Nevin Manimala

JMIR Res Protoc. 2025 Nov 11;14:e76509. doi: 10.2196/76509.

ABSTRACT

BACKGROUND: Lower limb amputation rates are increasing owing to aging and vascular diseases. However, no standardized rehabilitation protocol has been established for regaining walking ability. Conventional rehabilitation delays prosthetic gait training until 6-8 weeks post amputation, prolonging recovery and increasing medical expenses.

OBJECTIVE: This study aims to evaluate the impact of neurorehabilitation using the Hybrid Assistive Limb (HAL) for Medical Use Lower Limb Type, developed by Japan’s Tsukuba University and the robotics company Cyberdyne, on gait acquisition, improvement in activities of daily living (ADL), and enhancement of quality of life (QOL) in patients with lower limb amputation, and assess the effectiveness of early HAL-assisted gait training before and after amputation.

METHODS: This single-arm trial will include 20 patients undergoing unilateral transfemoral or transtibial amputations. HAL-assisted gait training will be performed 5 days per week (30 minutes per session) until postoperative week 8. The primary outcome is a 2-minute walking distance, while secondary outcomes include muscle strength, balance, gait parameters, and ADL/QOL measures. Statistical analyses will be conducted using SPSS (IBM Corp), and results obtained at the following time points will be compared: preoperative, postintervention, and 6-month follow-up.

RESULTS: The planned sample size is 20 patients, calculated using JMP version 12 (SAS Institute) based on an expected 1.5-fold improvement in 6-minute walk distance (effect size 0.8, α=.05, power=0.8). Analyses will be performed using SPSS version 15.0 (IBM Corp). The 2-minute walk test (primary outcome) and secondary outcomes will be compared at baseline, post intervention, and 6-month follow-up using 1-way analysis of variance or Kruskal-Wallis test, and P values <.05 and 95% CIs will be reported.

CONCLUSIONS: This is the first study to apply HAL-assisted neurorehabilitation to patients with lower limb amputations. Early gait training may increase prosthetic gait acquisition rates, shorten rehabilitation and hospitalization periods, and reduce medical costs. If effective, this study may contribute to the development of a Japan-originated rehabilitation program and provide clinical evidence supporting broader HAL implementation for patients with lower limb amputations.

TRIAL REGISTRATION: Japan Registry of Clinical Trials jRCTs062200031; https://jrct.mhlw.go.jp/latest-detail/jRCTs062200031.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/76509.

PMID:41217815 | DOI:10.2196/76509

Int J Lang Commun Disord. 2025 Nov-Dec;60(6):e70161. doi: 10.1111/1460-6984.70161.

ABSTRACT

PURPOSE: Previous studies conducted in Türkiye (Turkey) have revealed that the level of knowledge and awareness regarding swallowing disorders in neurogenic conditions among speech and language pathology students or graduates is relatively low. Furthermore, differences in curricula across various institutions highlight the need for standardized education in this area. This study aimed to assess changes in the knowledge and awareness levels of speech and language pathologists, as well as their opinions about the training, by organizing an educational programme focused on neurogenic communication and swallowing disorders.

METHOD: A total of 5 days (40 h) of training was carried out over three weekends, with the participation of 40 expert academicians from 20 different institutions. The training was attended by 247 participants on the first day. Before and after the training, a 40-question questionnaire was administered to measure the knowledge and awareness. One hundred and twenty-nine participants filled out both tests. After the training was completed, a 12-question evaluation questionnaire was applied to the participants.

RESULTS: The number of correct answers given by the participants who completed both the pre-test and post-test increased statistically significantly, from 19.09 ± 3.81 to 21.43 ± 3.67 (p < 0.001). The participants stated that their knowledge and awareness levels about the topics increased after the training, with a mean self-reported score of 8.99± 1.18 out of 10.

CONCLUSIONS: This training event was the first of its kind in the field of speech and language pathology in Türkiye. While a statistically significant increase in knowledge and awareness was observed following the training, participants’ overall knowledge levels remained relatively low. These findings underscore the need for additional and ongoing training to address existing gaps and further enhance professional competencies in this area.

WHAT THIS PAPER ADDS: What is already known on this subject Neurological diseases affect individuals of all age groups and may lead to communication, feeding and swallowing disorders. These problems negatively affect the quality of life of affected individuals and their caregivers. There is a deficiency in the knowledge, awareness and self-confidence levels of speech and language pathologists (SLPs) and SLP students regarding neurogenic communication and swallowing disorders. What this paper adds to existing knowledge There is a need for training and support in the field of neurogenic communication or swallowing disorders both in Turkey and in other countries. In order to address this need, training on neurogenic communication and swallowing disorders was provided to 4th-year students in the SLP undergraduate programme and graduated SLPs in Turkey. What are the potential or clinical implications of this work? With this training, the knowledge and awareness levels of 4th-year students in the SLP undergraduate programme and graduate SLPs regarding neurogenic communication and swallowing disorders have increased. However, at the end of the training, there are still deficiencies in the knowledge levels of the participants, and it is thought that more training may be needed to overcome these deficiencies.

PMID:41217808 | DOI:10.1111/1460-6984.70161

Global Spine J. 2025 Nov 11:21925682251395703. doi: 10.1177/21925682251395703. Online ahead of print.

ABSTRACT

Study DesignRetrospective cross-sectional study.ObjectivesTo investigate differences and correlations in multi-planar parameters across severity levels in female Lenke type 1 patients, and to identify key factors, thereby providing a basis for personalized preoperative planning.MethodsFull-spine X-rays of 117 female Lenke type 1 patients (40 mild, 40 moderate, 37 severe; aged 10-18 years) were analyzed. Twelve spinopelvic parameters including Cobb angle, apical vertebral translation (AVT), apical vertebral rotation (AVR), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sagittal vertical axis (SVA), and spinal tilt (ST) were measured using Mimics 21.0, followed by statistical analysis.ResultsCobb angle, AVT, and AVR increased significantly with severity (P < 0.001). The severe group had greater SVA and smaller ST (P = 0.011; P = 0.038). Regression analysis identified AVT and AVR as significant predictors for moderate (OR = 1.314; OR = 42.094) and severe groups (OR = 1.470; OR = 241.351) (all P < 0.05). In mild and moderate groups, LL showed positive correlations with TK and PI (r = 0.380-0.591) and negative correlations with SVA (r = -0.558; r = -0.332). No significant correlations existed between LL and PI, TK, or SVA in the severe group.ConclusionsIn female Lenke type 1 patients, correcting AVT and AVR is a central surgical objective, as they are integral to coronal and transverse deformities, and AVR also drives sagittal imbalance. LL serves as a pivotal compensation parameter for sagittal balance in these patients. In mild and moderate patients, sagittal balance can be achieved through LL-centric compensation mechanisms. However, in severe patients, LL loses its compensatory role, necessitating surgical intervention to restore sagittal balance.

PMID:41217807 | DOI:10.1177/21925682251395703

Vopr Kurortol Fizioter Lech Fiz Kult. 2025;102(5):28-38. doi: 10.17116/kurort202510205128.

ABSTRACT

The relevance of the study is due to the important therapeutic role of natural air ionization in the ground atmosphere of heath resorts, which many authors associate with the environment-forming role of forest. However, there are gaps in the investigations of the influence of phytoresources of different elements of tree and shrubbery vegetation on such an important physiological factor as ionization of oxygen molecules in the ground atmosphere under different meteorological and ecological conditions in health resorts and sanatorium-resort facilities.

OBJECTIVE: To study the aeroionization-forming functions of coniferous and deciduous tree plantations and possibilities of optimization of the therapeutic climate at the climatotherapeutic grounds of the sanatorium-resort facilities of the sanatorium-resort complex of the FMBA of Russia, general resort parks and terrain cures.

MATERIAL AND METHODS: The protocols of comprehensive route forest, microbioclimatic and ecological studies in coniferous and deciduous forest park plantations on the territories of SRC of the FMBA of Russia, general resort parks and terrain cures in different natural areas of Moscow and Ivanovo regions, Krasnodar and Stavropol territories for 2017-2024 were investigated. A total of 20 sample plots (SPs), on each of which standard sets of natural factors (indicators) of the therapeutic climate and landscape (air ionization, microclimate factors, finely dispersed aerosol in 9 channels of particle size from 0.2 to 5 μm in the ground atmosphere, elements and volume of phytoresources) were studied, were made. The methodological recommendations №13-21 of the FMBA of Russia for ranking the balneological potential of different indicators of the therapeutic climate were used. The obtained measurement results were statistically processed on the basis of Excel program.

RESULTS: We investigated taxational, environmental and microbioclimatic indicators on the mentioned SPs, according to which models of the dynamics of ion unipolarity coefficient (IUC) under the influence of air temperature (IUC=0.0206X+0.3953, where X – air temperature, °C); air humidity (IUC=-0.0003X²+0.0228X+0.6853, where X – relative humidity, %); illumination intensity (IUC=0.166ln(X)+0.6367, where X – illumination intensity, lux); volume of timber supply plantation (IUC=-0.0014X+1.2885, where X – timber supply plantation, m³/ha); level of finely dispersed aerosol of particle size >5 μm (IUC=0.2243X^{0, 4842}, where X – finely dispersed aerosol, p-s/cm³) in the underplant area of green spaces were developed.

CONCLUSION: The obtained data provide a better understanding of the role of active oxygen in the process of atmospheric carbon deposition by tree vegetation, which is relevant in the presence of global climate change, as well as confirms the influence of timber supply on such an important physiological factor as the ionization of the ground atmosphere, which has important balneological significance. Issues of ecological potential of health resort areas of sanatorium-resort facilities of the Russian Federation require further study.

PMID:41217796 | DOI:10.17116/kurort202510205128

Int J Lang Commun Disord. 2025 Nov-Dec;60(6):e70159. doi: 10.1111/1460-6984.70159.

ABSTRACT

BACKGROUND: Voice disorders are a major cause of difficulties in many areas of social life, as they can disrupt communication. Voice therapy, including vocal hygiene education, has an important role in the treatment of voice disorders, especially if applied in an individualised manner.

AIM: The aim of this study was to develop and validate a reliable and practical self-report tool, the Vocal Health Daily Tracking Form, for use in monitoring patients’ daily compliance with vocal hygiene practices and home-based voice therapy exercises.

METHODS AND PROCEDURES: A total of 266 volunteering participants, including 212 women and 54 men aged 18 and over who were university students from departments of speech and language therapy and audiology, participated in the research. The 12-item Vocal Health Daily Tracking Form, developed based on traditional voice therapy principles, was completed at least once by all 266 participants and twice by 60 of the participants. The validity and reliability of the form were evaluated in line with the statistical analysis of the obtained data.

OUTCOMES AND RESULTS: Statistical analyses confirmed that the Vocal Health Daily Tracking Form is a reliable and valid tool. While the Kaiser-Meyer-Olkin test value of the form was found to be very good at 0.799, the Bartlett test result was 961.473 (p < 0.05), confirming a strong correlation between the items of the form. The Cronbach alpha value of the study was found to be sufficient at 0.809. The total correlation values were between 0.326 and 0.651, and the amount of explained variance was sufficient at 33.28%. These findings confirmed that the scale is well constructed both conceptually and structurally and is a valid and reliable measurement tool.

CONCLUSIONS AND IMPLICATIONS: In addition to vocal hygiene recommendations, the individualisation of the therapy process and the use of methods based on behavioural techniques may contribute positively to the voice rehabilitation processes of individuals with voice disorders. The Vocal Health Daily Tracking Form has high validity and reliability values, confirming that it can be considered an important tool for monitoring and improving voice therapy processes. It may also help patients experience more regular and effective therapy processes by increasing their self-regulation and motivation during voice therapy.

WHAT THIS PAPER ADDS: What is already known on this subject Voice disorders are major health issues that negatively affect individuals’ communication abilities and quality of life (Cohen et al., 2006). These disorders may arise due to organic, neurological, or functional causes and may lead to abnormal changes in voice quality, pitch height, or intensity (Behrman, 2007). Voice therapy and various treatment methods, including vocal hygiene education and training, play an important role in the rehabilitation processes of individuals with voice disorders (Garabet et al., 2024). Homework assigned during the therapy process, including vocal exercises and hygiene practices, is of critical importance in increasing the effectiveness of the treatment (Desjardins et al., 2017). What this paper adds to the existing knowledge This study aimed to develop and validate a reliable and practical self-report tool, the Vocal Health Daily Tracking Form, to monitor patients’ daily compliance with vocal hygiene practices and home-based voice therapy exercises during voice rehabilitation. With that aim, the Vocal Health Daily Tracking Form was developed to allow patients to record their daily engagement with voice hygiene practices and vocal exercises. The validity and reliability of this new form were also evaluated. This study has presented the validity and reliability analysis of a voice monitoring form developed to increase patients’ compliance with voice therapy. Steady compliance with vocal hygiene and prescribed exercises conducted at home significantly affects treatment results, and the voice monitoring form proposed in this study was shown to have high validity (KMO = 0.799, p < 0.001) and reliability, indicating that it can be considered an important tool for monitoring daily practices that affect the outcomes of therapy processes. What are the potential or actual clinical implications for this work? This study is expected to serve as guidance for future research and clinical practices addressing patient compliance and behavioural management throughout the course of voice therapy.

PMID:41217785 | DOI:10.1111/1460-6984.70159

Genomics Proteomics Bioinformatics. 2025 Nov 11:qzaf103. doi: 10.1093/gpbjnl/qzaf103. Online ahead of print.

ABSTRACT

Genotype imputation is essential for medical genomics studies. Herein, we present the STROMICS imputation reference panel, constructed from high-depth whole-genome sequencing (WGS) data of 10,241 Chinese individuals. It includes 53,061,655 single-nucleotide variants and insertion-deletions, spanning 22 autosomes and the X chromosome. Imputation performance of the STROMICS and seven other reference panels was compared using WGS data from 159 individuals. STROMICS panel outperformed others in imputation quality, and in genome-wide population- and individual-level accuracy. Validation using 301 Chinese individuals from the 1000 Genomes Project demonstrated STROMICS achieving high imputation accuracy. Among the three Chinese subgroups, the STROMICS reference panel yielded the highest accuracy in Han Chinese in Beijing samples. Notably, STROMICS outperformed all the other panels for the insertion-deletion imputation. When imputing stroke-risk variants and their closely linked variants with STROMICS, only a small statistically significant difference in sensitivity was observed between diseased and healthy individuals for variants closely linked to stroke-risk variants. Furthermore, calculated using pruned variants, the genetic distances between diseased and healthy groups remained largely unchanged before and after imputation. Collectively, these findings indicate that the source material used to construct the STROMICS reference panel has minimal impact on its imputation performance. Finally, we demonstrated high accuracy of STROMICS for genotype imputation in the X-unique region. In conclusion, the STROMICS panel provides a high-quality reference for imputing genotypes across autosomes and the X chromosome in the Chinese population.

PMID:41217781 | DOI:10.1093/gpbjnl/qzaf103

JAMA Netw Open. 2025 Nov 3;8(11):e2542831. doi: 10.1001/jamanetworkopen.2025.42831.

ABSTRACT

IMPORTANCE: Infant mortality, ie, death within the first year of life, serves as a critical health indicator.

OBJECTIVE: To evaluate the association of maternal residence in counties with no or limited access to maternity care with infant mortality overall and by maternal race and ethnicity and timing of death.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used cohort-linked birth/infant death records for live births to US residents from 2017 to 2021, collected from the National Center for Health Statistics. Statistical analyses were conducted from July 2024 to June 2025.

EXPOSURES: Maternity care access by maternal county residence. Care access was categorized as none, low, moderate, or full based on availability of obstetric hospitals and birth centers, ratio of obstetric clinicians to births, and proportion of uninsured women aged 19 to 54 years.

MAIN OUTCOME AND MEASURES: The association between infant mortality and access to maternity care was assessed using multivariable log-binomial regression. Stratified analyses were conducted by timing of death (neonatal and postneonatal) and maternal race and ethnicity to assess for differences by subgroups.

RESULTS: A total of 18 682 916 live births were included (maternal age: 5 458 056 [29.2%] aged 30-34 years; maternal race and ethnicity: 4 426 077 [23.7%] Hispanic, 2 711 614 [14.5%] non-Hispanic Black, and 9 600 056 [51.4%] non-Hispanic White). Infant mortality rates (deaths per 1000 live births) increased as access decreased, with the highest rates in no-access counties (6.5 deaths per 10 000 live births) and the lowest in full-access counties (5.2 deaths per 1000 live births). The adjusted model found that infants in no-access counties had higher mortality risk compared with those in full-access counties (adjusted risk ratio, 1.14; 95% CI, 1.10-1.17; P < .001). When stratified by maternal race and ethnicity, non-Hispanic White infants in no-access counties had higher risk compared with non-Hispanic White infants in full-access counties (adjusted risk ratio, 1.20; 95% CI, 1.16-1.25). No significant differences were identified for other racial and ethnic groups. When stratified by timing of death, risk in the neonatal and postneonatal period was higher for infants in no-access counties compared with those in full-access counties (neonatal: adjusted risk ratio, 1.15; 95% CI, 1.11-1.19; postneonatal: adjusted risk ratio, 1.12; 95% CI, 1.06-1.17).

CONCLUSIONS AND RELEVANCE: In this population-based cross-sectional study, infants in no-access counties had higher mortality risk than those with full access, persisting regardless of time of death. When examined by race and ethnicity, differences in mortality risk between living in a full access and no access county were observed among White infants only, indicating that unmeasured barriers may limit the protective effect of access for some racial and ethnic groups.

PMID:41217753 | DOI:10.1001/jamanetworkopen.2025.42831

Int J Surg. 2025 Nov 11. doi: 10.1097/JS9.0000000000003871. Online ahead of print.

ABSTRACT

BACKGROUND: Perioperative hypoparathyroidism (hypoPT) represents a prevalent complication of thyroid surgery. Reported risk factors remain inconsistent, and identical factors may exert different effects depending on whether hypoPT is defined by serum calcium concentration or parathyroid hormone (PTH) levels. A comprehensive synthesis was undertaken to clarify risk factors for hypoPT under these distinct biochemical definitions.

MATERIALS AND METHODS: Three databases (PubMed, Embase and Scopus) were searched from inception to 2025. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated to examine associations between risk factors and perioperative hypoPT defined by calcium or PTH. Subgroup analyses were performed according to biochemical definitions, and publication bias was assessed with Begg’s and Egger’s tests.

RESULTS: Sixty-four studies reporting 19 risk factors were included. Sex was the most frequently analyzed variable. For hypoPT defined by calcium, significant associations were observed with female sex, parathyroid glands remaining in situ, central neck dissection, lateral neck dissection, malignant pathology, parathyroid autotransplantation, incidental parathyroidectomy, parathyroid tissue in the specimen, and type of surgery [total thyroidectomy vs partial thyroidectomy]. Higher postoperative PTH levels acted as a protective factor for calcium-defined hypoPT. For PTH-defined hypoPT, only malignant pathology showed a statistically significant association.

CONCLUSION: Thyroid cancer patients undergoing total thyroidectomy with lateral neck dissection are at greatest risk of perioperative hypoparathyroidism. Risk reduction relies on precise intraoperative identification of the parathyroid glands, improved surgical proficiency and awareness, and prompt correction of inadvertent excision.

PMID:41217744 | DOI:10.1097/JS9.0000000000003871

Discov Oncol. 2025 Nov 11;16(1):2090. doi: 10.1007/s12672-025-03932-y.

ABSTRACT

Osteosarcoma (OS) is an exceptionally aggressive bone cancer, and the identification of blood-based biomarkers for early detection and prognosis remains a significant challenge. This study aimed to investigate the causal relationships between circulating plasma proteins and OS risk using Mendelian randomization (MR). We utilized genome-wide association study (GWAS) summary statistics, which included 3,282 plasma protein traits from the IEU Open GWAS Project and the FinnGen consortium. Our MR analysis identified 59 proteins positively associated with OS risk, while 66 proteins were inversely associated. Notably, Lactoylglutathione lyase, also known as Glyoxalase 1 (GLO1), showed a significant protective effect on OS risk (IVW OR = 0.2871, 95% CI: 0.1602-0.5145, P = 2.7580 × 10^{– 5}). After false discovery rate (FDR) correction, this association remained significant (FDR_pavl < 0.1). These findings emphasize the potential of circulating proteins, particularly GLO1, as biomarkers for OS, reflecting its role in oxidative stress and inflammation regulation. The study underscores the importance of proteomic analysis in OS pathogenesis and suggests the need for further investigation to validate these associations and explore potential therapeutic targets, thereby providing new insights into the biological mechanisms of OS.

PMID:41217734 | DOI:10.1007/s12672-025-03932-y

Infection. 2025 Nov 11. doi: 10.1007/s15010-025-02665-y. Online ahead of print.

ABSTRACT

BACKGROUND: The detection of pathogens causing infections by conventional diagnostic methods can be challenging and next-generation sequencing (NGS) technology offers a promising alternative method. In this study, we evaluated the performance of real-time metagenomic next-generation sequencing (rt-mNGS) for the detection of pathogens in respiratory samples.

METHOD: We used rt-mNGS, using the Seqstant LiveGene Analysis platform, on 335 respiratory samples in comparison to conventional culture results.

RESULTS: We observed an overall good concordance in 71.64% (240/335) of the methods. The rt-mNGS outperformed the gold standard culture in 16.12% (54/335) of the samples, while the culture was superior in detecting the clinically relevant pathogen in 12.24% (41/335) of the samples. The non-inferiority of rt-mNGS was statistically significant (δ = 10, α = 0.05, 1 – β = 0.8). We also observed that the real-time analysis of NGS data is beneficial in obtaining reliable, timely results, as the initial report at cycle 46 exhibits a Positive Predictive Value (PPV) of 93.75% at the species-level with a sensitivity of 32.09%.

CONCLUSION: Overall, our study showed the non-inferiority of rt-mNGS compared to the standard-of-care microbiology for respiratory samples with statistical significance. Moreover, the rt-mNGS method exhibited superior sensitivity and superior overall performance. It also uniquely detected certain organisms that are typically hard to culture. However, rt-mNGS reported a higher number of false positives and faced limitations in detecting Aspergillus spp. In conclusion, the study highlights the potential of rt-mNGS as a powerful tool in clinical diagnostics of respiratory infections and beyond.

PMID:41217732 | DOI:10.1007/s15010-025-02665-y