Nevin Manimala

J Neurosurg Pediatr. 2025 Feb 28:1-7. doi: 10.3171/2024.12.PEDS24424. Online ahead of print.

ABSTRACT

OBJECTIVE: Hydrocephalus in children with posterior fossa tumors (PFTs) is commonly treated with extraventricular drain (EVD) placement, endoscopic third ventriculostomy (ETV), or tumor resection alone. However, the optimal treatment approach remains undetermined. Therefore, the objective of this study was to investigate the relationship between management of preoperative hydrocephalus in children with PFTs and the need for early postoperative CSF diversion and permanent drainage.

METHODS: This international multicenter retrospective cohort study included all pediatric patients (aged < 18 years) who underwent primary resection of a posterior fossa tumor at Alder Hey Children’s Hospital, United Kingdom, 2008-2018; Rigshospitalet University Hospital, Denmark, 2011-2020; Aarhus University Hospital, Denmark, 2011-2020; and McMaster University Medical Centre, Canada, 2003-2020. The primary outcome was early postoperative CSF diversion (ETV, EVD, or shunt of any kind within 30 days of tumor resection). The secondary outcome was the permanent drainage (ventriculoperitoneal shunt) rate within 30 days after resection. Univariate and multivariate logistic regression analyses were performed.

RESULTS: In total, 310 children with PFTs were included, of whom 234 (75.5%) had preoperative hydrocephalus. Preoperative hydrocephalus was successfully treated in more than 85%. Thirty-eight children (12.3%) required permanent drainage, with a higher incidence in those treated with preoperative EVD. However, no statistically significant association was found between choice of preoperative hydrocephalus management (EVD vs ETV vs tumor resection alone) and persistent hydrocephalus requiring either early postoperative CSF diversion surgery or permanent CSF drainage.

CONCLUSIONS: This large international multicenter study did not demonstrate a significant association between choice of management of preoperative hydrocephalus (EVD, ETV, or tumor resection alone) and persisting hydrocephalus requiring surgical intervention after tumor resection.

PMID:40020235 | DOI:10.3171/2024.12.PEDS24424

Int J Med Educ. 2025 Feb 25;16:36-44. doi: 10.5116/ijme.679e.07de.

ABSTRACT

OBJECTIVES: To cross-culturally validate the Feedback Orientation Scale in the clinical workplace, focusing on the Spanish adaptation of the instrument in the Chilean context.

METHODS: A cross-cultural validation of the Feedback Orientation Scale was conducted across six Chilean universities and nine health professions education programs. The target population were students in their clinical clerkship. The scale was translated through a rigorous process and was applied online. Validity and reliability of the constructs were evaluated through confirmatory factor analysis. A descriptive statistical analysis was conducted.

RESULTS: A total of 510 students participated (70% female, average age 24.1 years, 30% response rate). Students’ responses were from Medicine (n=128), Physiotherapy (n=128), Nursing (n=63), Dentistry (n=49), and five other disciplines. Confirmatory factor analysis showed a sufficient fit of the original factor structure CFI = 0.96, SRMR = 0.045, RMSEA = 0.051, 90% CI [0.044, 0.057]. Item loadings were above 0.50. Factor reliability ranged from 0.77 to 0.91. Overall, students’ perception of receptivity to feedback was positive, and the Feedback Self-efficacy subscale had the most “disagree” and “strongly disagree” responses.

CONCLUSIONS: Our findings provide evidence regarding the validity and reliability of the Feedback Orientation Scale for assessing the feedback orientation of health profession education students in the clinical workplace. Students scored lowest on two items related to feedback self-efficacy, indicating low confidence in handling feedback. This Feedback Orientation Scale can reveal valuable insights into how students may differ in their receptivity and use of feedback in the clinical workplace, informing teaching practices and interventions, and redesigning existing feedback practices.

PMID:40020220 | DOI:10.5116/ijme.679e.07de

JCO Clin Cancer Inform. 2025 Mar;9:e2400224. doi: 10.1200/CCI-24-00224. Epub 2025 Feb 28.

ABSTRACT

PURPOSE: Liquid biopsy, specifically circulating cell-free DNA (cfDNA), has emerged as a powerful tool for cancer early diagnosis, prognosis, and treatment monitoring over a wide range of cancer types. Computational modeling (CM) of cfDNA data is essential to harness its full potential for real-time, noninvasive insights into tumor biology, enhancing clinical decision making.

DESIGN: This work reviews CM-cfDNA methods applied to clinical oncology, emphasizing both machine learning (ML) techniques and mechanistic approaches. The latter integrate biological principles, enabling a deeper understanding of cfDNA dynamics and its relationship with tumor evolution.

RESULTS: Key findings highlight the effectiveness of CM-cfDNA approaches in improving diagnostic accuracy, identifying prognostic markers, and predicting therapeutic outcomes. ML models integrating cfDNA concentration, fragmentation patterns, and mutation detection achieve high sensitivity and specificity for early cancer detection. Mechanistic models describe cfDNA kinetics, linking them to tumor growth and response to treatment, for example, immune checkpoint inhibitors. Longitudinal data and advanced statistical constructs further refine these models for quantification of interindividual and intraindividual variability.

CONCLUSION: CM-cfDNA represents a pivotal advancement in precision oncology. It bridges the gap between extensive cfDNA data and actionable clinical insights, supporting its integration into routine cancer care. Future efforts should focus on standardizing protocols, validating models across populations, and exploring hybrid approaches combining ML with mechanistic modeling to improve biological understanding.

PMID:40020203 | DOI:10.1200/CCI-24-00224

Med Sci Sports Exerc. 2025 Feb 28. doi: 10.1249/MSS.0000000000003689. Online ahead of print.

ABSTRACT

PURPOSE: The application of horizontal resistance is key in sprint training to modulate velocity and promote adaptations. However, the interaction between velocity and resistance on muscle excitation remains insufficiently studied. This study assessed the electromyographic (EMG) activity of thigh and gluteal muscles in response to varying velocity and resistance during sprinting.

METHODS: Thirty-seven elite athletes (27 females and 10 males) performed two trials under three conditions: a 40-meter maximal sprint without resistance and two resisted sprints applied by a robotic device with resistive forces equivalent to 25% and 75% of body mass in a sled condition. EMG activity was recorded from eight muscles in the quadriceps, hamstrings, and gluteal muscle groups for both lower limbs. Generalized mixed models were used to analyze average EMG changes with increasing velocity as a function of resistance. Statistical parametric mapping was used to assess the changes within the stance and swing phases as a function of sprint phase and resistance.

RESULTS: Hamstring EMG activity increased with increasing velocity (+17.9% in stance phase without resistance) and decreased as resistance increased, with opposite effects observed in quadriceps muscles. Higher gluteal EMG activity was found during the late swing phase with increasing velocity and decreasing resistance. The biceps femoris long head exhibited the largest EMG increase with velocity (+23% in the stance phase) among hamstrings, while the semitendinosus showed the highest increase with reduced resistance (+27% in the stance phase).

CONCLUSIONS: External resistance and running speed influence thigh muscle activity differently, even within the same muscle group, likely due to distinct muscle architecture and function. These insights should be considered when designing sprint training programs to target specific muscle groups, avoid muscle overloading, and account for inter-individual differences to optimize performance and reduce injury risk.

PMID:40020195 | DOI:10.1249/MSS.0000000000003689

Int J Clin Exp Hypn. 2025 Feb 28:1-16. doi: 10.1080/00207144.2025.2469845. Online ahead of print.

ABSTRACT

An online survey of 103 clinicians using hypnosis was conducted to gain a broad real-world view of current practices, experiences, and perspectives on clinical hypnosis in Brazil. This research replicated a form focused on identifying clinical hypnosis practices across 31 countries, contributing to a global perspective on this intervention modality. The present study employed descriptive statistics in its data analysis. According to respondents, among the 36 most common uses of hypnosis, improving well-being, enhancing self-esteem, reducing stress, and controlling specific phobias and anxiety were reported as the most clinically effective applications. In Brazil, 90.3% of hypnotherapists do not consider hypnotizability relevant to the success of hypnotherapy. Concerns were raised about the technical-professional training of Brazilian hypnotherapists. This is the first investigation into hypnosis practices in Brazil. Although hypnosis has been regulated for over two decades by professional health councils, such as the Federal Council of Medicine and the Federal Council of Psychology, efforts to promote evidence-based practices must be made to address the identified gaps.

PMID:40020193 | DOI:10.1080/00207144.2025.2469845

Medicine (Baltimore). 2025 Feb 28;104(9):e41633. doi: 10.1097/MD.0000000000041633.

ABSTRACT

Currently, the precise interplay between autoimmune thyroiditis, particularly Hashimoto thyroiditis, and thyroid cancer remains ambiguous. While certain observational studies suggest autoimmune thyroiditis (including Hashimoto thyroiditis) as a predisposing factor for thyroid cancer. Nevertheless, it is still uncertain whether autoimmune thyroiditis is independently associated with thyroid cancer. We employed Mendelian randomization (MR) study methodology, a genetic analysis approach, to evaluate the causal impact of autoimmune thyroiditis on the occurrence of thyroid cancer. We obtained and synthesized statistical data by utilizing public available genome-wide association studies (GWAS). Our study utilized GWAS summary statistics datasets associated with autoimmune thyroiditis (including Hashimoto thyroiditis) as the exposure data source and selected GWAS summary statistics datasets related to thyroid cancer as the outcome data source. Single nucleotide polymorphisms closely associated with autoimmune thyroiditis were chosen as instrumental variables. We conducted 2-sample MR analyses to elucidate the causal association between autoimmune thyroiditis and thyroid cancer. The inverse variance-weighted (IVW) method was employed as the primary methodology, supplemented by additional MR methods including MR-Egger regression, weighted median, simple mode, and weighted mode analyses, to bolster the robustness of our findings. The MR analysis conducted using the IVW method did not confirm a causal relationship between autoimmune thyroiditis and thyroid cancer (odds ratio [OR] = 0.8554, 95% confidence interval [CI]: 0.7193 to 1.0172, P = .0772; OR = 0.8477, 95% CI: 0.7159 to 1.0039, P = .0555; and OR = 1.1324, 95% CI: 0.9342 to 1.3725, P = .2052, from 3 eligible dataset analyses, respectively). Additionally, MR analysis did not observe a causal association between Hashimoto thyroiditis and thyroid cancer (OR = 1.0449, 95% CI: 0.9400 to 1.1615, P = .4155; and OR = 0.9897, 95% CI: 0.8174 to 1.1984, P = .9159, from 2 eligible dataset analyses, respectively). Consistency in results across alternative MR methods was observed. This study employing MR methodology indicates the absence of significant causal relationship between exposure to autoimmune thyroiditis (including Hashimoto thyroiditis) and thyroid cancer. Further validation through larger-scale studies with increased sample sizes is warranted in future investigations.

PMID:40020149 | DOI:10.1097/MD.0000000000041633

Medicine (Baltimore). 2025 Feb 28;104(9):e41641. doi: 10.1097/MD.0000000000041641.

ABSTRACT

BACKGROUND: Our study aims to investigate whether there is a relationship by measuring the total oxidant/antioxidant load with the thiol/disulfide method in patients with unexplained infertility.

METHODS: A total of 82 participants were enrolled, consisting of 41 women with unexplained infertility and 41 fertile controls matched for age and body mass index (BMI). Hormonal profiles, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), thyroid-stimulating hormone (TSH), and prolactin, were assessed using the chemiluminescence immunoassay method. Thiol/disulfide homeostasis was evaluated using a validated automated spectrophotometric method, which measured native thiol (NT), total thiol (TT), and disulfide levels. Detailed quality control measures ensured the reliability of the results.

RESULTS: In the study, no significant difference was found between the infertile and fertile groups’ demographic (age) and clinical variables in terms of height, weight, BMI, FSH, LH, E2, TSH, prolactin, antral follicle count, TT, NT, and disulfide values (P > .05). The rates were found to be greater in the infertile group in disulfide/NT ratio and disulfide/TT ratio compared to the fertile group, even though there was no statistically significant difference between the groups’ disulfide/NT ratio, disulfide/TT ratio, and NT/TT ratio values. The fertile group, however, had a higher NT/TT ratio rate.

CONCLUSION: Although the unexplained infertility and fertile groups in the study did not differ in serum thiol and disulfide levels, the infertile group was found to have a relatively high disulfide/thiol ratio. More prospective studies on thiol/disulfide balance related to unexplained infertility may help to understand the relationship.

PMID:40020144 | DOI:10.1097/MD.0000000000041641

Medicine (Baltimore). 2025 Feb 28;104(9):e41671. doi: 10.1097/MD.0000000000041671.

ABSTRACT

The purpose of the study was to examine the association between depression and substance abuse and to assess their prevalence and associated factors. A cross-sectional design was employed. To collect data for the present study, 2 scales (Beck depression inventory and Alcohol, Smoking, and Substance Involvement screening Test [ASSIST]) was administered to students. Two hundred fifty seven Addis Ababa Institute of Technology final year regular undergraduate students were participated. The results revealed that a high correlation was found between depression and substance abuse. The prevalence of depression is 27.2%. Similarly, the prevalence of alcohol abuse, khat abuse, cigarette abuse and cannabis abuse are 25.5%, 17.7%, 9.5%, and 3.3% respectively. Hence, the overall substance abuse prevalence is 14%. Alcohol is most abused drug followed by khat abuse. Cigarette and cannabis abuse take the 3rd and 4th rank respectively. Multivariate test of significance reveals that gender, religion and the interaction of gender with religion, residence, and ethnicity had an effect on the two combined dependent measures. Females are more depressed than males. In turn, males are more substance abusers than females. The researchers suggested that the university to establish its own substance abuse prevention and treatment working center which is open for psychologists, therapist and other health workers.

PMID:40020139 | DOI:10.1097/MD.0000000000041671

Medicine (Baltimore). 2025 Feb 28;104(9):e41518. doi: 10.1097/MD.0000000000041518.

ABSTRACT

BACKGROUND: Diabetic nephropathy (DN) is the most prevalent and critical microvascular complication of diabetes mellitus, constituting a significant contributor to end-stage renal disease. Shenyankangfu tablets (SYKFP) are a pure traditional Chinese medicine compound. Current studies have shown that SYKFP combined with valsartan in the treatment of DN had therapeutic advantages. However, there is still a lack of systematic research. Therefore, meta-analysis was used to systematically evaluate the efficacy and safety of SYKFP combined with valsartan in treating DN and to provide evidence-based medical evidence for clinical application.

METHODS: CNKI, VIP, Wanfang, Chinese Biomedical Literature Service System, American Clinical Trial Registry, Embase, Web of Science, PubMed, and Cochrane Library databases were searched from the date of database establishment to August 2024. All randomized controlled trials of SYKFP in combination with valsartan for treating DN were collected, and the data of clinical trials that met the inclusion criteria were extracted. Meta-analysis was performed using Review Manager 5.4 and Stata 17.0.

RESULTS: Sixty-nine pieces of literature were retrieved, and 14 eligible randomized controlled trials were selected, with 1281 participants. The results of the meta-analysis showed that compared with valsartan alone in the treatment of DN, Shenyanangfu tablets combined with valsartan can improve the clinical efficacy rate (relative risk = 1.16, 95% CI [1.11, 1.22], P < .00001) and reduce blood creatinine (mean difference [MD] = -28.79, 95% CI [-31.16, -26.42], P < .00001), urea nitrogen (MD = -1.37, 95% CI [-1.52, -1.22], P < .00001), 24-hour urine protein quantification (MD = -0.59, 95% CI [-0.77, -0.40], P < .00001), fasting blood glucose (MD = -0.51, 95% CI [-0.77, -0.25], P = .0001) and the incidence of adverse events (relative risk = 0.74, 95% CI [0.43, 1.23], P = .24) were better than valsartan alone, and the difference was statistically significant.

CONCLUSION: SYKFP combined with valsartan can improve the clinical treatment efficiency of DN. They can effectively reduce the occurrence of urea nitrogen, blood creatinine, 24-hour urine protein quantification, fasting blood glucose, and adverse events.

PMID:40020136 | DOI:10.1097/MD.0000000000041518

Medicine (Baltimore). 2025 Feb 28;104(9):e41359. doi: 10.1097/MD.0000000000041359.

ABSTRACT

This study utilized Mendelian randomization (MR) analysis to explore the causal relationship between circulating cytokines and polycystic ovary syndrome (PCOS), and to identify potential biomarkers of PCOS mechanisms. Genetic instrumental variables for cytokines were derived from 2 large-scale genome-wide association studies (GWAS) involving 8293 and 14,824 European participants. Summary statistics from a GWAS meta-analysis (10,074 PCOS cases and 103,164 controls of European ancestry) were used in the discovery phase of MR analysis. Replication analysis utilized another GWAS meta-analysis dataset (3609 cases and 229,788 controls). The primary analysis employed the inverse-variance weighted (IVW) method, with secondary methods including constrained maximum likelihood model averaging, weighted median, and weighted mode. Meta-analysis was combined with MR results, while heterogeneity and horizontal pleiotropy were assessed using leave-one-out, MR-Egger intercept test, and Mendelian Randomization Pleiotropy Residual Sum and Outlier. Sensitivity analysis confirmed the robustness of the results. Reverse MR analysis was used to explore the association of PCOS with the identified cytokines. Meta-analysis revealed that increased CCL4 (C-C motif chemokine 4) levels were associated with a higher risk of PCOS (odds ratio [OR] = 1.123, 95% confidence interval [CI]: 1.056-1.195; P < .001). Decreased PCOS risk was linked to CXCL11 (C-X-C motif chemokine 11, OR = 0.930, 95% CI: 0.890-0.970; IVW-false discovery rate [FDR] P = 4.85 × 10-4) and CD6 (T-cell surface glycoprotein CD6 isoform, OR = 0.730, 95% CI: 0.890-0.970; IVW-FDR P = .008). Sensitivity analysis confirmed the robustness of the findings. MR analysis suggests a potential causal link between alterations in CCL4, CXCL11, CD6, and PCOS risk, highlighting the role of cytokines in PCOS development and progression, warranting further investigation.

PMID:40020129 | DOI:10.1097/MD.0000000000041359