Nevin Manimala

J Orthop Surg Res. 2025 Mar 7;20(1):249. doi: 10.1186/s13018-025-05641-2.

ABSTRACT

BACKGROUND: The emergence of multidrug-resistant bacteria has resulted in more complicated disease courses and worsening prognoses for patients with acute hematogenous osteomyelitis (AHO), increasing the necessity for surgical intervention. This research attempts to identify the risk variables related to surgical patients and build prediction models.

METHOD: From December 2015 to December 2022, children admitted to a single quaternary care pediatric hospital with AHO had their charts retrospectively reviewed. Based on the therapy methods, the patients were divided into 3 cohorts: multiple surgery, single surgery, and conservative care. Multivariate logistic regression analysis was used to identify independent risk factors related to single and recurrent surgery. A nomogram was created to visually represent the various risk factors, and a calibration curve was plotted to evaluate the model’s goodness of fit. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve were used to assess how well the models matched.

RESULTS: A total of 218 patients were included in the analysis, out of which 150 patients underwent surgical procedures, with 21 individuals undergoing multiple surgeries. The multivariate binary logistic regression revealed that an increase in absolute neutrophil counts (ANC) (adjusted odds ratio [aOR], 1.14 [95% confidence interval {CI}, 1.05-1.24]) and the presence of Methicillin-resistant Staphylococcus aureus (MRSA) (aOR, 6.97 [95% CI, 1.94-25.06]) were strong predictors of surgical intervention. The prediction model demonstrated an area under the curve (AUC) value of 0.76, while the Hosmer-Lemeshow test showed χ² = 7.3, P = 0.50. In another separated model, the C-reactive protein (CRP) level upon admission (aOR, 1.02 [95% CI, 1.00-1.03]) and the CRP level after the initial surgery (aOR, 1.04 [95% CI, 1.01-1.06]) strongly predict multiple surgeries, with the AUC value of 0.91 obtained and HosmerLemeshow test (χ² = 8.7, P = 0.36) yielded. The calibration curves of the two models were drawn separately, and it was observed that the slopes of both models were close to one.

CONCLUSION: Two prediction models were developed by statistical analysis of clinical data. Their accuracy and discrimination were validated, indicating a promising potential for clinical application.

PMID:40050999 | DOI:10.1186/s13018-025-05641-2

J Orthop Surg Res. 2025 Mar 6;20(1):244. doi: 10.1186/s13018-025-05635-0.

ABSTRACT

OBJECTIVE: Anterior cruciate ligament deficiency (ACLD) has traditionally been regarded as a contraindication for unicompartmental knee arthroplasty (UKA). However, advancements in surgical techniques and improvements in prosthetic manufacturing have challenged this notion. Controversy persists regarding whether the anterior cruciate ligament (ACL) influences the postoperative outcomes of fixed-bearing (FB) UKA. This study aimed to evaluate the impact of varying severities of ACLD on the clinical outcomes of FB-UKA.

METHODS: This retrospective analysis included 81 patients (87 knees) who underwent FB-UKA for anteromedial osteoarthritis (AMOA). Patients were categorised into three groups on the basis of preoperative MRI and intraoperative findings: the intact ACL group (31 knees), the partial ACLD group (39 knees), and the complete ACLD group (17 knees). Patient demographics (age, body mass index [BMI]), preoperative hip-knee-ankle angle (HKA), follow-up duration, and preoperative and last follow-up data, collected more than one year postoperatively, were recorded, including the Hospital for Special Surgery knee score (HSS), Lysholm score, visual analogue scale (VAS) for pain, range of motion (ROM), postoperative X-ray assessment of the position of the femoral component relative to the tibial component, as well as evaluation of radiolucent lines on the postoperative X-rays. Statistical analyses were conducted to determine differences in clinical outcomes, including pre-and postoperative changes, among the three groups. Postoperative complications, such as infection, aseptic loosening, prosthetic dislocation, or periprosthetic fractures requiring revision surgery, were recorded.

RESULTS: There were no significant differences among the three groups in terms of age, BMI, follow-up duration, preoperative HKA, baseline Lysholm score, HSS knee score, VAS score, or ROM (P > 0.05). Postoperatively, all three groups showed significant improvements in the Lysholm score, HSS knee score, VAS score, and ROM (P < 0.001), with no significant differences in the extent of improvement among the groups (P > 0.05). The position of the femoral component relative to the tibial component did not differ significantly among the groups (P > 0.05), and no radiolucent lines were observed in any of the patients. No patients experienced complications such as infection, aseptic loosening, periprosthetic fractures, or prosthetic dislocations that required revision surgery at the latest follow-up.

CONCLUSION: FB-UKA is a viable surgical option for the treatment of AMOA. For patients with AMOA and stable anteroposterior knee alignment, ACLD does not adversely affect short- to midterm outcomes following FB-UKA. Even in cases of partial or complete ACLD, careful patient selection and optimised surgical techniques can yield outcomes comparable to those in patients with intact ACLs.

PMID:40050997 | DOI:10.1186/s13018-025-05635-0

J Orthop Surg Res. 2025 Mar 7;20(1):251. doi: 10.1186/s13018-025-05633-2.

ABSTRACT

BACKGROUND: Current clinical studies on femoral head necrotic lesions primarily focus on the medial and lateral regions, while detailed MRI-based methods to evaluate the relationship between anterior or posterior necrosis and collapse remain lacking.

OBJECTIVE: By defining the anterior and posterior positions of the femoral head in MRI, a method was proposed for rapid clinical prognosis assessment of femoral head necrosis based on necrotic location.

METOHD: A retrospective analysis was conducted on TSE sequence T1W1 coronal plane images from 200 cases of femoral head necrosis. The frequency of necrotic lesions appearing on each MRI layer was statistically analyzed to construct a high-frequency necrotic layer set. Among these cases, 100 hips were randomly selected, and the relationship between femoral head collapse at one-year follow-up and different high-frequency necrotic layer sets was analyzed to identify the key necrotic layer set. Based on this, the anterior and posterior regions of the femoral head were defined on MRI. The remaining 100 hips were used as a validation set to assess the impact of anterior or posterior necrosis of the femoral head, as defined by this method, on collapse.

RESULTS: In this study, a total of eight high-frequency necrotic lesion layer sets (S1-S8) were constructed based on MRI data. Among them, S3 (L1 + L2 + L0 + L3) showed the strongest correlation with femoral head collapse, with an AUC of 0.662. Therefore, S3 was defined as the anterior side of the femoral head. Analysis of the validation set revealed that, using this method, the probability of femoral head collapse was 11.4 times higher when necrotic lesions appeared on the anterior side compared to the absence of necrosis on the anterior side.

CONCLUSION: In MRI, the anterior side of the femoral head corresponds to the S3 region, where necrosis increases the risk of collapse by 11.4 times.

PMID:40050989 | DOI:10.1186/s13018-025-05633-2

Environ Microbiome. 2025 Mar 6;20(1):28. doi: 10.1186/s40793-025-00688-4.

ABSTRACT

BACKGROUND: Theory predicts that biological communities can have multiple stable states in terms of their species/taxonomic compositions. The presence of such alternative stable states has been examined in classic ecological studies on the communities of macro-organisms (e.g., distinction between forest and savanna vegetation types). Nonetheless, it remains an essential challenge to extend the target of the discussion on multistability from macro-organismal systems to highly species-rich microbial systems. Identifying alternative stable states of taxonomically diverse microbial communities is a crucial step for predicting and controlling microbiome processes in light of classic ecological studies on community stability.

RESULTS: By targeting soil microbiomes, we inferred the stability landscapes of community structure based on a mathematical framework of statistical physics. We compiled a dataset involving 11 archaeal, 332 bacterial, and 240 fungal families detected from > 1,500 agroecosystem soil samples and applied the energy landscape analysis to estimate the stability/instability of observed taxonomic compositions. The statistical analysis suggested that both prokaryotic and fungal community structure could be classified into several stable states. We also found that the inferred alternative stable states differed greatly in their associations with crop disease prevalence in agroecosystems. We further inferred “tipping points”, through which transitions between alternative stable states could occur.

CONCLUSION: Our results suggest that the structure of complex soil microbiomes can be categorized into alternative stable states, which potentially differ in ecosystem-level functioning. Such insights into the relationship between structure, stability, and functions of ecological communities will provide a basis for ecosystem restoration and the sustainable management of agroecosystems.

PMID:40050988 | DOI:10.1186/s40793-025-00688-4

J Transl Med. 2025 Mar 6;23(1):278. doi: 10.1186/s12967-025-06317-5.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is the main cause of dementia with few effective therapies. We aimed to identify potential plasma biomarkers or drug targets for AD by investigating the causal association between plasma proteins and AD by integrating comprehensive Mendelian randomization (MR) and multi-omics data.

METHODS: Using two-sample MR, cis protein quantitative trait loci (cis-pQTLs) for 1,916 plasma proteins were used as an exposure to infer their causal effect on AD liability in individuals of European ancestry, with two large-scale AD genome-wide association study (GWAS) datasets as the outcome for discovery and replication. Significant causal relationships were validated by sensitivity analyses, reverse MR analysis, and Bayesian colocalization analysis. Additionally, we investigated the causal associations at the transcriptional level with cis gene expression quantitative trait loci (cis-eQTLs) data across brain tissues and blood in European ancestry populations, as well as causal plasma proteins in African ancestry populations.

RESULTS: In those of European ancestry, the genetically predicted levels of five plasma proteins (BLNK, CD2AP, GRN, PILRA, and PILRB) were causally associated with AD. Among these five proteins, GRN was protective against AD, while the rest were risk factors. Consistent causal effects were found in the brain for cis-eQTLs of GRN, BLNK, and CD2AP, while the same was true for PILRA in the blood. None of the plasma proteins were significantly associated with AD in persons of African ancestry.

CONCLUSIONS: Comprehensive MR analyses with multi-omics data identified five plasma proteins that had causal effects on AD, highlighting potential biomarkers or drug targets for better diagnosis and treatment for AD.

PMID:40050982 | DOI:10.1186/s12967-025-06317-5

BMC Rheumatol. 2025 Mar 6;9(1):28. doi: 10.1186/s41927-025-00478-y.

ABSTRACT

INTRODUCTION: Spondyloarthritis (SpA) exhibits predominantly musculoskeletal symptoms but also significant gastrointestinal (GI) and psychological manifestations. Subclinical gut inflammation is common in SpA, with frequent symptoms such as abdominal pain and diarrhea. Psychological issues like depression and anxiety are also prevalent, with a negative impact on quality of life. This study aimed to evaluate the presence of GI and psychiatric symptoms in SpA patients without inflammatory bowel disease (IBD) and their association with disease characteristics.

METHODS: Cross-sectional study, which included SpA patients from two rheumatology outpatient clinics. Patients were assessed for GI, and depressive symptoms (PHQ-9), perceived stress (PSS-10), disease activity (ASDAS, BASDAI) and functionality (BASFI). Laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and Secretory IgA. Statistical analysis involved Spearman correlation, linear regression, and multiple correspondence discriminant analysis (MCDA).

RESULTS: Among 98 SpA patients, 79.6% had axial SpA. High disease activity and functional impairment were common. 65.3% reported ≥ 2 GI symptoms, predominantly abdominal pain and diarrhea. Depression (PHQ-9 ≥ 10) was observed in 46.7% of patients, being moderate to severe in 25.0%. Depression, perceived helplessness, and lack of self-efficacy were associated with high disease activity and GI symptoms. MCDA identified strong correlations between depression, GI symptoms, and disease activity.

CONCLUSION: This study highlights the association between GI and psychological symptoms with disease activity and functionality in SpA patients. Depression and perceived helplessness are prevalent and closely associated with high disease activity and GI symptoms, suggesting the need for interdisciplinary management from early stages to improve patient outcomes.

PMID:40050979 | DOI:10.1186/s41927-025-00478-y

Trials. 2025 Mar 6;26(1):78. doi: 10.1186/s13063-025-08720-1.

ABSTRACT

BACKGROUND: Diabetes remains a significant contributor to global morbidity and mortality in the twenty-first century. Lifestyle modification strategies are widely recommended for effective diabetes management. Research suggests that a person-centered approach, implemented in either group or individual settings, offers considerable potential for improving long-term disease outcomes. Nutritional counseling using the operative group model has been tested and shown to yield positive health outcomes across diverse populations affected by diabetes. This study aims to evaluate the impact of group-based nutritional education, combined with individual standard care, compared to individual standard care alone, on health outcomes among patients diagnosed with type 2 diabetes.

METHODS: This study is a 12-month, parallel-group, randomized superiority controlled trial. Individuals diagnosed with type 2 diabetes will be randomized in a 1:1 ratio into one of two treatment arms: (1) individual usual care alone or (2) usual care supplemented with group-based nutritional education. The group nutritional education will consist of three sessions addressing the following themes: “Let’s Go Shopping,” “Healthy Plate,” and “Hunger and Satiety.” The primary outcome will be the change in HbA1c levels. Secondary outcomes will include fasting glucose, lipid profile, body mass, dinapenic abdominal obesity, blood pressure, eating behavior, adherence to nutritional counseling, and diabetes-related complications. All outcomes will be assessed at baseline and at 4, 8, and 12 months, except diabetes-related complications that will be assessed at baseline and 12 months. Sample size calculations were based on an estimated mean difference of 0.59 ± 1.39% in HbA1c with the intervention (patient-centered group), using a type I error rate of 5% and a type II error rate of 20%. It was determined that 88 participants per group (1:1 randomization; n = 176) would provide sufficient statistical power. Accounting for an anticipated dropout rate of 30%, a total of 252 participants will be recruited to ensure the necessary sample size is maintained throughout the study period.

DISCUSSION: The American Diabetes Association recommends interventions for patients with diabetes lasting more than 10 h over a period of 6 to 12 months to optimize health outcomes. Therefore, this study hypothesizes that integrating group-based nutritional education into standard treatment within a nutrition-specialized outpatient clinic may lead to further improvements in health parameters among individuals diagnosed with type 2 diabetes mellitus. TRIAL REGISTRATION {2A AND 2B}: Clinicaltrials.gov identifier, NCT05598203. Registered on 13 October 2022.

PMID:40050966 | DOI:10.1186/s13063-025-08720-1

J Orthop Surg Res. 2025 Mar 6;20(1):240. doi: 10.1186/s13018-024-05407-2.

ABSTRACT

PURPOSE: This study explored the anatomical variations and clinical implications of accessory ossicles in the spine, which are often identified incidentally but can significantly impact the differential diagnosis of spinal disorders.

METHODS: A comprehensive review of the literature from MEDLINE, the Cochrane Library, ScienceDirect, and Google Scholar up to April 2024 was conducted. Statistical analyses emphasized distinct patterns in prevalence, location, and correlation with symptoms, reinforcing the importance of accurate identification and appropriate patient management.

RESULTS: Limbus Vertebra (LV) was observed in 2.5% of the cases, predominantly in the lumbar spine (70%). Ossicles of the nuchal ligament were identified in approximately 5.6% of cases, with a higher prevalence in males than in females.Correlation analysis indicated a weak positive correlation between LV and symptom severity (r = 0.25, p = 0.05) and a strong positive correlation between the ossicles of the nuchal ligament and male predominance (r = 0.75, p < 0.01). Additional accessory ossicles, including Oppenheimer’s ossicles, accessory ossicles of the atlas, persistent ossiculum terminale, and os odontoideum, exhibited lower prevalence rates (< 2%), emphasizing their infrequency.

CONCLUSIONS: Accessory ossicles of the spine exhibit varied prevalence and clinical significance, with some presenting minor associations with symptoms and others linked to specific syndromes or spinal disorders. The prevalence of different ossicles shows notable heterogeneity, highlighting the need for careful differential diagnosis to prevent the misinterpretation of fractures or other spinal pathologies.

PMID:40050963 | DOI:10.1186/s13018-024-05407-2

BMC Sports Sci Med Rehabil. 2025 Mar 6;17(1):40. doi: 10.1186/s13102-025-01079-5.

ABSTRACT

BACKGROUND: This study aimed to investigate the relationship between exercise-induced leg pain, fear of pain, kinesiophobia and injury anxiety in amateur and professional athletes. Secondarily, the present study also aimed to investigate the relationship between women or men athletes and individual or team sports.

METHODS: A cross-sectional study was conducted with a total of 304 athletes. Participants were categorized as amateur and professional athletes, male and female athletes, individual and team athletes. Participants were evaluated with Exercise Induced Leg Pain Questionnaire (EILP), Fear of Pain Questionnaire (FOPQ), Sports Injury Anxiety Scale (SIAS), and Tampa Scale of Kinesiophobia (TSK). Parametric tests were used for statistical analysis. A statistical significance level of 0.05 was chosen.

RESULTS: Fear of pain and anxiety about sports injury were significantly less in men (p < 0.05). Loss of social support for sports injury anxiety was less in women (p < 0.05). Anxiety about sports re-injury was less in professional athletes (p < 0.05). Anxiety about letting down important Others and loss of social support were greater in team sports (p < 0.05). Besides, there was a positive, moderate, and significant correlation between the Fear of Pain Questionnaire- III Total and Tampa scale for kinesiophobia (r = 0.411, p < 0.01). Finally, a positive, moderate and significant correlation was found between Sport Injury Anxiety Scale Total and Tampa scale for kinesiophobia (r = 0.579, p < 0.01).

CONCLUSION: Exercise and movement were associated with psychological parameters related to injury and pain in athletes. Female athletes were found to have more injury anxiety and fear of pain. In addition, amateur athletes have more injury anxiety. Besides, injury anxiety was found to be higher in individuals in team sports. Future studies may further investigate these groups who are more disadvantaged in terms of anxiety, fear of pain and kinesiophobia. In addition, clinicians should pay attention to the criteria for a biopsychosocial approach by choosing appropriate descriptive phrases to avoid exacerbating athletes’ anxiety.

PMID:40050954 | DOI:10.1186/s13102-025-01079-5

BMC Nutr. 2025 Mar 6;11(1):49. doi: 10.1186/s40795-025-01034-0.

ABSTRACT

BACKGROUND: Legumes enhance food security in developing countries, necessitating an understanding of their properties. This study examined the nutritional, functional, and microbial qualities of legume-based flour blends from Small and Medium Enterprises (SMEs) in Malawi and Zambia. SMEs were chosen for their key role in local food production, distribution, and complementary food supply.

METHOD: A total of 36 legume-based flour blend samples were collected using snowball sampling, consisting of 21 samples (7 sets of 3 similar samples) from SMEs in Zambia and 15 samples (5 sets of 3 similar samples) from SMEs in Malawi. Samples were analyzed for proximate composition, energy, iron, and zinc content. The nutritional contributions to the Recommended Dietary Allowances (RDA) for children aged 1-3 years were assessed. Additionally, functional properties such as water-holding and oil-holding capacities were measured. Microbial analysis was performed, and the data were statistically analyzed to determine significance (p ≤ 0.05).

RESULTS: Our findings revealed substantial variability in the nutritional content of these flour blends. Protein content ranged from 9.4% to 41.5%, carbohydrates from 8.1% to 71.3%, crude fat from 2.3% to 26.8%, and crude fiber from 6.2% to 35.2%. Iron and zinc levels also varied significantly, from 2.9 to 21.9 mg/100 g and 2.2 to 5.2 mg/100 g, respectively. These inconsistencies highlight a lack of standardization in nutrient content for blends intended for infant feeding. When prepared as 96 g porridge servings for children aged 1-3 years, the blends provided notable contributions to the Recommended Dietary Allowance (RDA). However, their nutrient levels were generally lower compared to the standard Corn-Soy Blend Plus (CSB +). The flour blends also showed variations in physico-functional properties, and some had microbial loads exceeding 250 cfu/g, reflecting inadequate hygiene practices during processing.

CONCLUSION: To enhance their products, SMEs should ensure that their flour blends meet both nutritional and safety standards while striving to match or surpass the nutrient content of CSB + to remain competitive in the market.

PMID:40050953 | DOI:10.1186/s40795-025-01034-0