Nevin Manimala

Neurosurg Rev. 2025 May 26;48(1):445. doi: 10.1007/s10143-025-03616-9.

ABSTRACT

Spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer is an effective surgical option for traumatic brachial plexus injuries (BPIs) when nerve grafting is not applicable. It is performed via two approaches: anterior and posterior. Despite the theoretical advantages of the posterior approach, clinical trials have yielded variable outcomes. This study aimed to compare the outcomes of anterior and posterior approaches for SAN to SSN transfer in restoring the Range of motion (ROM) and strength of shoulder abduction and external rotation in BPIs. We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science to identify studies comparing anterior and posterior approaches for SAN to SSN transfer. Quality assessment was performed using the Cochrane RoB2 tool and Newcastle-Ottawa Scale. via RevMan 5.4, meta-analyses were conducted. We identified eight comparative studies with 311 patients (n = 140 for posterior transfer, n = 171 for anterior transfer). Both approaches showed comparable outcomes with statistically significant advantages to the posterior approach by a modest but meaningful difference in shoulder abduction ROM (MD: 8.98°, 95% CI: 1.19 to 16.78, P = 0.02, I² = 0%) and in the Modified Medical Research Council (MRC), The posterior approach was associated with 4.78 times higher odds of achieving a grade ≥ M3 on the MRC scale (OR: 4.78, 95% CI: 1.43 to 15.96, P = 0.01, I² = 0%). We suggest that when functional gains are a priority, surgeons consider the posterior approach while still accounting for patient/surgeon specific factors and injury details.

PMID:40415160 | DOI:10.1007/s10143-025-03616-9

Aging Clin Exp Res. 2025 May 26;37(1):169. doi: 10.1007/s40520-025-03065-w.

ABSTRACT

OBJECTIVE: This meta-analysis aimed to systematically assess whether physical activity (PA) can improve physical health(PH) and mental health(MH) in elderly.

METHOD: To conduct this meta-analysis, four databases were searched from the start to October 24, 2024 (Web of Science and PubMed in English, CNKI and Wanfang Data Knowledge Service Platform in Chinese). Eligibility criteria included (1) study populations aged ≥ 60 years of normal elderly, with no gender restrictions; (2) the experimental group included PA interventions; (3) the control group consisted of non-PA interventions or usual activities; (4) assessment results from health evaluation tools and psychological scales; (5) the research design was a controlled experimental study. The Cochrane bias risk tool was used to assess the quality of evidence for each study. Among 4,151 potential related articles, 9 met the criteria for inclusion in this review.

RESULTS: The PA intervention shows a high degree of statistical heterogeneity in the overall results for the PH of the elderly (I²=93.8%, p < 0.01). The effect size of the PA intervention on the PH of the elderly is 0.86 (95% CI: 0.08, 1.64), which is statistically significant. Subgroup analysis showed that in intervention frequency, the heterogeneity for interventions less than three times per week is low (I² = 25.6%); in intervention duration, interventions lasting less than 30 min is relatively high, the direction of the study results is quite consistent. The overall effect size is 2.32 (CI: 1.45, 3.20), indicating statistical significance; in overall intervention duration, the overall effect size for interventions lasting less than 12 weeks is (CI: 0.08, 1.59), while the effect sizes for the other two subgroups include 0, indicating non-significant results. The overall results for the MH of the elderly also exhibit a high degree of statistical heterogeneity (I²=95.3%, p < 0.01). The effect size of the PA intervention on the MH of the elderly is -0.22 (95% CI: -1.46, 1.03), which is not statistically significant. Subgroup analysis also showed no statistically significant differences. The PH and MH of the elderly may potentially improve through PA interventions, although further research is needed to clarify whether these benefits hold clinical significance beyond statistical significance.

CONCLUSION: PA interventions with a frequency of less than 3 times per week, each session lasting less than 30 min, and a total duration not exceeding 12 weeks may be more effective in improving the PH of the elderly. This study did not identify the optimal dosage for improving the MH of the elderly. These findings highlight the potential benefits of PA for PH in the elderly but underscore the need for more rigorous studies to determine optimal intervention parameters and to explore the clinical significance of PA for both PH and MH.

PMID:40415159 | DOI:10.1007/s40520-025-03065-w

Ann Surg Oncol. 2025 May 26. doi: 10.1245/s10434-025-17484-6. Online ahead of print.

ABSTRACT

BACKGROUND: Chest wall reconstruction using rigid or flexible materials presents controversial clinical outcomes, particularly regarding complications and mortality. The optimal material for various clinical scenarios remains uncertain. We conducted a meta-analysis to directly compare outcomes between rigid and flexible materials in chest wall reconstructions.

PATIENTS AND METHODS: We systematically searched PubMed, Embase, and Cochrane Library until 20 January 2025. Studies comparing chest wall reconstruction with rigid and flexible materials in adult patients were included. The effect measures used were mean differences for continuous outcomes and odds ratios for binary outcomes. Statistical analysis was conducted using random-effects models, and heterogeneity was evaluated with I² statistics.

RESULTS: In total, 13 retrospective studies involving 1111 patients were included. Of these, 39.5% underwent reconstruction with rigid materials and 60.5% with flexible materials. No statistically significant differences were found between materials in mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 0.70-4.97; p = 0.21), rupture (OR 2.02; 95% CI 0.49-8.26; p = 0.33), major complications (OR 1.49; 95% CI 0.84-2.63; p = 0.17), or pulmonary complications (OR 1.26; 95% CI 0.80-1.98; p = 0.31).

CONCLUSIONS: Our findings suggest that rigid and flexible materials yield similar clinical outcomes in chest wall reconstruction, though rigid materials were more frequently used for larger defects. Prospective studies with standardized criteria are needed to validate these findings.

PMID:40415155 | DOI:10.1245/s10434-025-17484-6

CNS Drugs. 2025 May 25. doi: 10.1007/s40263-025-01193-5. Online ahead of print.

ABSTRACT

BACKGROUND: Levodopa, dopamine agonists (DA) and monoamine oxidase inhibitors (MAOI) are all approved first-line therapies for Parkinson’s disease (PD), as monotherapy or in combination. Data on their use in the early management of patients with PD in real-life are lacking. Our objective was to assess the impact of early therapeutic strategies on the development of motor and neuropsychiatric complications using a nationwide PD cohort.

METHODS: NS-PARK is a cohort of patients with PD recruited between 2011 and 2021 from 26 expert centres for PD in France. We analysed the patients with less than 5-years disease duration and no motor complications at inclusion. We used interval censoring survival models to assess the associations between therapeutic strategies (levodopa monotherapy, levodopa alternative therapies or levodopa combinations) and motor fluctuations, dyskinesia, impulse control and related behaviours (ICRBs), apathy, psychosis/hallucination and daytime sleepiness. Analyses were adjusted for sex, age, disease duration, dopaminergic dose and disease severity.

RESULTS: We included 1722 patients (38.4% female, median age 67.7 years). At inclusion, 41% received levodopa monotherapy, 31% received levodopa alternative therapies and 28% received levodopa combinations. Compared with levodopa monotherapy, levodopa alternative therapies were associated with a lower dyskinesia risk (hazard ratio (HR) 0.48, 95% confidence interval (CI)[0.28-0.84]), but there was no significant difference in motor fluctuations. Both levodopa alternative and combinations therapies increased ICRBs risk (HR 4.06, 95% CI [2.48-6.67]; HR 5.16, 95% CI [3.00-8.86]) and decreased apathy risk (HR 0.36, 95% CI [0.26-0.49]; HR 0.52, 95% CI [0.39-0.69]). No association was found with psychosis/hallucination or daytime sleepiness.

CONCLUSIONS: In this real-life cohort, our data supported an association between levodopa alternative therapies and a lower risk of dyskinesia and apathy, but a higher risk of ICRBs compared with levodopa monotherapy.

GOV IDENTIFIER: NCT04888364. Registered June 2021.

PMID:40415148 | DOI:10.1007/s40263-025-01193-5

Clin Rheumatol. 2025 May 26. doi: 10.1007/s10067-025-07496-8. Online ahead of print.

ABSTRACT

BACKGROUND: Systemic sclerosis (SSc), is an autoimmune disease that affects multiple organs. Although physician’s Global Assessment (PGA) has been proved to be a useful tool in assessing the risk of outcomes in SSc patients, reliable grading criteria for SSc remain lacking. Early cardiac involvement particularly remains a diagnostic challenge.

OBJECTIVES: This study aims to assess the differences of clinical and cardiac magnetic resonance (CMR) in SSc patients with different duration and states, as indicated by PGA, identifying risk factors indicating potential cardiac involvement.

METHODS: SSc patients aged 18-70 years old without cardiac symptoms were recruited and underwent CMR at 3.0 T. PGA score was used to grade the SSc disease state: mild, the PGA score ranged from 0 to 1; and moderate/severe, the PGA score ranged from 1 to 3. The relationship between PGA and myocardial T1 values was analyzed using Spearman correlation coefficient. The inter-rater agreement in assessing PGA and the agreement between PGA and European Systemic sclerosis study group activity index (EScSG-AI) were evaluated using Kappa analysis. Linear regression analyses were conducted to evaluate the association between PGA and myocardial native T1 values.

RESULTS: Weak correlation was found between myocardial native T1 values and PGA score (r = 0.379, P = 0.002), particularly in SSc patients in moderate/severe disease state (r = 0.336, P = 0.008). Univariate linear regression analysis revealed that PGA was significantly associated with myocardial native T1 value (β, 15.316; 95%CI, 29.699-90.971; P < 0.001). Multivariate regression analysis showed that the association between PGA and myocardial native T1 value remained statistically significant after adjusting age and sex (model 1: β, 14.788; 95% CI, 35.257-94.461; P < 0.001), age, sex and myositis (model 2: β, 61.110; 95% CI, 32.177-90.043; P < 0.001), and age, sex, myositis, disease duration (model 3: β, 63.895; 95% CI 33.281-94.519; P < 0.001).

CONCLUSION: PGA was associated with myocardial native T1 values in asymptomatic SSc patients, suggesting that PGA might be a useful tool to evaluate subclinical myocardial involvement of SSc. Key Points • The Physician’s Global Assessment (PGA) may offer a low-cost, non-invasive method for identifying subclinical myocardial involvement in SSc patients, potentially enhancing screening and disease management. • These findings provide a basis for further longitudinal studies with larger cohorts to validate the role of PGA in predicting cardiac outcomes in SSc.

PMID:40415132 | DOI:10.1007/s10067-025-07496-8

J Community Health. 2025 May 26. doi: 10.1007/s10900-025-01478-2. Online ahead of print.

ABSTRACT

Occupational medicine and safety are now very well-established specialties world-wide. They bring together the essentials of clinical medicine and public health. However, the adoption of the principles of occupational medicine and safety was a long process in which both indifference and opposition had to be overcome. A leading pioneer in these fields, P.J. Imperato, MD, launched remarkable initiatives in the workplace some seventy years ago. He did so in the fields of heavy and marine construction. He first entered the field of occupational medicine in the late 1930’s when he served as the physician for the Sullivan Drydock and Repair Corporation, a ship yard in Brooklyn, New York. Some ten years later he was appointed Director of the Medical and Safety Department of the Merritt-Chapman and Scott Corporation (MC&S). His comprehensive initiatives led to measurable positive outcomes through a process of formative assessment. These assessments focused on injuries and deaths. As a result of the initiatives he implemented in a high-risk heavy construction industry, injuries and deaths statistically declined leading to savings in workers’ compensation and liability insurance payments. Imperato achieved all of this in the context of the high-risk construction of bridges, dams, tunnels, and housing developments by one of the leading construction companies in the United States.

PMID:40415125 | DOI:10.1007/s10900-025-01478-2

Neurosurg Rev. 2025 May 26;48(1):442. doi: 10.1007/s10143-025-03593-z.

ABSTRACT

The treatment of diffuse brainstem tumors is prescribed in most cases without morphological or molecular genetic verification. “Liquid biopsy” is a minimally invasive technique that provides information about the biology of tumors without a standard biopsy. We set out to determine the informativeness of this diagnostic method for detecting H3K27 and BRAF V600E mutations in patients with diffuse brainstem tumors. Thirty patients (10 children, 20 adults) with radiologically verified brainstem tumors underwent CSF collection via lumbar puncture. Cell-free DNA (cfDNA) isolated from the CSF was used for detection of H3F3A K28M and BRAF V600E mutations via digital droplet PCR. In 23 patients, the study of these mutations was performed in parallel in the pool of cfDNA and DNA isolated from tumor tissue obtained during a standard tumor biopsy. A mutation in the BRAF gene was not detected in any patient. The H3F3A K28M mutation was detected in 7 samples of cfDNA and 8 samples of DNA isolated from tumor tissue obtained from 23 patients for whom the study was performed in parallel. The sensitivity and specificity of H3F3A K28M mutation detection in CSF and tumor tissue were 87.5% and 100%, respectively (P < 0.001, relative risk = 0.063, 95% CI: 0.009-0.417). Minimally invasive diagnosis of diffuse brainstem tumors via the “liquid biopsy” method is informative for the detection of specific H3F3A K28M mutations and allows the verification of the diagnosis of diffuse midline glioma with H3K27 (H3K28M) alterations without a standard biopsy. Despite the promising results, an important limitation of the work is the small sample size, which affects the statistical results and conclusions. Large multicenter studies are needed to further investigate the value of liquid biopsy in brainstem gliomas.

PMID:40415124 | DOI:10.1007/s10143-025-03593-z

Sci Rep. 2025 May 25;15(1):18206. doi: 10.1038/s41598-025-03511-9.

ABSTRACT

Endometriosis is a common gynecological disorder that is associated with chronic pelvic pain, infertility, and metabolic complications. Sarcopenia, characterized by progressive skeletal muscle loss, predominantly affects older adults. This study explored the incidence and risk factors for sarcopenia in endometriosis patients using the NHANES dataset, which included 373 participants. Endometriosis was confirmed through self-report questionnaire, and sarcopenia was diagnosed via dual-energy X-ray absorptiometry. Covariates encompassed age, race, marital status, education attainment, poverty income ratio, smoking habits, and comorbidities. Statistical analyses were conducted using SPSS version 26.0, incorporating four multivariate regression models. The average age was 40.3 and 40.0 years in endometriotic participants with and without sarcopenia, respectively. Minority ethnicity had higher odds for sarcopenia (OR 6.00, 95% CI 1.24-29.07). A disease duration of endometriosis less than five years was associated with higher sarcopenia risk (OR 4.83, 95% CI 2.57-9.09). Conversely, lower educational levels were linked to a reduced chance of developing sarcopenia (OR 0.42, 95% CI 0.21-0.86). These findings were consistent across all regression models, indicating that ethnic minority status, higher educational attainment, and shorter disease duration are significant risk factors for concurrent sarcopenia in endometriosis patients.

PMID:40415119 | DOI:10.1038/s41598-025-03511-9

Sci Rep. 2025 May 25;15(1):18261. doi: 10.1038/s41598-025-99042-4.

ABSTRACT

In computational pathology, extracting and representing spatial features from gigapixel whole slide images (WSIs) are fundamental tasks, but due to their large size, WSIs are typically segmented into smaller tiles. A critical aspect of analyzing WSIs is how information across tiles is aggregated to predict outcomes such as patient prognosis. We introduce a model that combines a message-passing graph neural network (GNN) with a state space model (Mamba) to capture both local and global spatial relationships among the tiles in WSIs. The model’s effectiveness was demonstrated in predicting progression-free survival among patients with early-stage lung adenocarcinomas (LUAD). We compared the model with other state-of-the-art methods for tile-level information aggregation in WSIs, including statistics-based, multiple instance learning (MIL)-based, GNN-based, and GNN-transformer-based aggregation. Our model achieved the highest c-index (0.70) and has the largest number of parameters among comparison models yet maintained a short inference time. Additional experiments showed the impact of different types of node features and different tile sampling strategies on model performance. Code: https://github.com/rina-ding/gat-mamba .

PMID:40415116 | DOI:10.1038/s41598-025-99042-4

Sci Rep. 2025 May 26;15(1):18284. doi: 10.1038/s41598-025-94067-1.

ABSTRACT

Cervical cancer is the second most common cancer among females in Cameroon, with human papillomavirus (HPV) being the primary cause. While HPV vaccines are highly effective and have been introduced by Cameroon’s Ministry of Health (MOH), uncertainties persist regarding the determinants of HPV-related vaccine hesitancy. This study investigated the factors associated with parental HPV and cervical cancer awareness as well as parental HPV vaccine hesitancy in Cameroon. This cross-sectional study included 1,187 participants residing in Buea Health District (BHD) from August 2023 to March 2024. A pretested questionnaire adapted from the WHO’s vaccine hesitancy tool was used for data collection. Multivariable logistic regression generated adjusted odds ratios for lack of awareness and vaccine hesitancy. Younger ages and lower education levels were significantly associated with greater odds of HPV and cervical cancer unawareness. Parents with lower educational attainment and those unaware of HPV and cervical cancer had higher odds of vaccine hesitancy. Additionally, concerns about vaccine safety and side effects, distrust in the MOH and pharmaceutical companies, and lack of support from religious leaders were associated with parental vaccine hesitancy. In contrast, parents with a history of chronic illness had lower odds of being hesitant. The study identified several factors associated with parental HPV vaccine hesitancy. Addressing these factors could play a key role in improving vaccine uptake among children and eventually reducing cervical cancer rates in Cameroon.

PMID:40415103 | DOI:10.1038/s41598-025-94067-1