Nevin Manimala

Eur J Orthop Surg Traumatol. 2025 Oct 5;35(1):417. doi: 10.1007/s00590-025-04542-8.

ABSTRACT

PURPOSE: Distal femur fractures are challenging to manage and fixation with intramedullary nails or plates alone can fail. Linked nail plate constructs (NPC) are increasingly used for complex cases. This five-year review from a UK major trauma centre reports indications and patient outcomes.

METHODS: Patients treated for a distal femoral fracture with a NPC between 1st January 2020 and 1st January 2025 were identified. Patient demographics, mechanism of injury, fracture classification, procedural characteristics, postoperative weight-bearing status, union rates, complications and mortality were recorded.

RESULTS: Thirty-two patients were identified with a mean age of 70 years (20 to 98). Twenty-four (75%) patients were female with a median ASA of 3. There were five (16%) open fractures and ten (31%) peri-prosthetic fractures. Eight (25%) NPCs were revision operations following failure of primary fixation. All operations were performed by at least one consultant. In total, 31 (97%) patients were permitted unrestricted weight bearing postoperatively. Clinical union was achieved in 25 (96%) of 26 patients available for follow-up. There were no significant complications. Mortality rate at 30 days, 3 months and 12 months was 6%, 6% and 16%, respectively.

CONCLUSIONS: This study supports the use of nail plate construct (NPC) in the management of both primary and revision surgery for complex distal femoral fractures. Among 32 patients with a mean age of 70 years, NPC permitted immediate unrestricted weight bearing (97%) with a high rate of union (96%) and a low complication and mortality rates. These findings highlight NPC as an effective option for managing complex distal femur fractures.

PMID:41047422 | DOI:10.1007/s00590-025-04542-8

Signal Transduct Target Ther. 2025 Oct 6;10(1):328. doi: 10.1038/s41392-025-02427-0.

ABSTRACT

Transarterial chemoembolization (TACE) is the standard treatment for intermediate-stage hepatocellular carcinoma (HCC), yet its efficacy as a standalone therapy remains suboptimal. This phase 2 trial (ChiCTR2100049829) evaluated the feasibility and safety of TACE combined with atezolizumab and bevacizumab in patients with intermediate-stage HCC. Participants received TACE followed by atezolizumab and bevacizumab until disease progression, unacceptable toxicity, or death. The primary endpoint was objective response rate (ORR) assessed per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), ORR by modified RECIST (mRECIST), disease control rate (DCR), time to response (TTR), duration of response (DOR), and adverse events (AEs). Between August 21, 2021 and April 10, 2023, 45 patients were enrolled. As of the data cutoff on September 30, 2024, the median follow-up was 26.7 months. The ORR was 47% per RECIST v1.1 and 67% per mRECIST. Median PFS was 17.9 months, and median OS was 33.0 months. The DCR was 87% (RECIST v1.1) and 91% (mRECIST). Median TTR was 11.9 weeks (RECIST v1.1) and 4.9 weeks (mRECIST), with median DOR of 36.6 weeks (RECIST v1.1) and 44.4 weeks (mRECIST). Of the 45 patients, 44 experienced AEs of any grade, with 20 reporting grade 3-4 AEs; no grade 5 AEs were observed. TACE combined with atezolizumab and bevacizumab appears safe and feasible for intermediate-stage HCC, supporting further investigation in larger studies.

PMID:41047409 | DOI:10.1038/s41392-025-02427-0

Eur Spine J. 2025 Oct 6. doi: 10.1007/s00586-025-09400-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the clinical efficacy of posterior endoscopic surgery using a bone tunnel approach in treating cervical spondylotic radiculopathy (CSR) secondary to uncovertebral osteophytes.

METHODS: From January 2022 to July 2023, 68 patients diagnosed with cervical osseous foraminal stenosis due to uncovertebral osteophytes and treated with posterior endoscopic surgery through the bone tunnel approach were retrospectively enrolled in this study, with a minimum follow-up period of 1 year. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and success rate according to Odom’s criteria. Radiological outcomes were assessed by measuring the C2-7 sagittal Cobb angle (SCA), segmental angle (SA), and cervical curvature angle (CA) on the lateral, hyperflexion and hyperextension radiographs.

RESULTS: All the patients successfully underwent the procedure without severe complications. The mean operative duration was 84.1 ± 24.6 min, with an average hospital stay of 4.4 ± 2.2 days and a mean follow-up time of 14.7 ± 3.1 months. Significant improvements in the NDI and VAS scores were observed postoperatively (p < 0.05). At the final follow-up, the clinical success rate, defined as excellent or good outcomes, was 100% (43 excellent and 25 good outcomes). On lateral radiographs, no statistically significant differences were detected in SCA, CA, and SA measurements at various time points. On hyperextension radiographs, all measurements at the final follow-up were significantly larger than those taken pre- and postoperatively (p < 0.05). On hyperflexion radiographs, all postoperative measurements were significantly smaller than those taken preoperatively and at the final follow-up (p < 0.05).

CONCLUSION: Posterior endoscopic surgery through the bone tunnel approach is a safe and effective route for achieving direct neuroventral bony decompression, demonstrating favorable clinical and radiological outcomes in the treatment of CSR with uncovertebral osteophytes.

PMID:41047404 | DOI:10.1007/s00586-025-09400-z

Sci Rep. 2025 Oct 5;15(1):34652. doi: 10.1038/s41598-025-20839-4.

ABSTRACT

This paper presents a complete nonclassical symmetry analysis of the nonlinear integrable model known as the (4 + 1)-dimensional Boiti-Leon-Manna-Pempinelli (4D-BLMP) equation. The analysis is divided into two parts. The first part involves constructing systems of nonlinear partial differential equations for the determining equations based on the dimensions of the model. Five distinct cases of these systems are examined and solutions to these systems are found, leading to the creation of various new nonclassical symmetries. The second part focuses on classifying the developed unknown functions using the constructed nonclassical symmetries and their invariant formulations. These classified functions are then applied to obtain a range of new explicit exact solutions to the model. The paper also includes a graphical analysis of the dynamical behavior of these solutions, taking into account special parameter values. The results highlight the existence of various wave structures in the 4D-BLMP equation, setting it apart from other models that lack non-singular complexiton solutions. The analysis of higher-dimensional nonlinear integrable equations is essential because such models capture complex wave phenomena arising in mathematical physics, fluid dynamics, and optical systems. In particular, understanding their exact and nonclassical solutions provides deeper insight into the underlying dynamics and supports the development of effective analytical and numerical techniques.

PMID:41047386 | DOI:10.1038/s41598-025-20839-4

BMC Public Health. 2025 Oct 6;25(1):3311. doi: 10.1186/s12889-025-24629-5.

ABSTRACT

BACKGROUND: Improving the mental health and digital divide issues is crucial for promoting active aging. This study aimed to examine the bidirectional relationship and intricate mechanisms between social participation, social media use, and depressive symptoms among a nationwide sample of Chinese older adults.

METHODS: We utilized data from two waves (2018, 2020) of the China Health and Retirement Longitudinal Survey, which included 4928 older adults aged 60 years and above. We Used a cross-lagged model to examine the bidirectional relationship between social participation, social media use, and depressive symptoms.

RESULTS: In two years, social media use competency and social participation frequency can be predicted bidirectionally, and social media use competency and depressive symptoms can also be predicted bidirectionally. However, there is no cross-temporal bidirectional relationship between social participation frequency and depressive symptoms. Depressive symptoms can predict social participation frequency two years later, while social participation frequency cannot directly predict depressive symptoms. The mediation analysis indicated that social media use competency played a complete mediating role between social participation frequency and depressive symptoms.

CONCLUSIONS: Continuous social participation may enhance social media use competency and alleviate depressive symptoms in older adults. Social media use may alleviate the decrease in social participation frequency and increase in depressive symptoms in older adults. Therefore, social media can be an effective tool to promote the integration of the older adults into society and alleviate negative emotions.

PMID:41047381 | DOI:10.1186/s12889-025-24629-5

Cardiovasc Intervent Radiol. 2025 Oct 6. doi: 10.1007/s00270-025-04223-3. Online ahead of print.

ABSTRACT

PURPOSE: Interventional radiologists are among the healthcare professionals most exposed to ionizing scatter radiation. A 0.5 mm lead equivalent X-ray protective drape (MXPD, Mavig, Germany) was introduced to reduce operator radiation dose and has demonstrated efficacy during cardiac interventions. This study evaluates the efficacy of the MXPD during transfemoral liver interventions.

MATERIALS & METHODS: A single-center randomized controlled study was conducted to compare operator radiation exposure during transfemoral liver interventions (n = 100) with and without the MXPD. Primary outcome was the ratio of the combined operator radiation dose values-measured at the chest, eyes and both hands and normalized to the respective dose area products – between MXPD and control groups. Secondary outcomes included the ratios in operator radiation doses measured for the individual dosimeter locations.

RESULTS: The MXPD group showed a significantly lower normalized radiation dose per DAP (mean reduction 0.31 µSv; 95% CI 0.083-0.536, p = 0.009), representing a 43% reduction. The effect of the drape was the highest for the whole-body dose measured above the lead apron (55% reduction, p = 0.10), the left hand finger dose (43%, p = 0.20) and the eye lens dose estimated at the left temple (63%, p = 0.10) and in between the eyes (47%, p = 0.10).

CONCLUSION: The MXPD can effectively reduce operator radiation dose during transfemoral arterial liver interventions, offering a practical adjunct to standard protective measures.

LEVEL OF EVIDENCE: Level 1b, Randomized Controlled Trial.

PMID:41047378 | DOI:10.1007/s00270-025-04223-3

Nurs Health Sci. 2025 Dec;27(4):e70241. doi: 10.1111/nhs.70241.

ABSTRACT

This study aimed to examine the psychometric properties of the Turkish version of the Inpatient Experience with Nursing Care Scale (IPENCS). A methodological study included 523 inpatients in a university and a training and research hospital located in 2 provinces between April 2023 and April 2024. The language, content (I-CVI: 0.85-1.00; S-CVI: 0.99), and face validity of the scale were established. For construct validity, CFA analyses confirmed the good fit of the original scale. Convergent, divergent, and discriminant validity were established (ASV < MSV < AVE < 0.50; CR < 0.80; AVE < CR). Reliability analysis indicated that the total Cronbach’s α coefficient was 0.94 and item-total score correlations (0.507-0.687) were adequate. The ICC coefficient for test-retest was 0.705, and parallel form reliability and concurrent validity had a high correlation (r = 0.669, p < 0.05). The results showed that the Turkish version of the scale was a valid and reliable tool to determine the nursing care experience of inpatients. This scale, evaluating patients’ nursing care experiences during their hospitalization by focusing on the process rather than the outcome, would be a useful tool for nurses and healthcare managers to use to evaluate the service.

PMID:41047373 | DOI:10.1111/nhs.70241

World J Mens Health. 2025 Sep 25. doi: 10.5534/wjmh.250180. Online ahead of print.

ABSTRACT

PURPOSE: To assess the prevalence and predictors of absence of internal spermatic vein (ISV) reflux during varicocele embolization in infertile male.

MATERIALS AND METHODS: Demographic, clinical and laboratory data from 237 infertile males treated with percutaneous varicocele embolization between January 2017 and November 2024 were analyzed. Each patient underwent color Doppler ultrasound (CDUS) and semen analysis, both repeated 6 months post-procedure. Semen analysis values were based on 2021 World Health Organization reference criteria. Descriptive statistics and logistic regression models tested the association between predictors and embolization failure.

RESULTS: Median age was 28 (IQR 22-34) years. Median preoperative semen parameters included sperm concentration of 22 (10.0-44.5) ×10⁶/mL, progressive motility of 35% (25%-40%), and normal morphology of 3% (2%-5%). Nearly half (48.9%) had CDUS grade ≥4 varicocele. Venous access was achieved via the right internal jugular vein in 46.4% and right common femoral vein in 53.6% of cases. Treatment was not performed in 1.3% of patients due to failure in catheterizing the spermatic vein and in 10.5% due to absence of ISV insufficiency during Valsalva. ISV reflux was more frequently absent in patients with grade III vs. grade IV-V varicocele (72.0% vs. 48.3%, p=0.02). After 2020, expert-driven ultrasound reduced the rate of phlebography-negative varicoceles (40% vs. 60%, p=0.03). Patients with confirmed varicocele had lower sperm concentration (20×10⁶/mL vs. 26 ×10⁶/mL, p=0.02). Grade III varicocele (OR 5.2; p=0.01) and higher sperm concentration (OR 1.1; p=0.03) were independent predictors of absent ISV reflux. Those with grade III varicocele and sperm count >20 ×10⁶/mL had a 96% likelihood of reflux absence.

CONCLUSIONS: Grade III varicocele and higher preoperative sperm concentration independently predicted the absence of ISV reflux, highlighting their role in patient selection. After expert-driven US implementation, the rate of no varicocele at phlebography significantly decreased.

PMID:41047365 | DOI:10.5534/wjmh.250180

World J Mens Health. 2025 Aug 29. doi: 10.5534/wjmh.250161. Online ahead of print.

ABSTRACT

PURPOSE: This study evaluates the impact of a structured online medical statistics webinar on researchers in andrology, both clinicians and non-clinicians. The objectives were to: 1) emphasize the critical role of statistical literacy in medical and biomedical research, 2) evaluate participants’ baseline knowledge, 3) determine the impact of the webinar on knowledge acquisition and satisfaction, and 4) analyze the influence of gender and institutional setting on learning outcomes.

MATERIALS AND METHODS: The Global Andrology Forum (GAF) conducted a webinar comprising four expert-led lectures on medical statistics and male infertility research. Participants completed three online surveys evaluating baseline characteristics, pre- and post-course knowledge, and satisfaction.

RESULTS: Post-webinar analysis showed a significant improvement in statistical knowledge, with the mean percentage of correct responses rising from 55.6% (95% confidence interval [95% CI]: 51.35-59.86) to 66.8% (95% CI: 62.48-71.14) (p<0.05). Female participants demonstrated over twice as much a greater average score increase (16.1) compared to males (7.9), though the difference was not statistically significant (p=0.092). Participants from public institutions showed the most substantial improvement (p<0.001), while private sector participants had a more modest and non-significant increase (p=0.054). Overall satisfaction was high, with 77.6% of participants indicating that they would recommend the course to their colleagues.

CONCLUSIONS: This structured online webinar significantly improved the participants’ statistical knowledge, highlighting the importance of such training in medical research. The high levels of participant satisfaction and positive feedback regarding the course underscore the webinar’s success. This study highlights the potential for future targeted online statistical educational initiatives and the need for such training for researchers in andrology and biomedicine.

PMID:41047362 | DOI:10.5534/wjmh.250161

World J Mens Health. 2025 Aug 29. doi: 10.5534/wjmh.250173. Online ahead of print.

ABSTRACT

PURPOSE: With increasing life expectancy worldwide, many patients experience non-life-threatening yet debilitating conditions that affect their quality of life. Among these, lower urinary tract symptoms, a representative urologic disease in men, continue to affect a significant number of aging males in the era of population aging. South Korea and the United States have distinct healthcare systems with notable advantages and limitations. This article aimed to analyze current treatment trends in South Korea using the National Health Insurance Database and compare them with United States trends through literature reviews.

MATERIALS AND METHODS: We obtained statistical medical data using the Korean Healthcare Big Data Opening System provided by the Korea Health Insurance Review and Assessment Service. Data were collected across four categories: medical treatment for benign prostatic hyperplasia (BPH), surgical treatment for BPH, overactive bladder (OAB), and nocturia. The collected data were analyzed based on annual patient cases, medical expenses, age distribution, and prescribed medications.

RESULTS: Medical expenses for BPH surged significantly from $165 million in 2019 to $266 million in 2023. Although medication prescriptions followed a similar upward trend, the increase in surgical procedures was relatively modest. For OAB, medical costs have also shown a sharp rise, from $40 million in 2019 to $59 million in 2023, with a proportional increase in prescription volume. Regarding nocturia, anticholinergics (32.7%) and alpha-blockers (31.3%) were the most frequently prescribed medications, whereas desmopressin accounted for 19.9%.

CONCLUSIONS: It is essential to acknowledge the treatment disparities arising from differences in the healthcare systems of the United States and Korea and to adopt a patient-centered approach that prioritizes health in various contexts. A gradual transition toward developing a patient-centered and progressive healthcare system is imperative globally to address these disparities.

PMID:41047361 | DOI:10.5534/wjmh.250173