Nevin Manimala

Int J Oral Maxillofac Implants. 2025 Oct 8;0(0):1-21. doi: 10.11607/jomi.11375. Online ahead of print.

ABSTRACT

Titanium ions and particles (TiP) are associated with localized inflammatory response and may play a role in further peri-implant tissue breakdown.

OBJECTIVE: The purpose of this study was to evaluate presence of TiP after instrumentation of implant surfaces using different debridement methods.

METHODS: Six debridement methods, stainless steel (SS), titanium (T)-curette, ultrasonic tip (CV), an ultrasonic tip with plastic sleeve (CS), a CO2- and an Er,Cr:YSGG-laser were evaluated. A simulated defect was created around an implant in type II-bone block and irrigation was performed with water. A CO2-laser (non-contact, defocused beam, continuous wave, 2 W power) and an Er,Cr:YSGG-laser tip was used in contact with the implant (power of 2 W, 75 Hz, 40% water: 2% air). Twenty samples (per method) were collected using paper points after 30 seconds of instrumentation. Chemical composition analysis of the bone block, water irrigation and instruments (baseline) were evaluated for presence of TiP and liquid samples after instrumentation with an x-ray fluorescent spectrometer. Statistical analysis using simple t-test was performed for each debridement method.

RESULTS: Baseline measurements showed no TiP. TiP were found in SS-, T- and CV-groups with values of 0.02340.0181, 0.0072±0.0037, 0.0051±0.0041 ppm, respectively. TiP were not observed in CS-, and laser groups. The semiquantitative data showed higher presence of TiP in the SS-, T- and CV-groups in comparison to the baseline (P < .0001).

CONCLUSION: TiP were found after instrumentation using SS, T, CV, which may affect the disease etiology and outcomes of peri-implantitis therapy, compared to CS, CO2- or Er,Cr:YSGG-laser irradiation.

PMID:41061196 | DOI:10.11607/jomi.11375

Int J Oral Maxillofac Implants. 2025 Oct 8;0(0):1-29. doi: 10.11607/jomi.11589. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the influence of osseodensification (OD) and conventional drilling (CD) techniques on primary and secondary implant stability. The study also compares the effect of these techniques on peri-implant bone density, crestal bone level, alveolar ridge width, and concentration of TNF-α and IL-1β.

MATERIALS & METHODS: A total of 24 single or multiple edentulous sites were randomly and evenly allocated into two groups of 12, such that osteotomy preparation for implant placement was carried out using the OD technique in Group A and the CD technique in Group B. Follow-up evaluations were performed at 1, 4, and 6 months after implant placement. Intergroup and intragroup comparisons were performed with independent t-tests and paired t-tests respectively. Repeated measures ANOVA was applied to compare bone density across different time points. A p-value ≤ 0.05 was set as statistically significant.

RESULTS: Of 24 sites, only 20 (6 males, 5 females) were evaluated in the final analysis, as 3 subjects (1 male, 2 females) missed their follow-up visits. Group A showed significantly higher ISQ values immediately after implant placement (p ≤ 0.001), but not after 4 months (p = 0.053). No significant intergroup differences were found for bone density, crestal bone levels, ridge width, or TNF-α/IL-1β levels at all time points. Nevertheless, Group A exhibited significant postoperative increases in bone density (p = 0.003) and ridge width (p ≤ 0.001) relative to preoperative measurements.

CONCLUSION: OD offers a conservative and biologically favorable approach to implant osteotomy preparation, particularly beneficial in sites with compromised bone conditions by simultaneously enhancing primary stability, bone density, and ridge width without inducing adverse peri-implant tissue responses.

PMID:41061195 | DOI:10.11607/jomi.11589

J Am Acad Orthop Surg Glob Res Rev. 2025 Oct 7;9(10). doi: 10.5435/JAAOSGlobal-D-25-00295. eCollection 2025 Oct 1.

ABSTRACT

BACKGROUND: Bioinductive collagen implants (BCIs) have been growing in popularity for use in rotator cuff repair (RCR) over the past several years, but recent literature has raised concerns about the implants contributing to postoperative stiffness. The purpose of this study was to investigate the incidence of stiffness over a decade of experience with the BCI.

METHODS: A retrospective review was conducted of all cases of RCR using a BCI performed between September 2014 and December 2023. The primary outcome measure was postoperative range of motion, with significant stiffness defined by parameters in the existing literature. The secondary outcome measure was any revision procedure for stiffness.

RESULTS: After application of inclusion and exclusion criteria to 522 cases of RCR, there were 432 cases (390 individual patients) available for outcome analysis with an average follow-up of 34.9 months (range, 6 months to 9.25 years). There were only 12 cases (2.8%) of significant postoperative stiffness. All of them required additional operative intervention for stiffness, and all but two patients had at least one risk factor for stiffness. Stiffness rates were 4 of 291 (1.4%) for full-thickness tears and 8 of 141 (5.7%) for partial-thickness tears (P = 0.0149).

CONCLUSION: This study, the largest single cohort to date analyzing BCIs in RCR, found a low incidence of significant postoperative stiffness in cases associated with the use of the implant. Stiffness rates were markedly higher for repairs of partial-thickness tears. To further improve understanding of postoperative stiffness after RCR with BCI, better definitions and prospective comparative studies across larger groups are needed.

LEVEL OF EVIDENCE: Level IV, retrospective cohort with no comparison group.

PMID:41061192 | DOI:10.5435/JAAOSGlobal-D-25-00295

Blood Adv. 2025 Oct 8:bloodadvances.2025017035. doi: 10.1182/bloodadvances.2025017035. Online ahead of print.

ABSTRACT

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only potential curative therapy for myelodysplastic syndrome (MDS), recommended in higher-risk according to IPSS. We conducted a phase II multicenter trial (MDS-ALLO-RISK, CNT: NCT02757989) investigating whether allogeneic hematopoietic stem cell transplantation (HSCT) improves overall survival (OS) in patients with lower-risk myelodysplastic syndromes (MDS) who exhibit additional high-risk features (intermediate or higher IPSS-R risk, thrombocytopenia < 20 G/L, neutropenia < 0.5 G/L or failure to 2 lines of therapy). A total of 77 patients (median age 62.5) with low or intermediate-1 IPSS scores were enrolled and stratified based on the presence of a matched HLA donor: 62 patients in the donor arm and 15 without a donor . Despite high remission rates in transplanted patients (67.8% vs. 21.4%), the 3-year OS did not significantly differ between arms (57.6% in donor arm vs. 64.3% in non-donor arm, HR 0.75, p=0.53). The adjusted analysis using inverse probability of treatment weighting (IPTW) confirmed the lack of survival benefit with HSCT. Transplantation was associated with higher rates of chronic graft-versus-host disease (GVHD), severe infections, and non-relapse mortality (24.7%). Although quality of life improved slightly over time in transplanted patients, the difference was not statistically significant. The trial was stopped early due to slow enrollment and futility. The findings highlight the need for improving post-transplant outcomes to justify HSCT in lower-risk MDS patients with poor prognostic features.

PMID:41061188 | DOI:10.1182/bloodadvances.2025017035

JCO Glob Oncol. 2025 Oct;11:e2500012. doi: 10.1200/GO-25-00012. Epub 2025 Oct 8.

ABSTRACT

PURPOSE: In 2013, Brazil implemented a federal law (Law 12.732/2012) mandating cancer treatment to begin within 60 days of diagnosis. Among women with newly diagnosed estrogen receptor-positive (ER+) nonmetastatic breast cancer, we describe the diagnosis-to-treatment interval, patient and tumor characteristics, and the type of treatment received, and we assess these metrics by public versus private health care setting.

METHODS: The study included patients with early-stage ER+ breast cancer from 14 centers in Brazil who had completed locoregional care and received >6 months of adjuvant endocrine therapy (ET). Patient, tumor, and treatment characteristics were abstracted from clinical documentation and collected in REDCap. Qualitative variables were compared between groups using the chi-square or Fisher exact tests. For quantitative variables, the nonparametric Mann-Whitney test was used. P < .05 was considered significant.

RESULTS: From June 2021 to March 2024, 774 women enrolled in the study. The mean age at diagnosis was 56.5 years, and 55.2% received public health care. Women who received care at public institutions were more likely to be premenopausal at diagnosis (45.3% public v 29.2% private, P < .0001), living with no partner (45.6% public v 34.7% private, P = .002), and have lower educational levels (43.6% public v 6.8% private, P < .0001). Women treated in the public sector had more advanced disease with stage III tumors (29.3% public v 13.5% private, P < .0001) and were more likely to receive mastectomies (36.8% public v 29.8% private, P = .0003), axillary dissections (43.1% public v 18.1% private, P < .0001), chemotherapy (73.8% public v 58.5% private, P < .0001), and radiotherapy (87.0% public v 78.7% private, P = .002). Regarding adjuvant ET, women treated in the public sector had lower ovarian function suppression (6.8% public v 18.8% private, P < .0001) and higher tamoxifen use (52.4% public v 29.4% private, P < .0001). The diagnosis-to-treatment interval was longer in the public versus private system (93 v 41 days, P < .0001).

CONCLUSION: Our study revealed significant disparities in cancer care between patients with stage I to III ER+ breast cancer treated in public versus private health care systems in Brazil. Law 12.732/2012 has proven ineffective for patients treated in the public sector and is not being adequately observed or enforced by Brazilian authorities.

PMID:41061177 | DOI:10.1200/GO-25-00012

J Magn Reson Imaging. 2025 Oct 8. doi: 10.1002/jmri.70145. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetic resonance elastography (MRE) has demonstrated potential in characterizing intracranial tumors, including glioblastoma. The influence of pathology on measurement consistency and interobserver agreement needs evaluation to promote MRE implementation as a quantitative biomarker.

PURPOSE: To assess repeatability and interobserver agreement of absolute and normalized magnitude of the complex shear modulus (|G*|), storage modulus (G’), and loss modulus (G″) in glioblastoma.

STUDY TYPE: Prospective.

POPULATION: Thirteen adults (5 male, 8 female, mean age 66.23 years) with histopathologically confirmed glioblastoma.

FIELD STRENGTH/SEQUENCE: 3 T MRI, modified single-shot spin-echo echo-planar imaging.

ASSESSMENT: Two same-session MRE acquisitions were performed with patient repositioning. The solid tumor component was independently segmented by 2 observers on contrast-enhanced T1-weighted images co-registered to MRE maps.

STATISTICAL TESTS: Repeatability was assessed using the repeatability coefficient, coefficient of variation, and Bland-Altman plots, and interobserver agreement by the intraclass correlation coefficient. The Wilcoxon signed-rank test compared parameters and coefficients of variation between tumor-normal-appearing white matter and absolute and normalized measurements. Significance was set at 0.05.

RESULTS: Tumor |G*| and G’ showed repeatability coefficients of 0.07-0.08 kPa and 0.05 kPa, compared with 0.13 kPa (|G*|) and 0.15-0.16 kPa (G’) for normalized measurements. Coefficients of variation in tumor regions were 1.42% ± 1.12%-1.60% ± 1.41% for |G*| and 1.19% ± 0.96%-2.08% ± 2.22% for G’, significantly lower than normalized values (4.82% ± 4.49%-4.21% ± 4.27% for |G*|; 5.12% ± 5.04%-5.45% ± 4.53% for G’). Tumor |G*| and G’ showed excellent interobserver agreement (intraclass correlation coefficients 0.97 and 0.95). Tumor G″ demonstrated higher variability than |G*| and G’ (coefficients of variation 8.58% ± 7.69%-7.51% ± 6.73%), with no significant difference between absolute and normalized measurements (p = 0.14).

DATA CONCLUSION: Tumor |G*| and G’ are the most repeatable metrics in glioblastoma. Normalization reduces measurement repeatability due to normal-appearing white matter variability. The small sample size (n = 13) limits generalizability.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 2.

PMID:41061165 | DOI:10.1002/jmri.70145

JMIR Hum Factors. 2025 Oct 8;12:e66514. doi: 10.2196/66514.

ABSTRACT

BACKGROUND: Patients with inflammatory rheumatic diseases often experience drug-related problems (DRPs). As these can result in negative health consequences, DRPs should be identified and addressed in a timely manner. Text messaging between patients and pharmacists at the initiative of the patient has the potential to deliver support with DRPs more continuously, increase accessibility and efficiency, and enhance patient involvement in the process of identifying and solving DRPs.

OBJECTIVE: This study aimed to assess the feasibility of text messaging from both the patients’ and health care practitioners’ perspectives before a large-scale implementation.

METHODS: Adult patients using a disease-modifying antirheumatic drug were given access to text messaging with pharmacists to discuss DRPs for a period of 8 weeks. Patients received a response from a pharmacist within 4 working hours. Feasibility was evaluated based on five domains of Bowen’s framework for designing feasibility studies: (1) demand: actual use, expressed interest (user version of the Mobile Application Rating Scale – section E), and factors impacting future use; (2) limited efficacy: number of DRPs solved, DRPs resulting in follow-up, and DRPs warranting involvement of health care provider; (3) implementation: degree of execution (number of conversations answered within service level) and resources needed (pharmacists’ time investment per conversation); (4) acceptability: satisfaction and appropriateness (theoretical framework of acceptability); and (5) practicality: ability to carry out intervention activities (System Usability Scale). Data were collected by means of usage data and a questionnaire.

RESULTS: In total, 45 patients (median age 57, IQR 52-65 y; n=31, 69% female) and 5 pharmacists (median age 41, IQR 26-47 y; n=1, 20% female) actively participated in this study. In the demand domain, 158 unique DRPs were raised in 133 conversations, with a median of 3 (IQR 2-4) unique DRPs per patient. Expressed interest was rated high by patients (median 4, IQR 4-5), and 90% (37/41) of patients would recommend text messaging to others. In the limited-efficacy domain, all DRPs were solved, and 77% (122/158) of DRPs warranted involvement of a health care provider. In the implementation domain, 87% (116/133) of conversations were answered within the promised timeframe with a median time investment of 4:15 (IQR 2:21-7:27) minutes per conversation. Acceptability was rated high by patients (median 4, IQR 4-5) and pharmacists (median 5, IQR 4-5). Finally, in the practicality domain, System Usability Scale was scored above average for patients (mean 72, SD 18) and pharmacists (mean 81, SD 16).

CONCLUSIONS: Text messaging with pharmacists at the initiative of patients with rheumatic diseases seems feasible for discussing DRPs in terms of limited efficacy, implementation, acceptability, demand, and practicality for patients and pharmacists.

PMID:41061137 | DOI:10.2196/66514

BJS Open. 2025 Sep 8;9(5):zraf098. doi: 10.1093/bjsopen/zraf098.

ABSTRACT

BACKGROUND: Faecal immunochemical testing has rapidly been established as the first-line triage for patients with symptoms suspicious for colorectal cancer. However, the reported low compliance of test returns issued from primary care is concerning. This article reports the real-world impact of implementation of a double-faecal immunochemical testing pathway for symptomatic referrals into routine clinical practice.

METHODS: All eligible referrals between November 2021 and October 2022 were sent two faecal immunochemical tests via the faecal immunochemical testing interface office. Colorectal investigations were instigated if either test result was ≥10 µg haemoglobin per g. Referrals with double-negative results were reviewed by consultants who decided whether symptoms merited further investigation. Cancer registry follow-up data were cross-checked, and a further electronic registry allowed capture of re-referrals.

RESULTS: Some 5425 patients were triaged using double-faecal immunochemical testing, with 5116 (94.3%) completing at least 1 and 4607 (84.9%) both faecal immunochemical tests. The positivity of one test was 20.8%, rising to 27.8% where both tests were completed. The number of referred patients undergoing colorectal investigation fell from 90% before faecal immunochemical testing-directed pathways to 56.6% owing to a reduction in investigating patients with double-negative results. The double-faecal immunochemical testing pathway had a sensitivity of 94.3% for the detection of colorectal cancer, with 37.5% of cancers with a negative first test being detected by the second. Only 3.3% of patients triaged through the double-faecal immunochemical testing pathway were re-referred.

CONCLUSION: The double-faecal immunochemical testing pathway demonstrated high test return rates, a reduction in unnecessary investigations, and colorectal cancer detection rates similar to preimplementation rates.

PMID:41061132 | DOI:10.1093/bjsopen/zraf098

BJS Open. 2025 Sep 8;9(5):zraf096. doi: 10.1093/bjsopen/zraf096.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) screening programmes aim to detect early, asymptomatic cancers and improve survival. This study aimed to establish the proportion of interval cancers, and the consequences with regard to stage, clinical outcome, and overall survival. Risk factors associated with interval CRCs were investigated.

METHODS: The Scottish Bowel Screening Programme uses faecal immunochemical testing at a threshold of 80 µg haemoglobin per g as a positive trigger for investigation. Screening was offered to all eligible individuals in one region, from November 2017 to October 2021. Cancer registries were cross-checked to ensure complete capture of all cancers including interval CRCs. The primary outcome was rate of interval CRCs among participants with follow-up of 24 months, and its relationship to faecal immunochemical testing results, clinical variables, stage, time to diagnosis, and survival. The secondary outcome was identification of risk factors associated with interval CRCs.

RESULTS: The Scottish Bowel Screening Programme generated 316 583 tests during the study period. Participation was 71.0% of the eligible population (212 664 patients); it was greater among women (71.9 versus 70.0%; P < 0.001) and in higher socioeconomic areas (76.9 versus 58.6%; P < 0.001). In the screened population, 546 CRCs were diagnosed within 2 years of screening. Some 289 of these patients (52.9%) had positive bowel screening. There were 257 patients with interval CRCs, who waited a median of 13 (interquartile range 7-20) months for diagnosis. Of CRCs diagnosed, 24.9% had screening faecal immunochemical test results of < 10 µg haemoglobin per g. The interval CRC rate was greater in women, older patients, and among the least socioeconomically deprived. Interval CRCs were associated with worse 2-year all-cause mortality than screen-detected CRCs (23.0 versus 10.8%; P < 0.001). Importantly, 121 of the 257 interval CRCs (47.1%) had detectable faecal immunochemical test results at 10-79 µg haemoglobin per g.

CONCLUSION: Patients with interval CRCs and a detectable faecal immunochemical test result below the predetermined threshold appear to be significantly disadvantaged with respect to stage at presentation and survival. Almost half of interval CRCs diagnosed within 2 years had detectable haemoglobin on screening faecal immunochemical test and would be a target for lower positivity thresholds.

PMID:41061131 | DOI:10.1093/bjsopen/zraf096

ANZ J Surg. 2025 Oct 8. doi: 10.1111/ans.70308. Online ahead of print.

ABSTRACT

BACKGROUND: The demand for conversion gastric bypass bariatric procedures has increased; however, the ideal procedure remains contentious, and access to government-funded procedures remains limited. This study aimed to determine if the medium-term weight loss, reflux, and safety outcomes are significantly different in patients who receive conversion Roux-en-Y gastric bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in an Australian government-funded hospital (GFH).

DESIGN: This was a retrospective observational study of 251 adult participants who received conversion gastric bypass surgery at the Royal Brisbane and Women’s Hospital between January 1, 2015, and April 30, 2023. The primary outcome measure was the annual percentage total weight loss (%TWL) from 12 months to 5 years following conversion to RYGB versus OAGB. Secondary outcome measures were post-operative reflux, hospital length of stay (LOS), and complications within 90 days.

RESULTS: The annual median %TWL from 1 to 5 years post-surgery did not demonstrate a statistically significant difference between conversion RYGB and OAGB. Participants who had previously received a laparoscopic adjustable gastric banding (LAGB) and had a conversion to RYGB for gastro-oesophageal reflux demonstrated statistically significantly better annual %TBWL out to 4 years compared to those who had received a prior sleeve gastrectomy (SG) χ²(1) = 6.4, p = 0.011. Similarly, there was a statistically significant improved %TWL in patients with gastro-oesophageal reflux, who were converted to OAGB from primary LAGB compared to primary SG; however, this was only statistically significant out to 2 years χ²(1) = 4.2, p = 0.041. Pre- and post-operative gastro-oesophageal reflux and LOS were comparable in conversion RYGB and OAGB procedures. RYGB demonstrated a significantly higher incidence of the post-operative complications out to 90 days; p = 0.008.

CONCLUSION: RYGB and OAGB provide durable medium-term weight loss when performed as conversion procedures. Our results suggest that consistent, improved medium-term weight loss can be achieved in participants who undergo conversion gastric bypass in the context of reflux if they have previously received LAGB. There was no significant difference in the incidence of de-novo gastro-oesophageal reflux following either RYGB or OAGB.

PMID:41059548 | DOI:10.1111/ans.70308