its risk factors remain unclear. This review evaluates associations between clinical factors-including age, opioid use, ASA classification, diuretic use, oral rehydration practices, and NPO status-and thirst in critically ill and surgical patients.

METHODS: We systematically searched PubMed, EMBASE, Scopus, Web of Science, CNKI, and the Cochrane Library from inception to March 2025. Studies assessing risk factors for thirst using validated scales were included. Data extraction was performed independently by two reviewers. Pooled estimates were calculated using random-effects models with DerSimonian-Laird estimation, and heterogeneity was evaluated via Cochran’s Q and I² statistics. Publication bias was assessed using Doi plots.

RESULTS: Fifteen studies were included. Meta-analysis of 10 studies comparing age (N = 5644) yielded a weighted mean difference (WMD) of 1.080 years (95%CI: -0.673 to 2.833; p = 0.227; I² = 83%). Analysis of 5 studies on opioid use (N = 1636) showed a pooled odds ratio (OR) of 1.84 (95%CI: 0.95-3.56; p = 0.071; I² = 63%). For ASA classification (5 studies), the pooled OR was 1.196 (95%CI: 0.910-1.482; p < 0.001). Similarly, pooled ORs for diuretic use (1.286; 95%CI: 0.676-2.447), oral rehydration (0.815; 95%CI: 0.362-1.835), and NPO status (0.757; 95%CI: 0.195-2.948) were non-significant.

CONCLUSIONS: Although trends suggest that factors such as opioid use and higher ASA classification may increase odds of thirst, no single risk factor consistently predicts thirst among critically ill patients. Substantial heterogeneity across studies and potential publication bias underscore the need for further well-designed research to clarify these associations.

PMID:41364408 | DOI:10.1007/s11845-025-04193-y

Menopause. 2025 Dec 9. doi: 10.1097/GME.0000000000002708. Online ahead of print.

ABSTRACT

OBJECTIVES: This study examined the relationship of anxiety and depression with menopausal symptoms in postmenopausal women.

METHODS: This descriptive, cross-sectional study was conducted with 236 postmenopausal women aged 45-65 years. Data were collected using the Personal Information Form, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Menopause Symptom Assessment Scale. Descriptive statistics, Pearson correlation analysis, and multivariable-adjusted linear analysis were employed for the statistical evaluation of the data. The models were adjusted for the following covariates: age, educational status, income status, marital status, number of living children, presence of chronic disease, body mass index, duration of menopause, and perception of the menopausal period.

RESULTS: A statistically significant positive correlation was found between anxiety and menopausal symptoms (r=0.623, P<0.001). Multivariable-adjusted linear regression analysis indicated that a one-unit increase in anxiety was associated with a 0.424-unit increase in menopausal symptom scores (B=0.424, P<0.001). Similarly, a statistically significant positive correlation was observed between depression and menopausal symptoms (r=0.442, P<0.001). A one-unit increase in depression was associated with a 0.416-unit increase in menopausal symptom scores (B=0.416, P<0.001).

CONCLUSIONS: In conclusion, a significant relationship was found between anxiety and depression and menopausal symptoms. This finding highlights the importance of not overlooking psychological factors such as anxiety and depression when evaluating menopausal symptoms in postmenopausal women.

PMID:41364387 | DOI:10.1097/GME.0000000000002708

J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 9;9(12). doi: 10.5435/JAAOSGlobal-D-25-00096. eCollection 2025 Dec 1.

ABSTRACT

INTRODUCTION: This retrospective and systematic review examines wound closure rates across the fasciotomy approach and wound management technique for lower leg compartment syndrome.

METHODS: A retrospective review was done for adult patients treated with lower leg fasciotomy at one level 1 center from 2012 to 2022 by the CPT code. Patient data were collected, including time to fasciotomy closure and techniques used. P < 0.05 was considered significant. A systematic review was done for studies reporting time to wound closure or rates of skin grafting in the setting of fasciotomy by the surgical approach for lower leg acute compartment syndrome in accordance with the PRISMA guidelines.

RESULTS: Of 101 patients, mean time to closure was 9.83 ± 10.16 days. Time to closure was shorter for single-incision (7.00 ± 6.45 days) versus dual-incision fasciotomy (10.31 ± 10.60 days), although insignificantly. Wound management at the time of fasciotomy included VAC (n = 34, time to closure 9.29 ± 10.34 days), shoelace technique (n = 12, 7.36 ± 3.75 days), and packing (n = 37, 10.94 ± 10.56 days). 38.2% treated with VAC, 16.7% shoelace technique, and 67.6% packing required skin grafting (P = 0.043). No specific patient factors were associated with time to closure, or with early versus late closure, defined by median time to closure (6 days). Median was reported here, given the skew of our data, and is therefore more reflective of the central trend of our data. Skin grafting (30.2% versus 69.8%, P = 0.026), increasing LOS (9.25 ± 4.66 days versus 13.64 ± 8.68 days, P = 0.003), and ISS (7.20 ± 4.84 versus 10.79 ± 9.76, P = 0.028) were associated with delayed closure. ISS was the only factor significantly associated with delayed closure on multivariate analysis (P = 0.05). Table 5 outlines the 25 articles included for the systematic review.

CONCLUSION: Our analysis revealed trends toward increasing time to closure in dual-incision versus single-incision fasciotomy for lower leg compartment syndrome. Wound management markedly favored the wound vac or shoelace technique, corroborated by the results of our systematic review.

PMID:41364383 | DOI:10.5435/JAAOSGlobal-D-25-00096

J Robot Surg. 2025 Dec 9;20(1):70. doi: 10.1007/s11701-025-03024-7.

ABSTRACT

In this study, we examined the global distribution and regional dynamics of telesurgery research across 94 countries. Data retrieved from Scopus (October 2025) included both articles and reviews. Forty-six countries produced more than five publications, while 48 contributed fewer (1-5 papers), revealing broad but uneven global participation. The United States (n = 620) and China (n = 399) were the most productive nations, together exceeding one thousand publications. Other major contributors included the United Kingdom (148), Italy (146), Japan (128), Germany (115), Canada (112), and France (110), reflecting dominance by technologically advanced countries. Mid-range outputs came from Spain (57), Australia (51), Brazil (37), Netherlands (36), and Iran (35), whereas smaller nations such as Chile, Croatia, Denmark, Ireland, Norway, and South Africa each published six papers. At the regional level, Europe (n = 681) and Asia (n = 567) accounted for over two-thirds of total output. Europe showed early and steady growth from the 1980s, while Asia expanded sharply after 2015, driven by China, Japan, and South Korea. Other regions-Middle East (n = 91), Australia & Oceania (n = 51), Latin America (n = 42), and Africa (n = 23)-showed modest but increasing engagement after 2020, reflecting disparities in technological and funding capacity. The United States maintained long-term leadership through three phases-initiation, consolidation, and expansion-whereas China experienced rapid growth after 2015. Overall, these findings highlight both the global rise and persistent regional inequality in telesurgery research, underscoring the dominance of high-income nations and the growing participation of emerging economies.

PMID:41364376 | DOI:10.1007/s11701-025-03024-7

J Math Biol. 2025 Dec 9;92(1):11. doi: 10.1007/s00285-025-02309-7.

ABSTRACT

We consider a generalized version of the birth-death (BD) and death-birth (DB) processes introduced by Kaveh et al. (R Soc Open Sci 2(4):140465. https://doi.org/10.1098/rsos.140465 ), in which two constant fitnesses, one for birth and the other for death, describe the selection mechanism of the population. Rather than constant fitnesses, in this paper we consider more general frequency-dependent fitness functions (allowing any smooth functions) under the weak-selection regime. A particular case arises in evolutionary games on graphs, where the fitness functions are linear combinations of the frequencies of types. For a large population structured as a star graph, we provide approximations for the fixation probability which are solutions of certain ODEs (or systems of ODEs). For the DB case, we prove that our approximation has an error of order 1/N, where N is the size of the population. The general BD and DB processes contain, as special cases, the BD-* and DB-* (where * can be either B or D) processes described in Hadjichrysanthou et al. (Dyn Games Appl 1(3):386. https://doi.org/10.1007/s13235-011-0022-7 )-this class includes many examples of update rules used in the literature. Our analysis shows how the star graph may act as an amplifier, suppressor, or remains isothermal depending on the scaling of the initial mutant placement. We identify an analytical threshold for this transition and illustrate it through applications to evolutionary games, which further highlight asymmetric structural effects across different game types. Numerical examples show that our fixation probability approximations remain accurate even for moderate population sizes and across a wide range of frequency-dependent fitness functions, extending well beyond previously studied linear cases derived from evolutionary games, or constant fitness scenarios.

PMID:41364371 | DOI:10.1007/s00285-025-02309-7

Environ Monit Assess. 2025 Dec 9;198(1):26. doi: 10.1007/s10661-025-14826-5.

ABSTRACT

CDOM, an important ocean colour product, accounts for 90% of non-water UV absorption in the upper ocean. CDOM absorption triggers photochemical reactions resulting in the release of greenhouse gases and alters microbial bioavailability of organic matter. The three different approaches for retrieving a_dg(λ) from satellite data were validated using a_CDOM(λ) generated from OC-CCI-derived remote sensing reflectance (R_rs) and in situ measured a_CDOM(λ). The multiple linear regression (MLR) model performed better than the two exponential decay models in quantifying CDOM in the UV region. The better performance of R_rs-based algorithms indicated that absorption-based algorithms need considerable improvement when compared to algorithms based on the combined absorption by detrital matter and CDOM (a_dg(λ)). As a result, the absorption-based algorithm was modified as the ASCDOM algorithm, which demonstrated improved retrieval at 275, 355, 38 and 412 nm for a_CDOM(λ). The ASCDOM algorithm’s strong statistical performance highlights its accuracy in retrieving satellite products for water quality evaluations and ocean colour monitoring.

PMID:41364351 | DOI:10.1007/s10661-025-14826-5

JMIR Form Res. 2025 Dec 8. doi: 10.2196/82889. Online ahead of print.

ABSTRACT

BACKGROUND: Digital vaccination campaigns are increasingly used to address declining vaccine confidence, yet evidence from large-scale, real-world interventions in middle-income countries is limited. Meta’s Brand Lift Studies (BLS), which use randomized test-control exposure, provide Bayesian esti-mates of attitudinal shifts resulting from digital content. Mexico, with over 88.6 million active internet users, provides a setting to evaluate the impact of targeted campaigns on vaccine atti-tudes.

OBJECTIVE: This study evaluated the impact of five digital vaccination campaigns implemented by the Aso-ciación Mexicana de Vacunología (@Vacunologia) on Facebook and Instagram in Mexico be-tween 2021 and 2022 on key attitudinal constructs related to COVID-19 vaccine confidence.

METHODS: This study used a retrospective ecological design, we analyzed aggregated BLS results for five campaigns targeting different audiences and vaccination themes. Measured outcomes included standard ad recall, perceived importance, perceived safety, perceived efficacy, and concerns about side effects. Statistical significance within the BLS framework was defined as an incre-mental lift of ≥2 percentage points with ≥90% posterior probability of replication-a threshold consistent with Meta’s operational Bayesian approach. Exploratory comparisons across cam-paigns were conducted using one-way analysis of variance (ANOVA), unpaired t-tests, and Fish-er’s Exact Tests.

RESULTS: Campaigns reached 84.9 million accounts and generated 179.4 million impressions with a total investment of USD 215,600. All campaigns produced statistically significant improvements in at least one attitudinal outcome (Bayesian threshold ≥90%). Standard ad recall increased in four campaigns (ANOVA, P < .001), and concerns about side effects decreased in two campaigns (t-test, P = .049; P = .006). Perceived safety, importance, and efficacy improved in selected audi-ences, with stronger effects observed among younger users and women (ANOVA, P = .005). No direct behavioral outcomes (eg, vaccination uptake) were measured; therefore, the findings reflect attitudinal rather than behavioral change. However, these constructs are recognized as proximal predictors of vaccine decision-making and constitute health-related outcomes.

CONCLUSIONS: Large-scale digital vaccination campaigns can meaningfully strengthen attitudinal determinants of vaccine confidence in a middle-income context. This social media advertising campaigns effec-tively increased standard ad recall and improved perceptions of vaccine importance and safety, particularly among younger audiences and women in urban areas. However, changes in efficacy perceptions and concerns about side effects were limited. The innovation and implications of this study lie in evaluating large-scale, real-world digital vaccine campaigns in Latin America using experimental BLS data. Findings highlight that audience segmentation yield stronger perceptual shifts, suggesting that tailored digital strategies can complement traditional public health com-munication. While BLS does not measure behavioral endpoints, the observed attitudinal im-provements represent foundational steps toward influencing vaccine-related behaviors. Future work should link digital attitudinal metrics with vaccination and epidemiological data to assess real-world health impact.

PMID:41364336 | DOI:10.2196/82889