Nevin Manimala

Laryngoscope. 2025 May 19. doi: 10.1002/lary.32271. Online ahead of print.

ABSTRACT

OBJECTIVE: Cochlear implantation in otosclerosis patients presents unique surgical and programming challenges. The success and satisfaction of these patients heavily depend on precise speech processor fitting. Increased bone growth and tissue mass associated with otosclerosis can hinder electrical current flow, adding resistance to stimuli transmission to ganglion cells. This study aimed to evaluate mid- and long-term cochlear implant fitting in otosclerosis patients compared to a control group.

METHODS: This was a monocentric retrospective case-control study conducted at a tertiary referral center comparing patients with far advanced otosclerosis and a control group of post-lingually deafened individuals from the same database. Data collected included: age, sex, etiology, hearing deprivation duration, implantation age and side, surgical details, postoperative complications (e.g., tinnitus, dizziness, or facial nerve stimulation), hearing tests, and cochlear implant fitting details.

RESULTS: The study analyzed 80 patients: 29 with otosclerosis and 51 controls. Higher impedances were seen in the otosclerosis group at 2 and 5 years, statistically significant for basal, middle, and overall electrodes at 2 years. Higher C- and T-levels for apical electrodes at 2 years were identified, and neural response telemetry thresholds were significantly higher for medial and apical electrodes in otosclerosis patients at 2 years. Despite these differences, auditory outcomes at 5 years were comparable between groups.

CONCLUSION: These findings suggest significant tissue remodeling at the cochlear apex in otosclerosis patients, likely increasing resistance to electrical currents delivered by the implant. This highlights the importance of tailored programming and long-term monitoring for otosclerosis patients.

LEVEL OF EVIDENCE: Level 3.

PMID:40384602 | DOI:10.1002/lary.32271

Spine (Phila Pa 1976). 2025 May 19. doi: 10.1097/BRS.0000000000005392. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Cohort Study.

OBJECTIVE: This study aimed to compared radiographic and clinical outcomes in Adolescent Idiopathic Scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with and without thoracoplasty.

SUMMARY OF BACKGROUND DATA: Scoliosis is a three-dimensional deformity. As a result, patients often have an associated rib cage deformity, with clinical and aesthetic implications. Direct vertebral rotation (DVR) allows for some reduction of the rib hump; however, the deformed ribs remain deformed. Rib resection has been utilized to further reduce the rib hump, however there are concerns of increased pain, operative time, and blood loss.

METHODS: Retrospective review of 400 AIS patients undergoing PSF between 2018-2023. Patients were stratified based on those who underwent rib resectioning (RR) and those who did not (Non-Rib Resection, N-RR). Radiographic, surgical, and clinical outcomes were compared. Clinical outcomes were collected utilizing SRS-22 and our institution’s activity questionnaire, validated via “test-retest” method. All data is presented as medians, IQR, frequencies, and percents. Fisher’s Exact, Chi-squared, and Wilcoxon rank-sum tests were used.

RESULTS: 153 patients were in the RR group, 247 were in the N-RR. Preoperative rib hump was not statistically significant between the two groups (P=0.49). Final rib hump was 16.3 mm in RR patients and 29.8 mm in N-RR (P<0.001). RR had 60.5% rib hump correction; N-RR had 30.4% correction (P<0.001). Patient reported self-image (P=0.02) and mental health (P=0.01) scores had significantly improved in RR. No differences in 90-day complication rates (P=0.19) or self-reported return to activities (P>0.05).

CONCLUSION: Rib resectioned patients had approximately double the amount of rib hump correction at 60.5%, compared to those who did not undergo rib resectioning at 30.4%, with no increase in the rate of complications. RR patients had improved self-reported self-image and mental health scores, with no difference in timing for return to activities.

PMID:40384585 | DOI:10.1097/BRS.0000000000005392

Nurs Crit Care. 2025 May;30(3):e70055. doi: 10.1111/nicc.70055.

ABSTRACT

BACKGROUND: Increased workload is associated with a higher prevalence of missed nursing care.

AIM: Describe the prevalence of missed care in intensive care units (ICUs) and identify the workload scale most strongly associated with this prevalence.

STUDY DESIGN: A cross-sectional survey was combined with a longitudinal study conducted in 2024, between 15 January and 15 April, in France to assess the workload. A total of 1271 nurses working in 61 ICUs completed the questionnaire one time per shift.

RESULTS: A total of 72.3% of nurses reported at least one missed care. The Nursing Activities Score provided the strongest association with the prevalence of missed care compared to patient-to-nurse ratio and the Practice Environment Scale of the Nursing Work Index.

CONCLUSION: The prevalence of missed care and nursing workload was high. Nurses tended to focus on direct patient care.

RELEVANCE TO CLINICAL PRACTICE: Continuously assessing the prevalence of missed care can be a valuable tool for managing workload in ICUs.

PMID:40384582 | DOI:10.1111/nicc.70055

Stat Med. 2025 May;44(10-12):e70124. doi: 10.1002/sim.70124.

ABSTRACT

The MCP-Mod approach by Bretz et al. is commonly applied for dose-response testing and estimation in clinical trials. The MCP part of MCP-Mod was originally developed to detect a dose-response signal using a multiple contrast test, but it is not appropriate to make a specific claim that the drug has a positive effect at an individual dose. In this paper, we extend the MCP-Mod approach to obtain confirmatory p-values for detecting a dose-response signal as well as for the pairwise comparisons of the individual doses against placebo. We apply the closed test principle from Marcus et al. to the optimal contrast tests based on a candidate set of plausible dose-response shapes available at the planning stage of a clinical trial. We show that the contrast coefficients have to be optimized under suitable constraints to guarantee strong Type 1 error rate control at a pre-specified significance level. Motivated by a recent clinical trial, we evaluate the operating characteristics of the proposed methods in a comprehensive simulation study.

PMID:40384574 | DOI:10.1002/sim.70124

J Pineal Res. 2025 Apr;77(3):e70052. doi: 10.1111/jpi.70052.

ABSTRACT

Climate change, specifically high temperatures, can reduce soil moisture and cause hypersaline conditions, which creates an unsustainable agro-production system. Microbial symbionts associated with plants relinquish stressful conditions by producing stress-protecting substances. Melatonin is a signaling and stress-protecting molecule for plants, but is least known for microbial symbionts and their function in stress protection. Here, our study shows that the melatonin-synthesizing Bacillus velezensis EH151 (27.9 ng/mL at 96 h) significantly improved host plant (Glycine max L.) growth, biomass, photosynthesis, and reduced oxidative stress during heat and salinity stress conditions than the non-inculcated control. The EH151 symbiosis enhanced the macronutrient (P, Ca, and K) and reduced Na uptake in shoots during stress conditions. The microbial inoculation significantly expressed the high-affinity K⁺ transporter, MYB transcription factor, Salt Overly Sensitive 1, Na⁺/H⁺ antiporter 2, and heat shock transcription factors in spatio-temporal orders during heat and salinity stress (H&S 1, 3, 10, and 14 h). We observed that microbial strain significantly increased the plant’s endogenous abscisic acid (49.5% in H&S 10 h), jasmonic acid (71% in H&S 10 h), and melatonin biosynthesis (418% in H&S 14 h). Metabolome map of plant defense response showed that EH151 enhanced activation of amino acid metabolism pathways (e.g., glutamate (34%) L-aspartate (82%), glycine (18.5%), and serine (58%) under H&S 14 h compared to non-inoculation). Conversely, the free sugars and organic acids within the central carbon metabolism were significantly activated in non-inoculated combined heat and salinity stress compared to inoculated plants-suggesting lesser defense energy activated for stress tolerance. In conclusion, the current results show promising effects of the microbial abilities of melatonin that can regulate host growth and defense responses. Utilization of beneficial strains like B. velezensis EH151 could be the ideal strategy to improve stress tolerance and overcome the adverse impact of climate-induced abrupt changes.

PMID:40384569 | DOI:10.1111/jpi.70052

Stat Med. 2025 May;44(10-12):e70118. doi: 10.1002/sim.70118.

ABSTRACT

A dose optimization trial in oncology may be performed to compare an approved dose level of a given drug with a reduced dose level, testing the hypothesis that efficacy is maintained whilst reducing side effects and consequently improving adherence and quality-of-life. This is particularly relevant with modern therapeutic agents whose mechanisms of action imply that efficacy may not necessarily be linearly related to the dose. Using a conventional non-inferiority framework leads to large sample sizes that are often unfeasible in the phase IV setting. An alternative is to use a margin of practical non-inferiority, which we define in this paper and show how it can be exploited to justify a sample size. Whilst defining the extent of the margin, researchers also pre-specify the other dimensions of interest, such as receptor occupancy and/or side effects and quality-of-life, that will be used to establish practical non-inferiority if the observed efficacy of the reduced dose level lies within the margin. The comparison of efficacy is based on the observed difference between the reduced and the approved levels, instead of the confidence interval of this difference, leading to a reduction in sample size. The reduction in precision due to the smaller sample size is compensated by formally pre-specifying the additional dimensions to the decision process, allowing a more thorough assessment of the opportunity to reduce a dose in practice, with the many advantages that this may involve.

PMID:40384561 | DOI:10.1002/sim.70118

J Oral Rehabil. 2025 May 19. doi: 10.1111/joor.14011. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have examined the impact of tooth loss on nutrient intake, yielding mixed results.

OBJECTIVES: This cross-sectional study aimed to investigate the association among the number of teeth present, nutrient intake and food group consumption in Japanese adults with no history of the four major diseases (diabetes, cancer, heart disease and stroke).

METHODS: Data were obtained from the baseline survey of the Japan Multi-Institutional Collaborative Cohort study conducted in the Shizuoka and Daiko areas. Participants completed a self-administered questionnaire on their number of teeth, medical history (diabetes, cancer, heart disease and stroke), education level, employment status and lifestyle factors, such as diet, smoking history and exercise habits. The number of teeth was classified into four groups: 0 teeth, 1-19 teeth, 20-27 teeth and 28-32 teeth.

RESULTS: A total of 8912 individuals included in the analysis had a mean age ± SD of 51.7 ± 9.5 years, with women accounting for 53.6% of the total. In adult men, the number of teeth was negatively associated with the intake of vitamin D, n-3 highly unsaturated fatty acid intake and seafood, while in women, bread consumption was positively associated with the number of teeth.

CONCLUSIONS: These findings suggest that the number of teeth is independently associated with poor nutritional status in Japanese adults with no history of the four major diseases.

PMID:40384543 | DOI:10.1111/joor.14011

Stat Med. 2025 May;44(10-12):e70125. doi: 10.1002/sim.70125.

ABSTRACT

Given the rising complexity and burden of multimorbidity, it is crucial to provide evidence-based support for managing multimorbidity-related clinical outcomes. This study introduces a dynamic network approach to investigate conditional and time-varying interconnections in disease-specific clinical outcomes. Our method effectively tackles the issue of zero inflation, a frequent challenge in medical data that complicates traditional modeling techniques. The theoretical foundations of the proposed approach are rigorously developed and validated through extensive simulations. Using Taiwan’s health administrative claims data from 2000 to 2013, we construct 14 yearly networks that are temporally correlated, featuring 125 nodes that represent different disease conditions. Key network properties, such as connectivity, module, and temporal variation are analyzed. To demonstrate how these networks can inform multimorbidity management, we focus on breast cancer and analyze the relevant network structures. The findings provide valuable clinical insights that enhance the current understanding of multimorbidity. The proposed methods offer promising applications in shaping treatment strategies, optimizing health resource allocation, and informing health policy development in the context of multimorbidity management.

PMID:40384542 | DOI:10.1002/sim.70125

ANZ J Surg. 2025 May 19. doi: 10.1111/ans.70184. Online ahead of print.

ABSTRACT

INTRODUCTION: Limited knowledge exists on how post-graduate surgical coursework programs impact surgical research outputs in Australia. This study evaluated the impact of university-based teaching in research methods and supervisor characteristics on research quality and short-term research output for students undertaking the Master of Surgery (MS) post-graduate coursework degree within Australia.

METHODS: A retrospective cohort analysis of students enrolled in the dissertation for The University of Sydney MS program between 2010 and 2020. Grades for the dissertation and research subjects were extracted from the central university analytics. PubMed and Web of Science were used to determine if the dissertation was published and identify other publications by the students. A Google search was completed to identify supervisor characteristics. Statistical analysis involved logistic regression, multiple linear regression and negative binomial regression.

RESULTS: Three hundred and seventy-nine students were included in this study. Fifty-three percent of the students had an associated publication from their dissertation at a median of 18 months post-enrolment and a median journal impact factor of 2.19. Students averaged 2.1 additional publications (range 0-30) 2 years post-dissertation completion. Students with a distinction/high distinction grade in the dissertation subject or ≥ three journal publications prior were significantly more likely to publish their dissertation (OR 2.26, 95% CI = 1.42-3.61, p < 0.001; OR 3.35, 95% CI = 1.90-5.92, p < 0.001 respectively). Students who received a distinction/high distinction in the research methods subject had 64% more first-author publications within 2 years of finishing the dissertation (95% CI = 1.20-2.23, p = 0.002).

CONCLUSION: Engagement in structured teaching in research methods and prior research experience significantly improve short-term research output amongst early surgical researchers.

PMID:40384532 | DOI:10.1111/ans.70184

Int J Occup Saf Ergon. 2025 May 19:1-8. doi: 10.1080/10803548.2025.2499312. Online ahead of print.

ABSTRACT

Objective. This study aimed to determine the prevalence of enhanced physiologic tremor (EPT) among health personnel and identify common risk factors associated with this condition. Methods. The cross-sectional study was conducted at Benha University Hospital. A total of 535 healthcare professionals (HCPs) were involved in the final analysis. Neurological examinations were conducted under the supervision of the neurology department. Participants were considered to have a tremor according to the Consensus Statement criteria for the diagnosis of tremors. The generalized anxiety disorder assessment, the caffeine consumption questionnaire and the international physical activity questionnaire short-form were used to evaluate anxiety, daily caffeine consumption and physical activity levels, respectively. Results. The prevalence of EPT among HCPs was 5.42%. There was a statistically significant association between EPT and anxiety, smoking, caffeine consumption, sleep deprivation, past psychiatric history, regular exercising, and drug and substance usage. Conclusion. This study identified a high prevalence of EPT among HCPs. Factors associated with EPT include age, sleep deprivation, smoking, caffeine consumption, anxiety and psychiatric history. The findings highlight the need for mental health interventions to mitigate the EPT impact. Addressing stress and promoting well-being among HCPs is crucial for improving their work environment and performance.

PMID:40384531 | DOI:10.1080/10803548.2025.2499312