Nevin Manimala

Stroke. 2025 Mar 21. doi: 10.1161/STROKEAHA.124.048183. Online ahead of print.

ABSTRACT

BACKGROUND: Robotic rehabilitation, which provides a high-intensity, high-frequency therapy to improve neuroplasticity, is gaining traction. However, its effectiveness for upper extremity stroke rehabilitation remains uncertain. This study comprehensively reviewed meta-analyses on the effectiveness of upper extremity robot-assisted therapy in patients with stroke.

METHODS: We combined results from 396 randomized controlled trials (RCTs) in 16 meta-analyses and conducted a new meta-analysis using nonoverlapping RCTs and 6 additional RCTs published after 2024. Duplicate studies were removed, all data were from RCTs, and a random-effects model resolved heterogeneity. Effects were analyzed by comparing robot-assisted therapy with conventional therapy at the same dose and as an add-on to conventional therapy.

RESULTS: Compared with conventional therapy, the effect of robot-assisted therapy on the Fugl-Meyer assessment was summarized as a significant standardized mean difference (SMD) of 0.29 (95% CI, 0.14-0.44; number of individual RCTs reanalyzed, 100 RCTs), and the additional effect of robot-assisted therapy was an SMD of 0.42 (95% CI, 0.23-0.61; 16 RCTs). However, these Fugl-Meyer assessment improvements did not meet the minimum clinically important difference thresholds identified in previous studies: 12.4 for subacute and 3.5 for chronic stroke. For activities of daily living, only the additional effect was significant by SMD of 0.35 (95% CI, 0.17-0.54; 26 RCTs), muscle strength was significant by SMD of 0.46 (95% CI, 0.22-0.70; 31 RCTs), and spasticity was not significant by SMD of -0.25 (95% CI, -0.55 to 0.06; 25 RCTs).

CONCLUSIONS: Robot-assisted therapy shows statistically significant improvements in motor recovery as measured by the Fugl-Meyer assessment in patients with stroke, both at the same dose and as an add-on to conventional therapy; however, these improvements do not meet the minimum clinically important difference. These benefits are consistent across different stages of stroke recovery, different types of robotic devices, duration of intervention, and training sites. However, the heterogeneity of included studies in patient population, stroke severity, intervention protocol, and robot type limits generalizability. High-quality trials are needed to better define the value of robot-assisted therapy across various devices and strategies.

PMID:40115991 | DOI:10.1161/STROKEAHA.124.048183

Psychophysiology. 2025 Mar;62(3):e70045. doi: 10.1111/psyp.70045.

ABSTRACT

Facial expressions provide critical details about social partners’ inner states. We investigated whether event-related potentials (ERP) related to the visual processing of facial expressions are modulated by participants’ perceived arousal and valence at the stimulus level. ERPs were recorded while participants (N = 80) categorized the gender of faces expressing fear, anger, happiness, and no emotion. Participants then viewed each face again and rated them on arousal and valence using 1-9 Likert scales. For each participant, ratings of each unique face were linked back to corresponding ERP trials. ERPs were analyzed at all time points and electrodes using hierarchical mass univariate statistics. Three different ANOVA models were employed: the original emotion model, and models with valence or arousal ratings as trial-level regressors. Results from models with ratings highly overlapped with the original model, although they were more temporally restricted. The N170 component was the most impacted by arousal and valence ratings, with four out of six emotion contrasts revealing significant valence or arousal interactions. Emotion effects on the P2 component were mostly unrelated to ratings. On the EPN component, only two contrasts related to both arousal and valence ratings. Thus, ERP emotion effects are related to participants’ perceived arousal and valence of the stimuli, although this association depends on the contrast analyzed. These findings, their limitations, and generalizability are discussed in reference to existing theories and literature.

PMID:40115983 | DOI:10.1111/psyp.70045

J Gastrointest Oncol. 2025 Feb 28;16(1):17-26. doi: 10.21037/jgo-24-807. Epub 2025 Jan 9.

ABSTRACT

BACKGROUND: The prognosis of patients with gastric cancer with peritoneal metastasis (GCPM) is exceedingly poor. This study evaluated the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) with paclitaxel combined with S-1 and oxaliplatin (SOX) in the treatment of GCPM.

METHODS: Patients with pathologically confirmed primary gastric adenocarcinoma and laparoscopy-confirmed peritoneal metastasis were enrolled and randomized to receive either HIPEC plus SOX (HIPEC group) or SOX alone (SOX group). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were 1-year survival rate, overall survival (OS), and safety.

RESULTS: Among the included patients, 30 were assigned to the HIPEC group and 29 to the SOX group. Compared to the HIPEC group, the SOX group had a significantly higher median PFS (SOX: median 8.5 months, IQR, 3.8-21.8 months; HIPEC: median 6.1 months, IQR, 3.3-10.8 months; P=0.004) and OS (SOX: median 13.0 months, IQR, 6.3-16.6 months; HIPEC: median 10.0 months, IQR, 5.2-24.0 months; P=0.02). The 1-year survival rate was 50.0% in the SOX group and 37.9% in HIPEC group, but the difference was not statistically significant. No serious adverse events related to the protocol treatment occurred in any patients.

CONCLUSIONS: This trial failed to show the superiority of HIPEC with SOX over SOX alone. Further research into this regimen is needed.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03604614.

PMID:40115934 | PMC:PMC11921333 | DOI:10.21037/jgo-24-807

Rev Cuid. 2024 May 27;15(1):e3220. doi: 10.15649/cuidarte.3220. eCollection 2024 Jan-Apr.

ABSTRACT

INTRODUCTION: Family members of patients admitted to an Intensive Care Unit present high uncertainty level due to not knowing what is happening and to not having clear details about the related events; therefore, interventions are required to allow modulating those levels.

OBJECTIVE: To evaluate the effect of an educational Nursing intervention compared to conventional care on the uncertainty of family members of patients hospitalized in an ICU.

MATERIALS AND METHODS: An experimental study with a sample comprised by 132 relatives of patients admitted to an ICU, randomly distributed in four Solomon groups (33 in each group). The Nursing intervention based on the concepts of the Uncertainty in Illness Theory was applied to both experimental groups and devised under the Whittemore and Grey parameters with three moments: assessment; education about the relative’s hospitalization in the ICU; and accompaniment. This was done with pre-assessments for two groups and post-assessments for the four groups, using the PPUS-FM Uncertainty Scale. The data were analyzed by means of descriptive statistics and respective non-parametric analyses. The study took into account the ethical principles in research.

RESULTS: The family members in the experimental groups presented a lower final uncertainty level when compared to the control groups, with a difference of 73.04 points and a p-value of 0.001.

DISCUSSION: Standardized interventions and under a theoretical model allow reducing uncertainty in relatives of patients in ICUs.

CONCLUSIONS: The Nursing intervention based on the Uncertainty theory allows reducing uncertainty in relatives of patients hospitalized in an Intensive Care Unit.

PMID:40115899 | PMC:PMC11560101 | DOI:10.15649/cuidarte.3220

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:292-299. doi: 10.3760/cma.j.cn115330-20240812-00471. Online ahead of print.

ABSTRACT

Objective: To evaluate the safety, and feasibility of transoral robot-assisted retropharyngeal lymph node (RPLN) dissection. Methods: Clinical data of head and neck cancer patients who underwent transoral robot-assisted RPLN dissection from December 2017 to March 2024 at the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and Sun Yat-sen University Cancer Centre were retrospectively analyzed. A total of 35 patients(22 males, 13 females, aged 47.4±13.4 years old) with retropharyngeal lymph node metastases from head and neck cancer, including 20 cases of nasopharyngeal cancer, 9 cases of thyroid cancer, 2 cases of salivary adenocarcinoma, 2 cases of tonsil cancer and 2 cases of hypopharyngeal cancer. Operation time, intraoperative bleeding and complications, postoperative nasogastric tube retention time, hospital stay and complications were evaluated. Statistical analysis was performed using SPSS 22.0 software. Results: All patients successfully received transoral robot-assisted RPLN dissection without intermediate open surgery, with removals of 2 (1, 3) RPLNs. The total operation time was 130 (102, 210) minutes. The intraoperative bleeding was 50 (20, 100) ml, and there was no major bleeding or organ damage during the operation. Prophylactic tracheotomy was performed in 8 cases, and postoperatively nasogastric tubes were left in 22 patients, with retention time of 10.5 (7.5, 14.0) days. Postoperative hospital stay was 5 (4, 9) days. Postoperative complications included incision dehiscence in 4 cases and dysphagia in 4 cases. The median postoperative follow-up was 23.4 months, with progression or recurrence in 5 patients, including regional recurrence in 3 patients, lung metastasis in 1 patient, and bone metastasis in 1 patient. The 2-year regional failure-free survival and disease-free survival rates were 91.43% and 85.71%, respectively. Conclusion: Transoral robot-assisted RPLN dissection is a safe and feasible surgical method with less trauma, fewer complications, and higher safety. Patients need to be carefully selected at the initial stage of application.

PMID:40113568 | DOI:10.3760/cma.j.cn115330-20240812-00471

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:266-271. doi: 10.3760/cma.j.cn115330-20240807-00466. Online ahead of print.

ABSTRACT

Objective: To explore the safety, effectiveness, and short-term outcomes of transoral robotic surgery (TORS) for supraglottic laryngeal cancer. Methods: A retrospective analysis was conducted on patients with supraglottic laryngeal cancer who underwent TORS at Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Eye Ear Nose and Throat Hospital of Fudan University, and the First Affiliated Hospital of China Medical University between January 2018 and April 2024. Data on operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheostomy, nasogastric feeding, complications, and short-term follow-up were analyzed. Statistical analysis was performed using Python. Results: A total of 27 patients with supraglottic laryngeal cancer were included from the four centers, including 24 males and 3 females, with a median age of 66 (65, 68) years [M(Q₁, Q₃), same below]. There were 26 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma.The TNM staging included T1 in 10 cases (37.04%), T2 in 13 cases (48.15%), and T3 in 4 cases (14.81%); N0 in 14 cases (51.85%), N1 in 7 cases (25.93%), and N2 in 6 cases (22.22%). The Da Vinci Si system was used in 23 cases, and the Da Vinci Xi in 4 cases. The robotic surgical time was 53 (30, 58) min. Concurrent neck dissection was performed in 25 cases, neoadjuvant therapy was given preoperatively in 8 cases (29.63%), and postoperative radiotherapy was administered in 13 cases (48.15%). Tracheostomy was performed in 11 cases (40.74%). Nasogastric tube placement was required in 23 cases (85.19%), with a median duration of 16 (12, 21) days. The postoperative hospital stay was 9.19±4.07 days. The median follow-up time was 12 (3, 30) months. Local recurrence occurred in 2 cases. The 3-year overall survival rate was 100%, and the 3-year disease-free survival rate was 94.1%. Conclusion: With appropriate patient selection, TORS for supraglottic laryngeal cancer demonstrates satisfactory short-term outcomes, offering advantages in safety, efficacy, and minimal invasiveness. It can be considered a new treatment option for this condition.

PMID:40113567 | DOI:10.3760/cma.j.cn115330-20240807-00466

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:278-284. doi: 10.3760/cma.j.cn115330-20240806-00464. Online ahead of print.

ABSTRACT

Objective: To evaluate the clinical efficacy of transoral robotic surgery (TORS) in the treatment of malignant tongue base tumors. Methods: A multicenter study was conducted to collect and analyze the clinical data of patients with malignant tongue base tumors who underwent TORS between January 2017 and January 2023 at five otolaryngology-head and neck surgery centers in China, including Eye Ear Nose and Throat Hospital of Fudan University, Sun Yat-sen University Cancer Center, Tongji Hospital of Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, and the First Affiliated Hospital of China Medical University. Among the patients, 38 were males and 11 were females, with a mean age of 59.0±8.8 years. Baseline characteristics, complications, and follow-up data were compared between groups. Independent sample t-tests or Mann-Whitney U tests were used for comparisons of continuous variables; chi-square tests or Fisher’s exact tests were applied for categorical variables. Survival analysis was performed using the Kaplan-Meier method to calculate overall survival and disease-free survival, with differences between groups compared using the log-rank test. Results: Among the 49 patients, 41 (83.7%) were diagnosed with squamous cell carcinoma (SCC), with a p16 positivity rate of 51.2% (21/41). There were no statistically significant differences between the p16-positive group (n=21) and the p16-negative group (n=20) in age, sex, or postoperative bleeding (all P>0.05). However, there was a significant difference in TNM stage between the two groups (χ²=14.556, P=0.020), with the p16-positive group predominantly in stage I (66.7%) and the p16-negative group primarily in stages Ⅲ and Ⅳ (40.0% and 30.0%, respectively). The postoperative tracheotomy rate was 30.6% (15/49), and the incidence of postoperative bleeding was 6.1% (3/49). The 1-year and 3-year overall survival rates were 98.0% and 92.5%, respectively, while the 1-year and 3-year disease-free survival rates were 89.2% and 84.9%, respectively. No significant differences were observed between the p16-positive and p16-negative groups in 3-year overall survival (100% vs. 83.8%, χ²=1.093, P=0.518) or 3-year disease-free survival (68.2% vs. 88.9%, χ²=2.161, P=0.382). Conclusion: TORS for malignant tongue base tumors demonstrates high clinical safety and favorable oncological outcomes.

PMID:40113566 | DOI:10.3760/cma.j.cn115330-20240806-00464

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:258-265. doi: 10.3760/cma.j.cn115330-20240806-00463. Online ahead of print.

ABSTRACT

Objective: To explore the clinical application value of transoral robotic surgery (TORS) in the treatment of tonsil squamous cell carcinoma (TSCC). Methods: A retrospective analysis was conducted. The clinical data of 157 TSCC patients were collected who received TORS at five medical centers, namely the Sun Yat-sen University Cancer Center, Sun Yat-sen Memorial Hospital, Eye Ear Nose and Throat Hospital of Fudan University, the First Affiliated Hospital of China Medical University, and Tongji Hospital of Tongji Medical College, from 1 January 2017 to 31 July 2022. There were 130 males and 27 females, aged 24-85 years. All patients were followed-up at least for 2 years (2-year group), among them, 99 patients had a follow-up of 3 years (3-year group). The overall survival (OS), progression-free survival (PFS), clinical stage, human papillomavirus (HPV) infection status were analyzed. SPSS 25.0 and SAS 9.4 were used for statistical analysis. Results: The OS and PFS of the 2-year group were 91.7% and 87.9%, respectively. The OS and PFS of the 3-year group were 85.9% and 82.8%, respectively. The prognosis of patients with locally early-stage was better than that of locally advanced patients, with the OS of 94.4% for T1-2 vs. 78.0% for T3 (P=0.005) and the PFS of 91.2% for T1-2 vs. 75.0% for T3 (P=0.011) in the 2-year group; the OS of 91.1% for T1-2 vs. 65.0% for T3 (P=0.004) and the PFS of 88.6% for T1-2 vs. 60.0% for T3 (P=0.002) in the 3-year group; and also the OS of 90.0% for stage Ⅰ-Ⅱ vs. 79.5% for stage Ⅲ-Ⅳ (P=0.204) and the PFS of 86.7% for stage Ⅰ-Ⅱ vs. 76.9% for stage Ⅲ-Ⅳ (P=0.188) in the 3-year group. The prognosis of HPV-positive TSCC patients was better than that of HPV-negative patients in the 3-year group, with the OS of 90.9% for HPV-positive vs. 80.5% for HPV-negative (P=0.045) and the PFS of 90.9% for HPV-positive vs. 75.6% for HPV-negative (P=0.047). The average time of postoperative tracheal cannula indwelling was 25.1 days. The indwelling rate and average indwelling time of the postoperative nasogastric tube were 94.3% (148/157) and 8.5 days, respectively. Conclusion: TORS has outstanding survival benefits for TSCC patients. HPV-positive TSCC patients have a better prognosis than HPV-negative patients. TORS treatment of TSCC patients has advantages in postoperative recovery and quality of life.

PMID:40113565 | DOI:10.3760/cma.j.cn115330-20240806-00463

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Mar 20;60:300-304. doi: 10.3760/cma.j.cn115330-20240423-00227. Online ahead of print.

ABSTRACT

Objective: To investigate the complications of transoral robotic surgery (TORS) and to identify the risk factors for the complications. Methods: This was a retrospective study of 134 cases of head and neck tumors underwent TORS at the Department of Surgery of Beijing United Family Hospital from September 2017 to June 2024. There were 9 cases of benign tumors and 125 cases of malignant tumors, including 119 squamous cell carcinomas, 3 adenocarcinomas, 2 lymphomas, and 1 sarcoma. There were 37 cases of pure TORS and 97 cases of TORS combined with neck dissection. Postoperative complications within 90 days were collected and graded with the Clavien-Dindo system. χ² test was used for statistical analysis. Results: A total of 25 (18.7%) cases experienced surgical complications, including 9 cases with Clavien-Dindo grade≥Ⅲ complications. Postoperative complications included 2 cases of death, 3 cases of massive hemorrhage, 3 cases of pharyngeal fistula, 2 cases of aspiration pneumonia, 2 cases of minor bleeding, 1 case of tooth injury, 1 case of arytenoid dislocation, 2 cases of tongue laceration, and 10 cases of long-term (>3 months) tracheostomy open. Postoperative pharyngeal fistula was significantly correlated with the scope of neck dissection (χ²=9.86, P<0.05), and Clavien-Dindo grade≥Ⅲ complications were significantly correlated with the scope of neck dissection (χ²=13.91, P<0.05) and tumor N stage (χ²=14.33, P<0.05). Conclusion: The high N-stage and neck dissection involving more than three regions are risk factors for the complications of TORS for head and neck tumors.

PMID:40113561 | DOI:10.3760/cma.j.cn115330-20240423-00227

J Prosthet Dent. 2025 Mar 19:S0022-3913(25)00201-X. doi: 10.1016/j.prosdent.2025.02.052. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: Advances in implant planning have increased the use of printed surgical guides for precise implant placement. Accurate placement of implants relies on the stability of the surgical guide, therefore the effects of sterilization and disinfection on the dimensional accuracy of surgical guides require evaluation.

PURPOSE: The purpose of this in vitro study was to examine the level of distortion of printed surgical guides after steam sterilization and disinfection by immersion in 70% isopropyl alcohol to develop a protocol for the sterilization of surgical guides.

MATERIAL AND METHODS: A surgical guide was designed in Blue Sky Bio. Forty guides were printed with Formlabs Form 3B+ printer and Formlabs surgical guide resin following manufacturer’s instructions. Each guide was scanned with Primescan optical scanner before disinfection and sterilization. Twenty guides were individually packaged, and autoclave sterilized following manufacturer’s recommendation of 134 °C for 20 minutes. The remaining 20 guides were soaked in 70% isopropyl alcohol for 15 minutes. After sterilization and disinfection, the guides were scanned and standard tessellation language (STL) files from pre- and post-sterilization were compared by using the GeoMagic Control X software program to examine dimensional changes. Differences among the study groups were analyzed with a 1-sample t test to determine if the mean site’s value for each treatment group was statistically significant from zero and a 2-way repeat-measures ANOVA was used to detect differences among groups (α=.05).

RESULTS: The average deviation at the lingual, incisal, and buccal sites of the sterilized guides was 6.3 µm, -2.3 µm, and -20.6 µm, respectively. The average deviation at the lingual, incisal, and buccal sites of the chemically disinfected guides was -0.4 µm, 2.6 µm, and -0.8 µm, respectively. Sterilization showed a statistically significant value at the lingual and buccal surface (P<.05), while the chemical disinfection group did not show a statistically significant difference at any site (P>.05). The 2-way repeat-measures ANOVA test demonstrated there was a significant effect of treatment on the overall mean values (P<.001), with sterilization treatment giving an overall value 6.3 µm more negative than disinfection. There was also a significant effect of site (P<.001), and a significant interaction between treatment and site (P<.001).

CONCLUSIONS: Heat sterilization caused a significantly greater negative deviation than disinfection across the sites. A statistically significant distortion was found after sterilization, but not with chemical disinfection. However, the amount of distortion will likely not cause a clinically significant effect on the deviation of implant placement.

PMID:40113529 | DOI:10.1016/j.prosdent.2025.02.052