Nevin Manimala

J Am Acad Orthop Surg Glob Res Rev. 2025 Apr 8;9(4). doi: 10.5435/JAAOSGlobal-D-24-00146. eCollection 2025 Apr 1.

ABSTRACT

INTRODUCTION: With the advent of new classification systems and surgical options, clarification is needed regarding the most effective surgical management for refractory patellar tendinopathy (PT). The objective of this systematic review is to investigate outcomes of surgical management of refractory PT.

METHODS: PubMed was searched from January 1, 2000, through July 12, 2021, using the Medical Subject Headings function and the following Boolean operators: “Patellar Ligament/surgery”[Mesh] NOT “Anterior Cruciate Ligament”[Mesh]. Original research articles that discussed surgical management of PT were included, and outcomes were recorded.

RESULTS: Fifteen studies (2 studies level 1 and 13 studies level 4) were included comprising 485 patients with an average age of 29.5 years and 523 patellar tendons treated. The seven studies reporting both preoperative and postoperative Victorian Institute of Sports Assessment scores demonstrated increases of 39.60, whereas the seven studies reporting visual analog scores demonstrated decreases of 6.11. Average return-to-play rate was 87.08%. Study designs and in surgical techniques were heterogenous, which precluded the ability to perform a meta-analysis.

DISCUSSION: Surgical treatment of refractory PT leads to notable improvement in patient-reported outcomes and high return-to-play rates. However, there is a paucity of high-quality research investigating newer surgical options and classification systems for PT.

PMID:40215473 | DOI:10.5435/JAAOSGlobal-D-24-00146

JMIR Med Inform. 2025 Apr 11;13:e70752. doi: 10.2196/70752.

ABSTRACT

BACKGROUND: Improving processes regarding the management of electronic health record (EHR) requests for chronic antihypertensive medication renewals may represent an opportunity to enhance blood pressure (BP) management at the individual and population level.

OBJECTIVE: This study aimed to evaluate the effectiveness of the eRx HTN Chart Check, an integrated clinical decision support tool available at the point of antihypertensive medication refill request, in facilitating enhanced provider management of chronic hypertension.

METHODS: The study was conducted at two Mayo Clinic sites-Northwest Wisconsin Family Medicine and Rochester Community Internal Medicine practices-with control groups in comparable Mayo Clinic practices. The intervention integrated structured clinical data, including recent BP readings, laboratory results, and visit dates, into the electronic prescription renewal interface to facilitate prescriber decision-making regarding hypertension management. A difference-in-differences (DID) design compared pre- and postintervention hypertension control rates between the intervention and control groups. Data were collected from the Epic EHR system and analyzed using linear regression models.

RESULTS: The baseline BP control rates were slightly higher in intervention clinics. Postimplementation, no significant improvement in population-level hypertension control was observed (DID estimate: 0.07%, 95% CI -4.0% to 4.1%; P=.97). Of the 19,968 refill requests processed, 46% met all monitoring criteria. However, clinician approval rates remained high (90%), indicating minimal impact on prescribing behavior.

CONCLUSIONS: Despite successful implementation, the tool did not significantly improve hypertension control, possibly due to competing quality initiatives and high in-basket volumes. Future iterations should focus on enhanced integration with other decision support tools and strategies to improve clinician engagement and patient outcomes. Further research is needed to optimize chronic disease management through EHR-integrated decision support systems.

PMID:40215469 | DOI:10.2196/70752

J Clin Oncol. 2025 Apr 11:JCO2401739. doi: 10.1200/JCO-24-01739. Online ahead of print.

ABSTRACT

PURPOSE: Prognostic staging after neoadjuvant chemotherapy (NACT) is not included in American Joint Commission on Cancer (AJCC) staging. This study addressed this deficiency by including responses to therapy with standardized staging variables in a validated prognostic staging system for patients treated with NACT.

METHODS: The National Cancer Database was queried to identify 140,605 patients treated with NACT between 2010 and 2018. Three response categories (no response, partial response, and complete response [pCR]) were created on the basis of comparison of clinical and post-NACT pathologic staging. Univariate and multivariate analyses of clinical stage, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), and grade were analyzed for each category. Predictive models for each response category were validated using the bootstrap technique. Calibration plots compared predicted and observed 3-year survival probabilities in the training and validation data sets.

RESULTS: Each validated model demonstrated statistically significant survival differences in the postneoadjuvant prognostic stage assignment. Of all patients with a pCR, 94.2% were assigned to postneoadjuvant ypStage I compared with 35.5% of patients with no response. Advancing clinical stage had a progressive but small impact on overall survival (OS) with pCR (high-grade, triple-negative breast cancer [TNBC]: cStage I, 97% v cStage IIIB/IIIC, 91%; grade 2 luminal A: 97% v 91%) but was associated with a profound decrease in OS with no response for TNBC or HER2+ disease (high-grade TNBC 89% v 50%) and less profound for grade 2 luminal A disease with no response (97% v 81%).

CONCLUSION: We present a novel, validated prognostic staging system that predicts OS according to the response to NACT. These data will provide AJCC stage assignments for a growing proportion of patients treated with NACT.

PMID:40215445 | DOI:10.1200/JCO-24-01739

JCO Glob Oncol. 2025 Apr;11:e2400615. doi: 10.1200/GO-24-00615. Epub 2025 Apr 11.

ABSTRACT

PURPOSE: Oncology has experienced substantial growth in clinical trial activity over the past two decades, but a comprehensive evaluation of radiation oncology research is lacking. This study analyzed trends in radiation therapy trials using data from ClinicalTrials.gov.

MATERIALS AND METHODS: A comprehensive analysis was conducted on 4,253 radiation oncology trials registered in the database. Key outcomes examined included trends in trial activity over time, the geographic distribution of trials, and the phases of clinical trials conducted.

RESULTS: Clinical trial activity in radiation oncology has increased significantly, with 4,253 trials registered by February 2024. Digestive, CNS, and head and neck cancers accounted for 49.7% of studies. Research on oligometastasis emerged in the past decade (2.2%), while hematology trials declined (9.7%). Phase II trials dominated (51.3%), with most originating in North America (58.2%). Europe (21.2%) and Asia (25.2%) have shown increasing contributions, reflecting a global shift. Only 6% of trials received industry funding, highlighting the financial challenges in the field.

CONCLUSION: These findings underscore the dynamic nature of radiation oncology research and the need to address regional disparities, advance novel technologies and drug-radiotherapy combinations through phase I and III trials, and increase industry investment.

PMID:40215439 | DOI:10.1200/GO-24-00615

JCO Glob Oncol. 2025 Apr;11:e2400255. doi: 10.1200/GO-24-00255. Epub 2025 Apr 11.

ABSTRACT

PURPOSE: In 2012, Kenya announced its commitment to prioritizing cervical cancer (CC) services with the National Cervical Cancer Prevention Program. However, gaps in implementation remain, causing suboptimal uptake. The goal of this study is to provide a situational analysis of 19 government health facilities in Kenya to assess facilities’ capacity to provide CC screening and treatment.

METHODS: We conducted a retrospective data review at 19 health facilities in Siaya and Busia counties of Kenya from September 2021 to September 2022 to assess availability and uptake of CC services. Key variables included hospital volume, positivity, and numbers of women screened, treated, and referred. Notes were taken to document challenges with service provision and data collection. The retrospective review informed site matching for a proposed cluster-randomized trial.

RESULTS: There were a total of 16,757 CC screenings or rescreenings documented across the 19 study sites during the study period. Across the 19 facilities, 10.8% of the women enrolled in care at the hospital were screened during the data collection period. The overall positivity was 3.8% but ranged from 0.7% to 16.7%. Of the 19 facilities offering CC screening, five lacked the required equipment to provide same-day treatment, and complex referral pathways were noted for women needing to seek care elsewhere. Challenges with documentation were noted at all stages of CC services.

CONCLUSION: Gaps noted were low screening rates, opportunities to improve the efficiency of CC services, structural limitations in implementing the screen-and-treat approach, and poor documentation of CC services and outcomes. Urgent action is needed to ensure that all facilities offering CC screening are equipped with the personnel, supplies, and equipment necessary to conduct guideline-adherent same-day cryotherapy or thermal ablation treatment and improve documentation at the facility level to track CC services across the cascade of care.

PMID:40215437 | DOI:10.1200/GO-24-00255

J Clin Oncol. 2025 Apr 11:JCO2402026. doi: 10.1200/JCO-24-02026. Online ahead of print.

ABSTRACT

In the phase III CodeBreaK 300 study, sotorasib 960 mg-panitumumab significantly prolonged progression-free survival (PFS) versus investigator’s choice (trifluridine/tipiracil or regorafenib) in patients with KRAS G12C-mutated chemorefractory metastatic colorectal cancer (mCRC). One hundred sixty patients were randomly assigned 1:1:1 to receive sotorasib 960 mg-panitumumab (n = 53), sotorasib 240 mg-panitumumab (n = 53), or investigator’s choice (n = 54; crossover permitted after primary analysis). Overall survival (OS) analysis, a key secondary end point, although not adequately powered, was prespecified at 50% maturity (after approximately 80 deaths). In this study, we report the OS, updated overall response rates (ORRs), and data for safety. After a median follow-up of 13.6 months, 24, 28, and 30 deaths occurred in the sotorasib 960 mg-panitumumab, sotorasib 240 mg-panitumumab, and investigator’s choice arms, respectively; updated objective response rates (ORRs; 95% CI) were 30.2% (95% CI, 18.3 to 44.3), 7.5% (95% CI, 2.1 to 18.2), and 1.9% (95% CI, 0.0 to 9.9), respectively. Compared with investigator’s choice, the hazard ratios (HRs [95% CI]) for OS were 0.70 (95% CI, 0.41 to 1.18; two-sided P = .20) with sotorasib 960 mg-panitumumab and 0.83 (95% CI, 0.49 to 1.39; two-sided P = .50) with sotorasib 240 mg-panitumumab. No new safety signals were observed. Although not statistically significant, the observed OS HR and ORR along with prior PFS and safety findings support sotorasib 960 mg-panitumumab as a standard of care in patients with chemorefractory KRAS G12C mCRC.

PMID:40215429 | DOI:10.1200/JCO-24-02026

J Int Med Res. 2025 Apr;53(4):3000605251328617. doi: 10.1177/03000605251328617. Epub 2025 Apr 11.

ABSTRACT

IntroductionClavicular fractures, particularly comminuted fractures, are common injuries that can affect shoulder function and upper limb mobility. The management of these fractures, especially using surgical approaches and fixation methods, remains a key area of clinical focus. Preserving the periosteum during surgery may improve fracture healing and reduce complications. This study explored the clinical efficacy of a periosteum-preserving surgical technique combined with a Nice knot-assisted locking plate for treating comminuted clavicular fractures.MethodsA total of 85 patients with comminuted clavicular fractures were included in this retrospective study. According to the Allman classification, 56 (65.9%) cases were type IC, 19 (22.4%) were type II, 9 (10.9%) were type III, and 1 (1.1%) involved comminuted fractures across the entire clavicle. All patients underwent surgical treatment using a periosteum-preserving approach combined with a Nice knot-assisted locking plate. Fracture healing time, upper limb function (measured via Constant-Murley score and disabilities of the arm, shoulder, and hand questionnaire), and postoperative complications were assessed 6 and 12 months postoperatively.ResultsThe median healing time was 13 weeks, with no cases of nonunion reported. At 6 months postoperatively, the Constant-Murley and disabilities of the arm, shoulder, and hand scores were excellent. Although a statistically significant difference (P < 0.05) was observed in these scores between 6 and 12 months, all patients reported satisfactory recovery of shoulder function and upper limb mobility. No significant differences (P > 0.05) in fracture healing time or upper limb function recovery were observed across different types of clavicular fractures. Six (7.1%) patients experienced temporary numbness in the subclavian region, which gradually resolved by the final follow-up.ConclusionThe periosteum-preserving approach with Nice knot-assisted locking plate fixation proved to be an effective and reliable treatment for comminuted clavicular fractures. The technique was associated with favorable healing times, excellent functional outcomes, and low complication rates. Preservation of the periosteum and soft tissue during surgery may considerably reduce intraoperative trauma and improve postsurgical recovery. Further studies with larger sample sizes and longer follow-up periods are needed to confirm the long-term benefits of this approach.

PMID:40215412 | DOI:10.1177/03000605251328617

J Int Med Res. 2025 Apr;53(4):3000605251328608. doi: 10.1177/03000605251328608. Epub 2025 Apr 11.

ABSTRACT

BackgroundWhite spot lesion formation around orthodontic brackets is a major complication associated with fixed orthodontic treatment.ObjectiveThis review aimed to evaluate the current evidence regarding the differences in white spot lesion formation between self-ligating and conventional ligating brackets.MethodsEleven bibliographic databases were searched until January 2025. This review covered parallel-group and split-mouth randomized controlled trials, controlled clinical trials, and cross-sectional studies that investigated the differences in white spot lesion formation between self-ligating and conventional ligating brackets.ResultsThree randomized controlled trials, one controlled clinical trial, and one cross-sectional study were included in this systematic review. Among these, three studies were classified as having a low risk of bias. Four of the five included studies showed no statistically significant difference in white spot lesion formation between the two types of bracket systems (p < 0.05).ConclusionThere are no potential differences in white spot lesion formation between self-ligating and conventional ligating bracket systems. However, orthodontists must be aware of the other factors affecting white spot lesion formation, with oral hygiene being the most critical factor.Registration: The protocol was registered in the PROSPERO database (CRD42022353478) on 25 August 2022.

PMID:40215411 | DOI:10.1177/03000605251328608

J Int Med Res. 2025 Apr;53(4):3000605251328245. doi: 10.1177/03000605251328245. Epub 2025 Apr 11.

ABSTRACT

ObjectivesThis study aimed to identify risk factors for postoperative recurrence in patients with perianal fistulizing Crohn’s disease and assess the predictive value of fecal calprotectin and serum miRNA6086.MethodsFrom 105 patients with perianal fistulizing Crohn’s disease, blood and fecal samples as well as clinical data were collected. Analysis of blood tests, C-reactive protein, miRNA6086, and fecal calprotectin revealed postoperative recurrence risk factors. Receiver operating characteristic curve analysis assessed the predictive accuracy of miRNA6086 and fecal calprotectin for perianal fistulizing Crohn’s disease recurrence and determined their optimal cutoff values, sensitivity, and specificity.ResultsOf the 105 patients with perianal fistulizing Crohn’s disease, 33 (31.4%) experienced recurrence. Anal fistula type, preoperative miRNA6086, and fecal calprotectin levels were identified as independent risk factors for postoperative recurrence. Receiver operating characteristic curve analysis revealed that miRNA6086 had a cutoff value of 0.3195, sensitivity of 65.28%, specificity of 66.67%, and area under curve value of 0.6589 (95% confidence interval, 0.5503-0.7674). Fecal calprotectin had a cutoff value of 0.6073, sensitivity of 81.94%, specificity of 78.79%, and area under curve value of 0.8224 (95% confidence interval, 0.5503-0.7674). Combined miRNA6086 and fecal calprotectin detection had a cutoff value of 0.7121, sensitivity of 83.33%, specificity of 87.88%, and area under curve value of 0.9146 (95% confidence interval, 0.8547-0.9744).ConclusionAnal fistula type, preoperative miRNA6086, and fecal calprotectin levels are independent risk factors for perianal fistulizing Crohn’s disease recurrence. Combined detection of miRNA6086 and fecal calprotectin levels enhances predictive accuracy for postoperative recurrence.

PMID:40215410 | DOI:10.1177/03000605251328245

JMIR Form Res. 2025 Apr 11;9:e65188. doi: 10.2196/65188.

ABSTRACT

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients.

OBJECTIVE: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT.

METHODS: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the “think aloud” method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months.

RESULTS: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection.

CONCLUSIONS: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation.

PMID:40215402 | DOI:10.2196/65188