Nevin Manimala

Orthopadie (Heidelb). 2025 Sep 1. doi: 10.1007/s00132-025-04709-5. Online ahead of print.

ABSTRACT

BACKGROUND: The advent of navigation, followed by robotics in knee prosthetic surgery aims, among other things, to enhance the alignment of components and to improve the control of stress forces (i.e., weight, gravity, and static and dynamic stabilizers) on the bearing surface throughout the range of motion; however, the benefits of robotic-assisted total knee arthroplasty (TKA) are debated.

OBJECTIVE: This quasi-randomized controlled trial (RCT) compares robotic-assisted and conventional TKA, focusing on surgical duration, hospital stay and serum markers. It aims to address current gaps in the literature and clarify potential advantages.

MATERIAL AND METHODS: All patients who received a TKA at the Department of Orthopedic Surgery of the Eifelklinik St. Brigida in Simmerath, Germany, between 2021 and 2025 were prospectively invited to participate in the present clinical trial. All patients followed the same clinical, imaging, and anesthesiological presurgical and postsurgical pathways irrespective of their allocation. All surgeries were performed using a standard medial parapatellar approach and a functional alignment philosophy. Both groups received the same implants, and patients followed the same postoperative physiotherapy program. Deviation from the planned surgical procedure and rehabilitation protocol warranted exclusion from the study. For patients allocated to robotic-assisted TKA, the CORI system (Smith & Nephew plc, Watford, United Kingdom) was used.

RESULTS: A total of 1099 patients completed the study, 59% (649 of 1099) of the patients were women and 50% (547 of 1099) of TKAs were performed on the left side. The mean body mass index (BMI) was 30.2 ± 4.9 kg/m^2, and the mean age was 66.9 ± 8.2 years. Comparability was found between the two cohorts regarding the number of women, side of surgery, mean BMI, age, hemoglobin, hematocrit and leucocyte count at admission. Robotic-assisted TKA was associated with a longer surgical time of 1.6 min (p = 0.04) and a lower C‑reactive protein level at both the first (p = 0.0003) and fifth (p = 0.003) postoperative days. No other difference between groups was found.

CONCLUSION: Robotic-assisted TKA was associated with lower serum C‑reactive protein levels. No difference was found in the length of hospitalization and erythropoietic function in serum. Although the surgical execution of conventional TKA was statistically significantly faster, the clinical relevance of the endpoint surgical duration is negligible.

PMID:40888957 | DOI:10.1007/s00132-025-04709-5

World J Urol. 2025 Sep 1;43(1):523. doi: 10.1007/s00345-025-05901-0.

ABSTRACT

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has undergone numerous technological innovations recently that make it even less invasive, but global adoption of these innovations remains unclear. This study sought to compare the effect of region and education on the penetrance of recent advances in PCNL worldwide.

METHODS: An anonymous 32-item survey was developed and distributed via the Endourological Society’s Twitter/X account in November 2023. The survey collected data on participants’ geographic region, PCNL volume, fellowship training, and PCNL practices. Descriptive statistics were calculated, and chi-square or Fisher’s exact tests were used for comparisons.

RESULTS: Responses were received from 160 PCNL providers worldwide. Respondents were categorized by geography, fellowship training, and procedural volume. Spinal anesthesia was more commonly used by Asian providers (31%, p = 0.001), while supine positioning was notably more common in Europe (76%, p = 0.001). Asian providers favored pneumatic energy (63%), while North American and European providers more frequently used dual energy lithotripters (31-72%) and hemostatic tract agents (p < 0.001). High-volume providers and those with more post-fellowship experience tended to use smaller sheaths, including mini-PCNL. Postoperative imaging practices also varied by region and fellowship-training status.

CONCLUSION: PCNL practices vary significantly worldwide, influenced by regional, economic, and experiential factors. Our survey indicates a significant shift in practices with 41% of providers using supine position and over 50% doing tubeless PCNL. However, ultrasound access has been slow to gain widespread use with 73% still using predominantly fluoroscopy, similar to prior studies. Further randomized studies are needed to establish the clinical effectiveness of new technologies and to drive standardization of care across geographic and economic barriers.

PMID:40888955 | DOI:10.1007/s00345-025-05901-0

J Robot Surg. 2025 Sep 1;19(1):543. doi: 10.1007/s11701-025-02708-4.

ABSTRACT

The aim of our study is to compare and assess the correlation of preoperative factors, intraoperative events and post-operative outcomes of robot assisted transperitoneal (RATP) and robot assisted retroperitoneal (RARP) partial nephrectomy (PN) in T1 renal cancer. Data from 2609 patients during the period of 10 years who underwent either RATP or RARP partial nephrectomies was retrospectively analyzed. We compared preoperative factors (age, BMI, tumour size/stage, PADUA score, preoperative eGFR, history of previous abdominal and ipsilateral surgery), intraoperative events: operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and post-operative outcomes: complications, eGFR, positive surgical margins (PSM), and death due to disease (DOD) or due to other causes (DOC) and survival rates. Patients in the RATP-PN group were younger, PADUA score was similar in both groups-9, tumour size was smaller in RARP-PN. OT (103 min. vs 86 min) and WIT (23 min vs 10 min) were longer in RATP-PN (p < 0.001). EBL was higher in RATP-PN and in T1b tumours (p = 0). At 40 months follow-up, eGFR was same in both groups. There were slightly more Clavien-Dindo ≥3a complications in RARP-PN cohort. T1b tumours showed higher EBL than T1a tumours (p = 0). At end of follow-up, in RP group, 79.86% were alive, 3.87% DOD and 16.86% DOC; in TP cohorts, at 40 months of follow-up, 82.68% were alive, 2.66% DOD and 14.66% DOC. There is no relation between preoperative demographic or tumour factors on post operative complications. Tumour size and PADUA score had no effect on EBL Advanced age is a strong predictor for DOC in both T1a and T1b tumours; high PADUA score is associated with DOD in T1a tumours but not in T1b tumours.

PMID:40888954 | DOI:10.1007/s11701-025-02708-4

Acta Neurochir (Wien). 2025 Sep 1;167(1):235. doi: 10.1007/s00701-025-06647-9.

ABSTRACT

PURPOSE: Anterior choroidal artery (AChoA) aneurysms are rare and pose a significant treatment challenge due to the artery’s small caliber and critical vascular territory. Endovascular treatment (EVT) has become a preferred approach, but optimal management strategies remain debated. This study compares the efficacy and safety of different EVT techniques, including primary coiling, stent-assisted coiling (SAC), and flow diversion (FD), in treating AChoA aneurysms.

METHODS: Patients were categorized by endovascular technique, aneurysm morphology, and rupture status. Angiographic occlusion rates were assessed using the Raymond-Roy Occlusion Scale (RROS), and clinical outcomes were measured via the Modified Rankin Scale (mRS) at discharge and follow-ups. Statistical analyses compared occlusion rates, procedural complications, and functional outcomes among treatment groups.

RESULTS: In this study, 60 patients with 80 anterior choroidal artery aneurysms were treated. Among these, 44 aneurysms (55%) were classified as dependent, meaning the choroidal branch arose from the aneurysm dome or neck, while 36 aneurysms (45%) were independent, originating from the carotid artery near the choroidal branch. Primary coiling was used in 29 cases, stent-assisted coiling (SAC) in 21, and flow diversion (FD), with or without additional coiling, in 30 cases. Complete occlusion rates were significantly higher with SAC (83.3%) and FD (76.1%) compared to primary coiling (31.8%) (p < 0.05). Flow diversion was associated with more technical complications (25%), and ischemic events were more common in dependent aneurysms (p < 0.05). Importantly, no cases of symptomatic AChoA occlusion occurred after FD treatment. The overall mortality rate was 5%, with all deaths occurring in the primary coiling group among patients with ruptured aneurysms.

CONCLUSION: EVT of AChoA aneurysms is effective, with SAC and FD demonstrating superior occlusion rates compared to primary coiling. FD carries a higher risk of technical complications but maintains AChoA patency. To optimize outcomes, treatment choice should be guided by aneurysm morphology and patient risk factors.

PMID:40888948 | DOI:10.1007/s00701-025-06647-9

Lasers Med Sci. 2025 Sep 1;40(1):347. doi: 10.1007/s10103-025-04590-w.

ABSTRACT

The present study aimed to compare photobiomodulation (PBMT) and the use of a non-steroidal anti-inflammatory drug (NSAID), after surgical removal of lower lip lesions with a high-power diode laser. This was a series of 13 cases, in which all subjects were treated with high-power diode laser (808 nm) in continuous mode, with a power between 2.0 and 2.5 W. In the experimental group (G1) (n = 7), the subjects underwent PBMT using a low-power laser (LPL) (660 nm, 1 J, 40 mW, spot area of ​​0.04 cm², punctual), on the first, third and seventh post-surgery day. In the control group (G2) (n = 6), a NSAID (nimesulide 100 mg, every 12 h, for five days) was prescribed, and the LPL device was positioned, without being activated, to mimic the PBMT. The visual analogue scale (VAS) was applied to assess postoperative pain. The size of the surgical wound was measured immediately after surgery, as well as after two, seven, 15 and 30 days. For statistical analysis, the significance level was set at p < 0.05. Most subjects were male (53.8%) with a mean age of 44.7 years. Subjects in G1 reported less pain during follow-ups than those in G2, but with no significant differences between groups in all experimental times (p > 0.05). In the analysis, after seven days, the G1 presented a smaller surgical wound (p = 0.017). PBMT can be an alternative in relation to the use of nimesulide, allowing for less painful symptoms and optimization of the healing process.

PMID:40888946 | DOI:10.1007/s10103-025-04590-w

Behav Sleep Med. 2025 Sep 1:1-26. doi: 10.1080/15402002.2025.2552787. Online ahead of print.

ABSTRACT

OBJECTIVES: Sleep and depression are known to be related in patients with fibromyalgia but the strength of this association is not well defined. Hence, this study aimed to investigate the association between subjective and objective sleep parameters with depression and to quantitatively summarize the results.

METHODS: Five English databases (PubMed, Web of Science, Scopus, Science Direct, Google Scholar) were systematically searched for studies published between January 2000 and March 2025. Statistical analyses were performed using MedCalc software.

RESULTS: 28 studies matched the inclusion criteria, with a total sample size of 3,027 patients. Of these, 14 studies were included in the meta-analysis evaluating the association between PSQI and depression, which revealed a weakly positive association [pooled correlation coefficient r = 0.353 (95% CI: 0.264 to 0.435)]. In the meta-analysis of two PSG studies, TST showed a weak, non-significant inverse relationship with depression (r = -0.09). Other parameters WASO, sleep latency, sleep efficiency and % REM sleep also showed no significant associations. These PSG related findings remain non-conclusive and warrant further investigation.

CONCLUSION: This meta-analysis highlights that there is a weak to moderate level of positive association between subjective sleep quality and depression in patients with fibromyalgia. High-quality PSG studies are needed to clarify the relationship of PSG parameters with depression.

PMID:40888259 | DOI:10.1080/15402002.2025.2552787

Diabetes Obes Metab. 2025 Sep 1. doi: 10.1111/dom.70088. Online ahead of print.

ABSTRACT

AIMS: Type 2 diabetes (T2D) is a highly heterogeneous disease characterised by subtypes with variations in aetiology, disease progression, and risk of complications. However, potential drug targets for these subtypes have not been explored. This study aims to investigate potential drug targets by integrating proteomics.

MATERIALS AND METHODS: Summary-level data of circulating proteins were extracted from the UK Biobank and the deCODE Health Study. Genetic associations with five diabetes subtypes were obtained from Swedish All New Diabetics in Scania and Malmö Diet and Cancer cohort, including severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD). The associations between circulating proteins and diabetes subtypes were assessed through Mendelian randomisation, followed by multiple sensitivity and colocalization analyses. Additionally, tissue-specific, pathway and functional enrichment analysis, assessment of protein druggability, and the protein-protein interaction (PPI) networks were used to further explore biological mechanisms and therapeutic potential.

RESULTS: Genetically predicted levels of 2, 2, 9, 3, and 5 circulating proteins were associated with SIRD, SIDD, MARD, MOD, and SAID, respectively. Colocalization analyses further revealed links between GRN with MARD/SIRD, LILRB5 with SIDD/MARD, CR1 with MARD, TNFSF12 with MOD, and DAPK2 with SAID. Enrichment analysis suggested that these proteins were mainly enriched in blood and adipose tissues and involved in immune and inflammatory related pathways. PPI analysis revealed GRN, TNFSF12, and DAPK2 are associated with known T2D targets.

CONCLUSIONS: Our study identified several potential drug targets for different subtypes of diabetes using an integrated genetic approach, yielding new insights for precision medicine of diabetes.

PMID:40888248 | DOI:10.1111/dom.70088

Clin Nephrol. 2025 Sep 1. doi: 10.5414/CN111681. Online ahead of print.

ABSTRACT

INTRODUCTION: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are critical public health issues in South Korea, with an increasing number of dialysis patients. Cardiovascular outcomes, significantly affected by dyslipidemia, remain the leading cause of morbidity and mortality. This study explores the age and sex-specific impacts of dyslipidemia treatment on mortality in elderly hemodialysis patients.

MATERIALS AND METHODS: We conducted a retrospective cohort study with 2,736 newly diagnosed hemodialysis patients aged 70 years and older from 16 Korean hospitals (January 2010 to December 2017). The impact of statin therapy on mortality was assessed considering baseline characteristics, comorbidities, and lipid profiles. Statistical analyses included Kaplan-Meier survival curves and Cox proportional hazards models with covariate adjustments.

RESULTS: Statin use significantly reduced all-cause mortality in both men and women (hazard ratio (HR), 0.76 (0.66 – 0.87) in men; HR, 0.85 (0.73 – 0.99) in women). This benefit was not statistically significant in patients aged 80 and above, especially among females. An inverse relationship between low-density lipoprotein (LDL) levels, and mortality was observed in men, while a U-shaped relationship was noted in females. The unfavorable effects associated with lower LDL levels were more pronounced in the female group.

CONCLUSION: Dyslipidemia treatment improves survival in elderly hemodialysis patients, particularly in males, though benefits diminish in those aged 80 and above. Effective patient outcomes require addressing malnutrition and inflammation alongside lipid levels. Further research is necessary to refine treatment guidelines for this demographic.

PMID:40888194 | DOI:10.5414/CN111681

Soft Matter. 2025 Sep 1. doi: 10.1039/d5sm00633c. Online ahead of print.

ABSTRACT

Electrostatic correlation free energy (ECF) is the basis for modeling the thermodynamic behavior of polyelectrolyte solutions. In the past, it has mainly been estimated using the Edwards approximation, valid for infinite chains. Here, we show that the leading contribution due to finite molecular size is of order N^-1, regardless of the fractal dimension d, where N is proportional to molecular weight. This contribution is a local effect, originating from the missing correlations among connected charges near chain ends. In contrast, the contribution from the long-wavelength or infrared regime is weaker, of order N^-3/d ln N. Closed-form expressions for the free energy are provided for polyelectrolytes exhibiting either coil- or rod-like statistics, in the absence or presence of small ions. The consequence of the end effect is demonstrated by evaluating the phase diagram, surface tension, and molecular weight-driven partitioning.

PMID:40888180 | DOI:10.1039/d5sm00633c

Health Expect. 2025 Oct;28(5):e70408. doi: 10.1111/hex.70408.

ABSTRACT

BACKGROUND: User-generated content (UGC) on YouTube has reshaped news dissemination, fostered engagement, raised concerns about credibility, algorithmic influence and the spread of misinformation. This study addresses the gap in understanding how UGC engagement, trust and algorithmic awareness influence digital news consumption.

METHODS: A convergent parallel mixed-methods design was employed, integrating survey data (n = 100), qualitative interviews and content analysis of 200 YouTube news videos. Data were collected over 6 weeks. Quantitative analyses included ANOVA, multivariate regression and structural equation modelling (SEM), while qualitative data were thematically analysed to contextualise statistical findings.

RESULTS: UGC news consumption (M = 3.21, SD = 1.14) exceeded traditional news (M = 2.95, SD = 1.20), with trust in UGC (M = 3.48, SD = 1.05) surpassing traditional sources (M = 3.12, SD = 1.17). SEM analysis confirmed that UGC engagement significantly increased trust (β = 0.42, p < 0.001), while algorithmic influence negatively affected trust (β = -0.33, p = 0.015). Sensationalist content attracted higher engagement (30.0%) but had lower credibility, with misinformation prevalent in 38.0% of analysed videos.

CONCLUSION: Findings highlight the need for platform transparency, stronger content verification and policy interventions to balance engagement-driven algorithms and news credibility. Media literacy initiatives are crucial for equipping users with the critical evaluation skills they need.

PMID:40888149 | DOI:10.1111/hex.70408