Nevin Manimala

Medicine (Baltimore). 2025 Jan 3;104(1):e41220. doi: 10.1097/MD.0000000000041220.

ABSTRACT

This study compares the efficacy of the TiRobot with traditional external aiming frames in distal locking of femoral intramedullary nails. A cohort of 44 patients, who underwent intramedullary nailing treatment for femoral fractures between October 2020 and October 2023, was retrospectively analyzed. Participants were allocated into 2 groups. The observation group (n = 22) received TiRobot assistance for distal locking of femoral intramedullary nails, and the control group (n = 22) was managed using conventional external aiming frames. Key variables included the first-attempt success rate of distal locking, number of fluoroscopic exposures, time to achieve locking, and volume of intraoperative blood loss. The observation group, assisted by TiRobot, achieved a significantly higher first-attempt success rate of 90.9%, as compared to 54.5% in the control group. All initial failures were subsequently managed manually, with a statistically significant difference noted between the groups (P < .05). Furthermore, the observation group required fewer fluoroscopic exposures (11.00 ± 2.93) than the control group (19.68 ± 16.28) (P < .05). The time to achieve locking was significantly shorter in the observation group (14.05 ± 3.37 min) compared to the control group (24.41 ± 14.93 min) (P < .05). The volume of intraoperative blood loss was reduced in the observation group (54.55 ± 5.54 mL) versus the control group (60.45 ± 11.01 mL) (P < .05). The incorporation of TiRobot in the distal locking of femoral intramedullary nailing prominently enhances the first-attempt success rate, reduces the procedural time and intraoperative blood loss, and diminishes the radiation exposure for both healthcare providers and patients.

PMID:40184090 | DOI:10.1097/MD.0000000000041220

Medicine (Baltimore). 2025 Jan 3;104(1):e41209. doi: 10.1097/MD.0000000000041209.

ABSTRACT

The causal relationship between childhood obesity and osteoporosis is not yet clear. Two-sample randomized Mendelian analysis was applied to examine the causal relationship between childhood obesity and osteoporosis. This study employs a two-sample Mendelian randomization (MR) approach. The single-nucleotide polymorphisms associated with childhood obesity and summary-level data for osteoporosis were selected from publicly published genome-wide association study. The childhood obesity dataset includes individuals under the age of 18 with a body mass index exceeding the 95th percentile, representing both male and female European children. The osteoporosis dataset includes individuals with osteoporosis from the European population (age 0-70), encompassing both genders. MR analysis was primarily conducted via inverse-variance weighted analysis. Quality of our study was assessed according to STROBE-MR guidelines. MR analysis revealed a statistically significant association between childhood obesity and osteoporosis via the inverse-variance weighted method (odds ratio 0.9985, 95% CI [0.9974, 0.9996], P = .0087). Other MR analysis methods also confirmed this result. The heterogeneity analysis and sensitivity analysis show the accuracy and robustness of our results. Our MR study revealed a significant causal relationship between childhood obesity and osteoporosis, indicating that childhood obesity can reduce the incidence of osteoporosis.

PMID:40184084 | DOI:10.1097/MD.0000000000041209

Medicine (Baltimore). 2025 Jan 3;104(1):e40866. doi: 10.1097/MD.0000000000040866.

ABSTRACT

BACKGROUND: To compare the efficacy and safety of robot-assisted laparoscopic hepatectomy (RALH) with laparoscopic hepatectomy (LH) in the treatment of liver tumors.

METHODS: A comprehensive search of English-language literature was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from January 2000 to June 2024. Studies comparing RALH and LH for liver tumors were identified, and after qualitative evaluation, a meta-analysis was performed using Stata 16.0 software.

RESULTS: After applying inclusion and exclusion criteria, 42 articles were included, including 29,969 patients, with 5673 in the RALH group and 24,296 in the LH group. The meta-analysis showed that compared with the LH group, surgery time was longer in the RALH group (MD = 55.33; 95% CI: 34.84-75.83; P < .001), the conversion to open surgery rate was higher (RR = 1.04; 95% CI: 1.03-1.05; P < .001), the total cost was higher (MD = 0.43; 95% CI: 0.14-0.73; P = .004), and the tumor diameter was larger (MD = 0.37; 95% CI: 0.24-0.49; P < .001). Additionally, the R1 resection rate was higher in the RALH group (RR = 1.04; 95% CI: 1.03-1.06; P < .001). However, there were no significant differences between the groups in terms of intraoperative transfusion rate, hepatic hilar occlusion rate, postoperative complications, postoperative hospital stay, mortality rate, malignancy rate, or R0 resection rate (P > .05).

CONCLUSION: Based on current evidence, RALH is safe and effective, although it is associated with higher total costs, increased blood transfusion rates, and longer operative times. However, there were no significant differences between RALH and LH in terms of other outcome indicators, suggesting that both procedures offer similar surgical efficacy and safety. Further clinical randomized controlled trials are needed to confirm these findings.

PMID:40184083 | DOI:10.1097/MD.0000000000040866

Diabetes Obes Metab. 2025 Apr 4. doi: 10.1111/dom.16345. Online ahead of print.

ABSTRACT

AIMS: Proteinuria is a risk factor for end-stage kidney disease (ESKD) and cardiovascular disease (CVD) in patients with diabetes. However, the clinical implications of fluctuating proteinuria are unclear. We investigated the proteinuria burden and the risks of clinical outcomes in patients with diabetes using the Korean National Health Insurance Service database.

MATERIALS AND METHODS: This retrospective cohort study included patients with diabetes who participated in a national health screening between 2015 and 2016, with records of three previous health screenings. Each end-point was followed until 31 December 2022. The proteinuria burden (range: 0-4) was defined as the cumulative number of positive urine protein dipstick tests at each health screening. The outcomes included ESKD, CVD and all-cause mortality.

RESULTS: Among 1 264 699 patients, 86.3%, 9.4%, 2.5%, 1.2% and 0.6% had proteinuria burdens of 0 to 4, respectively. The proteinuria burden and risks of clinical outcomes had dose-dependent associations; compared to proteinuria burden 0, the adjusted hazard ratio (95% confidence interval) of proteinuria burdens 1, 2, 3 and 4, respectively, were as follows: ESKD, 3.539 (3.326-3.766), 9.373 (8.816-9.965), 14.539 (13.652-15.484) and 19.704 (18.412-21.087); CVD, 1.247 (1.214-1.280), 1.530 (1.465-1.599), 1.815 (1.713-1.923) and 2.032 (1.883-2.192); and all-cause mortality, 1.335 (1.302-1.369), 1.703 (1.635-1.774), 1.959 (1.855-2.068) and 2.092 (1.945-2.250). Within the same proteinuria burdens, late-positive proteinuria was associated with worse outcomes than early-positive proteinuria.

CONCLUSIONS: The proteinuria burden was dose-dependently associated with clinical outcomes in patients with diabetes. Even a single positive dipstick test requires active management.

PMID:40183204 | DOI:10.1111/dom.16345

Am J Ind Med. 2025 Apr 4. doi: 10.1002/ajim.23719. Online ahead of print.

ABSTRACT

BACKGROUND: Methods of delivering occupational safety and health (OSH) training have shifted from in-person to online. Widespread delivery of a standardized OSH training course in three modalities in the province of Ontario, Canada allowed measurement of differences in their effectiveness.

METHODS: Learners (N = 899) self-selected into face-to-face (F2F) instructor-led learning, online instructor-led synchronous distance learning, or online self-paced e-learning. Pre- and post-training surveys collected information on knowledge and other measures. Multiple regression analyses compared modalities on knowledge achievement (0%-100% scale; the primary outcome), engagement, perceived utility, perceived applicability, self-efficacy, and intention-to-use.

RESULTS: F2F learners achieved a statistically significant 2.5% (95% CI: 0.3%, 4.7%) higher post-training knowledge score than distance learners (Cohen’s d = 0.23, which is considered small). A statistically insignificant difference of 0.4% (95%: -1.4%, 2.3%) was seen between e-learners and distance learners. Collaborating training providers regarded these differences as not meaningful in practice. Statistically significant differences between modalities were seen for engagement, perceived utility, and self-efficacy. Scores of F2F learners were more favorable than scores of distance learners, which were, in turn, more favorable than scores of e-learners.

CONCLUSIONS: This study provides evidence that there are small to no differences among F2F, distance and e-learning in their ability to ensure knowledge achievement among learners. This finding is likely generalizable to other well-designed short-term OSH training aimed at acquiring new knowledge. More research is needed to understand whether there are important differences across these modalities in basic OHS skill acquisition and transfer of learning to the workplace.

PMID:40183197 | DOI:10.1002/ajim.23719

Clin Implant Dent Relat Res. 2025 Apr;27(2):e70014. doi: 10.1111/cid.70014.

ABSTRACT

INTRODUCTION: The present study aimed to evaluate and to compare the influence of anatomical variables such as sinus width (SW), inner maxillary sinus contour length (IMSCL), and residual ridge height (RRH) on new bone formation (%NBF) for deproteinized porcine (DPBM) and bovine bone mineral (DBBM) used for lateral window sinus augmentation (LWSA) grafting.

MATERIAL AND METHODS: For LWSA groups grafted either with DPBM (n = 10) or DBBM (n = 13) a linear- as well as a multivariate-regression analysis was conducted between measured %NBF and radiographically retrospectively assessed anatomical variables (SW/IMSCL/RRH). Correlations as well as regression coefficients (R²) were calculated, evaluating the influence of anatomical variables on %NBF with differentiation between both xenogenic graft materials used.

RESULTS: With no differences for patient-epidemiologic data, for anatomical variables as well as for surgical- and patient-related risk factors, comparison between the two LWSA groups was possible. The linear-regression analysis provided significant correlations between histomorphometrically evaluated %NBF and SW (DPBM: r = -0.660, p = 0.038; DBBM: r = -0.614, p = 0.026) as well as between %NBF and IMSCL (DPBM: r = -0.737; p = 0.015, DBBM: r = -0.573, p = 0.041), but not for RRH. Between SW/IMSCL/RRH and %NBF, regression-coefficients-(R²) of 0.435/0.543/0.258 using DPBM and R² of 0.377/0.328/0.053 using DBBM represented evidently higher influences of anatomical structures when porcine graft material was applied. The multivariate-regression analysis confirmed the different influence between various xenogenic graft materials on % NBF as well with a pronounced effect for porcine material (DPBM: R² = 0.591 [59.1%] vs. DBBM: R² = 0.314 [31.4%]).

CONCLUSION: In LWSA, anatomical structures such as SW and IMSCL significantly affect new bone formation, though with varying effects for different xenogenic (porcine vs. bovine) bone mineral graft materials used.

PMID:40183191 | DOI:10.1111/cid.70014

BJOG. 2025 Apr 4. doi: 10.1111/1471-0528.18158. Online ahead of print.

ABSTRACT

INTRODUCTION: Abnormal placental lesions are commonly identified in stillbirth. Interpreting these lesions and their contribution to fetal demise presents significant challenges. Recommended CODAC classification does not include detailed placental examination results.

OBJECTIVE: This study reports abnormal placental patterns in relation to the distribution of stillbirth causes in order to refine the categories of causes.

DESIGN: Data from the Ille-Et-Vilaine Stillbirth cohort, an exhaustive register of stillbirth cases across the Ille-et-Vilaine French department, were implemented in 2010.

SETTING: All seven maternity wards in the Ille-et-Vilaine department, France.

POPULATION: All cases of stillbirth located in the Ille-et-Vilaine department between 2010 and 2019.

METHODS: Descriptive statistics were used with the chi-squared test.

MAIN OUTCOME MEASURES: All placental examinations were reported following the Amsterdam consensus. Cause of death was ascertained according to the CODAC (Classification of Cause of Death and Associated Conditions) classification during multidisciplinary meetings.

RESULTS: A total of 566 stillbirths were documented. The most frequent stillbirth causes were placental cause (36%), followed by umbilical cord (11%) and infections (9%). Stillbirth remained unexplained in 17% of cases. Small placenta and maternal malperfusion emerged as the most frequent placental lesions within the placental stillbirth group (65%), but also within the maternal cause groups (65%).

CONCLUSION: Placental vascular anomalies were the most frequent cause of stillbirth in this study. Based on the combined use of international classification and observation of histological anomalies, our data suggest the existence of a vascular stillbirth group defined by vascular lesions associated with maternal or fetal expression.

PMID:40183189 | DOI:10.1111/1471-0528.18158

Muscle Nerve. 2025 Apr 4. doi: 10.1002/mus.28407. Online ahead of print.

ABSTRACT

INTRODUCTION/AIMS: Hypermetabolism and weight loss are established negative prognostic factors in amyotrophic lateral sclerosis (ALS). However, the role of individualized body composition parameters in predicting ALS progression has been underexplored. This study aimed to investigate the correlation between nutritional parameters, neurofilament light chain (NfL) levels, and disease progression in ALS patients.

METHODS: The Global Leadership Initiative on Malnutrition criteria were used to define malnutrition in this study. Nutritional status was assessed using body mass index and bioelectrical impedance analysis. The rate of disease progression was defined by the change in the Revised ALS Functional Rating Scale score (ΔFRS). NfL was quantified using single molecule array technology. Spearman’s analyses were used to assess correlations.

RESULTS: Sixty of 110 ALS patients were classified as malnourished. There was a strong positive correlation between NfL and ΔFRS (r = 0.71), and a moderate negative correlation with disease duration (r = -0.55). The correlations between NfL and body composition parameters were statistically significant, although weak. NfL levels were significantly higher in fast progressors (p < 0.0001 compared to slow progressors) and in malnourished patients (p = 0.0001). Of the 34 fast progressor patients, 28 (82%) exhibited some degree of malnutrition.

DISCUSSION: Our findings indicate that poor nutritional status, particularly reduced skeletal muscle mass-both independently and in combination with fat mass loss-is associated with elevated NfL levels and faster ALS progression. NfL, combined with nutritional parameters, could serve as a valuable biomarker for disease severity. Further research is warranted to clarify the role of skeletal muscle abnormalities in ALS progression.

PMID:40183173 | DOI:10.1002/mus.28407

NeuroRehabilitation. 2025 Feb;56(1):78-80. doi: 10.1177/10538135241303581. Epub 2025 Feb 25.

ABSTRACT

BackgroundPrognostic models have the potential to support people with Multiple Sclerosis (pwMS) and clinicians in treatment decision-making, enable stratified and precise interpretation of interventional trials, and offer insights into disease mechanisms. Despite many researchers being involved in developing these models to predict clinical outcomes in multiple sclerosis (MS), no widely accepted prognostic model is currently used in clinical practice.ObjectiveCommentary on the review by Reeve et al. (2023) to identify and summarise multivariable prognostic models, and their validation studies for quantifying the risk of clinical disease progression, worsening, and activity in pwMS.MethodsThis review included studies evaluating statistically developed multivariable prognostic models aiming to predict clinical disease progression, worsening, and activity, as measured by disability, relapse, conversion to definite MS, conversion to progressive MS, or a composite of these in adult individuals with MS.ResultsThe review included 57 studies, comprising 75 model developments, 15 external validations, and six author-reported validations. Only two models were validated multiple times externally, and none by independent researchers. The outcomes evaluated included disease progression (41%), relapses (8%), conversion to definite MS (18%), and conversion to progressive MS (28%). All models required specialist skills, 59% needed specialized equipment, and 52% lacked sufficient details for application or independent validation. Reporting quality was poor, and most models had a high risk of bias. The findings suggest increases in the number of participants on treatment, diverse diagnostic criteria, the use of biomarkers, and machine learning over time.ConclusionsDespite the development of many prognostic prediction models in pwMS, current evidence is insufficient to recommend any of these models for clinical use due to the high risk of bias, poor reporting, and lack of independent validation. The review’s findings necessitate a cautious approach to integrating existing MS prognostic models into rehabilitation practice.

PMID:40183167 | DOI:10.1177/10538135241303581

NeuroRehabilitation. 2025 Feb;56(1):19-29. doi: 10.1177/10538135241296742. Epub 2025 Feb 9.

ABSTRACT

BackgroundThe Covid-19 pandemic has accelerated the adoption of telerehabilitation as a tool to overcome geographical barriers, scarcity of care providers, and improve access to rehabilitation services. However, limited studies exist on its acceptability among care recipients particularly in low-and-middle-income countries.ObjectiveThis mixed-methods study explored the perception and acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria.MethodsA convenient sample of 44 stroke survivors was surveyed, and six participated in a focus group discussion (FGD). Quantitative data was analyzed using inferential statistics at p < 0.05. Qualitative data was thematically analysed.ResultsParticipants (61.4% males) were aged 60.93 ± 13.10 years. 19(43.3%) of them were favorably disposed to receiving treatment via telerehabilitation. Acceptability differed significantly across marital status, level of education, and socioeconomic status (p < 0.05). Qualitative findings indicated positive perceptions, although participants preferred telerehabilitation as an adjunct to face-to-face physiotherapy. Barriers included unstable internet connectivity, high costs of data, and lack of personal contact with physiotherapists. Facilitators included using telerehabilitation for additional or missed sessions, and the provision of necessary equipment and data by the government.ConclusionOur findings revealed limited acceptability of telerehabilitation among stroke survivors in Ibadan, Nigeria. This underscores the need to address the identified concerns and barriers, to enhance acceptability. A contextualized and multifaceted approach can help create awareness about the effectiveness of telerehabilitation and improve its acceptability.

PMID:40183163 | DOI:10.1177/10538135241296742