Nevin Manimala

Arch Osteoporos. 2025 Nov 27;20(1):146. doi: 10.1007/s11657-025-01637-x.

ABSTRACT

Over 14 years, hip fracture patients grew older, with shorter hospital stays. Femoral neck fractures were more common than intertrochanteric fractures, but the latter had worse functional outcomes and higher complications. Surgery was standard, with nailing for intertrochanteric and arthroplasty for femoral neck fractures. Older age increased adverse outcomes.

AIM: We aimed to investigate trends in patient characteristics and outcomes in patients after hip fractures.

METHODS: We analyzed data from hip fracture patients treated at our trauma center between January 2009 and December 2022. Variables included fracture type, sex, age, BMI, admission/discharge times, anesthesia type, ASA classification, treatment methods, surgery duration, discharge activities of daily living, and complications.

RESULTS: This retrospective study of 2965 hip fracture patients revealed a predominance of femoral neck fractures (56.6%) over intertrochanteric fractures (43.4%), with females comprising two-thirds of cases. Mean patient age increased significantly over time, particularly for intertrochanteric fractures (79.4 vs. 75.0 years for femoral neck). Hospital stays markedly decreased (25.5 to 9.1 days for intertrochanteric; 20.2 to 8.9 days for femoral neck). Intertrochanteric fractures were associated with worse functional outcomes (discharge ADL, 38.5 vs. 42.2, P = 0.009) and higher ICU admission (11.4% vs. 6.0%, P < 0.001). Surgical management dominated (92.3%), with intramedullary nailing for intertrochanteric fractures (86.3%) and arthroplasty for femoral neck fractures (73.7%). ASA classification indicated poorer physiological status in intertrochanteric fracture patients (P < 0.001). In-hospital mortality escalated with age and prolonged injury-to-admission time (P < 0.001).

CONCLUSION: During 2009-2022, the mean age of hip fracture patients increased significantly, while hospital stays decreased. Intertrochanteric fractures were associated with poorer functional outcomes and higher complication rates compared to femoral neck fractures. Surgical management, particularly intramedullary nailing and arthroplasty, predominated. Older adults exhibited the higher burden of adverse outcomes, with mortality and complications rising with age.

PMID:41307770 | DOI:10.1007/s11657-025-01637-x

Clin Exp Med. 2025 Nov 27. doi: 10.1007/s10238-025-01964-w. Online ahead of print.

ABSTRACT

Till now, the management of autoimmune thyroid diseases (AITD) depends on symptomatic treatment and replacement or anti-thyroid therapy. Uncovering the pathophysiologic mechanisms of autoimmunity provides hope for new insights into management. These new treatments aim to modulate the immune reaction and stop the autoimmune process. T regulatory cells (Tregs) are central in antagonising autoimmunity. This study aimed to compare the number of CD4/CD25/FOXP3 T regulatory cells in the different forms of autoimmune thyroid diseases and in the normal population, and to compare the number of CD4 + CD25 + FOXP3 + T regulatory cells between the different forms of AITD, HT, and GD. Also, to investigate the difference in the number of CD4/CD25/FOXP3 T regulatory cells in AITD associated with allergic disorders on one hand and autoimmune thyroid diseases not associated with allergic disorders on the other hand. This study included 18 patients suffering from Hashimoto’s thyroiditis (HT), 15 patients suffering from Graves’ disease (GD); and, for comparison, the Tregs level was measured in 15 healthy control patients. A statistically significant decrease was found regarding CD4/CD25, CD25/FOXP3 percentages and CD4/CD25/FOXP3 absolute number between patients of AITD and the normal population. The absolute number of CD4/CD25/FOXP3 was lower in the GD group than in HT group. Allergic comorbidities do not influence Tregs percentage or their CD4/CD25/FOXP3 absolute number in any of the AITD forms. Tregs may be a potential therapeutic target for AITD.

PMID:41307767 | DOI:10.1007/s10238-025-01964-w

J Perioper Pract. 2025 Nov 27:17504589251390407. doi: 10.1177/17504589251390407. Online ahead of print.

ABSTRACT

INTRODUCTION: Identifying risk factors for acute kidney injury (AKI) following major non-cardiac surgery is challenging due to heterogeneous findings and variable relevance across published studies. This complexity hinders the development of a standardised prognostic model.

METHODS: A systematic review and meta-analysis were conducted based on an extensive literature search (2002-2022) in PubMed, Scopus, Web of Science, Cochrane Central, LILACS, and Dart Europe. Studies were independently screened and selected, with extraction of relevant preoperative and intraoperative variables. Meta-analysis was performed using RevMan 5.4.

RESULTS: Out of 533 studies, ten met inclusion criteria. Significant risk factors for postoperative AKI included diabetes mellitus (OR: 1.65, CI: 1.20-2.27), hypertension (OR: 1.86, CI: 1.36-2.54), ACE inhibitors or ARBs use (OR: 1.76, CI: 1.48-2.09), ischaemic heart disease (OR: 1.93, CI: 1.55-2.41), and male sex (OR: 1.28, CI: 1.07-1.53). Protective factors were female sex (OR: 0.72, CI: 0.54-0.96) and higher preoperative haemoglobin (MD: -0.41, CI: -0.52 to -0.30). Trends without statistical significance were noted for older age, low glomerular filtration rate, prolonged operative time, and higher serum creatinine.

CONCLUSIONS: Comorbidities and certain pharmacological treatments significantly elevate postoperative AKI risk. These findings underscore the need for vigilant preoperative risk stratification.PROSPERO registration:CRD420251111455.

PMID:41307212 | DOI:10.1177/17504589251390407

Mov Disord Clin Pract. 2025 Nov 27. doi: 10.1002/mdc3.70454. Online ahead of print.

ABSTRACT

BACKGROUND: Bilateral globus pallidus internus deep brain stimulation (GPi-DBS) is a proven safe and effective treatment in certain forms of idiopathic or inherited dystonia (ID/IN). Its effects in acquired dystonia such as in dyskinetic cerebral palsy (DCP) however vary widely. The impact of GPi-DBS on speech and swallowing, which significantly affect quality of life, remains poorly understood, especially in pediatric patients.

OBJECTIVE: To evaluate GPi-DBS effects on speech and swallowing using the Frenchay Dysarthria Assessment 2 (FDA-2), in pediatric patients with dystonia, and assess how the effects differ between DCP and ID/IN patients.

METHODS: This pro- and retrospective multicenter study analyzes speech and swallowing pre- and 12 months post-GPi-DBS using FDA-2, including prospective data from the STIM-CP trial and retrospective data from the GEPESTIM registry.

RESULTS: Twenty-six patients were included (17 male, 9 female; 14 DCP, 12 ID/IN) with mean age of 12.2 years at DBS. No significant changes in FDA-2 total scores were observed pre- and post-DBS (pre: 46.3 ± 33.6; post: 46.3 ± 34.2). ID/IN patients showed consistently higher scores compared to DCP patients both pre- and post-DBS (P < 0.005). When adjusted for age, medication, and pre-surgical values, group differences narrowed, with minimal changes from baseline in both groups.

CONCLUSION: GPi-DBS did not significantly change FDA-2 scores pre- and post-DBS. Assessing speech and swallowing in pediatric patients with dystonia, impaired expressive language and/or intellectual disability is challenging. More comprehensive and patient-centered assessment tools are needed to fully capture DBS effects on these domains in these complex disabled patients.

PMID:41307194 | DOI:10.1002/mdc3.70454

Health Promot Pract. 2025 Nov 27:15248399251390503. doi: 10.1177/15248399251390503. Online ahead of print.

ABSTRACT

Explanations of Benefits (EOBs) are claims documents sent by health insurers to notify policyholders of charges for their and their covered dependents’ medical care. EOBs can result in a breach of patient confidentiality for dependents; dependents may also avoid seeking health care services from fear of potential disclosure. We conducted an online survey in Fall 2021 with a convenience sample of adolescents and young adults (AYA) to gather pilot data on EOB-related barriers for AYA in Pennsylvania, which contributed to creating an informational toolkit. We characterized the sample using descriptive statistics and analyzed open-ended text responses using rapid-turnaround qualitative methods. Sixty-six AYA completed the survey; most were aged 18 to 25 and reported being dependent on a parent’s or guardian’s insurance plan. Key themes emerged, including health care avoidance due to fear of adult disapproval and desire for educational resources. Informed by these data and with the support of community organizations, we employed health communication strategies to develop a digital toolkit to engage AYA around this privacy issue and pending EOB-related legislation in Pennsylvania. The toolkit contains educational materials (e.g., text, images, infographics), social media prompts (e.g., templated text), and links to additional educational and advocacy resources to empower AYAs to make informed decisions about their health and health care needs.

PMID:41307172 | DOI:10.1177/15248399251390503

Head Neck. 2025 Nov 27. doi: 10.1002/hed.70106. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative adjuvant therapy strategies are generally determined based on pathological risk stratification in oral cancer. However, the efficacy of postoperative adjuvant therapy in patients with intermediate-risk factors for recurrence of oral cancer such as close surgical margins, pT3-T4 classification, pN2-N3 nodal status, perineural invasion, vascular invasion, lymphatic invasion and pattern of invasion remains unclear, and no standardized treatment guidelines or consensus have been established to date. Therefore, this study retrospectively analyzed the clinical significance of risk factors for pathological recurrence in patients with advanced oral cancer and evaluated the impact of postoperative adjuvant therapy on patient prognosis.

METHODS: This retrospective clinical study included 130 patients who underwent initial radical surgical resection for advanced oral squamous cell carcinoma (OSCC) at our institution between January 2010 and December 2023. The postoperative recurrence risk factors included ENE of the cervical lymph nodes, positive surgical margins, close surgical margins, pathological T classification (pT3 or pT4), pathological N classification (pN2 or pN3), metastasis to level IV or V lymph nodes, perineural invasion, vascular invasion, and lymphatic invasion. We analyzed the relationships among the presence of these risk factors, administration of postoperative adjuvant therapy (RT or CRT), occurrence of recurrence or metastasis, and patient prognosis (DFS).

RESULTS: Patients with lymphatic invasion had a significantly lower survival rate than those without lymphatic invasion (66.7% vs. 82.8%, p < 0.05). Although pT4, pN2-N3, perineural invasion-positive and vascular invasion-positive did not reach statistical significance, a trend toward reduced survival was observed in each case. The perineural invasion-positive group had significantly higher recurrence and metastasis rates than the perineural invasion-negative group (51.9% vs. 23.6%, p < 0.05). Multivariate analysis using logistic regression also confirmed the presence of perineural invasion as an independent prognostic factor (HR = 4.496, p = 0.019).

CONCLUSIONS: This study demonstrated that perineural invasion is a significant risk factor for recurrence and that lymphatic invasion is a poor prognostic factor in oral cancer. Postoperative adjuvant therapy in patients with perineural or lymphatic invasion-positive disease contributed to reduced recurrence rates and prolonged survival. These findings suggest that the pathological evaluation of perineural and lymphatic invasions is an important indicator in determining the appropriateness of postoperative adjuvant therapy.

PMID:41307158 | DOI:10.1002/hed.70106

Hand (N Y). 2025 Nov 27:15589447251392939. doi: 10.1177/15589447251392939. Online ahead of print.

ABSTRACT

BACKGROUND: Hand and wrist injuries place a large burden on US emergency departments, and the injury mechanism is often related to consumer products. The purpose of this study is to identify the consumer products most frequently associated with injuries of the hand and wrist that present to US emergency departments and analyze demographic variables and disposition status.

METHODS: The National Electronic Injury Surveillance System database was queried for hand and wrist injuries in patients of all ages from 2018 to 2022. Consumer product codes, demographics, injury sustained, diagnosis, and disposition were analyzed using descriptive statistics and multivariate logistic regression analysis.

RESULTS: Knives accounted for 11% of all injuries, and doors were the next most common consumer product identified (n = 15 827; 5.8%). The highest proportion of injuries occurred in patients ages 15 through 24 (n = 51 900; 19%). The consumer product varied significantly by age group: doors were most common for ages 1 through 9, sports equipment for ages 10 through 14, knives for ages 15 through 80, and floors or stairs for patients older than 80. Discharge disposition was primarily outpatient (n = 257 895; 94%). Age, male sex, stairs, floors, and windows were associated with significantly higher odds of admission.

CONCLUSIONS: The most common consumer product codes involved in injuries varied significantly between age groups, likely reflecting different common injury mechanisms. Knives were the most common consumer product identified. Patients were more likely to be admitted if older than 65, male, or injured with floor, stairs, or windows.

PMID:41307144 | DOI:10.1177/15589447251392939

Spine (Phila Pa 1976). 2025 Nov 27. doi: 10.1097/BRS.0000000000005581. Online ahead of print.

ABSTRACT

STUDY DESIGN: Systematic review and proportional meta-analysis.

OBJECTIVE: To assess and compare overall and specific complication rates across tubular, uniportal, and biportal minimally invasive techniques for cervical spine surgery.

SUMMARY OF BACKGROUND DATA: The three primary minimally invasive spine surgery (MISS) approaches are tubular retractor-based surgery, uniportal endoscopic spine surgery, and biportal endoscopic spine surgery. Each has distinct benefits: tubular approaches rely on familiar instruments and surgical corridors, uniportal techniques reduce skin incision size and tissue disruption, and biportal methods preserve tissue while providing dual working channels that improve surgical access compared to uniportal approaches. However, the relative complication rates of tubular, uniportal, and biportal techniques remain unclear.

METHODS: This review was registered in PROSPERO (CRD42024594335). Following PRISMA guidelines, we conducted a systematic review and meta-analysis. PubMed, Medline, Embase, and Cochrane Library were searched (Jan 2013-Mar 2024) for cervical MISS studies. Studies with ≥10 adult patients reporting UESS complication rates were included. Conference abstracts, reviews, meta-analyses, and non-English articles were excluded. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. A random-effects model was applied.

RESULTS: Twenty-one studies (1299 patients) were included, with average patient ages ranging from 47 to 74.5 years and 64% male. All studies had low bias risk. Follow-up periods ranged from 3 to 33 months. The pooled complication rate for cervical MISS was 5% (95% CI [3%-7%]), with heterogeneity (I²=59%). Subgroup analysis showed complication rates of 4% (95% CI [1%-10%], I²=70%) for tubular, 6% (95% CI [2% -12%], I2=46%) for uniportal, and 5% (95% CI [2%-8%], I2=39%) for biportal. No statistically significant differences were found (P=0.85). Nerve injury rates were higher with the uniportal approach (6%, 95% CI [2%-16%], P=0.02). Dural tears (1%, 95% CI [0%-2%], I²=0%) and postoperative hematomas (0%, 95% CI [0%-3%], I²=0%) had low incidence, with no significant differences between approaches (P=0.61 and P=0.78, respectively).

CONCLUSIONS: Cervical MISS demonstrates a low overall complication rate, with tubular approaches showing a numerically lower risk, though differences were not statistically significant. Larger comparative studies are needed to provide more definitive results for better clinical application.

PMID:41307142 | DOI:10.1097/BRS.0000000000005581

Pediatr Dev Pathol. 2025 Nov 27:10935266251385782. doi: 10.1177/10935266251385782. Online ahead of print.

ABSTRACT

BACKGROUND: Intervillous thrombi (IVT) is one of the most common pathology findings during placental examination. The etiology and clinical significance of IVT are controversial.

MATERIALS AND METHODS: We previously collected placental data with fetal birth data and maternal pregnancy characteristics, and we examined IVT in the context of maternal, fetal, and placental pathology.

RESULTS: A total of 3119 placentas with fetal birth and maternal pregnancy characteristics were examined, and IVT was found in 644 placentas (20.6%). IVT was statistically associated with advanced maternal age (P = .01) and clinical preeclampsia (P = .02). IVT was significantly associated with placental infarcts (P < .01), mural arterial hypertrophy (P = .02) as well as placental abruption (P < .01). In addition, IVT was significantly associated with velamentous cord insertion (P < .01). Regression analysis demonstrated the persistence of association between IVT placental infarct, in addition to 2 vessel cord (SUA) and fetal inflammatory response (FIR, acute funisitis/fetal vasculitis).

CONCLUSION: Our data showed that IVT was independently associated with placental infarct, single umbilical artery, and fetal inflammatory response after regression analysis. The association of IVT with single umbilical artery and fetal inflammatory response points to fetal blood flow as potential pathogenic basis, providing new insight into pathogenic mechanisms and clinical significance.

PMID:41307115 | DOI:10.1177/10935266251385782

Spine (Phila Pa 1976). 2025 Nov 27. doi: 10.1097/BRS.0000000000005580. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective, multicenter, single-blind, randomized, controlled pivotal study.

OBJECTIVE: Compare time-to-fusion in patients treated with P-15L (PearlMatrixTM P-15 Peptide Enhanced Bone Graft) versus local autograft over 24 months and evaluate changes in pain and quality of life at 24 months relative to baseline.

SUMMARY OF BACKGROUND DATA: P-15L, an FDA-designated Breakthrough Device, is a composite bone graft with P-15, a 15-amino acid polypeptide that promotes cellular adhesion, proliferation, and differentiation to support bone formation.

METHODS: Patients (22-80 y) with degenerative disc disease were randomized to the investigational (P-15L) or control (local autograft) group during single-level transforaminal lumbar interbody fusion (TLIF) with a PEEK cage and supplemental pedicle screw fixation. Fusion assessments occurred at 6, 12, and 24 months. Time-to-fusion was tested for superiority as compared to the control using Kaplan-Meier survival analysis. Back and leg pain were measured using the Visual Analog Scale (VAS) and quality of life was assessed using the Short Form Survey (SF-12).

RESULTS: The analysis included 290 patients from 33 sites; 141 (48.6%) received P-15L and 149 (51.3%) received local autograft. At randomization, at least 1 risk factor for pseudoarthrosis (obesity, nicotine use, or diabetes) was reported in 58.9% (83/141) of the investigational group and 60.4% (90/149) of the control group. More patients in the investigational than the control group achieved fusion at 6 months (Kaplan-Meier fusion rates 57.6% vs 26.9%, respectively), 12 months (68.8% vs 41.5%, respectively), and 24 months (81.1% vs 54.9%, respectively). P-15L was statistically superior to autograft for time-to-fusion (hazard ratio=1.87, 95% CI: 1.47, 2.38; P<0.0001). There was marked improvement in VAS and SF-12 relative to baseline in both groups at 24 months.

CONCLUSION: P-15L promotes statistically superior earlier time-to-fusion than local autograft in instrumented TLIF. Both treatments resulted in clinically meaningful improvements in pain and quality of life at 24 months.

LEVEL OF EVIDENCE: 1.

PMID:41307110 | DOI:10.1097/BRS.0000000000005580