Nevin Manimala

Clin Rheumatol. 2025 Sep 4. doi: 10.1007/s10067-025-07670-y. Online ahead of print.

ABSTRACT

OBJECTIVES: This study compared the incidence and time-to-event outcomes of ocular extraintestinal manifestations (O-EIMs) and EIMs among patients with human leukocyte antigen (HLA)-B27-associated diseases receiving different classes of immunotherapy.

METHODS: A retrospective cohort study was conducted using aggregated electronic health records from the TriNetX network between January 1, 2014, and December 31, 2024. Patients with HLA-B27-associated diseases were included if they were newly prescribed tumor necrosis factor (TNF), janus kinase (JAK), or interleukin (IL) inhibitors on or after their initial diagnosis. The cumulative incidence of O-EIMs and EIMs was calculated per 100 person-years. Kaplan-Meier estimates were used to graph time-to-event outcomes using R Studio (version 4.4.1).

RESULTS: We identified 22,287 patients [mean age 47.2 (16.8) years; 13,132 (58.9) % women]. The cumulative incidence of anterior uveitis from the index date was 0.11 cases per 100 person-years. According to first medication prescribed, the incidence of anterior uveitis was lowest in patients prescribed IL inhibitors, followed by JAK and TNF inhibitors (0.07%, 0.10%, and 0.20%, cases per 100 person-years respectively). Time-to-event analysis showed a higher likelihood of anterior uveitis with initial TNF inhibitor use, although the difference was not statistically significant. Regarding EIMs, incident sacroiliitis was highest with TNF (0.91%), followed by JAK (0.72%) and IL (0.37%). Psoriatic dermatitis incidence was highest with JAK inhibitors (2.85%), compared to TNF (2.19%) and IL (2.17%).

CONCLUSION: In this cohort study of patients with HLA-B27-associated diseases, the lack of statistical significance indicates similar effectiveness across immunotherapy classes in preventing O-EIMs and EIMs. Key Points • Large-scale comparative study assessing time-to-incident O-EIMs and EIMs in patients with HLA-B27-associated diseases treated with TNF, JAK, or IL inhibitor therapies using real-world data from the TriNetX network. • Low overall incidence of O-EIMs and EIMs was observed across all immunotherapy classes, with no statistically significant difference in time-to-event outcomes, indicating similar effectiveness in preventing these manifestations.

PMID:40906344 | DOI:10.1007/s10067-025-07670-y

Sleep Breath. 2025 Sep 4;29(5):280. doi: 10.1007/s11325-025-03448-3.

ABSTRACT

PURPOSE: Armodafinil has been approved for treating excessive daytime sleepiness (EDS) in OSA patients who still experience EDS after adequately treated with CPAP. However, the effectiveness of armodafinil administration in OSA patients with suboptimal CPAP usage and persistent EDS remains unexplored.

METHOD: A 12-week prospective cohort study enrolled 33 moderate to severe OSA patients with suboptimal CPAP usage (2- < 4 h/night) who experienced EDS and were naïve to armodafinil. Patients received daily 150 mg of armodafinil and continued using CPAP. Efficacy and adverse events were evaluated.

RESULTS: A total of 30 patients with mean age of 45.10 ± 10.74 years and Epworth sleepiness scale (ESS) of 13.93 ± 3.16 completed the study; however, one participant completed only the 8-week follow-up. After 12 weeks, ESS was significantly decreased by 5.03 ± 4.22 (p < 0.001). Clinical global impression (CGI) rated by investigators and by participants was significantly decreased by 1.79 ± 0.72 (p < 0.001) and 1.93 ± 0.75 (p < 0.001); respectively. Pittsburgh sleep quality index (PSQI) was significantly decreased by 5.27 ± 2.93 (p < 0.001). The OSLER error index did not significantly improved (p = 0.61); however, a trend toward improvement was observed in patients with baseline psychomotor vigilance impairment (p = 0.17). While CPAP adherence showed no statistically significant change, there was a trend toward improvement from 2.99 ± 0.63 h/night at baseline to 3.47 ± 1.38 h/night (p = 0.09). No serious side effects were observed.

CONCLUSION: In moderate to severe OSA patients with suboptimal CPAP usage who still experience EDS, administering armodafinil over 12 weeks period significantly improved EDS and sleep quality subjectively without compromising CPAP adherence. Armodafinil demonstrated excellent tolerability with self-limiting side effects.

PMID:40906339 | DOI:10.1007/s11325-025-03448-3

Sleep Breath. 2025 Sep 4;29(5):281. doi: 10.1007/s11325-025-03455-4.

ABSTRACT

PURPOSE: The objectives of this study were to monitor transcutaneous and end-tidal partial pressures of CO₂ simultaneously during polysomnography, determine the advantages and disadvantages of each method, and identify relevant factors that can affect the results.

METHODS: This cross-sectional study enrolled 55 adults who underwent polysomnography at the Ajou University Hospital Sleep Center between February 2021 and September 2022. They were volunteers who spontaneously breathed room air. Polysomnography reports, including those of CO₂ monitoring, of all participants were reviewed and analyzed by sleep experts. Generalized Estimation Evaluation, Bon Ferroni Post Hoc and multivariable regression analysis were used for statistical analysis.

RESULTS: Throughout all sleep stages, the mean, highest, and lowest values of end-tidal and transcutaneous partial pressure of CO₂ showed significant differences. The mean transcutaneous partial pressure was higher than the mean end-tidal partial pressure by 2.53 mmHg. The apnea index, apnea-hypopnea index, and height were significant factors affecting the difference between the mean transcutaneous and end-tidal partial pressure of CO₂. As the obstructive sleep apnea grade increased, the mean end-tidal CO₂ partial pressure value decreased. Two patients had hypoventilation; one met the criteria based on the transcutaneous partial pressure of CO₂ and the other met those based on the end-tidal partial pressure of CO₂.

CONCLUSION: During diagnostic sleep studies, the application of both transcutaneous and end-tidal measurements is suggested for stable and accurate monitoring of partial pressure of CO₂ and complementary analysis.

PMID:40906334 | DOI:10.1007/s11325-025-03455-4

Cancer Causes Control. 2025 Sep 4. doi: 10.1007/s10552-025-02042-y. Online ahead of print.

ABSTRACT

BACKGROUND: Cachexia accounts for about 20% of all cancer-related deaths and it is indicative of poor prognosis and progressive functional impairment. The role of the gut microbiome in the development of cachexia in colorectal cancer (CRC) patients has not been established.

METHODS: Pre-surgical stool samples from n = 103 stage I-III CRC patients in the ColoCare Study were analyzed using 16S rRNA gene sequencing (Illumina) to characterize fecal bacteria. We calculated estimates of alpha- and beta-diversity and a priori- and exploratory-selected bacterial relative abundance. Using Fearon criteria, cachexia onset at 6 months post-surgery was defined as > 5% weight loss over the past 6 months and/or body mass index (BMI) of < 20 kg/m² and weight loss of > 2%. Associations of microbial metrics with cachexia onset were estimated using multivariable logistic regression models.

RESULTS: Higher alpha-diversity was positively associated with cachexia onset, with stronger associations in females, patients < 65 years, those receiving adjuvant treatment, consuming high fiber, or with energy intake outside USDA recommendations (p < 0.05). Porphyromonas (OR = 0.51, 95% CI 0.26-0.89, p = 0.03) and Actinomyces (OR = 0.72, 95% CI 0.48-1.03, p = 0.08) were inversely associated with cachexia, although the association for Actinomyces did not reach statistical significance. Stratified analyses revealed a stronger inverse association between Porphyromonas and cachexia onset in males, patients with rectal or stage III tumors, those receiving neoadjuvant treatment, physically inactive individuals, and those consuming low fiber. However, these associations did not reach statistical significance (0.05 ≤ p < 0.10).

CONCLUSION: Higher gut microbial alpha-diversity and lower relative abundances of the genera Porphyromonas and Actinomyces in pre-surgery stool samples were associated with onset of cachexia in CRC patients six months post-surgery. This is the first study to explore a link between the gut microbiome and cachexia in CRC patients, providing novel insights into the biology of cachexia and potential clinical interventions.

PMID:40906320 | DOI:10.1007/s10552-025-02042-y

Aesthetic Plast Surg. 2025 Sep 4. doi: 10.1007/s00266-025-05189-w. Online ahead of print.

ABSTRACT

INTRODUCTION: This meta-analysis evaluates the impact of ethnicity-conscious rhinoplasty on patient satisfaction and complication rates. Traditional rhinoplasty techniques often overlook ethnic anatomical differences, leading to suboptimal aesthetic outcomes and higher revision rates. In contrast, individualised approaches aim to optimise both form and function by tailoring procedures to specific anatomical and cultural contexts.

METHODS: A systematic search of PubMed, PROSPERO, DynaMed, EMBASE, and the Cochrane Library was conducted in April 2025. Seventeen comparative clinical studies (2003-2023) were included in a PRISMA-compliant meta-analysis (PROSPERO ID: CRD420251045319). Primary outcomes were patient-reported satisfaction, complication rates, and revision frequency. Secondary analyses assessed effectiveness of specific surgical techniques across major ethnic groups: Hispanic/Mestizo, African-American, Middle Eastern, Indian-American, Asian, and Caucasian. Statistical analyses used RevMan 5.4 with random-effects modelling and I² for heterogeneity. Study quality was evaluated using the Newcastle-Ottawa scale and AHRQ criteria.

RESULTS: Ethnicity-conscious rhinoplasty was associated with significantly greater patient satisfaction (SMD = 0.68 [95% CI 0.63-0.73]; p < 0.001). The highest satisfaction was observed in multi-ethnic (SMD = 0.76), African-American (0.71), and Middle Eastern (0.63) groups. Indian (0.58) and Asian (0.55) patients also showed favourable outcomes, while Caucasian patients had the lowest satisfaction (0.21). Tailored approaches resulted in lower complication (8.7%) and revision (5.3%) rates compared to conventional methods (17.4% and 12.1%). Heterogeneity was minimal (I² = 0%), with no evidence of publication bias.

CONCLUSION: Ethnicity-conscious rhinoplasty enhances patient satisfaction and safety across diverse populations. These findings support the need for culturally and anatomically informed surgical planning in modern aesthetic practice.

LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40906288 | DOI:10.1007/s00266-025-05189-w

Aesthetic Plast Surg. 2025 Sep 4. doi: 10.1007/s00266-025-05185-0. Online ahead of print.

ABSTRACT

BACKGROUND: No studies in Japan have investigated delayed-onset inflammatory nodules as an adverse event following hyaluronic acid (HA) injections. Our institution, located in a rural area with no nearby aesthetic clinics, allows for comprehensive follow-up of HA-treated patients. This study analyzed complications from 673 cases over 6 years, focusing on delayed-onset inflammatory nodules.

METHODS: A retrospective review of medical records was conducted for patients treated with AbbVie-Allergan HA products between January 2018 and December 2023. Adverse events were categorized as acute complications or delayed-onset inflammatory nodules. Statistical analysis assessed product type, time to onset, patient history, and treatment approaches.

RESULTS: One acute allergic reaction and seven cases (1.07%) of delayed-onset inflammatory nodules were identified. Volbella was involved in 4 cases, Volift in 1 case, Voluma in 1 case, and Ultra Plus in 1 case. Statistical analysis revealed a significantly higher incidence with Volbella (p = 0.0484). The average onset was 144 days, with no seasonal pattern. Among affected patients, three had a history of non-HA-related allergies, and one had a preceding infection. Treatments included oral antibiotics (2 cases), oral antihistamines (5 cases), topical steroids (3 cases), hyaluronidase injections (4 cases), oral steroids (2 cases), and surgical intervention (1 case).

CONCLUSIONS: Delayed-onset inflammatory nodules occurred in approximately 1% of cases, with Volbella showing the highest incidence. Patients with allergies or prior infections may have an increased risk. Comprehensive informed consent should emphasize potential delayed complications to ensure patient understanding.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID:40906285 | DOI:10.1007/s00266-025-05185-0

Knee Surg Sports Traumatol Arthrosc. 2025 Sep 4. doi: 10.1002/ksa.70052. Online ahead of print.

ABSTRACT

PURPOSE: To compare graft synovialization and tear rates between autograft and allograft anterior cruciate ligament (ACL) reconstruction based upon second-look arthroscopy (SLA), along with joint stability, subjective and objective clinical outcomes.

METHODS: A systematic search of PubMed, Embase and the Cochrane Library was conducted on 7 March 2025, to identify studies reporting graft synovial coverage and tear rates on SLA following primary ACL reconstruction. Meta-analyses were conducted using a random-effects model with logit transformation. Study weights were calculated via the inverse variance method. Heterogeneity was assessed using Cochran’s Q and the I² statistic. Forest plots were created to display individual and pooled estimates with 95% confidence intervals.

RESULTS: A total of 26 clinical studies comprising 2891 patients were included in this systematic review. Of these, 2164 patients underwent ACL reconstruction with autografts and 727 with allografts. SLA was performed in 2009 patients, including 1570 in the autograft group (78.1%) and 481 in the allograft group (23.9%). Good synovial coverage (>50% of the graft) was observed in 1303 autograft cases (83%) and 341 allograft cases (70.9%) (p < 0.001). Poor synovial coverage (<50%) was seen in 146 autografts (9.3%) and 93 allografts (19.3%) (p < 0.001). Torn grafts were found in 125 autografts (8%) and 25 allografts (10%) (n.s.). No significant differences in synovial coverage or graft tear rates were observed when comparing single bundle versus double bundle ACL reconstructions. Mean anterior tibial translation was significantly lower in the autograft group compared to the allograft group (1.23 ± 0.68 vs. 2.00 ± 0.38 mm; p < 0.001). No significant differences were noted in postoperative Lachman (n.s.) and pivot shift tests (n.s.), or in subjective outcomes based on Lysholm (p = 0.05) and Tegner scores (n.s.). However, significantly more patients in the autograft group achieved normal (A) or nearly normal (B) International Knee Documentation Committee (IKDC) objective scores (p = 0.02), whereas higher rates of abnormal or severely abnormal (grades C and D) IKDC scores were observed in the allograft group (p < 0.001). Remnant-preserving ACL reconstruction resulted in significantly better synovial coverage, fewer graft tears and improved knee stability compared to conventional ACL reconstruction (all p < 0.001), with no difference in cyclops lesion incidence (n.s.).

CONCLUSIONS: Autograft ACL reconstruction showed superior synovial coverage, lower retear and failure rates, reduced anterior tibial translation and better IKDC objective scores compared to allografts. Remnant-preserving techniques further enhanced synovial coverage, lowered graft tear rates and improved joint stability. No significant differences in synovial coverage, graft tears or failure rates were observed between single bundle and double bundle ACL reconstruction.

LEVEL OF EVIDENCE: Level IV, systematic review and meta-analysis.

PMID:40905314 | DOI:10.1002/ksa.70052

Knee Surg Sports Traumatol Arthrosc. 2025 Sep 4. doi: 10.1002/ksa.70025. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to characterize the mechanism of multi-ligament knee injury (MLKI) sustained during a National Football League (NFL) game through video analysis.

METHODS: A retrospective video analysis of official NFL game footage spanning 1997-2022 was performed. Players with MLKIs were identified from publicly available injury surveillance data. Player and game demographic information was collected. Athletes were categorized based on ligament injury patterns. Videos including MLKI were analyzed to categorize injuries based on non-contact, indirect or direct contact mechanisms and determine the hip, knee and ankle position at the time of injury. Differences across MLKI groups were identified by Fisher’s exact test.

RESULTS: Thirty-five MLKIs were identified. MLKIs most commonly occurred from direct contact to the limb (80%), with the second most common injury mechanism being indirect contact (14.3%). The most common MLKI was injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) (65%), while the second most common was the ACL and lateral collateral ligament (LCL) (15%). Direct contact MLKI most often resulted in a valgus and external rotational force about a flexed knee (58%). There were statistically significant differences when comparing the direction of contact, hip and knee position between injury MLKI groups. Combined ACL and MCL injury commonly occurs with knee flexion, valgus and external rotation. Combined ACL/posterior cruciate ligament (PCL) or ACL/LCL injuries occurred most commonly with varus and internal rotational forces on an extended knee. Multiligament injuries involving three ligaments occurred only from direct contact mechanisms.

CONCLUSION: Various injury mechanisms and characteristics result in different types of MLKI in NFL athletes, though the vast majority of MLKIs occur from direct contact forces to the knee. Combined ACL and MCL injury occurred most frequently, resembling the mechanism and lower extremity position for isolated ACL injury, though it frequently occurs due to direct contact with the knee.

LEVEL OF EVIDENCE: Level IV.

PMID:40905306 | DOI:10.1002/ksa.70025

Parasitology. 2025 Sep 4:1-6. doi: 10.1017/S0031182025100632. Online ahead of print.

ABSTRACT

Rosacea is a chronic inflammatory skin disease affecting approximately 5.4% of the world population. Among its pathogenic factors is infestation by Demodex spp. Standardized skin surface biopsy (SSSB) and direct microscopic examination (DME) are widely used methods to measure Demodex spp density (Dd); however, there is no agreement on the method of choice, nor the prevalence of infestation in rosacea patients. This study compared both techniques in rosacea patients. A prospective study was conducted with 61 patients diagnosed with rosacea by dermatologists from two dermatology centres. Dd was evaluated using SSSB and DME in each patient. Results, median sampling time and reported pain were analyzed using appropriate statistical methods. The median Dd was significantly higher with SSSB (11 mites/cm²) compared to DME (1 mites/cm²; P < 0.001). Infestation (>5 mites/cm²) was detected in 64% of patients with SSSB and in 28% with DME (P < 0.001). The median sampling time was longer for SSSB (60 s) than for DME (30 s; P < 0.001). Both methods were associated with mild pain, slightly lower with DME (P = 0.033). SSSB proved more effective than DME for detecting Demodex spp. in rosacea, identifying a greater total number of mites and a higher percentage of infestation. Up to 64% of rosacea patients showed infestation with Demodex spp. using the SSSB technique. The results reinforce the use of SSSB as the standard technique for diagnosing Demodex spp. infestation in rosacea patients.

PMID:40905295 | DOI:10.1017/S0031182025100632

Reprod Domest Anim. 2025 Sep;60(9):e70118. doi: 10.1111/rda.70118.

ABSTRACT

This experiment evaluated the effects of increasing MitoQ concentrations in semen extender on post-thaw quality of Holstein bull sperm, including motility, membrane integrity, antioxidant status and viability. Semen samples were collected, pooled and diluted with extender containing 0 (control), 5, 50, 500 and 1000 nM of MitoQ and frozen through the standard procedure. An increase in MitoQ supplementation positively influenced total and progressive motility, as well as average path velocity; however, these effects were not statistically significant until the concentration reached 50 nM. The highest MitoQ level (1000 nM) showed no difference from the control group. Supplementation of semen extender with 50 and 500 nM of MitoQ significantly increased sperm membrane integrity and mitochondrial activity. Sperm viability improved significantly in concentrations of 5, 50 and 500 nM of MitoQ compared to control, whereas 1000 nM of MitoQ did not show any difference from the control group. Moreover, MitoQ significantly reduced MDA level regardless of its concentration. The concentrations of 50 and 500 nM of MitoQ significantly reduced ROS concentration. It can be concluded that 50 and 500 nM of MitoQ in extender can improve sperm quality parameters in bull semen.

PMID:40905291 | DOI:10.1111/rda.70118