Nevin Manimala

Ann Intern Med. 2025 Jan 28. doi: 10.7326/ANNALS-24-00165. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies indicate that 1% to 4% of Epstein-Barr virus (EBV)-seronegative recipients of EBV-seropositive donor (EBV D+/R-) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.

OBJECTIVE: To determine the associations between pretransplant EBV D+/R- and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.

DESIGN: Retrospective cohort study.

SETTING: Two large U.S. transplant centers.

PARTICIPANTS: Epstein-Barr virus D+/R- and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.

MEASUREMENTS: Exposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.

RESULTS: The final cohort comprised 104 EBV D+/R- recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R- recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R- recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein-Barr virus D+/R- recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).

LIMITATION: Two-center study.

CONCLUSION: Compared with previous studies, this study showed that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.

PRIMARY FUNDING SOURCE: National Institutes of Health.

PMID:39869913 | DOI:10.7326/ANNALS-24-00165

J Med Internet Res. 2025 Jan 27;27:e69080. doi: 10.2196/69080.

ABSTRACT

BACKGROUND: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear.

OBJECTIVE: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan.

METHODS: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1-happiness and life satisfaction, domain 2-physical and mental health, domain 3-meaning and purpose, domain 4-character and virtue, domain 5-close social relationships, and domain 6-health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing.

RESULTS: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities.

CONCLUSIONS: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being.

PMID:39869904 | DOI:10.2196/69080

JMIR Ment Health. 2025 Jan 27;12:e67478. doi: 10.2196/67478.

ABSTRACT

BACKGROUND: Insomnia is a prevalent sleep disorder affecting millions worldwide, with significant impacts on daily functioning and quality of life. While traditionally assessed through subjective measures such as the Insomnia Severity Index (ISI), the advent of wearable technology has enabled continuous, objective sleep monitoring in natural environments. However, the relationship between subjective insomnia severity and objective sleep parameters remains unclear.

OBJECTIVE: This study aims to (1) explore the relationship between subjective insomnia severity, as measured by ISI scores, and activity-based objective sleep parameters obtained through wearable devices; (2) determine whether subjective perceptions of insomnia align with objective measures of sleep; and (3) identify key psychological and physiological factors contributing to the severity of subjective insomnia complaints.

METHODS: A total of 250 participants, including both individuals with and without insomnia aged 19-70 years, were recruited from March 2023 to November 2023. Participants were grouped based on ISI scores: no insomnia, mild, moderate, and severe insomnia. Data collection involved subjective assessments through self-reported questionnaires and objective measurements using wearable devices (Fitbit Inspire 3) that monitored sleep parameters, physical activity, and heart rate. The participants also used a smartphone app for ecological momentary assessment, recording daily alcohol consumption, caffeine intake, exercise, and stress. Statistical analyses were used to compare groups on subjective and objective measures.

RESULTS: Results indicated no significant differences in general sleep structure (eg, total sleep time, rapid eye movement sleep time, and light sleep time) among the insomnia groups (mild, moderate, and severe) as classified by ISI scores (all P>.05). Interestingly, the no insomnia group had longer total awake times and lower sleep quality compared with the insomnia groups. Among the insomnia groups, no significant differences were observed regarding sleep structure (all P>.05), suggesting similar sleep patterns regardless of subjective insomnia severity. There were significant differences among the insomnia groups in stress levels, dysfunctional beliefs about sleep, and symptoms of restless leg syndrome (all P≤.001), with higher severity associated with higher scores in these factors. Contrary to expectations, no significant differences were observed in caffeine intake (P=.42) and alcohol consumption (P=.07) between the groups.

CONCLUSIONS: The findings demonstrate a discrepancy between subjective perceptions of insomnia severity and activity-based objective sleep parameters, suggesting that factors beyond sleep duration and quality may contribute to subjective sleep complaints. Psychological factors, such as stress, dysfunctional sleep beliefs, and symptoms of restless legs syndrome, appear to play significant roles in the perception of insomnia severity. These results highlight the importance of considering both subjective and objective assessments in the evaluation and treatment of insomnia and suggest potential avenues for personalized treatment strategies that address both psychological and physiological aspects of sleep disturbances.

TRIAL REGISTRATION: Clinical Research Information Service KCT0009175; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26133.

PMID:39869900 | DOI:10.2196/67478

J Med Internet Res. 2025 Jan 27;27:e58656. doi: 10.2196/58656.

ABSTRACT

BACKGROUND: The COVID-19 pandemic reshaped social dynamics, fostering reliance on social media for information, connection, and collective sense-making. Understanding how citizens navigate a global health crisis in varying cultural and economic contexts is crucial for effective crisis communication.

OBJECTIVE: This study examines the evolution of citizen collective sense-making during the COVID-19 pandemic by analyzing social media discourse across Italy, the United Kingdom, and Egypt, representing diverse economic and cultural contexts.

METHODS: A total of 755,215 social media posts from X (formerly Twitter) were collected across 3 time periods: the virus’ emergence (February 15 to March 31, 2020), strict lockdown (April 1 to May 30, 2020), and the vaccine rollout (December 1, 2020 to January 15, 2021). In total, 284,512 posts from Italy, 261,978 posts from the United Kingdom, and 209,725 posts from Egypt were analyzed using the latent Dirichlet allocation algorithm to identify key thematic topics and track shifts in discourse across time and regions.

RESULTS: The analysis revealed significant regional and temporal differences in collective sense-making during the pandemic. In Italy and the United Kingdom, public discourse prominently addressed pragmatic health care measures and government interventions, reflecting higher institutional trust. By contrast, discussions in Egypt were more focused on religious and political themes, highlighting skepticism toward governmental capacity and reliance on alternative frameworks for understanding the crisis. Over time, all 3 countries displayed a shift in discourse toward vaccine-related topics during the later phase of the pandemic, highlighting its global significance. Misinformation emerged as a recurrent theme across regions, demonstrating the need for proactive measures to ensure accurate information dissemination. These findings emphasize the role of cultural, economic, and institutional factors in shaping public responses during health crises.

CONCLUSIONS: Crisis communication is influenced by cultural, economic, and institutional contexts, as evidenced by regional variations in citizen engagement. Transparent and culturally adaptive communication strategies are essential to combat misinformation and build public trust. This study highlights the importance of tailoring crisis responses to local contexts to improve compliance and collective resilience.

PMID:39869893 | DOI:10.2196/58656

J Med Internet Res. 2025 Jan 27;27:e64649. doi: 10.2196/64649.

ABSTRACT

BACKGROUND: Uncertainty in the diagnosis of lung nodules is a challenge for both patients and physicians. Artificial intelligence (AI) systems are increasingly being integrated into medical imaging to assist diagnostic procedures. However, the accuracy of AI systems in identifying and measuring lung nodules on chest computed tomography (CT) scans remains unclear, which requires further evaluation.

OBJECTIVE: This study aimed to evaluate the impact of an AI-assisted diagnostic system on the diagnostic efficiency of radiologists. It specifically examined the report modification rates and missed and misdiagnosed rates of junior radiologists with and without AI assistance.

METHODS: We obtained effective data from 12,889 patients in 2 tertiary hospitals in Beijing before and after the implementation of the AI system, covering the period from April 2018 to March 2022. Diagnostic reports written by both junior and senior radiologists were included in each case. Using reports by senior radiologists as a reference, we compared the modification rates of reports written by junior radiologists with and without AI assistance. We further evaluated alterations in lung nodule detection capability over 3 years after the integration of the AI system. Evaluation metrics of this study include lung nodule detection rate, accuracy, false negative rate, false positive rate, and positive predictive value. The statistical analyses included descriptive statistics and chi-square, Cochran-Armitage, and Mann-Kendall tests.

RESULTS: The AI system was implemented in Beijing Anzhen Hospital (Hospital A) in January 2019 and Tsinghua Changgung Hospital (Hospital C) in June 2021. The modification rate of diagnostic reports in the detection of lung nodules increased from 4.73% to 7.23% (χ²₁=12.15; P<.001) at Hospital A. In terms of lung nodule detection rates postimplementation, Hospital C increased from 46.19% to 53.45% (χ²₁=25.48; P<.001) and Hospital A increased from 39.29% to 55.22% (χ²₁=122.55; P<.001). At Hospital A, the false negative rate decreased from 8.4% to 5.16% (χ²₁=9.85; P=.002), while the false positive rate increased from 2.36% to 9.77% (χ²₁=53.48; P<.001). The detection accuracy demonstrated a decrease from 93.33% to 92.23% for Hospital A and from 95.27% to 92.77% for Hospital C. Regarding the changes in lung nodule detection capability over a 3-year period following the integration of the AI system, the detection rates for lung nodules exhibited a modest increase from 54.6% to 55.84%, while the overall accuracy demonstrated a slight improvement from 92.79% to 93.92%.

CONCLUSIONS: The AI system enhanced lung nodule detection, offering the possibility of earlier disease identification and timely intervention. Nevertheless, the initial reduction in accuracy underscores the need for standardized diagnostic criteria and comprehensive training for radiologists to maximize the effectiveness of AI-enabled diagnostic systems.

PMID:39869890 | DOI:10.2196/64649

Acta Orthop Belg. 2024 Dec;90(4):745-758. doi: 10.52628/90.4.12611.

ABSTRACT

Chondrosarcomas are the second most common primary bone sarcoma. Due to chondrosarcomas relative resistance to chemotherapy and radiation, surgical treatment has become the mainstay treatment option. The purpose of our study was to understand the proportion of patients in this population who undergo non-operative treatment options secondary to various reasons and analyze the difference in survival as well as patient and cancer specific characteristics between the two groups. We retrospectively reviewed the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary chondrosarcoma from 1973 to 2015. We evaluated the patients for both descriptive characteristics as well as cancer specific characteristics. We then performed a propensity matched analysis and other analyses to compare difference in cancer characteristics as well as survival. There were 3048 patients with chondrosarcoma of the bone during our study period of which 188(6.2%) patients did not undergo operative treatment either due to refusal of cancer directed surgery or contraindicated to surgery. A one unit increase in age was significantly associated with increased odds of not undergoing surgery(Odds Ratio 1.04;95% CI, 1.03- 1.05). No statistically significant difference(P = 0.9) in survival was noted between patients with long bone, grade 1 chondrosarcomas regardless of if they did or did not undergo operative treatment. This study provides data to inform the patient on their decisions for or against surgery and may assist the surgeons in counseling patients regarding the surgical treatment of chondrosarcomas. Patients not undergoing operative treatment for chondrosarcomas are at statistically significantly increased risk of mortality.

PMID:39869879 | DOI:10.52628/90.4.12611

Acta Orthop Belg. 2024 Dec;90(4):739-743. doi: 10.52628/90.4.12808.

ABSTRACT

Metastasis stands as one of the most prominent prognostic factors in osteosarcoma. Over 70% of metastatic osteosarcoma occurrences affect the lung. Nonetheless, to date, there has been a scarcity of research addressing predictive factors for lung metastasis risk in osteosarcoma. The objective of this study is to identify the predictive factors that have a role in the risk of lung metastasis in osteosarcoma. This is a retrospective study conducted between January 2018 until January 2023. From the obtained research subjects, an assessment selection was carried out using inclusion and exclusion criteria. Subsequently, preoperative data related to predictive factors will be collected from the research subjects, followed by a clinicopathological conference, chemotherapy, and surgery. Afterward, an evaluation of pulmonary metastasis will be conducted six months after the diagnosis. A total of 47 osteosarcoma patients who met the inclusion and exclusion criteria were analyzed. Bivariate and multivariate logistic regression analyses revealed statistically significant predictive factors for the risk of pulmonary metastasis in osteosarcoma: ALP levels (p=0.014), LDH levels (p=0.038), presence of pathological fractures (p=0.025), and tumor size (p=0.027).

PMID:39869878 | DOI:10.52628/90.4.12808

Acta Orthop Belg. 2024 Dec;90(4):731-737. doi: 10.52628/90.4.10536.

ABSTRACT

Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLPS) are low-grade, slow-growing, and locally aggressive tumors. We investigated clinical outcomes and recurrence factors for ALT/WDLPS of the extremities. This is retrospective study across three institutions which included patients who underwent surgery for ALT/WDLPS from 2001 to 2019. We collected the data such as the patient demographics, anatomical locations of the tumors (subcutaneous, intramuscular, intermuscular, upper extreme/lower extremity), immunohistochemical data, and the resected margin status. The following variables were evaluated as potential recurrence factors: age, sex, tumor diameter, anatomical location of the tumor, immunohistochemical results, and resected margins. The 5- year local recurrence-free survival rate (RFS) was calculated and differences in survival were assessed. Sixty-two patients were identified, including 29 men and 33 women. The mean age was 63.7 years (range, 34-82 years). The average maximum tumor diameter was 15.9 cm (range, 5-28 cm). The maximum tumor diameter (≥20 cm) was significantly associated with local recurrence (p=0.042). Ten patients (16.1%) developed local recurrence, and the mean time to recurrence was 48.4 months (range, 5-161 months). In our series of 62 patients, the differences in local recurrences were not statistically significant for age, sex, tumor site, surgical margin (R0 or not) and immunohistochemical results. Tumor diameter ≥20 cm, which was the only identified factor for recurrence.

PMID:39869877 | DOI:10.52628/90.4.10536

Acta Orthop Belg. 2024 Dec;90(4):699-707. doi: 10.52628/90.4.12369.

ABSTRACT

Correct treatment of chronic osteomyelitis depends on proper identification of the bone-infecting microorganism, but it is difficult identify the specific etiology in previously treated patients and in those with implants. Small colony variants auxotrophyc for menadione had been related with false-negative results in culture of patient with chronic osteomyelitis, but menadione supplementation can increase bone culture performance. The purpose was to evaluate the effect of menadione supplementation on isolates in bone cultures, in a cohort of patients with osteomyelitis, Medellín- Colombia. We performed a study of a retrospective cohort with 40 adult patients with culture-negative and chronic osteomyelitis, supplemented with 3 doses of menadione. Effect was defined as the proportion of positive bone cultures after treatment administration. The comparison of the effect with clinical variables was made with Chi-square, Fisher and Mann-Whitney U test in SPSS 29.0. Microbiological isolates from bone culture ranged from 0% (pre- treatment) to 62.5% (post-treatment), mainly S. aureus sensitive to methicillin, coagulase-negative Staphylococcus, E. coli and Enterobacter spp. This effect did not present statistical differences according to the clinical characteristics or comorbidities of the patients. We concluded that in patients with chronic osteomyelitis and negative bone cultures, menadione supplementation produces a high proportion of isolates and identification of the etiological agent, which favors correct treatment and reduces readmissions, complications, and resistance to antibiotics.

PMID:39869875 | DOI:10.52628/90.4.12369

Acta Orthop Belg. 2024 Dec;90(4):659-664. doi: 10.52628/90.4.13073.

ABSTRACT

This prospective, observational cohort study compares the clinical and radiographic outcomes of the modified Weaver and Dunn (WD) technique with the newer, anatomical double-button plus tendon allograft technique (DB), and the suture anchor repair plus tendon allograft (SA). The study cohort includes 53 patients, who underwent surgery for acromioclavicular joint (ACJ) dislocation Rockwood type 3, 4 and 5. Patient-reported outcome scores and clinical results, including Disabilities of the Arm, Shoulder and Hand (DASH), the Subjective Shoulder Value (SSV), the Visual Analogue Scale (VAS) and the Constant score (CS) results as well as loss of reduction rates on plain radiographs were compared. Nineteen patients in the DB group, 19 patients in the SA group and 15 patients in the WD group were included. Average time of follow up was 5 years. The mean VAS scores (SD) were 0.3 (0.6), 0.5 (0.8) and 1.2 (1.4) in the WD, DB and SA groups (p=0.06). There were no significant differences in DASH, SSV and Constant scores between groups. Loss of reduction on plain radiographs occurred in 4 patients in total (1 WD, 1 DB, 2 SA). The SSV score, the DASH score, the Constant score and the VAS-score revealed no statistically significant differences between the group with good alignment compared to groups with partial reduction or loss of reduction. In conclusion we can state that the use of anatomical reconstruction techniques with tendon allograft and additional button or suture anchors fixation does not affect the clinical and radiographical outcomes compared to the classic Weaver and Dunn procedure. Loss of reduction was not correlated to worse clinical outcome scores.

PMID:39869870 | DOI:10.52628/90.4.13073