Nevin Manimala

BMC Nurs. 2025 Feb 7;24(1):143. doi: 10.1186/s12912-025-02793-8.

ABSTRACT

AIM: This study carried out to examine the effects of nursing care given to coronary intensive care patients according to their circadian rhythms on sleep quality, pain, anxiety, and delirium.

STUDY DESIGN: This study was designed as a randomised controlled, clinical investigation. The study population consisted of patients treated in the coronary care unit of a training and research hospital between September 2022 and February 2023. Total of 44 participants were included. The included participants were followed up for 3 days in the coronary intensive care unit. Data were collected using “Patient Information Form, Sleep Quality Scale in Coronary Intensive Care Patients (SQ-CC), Visual Analogue Scale (VAS), Morningness-Eveningness Questionnaire (MEQ), Hospital Anxiety and Depression Scale (HADS), Intensive Care Delirium Screening Checklist (ICDSC).” In addition, melatonin and cortisol measurements were made, and sleep data were taken with a smartwatch. Patients with intermediate chronotype, delirium, on ventilator support, or using sedative drugs were excluded. The chronotypes of the participants were determined, and the patients in the intervention group were given nursing care by their circadian rhythms. No intervention was made to the control group, and their routine care was continued in accordance with intensive care unit functioning. Frequency distribution, dependent and independent sample t-test, Wilcoxon test, repeated measures analysis of variance, Mann Whitney U, and chi-square analysis were used to evaluate the data. The study has been registered in ClinicalTrials.gov (Identifiers: NCT04934436). During statistical analysis, the groups were coded as Group A and Group B, ensuring blinding for the statistician.

RESULTS: The intervention group’s sleep quality increased compared to the control group (post-test SQ-CC total scores: intervention group 22.41 ± 6.67 vs. control group 50.45 ± 10.63, p < 0.001). Although no significant difference was found between the groups as a result of the study, there was a significant decrease in the pain score in the intervention group (VAS pre-test: 1.55 ± 2.15, post-test: 0.68 ± 2.21, p = 0.036). The anxiety of the intervention group decreased significantly compared to the control group (post-test HADS-Anxiety scores: intervention group 3.18 ± 3.29 vs. control group 8.50 ± 5.66, p = 0.001). The post-test delirium score was higher in the control group compared to the intervention group (post-test ICDSC scores: intervention group 0.32 ± 0.48 vs. control group 1.18 ± 0.50, p < 0.001). Melatonin increased and cortisol decreased in both groups without statistically significant differences between them (melatonin and cortisol levels: p > 0.05). Considering the sound levels in the environment, the first-night decibel mean was significantly higher in the intervention group than in the control group (first-night decibel mean: intervention group 56.58 ± 2.43 dB vs. control group 54.51 ± 2.41 dB, p < 0.05). Finally, the smartwatch data show no significant difference in sleep times between groups (p < 0.05), but the intervention group had more deep and total sleep, while the control group had less deep sleep.

CONCLUSIONS: Nursing care given in accordance with the circadian rhythm increases sleep quality and reduces the risk of delirium and anxiety in patients followed up with acute coronary syndrome in the coronary intensive care unit.

PMID:39920733 | DOI:10.1186/s12912-025-02793-8

J Orthop Surg Res. 2025 Feb 7;20(1):147. doi: 10.1186/s13018-025-05545-1.

ABSTRACT

OBJECTIVE: Through this study we aimed to present the latest and most comprehensive pooled analysis, providing an updated evaluation of the efficacy and safety of sequential therapy for primary osteoporosis, using bone formation promoters followed by bone resorption inhibitors.

METHODS: PubMed, the Cochrane Library, Web of Science, and Embase databases were retrieved to identify pertinent studies. Randomized controlled trials (RCTs) on the sequential therapy of primary osteoporosis with bone formation promoters followed by bone resorption inhibitors were included. Data from clinical studies that met the eligibility criteria were extracted, and quality assessment and meta-analysis were performed using RevMan v5.4 and Stata v15.0. Sensitivity and subgroup analyses were performed to find the source of heterogeneity and discover more findings.

RESULTS: A total of 10 eligible articles involving 14,510 patients (7171 in the intervention group versus 7339 in the comparator group) were included for the evidence synthesis. The baseline characteristics of the two groups were similar. Pooled analysis showed that the intervention group (bone formation promoters followed by bone resorption inhibitors) increased BMD at the spine (SMD:1.64; 95% CI: 0.97, 2.31; P < 0.00001; I² = 99%), femoral neck (SMD: 0.57; 95% CI: 0.16, 0.99; P = 0.007; I² = 96%), and total hip (SMD: 0.82; 95% CI: 0.16, 1.48; P = 0.02; I² = 97%) compared with the comparator group (monotherapy or combination therapy using two drugs)for postmenopausal osteoporosis patient; however, there was no statistically significant difference observed in the increase of BMD at the 1/3 distal radius comparing the intervention group and comparator group (SMD: -0.25; 95% CI: -1.49, 0.99; P = 0.069; I² = 92%). The incidence of new fractures was reduced in the intervention group relative to the comparator group (RR: 0.60; 95% CI: 0.43, 0.82; P = 0.001; I² = 75%). The incidence of adverse events differed statistically between the two groups (RR: 0.85; 95% CI: 0.76, 0.95; P = 0.004; I² = 97%), but the difference in adverse event incidence was not statistically significant among subgroups within the intervention and comparator groups. The intervention group had a superiority of Clinical efficacy.

CONCLUSION: Among patients with primary osteoporosis, sequential therapy with bone formation promoters followed by bone resorption inhibitors substantially increased BMD at sites such as the spine, femoral neck, and total hip while concurrently mitigating fracture risks. However, benefits regarding BMD at the 1/3 distal radius and the incidence of adverse events have not yet been established.

STUDY REGISTRATION: Registered on PROSPERO (ID: CRD42023437188).

PMID:39920732 | DOI:10.1186/s13018-025-05545-1

BMC Surg. 2025 Feb 7;25(1):58. doi: 10.1186/s12893-024-02752-1.

ABSTRACT

OBJECTIVE: To explore the early efficacy of an artificial intelligence preoperative planning system (AIHIP system) for assisting in hip revision surgery.

METHODS: The clinical data of 25 patients (26 hips) who underwent hip revision between June 2019 and December 2023 and who met the selection criteria were retrospectively analyzed. There were 13 males and 12 females; the ages ranged from 44 to 90 years, with a mean of 69.1 years. The patients’ replacement of prosthesis model, operation time, hospitalization time, postoperative time out of bed, etc., as well as the occurrence of adverse events such as postoperative infection, fracture, and loosening of the prosthesis were recorded. The Harris Hip score (HHS) was used to evaluate the function of the affected limbs preoperatively, and 1 week and 6 months postoperatively, and hip mobility was compared preoperatively and 6 months postoperatively.

RESULTS: All 25 patients were followed up for 6 to 59 months, with an average of 25.3 months. Except for one patient who developed a thigh hematoma (treated with incision and drainage and decompression) and hip dislocation in one hip (repaired), the remaining patients experienced no adverse events such as loosening of the prosthesis or infection. The postoperative acetabular cup type matching degree completely matched 25 hips, not matching 1 hip (+ 2 number), for a matching rate of 96.15%; the femoral stem type matching degree completely matched 25 hips, generally matching 1 hip (-1 number), for a matching rate of 100%. The Harris scores were 54.7 ± 9.6 and 89.6 ± 7.0 at 1 week and 6 months after surgery, respectively, which were significantly improved (P < 0.05) compared with the preoperative scores of 33.5 ± 8.3, and further improved at 6 months after surgery compared with the 1-week period (P < 0.05). The patients’ hip function was evaluated according to the Harris score at 6 months after surgery, and they were assigned to 23 good hips and 3 medium hips, which could satisfy daily life needs. Hip mobility at 6 months after surgery was 111.15 ± 9.72°, and the difference was statistically significant compared with the preoperative value of 79.42 ± 17.51° (t = -8.077, P < 0.001).

CONCLUSION: AIHIP system-assisted treatment of THA postoperative revision patients can improve the precision of revision surgery, and reduce the difficulty of surgery, in patients with good postoperative recovery and satisfactory early outcomes.

PMID:39920717 | DOI:10.1186/s12893-024-02752-1

Eye Contact Lens. 2025 Feb 6. doi: 10.1097/ICL.0000000000001173. Online ahead of print.

ABSTRACT

OBJECTIVES: This study investigated the safety of rigid corneal lenses in children with unilateral aphakia after cataract surgery and observed the visual rehabilitation longitudinally.

METHODS: This retrospective cohort study performed a 3-year follow-up of 21 infants (age 5.9±3.3 months) with unilateral congenital cataracts who started wearing rigid corneal contact lenses after cataract surgery. The basic presurgical patient information included chief complaint, intraocular pressure (IOP), axial length, corneal width, anterior segment, and fundus examination. The postsurgical visual acuity, IOP, and anterior segment were examined during regular postoperative follow-up visits. Keratometry was performed when contact lenses had to be changed.

RESULTS: Of the 21 patients, 15 were male and 6 were female. Before surgery, the affected and nonaffected eyes had similar IOP (9.5±3.5 vs. 9.2±2.8 mm Hg; P=0.502) and axial length (19.2±1.5 vs. 19.4±0.96; P=0.333). The corneal diameter in the affected eyes was smaller than in the nonaffected eyes (10.2±0.7 vs. 10.6±0.6 mm; P=0.002). After surgery, the logarithm of the minimum angle of resolution vision of the affected eyes improved gradually, showing values of 1.12±0.28, 0.78±0.37, and 0.62±0.38 at 1, 2, and 3 years after surgery, respectively. The respective values in the unaffected eyes were 0.58±0.14, 0.40±0.13, and 0.33±0.16. The mean keratometric astigmatism and keratometry 1 and 3 years after surgery were statistically similar (2.09±1.21 vs. 1.73±1.16 D, P=0.272; 44.82±3.15 vs. 44.39±2.75 D, P=0.324, respectively). No serious complications occurred during the follow-up.

CONCLUSION: The rigid corneal lens is well tolerated and safe in aphakic eyes and can effectively improve children’s visual acuity after unilateral cataract surgery. For patients able to receive rigid corneal lenses, intraocular lens implantation can be delayed until after the age of three.

PMID:39919313 | DOI:10.1097/ICL.0000000000001173

Am J Sports Med. 2025 Feb 7:3635465241313386. doi: 10.1177/03635465241313386. Online ahead of print.

ABSTRACT

BACKGROUND: Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping.

PURPOSE: To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively.

STUDY DESIGN: Cohort study; Level of evidence, 2.

METHODS: A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared.

RESULTS: The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone-patellar tendon-bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years.

CONCLUSION: Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries.

REGISTRATION: NCT02771548 (ClinicalTrials.gov identifier).

PMID:39919304 | DOI:10.1177/03635465241313386

Ophthalmic Epidemiol. 2025 Feb 7:1-9. doi: 10.1080/09286586.2025.2458245. Online ahead of print.

ABSTRACT

PURPOSE: To explore the genetic links between obesity, glycemic traits and retinal vein occlusion (RVO).

METHODS: Summary-level statistics for obesity and glycemic traits were extracted from publicly available genome-wide association studies (GWAS) of European participants in the IEU Open GWAS database. Genetic associations with clinically diagnosed RVO were obtained from the FinnGenresearch project (372 cases and 182,573 controls). Two-sample Mendelian randomization (MR) and multivariate MR (MVMR) analysis were performed to determine the total effect and direct effect, respectively.

RESULTS: After adjustment for the false discovery rate (FDR), the primary inverse-variance-weighted (IVW) methods indicated that the odds ratios of RVO increased with per 1-standard deviation increased in body mass index (BMI) (OR = 1.94, 95% CI: 1.23-3.08,p-FDR = 0.025), waist circumference (OR = 2.4, 95% CI: 1.36-4.24, p-FDR = 0.019), fasting glucose (OR = 5.01, 95% CI: 2-12.55, p-FDR = 0.0067) and two-hour glucose (OR = 3.17, 95% CI: 1.63-6.18,p-FDR = 0.0067). Higher whole-body fat-free mass (OR = 0.45, 95% CI: 0.26-0.8,p-FDR = 0.025) is a potential protective factor for RVO. In addition, the results of MVMR showed that BMI, whole-body fat-free mass, fasting glucose and two-hour glucose were independent factors that had a direct impact on the onset of RVO.

CONCLUSIONS: Our comprehensive MR analysis suggested significant genetic associations between BMI, whole-body fat-free mass, fasting glucose, two-hour glucose and RVO. This study highlighted the importance of weight, blood glucose management and physical activity for primary prevention and control of RVO.

PMID:39919303 | DOI:10.1080/09286586.2025.2458245

J Neurosurg Spine. 2025 Feb 7:1-12. doi: 10.3171/2024.9.SPINE24580. Online ahead of print.

ABSTRACT

OBJECTIVE: This review analyzes the current surgical strategies and management modalities for chronic low-back pain (CLBP). In this study, the authors provide a structured review of the current state of surgical treatments for CLBP, including the rationale for surgery, indications, and novel therapies.

METHODS: An extensive review of the literature on the surgical management of CLBP was performed using the MEDLINE, Cochrane, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials databases from March 1993 to May 2024. Terms used in the search were (“low back pain/surgery” [MeSH] AND “chronic” AND “lumbar”) and (“chronic” AND “low back pain” AND “lumbar spine” AND “surgery”). The search produced 1951 articles, of which 167 were removed as duplicates, leaving 1784 for screening. Of these, 1593 articles were excluded, and 191 were retrieved to evaluate eligibility. After this evaluation, 76 articles were included in the review. No statistical analysis was performed.

RESULTS: This structured review revealed a range of surgical interventions available for CLBP. These interventions included fusion, stabilization, posterior interspinous devices, and nonoperative management, such as intensive rehabilitation and cognitive behavioral therapy. The evidence suggests that although spinal fusions are not superior in terms of Oswestry Disability Index function or pain level, they do outperform nonoperative management without intensive rehabilitation therapy. This finding is significant because it highlights the potential of surgical strategies to complement other treatments, such as pharmacological and noninterventional procedures, in managing CLBP.

CONCLUSIONS: The current evidence strongly advocates for a comprehensive approach to the management of CLBP. Patients with CLBP should be evaluated for surgical approaches when anatomical causes have been identified and multidisciplinary strategies have been implemented. It is reassuring to note that emerging multimodal strategies are beginning to complement neurosurgery care, and they should be integrated into the treatment plan as more substantial evidence becomes available. This emphasis on a multidisciplinary approach underscores the importance of considering all available strategies in CLBP management.

PMID:39919297 | DOI:10.3171/2024.9.SPINE24580

J Med Internet Res. 2025 Feb 7;27:e63799. doi: 10.2196/63799.

ABSTRACT

BACKGROUND: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas.

OBJECTIVE: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas.

METHODS: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence.

RESULTS: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8%) and the high-growth group (n=229, 10.2%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95% CI 1.164-2.959).

CONCLUSIONS: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents’ internet use behaviors to mitigate negative effects on their mental health.

PMID:39919294 | DOI:10.2196/63799

J Neurosurg Spine. 2025 Feb 7:1-9. doi: 10.3171/2024.10.SPINE24584. Online ahead of print.

ABSTRACT

OBJECTIVE: Carbon fiber instrumentation has gained popularity in spine oncology for its radiographic advantage of reduced artifact on imaging. With its increased use in patients who undergo radiation therapy, the dosimetric accuracy of postoperative radiation with carbon fiber constructs compared to classic titanium instrumentation becomes an important question. The purpose of this study was to compare the dosimetric accuracy of postoperative radiation in carbon fiber-instrumented versus titanium-instrumented cadaveric cervical spines after corpectomy.

METHODS: Two cadaveric specimens underwent two-level corpectomy using either titanium or carbon fiber instrumentation. Dosimeter chips were placed circumferentially around the constructs to calculate the dose of radiation to surrounding areas. The cadavers underwent one round of radiation with their respective constructs, and the dose of radiation was calculated and compared to the measured dose in each chip. After the first round of radiation, the instrumentation was switched between cadavers and the radiation therapy was repeated. The difference between the calculated and measured dose in carbon fiber versus that in titanium instrumentation in each cadaveric model was subsequently compared.

RESULTS: There was a significant difference in the dosimetry calculated at the area of the spinal cord dorsal to the corpectomy cage, with 68% less variability between the calculated and measured dose in the carbon fiber construct compared to that of the titanium construct. The mean variation of the measured dose at the spinal cord was 7.73% in titanium versus 4.6% in carbon fiber (p = 0.024, 1-tail; p = 0.048, 2-tail). There was also 30% less variability between the measured and calculated dose in the carbon fiber construct at the dosimeter chips lateral to the spinal cord, with a mean variation in the carbon fiber-instrumented cadaver of 4.94% compared to 6.45% with titanium (p = 0.01, 1-tail; p = 0.02, 2-tail). When all the dosimeters were combined without the control group, there was a statistically significant 14.5% difference in the mean variation of the calculated versus measured doses between the carbon fiber-instrumented cadavers versus titanium-instrumented cadavers (4.8% vs 5.5%, respectively; p = 0.015, 1-tail; p = 0.03, 2-tail).

CONCLUSIONS: There is less variation in the calculated versus measured doses of radiation therapy in carbon fiber instrumentation compared to titanium instrumentation. This suggests improved radiation therapy delivering accuracy and complication avoidance in carbon fiber-instrumented spines.

PMID:39919293 | DOI:10.3171/2024.10.SPINE24584

J Med Internet Res. 2025 Feb 7;27:e63550. doi: 10.2196/63550.

ABSTRACT

BACKGROUND: ChatGPT, a conversational artificial intelligence developed by OpenAI, has rapidly become an invaluable tool for researchers. With the recent integration of Python code interpretation into the ChatGPT environment, there has been a significant increase in the potential utility of ChatGPT as a research tool, particularly in terms of data analysis applications.

OBJECTIVE: This study aimed to assess ChatGPT as a data analysis tool and provide researchers with a framework for applying ChatGPT to data management tasks, descriptive statistics, and inferential statistics.

METHODS: A subset of the National Inpatient Sample was extracted. Data analysis trials were divided into data processing, categorization, and tabulation, as well as descriptive and inferential statistics. For data processing, categorization, and tabulation assessments, ChatGPT was prompted to reclassify variables, subset variables, and present data, respectively. Descriptive statistics assessments included mean, SD, median, and IQR calculations. Inferential statistics assessments were conducted at varying levels of prompt specificity (“Basic,” “Intermediate,” and “Advanced”). Specific tests included chi-square, Pearson correlation, independent 2-sample t test, 1-way ANOVA, Fisher exact, Spearman correlation, Mann-Whitney U test, and Kruskal-Wallis H test. Outcomes from consecutive prompt-based trials were assessed against expected statistical values calculated in Python (Python Software Foundation), SAS (SAS Institute), and RStudio (Posit PBC).

RESULTS: ChatGPT accurately performed data processing, categorization, and tabulation across all trials. For descriptive statistics, it provided accurate means, SDs, medians, and IQRs across all trials. Inferential statistics accuracy against expected statistical values varied with prompt specificity: 32.5% accuracy for “Basic” prompts, 81.3% for “Intermediate” prompts, and 92.5% for “Advanced” prompts.

CONCLUSIONS: ChatGPT shows promise as a tool for exploratory data analysis, particularly for researchers with some statistical knowledge and limited programming expertise. However, its application requires careful prompt construction and human oversight to ensure accuracy. As a supplementary tool, ChatGPT can enhance data analysis efficiency and broaden research accessibility.

PMID:39919289 | DOI:10.2196/63550