Nevin Manimala

Cureus. 2024 Dec 17;16(12):e75896. doi: 10.7759/cureus.75896. eCollection 2024 Dec.

ABSTRACT

Background Pre-pectoral implant-based breast reconstruction has become increasingly popular because it is associated with less postoperative pain and earlier recovery than traditional sub-pectoral techniques. Acellular dermal matrix (ADM) in pre-pectoral reconstruction is thought to provide additional support for the implant and improve cosmetic outcomes. However, it leads to additional costs. This study aimed to compare the early outcomes of pre-pectoral implant-based breast reconstruction with and without mesh. Methodology An observational, single-surgeon, retrospective cohort analysis was conducted to evaluate patients who underwent one-stage pre-pectoral breast reconstruction between May 2019 and July 2023 at Royal Wolverhampton NHS Trust. Patient characteristics such as demographics, implant size, and postoperative complications were noted and compared. Statistical significance between groups was evaluated using chi-square tests, and a p-value <0.05 was deemed statistically significant. Results A total of 101 patients were included, with 52 patients with ADM and 49 patients without ADM. In total, 60 implant reconstructions were included in each group. Patients in the ADM group were younger than patients in the cohort without the mesh (median = 50 versus 56 years). Patients with ADM also had a higher median volume of breast implants than patients without mesh (430 vs. 330 cc). There were statistically more patients requiring postoperative radiotherapy in the ADM mesh group (p = 0.049). The early postoperative outcomes in both groups were comparable with no statistical differences in the rate of infection, seroma requiring aspiration, or implant loss. Conclusions This study which is one of the few studies comparing one-stage pre-pectoral implant reconstruction with and without mesh demonstrated that pre-pectoral reconstruction with no ADM is cost-effective and associated with comparable early postoperative outcomes. Our early observational series showed satisfactory outcomes; however, further studies are required to investigate longer-term and patient-related outcomes.

PMID:39807470 | PMC:PMC11728804 | DOI:10.7759/cureus.75896

Cureus. 2024 Dec 14;16(12):e75705. doi: 10.7759/cureus.75705. eCollection 2024 Dec.

ABSTRACT

PURPOSE: This study aims to evaluate the effects of taper angle and the number of insertion-removal cycles on the retention force of 4 mol% yttria partially stabilized zirconia (4Y-PSZ) double crowns over time.

MATERIALS AND METHODS: Primary and secondary crowns were fabricated using 4Y-PSZ with taper angles of 2°, 4°, and 6° (n=15). Retention force during crown removal was measured after applying 50-N and 100-N loads. Insertion-removal cycles were performed at 0, 2500, 5000, 7500, and 10,000 cycles, and retention force was assessed at each stage. Contact conditions between the inner and outer crowns were evaluated via color mapping at 0 and 10,000 cycles. Two-way ANOVA was used for statistical analysis, followed by Tukey’s test for multiple comparisons.

RESULTS: Retention force significantly decreased with smaller taper angles and higher cycle numbers (p<0.01). For a taper angle of 4°, the initial retention force of 10.36 N decreased significantly to 5.98 N after 10,000 cycles (p<0.01). For a taper angle of 6°, the initial retention force of 1.64 N dropped to 0.03 N after 10,000 cycles. Color mapping revealed continuous contact along the axial surface, with strong point contacts, particularly in the central axial region. Smaller taper angles exhibited stronger contact points, which decreased with repeated cycles, indicating changes in contact conditions.

CONCLUSIONS: Higher retentive forces were achieved with increased loading pressures and smaller taper angles, while repeated insertion-removal cycles led to a progressive reduction in retention. These findings provide foundational data supporting the clinical application of 4Y-PSZ double crowns.

PMID:39807467 | PMC:PMC11728211 | DOI:10.7759/cureus.75705

Cureus. 2024 Dec 14;16(12):e75707. doi: 10.7759/cureus.75707. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Cervical cancer is considered one of the most common gynecological malignancies with an increased incidence in developing countries. Magnetic resonance imaging (MRI) plays a valuable role in staging cervical cancer and providing valuable information necessary for selecting the appropriate treatment plan, while closely correlating with the prognosis of the patient.

OBJECTIVE: The aim of this study is to assess the diagnostic value of diffusion-weighted imaging (DWI) in the preoperative loco-regional staging of cervical carcinoma. Our purpose is to establish apparent diffusion coefficient (ADC) values of cervical carcinoma compared with normal cervical tissue and their variability based on different pathological characteristics of the lesions.

MATERIAL AND METHODS: It is a retrospective analysis of 57 patients diagnosed with cervical cancer, who underwent MRI examinations. The study evaluated the aspect of the lesions on T2-weighted imaging, DWI, ADC maps, and pre- and post-contrast T1-weighted imaging with fat saturation.

RESULTS: The ADC mean values ranged between 0.63 × 10^-3 mm²/second and 0.99 × 10^-3 mm²/second (mean 0.79) for tumoral tissue and 1.33 × 10^-3 mm²/second and 1.74 × 10^-3 mm²/second (mean 1.59) for surrounding non-affected cervical tissue. The ADC mapping showed a decreasing trend with the increased sizes of the tumors (p<0.001). The ADC mean showed lower values with increased International Federation of Gynecology and Obstetrics (FIGO) stage of the tumors. The ADC mean value for cases that had spread to other organs (IVA+IVB) was significantly lower than that of the early stages (IB1 + IB2 + IIA2), stage IIB, and stages IIIA+IIIC1+IIIC2 (p<0.001). The ADC mean value of stage III disease was significantly lower than that of stage IIB, respectively early stages (p<0.001). The ADC mean value of the stage IIB tumor was significantly lower than that of the early stages (p<0.001). The differences in ADC mean values based on the histopathological type and differentiation grade were not statistically significant. The ADC mean value of the cases with positive pelvic lymph nodes was significantly lower than in those with negative lymph nodes (p<0.001).

CONCLUSION: ADC mean values of cervical carcinoma are significantly lower than those from unaffected uterine tissue and they also correlate with the severity of the disease. The advancements and additional capabilities DWI can bring are the elements of interest in this article. Using DWI means a more accurate capability in diagnosing cervical cancer, providing a compelling argument for its integration into standard clinical practice. This study discusses the quantitative imaging parameters of DWI such as ADC values, which can provide objective measurements for tumor evaluation. These parameters can be standardized and used across different institutions, enhancing the reproducibility and reliability of imaging findings.

PMID:39807463 | PMC:PMC11728805 | DOI:10.7759/cureus.75707

Cureus. 2024 Dec 13;16(12):e75654. doi: 10.7759/cureus.75654. eCollection 2024 Dec.

ABSTRACT

This study investigates the safety of three different daily dosages of a liquid blend containing kava and kratom (Feel Free® Classic Tonic {FFCT}) in healthy adults over six consecutive days of supplementation. Both kava and kratom have been used traditionally for hundreds of years, but there is limited data on the combined safety of these ingredients. In this randomized, double-blind, placebo-controlled trial, the participants were assigned to receive one of three daily dosages of FFCT or placebo. Safety assessments included the monitoring of vital signs, clinical chemistry, hematology, and withdrawal symptoms using the Clinical Opiate Withdrawal Scale (COWS) and the Subjective Opiate Withdrawal Scale (SOWS). The results indicate that FFCT was safe, with mild to moderate adverse events (AEs) such as nausea, headaches, and fatigue, particularly in the high-dosage (HD) group. No significant changes in liver or kidney function were noted, and all vital signs remained within normal physiological ranges although some statistically significant changes in blood pressure (BP) and respiratory rate (RR) were observed. There were no clinically significant observations in COWS or SOWS scores despite a small but statistically significant increase in COWS total score in the high-dose group on day 7. Overall, FFCT appears safe for short-term use in healthy adults, with no significant impact on vital signs, laboratory values, or withdrawal symptoms.

PMID:39807458 | PMC:PMC11726919 | DOI:10.7759/cureus.75654

Cureus. 2024 Dec 14;16(12):e75704. doi: 10.7759/cureus.75704. eCollection 2024 Dec.

ABSTRACT

Introduction The role of the condylar position in the correct functioning of the stomatognathic system has been the center of the study. Using cone-beam computed tomography (CBCT), this study looked at the three-dimensional (3D) position of the condylar bone in patients from Class I, Class II, Division 1, and Division 2. Materials and methods This cross-sectional, retrospective study was conducted using 102 CBCT records, with 34 records allocated to each category of malocclusion classification, such as dentoskeletal Class I, skeletal Class II, and dental Class II, Division 1 and 2. CBCT scans were conducted utilizing a Carestream New Generation CBCT apparatus (Carestream Dental, Atlanta, Georgia) in accordance with a standardized protocol (operating at a voltage of 120 kV, a current of 80 mA, a seven-second scan time, a field of view (FOV) measuring 10 x 10 cm, and a resolution of 0.2 voxels, and 1-mm slice thickness). The condylar position was assessed as the superior, inferior, and medial distance of the condyle from the glenoid fossa, along with the condylar angle. The distance from the most anterior point on the anterior surface of the condyle to the articular eminence was taken as anterior condylar distance; the distance of the superior surface of the condyle from the deepest point of the glenoid fossa was taken as superior condylar distance; the distance of the posterior surface of the condyle from the glenoid fossa was taken as posterior condylar distance; the condylar angle was measured as an angle between the XY line and the FH’ line passing through X, where X is the center of the condyle; and the distance of the medial surface of the condyle from the glenoid fossa was taken as medial distance. The data were then subjected to statistical analyses. Results For anterior distance, the highest distance was noted in Class II Division 1 (3.32 ± 0.4 mm), and the lowest was seen in Class I (2.43 ± 0.26 mm). In the posterior distance, Class I exhibited the highest mean distance of 2.05 ± 0.14 mm, while Class II Division 1 showed the lowest distance of 1.83 ± 0.18 mm. For superior distance, the highest mean value was noticed in Class I patients at 2.92 ± 0.22 mm, and the lowest value was seen in Class II Division 1 at 2.61 ± 0.35 mm (p=0.001). For the condylar angle, the highest mean value was observed in Class I (30.96 ± 1.91⁰) and the lowest in Class II Division 1 (26.71 ± 1.48⁰), with p=0.001. Confirmatory factor analysis revealed that the most substantial loading was attributed to the condylar angle at -2.28, signifying its significant contribution to Fc1. Conclusion The condyle was placed anteriorly, superiorly, and medially in Class II Division 1 and posteriorly in Class II Division 2, compared to Class I patients.

PMID:39807453 | PMC:PMC11728205 | DOI:10.7759/cureus.75704

BMC Psychol. 2025 Jan 13;13(1):34. doi: 10.1186/s40359-025-02365-0.

ABSTRACT

BACKGROUND: Schizophrenia is a multifactorial disorder influenced by various biological and psychosocial factors. This study aimed to determine the characteristics and associated factors of expressed emotion (EE) among caregivers of individuals with schizophrenia.

METHODS: From May to July 2024, a cross-sectional study was conducted with caregivers of individuals with schizophrenia across multiple hospitals in Southern Thailand. The study utilized four questionnaires: (1) Demographic inquiry, (2) The Thai Expressed Emotion Scale (TEES), (3) The Thai General Health Questionnaire (GHQ-12), and (4) The Zarit Burden Interview (ZBI). Data were analyzed using descriptive statistics. The groups analyzed were compared using the Analysis of Variance (ANOVA) or Kruskal-Wallis test, the Student t-test or Wilcoxon rank sum test, and the Chi-square test. Multiple logistic regression analysis was performed.

RESULTS: In a survey of 200 caregivers, 70.5% were female. They had a median caregiving duration of 108 months, with an interquartile range (IQR) of 36 to 180 months. Notably, 51.0% of caregivers reported no mental health problems, as assessed by the GHQ-12, while 29.0% indicated experiencing severe burden. The median score on the TEES was 99.0, with an IQR of 84.7 to 109.0. Furthermore, 46.0% of caregivers reported TEES above the median score, indicating high levels of EE. There was also a significant correlation between caregiver burden and EE scores. Those experiencing severe burden had an EE score of 110.5 compared to 94.0 for those with no burden, which was statistically significant (p = 0.001). Multiple logistic regression analysis revealed that high EE among caregivers was associated with factors such as the patient’s duration of illness, caregiver occupation, and mental health status.

CONCLUSION: Nearly half of the caregivers of individuals with schizophrenia reported high levels of EE, with increased caregiver burden associated with higher EE levels. Factors such as the duration of the patient’s illness, caregiver occupation, and mental health status were also associated with higher EE. Moreover, caregivers’ emotional responses and expressions are complex and dynamic. Thus, focusing on providing support to caregivers can have a positive impact on the well-being of both caregivers and individuals with schizophrenia.

PMID:39806518 | DOI:10.1186/s40359-025-02365-0

J Health Popul Nutr. 2025 Jan 13;44(1):9. doi: 10.1186/s41043-025-00745-1.

ABSTRACT

PURPOSE: Evidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD.

METHODS: 5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life’s essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD.

RESULTS: Among 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37-0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13-0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61-0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings.

CONCLUSIONS: Higher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.

PMID:39806517 | DOI:10.1186/s41043-025-00745-1

Syst Rev. 2025 Jan 13;14(1):11. doi: 10.1186/s13643-024-02726-7.

ABSTRACT

BACKGROUND: Impaired intrauterine growth, a significant global health problem, contributes to a higher burden of infant morbidity and mortality, mainly in resource-poor settings. Maternal anemia and undernutrition, two important causes of impaired intrauterine growth, are prioritized by global nutrition targets of 2030. We synthesized the evidence on the role of preconception nutrition supplements in reducing maternal anemia and improving intrauterine growth.

METHODS: We undertook a review of the randomized controlled trials (RCTs) assessing the effect of preconception nutrition supplements on maternal hemoglobin, an indicator to estimate maternal anemia, and markers of intrauterine growth including birth weight, length, head circumference, and small for gestational age. Additionally, we examined preterm birth as an important perinatal outcome. We searched PubMed, CINAHL, Web of Science, Cochrane Central, and Embase. We computed summary mean differences and risk ratios (RR) with 95% confidence intervals (CIs) using random-effect models. We employed I² and Cochran’s Q test statistics to assess heterogeneity. We used a revised Cochrane risk-of-bias (RoB version 2.0) and GRADE (grading of recommendations, assessment, development, and evaluation) tools to assess the risk of bias and quality of evidence of eligible RCTs, respectively.

RESULTS: We identified 20 eligible RCTs (n = 27,659 women). Preconception nutrition supplements (iron and folic acid, multiple micronutrients, and a lipid-based nutrient supplement) overall increased maternal hemoglobin by 0.30 g/dL ((0.03, 0.57); I² = 79%; n=9). However, we did not find a significant effect of the supplements on birth weight (12.25 gm ((- 22.66, 47.16); I² = 55%; n=10)), length (0.15 cm (- 0.26, 0.56); I² = 68%; n = 5), head circumference (- 0.23 cm (- 0.88, 0.43); I² = 84%; n=4), small for gestational age (RR 0.91 (0.80, 1.04); I² = 31%; n=8), or preterm birth (RR 0.93 (0.69,1.25); I² = 57%; n=12). In general, the quality of evidence was assessed as very low to moderate.

CONCLUSION: Preconception nutrition supplements studied to date appear to reduce maternal anemia. However, it is uncertain whether there are beneficial effects of the supplements on intrauterine growth. Low quality of evidence warrants future well-designed RCTs to produce solid scientific data, particularly of a more comprehensive package of preconception nutrition supplements that include both macro- and micronutrients.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023464966.

PMID:39806515 | DOI:10.1186/s13643-024-02726-7

Skelet Muscle. 2025 Jan 13;15(1):2. doi: 10.1186/s13395-024-00371-1.

ABSTRACT

BACKGROUND: Duchenne muscular dystrophy (DMD) is a prevalent, fatal degenerative muscle disease with no effective treatments. Mdx mouse model of DMD exhibits impaired muscle performance, oxidative stress, and dysfunctional autophagy. Although antioxidant treatments may improve the mdx phenotype, the precise molecular mechanisms remain unclear. This study investigates the effects of aminoguanidine hemisulfate (AGH), an inhibitor of reactive oxygen species (ROS), on mitochondrial autophagy, oxidative stress, and muscle force in mdx mice.

METHODS: Male wild-type (WT) and mdx mice were divided into three groups: WT, mdx, and AGH-treated mdx mice (40 mg/kg intraperitoneally for two weeks) at 6 weeks of age. Gene expression, western blotting, H&E staining, immunofluorescence, ROS assays, TUNEL apoptosis, glutathione activity, and muscle force measurements were performed. Statistical comparisons used one-way ANOVA.

RESULTS: AGH treatment significantly reduced the protein levels of LC3, and p62 in mdx mice, indicating improved autophagy activity and the ability to clear damaged mitochondria. AGH restored the expression of mitophagy-related genes Pink1 and Parkin and increased Mfn1, rebalancing mitochondrial dynamics. It also increased Pgc1α and mtTFA levels, promoting mitochondrial biogenesis. ROS levels were reduced, with higher Prdx3 and MnSOD expression, improving mitochondrial antioxidant defenses. AGH normalized the GSSG/GSH ratio and decreased glutathione reductase and peroxidase activities, further improving redox homeostasis. Additionally, AGH reduced apoptosis, shown by fewer TUNEL-positive cells and lower caspase-3 expression. Histological analysis revealed decreased muscle damage and fewer embryonic and neonatal myosin-expressing fibers. AGH altered fiber composition, decreasing MyH7 while increasing MyH4 and MyH2. Muscle force improved significantly, with greater twitch and tetanic forces. Mechanistically, AGH modulated the AKT/FOXO1 pathway, decreasing myogenin and Foxo1 while increasing MyoD.

CONCLUSIONS: AGH treatment restored mitochondrial autophagy, reduced oxidative stress, apoptosis, and altered muscle fiber composition via the AKT/FOXO1 pathway, collectively improving muscle force in mdx mice. We propose AGH as a potential therapeutic strategy for DMD and related muscle disorders.

PMID:39806512 | DOI:10.1186/s13395-024-00371-1

Virol J. 2025 Jan 13;22(1):10. doi: 10.1186/s12985-025-02626-9.

ABSTRACT

BACKGROUND: Mycoplasma pneumoniae (MP) is a common pathogen for respiratory infections in children. Previous studies have reported respiratory tract microbial disturbances associated with MP infection (MPI); however, since the COVID-19 pandemic, respiratory virome data in school-aged children with MPI remains insufficient. This study aims to explore the changes in the respiratory virome caused by MPI after the COVID-19 pandemic to enrich local epidemiological data.

METHODS: Clinical samples from 70 children with MPI (70 throat swab samples and 70 bronchoalveolar lavage fluid (BALF) samples) and 78 healthy controls (78 throat swab samples) were analyzed using viral metagenomics. Virus reads were calculated and normalized using MEGAN.6, followed by statistical analysis.

RESULTS: Principal Coordinate Analysis (PCoA) showed that viral community diversity is a significant difference between disease cohorts and healthy controls. After MPI, the number of virus species in the upper respiratory tract (URT) increased obviously, and the abundance of families Poxviridae, Retroviridae, and Iridoviridae, which infect vertebrates, rose evidently, particularly the species BeAn 58,085 virus (BAV). Meanwhile, phage alterations in the disease cohorts were predominantly characterized by increased Myoviridae and Ackermannviridae families and decreased Siphoviridae and Salasmaviridae families (p < 0.01). In addition, some new viruses, such as rhinovirus, respirovirus, dependoparvovirus, and a novel gemykibvirus, were also detected in the BALF of the disease cohort.

CONCLUSIONS: This cross-sectional research highlighted the respiratory virome characteristics of school-aged children with MPI after the COVID-19 outbreak and provided important epidemiological information. Further investigation into the impact of various microorganisms on diseases will aid in developing clinical treatment strategies.

PMID:39806507 | DOI:10.1186/s12985-025-02626-9