Nevin Manimala

J Robot Surg. 2025 Feb 4;19(1):60. doi: 10.1007/s11701-025-02222-7.

ABSTRACT

Robotic right colectomy (RRC) has been researched and compared in the past to the laparoscopic approach (LRC). However, it remains unclear whether RRC outperforms LRC in patients aged 65 or older with colon cancer or adenoma. Thus, this systematic review and meta-analysis aims to compare the short-term outcomes of RRC to LRC in this particular age group. PubMed, Scopus, and Cochrane Library were searched for related literature. Studies and data were extracted by two independent reviewers. Inverse variances weighted mean differences (WMD) with random effects model were used for continuous values, and odds ratios (OR) with random effects model using the Mantel-Haenszel’s formula were used for dichotomous values. Heterogeneity using Higgins I² and p values were calculated. A sensitivity analysis was performed for operative duration and number of harvested lymph nodes. In total 382 patients, 157 in RRC and 225 in LRC, were included in this study. A statistically significant increase of 43.91 min [95%CI: 19.61, 68.22], P = 0.001, was observed regarding operative duration in the RRC group, compared to LRC, but with high heterogeneity, I² = 89%. However, a statistically significant decrease of 42% [OR = 0.58 (0.34, 0.98), P = 0.04, I²=2%] was observed with regard to overall complications in RRC compared to LRC. Non-significant differences between the two approaches were observed in the number of harvested lymph nodes [WMD = 0.44 (95%CI: -3.94, 4.82), P = 0.85, I² = 52%], wound infections [OR = 0.63 (95%CI: 0.11, 3.52), P = 0.60, I² = 13%], rate of ileus [OR = 0.29 (95%CI: 0.08, 1.00), P = 0.05, I² = 0%], length of hospitalization [WMD = 0.18 (95%CI: – 0.74, 1.11), P = 0.70, I² = 0%], and anastomotic leakage [OR = 0.52 (95%CI: 0.09, 3.11), P = 0.47, I² = 0%]. The results of the operative duration and number of harvested lymph nodes remained statistically significant and non-significant, respectively, after sensitivity analysis. Robotic right colectomy appears to require a longer operative duration, but possibly offers lower rates of overall complications, compared to laparoscopic right colectomy in patients ≥ 65 years of age. Due to the lack of studies identified in the literature, and the ones included being non-randomized, no solid conclusions can be drawn and cautious interpretation of the results is advised. Future studies are necessary to further examine both short- and long-term outcomes. Prospero registration: CRD42024603354.

PMID:39904868 | DOI:10.1007/s11701-025-02222-7

Int Endod J. 2025 Feb 4. doi: 10.1111/iej.14207. Online ahead of print.

ABSTRACT

AIM: To evaluate whether performing apical patency (AP) poses a risk for the development of osteonecrosis in rats treated with the antiresorptive drugs Zoledronic Acid (ZA) or Denosumab (DMAB).

METHODOLOGY: Forty-two male Wistar rats were divided into six groups according to the medication administered and whether apical patency was performed (n = 7): ZA, ZA-AP, DMAB, DMAB-AP, and the control groups CON and CON-AP. The ZA and ZA-AP groups received 0.125 mg/kg of ZA, while the DMAB and DMAB-AP groups received 0.25 mg/kg of DMAB, both administered via intraperitoneal injection twice a week for 4 weeks. One week after completing drug administration, endodontic access was performed on the distal occlusal fossa of the lower left first molars in all animals. AP was carried out in the distal canal of the ZA-AP, DMAB-AP, and CON-AP groups using a size 10 K-file with the aid of an electronic apex locator, extending beyond the apical foramen. In the other groups, the file was inserted up short of apex as determined by electronic apex locator measurement. Coronal sealing was performed and after 21 days, the animals were euthanized, and visual analysis, micro-CT, and histopathological assessments were conducted to evaluate the presence or absence of osteonecrosis. Statistical analysis was performed using frequency statistics and a GLM multivariate ANOVA model followed by Tukey’s test with significance at p < .05.

RESULTS: None of the animals exhibited bone exposure or other clinical signs associated with medication-related osteonecrosis of the jaw. No cortical bone destruction, periosteal reaction, or bone sequestration was observed in the micro-CT or histopathological assessments. Medication significantly influenced some micro-CT parameters (p < .05), while the apical patency alone did not (p > .05). When interacting with medication*apical patency, the ZA-AP group showed a significantly lower percentage of bone volume and bone mineral density compared to the ZA group, a tendency not observed in DMAB groups (p < .05).

CONCLUSIONS: Apical patency in rats treated with zoledronic acid or denosumab did not cause osteonecrosis of the jaw, only micro-CT changes in bone microarchitecture that cannot be linked to osteonecrosis in zoledronic acid treated animals.

PMID:39904856 | DOI:10.1111/iej.14207

Ann Surg Oncol. 2025 Feb 4. doi: 10.1245/s10434-025-16950-5. Online ahead of print.

ABSTRACT

BACKGROUND: Pylorus-preserving partial pancreatoduodenectomy (ppPD) is a treatment for tumors of the pancreatic head. Delayed gastric emptying (DGE) is one of the most common complications following ppPD. In a retrospective analysis, intraoperative endoluminal pyloromyotomy (PM) was shown to be associated with a reduction in DGE rates.

OBJECTIVE: The aim of this randomized controlled trial was to investigate the effect of intraoperative endoluminal PM on DGE after ppPD.

METHODS: Patients undergoing ppPD were randomized intraoperatively to receive either PM or atraumatic stretching of the pylorus prior to creation of the duodenojejunostomy. The primary endpoint was the rate of DGE within 30 days after surgery.

RESULTS: Sixty-four patients were randomly assigned to the PM group and 64 patients were assigned to the control group. There were no differences between the two groups regarding baseline characteristics. The DGE rate was 59.4% (76/126). In two patients (1.6%) DGE was not assessable. The most common DGE grade was A (51/126, 40.5%), followed by B (20/126, 15.9%) and C (5/126, 4.0%). The rate of DGE was 62.5% in the PM group versus 56.3% in the control group (odds ratio 1.41, 95% confidence interval 0.69-2.90; p = 0.34). The complication rate did not differ between both groups (p = 0.79) and there were no differences in quality of life on postoperative day 30.

CONCLUSIONS: Intraoperative endoluminal PM did not reduce the rate or severity of DGE after ppPD compared with atraumatic stretching of the pylorus.

PMID:39904851 | DOI:10.1245/s10434-025-16950-5

J Gen Intern Med. 2025 Feb 4. doi: 10.1007/s11606-025-09398-6. Online ahead of print.

ABSTRACT

BACKGROUND: Hypertension onset is linked to sleep, but the precise sleep duration affecting it remains unclear. Our goal is to pinpoint the sleep duration impacting hypertension incidence, offering valuable insights for prevention and management.

METHODS: We conducted a systematic search in PubMed, Embase, Web of Science, CNKI, Cqvip, and Wanfang Database, up to May 30, 2023, focusing on cohort studies examining the association between nighttime sleep duration and hypertension risk in adults aged 18 and above. Two authors independently performed data extraction, quality assessment, and synthesis based on predefined criteria. A random-effects model was used to estimate pooled effect sizes with 95% confidence intervals (CIs). Heterogeneity was quantified using the I² statistic, with potential sources explored through subgroup and sensitivity analyses to validate the robustness of the results.

RESULTS: Out of the 173,734 participants included in the meta-analysis, 41,528 eventually developed hypertension. The analysis revealed a correlation between short sleep duration and increased risk of hypertension: 1.07 (95% CI 1.00-1.14) for those sleeping ≤ 7 h, 1.04 (95% CI 1.02-1.07) for 6-7 h, and 1.17 (95% CI 1.06-1.28) for < 6 h. For women, with sleep duration 6-7 and < 6 h, the pooled risk of hypertension incidence was 1.07 (1.02-1.12) and 1.12 (1.06-1.19). In individuals under 60 years of age, an elevated risk of hypertension was observed with sleep durations of less than 6 h and between 6 and 7 h, with pooled risks of 1.24 (95% CI 1.10-1.39) and 1.05 (95% CI 1.00-1.11), respectively.

CONCLUSIONS: Hypertension is significantly correlated with sleep duration under 7 h, especially in women and those under 60, highlighting the importance of sleep management in hypertension prevention and treatment strategies.

TRIAL REGISTRATION: PROSPERO: CRD42022345513.

PMID:39904837 | DOI:10.1007/s11606-025-09398-6

Obes Surg. 2025 Feb 4. doi: 10.1007/s11695-025-07681-3. Online ahead of print.

ABSTRACT

BACKGROUND: Obesity is increasingly prevalent worldwide and has been linked to various health conditions, including hypothyroidism.

METHODS: Summary-level GWAS data from the UK Biobank and the FinnGen Biobank were used for Mendelian randomization analysis. The impact of BMI on autoimmune hypothyroidism through putative mediators was assessed through a four-step analytical process. Statistical analyses, including the inverse-variance-weighted (IVW) method, weighted median (WM), and MR-Egger methods, were employed to evaluate causal relationships and detect horizontal pleiotropy. Mediation analysis was performed using a two-step method to assess the causal relationships between BMI, putative mediators, and autoimmune hypothyroidism.

RESULTS: Higher BMI was associated with an increased risk of autoimmune hypothyroidism. Mean corpuscular volume, eosinophil count, and cystatin C levels were found to mediate this association.

CONCLUSIONS: BMI positively correlates with autoimmune hypothyroidism, with mean corpuscular volume, eosinophil count, and cystatin C levels mediating this relationship. Further research is needed to confirm these findings and explore causal relationships across diverse populations.

PMID:39904833 | DOI:10.1007/s11695-025-07681-3

Can J Anaesth. 2025 Feb 4. doi: 10.1007/s12630-025-02908-4. Online ahead of print.

ABSTRACT

PURPOSE: When difficulty with laryngoscopy is encountered, confirmation of endotracheal access can be confirmed using the tactile feedback (i.e., tracheal clicks) of a tracheal tube introducer (bougie). There is anecdotal evidence that a bougie placed in the esophagus may have a unique, tactile “boggy” resistance. In this study, we aimed to elucidate the sensitivity and specificity of clicks and boggy resistance for infrequent airway providers in cadaveric airways.

METHODS: We conducted a prospective observational study using descriptive statistics to examine the diagnostic accuracy of clicks and boggy resistance for bougies placed in cadaveric airways. We recruited prehospital providers from within Atlantic Canada who then underwent a brief formal training protocol. Cadavers were equipped with a static laryngoscope and bougie (placed either in the trachea or esophagus). Each participant, blinded to bougie placement, was then tested on two separate cadavers and asked whether they felt clicks and/or boggy resistance.

RESULTS: Thirty-seven paramedics participated in the study (32 advanced care paramedics, five critical care paramedics) and were randomized to perform 74 bougie assessments on cadaveric airways. For tracheal clicks, we calculated an overall sensitivity of 86% (95% confidence interval [CI], 75 to 98) and an overall specificity of 81% (95% CI, 68 to 94). Sensitivity for the esophageal boggy resistance test was 78% (95% CI, 65 to 92) while specificity was 86% (95% CI, 75 to 98).

CONCLUSION: Following a brief training session, prehospital providers who intubate infrequently seemed to show a relatively high degree of accuracy using tracheal clicks and esophageal boggy resistance to confirm bougie placement in cadaveric airways.

PMID:39904826 | DOI:10.1007/s12630-025-02908-4

Int Urol Nephrol. 2025 Feb 4. doi: 10.1007/s11255-025-04395-4. Online ahead of print.

ABSTRACT

PURPOSE: To compare the safety and efficacy of percutaneous laser ablation and radical nephroureterectomy for renal pelvic tumors.

METHODS: This prospective cohort study included 30 patients diagnosed with renal pelvic tumors who met the established selection criteria. The cohort was divided into two groups: Group I, consisting of 15 patients who underwent percutaneous laser ablation, and Group II, comprising 15 patients who received radical nephroureterectomy. Comprehensive data collection encompassed demographic information, intraoperative and postoperative outcomes, and disease-free survival.

RESULTS: The analysis revealed that percutaneous laser ablation offered modest benefits over radical nephroureterectomy in terms of reduced surgical duration (P < 0.01) and shorter hospital stays (P = 0.03). However, in evaluating long-term oncologic outcomes, percutaneous laser ablation did not achieve parity with radical nephroureterectomy. Although the differences in long-term outcomes were not statistically significant (HR: 0.48; 95% CI 0.05-4.92, P = 0.54), radical nephroureterectomy exhibited a slight advantage in disease-free survival.

CONCLUSION: Percutaneous laser ablation presents a safe and effective, less invasive treatment alternative, rendering it a feasible option for patients who are either unable or unwilling to undergo radical nephroureterectomy due to comorbid conditions or personal preferences.

PMID:39904823 | DOI:10.1007/s11255-025-04395-4

Mem Cognit. 2025 Feb 4. doi: 10.3758/s13421-025-01687-z. Online ahead of print.

ABSTRACT

The goal of the present study was to test the hypothesis that cross-language activation of cognates significantly increases working memory capacity for bilingual readers. Highly proficient, Spanish-English bilinguals completed the reading span task (RST) in which participants made sentence plausibility judgments while simultaneously holding target words in memory for later recall. Across three experiments the cognate status of either the constituent sentence words or follow-up targets was manipulated. Contrary to our predictions, the presence of cognates in the stimulus set did not have a uniform benefit on performance. Instead, the pattern of performance across experiments indicates that the presence of cognates caused a shift in resource allocation across the two subtasks of the RST. Specifically, when the cognate manipulation was in the target words, sentence plausibility judgments were more accurate in the cognate condition. When the cognate manipulation was in the sentences, target word recall was superior while sentence plausibility judgment accuracy was worse in the cognate condition. The ease of facilitated lexical access of cognate words may have induced this reallocation of resources to the alternative task. These findings have critical implications for the valid use of the RST as a measure of working memory capacity for comprehension in bilingual populations as well as our understanding of the working memory demands of bilingual sentence comprehension and how these are modulated by cross-language lexical activation dynamics.

PMID:39904819 | DOI:10.3758/s13421-025-01687-z

Environ Monit Assess. 2025 Feb 4;197(3):240. doi: 10.1007/s10661-025-13669-4.

ABSTRACT

The River Ganga is a vital lifeline for millions, and several authors reported that its quality has been deteriorating. Several initiatives have been taken by the government, but the situation is not up to the mark. Hence, water quality assessments are essential for sustainable river water management and restoring its ecological balance. This work employed spatiotemporal analysis of 20 hydrochemical variables, water quality indices (WQI), and multivariate statistics to assess the water quality of River Ganga. Water samples (n = 220) were collected at 20 locations (divided into four zones, namely upper (UZ), middle (MZ), lower (LZ), and estuarine (EZ)) based on the geographical nature and anthropogenic pressure. The study found that most of the water variables (specific conductivity (SC), pH, BOD, total alkalinity (TA), total hardness (TH), Ca-H, Mg-H, chlorinity (Cl-), salinity, nitrate-N, silicate and total dissolved solids (TDS)) were lowest reported at UZ while the highest at EZ. TH, salinity, Mg-H, Ca-H, TDS, Cl-, and SC in EZ, were above the drinking water limits and these variables markedly affect the river’s water quality attributes, possibly increased by tidal influences. WQI indicated that the UZ was clean (26-50) in all seasons, MZ and LZ were good to poor (50-75) in all seasons, and EZ was unsuitable for drinking (> 100) in all seasons. Seasons were grouped into three clusters: less polluted (monsoon); slightly polluted (post-monsoon); and polluted (winter and pre-monsoon). The principal component analysis formed five clusters based on eigenvalue > 1: PC1 having TH, salinity, Mg-H, Ca-H, TDS, Cl-, and SC mainly influenced by tidal factor; PC2 having temperature, transparency, and DO was influenced by metrological source; PC3 (pH, TA, velocity) and PC4 (BOD, silicate) thought to be both natural as well as manmade; and PC5 was influenced by agricultural runoff (total phosphorus and NO₃-N) and sewage water (TN) discharge. The study emphasized the significance of multivariate statistical techniques in discerning the variability patterns of parameters, as well as in formulating management strategies to enhance river water quality by pinpointing the most impactful parameters contributing to water quality degradation.

PMID:39904812 | DOI:10.1007/s10661-025-13669-4

Acta Neurochir (Wien). 2025 Feb 4;167(1):34. doi: 10.1007/s00701-025-06447-1.

ABSTRACT

BACKGROUND: Several studies have attributed decreasing case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (aSAH) to the gradually increasing use of endovascular treatment without considering improvements in other outcome-affecting factors. To assess the independent effect of a treatment modality on CFRs, we investigated CFR changes in a high-volume center rapidly transitioning from surgical to endovascular operations as the first-line treatment for all aSAH patients except those with middle cerebral artery (MCA) aneurysms.

METHODS: We identified all surgically/endovascularly treated aSAH patients in Helsinki University Hospital (HUH) during 2012-2017. As the treatment shift occurred in 2015, we defined two treatment eras: surgical (2012-2014) and endovascular (2015-2017). We compared time-dependent changes in 1-year CFRs between non-MCA and MCA patients using a Poisson regression model. To analyze consistency in operation rates, we also identified sudden-death and conservatively treated aSAHs in the HUH catchment area via two externally validated registers.

RESULTS: Of all 665 hospitalized aSAH cases in the HUH catchment area, 557 (84%) received operative treatment; 367 (66%) underwent surgical and 190 (34%) endovascular operations. Between the treatment eras, endovascular treatment for non-MCA cases increased from 21 to 79%, whereas 99% of the MCA cases were treated surgically during the whole study-period. Among the operatively treated patients, the 1-year CFRs decreased similarly in patients with non-MCA (42%; from 14 to 8%; adjusted risk ratio (aRR) = 0.66 (95% CI 0.37-1.19)) and MCA aneurysms (42%; from 15 to 9%; aRR = 0.66 (0.16-1.60)). The proportion of operatively treated patients, their clinical condition on admission, and amount of bleeding on the first CT-scan remained unchanged over time.

CONCLUSIONS: We found similar CFR decreases in aSAH groups with and without undergoing a fast transition from surgery to endovascular operations, providing real-world evidence on the small independent effect of endovascular treatment on the decreasing CFRs in high-volume centers.

PMID:39904810 | DOI:10.1007/s00701-025-06447-1