Nevin Manimala

Ir J Med Sci. 2025 Jul 9. doi: 10.1007/s11845-025-04000-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Intramedullary (IM) femoral nailing in the form of cephalomedullary (CM) nailing is a common treatment of intertrochanteric femoral fractures. Previous literature has demonstrated higher revision rates of left intertrochanteric fractures. Helical blade constructs offer a theoretical advantage over a screw design.

OBJECTIVES: The objective of this study is to examine 3 year revision rates for right vs left CM nails with helical blade head screw. No current studies exist which compare revision rates in left versus right IM nails over this defined time period.

STUDY DESIGN AND METHODS: Patients who sustained intertrochanteric femoral fracture subsequently treated by CM nailing between July 2021 and December 2022 were retrospectively identified from a database of orthopaedic patients. Patients were stratified based on left-sided or right-sided fracture. Criteria for inclusion were anterograde femoral nails, performed for Intertrochanteric hip fractures. Exclusion criteria included revision nails, retrograde nails, diaphyseal and subtrochanteric fractures, reverse oblique fracture patterns and prophylactic nails. The primary outcome was 3 year revision rate. Relevant frequency statistics were generated for each cohort with odds ratios comparing revision rates between the two groups.

RESULTS: n = 104 patients were included in the final sample, comprising n = 48 left and n = 56 right sided intertrochanteric fractures who underwent CM nailing. n = 4 (3.8%) TFNAs underwent subsequent surgical revision. Incidence of revision was higher in patients undergoing left IM nailing Left: 3/48, 0.063, Right: 1/56, 0.018, Odds Ratio: 3.667, 95% Confidence Interval: 0.37 – 36.47, p = 0.268).

CONCLUSION: A greater proportion of patients who sustained a left sided intertrochanteric fracture and were surgically treated with CM nailing underwent revision surgery within 3 years of initial surgery compared to right sided CM nails.

PMID:40632474 | DOI:10.1007/s11845-025-04000-8

J Immigr Minor Health. 2025 Jul 9. doi: 10.1007/s10903-025-01726-6. Online ahead of print.

ABSTRACT

Adolescence and early adulthood are associated with an increase in mental health problems. Migration is also a risk factor for mental disorders. Yet, we know little about the risk of mental disorders among young descendants of immigrants. This study aims to investigate the risk of being diagnosed with a mental disorder between the ages of 16-30 years among those born in Norway with at least one immigrant parent compared to those with Norwegian-born parents. Data were sourced from the Medical Birth Registry of Norway, the Norwegian Patient Register, and Statistics Norway. Cox proportional hazard regressions were used to estimate hazard ratios (HR) of receiving diagnoses of depression, anxiety, bipolar affective disorders, eating disorders, and schizophrenia among those with one or two immigrant parents, in total and by parental region of origin. Individuals with Norwegian-born parents were the reference group. Analyses were adjusted for sex, year of birth, and parental education. Individuals with two immigrant parents had a lower hazard of most mental disorder diagnoses, including anxiety, depression, bipolar affective disorder, and eating disorders, compared to those with Norwegian-born parents, but a higher hazard of a schizophrenia diagnosis. Individuals with one immigrant parent showed a higher hazard of mental disorder diagnoses compared to those with two Norwegian-born parents. These patterns were generally consistent across parental regions of origin. The findings show a lower risk of a diagnosis among those with two immigrant parents. It is unclear whether this is due to better health, different patterns of help-seeking or barriers to care. Higher risk of diagnoses among those with one immigrant parent points towards a need for targeted preventive measures.

PMID:40632466 | DOI:10.1007/s10903-025-01726-6

Clin Drug Investig. 2025 Jul 9. doi: 10.1007/s40261-025-01456-5. Online ahead of print.

ABSTRACT

BACKGROUND: Pembrolizumab shows effectiveness in treating metastatic non-small cell lung cancer (metNSCLC), with a subgroup of patients experiencing long-term survival (LTS) benefits. The existence of a LTS subgroup may influence the cost-effectiveness of pembrolizumab monotherapy compared with platinum-based chemotherapy. This study aims to assess the potential implications of such a subgroup on the cost-effectiveness for patients with non-squamous metNSCLC and PD-L1 ≥ 50% who are ineligible for targeted therapies.

METHODS: This study used a decision analytic model based on Dutch real-world data (2008-2014). Two strategies were simulated: (1) a chemotherapy strategy: patients receive chemotherapy in the first-, second-, and third-line; and (2) a pembrolizumab strategy: patients receive first-line pembrolizumab followed by chemotherapy for those progressing to second- and third-lines. The pembrolizumab strategy is evaluated with and without the assumption that there is a LTS subgroup. The LTS subgroup is assumed to be free from metNSCLC-related progression after treatment. Costs (2022 €), including drug costs, other direct medical costs, family costs, and healthcare costs in life years gained, are considered from first-line treatment to death. Effects are measured in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) is assessed using an €80,000/QALY threshold. Threshold analyses are performed on the size and mortality rate of the LTS subgroup and on the price of pembrolizumab.

RESULTS: QALYs per patient were 0.65 for chemotherapy, 1.24 for pembrolizumab without LTS, and 3.52 for pembrolizumab with LTS. Average costs per patient were €58,800 for chemotherapy, €154,600 for pembrolizumab without LTS, and €178,600 for pembrolizumab with LTS. Pembrolizumab without LTS was not cost-effective compared with chemotherapy (ICER €167,600/QALY), but pembrolizumab with LTS (30% of simulated population) was cost effective (ICER of €43,100/QALY). Threshold analyses showed that a LTS subgroup size of at least 10% or halving the price of pembrolizumab was needed for pembrolizumab to be cost-effective.

CONCLUSIONS: Pembrolizumab is a cost-effective first-line treatment for patients with metNSCLC and PD-L1 ≥ 50% in the Netherlands when at least 10% of patients are long-term survivors. Without long-term survivors, this treatment is not cost-effective. Therefore, it is crucial to consider long-term survivors in assessing the cost-effectiveness of immunotherapy in metNSCLC.

PMID:40632461 | DOI:10.1007/s40261-025-01456-5

Obes Surg. 2025 Jul 9. doi: 10.1007/s11695-025-08033-x. Online ahead of print.

ABSTRACT

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has long been one of the main metabolic and bariatric choices. It has been the most frequently used conversional procedure for a sleeve gastrectomy (SG) with suboptimal initial clinical response (SoCR) or recurrent weight gain (RWG). RYGB provides its effect through both dietary restriction and malabsorption, with efficient weight and metabolic control relating to the excluded gut. This study was designed to investigate the effect of long biliopancreatic limb (BPL) RYGB versus short BPL RYGB post-SoCR or RWG of SG on weight loss and metabolic profile.

PATIENTS AND METHODS: This is a randomized controlled trial that included patients who had undergone SG with SoCR or RWG and were equally enrolled in the long BPL (LRYGB-LBPL) group and the short BPL group (LRYGB-SBPL). The patients were followed for 1 year, and weight loss, metabolic profile, and postoperative complications were analyzed. The LRYGB-LBPL group showed statistically significant improvements in EBMIL%, HbA1c reduction, and HDL levels, while other outcomes showed no significant differences. This study’s findings suggest that extending the BPL length in conversional RYGB may enhance the procedure’s effectiveness in certain aspects of weight reduction and metabolic profile, although many outcomes were similar between groups.

PMID:40632449 | DOI:10.1007/s11695-025-08033-x

J Endocrinol Invest. 2025 Jul 9. doi: 10.1007/s40618-025-02644-y. Online ahead of print.

ABSTRACT

PURPOSE: The optimal management of locally advanced differentiated thyroid cancer (DTC) remains a topic of debate, and the adoption of adjuvant external beam radiotherapy (EBRT) is discussed. This study aimed to evaluate the efficacy of EBRT with volumetric modulated arc radiotherapy (VMAT) in improving locoregional relapse-free survival (LRFS) in addition to surgery and radioiodine therapy (RAI). Secondary objective was to assess the tolerability of EBRT with VMAT.

METHODS: This monocentric, retrospective study included patients with locally advanced DTC, positive resection margins (R1) or lymph node metastases with extra-nodal extension who underwent total thyroidectomy and RAI. Patients were grouped based on whether they received adjuvant EBRT after surgery and RAI, and outcomes were compared.

RESULTS: Overall, 25 patients were included. EBRT group comprised 10 patients and non-EBRT group 15 patients. In the EBRT group, none experienced locoregional recurrence, compared to 60% in the non-EBRT group. Comparison of the survival curves showed a statistically significant difference (p = 0.043). Additionally, no severe treatment-related adverse effects were reported, indicating good tolerability of EBRT. Distant Disease-Free Survival (DDFS) was similar between the groups.

CONCLUSION: Adjuvant EBRT using VMAT improves LRFS in patients with locally advanced DTC, without adding significant toxicity. Locoregional control potentially avoid repeated neck surgeries and their associated side effects. Despite some limitations, our findings support the integration of EBRT into treatment protocols for selected high-risk patients. Further studies are needed to confirm these results and to evaluate the long-term impact of EBRT on survival and quality of life.

PMID:40632443 | DOI:10.1007/s40618-025-02644-y

J Robot Surg. 2025 Jul 9;19(1):366. doi: 10.1007/s11701-025-02549-1.

ABSTRACT

Colorectal surgeons have been early adopters of MIS. The objective of this study was to evaluate whether use of minimally invasive surgery (MIS) for colorectal cancers (CRC) has had an impact on use of MIS for hepatic, pancreatic, biliary, and gastric cancer (HPB/gastric) at the hospital level. We hypothesized that there is cross-specialty, hospital-level impact between colorectal and HPB/gastric surgeons in their use of MIS. Using the 2010-2019 National Cancer Database, we identified patients with histologically confirmed cancers who underwent curative-intent surgery. The hospital-level use of MIS for CRC and HPB/gastric cancers was standardized by adjusting hospital and patient covariates. Using these adjusted MIS rates as covariates, the yearly-level odds of receiving MIS for HPB/gastric cancers were estimated using logistic regression models. 87,241 and 134,019 patients (median age 65 years) with HPB/gastric cancers and CRC, respectively, were included. The proportion of hospitals performing more than 50% of their cases via MIS for both groups of cancers increased from 1% in 2010 to 27% in 2019. The proportion of hospitals performing more than 10% of their cases via a robotic approach increased from 1 to 33%. The odds of receiving MIS among patients with HPB/gastric cancers were more strongly associated with the level of MIS use for HPB/gastric cancer in the previous year than with MIS use for CRC. Adoption of MIS for HPB/gastric cancers appears to be influenced to a greater degree by intra-specialty factors rather than by cross-specialty use of MIS for CRC.

PMID:40632432 | DOI:10.1007/s11701-025-02549-1

Ophthalmol Ther. 2025 Jul 9. doi: 10.1007/s40123-025-01196-x. Online ahead of print.

ABSTRACT

INTRODUCTION: This study examined visual outcomes and complication rates after early pars plana vitrectomy (PPV) in eyes with endophthalmitis.

METHODS: The study was designed as a single-center, retrospective, observational database study. A total of 92 eyes treated with early PPV for endophthalmitis at the University Hospital Zurich between 2006 and 2016 were included. Endophthalmitis cases following cataract surgery (CAT, n = 44), intravitreal injection (IVI, n = 12), trabeculectomy (TRAB, n = 6), and Others (e.g., trauma or endogenous, n = 30) were assessed. Visual acuity (VA) and intraocular pressure (IOP) from prior to endophthalmitis to 12 months after PPV were analyzed. Secondary outcomes included complications following the procedure.

RESULTS: CAT and IVI groups showed good visual outcomes. Final VA in CAT and IVI groups was not statistically different to prior to endophthalmitis (CAT p = 0.840, IVI p = 0.933). In the CAT group, 78.9% of eyes with a starting VA of > light perception achieved ≥ 20/40 final VA. The highest rate of patients with at least one complication was observed in TRAB (100%), followed by Others (63.3%), IVI (50.0%), and CAT groups (40.9%).

CONCLUSION: Early PPV may be beneficial in endophthalmitis following cataract surgery and intravitreal injection, regardless of initial VA.

PMID:40632428 | DOI:10.1007/s40123-025-01196-x

J Exp Biol. 2025 Jul 9:jeb.250379. doi: 10.1242/jeb.250379. Online ahead of print.

ABSTRACT

Onymacris plana (Coleoptera: Tenebrionidae) is a black beetle that runs at high speed for a pedestrian insect in direct solar radiation in the Namib Desert, a behaviour expected to impose potentially lethal body temperature within minutes. We measured the body temperature of beetles active in their natural habitat using fine thermocouples inserted into the prothorax. The measurements revealed that when beetles sprinted in conditions of low wind, high radiation and moderate ambient temperature, their body temperature dropped rather than rose. The effect depended on convective cooling and efficient locomotion, i.e., sprinting with low energy expenditure. We confirmed the convection effect in the laboratory by exposing beetles to combinations of radiation, air temperature and wind speed comparable to those found in the Namib Desert and simulating the forced convection of running in a headwind. Under these simulated conditions, peak radiation caused the temperature of stationary male beetles to rise at about 6°C min-1 and females at almost 4°C min-1. However, in wind-calm conditions at peak radiation, the convection of simulated running dropped the equilibrium body temperature of live beetles by about 13°C. We believe that ours is the first report of exercise-induced cooling in a pedestrian animal and that O. plana’s diurnal lifestyle depends on that exercise-induced cooling.

PMID:40631420 | DOI:10.1242/jeb.250379

Am J Hum Biol. 2025 Jul;37(7):e70105. doi: 10.1002/ajhb.70105.

ABSTRACT

OBJECTIVE: To determine the association between relative leg length and insulin resistance according to rural, urban, and rural-urban migrant groups.

METHODS: Cross-sectional study using data from the PERU MIGRANT study (2007-2008). The exposure was relative leg length categorized as short, normal, or long, and the outcome was insulin resistance (logarithm of homeostatic model assessment log-HOMA2-IR). Linear regression models with log transformation, adjusted for sex, age, parental education, hip circumference, and physical activity level, were employed to estimate geometric mean ratios of insulin resistance across leg length categories. Interaction effects of population groups (rural, urban, and migrants) on insulin resistance were explored, along with mediation analysis of central obesity and excess body fat in the main relationship.

RESULTS: Using data from 947 participants, 52.7% female, mean age 47.7 years (SD = 11.9), we found a robust inverse association between relative leg length and insulin resistance. The geometric mean of insulin resistance in subjects with long leg length was 43% (e^β1: 0.57, 95% CI: 0.47-0.69) lower than those in the normal category. A significant interaction effect of the population group on relative leg length categories (p < 0.001) was observed, particularly in the migrant and rural groups. Excess body fat and abdominal obesity explained 33% and 12% of the association between relative leg length and insulin resistance, respectively.

CONCLUSIONS: Longer leg length was associated with lower insulin resistance values, with a greater interaction effect observed among the rural-urban migrant and urban groups. These findings support the hypothesis that metabolic disorders in adults may be traceable to nutritional and developmental conditions early in life.

PMID:40631411 | DOI:10.1002/ajhb.70105

Cancer Med. 2025 Jul;14(13):e71026. doi: 10.1002/cam4.71026.

ABSTRACT

INTRODUCTION: Digital symptom monitoring effectively reduces symptom burden in cancer patients receiving treatment. However, concerns persist about whether digital interventions are equitable across racial groups, and limited studies have reported on differences between racial groups. This secondary analysis compared engagement, satisfaction, and cancer symptom reduction benefits in Black and White participants utilizing an electronic capture of patient-reported outcome (ePRO) reporting system, symptom care at home (SCH), throughout chemotherapy.

METHODS: Participants undergoing cancer treatment at a comprehensive cancer center reported daily on the 11 common oncology symptoms via electronic patient reporting (ePRO) on a scale of 0-10. The mean symptom burden over time was compared between Black and White patients. End-of-study patient satisfaction ratings were completed and compared between Black and White patients receiving chemotherapy at a comprehensive cancer center in Atlanta, Georgia, USA.

RESULTS: Of the 357 self-identified participants, 239 (66.95%) were Black, and 118 (33.05%) were White. Black participants were more likely to be female, have breast cancer, not currently married, and have less than a 4-year college degree compared to Whites. Black participants had lower adherence to daily symptom reporting (65.25%; SD = 26.90 vs. 72.75%; SD 22.45; p = 0.01), but both groups reported the majority of days. The intervention produced a significant improvement in symptom burden (p < 0.001), with a mean improvement of 0.14 symptom burden points per week with equal benefit between Blacks and Whites (p = 0.27). Overall satisfaction was high for both groups, with a trend toward higher Black satisfaction (p = 0.06).

CONCLUSION: Carefully designed digital health technologies can be acceptable and beneficial in reducing symptom burden for both Blacks and Whites. All patients, but particularly Black patients, may benefit from tailored encouragement strategies to report their symptoms. This paper provides evidence that ePRO reporting systems do not perpetuate inequity but, in fact, benefit cancer patients across racial groups.

PMID:40631393 | DOI:10.1002/cam4.71026