Nevin Manimala

Semin Pediatr Surg. 2025 Oct 15:151564. doi: 10.1016/j.sempedsurg.2025.151564. Online ahead of print.

ABSTRACT

BACKGROUND: Pancreatic trauma in the pediatric population is an uncommon but highly morbid injury. Its management remains controversial, with treatment strategies ranging from non-operative management (NOM) to upfront operative management (OM), primarily guided by the patient’s hemodynamic stability and the integrity of the main pancreatic duct. This systematic review and meta-analysis aim to elucidate the comparative effectiveness and safety of NOM versus OM for pediatric pancreatic trauma.

METHODS: Following PRISMA guidelines, a systematic search was conducted in seven major databases (including PubMed/MEDLINE, EMBASE, and Scopus) up to September 10, 2025. From 320 identified records, 17 observational studies met the eligibility criteria, comprising 1147 patients. A random-effects meta-analysis was performed to calculate pooled Odds Ratios (OR) with 95% Confidence Intervals (CI) for key outcomes, including mortality, overall complications, pancreatic pseudocyst, and fistula. Bayesian analysis was used for corroboration, and the certainty of evidence was assessed using the GRADE framework.

RESULTS: The analysis found no significant difference between NOM and OM for mortality (OR 0.89; 95% CI 0.48-1.66; I²=0%) or overall complications (OR 0.75; 95% CI 0.41-1.38; I²≈41%). However, a significant clinical trade-off emerged for specific complications. NOM was associated with a significantly higher risk of pancreatic pseudocyst (OR 2.56; 95% CI 1.55-4.23; I²=0%). Conversely, NOM was associated with a substantially lower risk of pancreatic fistula compared to OM (OR 0.27; 95% CI 0.11-0.69; I²=0%). Evidence for other secondary outcomes was largely inconclusive due to statistical imprecision. The certainty of evidence for all outcomes was rated as very low.

CONCLUSION: Non-operative management is a viable and safe primary strategy in selected pediatric patients with pancreatic trauma and does not appear to increase mortality. The therapeutic decision hinges on a crucial trade-off: NOM increases the risk of pseudocyst formation, while OM increases the risk of iatrogenic fistula. Despite the very low certainty of the available evidence-an inherent limitation of trauma research-these findings provide a critical framework for facilitating shared decision-making. Prospective, multi-center registry studies are urgently needed to establish more definitive guidelines.

PMID:41152091 | DOI:10.1016/j.sempedsurg.2025.151564

Med Intensiva (Engl Ed). 2025 Oct 27:502341. doi: 10.1016/j.medine.2025.502341. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the effect of early physiotherapy (ePHYS) on patients’ functional quality of life one year after discharge.

DESIGN: Prospective observational study.

SETTINGS: Adult polyvalent ICU.

PATIENTS OR PARTICIPANTS: Patients with SARS-CoV2 pneumonia requiring invasive mechanical ventilation between March 2020 and July 2022.

INTERVENTION: Early physiotherapy.

MAIN VARIABLES OF INTEREST: Quality of life measured by CFS, Barthel and SF36 on ICU admission, at hospital discharge and one year after hospital discharge.

RESULTS: Ninety-nine patients included. In the raw data analysis we observed statistically significant differences in SAPS-3 (Mdn_No-ePHYS = 59 [53.5-64.5]; Mdn_Yes-ePHYS = 53 [47-58]; P = .001). After propensity score, we did not observe statistically significant differences except for two SF-36 items: social activities (Mdn_No-ePHYS = 56.2 [37.5-71.9]; Mdn_Yes-ePHYS = 75 [62.5-97.5]; P = .004; Wilcoxon r effect size = 0.5) and one-year health transition (Mdn_No-ePHYS = 50 [50-75]; Mdn_Yes-ePHYS = 75 [50-100]; P = .031; Wilcoxon r effect size = 0.29), where patients who belonged to NO-ePHYS had lower scores than those who did receive ePHYS.

CONCLUSIONS: Despite not having found statistically significant differences in most of the items assessed, we should highlight that patients who received ePHYS reported a clear positive influence on their lives.

PMID:41152078 | DOI:10.1016/j.medine.2025.502341

Health Promot J Austr. 2026 Jan;37(1):e70121. doi: 10.1002/hpja.70121.

ABSTRACT

Apartments are often located in dense, mixed-use neighbourhoods designed to encourage walking and support healthier lifestyles; however, the extent to which these environments benefit all population groups equally with respect to weight-related outcomes is unclear. We investigated the association between neighbourhood disadvantage (ND) and body mass index (BMI) amongst urban Australian apartment dwellers and the extent to which their local neighbourhood environment, apartment building environment, and health behaviours contributed to this relationship. We surveyed residents (n = 955) from recently constructed apartment complexes (n = 108) in areas of low, mid, and high disadvantage across Sydney, Melbourne, and Perth. Residents in more disadvantaged neighbourhoods had higher BMIs than those in more advantaged areas, with BMI differences of 0.80 kg/m² (95% CI: 0.18, 1.42) and 0.98 kg/m² (95% CI: -0.01, 1.98) for middle and high disadvantage groups, respectively. Apartment building characteristics and neighbourhood characteristics contributed only marginally to this association, whilst meal consumption practises and physical activity behaviours emerged as key influences. The findings further underscore the entrenched relationship between ND and BMI, with a socioeconomic gradient present even for a population group that lives in more urban, higher density neighbourhoods. To address obesity-related inequities in Australia, there is a need for multifaceted interventions that support healthier energy-balance related behaviours amongst disadvantaged populations.

PMID:41152072 | DOI:10.1002/hpja.70121

Sleep Health. 2025 Oct 27:S2352-7218(25)00176-7. doi: 10.1016/j.sleh.2025.08.006. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: The goal of this study was to examine feasibility, acceptability, and preliminary efficacy of WePAP, a novel, couples-based treatment to promote positive airway pressure adherence in patients with obstructive sleep apnea and sleep quality in patients and partners.

METHODS: Patients who were recently diagnosed with obstructive sleep apnea and intended to start positive airway pressure and their partners completed pre-treatment self-report measures of study constructs and actigraphy. Couples were randomly assigned to WePAP or information control groups. Post-PAP assessments and adherence downloads were completed at 1 month and 3 months. Primary analyses evaluated feasibility, acceptability, and preliminary efficacy between the WePAP and information control groups. Secondary analyses examined between- and within-group changes in sleep, mood, and quality of life.

RESULTS: The study enrolled 37 midlife and older adults (n=74, age m=62.97; SD=9.04). WePAP couples were 100% adherent with the 3 sessions. Compared with the information control group, patients and partners in WePAP rated the intervention more favorably and were more satisfied. Positive airway pressure adherence was high in both groups and the difference was not statistically significant (PAP use ≥4h=76% in WePAP and 72% in information control at 3 months). There were significant within-group differences for sleep quality, such that patients in both groups showed significant improvements in self-reported sleep, mood, and quality of life at 3 months. Patients in both groups showed improvements in sleep-related daytime impairment; however, only partners in the WePAP group showed improvement in sleep-related daytime impairment.

CONCLUSIONS: The results demonstrate that WePAP is feasible and well-liked by patients and partners, but it did not demonstrate greater adherence or improved sleep quality in this sample of highly adherent patients. Future studies should examine longer-term outcomes and enroll patients at greater risk for nonadherence to positive airway pressure.

PMID:41152068 | DOI:10.1016/j.sleh.2025.08.006

J Orthop Sci. 2025 Oct 27:S0949-2658(25)00289-1. doi: 10.1016/j.jos.2025.10.005. Online ahead of print.

ABSTRACT

BACKGROUND: The distal femoral closing wedge osteotomy is a common method for treating the femoral deformity in knee osteoarthritis. However, due to the lack of appropriate surgical devices, there are shortcomings: difficulty of positioning hinge area, complex calculation of corrective angle, and hinge damage. This study aimed to develop a positioning device to solve the above problems.

METHODS: Computer-aided design software and three dimensional (3D) printer were used to design, modify, and print the novel device. The Sawbones experiment was used for functional verification and preliminary clinical application was conducted to evaluate the effectiveness of the device.

RESULTS: In the Sawbones experiment, with assistance of the novel device, the angle of the first positioning was more accurate than the conventional method (p < 0.05) and retained the fixed hinge width (p < 0.05). In preliminary clinical application, the average time for accurate positioning hinge was 75s and the average fluoroscopy was 2 times. Hinge fracture occurred in 1 case. The average operation time was 47 min. The hip-knee-ankle angle (HKA) improved from preoperative (171.16 ± 2.65°) to postoperative (180.55 ± 1.21°) (p < 0.01) and the mechanical lateral distal femoral angle (mLDFA) was significantly improved compared with the pre-operation (94.45 ± 1.26° vs 87.31 ± 1.10°, p < 0.01). The angle between the anatomic axis of the femur and the Blumensaat’s line (AFBL) was no statistically significant difference compared with the pre-operation (p > 0.05). After 9 months, the american knee society score (AKSS) was from preoperative (63.64 ± 4.74) to postoperative (92.82 ± 2.71) (p < 0.01) and Lysholm score was significantly improved (56.82 ± 5.38 vs 91.27 ± 2.24, p < 0.01). The pain symptoms were relieved and the visual analogue scales (VAS) was significantly reduced compared with the pre-operation (p < 0.01).

CONCLUSIONS: The positioning device had the functions of calculation-free of corrective angle and hinge retention, which was an efficient device for the distal femoral closing wedge osteotomy.

PMID:41152049 | DOI:10.1016/j.jos.2025.10.005

J Prosthet Dent. 2025 Oct 27:S0022-3913(25)00793-0. doi: 10.1016/j.prosdent.2025.10.020. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Research on the mechanical performance, particularly the fracture resistance, of recently introduced glass-composite and hybrid ceramic resin materials used with additive manufacturing (AM) and subtractive manufacturing (SM) techniques, and indicated for definitive restorations, remains limited.

PURPOSE: The purpose of this in vitro study was to evaluate and compare the fracture resistance of AM or SM crowns in different resin-based materials through fatigue cyclic loading and load-to-fracture testing.

MATERIAL AND METHODS: A standardized maxillary molar preparation was used to fabricate a zirconia master die, which was then scanned and reproduced in resin using a digital light processing (DLP) 3-dimensional (3D) printer. Two resins for AM (Pro Resins Crown X and Flexcera Smile Ultra+) and 2 resins for SM (Shofu HC and Brilliant Crios), all containing inorganic fillers (glass or ceramic), were used to fabricate identical computer-aided design (CAD) crowns (n=15). These crowns were then cemented using a standard protocol. Specimens underwent fatigue cyclic loading via 1.2 million cycles at 49 N, followed by the load-to-fracture test using a universal testing machine. Statistical analysis included 1-way ANOVA and the Tukey post hoc test (α=.05).

RESULTS: All crowns withstood cyclic loading. A statistically significant difference in fracture load was observed across different crowns manufactured by using different resin-manufacturing technology pairs (P<.001). SM-S group exhibited the lowest fracture resistance (2184 ±660.2 N), whereas the other 3 groups exceeded 2500 N, with no significant differences among them (P>.05).

CONCLUSIONS: AM crowns demonstrated fracture resistance comparable to SM crowns during and after fatigue cyclic loading and load-to-fracture tests. All crowns showed fracture resistance loads higher than previously reported clinically acceptable load values, supporting their potential for clinical use.

PMID:41152036 | DOI:10.1016/j.prosdent.2025.10.020

Dent Mater. 2025 Oct 27:S0109-5641(25)00793-6. doi: 10.1016/j.dental.2025.10.003. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to develop a bleaching hydrogel containing 6 %HP and Biosilicate®(BioS) doped with manganese oxide (MnO_BioS), irradiated with violet LED-light.

METHODS: MnO was incorporated into BioS via the oxide fusion route, and BioS/MnO_BioS (0 % and 10 %wt) were combined with 6 %HP. Particles and gel’s characterization (n = 5), bioactivity assay (FTIR), photocatalytic evaluation (MB/ppm), HP decomposition rate (%), and pH evaluation were performed. Enamel/dentin blocks (n = 10) were treated: 35 %HP (positive control), 6 %HP gels BioS/MnO_BioS (0 % and 10 % wt), irradiated or not with LED. Bleaching was performed in three 30-min sessions at 7-day intervals. Specimens were evaluated for color change (ΔE₀₀), whiteness index (ΔWI_D), surface hardness recovery (%SHR), carbonate and phosphate (CO₃²⁻/PO₄³ ⁻) ratio in enamel before (T₀) and after treatments (T₁), and surface morphology at T₁. Data were analyzed by two-way ANOVA with Tukey’s post-hoc (α = 0.05).

RESULTS: 6 %HP_MnO_BioS_LED increased gel photocatalysis, HP decomposition, and pH when compared to 6 %HP and 35 %HP (p < 0.05). 6 %HP_MnO_BioS_LED showed statistically similar results to 35 %HP in ΔE₀₀, ΔWI_D, Δa, Δb, and ΔL (p < 0.05). The 35 %HP and 35 %HP_LED showed the lowest %SHR, followed by the 6 %HP and 6 %HP_LED BioS and MnO_BioS-containing groups showed higher carbonate/phosphate ratios compared to the other groups (p < 0.05).

CONCLUSIONS: The groups containing MnO_BioS and BioS, regardless of LED-light irradiation, exhibited higher %SHR and carbonate/phosphate ratio compared to 35 %HP and 35 %HP_LED. Additionally, 6 %HP_MnO_BioS_LED increased gel pH, photocatalysis, HP decomposition and exhibited bleaching efficacy similar to 35%HP.

SIGNIFICANCE: This approach provides a safer alternative to 35 %HP gels, achieving superior bleaching outcomes with six times lower concentration of HP, while enhancing enamel calcium and phosphate levels and preserving mineral integrity.

PMID:41152034 | DOI:10.1016/j.dental.2025.10.003

Chemphyschem. 2025 Oct 28:e202500524. doi: 10.1002/cphc.202500524. Online ahead of print.

ABSTRACT

Using scanning tunneling microscopy, Cu and Co tetraphenyl monobenzo porphyrins are used as probe molecules to better understand the T-type interactions within well-ordered islands of Cu and Co tetraphenyl trans-dibenzo porphyrins on Cu(111). The islands are made up of molecular rows, held together by T-type interactions between isoindole and phenyl rings of adjacent molecules. The monobenzo molecules are found to be depleted within the bulk of the molecular rows and enriched at the edges terminating the rows. By counting over 50 000 molecules and using equilibrium considerations, the T-type interaction energies within the trans-dibenzo islands are estimated and the derived values are compared to values previously calculated with density functional theory, which find very good agreement for Cu-TPtdBP but less satisfying agreement for Co-TPtdBP.

PMID:41152015 | DOI:10.1002/cphc.202500524

Eur J Endocrinol. 2025 Oct 28:lvaf214. doi: 10.1093/ejendo/lvaf214. Online ahead of print.

ABSTRACT

OBJECTIVE: Lipodystrophy syndromes comprise a group of rare diseases characterized by loss of adipose tissue without nutritional or catabolic causes. As the rarity of these conditions necessitates collaboration, the European Consortium of Lipodystrophies (ECLip) established an international, longitudinal registry for patients with all forms of lipodystrophy (excluding HIV-associated cases).

METHODS: From December 2017 to November 2023, 19 centres from 13 countries recruited 631 patients into the ECLip registry. Cross-sectional data were analysed using descriptive statistics.

RESULTS: Prospective data was available for 467 patients (82.7%, female; 86.5% adults; median age 44.0 years). Familial partial lipodystrophy (FPLD) was the most common subtype (57.4%), especially FPLD2 (37.9%). However, in men congenital generalized lipodystrophy was nearly as common as FPLD (33.3% vs. 35.8%). Symptoms at onset varied by subtype, with loss of adipose tissue being the most frequent. More than 70% of the patients suffered from metabolic complications, particularly dyslipidaemia (59.0%) and diabetes (48.4%) but prevalence and severity varied between subtypes (prevalence of diabetes for example 76.9% in patients with acquired partial lipodystrophy vs 8.7% in acquired localized lipodystrophy). Metreleptin, the only disease-specific treatment, was used by 11.6% of all patients. 34 deaths were documented, primarily due to cardiovascular events and cancer. Patients with generalized forms of lipodystrophy died earlier compared to patients with partial forms (median age at death 27.0 vs. 72.0 years).

CONCLUSION: This study describes the largest cohort of patients with lipodystrophy reported to date. The dataset offers a comprehensive view of the epidemiology, clinical presentation, and associated comorbidities of lipodystrophy.

PMID:41152002 | DOI:10.1093/ejendo/lvaf214

Orthop Surg. 2025 Oct 28. doi: 10.1111/os.70194. Online ahead of print.

ABSTRACT

OBJECTIVE: Intraoperative femoral condylar avulsion fractures during total knee arthroplasty (TKA) are rare but potentially lead to joint instability and poor outcomes if not properly managed. However, the necessity of using condylar-constrained prostheses in these cases remains controversial. This retrospective study examines the incidence, management approaches, and radiological outcomes of these fractures.

METHODS: A total of 47 patients (11 males, 36 females; mean age 67.1 ± 7.0 years) with femoral condylar avulsion fractures were identified from 4290 TKAs performed between January 2008 and December 2022, matched with nonfracture patients at a 1:1 ratio by age, gender, and BMI. Intraoperative fractures were treated using cancellous bone screws or nonabsorbable sutures based on the size of the fracture fragment, without the insertion of condylar constrained prostheses. All patients underwent outpatient follow-up, with data collected on preoperative diagnosis, body mass index (BMI), knee range of motion (ROM), and type of prosthesis used. Key radiological indicators assessed included proximal tibia varus angle (PTVA), distal femoral valgus angle (DFVA), joint line congruence angle (JLCA), hip-knee-ankle angle (HKA), and preoperative subluxation status.

RESULTS: The incidence of femoral condylar avulsion fracture in primary TKA was found to be 1.1%. Over a follow-up period of 1.5-3 years, no instability was noted in any patients. Significant differences were observed between fracture and nonfracture groups in PTVA (82.02 ± 3.39 vs. 85.32 ± 1.87, p = 0.01), DFVA (85.53 ± 2.73 vs. 87.51 ± 5.29, p = 0.02), and HKA (8.81 ± 3.30 vs. 6.53 ± 2.21, p = 0.01). However, the Knee Society Score (KSS) at last follow-up showed no statistical difference (p = 0.05).

CONCLUSION: Femoral condylar avulsion fractures during primary TKA may be linked to joint deformities. Fixation methods using cancellous bone screws or nonabsorbable sutures, combined with a hinged knee brace, resulted in favorable clinical and radiological outcomes, with no need for prosthesis modification.

PMID:41152001 | DOI:10.1111/os.70194