Nevin Manimala

Knee. 2025 Mar 4;54:136-145. doi: 10.1016/j.knee.2025.01.006. Online ahead of print.

ABSTRACT

BACKGROUND: Our aim was to compare posterior tibial slope (PTS) values, distribution, deviation from manufacturer’s recommended value and restoration of this value in total knee arthroplasty (TKA) with tibial component placement using intramedullary (IM) and extramedullary (EM) methods, and to analyze factors affecting these values.

METHODS: A total of 151 knees operated with Zimmer-Biomet NexGen® LPS Fixed Bearing Knee TKA between 2022 and 2024 were retrospectively investigated. Knees were grouped by method of tibial component placement (IM or EM). Pre-operative descriptive data, postoperative PTS, scatteredness of PTS, difference between pre-operative and postoperative PTS, deviation from 7° which was claimed by the manufacturer and rate of outliers were compared between groups. Factors that might affect postoperative PTS in the EM group were analyzed.

RESULTS: Ninety-five knees (62.9%) in the EM group and 56 knees (37.1%) in the IM group were analyzed. Mean PTS decreased from 8.8 ± 3.5° to 6.7 ± 2.7° (P < 0.001) in the EM group, and from 10 ± 4.1° to 4.9 ± 2.6° (P < 0.001) in the IM group. Postoperative PTS was significantly lower in the IM group (P < 0.001). Mean deviation from 7° claimed by the manufacturer was 2.4 ± 1.4° for the EM group and 2.8 ± 1.8° for the IM group (P = 0.14). In 15 of 151 patients (9.9%), postoperative PTS was above 10°. Linear regression analysis revealed a moderate effect of pre-operative PTS and weight in the EM group.

CONCLUSIONS: Although not statistically significant, the EM method is closer to the manufacturer’s recommendation for sagittal alignment. However, both groups had a wide range of PTS and a large number of outliers. Both methods are not reliable in terms of PTS reproducibility and consistency.

PMID:40043327 | DOI:10.1016/j.knee.2025.01.006

Neurol Res. 2025 Mar 5:1-6. doi: 10.1080/01616412.2025.2472841. Online ahead of print.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) is the leading cause of major neurodegenerative cognitive impairment. The risk of developing AD is influenced by a complex interaction of genetic predisposition and environmental factors. Among the genetic risk factors, the APOE ɛ4 allele is the most significant, while variants in the TREM2 (Triggering Receptor Expressed on Myeloid Cells 2) and ABCA7 (ATP-binding cassette transporter A7) genes have also been associated with an increased risk of AD.

OBJECTIVE: This study aimed to investigate the association of APOE ɛ4, TREM2 gene variants (rs75932628 [p.R47H] and rs2234253 [p.T96K]), and ABCA7 gene variants (rs142076058 and rs115550680) with sporadic AD in the Tunisian population. Methods: A case-control study was conducted including 222 Tunisian patients diagnosed with sporadic AD and 99 cognitively healthy controls. Genotyping was performed to assess the presence and association of the selected genetic variants with AD. Statistical analyses were conducted to determine the significance of genetic associations.

RESULTS: A significant association was found between the TREM2 rs2234253 (p.T96K) variant and AD, with the T allele identified as a risk factor in the Tunisian population. The APOE ɛ4 allele was also associated with an increased risk of developing AD. However, no significant association was observed for the ABCA7 gene variants or the TREM2 rs75932628 (p.R47H) variant in either the AD or control groups.

CONCLUSION: Our findings suggest that the TREM2 rs2234253 (p.T96K) variant is a significant genetic risk factor for late-onset AD (LOAD) in the Tunisian population. Further studies with larger cohorts are needed to validate these findings and explore potential gene-gene interactions contributing to AD risk.

PMID:40043316 | DOI:10.1080/01616412.2025.2472841

Am J Respir Crit Care Med. 2025 Mar 5. doi: 10.1164/rccm.202501-0093RL. Online ahead of print.

NO ABSTRACT

PMID:40043304 | DOI:10.1164/rccm.202501-0093RL

Am J Respir Crit Care Med. 2025 Mar 5. doi: 10.1164/rccm.202409-1752OC. Online ahead of print.

ABSTRACT

Rationale: There is no broadly accessible treatment for patients with refractory chronic cough, a disease characterized by chronic cough that persists despite treatment for other cough-related etiologies or has no identified underlying cause. Objectives: SOOTHE (NCT04678206), a Phase 2b, randomized, placebo-controlled trial, evaluated the efficacy and safety of P2X3 antagonist camlipixant in adults with refractory chronic cough (cough duration ≥1 year; baseline awake cough frequency ≥25 coughs/hour). Methods: After a single-blind, 16-day placebo run-in, patients were randomized (1:1:1:1) to receive camlipixant 12.5, 50, or 200 mg twice-daily, or placebo for 4 weeks. The primary endpoint was change from baseline to Day 28 in objective 24-hour cough frequency. Secondary endpoints included cough severity and cough-related quality of life. Measurements and Main Results: Overall, 310 patients were randomized. A statistically significant reduction in placebo-adjusted 24-hour cough frequency was seen in the 50 mg (-34.4%; 95% confidence interval: -50.5 to -13.3; P=0.0033) and 200 mg (-34.2%; 95% confidence interval: -50.7 to -12.2; P=0.0047) camlipixant arms. All camlipixant arms showed a trend for greater improvement in Cough Severity Visual Analog Scale and Leicester Cough Questionnaire over placebo. Camlipixant was well tolerated with no serious treatment emergent adverse events reported. Taste alteration occurred in 4.8-6.5% of patients in camlipixant arms (vs. 0% with placebo); these were usually mild-moderate. Conclusions: Camlipixant treatment reduced cough frequency and improved patient reported outcomes in patients with refractory chronic cough, with an acceptable safety profile. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT04678206.

PMID:40043302 | DOI:10.1164/rccm.202409-1752OC

J Craniofac Surg. 2025 Mar 5. doi: 10.1097/SCS.0000000000011179. Online ahead of print.

ABSTRACT

OBJECTIVE: Accurate assessment of the periodontal ligament (PDL) is critical for developing effective treatment plans in periodontics, orthodontics, prosthodontics, and maxillofacial surgical. This study aimed to investigate the influence of cone-beam computed tomography (CBCT) voxel size (0.3 and 0.1 mm) on the accuracy of PDL surface area measurements.

METHODS: Thirty-nine teeth, including both single-rooted and multirooted types, were obtained from 5 human skulls and imaged using CBCT and high-resolution computed tomography (CT). The PDL was segmented and reconstructed using Mimics and 3-matic software to determine surface area measurements. Statistical analyses included paired t tests (P<0.05) to identify significant differences and Bland-Altman plots to evaluate agreement between measurements obtained at different voxel sizes.

RESULTS: Paired t tests demonstrated a statistically significant difference in PDL surface area measurements based on voxel size (t=4.959, P=0.001). Bland-Altman analysis revealed that measurements obtained with a voxel size of 0.1 mm were, on average, 5.07 mm² larger than those obtained with a voxel size of 0.3 mm.

CONCLUSIONS: Voxel size significantly affects the precision of PDL surface area measurements, with smaller voxels yielding greater surface detail and higher surface area values. High-resolution CT provided more accurate and reliable measurements of PDL surface area compared with CBCT.

PMID:40043300 | DOI:10.1097/SCS.0000000000011179

Aust J Gen Pract. 2025 Mar;54(3):143-151. doi: 10.31128/AJGP-06-24-7324.

ABSTRACT

BACKGROUND AND OBJECTIVES: It is important for general practitioners (GPs) to understand the barriers and facilitators that transgender, gender-diverse and non-binary patients (TGDNB) experience when accessing health care. The aim of this study was to explore the experiences of patients accessing and receiving gender-affirming care.

METHOD: Patients who attended a sexual health clinic for gender-affirming care (GAC) were invited to participate in a feedback questionnaire that explored the referral process, access to care and perceptions of the clinic.

RESULTS: Few patients found out about the service from their GP. Many patients had difficulty accessing GAC but, once aware of services, most had no difficulty obtaining a GP referral. Difficulties accessing GAC included a lack of knowledge from medical professionals, lengthy and complicated processes, cost, confidentiality concerns and being misgendered. Patients found inclusive signage helpful and appreciated being asked about pronouns and chosen name. There was a high level of satisfaction with GAC.

DISCUSSION: GPs should be aware of strategies to ensure TGDNB patients feel safe accessing healthcare, including the availability of specialist services and referral pathways.

PMID:40043293 | DOI:10.31128/AJGP-06-24-7324

Aust J Gen Pract. 2025 Mar;54(3):135-141. doi: 10.31128/AJGP-06-24-7303.

ABSTRACT

BACKGROUND AND OBJECTIVES: Sexual assault services in New South Wales (NSW), Australia provide crisis support from a counsellor working with a forensically trained doctor, or nurse, providing medical care and the option of forensic examination. The aim of this paper is to gain an understanding of the experience of recent sexual assault victim-survivors who accessed one of these 24-hour services.

METHOD: A feedback questionnaire was offered to victim-survivors on completion of the integrated crisis response. A descriptive analysis was performed.

RESULTS: Results demonstrate that the patients’ experiences were positive, with 98% (279/284) recommending a friend that is in the same situation to access the service. Most found the examination reassuring 75% (202) or OK 20% (54), with only 2% (6) reporting it as traumatising and 3% (7) other. Many said the service was not visible enough. Only 4% of patients were referred from general practitioners (GPs).

DISCUSSION: The service provided a positive experience for victim-survivors but needs to be more visible. GPs might benefit from increased knowledge of services and referral pathways available to victim-survivors of sexual assault.

PMID:40043292 | DOI:10.31128/AJGP-06-24-7303

Aust J Gen Pract. 2025 Mar;54(3):101-108. doi: 10.31128/AJGP-02-24-7155.

ABSTRACT

BACKGROUND AND OBJECTIVES: Patient access to medicinal cannabis (MC) is impacted by several factors, despite legalisation of it for medicinal and related scientific purposes in 2016. This scoping review aimed to examine the barriers and enablers to accessing MC through general practitioners (GPs) in Australia.

METHOD: Scientific and grey literature meeting inclusion criteria were identified from 2016 to 2023, resulting in 11 papers and 40 webpages being included in this review.

RESULTS: Many GPs reported inadequate knowledge surrounding MC, forming a barrier to their approachability to discussion with patients. Living rurally and earning less money were barriers to patients’ ability to seek MC. Telehealth cannabis clinics lessened geographical barriers, but not financial barriers.

DISCUSSION: Although stigma and demographic access barriers to MC are decreasing with cultural, industry and healthcare system shifts, inequitable access is still occurring due to the economic burden on patients. GPs reported having difficulties in navigating the prescribing process and accessing the most up-to-date evidence for clinical use due to time scarcity.

PMID:40043285 | DOI:10.31128/AJGP-02-24-7155

Aust J Gen Pract. 2025 Mar;54(3):96-100. doi: 10.31128/AJGP-09-23-6972.

ABSTRACT

BACKGROUND: A substantial increase in prescribing and dispensing of high-risk psychoactive medicines, including opioid analgesics and benzodiazepines, has resulted in an increase in serious harm from use and misuse, including non-fatal and fatal overdose.

OBJECTIVE: The aim of this paper is to describe the need for real-time information about patients’ receipt of high-risk psychoactive medicines and the development of SafeScript, Victoria’s real-time prescription monitoring system.

DISCUSSION: SafeScript uses existing prescription exchange services to collect prescribing and dispensing data about psychoactive medicines subject to misuse or high-risk use. The introduction of SafeScript was accompanied by extensive support measures to encourage and support an effective professional response for patients recognised to be at risk of harm from their use of these medicines. Use is mandatory, and SafeScript is integrated into the professional’s workflow. Alerts about several high-risk situations (high opioid daily dose, high-risk medicine combinations, supply by multiple providers) are automatically generated and provided to the professional user at the time of their SafeScript use.

PMID:40043284 | DOI:10.31128/AJGP-09-23-6972

JCO Clin Cancer Inform. 2025 Mar;9:e2400194. doi: 10.1200/CCI-24-00194. Epub 2025 Mar 5.

ABSTRACT

PURPOSE: To comprehensively analyze the association between preoperative maximum standardized uptake value (SUV_max) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography and postoperative recurrence in resected non-small cell lung cancer (NSCLC) using machine learning (ML) and statistical approaches.

PATIENTS AND METHODS: This retrospective study included 643 patients who had undergone NSCLC resection. ML models (random forest, gradient boosting, extreme gradient boosting, and AdaBoost) and a random survival forest model were developed to predict postoperative recurrence. Model performance was evaluated using the receiver operating characteristic (ROC) AUC and concordance index (C-index). Shapley additive explanations (SHAP) and partial dependence plots (PDPs) were used to interpret model predictions and quantify feature importance. The relationship between SUV_max and recurrence risk was evaluated by using a multivariable Cox proportional hazards model.

RESULTS: The random forest model showed the highest predictive performance (ROC AUC, 0.90; 95% CI, 0.86 to 0.97). The SHAP analysis identified SUV_max as an important predictor. The PDP analysis showed a nonlinear relationship between SUV_max and recurrence risk, with a sharp increase at SUV_max 2-5. The random survival forest model achieved a C-index of 0.82. A permutation importance analysis identified SUV_max as the most important feature. In the Cox model, increased SUV_max was associated with a higher risk of recurrence (adjusted hazard ratio, 1.03 [95% CI, 1.00 to 1.06]).

CONCLUSION: Preoperative SUV_max showed significant predictive value for postoperative recurrence after NSCLC resection. The nonlinear relationship between SUV_max and recurrence risk, with a sharp increase at relatively low SUV_max values, suggests its potential as a sensitive biomarker for early identification of high-risk patients. This may contribute to more precise assessments of the risk of recurrence and personalized treatment strategies for NSCLC.

PMID:40043221 | DOI:10.1200/CCI-24-00194