Nevin Manimala

Hernia. 2025 Nov 29;30(1):25. doi: 10.1007/s10029-025-03518-1.

ABSTRACT

INTRODUCTION: Inguinal hernia is a common occurrence affecting one in four men. Recurrence is a major clinical pitfall that affects about 10% of patients with increased recurrence and postoperative complications after a revision repair. Reoperation due to metachronous contralateral inguinal hernia is another possible outcome. The impact of minimally invasive surgery (MIS) techniques on inguinal hernia recurrence rates as compared to open surgery is less clear and further confounded by the adoption of robotic approaches. The aim of this study was to compare reoperation rates.

METHODS: Adult patients who underwent primary unilateral inguinal hernia repair (IHR) in an outpatient setting between January 2015 and December 2021 were queried from the Merative^TM MarketScan® Research Databases. Reoperation for IHR within two years was compared across surgical approaches: Open (O-IHR), Laparoscopic (L-IHR), and Robotic (R-IHR). Reoperations were further categorized and analyzed separately for recurrent and non-recurrent IHR. Secondary outcomes included all-cause total healthcare expenditures, assessed during the index operation and up to two years postoperatively, based on combined insurer and patient payments. A 1:1 propensity score matching approach was applied, with Cox proportional hazards regression used to analyze reoperation risk, and generalized linear regression models employed to evaluate expenditures.

RESULTS: A total of 73,870 patients undergoing IHR (39,591 [53.6%] O-IHR, 30,858 [41.8%] L-IHR, and 3,421 [4.6%] R-IHR) were included. As compared to O-IHR, any IHR reoperation risk at 2-years was about 42% lower with R-IHR (HR = 0.58, p = 0.002) and about 16% lower with L-IHR (HR= 0.84, p < .001). As compared to O-IHR, total expenditure for the index surgery was approximately $3,391 higher with L-IHR (p < .001) and $4,137 higher with R-IHR (p < .001). R-IHR had about $615 higher index expenditure than L-IHR (p = 0.004).

CONCLUSION: The current study demonstrates that robotic IHR is associated with a lower risk of reoperations at 2 years after an initial repair as compared to L-IHR and O-IHR, but higher index expenditure in the outpatient setting for an economically active population.

PMID:41317213 | DOI:10.1007/s10029-025-03518-1

J Neurol. 2025 Nov 29;272(12):792. doi: 10.1007/s00415-025-13455-9.

ABSTRACT

OBJECTIVE: To develop individualized nomograms integrating cortical morphometric measures with 3D multi-parametric MRI radiomics to predict disability progression (DP) and cognitive worsening (CW) in patients with relapsing-remitting multiple sclerosis (RRMS).

MATERIALS AND METHODS: In this multicenter study, 191 RRMS patients from two centers were divided into internal (training and validation sets, n = 158) and external validation (n = 33) sets. All patients underwent clinical and neuropsychological evaluations at both baseline and 2-year follow-up visits. Cortical morphometric metrics were extracted from 3D T1W images, with radiomics features were assessed within MS plaques on 3D DIR, 3D FLAIR, and 3D T1W images. Four models-clinical-only, radiomics-only, cortical morphometric-only, and a combined model-were developed. A nomogram was developed based on a multivariable logistic regression model to provide individualized probability estimates of DP and CW. Predictive performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

RESULTS: The combined nomogram outperformed models using clinical, radiomic, or cortical morphometric features alone in predicting DP, achieving an area under the curve (AUC) (95% confidence interval [CI]) of 0.950 (0.878-0.994) in the internal cohort and 0.904 (0.781-0.987) in the external cohort. Similarly, the nomogram for CW demonstrated excellent performance, with AUCs of 0.916 (0.831-0.984) and 0.889 (0.752-0.981) in the respective cohorts. Decision curve analysis confirmed the clinical utility of the nomograms.

CONCLUSION: Cortical atrophy, reduced morphological complexity, and high heterogeneity of MS lesions play significant roles in explaining DP and CW in MS. Nomograms integrating clinical indicators, cortical morphometric features, and 3D multi-parametric MRI radiomics, shows potential as a clinical tool for predicting disease progression, facilitating individualized management in RRMS patients.

PMID:41317205 | DOI:10.1007/s00415-025-13455-9

Eur J Orthop Surg Traumatol. 2025 Nov 29;36(1):29. doi: 10.1007/s00590-025-04595-9.

ABSTRACT

BACKGROUND: Studies on venous thromboembolism (VTE) in patients with traumatic pelvic and acetabular fractures have shown variable epidemiology, risk factors and outcomes.

METHODS: This retrospective study evaluated patients with traumatic pelvic and/or acetabular fractures who were admitted to a Level 1 trauma center in Riyadh, Saudi Arabia between January 2016 and December 2022. We compared patients who had VTE to those who did not.

RESULTS: The study evaluated 437 patients with (median age: 37 years; 72.8% males). VTE occurred in 42 patients (9.6%), with deep-vein thrombosis and pulmonary embolism occurring at almost equal rates. Patients with VTE were older and more likely to receive tranexamic acid (16.7% vs. 9.9%, p = 0.06), red blood cell (26.2% vs. 13.2%, p = 0.02) and platelet (9.5% vs. 3.8%, p = 0.08) transfusions, and pelvic angioembolization (9.5% vs. 3.0%, p = 0.03). The most common associated injuries were chest injury (28.4%) and abdomen/pelvis injury (23.8%). Pharmacologic thromboprophylaxis was used in 94.1% of patients, predominantly enoxaparin. The significant predictors of VTE were age, admission to the intensive care unit (odds ratio 2.746, 95% confidence interval 1.041-7.240) and hospital length of stay. The timing of pharmacologic thromboprophylaxis was not significantly associated with VTE. Patients with VTE had similar hospital mortality compared with those without VTE (4.8% vs. 4.1%, respectively; p = 0.83) but stayed for a longer period in the hospital (median stay: 21.5 days vs. 12.0 days, respectively; p < 0.0001).

CONCLUSIONS: VTE was diagnosed in almost 1 in 10 patients with traumatic pelvic and/or acetabular fractures. The need for admission to the intensive care unit, but not the timing of pharmacologic thromboprophylaxis, predicted VTE.

PMID:41317201 | DOI:10.1007/s00590-025-04595-9

Arch Gynecol Obstet. 2025 Nov 29. doi: 10.1007/s00404-025-08179-0. Online ahead of print.

ABSTRACT

OBJECTIVES: This meta-analysis seeks to clarify the relationship between hysterectomy, oophorectomy, and the subsequent risk of developing breast cancer.

METHODS: A comprehensive literature search was conducted across PubMed, the Cochrane Library, and Embase to identify relevant studies. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were performed using Stata software (version 14.0), with hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) calculated. Publication bias was assessed using funnel plots and Egger’s test.

RESULTS: A total of 12 studies were included, comprising 9 cohort studies and 3 case-control studies, with publication years ranging from 1988 to 2023, involving 5,868,660 participants, predominantly from the United States. The analysis revealed that both hysterectomy and oophorectomy are associated with a reduced risk of breast cancer, lowering the risk by 16% (HR 0.84; 95% CI: 0.76-0.92; I² = 76.5%; P < 0.001). Standalone hysterectomy was associated with a 13% reduction in breast cancer risk (HR 0.87; 95% CI: 0.77-0.99; I² = 82.3%; P = 0.033), while bilateral oophorectomy reduced the risk by approximately 19% (HR 0.81; 95% CI: 0.68-0.96; I² = 61.7%; P = 0.016). In contrast, unilateral oophorectomy did not significantly affect the risk of breast cancer (HR 0.89; 95% CI: 0.71-1.11; I² = 45.5%; P = 0.288). Patients who underwent bilateral oophorectomy and received hormone therapy experienced a 20% reduction in breast cancer risk (HR 0.80; 95% CI: 0.68-0.93; I² = 38.5%; P = 0.005), whereas those who did not receive hormone therapy showed no significant risk reduction (HR 0.87; 95% CI: 0.69-1.10; I² = 48.5%; P = 0.254). Premenopausal bilateral oophorectomy was associated with a 13% decrease in breast cancer incidence risk (HR 0.87; 95% CI: 0.79-0.96; I² = 0%; P = 0.004), while postmenopausal bilateral oophorectomy had no significant impact (HR 0.95; 95% CI: 0.88-1.03; I² = 1.2%; P = 0.196).

CONCLUSIONS: This meta-analysis suggests that both hysterectomy and oophorectomy are significantly associated with a reduction in breast cancer risk. The effectiveness of bilateral oophorectomy appears to be modulated by hormone therapy and menopausal status. Further research is needed to clarify these associations and to explore the underlying biological mechanisms.

PMID:41317195 | DOI:10.1007/s00404-025-08179-0

Eur Radiol. 2025 Nov 29. doi: 10.1007/s00330-025-12154-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the reproducibility and the diagnostic accuracy of MRI for the assessment of (#)ENZIAN classification in patients with deep endometriosis by means of a meta-analysis.

MATERIALS AND METHODS: MEDLINE and EMBASE databases were searched for relevant articles from January 1, 2005, to January 1, 2025. Data on MRI reproducibility (interobserver/intraobserver kappa) were extracted for P (peritoneum), O (ovary), T (tubo-ovarian condition), A (vagina/rectovaginal space), B (utero-sacral ligaments), C (rectum/sigmoid colon), FA (F adenomyosis), FB (F bladder), FU (F ureter), FI (F intestinum), and FO (F other). Pooled sensitivity, specificity, PPV, and NPV were calculated for each compartment.

RESULTS: Twelve articles (1024 patients) were included, of which 7 used ENZIAN and 5 used #ENZIAN. MRI-based (#)ENZIAN showed high reliability for O, A, B, and C, with substantial or excellent agreement in most studies. MRI-based (#)ENZIAN showed high diagnostic values for O, T, A, B, and C. Sensitivity and specificity for O were 97.5% and 96.4% and for T, 94.1% and 89.1%, respectively. Sensitivity values for A, B, and C were slightly lower, but remained high at 76.1%, 83.4%, and 79.1% respectively, and specificity values were high at 92.4%, 87.8%, and 94.8%. Sensitivity values for FA, FB, and FI were low, with values of 64.6%, 56.9%, and 66.8%. Data for P, FU, and FO were insufficient and could not be pooled.

CONCLUSION: MRI-based (#)ENZIAN showed high reliability for compartments O, T, A, B, and C. Data for other compartments were either insufficient or the diagnostic accuracy was low.

KEY POINTS: Question What is the diagnostic value of MRI in the assessment of (#) ENZIAN classification in patients with deep endometriosis? Findings MRI-based(#)ENZIAN showed high diagnostic values for compartments O, T, A, B, and C. Data on the remaining compartments were insufficient, or the diagnostic accuracy was low. Clinical relevance MRI-based (#) ENZIAN can be used for assessing endometriosis located at the ovaries, tubal ovarian condition, vaginal-rectovaginal space, utero-sacral ligaments, and rectosigmoid. For other compartments, more data are needed and clear definitions might also improve the role of MRI.

PMID:41317188 | DOI:10.1007/s00330-025-12154-3

Clin Oral Investig. 2025 Nov 29;29(12):592. doi: 10.1007/s00784-025-06663-0.

ABSTRACT

OBJECTIVE: To evaluate the effects of concentrated growth factors (CGFs) combined with Bio-Oss bone substitute on the periodontal healing of adjacent teeth following impacted tooth extraction.

METHODS: This single-centre prospective controlled study enrolled 60 patients requiring bilateral impacted mandibular third molar extraction. Patients were randomly allocated to a test group (n = 30; extraction socket filled with CGFs + Bio-Oss and covered with a CGF membrane) or control group (n = 30; natural healing). Primary outcomes included periodontal probing depth (PD) and distal bone height measured by cone beam computed tomography at baseline and 3 and 6 months. Secondary outcomes comprised the visual analogue scale (VAS) pain scores, swelling assessment and dry socket incidence. Statistical analysis was performed using SPSS 26.0, with significance set at P < 0.05.

RESULTS: A total of 60 patients were enrolled in this randomised single-blind clinical trial. The test group showed significantly greater PD reduction (2.41 ± 0.89 vs. 1.52 ± 0.73 mm, P < 0.001) and bone height gain (2.87 ± 1.12 vs. 1.63 ± 0.91 mm, P < 0.001) at 6 months than the control group. The VAS pain scores were significantly lower in the test group at days 3 and 7 (P < 0.001). No cases of dry socket occurred in the test group, compared with three cases (11.1%) in the control group. Multivariate analysis revealed that CGFs + Bio-Oss application was the strongest predictor of bone gain ≥ 2 mm (β = 0.412, P < 0.001).

CONCLUSION: Concentrated growth factors combined with Bio-Oss significantly enhance periodontal healing and bone regeneration at adjacent teeth following impacted tooth extraction while reducing postoperative complications. This combined approach represents a promising strategy for clinical practice.

PMID:41317186 | DOI:10.1007/s00784-025-06663-0

Eur J Orthop Surg Traumatol. 2025 Nov 29;36(1):28. doi: 10.1007/s00590-025-04584-y.

ABSTRACT

INTRODUCTION: We investigated outcomes of patients treated with either locked plating or retrograde intramedullary nailing (IMN) at a single institution and compared outcomes of retrograde IMN to locked plating for periprosthetic distal femur fractures.

METHODS: We reviewed 241 subjects with distal femur fractures around total knee arthroplasty (TKA) treated with locked plating (197) or retrograde IMN (44). Mean age was 77 years, 78% were female, and mean BMI was 32 kg/m². There were 27% Su I, 41% Su II, and 32% Su III fractures. There were 87% primary TKAs and 13% revision TKAs. Mean follow-up was 3 years.

RESULTS: Overall nonunion rate was 10% and 5-year survivorship free of any revision was 81%, with the most common reasons being nonunion (49%), infection (19%), and aseptic TKA loosening (11%). Patients with prior TKA infection (HR 3; p = 0.02), revision TKA (HR 2; p = 0.03), Su III fractures (HR 2.5; p = 0.04) were at increased risk of revision. There was a trend toward higher non-union rate in the locked plating group (11% vs. 2%; p = 0.07). Those with locked plating had higher rates of osteoporosis (70% vs. 52%; p = 0.02), prior revision TKA (16% vs. 2%; p = 0.02), and Su Type III fractures (36% vs.16%, p = 0.047). Five-year survivorship free of any revision for locked plating and retrograde IMN were 80% and 84%, respectively, with no significant difference in revision, reoperation, or non-operative complications.

CONCLUSIONS: Both locked plating and retrograde IMN are viable fixation options for periprosthetic distal femur fractures after TKA. Those treated with locked plating had higher rates of osteoporosis, prior revision TKA, and more distal fractures, but did not demonstrate a significant increased risk for reoperation or revision.

LEVEL OF EVIDENCE: Level III, Retrospective comparative cohort study.

PMID:41317180 | DOI:10.1007/s00590-025-04584-y

Eur J Pediatr. 2025 Nov 29;184(12):807. doi: 10.1007/s00431-025-06660-1.

ABSTRACT

Off-label prescribing in pediatric care is common due to the lack of age-specific drug formulations, posing risks to safety and efficacy. Understanding how Italian hospitals manage and regulate this practice is essential to improving oversight and promoting safer prescribing. A multicenter, cross-sectional survey was conducted from November 13, 2024, to January 31, 2025, under the Italian Network for Pediatric Clinical Trials (INCiPiT). Fifty facilities participated; 64% of those with < 5000 pediatric admissions had Neonatal Intensive Care Units (NICUs) and birth centers. Off-label prescribing was strongly associated with NICUs, increasing up to 50% following compassionate use refusal. Notably, 25% of centers were unaware of prescribing frequency. Facilities with digital tracking and dedicated research units had better regulatory compliance and higher compassionate use approval rates.

CONCLUSION: The present analysis revealed that off-label prescribing is pervasive and predominantly driven by institutional specialization rather than hospital size. The implementation of structured oversight, digital infrastructure, and cost monitoring has been demonstrated to enhance regulatory compliance. The findings of this study support the need for standardized procedures and policy alignment to ensure safe pediatric pharmacotherapy.

WHAT IS KNOWN: • Off-label drug prescribing in pediatric care is a prevalent practice, primarily attributable to the paucity of age-appropriate formulations and clinical trial data for children.This practice entails potential risks associated with drug safety, efficacy, and dosing accuracy, particularly in vulnerable populations such as neonates and infants. • Regulatory oversight and institutional awareness of off-label use vary significantly across healthcare systems, with limited data available on how hospitals manage these prescriptions at the organizational level.

WHAT IS NEW: • This nationwide Italian survey reveals that off-label prescribing in Italian pediatric hospitals is primarily driven by institutional specialization-especially NICU presence-rather than hospital size, with digital tracking and research units linked to better regulatory compliance. • A significant portion of facilities lack awareness of their off-label prescribing rates, highlighting the need for standardized oversight and national policy alignment to ensure safer pediatric drug use.

PMID:41317175 | DOI:10.1007/s00431-025-06660-1

Neurosurg Rev. 2025 Nov 29;49(1):35. doi: 10.1007/s10143-025-03980-6.

ABSTRACT

Thirty-day readmission rates are commonly used as quality indicators (QIs) due to their feasibility and financial impact on healthcare systems. However, their validity in neurosurgical oncology remains uncertain. This study evaluates 30-day readmission rates following craniotomies for brain tumor resection, focusing on causes, predictors, and their impact on overall survival (OS). A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Cochrane, Scopus, and Web of Science databases were queried for studies reporting 30-day readmission rates in craniotomies for brain tumors. Meta-analysis with random-effects modeling was performed for pooled readmission rates, causes, predictors, and survival outcomes. Individual patient data (IPD) for overall survival were available for glioblastoma patients from four studies and were reconstructed from Kaplan-Meier curves to assess the association between readmission and survival. Eleven studies involving 132,791 patients yielded a pooled 30-day readmission rate of 13% (95% CI: 11%-16%). Neurological (50%) and infectious (25%) causes were the most common readmission indications. Surgical site infections accounted for 11% (7%-16%) and thromboembolic events for 12% (9%-16%) of all readmissions. Preoperative characteristics, including functional status, were consistent predictors of readmission. Among glioblastoma patients, reconstructed IPD from four studies demonstrated that readmitted patients had significantly shorter median overall survival compared with non-readmitted patients (6.4 vs. 8.7 months, p < 0.0001). Thirty-day readmission rates provide insights into neurosurgical oncology care but have limitations as standalone QIs. A combination of QIs would offer a more comprehensive and accurate assessment of care quality. Efforts to reduce readmissions should address modifiable risk factors, such as preventing SSIs and thromboembolic events, and optimizing perioperative care.

PMID:41317174 | DOI:10.1007/s10143-025-03980-6

J Perianesth Nurs. 2025 Nov 28:S1089-9472(25)00356-9. doi: 10.1016/j.jopan.2025.06.015. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty is a common orthopedic surgery that can cause anxiety, shivering, and hemodynamic changes in patients. The study aimed to compare the effects of a combination of valerian and Melissa officinalis (Norogol) with clonidine on anxiety, hemodynamic changes, and shivering in total knee replacement.

DESIGN: A parallel-group randomized controlled trial was used.

METHODS: Ninety-six patients were divided into 3 groups: a combination of valerian and M. officinalis (Norogol), clonidine, and a placebo, with 32 individuals in each group. Patients received one capsule each night, starting two nights before surgery. Anxiety levels were assessed before medication and before surgery using the Spielberger questionnaire. Shivering was evaluated using the Crossley-Mahajan scale during recovery. Hemodynamic changes were monitored before drug administration, during surgery, and after surgery. The analysis of variance test was employed to compare quantitative variables FINDINGS: There were no significant differences in age and gender among the groups. The average shivering score in the Norogol and clonidine groups was significantly lower than that of the placebo group up to 60 minutes after the operation (P < .001). Both obvious and hidden anxiety levels in the intervention groups decreased, while anxiety increased in the control group. Hemodynamic factors, including systolic blood pressure and heart rate, decreased in all three groups; however, there were no significant differences among the groups.

CONCLUSIONS: The results indicated that Norogol was as effective as clonidine in reducing shivering in patients after surgery. Although the intervention groups showed a decrease in both obvious and hidden anxiety, the reduction was not statistically significant.

PMID:41317165 | DOI:10.1016/j.jopan.2025.06.015