Nevin Manimala

JMIR Form Res. 2025 Feb 12;9:e59533. doi: 10.2196/59533.

ABSTRACT

BACKGROUND: In the Netherlands, 545,900 people experienced chronic obstructive pulmonary disease (COPD) in 2022. Physical therapy following the Royal Dutch Society for Physiotherapy (Koninklijk Nederlands Genootschap voor Fysiotherapie) guidelines for COPD treatment is a proven effective treatment for people with COPD. The revised guidelines include a new recommendation: a patient’s physical activity level should be assessed with an activity tracker (AT). Literature shows that the implementation of eHealth in clinical practice, in this case, ATs, is challenging.

OBJECTIVE: This study aims (1) to assess how and why ATs are currently used in physical therapy in patients with COPD and (2) to determine which barriers and facilitators are of relevance for optimal implementation of ATs during the clinical reasoning process of physical therapists in patients with COPD.

METHODS: A cross-sectional study was used to evaluate the implementation of ATs in physical therapy. Included participants were physical therapists who were affiliated with Chronisch ZorgNet and had a specialization in COPD treatment. The survey content was based on the Consolidated Framework for Implementation Research, the theory of planned behavior, the framework “experiences of patients with commercially available ATs,” and the Koninklijk Nederlands Genootschap voor Fysiotherapie guidelines for COPD. Physical therapists were questioned via a digital survey.

RESULTS: In total, 211 completed surveys were analyzed. Of the 211 participating physical therapists, 108 (51.2%) used ATs, whereas most of them (n=82, 75.9%) already used ATs before it was advised in the guidelines. Physical therapists indicated that the most important reason to use ATs is that they experience it as an added health care value. Both users and nonusers indicated that the most important reason why they do not use ATs is because their patients do not want to use an AT. The second reason was a lack of knowledge in the nonuser group. Moreover, both users and nonusers indicated that the implementation of ATs was not prepared and planned for within their center.

CONCLUSIONS: Overall, these results show that ATs are not yet fully implemented in the Dutch general physical therapy practice in patients with COPD, as recommended by current evidence-based guidelines. Physical therapists need guidance for the successful implementation of ATs. This could be accomplished by providing training for physical therapists, integrating ATs into the education of (future) physical therapists, and providing support during the implementation process of ATs for both the physical therapists and management.

PMID:39937970 | DOI:10.2196/59533

JBJS Rev. 2025 Feb 12;13(2). doi: 10.2106/JBJS.RVW.24.00201. eCollection 2025 Feb 1.

ABSTRACT

BACKGROUND: Since its inception, activity level and bone quality have been essential considerations for patients undergoing hip resurfacing arthroplasty (HRA). Moreover, younger patients tend to experience fewer complications, lower revision rates, and better outcomes after any surgery. This study aims to compare the clinical outcomes, complication rates, and survivorship rates between younger and older patients undergoing HRA, providing insights into whether active older patients with appropriate bone quality can still achieve significant benefits from HRA.

METHODS: A literature search was conducted using PubMed, Embase, and Scopus databases. Articles were screened by title and abstract, followed by full-text review. A meta-analysis was performed using a random effects model to compare UCLA scores and odds of prosthesis survivorship between younger (<50 years of age) and older (>50 years of age) patients in studies comparing both age groups. Statistical significance was defined as a 95% confidence interval that does not include 1. In addition, the average complication and prosthesis survivorship rates were calculated and compared between younger and older hips using both comparative and noncomparative studies.

RESULTS: From an initial pool of 1,286 articles, 31 met inclusion criteria, encompassing 22,691 patients. Analysis revealed a pooled mean age of 33.65 years for the younger cohort and 63 years for the older cohort, and a complication rate of 5.37% in younger compared with 3.83% in older hips. The difference in postoperative UCLA scores was deemed statistically insignificant based on meta-analysis. However, the difference in mean survivorship rates was found to be statistically significant at 86% for younger and 94.9% for older patients through univariate analysis and meta-analysis.

CONCLUSION: There is no significant difference in postoperative outcomes between younger and older patients undergoing HRA. In fact, older patients seem to experience higher prosthesis survivorship rates compared with younger cohorts. Older patients who are active and possess good bone quality can achieve outcomes comparable to their younger counterparts, indicating that HRA may be viable for a broader age range than previously considered.

LEVEL OF EVIDENCE: Level III, systematic review of Level II, III, and IV studies. See Instructions for Authors for a complete description of levels of evidence.

PMID:39937926 | DOI:10.2106/JBJS.RVW.24.00201

Sci Adv. 2025 Feb 14;11(7):eadt5088. doi: 10.1126/sciadv.adt5088. Epub 2025 Feb 12.

ABSTRACT

Climate change affects lightning frequency and wildfire intensity globally. To date, model limitations have prevented quantifying climate-lightning-wildfire interactions comprehensively. We exploit advances in Earth System modeling to examine these three-way interactions and their sensitivities to idealized CO₂ forcing in 140-year simulations. Lightning sensitivity to global temperature change (+1.6 ± 0.1% per kelvin) is mitigated by compensating atmospheric effects. Global burned area sensitivity to temperature (+13.8 ± 0.3% per kelvin) is largely driven by intensified fire weather and increased biomass but marginally by lightning changes. We find a universal law characterizing regional-scale modeled fire activity and its CO₂ sensitivity, consistent with basic principles of statistical mechanics. Last, a negative climate feedback through intensified aerosol direct effect from fire emissions reaches an equivalent decrease of 0.91 ± 0.01% in CO₂ radiative forcing. However, this feedback contributes to polar amplification. Our analysis shows that climate-lightning-wildfire interactions involve multiple compensating and amplifying feedbacks, which are sensitive to anthropogenic CO₂ forcing.

PMID:39937907 | DOI:10.1126/sciadv.adt5088

Braz J Cardiovasc Surg. 2025 Feb 12;40(1):e20240088. doi: 10.21470/1678-9741-2024-0088.

ABSTRACT

OBJECTIVER: The aim of this study was to determine the clinical outcomes of patients with acute type A aortic dissection comparing proximal aortic repair vs. total arch replacement.

METHODS: This was a retrospective cohort study. We included all acute type A aortic dissection procedures from January 2002 to November 2022. Groups were defined according to the extent of aortic replacement (hemiarch repair vs. total arch replacement). We collected data from pre, intra, and postoperative variables. Our main endpoints were stroke rate, spinal cord injury, and in-hospital mortality. We performed a statistical analysis for between-group comparisons according to the nature and distribution of variables. Bivariate analyses were done using the Mann-Whitney U test and for categorical variables, the Chi-square test or Fisher’s exact test. Significance was established at alpha level of 0.05.

RESULTS: We identified 107 acute type A aortic dissection procedures (69 hemiarch repairs vs. 38 total arch replacements). There were no differences in postoperative outcomes such as surgical site infection or acute kidney injury. Bleeding reoperation was more frequent in the hemiarch group (30% vs. 11 %). We did not find statistically significant differences in stroke rate, spinal cord injury, or in-hospital mortality.

CONCLUSION: Acute type A aortic dissection treatment is still a challenge. Total arch replacement does not increase the risk of major early postoperative complications in comparison to hemiarch repair. The extended repair seems to provide benefits such as a lower risk of reoperation. Total arch replacement should be performed in selected patients, as it may improve long-term outcomes.

PMID:39937874 | DOI:10.21470/1678-9741-2024-0088

PLoS One. 2025 Feb 12;20(2):e0317679. doi: 10.1371/journal.pone.0317679. eCollection 2025.

ABSTRACT

Inspiratory muscle weakness may affect exercise tolerance; however, the relationship between inspiratory muscle strength and the 6-minute walk distance (6MWD) in patients with acute heart failure (AHF) is unknown. This study aimed to quantitatively investigate the association between inspiratory muscle strength at the start of cardiac rehabilitation (CR) and 6MWD at discharge in patients with AHF. This single-center, retrospective, observational study enrolled 275 patients with AHF who underwent CR. Patients unable to walk before admission, with isometric knee extensor strength/weight (%IKES) < 0.3 kgf/kg at the start of CR, or unable to undergo examination were excluded. Maximum inspiratory mouth pressure (PI-max) was used as an indicator of inspiratory muscle strength and was measured at the start of CR. The measured PI-max was divided by the predicted value and used for analysis (%PI-max). The primary outcome was 6MWD, an indicator of exercise tolerance, and was measured at discharge. Statistical analysis was performed using multiple regression analysis, with 6MWD at discharge as the dependent variable and %PI-max at the start of CR as the independent variable. Covariates were age, New York Heart Association class, physical frailty, and %IKES at the start of CR. The final analysis included 94 patients (median age 83.0 years, 57.5% male). Multiple regression analysis showed that %PI-max at the start of CR was significantly associated with 6MWD at discharge even after adjustment for covariates (β = 0.223, 95% confidence interval: 0.063-0.382, p = 0.007). PI-max was a factor associated with 6MWD at discharge in patients with AHF. In conclusion, increased inspiratory muscle strength may contribute to improved 6MWD in patients with AHF.

PMID:39937872 | DOI:10.1371/journal.pone.0317679

Mutagenesis. 2025 Feb 12:geae029. doi: 10.1093/mutage/geae029. Online ahead of print.

ABSTRACT

DNA damage is a common event in cells, resulting from both internal and external factors. The maintenance of genomic integrity is vital for cellular function and physiological processes. The inadequate repair of DNA damage results in the genomic instability, which has been associated with the development and progression of various human diseases. Accumulation of DNA damage can lead to multiple diseases, such as neurodegenerative disorders, cancers, immune deficiencies, infertility and aging. This comprehensive review delves the impact of alterations in DNA damage response genes (DDR) and tries to elucidate how and to what extent the same traits modulate diverse major human diseases, such as cancer, neurodegenerative diseases, and immunological disorders. DDR is apparently the trait connecting important complex disorders in humans. However, the pathogenesis of the above disorders and diseases are different and leading to the divergent consequences. It is important to discover the switch(es) that direct further the pathogenic process either to proliferative, or degenerative diseases. Our understanding the influence of DNA damage on diverse human disorders may enable a development of the strategies to prevent, diagnose, and treat these diseases. In our article, we analysed publicly available GWAS summary statistics from the NHGRI-EBI GWAS Catalog and identified 12,009 single nucleotide polymorphisms (SNPs) associated with cancer. Among these, 119 SNPs were found in DDR pathways, exhibiting significant p-values. Additionally, we identified 44 SNPs linked to various cancer types and neurodegenerative diseases (NDDs), including four located in DDR-related genes: ATM, CUX2, and WNT3. Furthermore, 402 SNPs were associated with both cancer and immunological disorders, with two found in DDR gene RAD51B. This highlights the versatility of the DDR pathway in multifactorial diseases. However, the specific mechanisms that regulate DDR to initiate distinct pathogenic processes remain to be elucidated.

PMID:39937585 | DOI:10.1093/mutage/geae029

Cancer. 2025 Feb 15;131(4):e35725. doi: 10.1002/cncr.35725.

ABSTRACT

BACKGROUND: Previous estimates of the number of cancers attributable to physical inactivity in the United States have typically focused on only three malignancies (colon, endometrial, and postmenopausal breast cancer). Contemporary epidemiologic evidence suggests that physical inactivity could contribute to up to 15 types of cancer, and a dose-response effect has been demonstrated for 13 of these. This study estimated the number of cancers diagnosed in the United States in 2015 due to physical inactivity for these 13 sites.

METHODS: Data from the 2005 National Health Interview Survey were used to estimate physical activity prevalence and, with the assumption of a 10-year latency period, 2015 cancer incidence data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Incidence US Cancer Statistics Public Use Database.

RESULTS: The potential impact fraction was estimated to be 4.1%, which meant that 30,951 of 761,625 incident cancers at the 13 sites could have been prevented in the United States in 2015 if adults had increased physical activity by one category in 2005 (approximately 7.5 additional metabolic equivalent task hours per week [MET-h/week]). Theoretically, 85,415 of 761,625 incident cancers at the 13 sites (population attributable fraction, 11.2%) could have been prevented if all adults had achieved the highest level of physical activity (>30 MET-h/week).

CONCLUSIONS: When estimates are based on updated epidemiologic evidence regarding physical inactivity and cancer risk, substantially more cancers are attributable to physical inactivity than previously reported. A greater focus on physical activity promotion is warranted for cancer control in the United States.

PMID:39937584 | DOI:10.1002/cncr.35725

Lymphat Res Biol. 2025 Feb 12. doi: 10.1089/lrb.2024.0006. Online ahead of print.

ABSTRACT

Background: Female genital lymphedema (FGL) is a challenging disease, and appropriate preoperative evaluation is crucial before surgical treatments. Computed tomography (CT) is expected useful for FGL evaluation, but little is known. This study aimed to clarify characteristic CT findings of FGL with a case report of CT findings-guided lymphaticovenous anastomosis (LVA). Methods: Medical charts of secondary lower extremity lymphedema patients who underwent CT and indocyanine green (ICG) lymphography were reviewed. Genital regions with dermal backflow patterns on ICG lymphography were diagnosed as FGL. Prevalence of characteristic CT findings of lymphedema was compared between genitalia regions with and without FGL. A case of genital lymphedema treated with LVA under the guidance of CT findings was presented. Results: A total of 51 patients (32 with FGL, and 19 without FGL) were included in this study. Genital ICG included stages 0/I/II/III/IV/V in 19 (37.3%)/5 (9.8%)/11 (21.6%)/9 (17.6%)/7 (13.7%)/0 (0%) cases, respectively. Characteristic CT findings included thick skin in 14 (27.5%), thick fascia in 17 (33.3%), high density of the superficial fat in 11 (21.6%), high density of the deep fat in 13 (25.5%), fluid collection in 8 (15.7%), detectable inguinal lymph node in 42 (82.4%), and honeycomb appearance in 7 regions (13.7%). Between genital regions with and without FGL, there were statistically significant differences in all the characteristic CT findings (p < 0.05). Conclusions: Characteristic CT findings of secondary FGL were identified. Preoperative CT evaluation may be useful for selecting appropriate LVA sites for optimal results.

PMID:39937577 | DOI:10.1089/lrb.2024.0006

J Surg Res. 2025 Jan;305:237-245. doi: 10.1016/j.jss.2024.11.031. Epub 2024 Dec 27.

ABSTRACT

INTRODUCTION: This study aimed to compare the outcomes of three-dimensional (3D) image-guided video-assisted thoracic surgery (VATS) segmentectomy performed with and without preoperative localization for the resection of small pulmonary nodules.

METHOD: Between July 2015 and December 2022, 439 patients who underwent 3D image-guided VATS segmentectomy for early-stage lung cancer were enrolled. Based on whether preoperative localization was performed, the patients were divided into two groups as follows: the localization (n = 96) and nonlocalization groups (n = 343). The primary endpoints were the resection success rate and surgical margins.

RESULTS: Resection was successfully performed in 95 (99.0%) and 340 (99.1%) patients in the localization and nonlocalization groups, respectively (P = 1.000). One and three patients in the localization and nonlocalization groups, respectively, required conversion to extended segmentectomy due to inadequate surgical margins. The median surgical margins were 20 (range, 14-30) mm and 22 (range, 14-30) mm in the localization and nonlocalization groups, respectively (P = 0.410). However, overall complications were significantly more frequent in the localization group (9.4%) than in the nonlocalization group (4.1%; P = 0.040). This result was further supported by findings from multivariate logistic regression analysis. A subgroup analysis of high-risk small pulmonary nodules indicated no statistically significant differences between the groups concerning the primary endpoints.

CONCLUSIONS: 3D image-guided VATS segmentectomy performed with and without preoperative localization had comparable resection success rates and surgical margins. However, the procedure without preoperative localization was associated with fewer postoperative complications.

PMID:39937556 | DOI:10.1016/j.jss.2024.11.031

J Surg Res. 2025 Jan;305:231-236. doi: 10.1016/j.jss.2024.11.040. Epub 2024 Dec 27.

ABSTRACT

INTRODUCTION: Operative selection in metabolic surgery is a complex, collaborative process between patient and surgeon, considering factors such as risk, cost, desired weight loss, and resolution of associated comorbidities. This study aimed to explore the association of patient demographics and body mass index on operative selection.

MATERIALS AND METHODS: Retrospective review of 388 patient surveys prior to initial surgical visit (2020-2023) was conducted at a single institution. Patient demographics as well as operation preference prior to the initial visit and procedure ultimately performed were evaluated. Categorical variables were summarized as frequency and percentage and compared using chi-square tests. Continuous measures were summarized as means and standard deviations and compared using analysis of variance. Proceeding with the originally preferred procedure was modeled using multivariable logistic regression.

RESULTS: Prior to the initial visit, 62.1% of patients indicated preference toward sleeve gastrectomy, while 14.9% indicated preference toward Roux-en-Y gastric bypass. Notably, initial patient preferences aligned with the actual procedure, with 69.3% of sleeve gastrectomy-desiring patients and 62.1% of Roux-en-Y gastric bypass-desiring patients receiving their preferred operation. Factors associated with actual procedure performed included male sex (OR 3.27 [1.04, 10.26]) and presence of preoperative sleep apnea (OR 0.41 [0.20,0.81]) and hypertension (OR 0.46 [0.22,0.96]). Other factors that showed an association with preference, but were not statistically significant, included body mass index.

CONCLUSIONS: Patients’ comorbidities and sex are associated with the likelihood of undergoing the preferred operation procedure. However, most patients underwent their preferred procedure, highlighting the importance of patients’ selection.

PMID:39937555 | DOI:10.1016/j.jss.2024.11.040