Nevin Manimala

Knee Surg Sports Traumatol Arthrosc. 2025 Aug 19. doi: 10.1002/ksa.12810. Online ahead of print.

ABSTRACT

PURPOSE: Kinematic alignment (KA) in total knee arthroplasty (TKA) aims to restore the patient’s native joint anatomy by resurfacing the distal and posterior femoral condyles. However, the trochlear anatomy is often overlooked, raising concerns about potential relative internal rotation of the femoral component. The aim of this study was to define the 𠄈mid-flexion trochlear line’ (MTL) and assess its orientation relative to the posterior condylar line, hypothesising a parallelism between the two.

METHODS: A total of 158 knees (145 patients) undergoing KA TKA were prospectively analysed, after excluding post-traumatic osteoarthritis, cases with trochlear dysplasia, and femoral component flexion >5°. The anterior chamfer cut was conducted with a posterior referencing guide and the most prominent points of the medial and lateral trochlear facets-defining the MTL-were measured with a caliper. The MTL orientation relative to the posterior condylar line was calculated as the difference between the medial and lateral trochlear facets, with the two lines considered parallel for differences of 0 ± 1 mm. Two one-sided tests was implemented to assess equivalence between the two lines within a ±1 mm threshold. Correlations with coronal plane parameters (hip-knee-ankle angle [HKA], medial proximal tibial angle [MPTA] and lateral distal femoral angle [LDFA]) were assessed with Pearson’s correlation coefficient. Statistical significance was set at p < 0.05.

RESULTS: The mean difference between the medial and lateral trochlear facets was 0.1 ± 1.40 mm, with 81.7% of cases falling within the 0 ± 1 mm range, indicating parallelism between the posterior condylar line and the mid-flexion trochlear line (p = 0.709). No significant correlations were observed between MTL orientation and HKA, MPTA or LDFA.

CONCLUSIONS: Referencing the posterior condylar line accurately restores MTL orientation in the vast majority of patients, irrespective of coronal plane parameters. These findings support the biomechanical rationale of kinematic alignment, dispelling concerns about femoral component internal rotation.

LEVEL OF EVIDENCE: Level IV, prospective observational study.

PMID:40827491 | DOI:10.1002/ksa.12810

Urol Res Pract. 2025 Jul 29;51(4):146-152. doi: 10.5152/tud.2025.25001.

ABSTRACT

Objective: Dysfunctional voiding (DV) is an often-underdiagnosed condition primarily affecting younger patients with lower urinary tract symptoms (LUTS). Characterized by a lack of coordination between the detrusor muscle and the external urethral sphincter, DV commonly manifests as urinary frequency, urgency, and incontinence. Despite its significant impact, urodynamic studies (UDS), the gold standard for diagnosis, are frequently inaccessible in remote or under-resourced areas. This study investigates non-invasive clinical parameters to facilitate provisional DV diagnosis. Methods: A retrospective analysis of 813 patients who underwent UDS for LUTS over 3 years (2021-2024) was conducted. Excluding those with neurological disorders or urethral strictures, 516 patients were evaluated, identifying 67 with DV. Parameters were examined across 2 age groups: under 50 years and 50 years or older, focusing on symptomatology, uroflowmetry, and associated conditions. Statistical analyses, including Chi-square tests and multivariate logistic regression, were employed to identify significant predictors. Results: Of the 67 patients diagnosed with DV, 64 were under 50 years of age. Statistically significant associations were found between DV and increased diurnal frequency, pre-existing heightened anxiety, obstructive uroflowmetry patterns, constipation, and hypertonic anal sphincter. The proposed non-invasive criteria-SHADE (Staccato/obstructive voiding pattern, Heightened anxiety, Age <50, Diurnal frequency, Exclusion of stricture or neurological disease)-demonstrated over 95% positive predictive value for DV. Conclusion: Early and accurate diagnosis of DV can be enhanced through non invasive clinical criteria, particularly in settings where urodynamic testing is limited. Implementing the SHADE criteria can facilitate prompt, targeted management of DV, improving patient outcomes in resource-constrained environments.

PMID:40827436 | DOI:10.5152/tud.2025.25001

Physiother Theory Pract. 2025 Aug 19:1-10. doi: 10.1080/09593985.2025.2549455. Online ahead of print.

ABSTRACT

INTRODUCTION: Assessing the state of functioning and disability post-stroke is essential for managing treatment and allocating appropriate resources.

PURPOSE: To explore the minimal important change (MIC) of the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with chronic stroke using different statistical approaches.

METHODS: WHODAS 2.0 was administered at baseline and after six months. MIC was estimated through distribution-based methods, anchor-based approaches, and ROC curve analysis using the Youden’s index. A logistic regression model was also applied to estimate a predictive MIC (MIC_pred). Positive and negative predictive values (PPV and NPV) were estimated for three MIC thresholds.

RESULTS: Fifty participants with chronic stroke were included (48% male; mean age approximately 60 years). Most (78%) had mild disability, and 80% showed functional improvement after six months. MIC estimates varied: 1.6 points (standard error of measurement), 5.28 points (0.33 × SD), and 8 points (0.5 × SD). ROC analysis yielded an AUC of 0.67, Youden’s index of 0.35, sensitivity of 75%, specificity of 60%, and MIC ≤ 1.89 points. MIC_pred was 10.3 points (Nagelkerke R² = 0.078). The threshold of 5.28 points showed the best PPV (90.67%) and modest NPV (26.32%).

CONCLUSION: MIC values for WHODAS 2.0 in chronic stroke differ by method. The 5.28-point threshold offered the most balanced predictive value but should be interpreted cautiously. The findings support using multiple methods and emphasize the need for patient-centered assessment and methodological consistency in MIC determination.

PMID:40827421 | DOI:10.1080/09593985.2025.2549455

J Esthet Restor Dent. 2025 Aug 19. doi: 10.1111/jerd.70021. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of prolonged solvent evaporation on the clinical performance of universal adhesive systems in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS: A total of 148 NCCLs were randomly placed in 28 subjects according to: SUP5 (Scotchbond Universal Plus adhesive [ethanol-water] evaporated for 5 s); SUP25 (SUP evaporated for 25 s); GBU5 (Gluma Bond Universal adhesive [acetone-water] evaporated for 5 s); GBU25 (GBU evaporated for 25 s). Restorations were evaluated at baseline and 6 months, using the updated FDI criteria. Appropriate statistical analyses were performed (α = 0.05).

RESULTS: The recall rate was 100% at 6 months. The retention rates were 83.4% for SUP5, 97.3% for SUP25, 100% for GBU5, and 97.3% for GBU25. A significantly lower retention rate was observed for SUP5 compared to GBU5 (p = 0.04). No significant differences among the groups were observed when secondary parameters were evaluated (p > 0.05).

CONCLUSIONS: Prolonged solvent evaporation time, whether for ethanol-water or acetone-water based universal adhesives, did not improve their clinical performance in NCCLs after 6 months. However, the lowest retention rate was observed in the ethanol-water adhesive when evaporated for only 5 s.

CLINICAL SIGNIFICANCE: Extended solvent evaporation time for universal adhesives does not significantly affect their short-term clinical performance.

PMID:40827419 | DOI:10.1111/jerd.70021

Epilepsia. 2025 Aug 19. doi: 10.1111/epi.18604. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess and compare the detection rates of peri-ictal abnormalities using magnetic resonance imaging (MRI) and computed tomography perfusion (CTP) in patients with non-convulsive status epilepticus (NCSE).

METHODS: We conducted a systematic literature search in five databases up to February 2025. Studies reporting peri-ictal MRI abnormalities (PMAs) or cerebral perfusion abnormalities (CPAs) in patients with NCSE were included. Meta-analyses of proportions were performed using a random-effects model. Subgroup analyses and meta-regression were used to compare detection rates across imaging modalities.

RESULTS: Nineteen studies were included (15 MRI, 4 CTP), comprising 562 patients for MRI and 72 for CTP. The pooled detection rate of peri-ictal abnormalities was 50.0% (95% confidence interval [CI]: 34.0%-65.0%) for MRI and 79.3% (95% CI: 54.3%-92.5%) for CTP. Among the MRI modalities, arterial spin labeling (ASL) demonstrated the highest detection rate at 88.8% (95% CI: 32.9%-99.2%). CTP showed a significantly higher detection rate than MRI (χ² = 3.97, p = 0.046); meta-regression indicated increased odds of detection with CTP (odds ratio [OR] = 4.06, 95% CI: 0.97-16.99, p = 0.055). No statistically significant difference was found between ASL and CTP (χ² = 0.22, p = 0.636).

CONCLUSIONS: CTP demonstrates a higher detection rate than conventional MRI for peri-ictal abnormalities in patients with NCSE, supporting its utility in rapid diagnosis and differential workup. Among MRI sequences, ASL showed the highest detection rates, highlighting its potential role in the diagnostic assessment of NCSE. Although MRI remains essential for clarifying etiology, its effectiveness in detecting PMA is highly dependent on the sequences used.

PMID:40827398 | DOI:10.1111/epi.18604

Hypertension. 2025 Aug 19. doi: 10.1161/HYPERTENSIONAHA.125.25003. Online ahead of print.

ABSTRACT

BACKGROUND: Preeclampsia is characterized by hypertension, proteinuria, and elevated antiangiogenic sFlt-1 (soluble fms-like tyrosine kinase-1) levels. Despite extensive research, mechanisms underlying sFlt-1 dysregulation remain unclear. This hypothesis-testing study investigated whether ferroptosis, a lipid peroxidation-driven cell death mechanism, contributes to preeclamptic placental pathogenesis and sFlt-1 release, and whether drug repurposing could identify novel therapeutic options.

METHODS: We analyzed oxidized phosphatidylethanolamines in human preeclamptic and healthy placental tissues using redox phospholipidomics. In placental explants, we evaluated ferroptosis effects on sFlt-1 release using Ferrostatin-1 and deferoxamine as inhibitors. We screened 6520 FDA-approved drugs (pregnancy categories A-C) to identify effective ferroptosis inhibitors in primary trophoblasts. Statistical analyses used Student t test and 1-way ANOVA with multiple comparison corrections.

RESULTS: Preeclamptic placentas showed significant accumulation of oxidized phosphatidylethanolamines compared with controls. Inducing ferroptosis in placental explants increased sFlt-1 release, while inhibition using Ferrostatin-1 and deferoxamine reduced sFlt-1 levels (P<0.01). Our screen identified dipyridamole and promethazine as potent ferroptosis inhibitors, reducing lipid peroxidation, preserving glutathione levels, and decreasing sFlt-1 release in preeclamptic explants.

CONCLUSIONS: This study establishes placental ferroptosis as a key mechanism in early preeclampsia and demonstrates its direct link to sFlt-1 dysregulation. Our systematic drug screening approach identified approved drugs with antiferroptotic activity, suggesting a novel therapeutic strategy for preeclampsia management through drug repurposing. Further research is needed to establish optimal dosing and confirm efficacy in vivo.

PMID:40827397 | DOI:10.1161/HYPERTENSIONAHA.125.25003

Clin Neuropsychol. 2025 Aug 19:1-20. doi: 10.1080/13854046.2025.2541661. Online ahead of print.

ABSTRACT

Objective: Intra-individual cognitive variability (IICV) has been found to predict cognitive decline and dementia incidence among older adults based on a one follow-up testing paradigm while the association between IICV and daily functioning is less studied. The current study intended to investigate the predictability of IICV on the trajectory of decline in cognition and self-report daily functioning among older adults, tracked with multiple time points. Method: The current study employed a diverse, longitudinal, archival data set from the Rush Alzheimer’s Disease Center (N = 4,319) and examined 5 waves of data with growth curve modeling. Multiple sensitivity analyses were followed up to scrutinize the robustness of study results, accounting for demographic covariates, baseline mean cognitive performance, skewness, and attrition. Results: Results supported the main hypothesis that the trend of IICV predicted the trajectory of cognition, β = .-57, p = .002, and self-reported daily functioning, β = .48, p = .037, and the results were robust against the inclusion of covariates, skewness, and attrition. Conclusions: With a rigorous methodology and statistical approach, the current study contributed to the scientific and medical understanding of IICV and lent support to the clinical use of IICV in neuropsychological assessment. Methodological strengths and limitations were noted.

PMID:40827377 | DOI:10.1080/13854046.2025.2541661

Urol Res Pract. 2025 Jul 29;51(4):136-140. doi: 10.5152/tud.2025.24053.

ABSTRACT

Objective: This retrospective cross-sectional study aimed to compare functional and surgical outcomes after open simple prostatectomy (OSP) between patients who underwent prior transurethral resection of the prostate (TURP) and those who did not. Methods: Between March 2009 and April 2019, 723 patients underwent TURP, of whom 20 (2.7%) subsequently underwent OSP (Group 1). This group was matched with a group of patients who had solely undergone OSP (Group 2), with matching criteria including age, prostate-specific antigen level, prostate volume, and prostate weight. Results: Group 1 showed a statistically significant lower decrease in hemoglobin levels after surgery (p = .006); however, no significant differences were observed between the groups in terms of operation time (P=.508), hospital stay (P=.065), transfusion rate (P=.331), enucleated prostate volume (P=.733), or changes in creatinine levels (P =.418). Regarding early postoperative complications, the 2 groups showed no significant difference (0.349). Late postoperative complications occurred in 30% of Group 1 and 33% of Group 2, which was not significantly different either (P = .241). Both groups achieved similar early continence rates (88%) within the first 6 months after surgery. Late continence rates (after 6 months) were also comparable, with 94% in Group 1 and 88% in Group 2. Finally, no significant differences were found in patient satisfaction levels, measured on a qualitative scale ranging from “dissatisfied” to “highly satisfied.” Conclusion: Prior TURP did not significantly affect the surgical or functional outcomes of subsequent OSP, with comparable results observed between patients with and with- out a history of TURP.

PMID:40827367 | DOI:10.5152/tud.2025.24053

Psychiatry Clin Psychopharmacol. 2025 Jun 25;35(3):304-310. doi: 10.5152/pcp.2025.241063.

ABSTRACT

Background: Rhinoplasty, performed for aesthetic and functional purposes, is among the most common cosmetic procedures worldwide. While previous studies have investigated the impact of social media and self-esteem on cosmetic surgery motivations, comparisons between aesthetic and functional rhinoplasty candidates remain limited. This study evaluates the sociodemographic, psychological, and behavioral profiles of these groups, focusing on social media use and self-esteem. Methods: This cross-sectional study included 103 rhinoplasty candidates divided into 2 groups based on their primary motivation: functional (Group 1) or aesthetic (Group 2). Data were collected using a Sociodemographic Data Form, the Rosenberg Self-Esteem Scale (RSES), and the Bergen Social Media Addiction Scale (BSMAS). Statistical analyses included chi-square, Fisher’s exact test, and Mann-Whitney U-tests. Results: Most participants (70.9%) sought rhinoplasty for aesthetic reasons. The median age of Group 2 (23.0) was significantly lower than that of Group 1 (29.5) (P < .001). Females and single individuals were more likely to seek aesthetic rhinoplasty (P < .001). Social media use, particularly Instagram, was significantly higher in Group 2; 53.4% spent over 3 hours daily on social media, compared to 10% in Group 1 (P < .001). Group 1 showed higher self-esteem scores than Group 2 (34.0 vs. 31.0, P < .001). Conclusion: Aesthetic rhinoplasty is associated with a younger age, female gender, lower self-esteem, and greater social media use. These findings emphasize the need for preoperative assessments addressing psychological vulnerabilities and social media influences to improve patient satisfaction and outcomes.

PMID:40827351 | DOI:10.5152/pcp.2025.241063

Int J Cosmet Sci. 2025 Aug 19. doi: 10.1111/ics.70020. Online ahead of print.

ABSTRACT

OBJECTIVE: Over the last two decades, consumers have been calling for greater transparency for ingredient sourcing and manufacturing practices; therefore, more sustainable alternatives need to be evaluated to meet industry demands. While many organizations give standards for ‘clean’, ‘organic’ and ‘natural’ cosmetic products, sustainable formulations lack standardization and harmonization globally. This study aimed to formulate sustainable lipsticks and moisturizers using resources and standards currently available in the cosmetic industry and compare select sustainable alternatives to a conventional control product.

METHODS: After thoroughly screening ingredients for each product type, five different lipsticks and five batches of moisturizers were formulated and tested for quality, performance and stability characteristics.

RESULTS: Pay-off and friction were the most different among the lipsticks, with M4, the lipstick containing sustainable ingredients, having the highest average friction and pay-off at Week 1. As for the moisturizers, spreadability had the largest differences, mostly due to the different emulsifier systems, as expected.

CONCLUSION: Incorporating sustainable ingredients can be challenging, but having quality products while being more environmentally friendly is possible. These case studies are meant to serve as examples for formulation chemists.

PMID:40827337 | DOI:10.1111/ics.70020