Nevin Manimala

J Gastrointest Cancer. 2025 Nov 29;56(1):230. doi: 10.1007/s12029-025-01352-3.

ABSTRACT

PURPOSE: Neoadjuvant chemoradiotherapy (NACRT) is standard for locally advanced rectal cancer. Accurate response assessment is essential, particularly to identify complete responders eligible for organ-preserving strategies. While MRI is widely used, 18 F-FDG PET-CT has been proposed as a complementary modality. This study compared MRI-based Tumor Regression Grade (mrTRG) and PET-CT parameters in predicting pathological response.

METHODS: A retrospective analysis was conducted at Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, from January 2013 to May 2024. A total of 268 patients underwent MRI and PET-CT before and after NACRT, followed by surgery. Response was categorized using mrTRG and pathological TRG (pTRG). PET-CT response was assessed by changes in SUVmax. Diagnostic accuracy of mrTRG and PET-CT was evaluated using statistical tests, kappa agreement, and ROC curves.

RESULTS: Of 268 patients, 27.2% were classified as good responders (mrTRG 1-2), whereas 46.2% had good pathological response (pTRG 0-1). The correlation between mrTRG and pTRG was weak (kappa = 0.215). PET-CT showed a mean SUVmax reduction of 58.2%, with greater decline in responders. However, ROC analysis demonstrated poor discriminative ability (AUC = 0.502), indicating no advantage over MRI. Combining MRI and PET-CT imaging slightly improved accuracy in matching pathological grading (κ = 0.36).

CONCLUSION: MRI remains the preferred modality for post-NACRT response assessment in rectal cancer, showing moderate predictive accuracy. PET-CT, despite reflecting metabolic changes, is not reliable in distinguishing complete responders. A combined multimodal approach may improve evaluation and support individualized treatment planning.

PMID:41317281 | DOI:10.1007/s12029-025-01352-3

Sleep Breath. 2025 Nov 29;29(6):371. doi: 10.1007/s11325-025-03483-0.

ABSTRACT

PURPOSE: To investigate the association between multidimensional sleep health (MDSH) and psychological distress in Japanese community residents.

METHODS: A self-administered questionnaire survey was conducted from December 2022 to February 2023 among residents of Kyoto City aged 40 years or older. MDSH was assessed using the RU_SATED, which evaluates six dimensions of sleep health-regularity, satisfaction, alertness, timing, efficiency, and duration-and generates a total score. Psychological distress was measured using the Kessler 6 (K6) scale and a single-item question about perceived stress. Associations between sleep health and psychological distress were analyzed using multivariable logistic regression.

RESULTS: Data from 661 respondents (57.9% female; mean age: 64.9 years; 68.4% urban residents) were analyzed. The prevalence of K6-5 distress, K6-13 distress, and perceived stress was 28.9%, 3.0%, and 20.0%, respectively. K6 scores were negatively correlated with total RU_SATED scores (rs = -0.252, p < 0.001). Each 1-point increase in the RU_SATED score was associated with a 0.325-point decrease in the K6 score. Multivariable logistic regression showed that K6-5 distress was associated with all six RU_SATED dimensions (odds ratios [OR] = 0.309-0.671), while K6-13 distress was associated with satisfaction (OR = 0.176). Perceived stress was associated with regularity, satisfaction, and duration (OR = 0.246-0.653).

CONCLUSION: Higher RU_SATED scores were negatively associated with psychological distress, with each sleep dimension showing a distinct relationship. Further research is warranted to examine these associations in more diverse populations.

PMID:41317241 | DOI:10.1007/s11325-025-03483-0

Eat Weight Disord. 2025 Nov 29;30(1):92. doi: 10.1007/s40519-025-01800-w.

ABSTRACT

OBJECTIVE: Despite several studies assessing the impact of resveratrol on obesity indices, previous meta-analyses show conflicting results. Therefore, we conducted this critical umbrella review of interventional meta-analyses on the effect of resveratrol supplementation on body mass index (BMI), body weight (BW), waist circumference (WC), and body fat.

METHODS: Searches were conducted across multiple databases to identify all relevant meta-analyses up to September 30th, 2025. Reported pooled effect sizes (ESs) and 95% confidence intervals (CIs) were extracted from each included study and synthesized using a random-effects model. Methodological quality was assessed using the AMSTAR 2 tool.

RESULTS: Ultimately, 18 meta-analyses were included, with results showing a small but statistically significant reduction in BW (ES: – 0.18 kg, 95% CI – 0.32 to – 0.03, p = 0.02), BMI (ES: – 0.14 kg/m², 95% CI – 0.2 to – 0.08, p < 0.001), WC (ES – 0.43 cm, 95% CI – 0.64 to – 0.22, p < 0.001), and body fat (ES: – 0.3 kg, 95% CI – 0.48 to – 0.12, p = 0.001) in the resveratrol group compared to the control group, with subgroup analysis revealing statistical significance only in subgroups with doses > 400 mg/day and study duration ˃ 12 weeks.

CONCLUSION: Our review confirms that resveratrol supplementation reduces BW, BMI, WC, and body fat, particularly on doses > 400 mg/day and interventions lasting ˃12 weeks, with small effect sizes. Based on our findings, resveratrol supplementation could be considered as a complementary therapy in the management of obesity.

PMID:41317227 | DOI:10.1007/s40519-025-01800-w

Hernia. 2025 Nov 29;30(1):25. doi: 10.1007/s10029-025-03518-1.

ABSTRACT

INTRODUCTION: Inguinal hernia is a common occurrence affecting one in four men. Recurrence is a major clinical pitfall that affects about 10% of patients with increased recurrence and postoperative complications after a revision repair. Reoperation due to metachronous contralateral inguinal hernia is another possible outcome. The impact of minimally invasive surgery (MIS) techniques on inguinal hernia recurrence rates as compared to open surgery is less clear and further confounded by the adoption of robotic approaches. The aim of this study was to compare reoperation rates.

METHODS: Adult patients who underwent primary unilateral inguinal hernia repair (IHR) in an outpatient setting between January 2015 and December 2021 were queried from the Merative^TM MarketScan® Research Databases. Reoperation for IHR within two years was compared across surgical approaches: Open (O-IHR), Laparoscopic (L-IHR), and Robotic (R-IHR). Reoperations were further categorized and analyzed separately for recurrent and non-recurrent IHR. Secondary outcomes included all-cause total healthcare expenditures, assessed during the index operation and up to two years postoperatively, based on combined insurer and patient payments. A 1:1 propensity score matching approach was applied, with Cox proportional hazards regression used to analyze reoperation risk, and generalized linear regression models employed to evaluate expenditures.

RESULTS: A total of 73,870 patients undergoing IHR (39,591 [53.6%] O-IHR, 30,858 [41.8%] L-IHR, and 3,421 [4.6%] R-IHR) were included. As compared to O-IHR, any IHR reoperation risk at 2-years was about 42% lower with R-IHR (HR = 0.58, p = 0.002) and about 16% lower with L-IHR (HR= 0.84, p < .001). As compared to O-IHR, total expenditure for the index surgery was approximately $3,391 higher with L-IHR (p < .001) and $4,137 higher with R-IHR (p < .001). R-IHR had about $615 higher index expenditure than L-IHR (p = 0.004).

CONCLUSION: The current study demonstrates that robotic IHR is associated with a lower risk of reoperations at 2 years after an initial repair as compared to L-IHR and O-IHR, but higher index expenditure in the outpatient setting for an economically active population.

PMID:41317213 | DOI:10.1007/s10029-025-03518-1

J Neurol. 2025 Nov 29;272(12):792. doi: 10.1007/s00415-025-13455-9.

ABSTRACT

OBJECTIVE: To develop individualized nomograms integrating cortical morphometric measures with 3D multi-parametric MRI radiomics to predict disability progression (DP) and cognitive worsening (CW) in patients with relapsing-remitting multiple sclerosis (RRMS).

MATERIALS AND METHODS: In this multicenter study, 191 RRMS patients from two centers were divided into internal (training and validation sets, n = 158) and external validation (n = 33) sets. All patients underwent clinical and neuropsychological evaluations at both baseline and 2-year follow-up visits. Cortical morphometric metrics were extracted from 3D T1W images, with radiomics features were assessed within MS plaques on 3D DIR, 3D FLAIR, and 3D T1W images. Four models-clinical-only, radiomics-only, cortical morphometric-only, and a combined model-were developed. A nomogram was developed based on a multivariable logistic regression model to provide individualized probability estimates of DP and CW. Predictive performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

RESULTS: The combined nomogram outperformed models using clinical, radiomic, or cortical morphometric features alone in predicting DP, achieving an area under the curve (AUC) (95% confidence interval [CI]) of 0.950 (0.878-0.994) in the internal cohort and 0.904 (0.781-0.987) in the external cohort. Similarly, the nomogram for CW demonstrated excellent performance, with AUCs of 0.916 (0.831-0.984) and 0.889 (0.752-0.981) in the respective cohorts. Decision curve analysis confirmed the clinical utility of the nomograms.

CONCLUSION: Cortical atrophy, reduced morphological complexity, and high heterogeneity of MS lesions play significant roles in explaining DP and CW in MS. Nomograms integrating clinical indicators, cortical morphometric features, and 3D multi-parametric MRI radiomics, shows potential as a clinical tool for predicting disease progression, facilitating individualized management in RRMS patients.

PMID:41317205 | DOI:10.1007/s00415-025-13455-9

Eur J Orthop Surg Traumatol. 2025 Nov 29;36(1):29. doi: 10.1007/s00590-025-04595-9.

ABSTRACT

BACKGROUND: Studies on venous thromboembolism (VTE) in patients with traumatic pelvic and acetabular fractures have shown variable epidemiology, risk factors and outcomes.

METHODS: This retrospective study evaluated patients with traumatic pelvic and/or acetabular fractures who were admitted to a Level 1 trauma center in Riyadh, Saudi Arabia between January 2016 and December 2022. We compared patients who had VTE to those who did not.

RESULTS: The study evaluated 437 patients with (median age: 37 years; 72.8% males). VTE occurred in 42 patients (9.6%), with deep-vein thrombosis and pulmonary embolism occurring at almost equal rates. Patients with VTE were older and more likely to receive tranexamic acid (16.7% vs. 9.9%, p = 0.06), red blood cell (26.2% vs. 13.2%, p = 0.02) and platelet (9.5% vs. 3.8%, p = 0.08) transfusions, and pelvic angioembolization (9.5% vs. 3.0%, p = 0.03). The most common associated injuries were chest injury (28.4%) and abdomen/pelvis injury (23.8%). Pharmacologic thromboprophylaxis was used in 94.1% of patients, predominantly enoxaparin. The significant predictors of VTE were age, admission to the intensive care unit (odds ratio 2.746, 95% confidence interval 1.041-7.240) and hospital length of stay. The timing of pharmacologic thromboprophylaxis was not significantly associated with VTE. Patients with VTE had similar hospital mortality compared with those without VTE (4.8% vs. 4.1%, respectively; p = 0.83) but stayed for a longer period in the hospital (median stay: 21.5 days vs. 12.0 days, respectively; p < 0.0001).

CONCLUSIONS: VTE was diagnosed in almost 1 in 10 patients with traumatic pelvic and/or acetabular fractures. The need for admission to the intensive care unit, but not the timing of pharmacologic thromboprophylaxis, predicted VTE.

PMID:41317201 | DOI:10.1007/s00590-025-04595-9

Arch Gynecol Obstet. 2025 Nov 29. doi: 10.1007/s00404-025-08179-0. Online ahead of print.

ABSTRACT

OBJECTIVES: This meta-analysis seeks to clarify the relationship between hysterectomy, oophorectomy, and the subsequent risk of developing breast cancer.

METHODS: A comprehensive literature search was conducted across PubMed, the Cochrane Library, and Embase to identify relevant studies. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were performed using Stata software (version 14.0), with hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) calculated. Publication bias was assessed using funnel plots and Egger’s test.

RESULTS: A total of 12 studies were included, comprising 9 cohort studies and 3 case-control studies, with publication years ranging from 1988 to 2023, involving 5,868,660 participants, predominantly from the United States. The analysis revealed that both hysterectomy and oophorectomy are associated with a reduced risk of breast cancer, lowering the risk by 16% (HR 0.84; 95% CI: 0.76-0.92; I² = 76.5%; P < 0.001). Standalone hysterectomy was associated with a 13% reduction in breast cancer risk (HR 0.87; 95% CI: 0.77-0.99; I² = 82.3%; P = 0.033), while bilateral oophorectomy reduced the risk by approximately 19% (HR 0.81; 95% CI: 0.68-0.96; I² = 61.7%; P = 0.016). In contrast, unilateral oophorectomy did not significantly affect the risk of breast cancer (HR 0.89; 95% CI: 0.71-1.11; I² = 45.5%; P = 0.288). Patients who underwent bilateral oophorectomy and received hormone therapy experienced a 20% reduction in breast cancer risk (HR 0.80; 95% CI: 0.68-0.93; I² = 38.5%; P = 0.005), whereas those who did not receive hormone therapy showed no significant risk reduction (HR 0.87; 95% CI: 0.69-1.10; I² = 48.5%; P = 0.254). Premenopausal bilateral oophorectomy was associated with a 13% decrease in breast cancer incidence risk (HR 0.87; 95% CI: 0.79-0.96; I² = 0%; P = 0.004), while postmenopausal bilateral oophorectomy had no significant impact (HR 0.95; 95% CI: 0.88-1.03; I² = 1.2%; P = 0.196).

CONCLUSIONS: This meta-analysis suggests that both hysterectomy and oophorectomy are significantly associated with a reduction in breast cancer risk. The effectiveness of bilateral oophorectomy appears to be modulated by hormone therapy and menopausal status. Further research is needed to clarify these associations and to explore the underlying biological mechanisms.

PMID:41317195 | DOI:10.1007/s00404-025-08179-0

Eur Radiol. 2025 Nov 29. doi: 10.1007/s00330-025-12154-3. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the reproducibility and the diagnostic accuracy of MRI for the assessment of (#)ENZIAN classification in patients with deep endometriosis by means of a meta-analysis.

MATERIALS AND METHODS: MEDLINE and EMBASE databases were searched for relevant articles from January 1, 2005, to January 1, 2025. Data on MRI reproducibility (interobserver/intraobserver kappa) were extracted for P (peritoneum), O (ovary), T (tubo-ovarian condition), A (vagina/rectovaginal space), B (utero-sacral ligaments), C (rectum/sigmoid colon), FA (F adenomyosis), FB (F bladder), FU (F ureter), FI (F intestinum), and FO (F other). Pooled sensitivity, specificity, PPV, and NPV were calculated for each compartment.

RESULTS: Twelve articles (1024 patients) were included, of which 7 used ENZIAN and 5 used #ENZIAN. MRI-based (#)ENZIAN showed high reliability for O, A, B, and C, with substantial or excellent agreement in most studies. MRI-based (#)ENZIAN showed high diagnostic values for O, T, A, B, and C. Sensitivity and specificity for O were 97.5% and 96.4% and for T, 94.1% and 89.1%, respectively. Sensitivity values for A, B, and C were slightly lower, but remained high at 76.1%, 83.4%, and 79.1% respectively, and specificity values were high at 92.4%, 87.8%, and 94.8%. Sensitivity values for FA, FB, and FI were low, with values of 64.6%, 56.9%, and 66.8%. Data for P, FU, and FO were insufficient and could not be pooled.

CONCLUSION: MRI-based (#)ENZIAN showed high reliability for compartments O, T, A, B, and C. Data for other compartments were either insufficient or the diagnostic accuracy was low.

KEY POINTS: Question What is the diagnostic value of MRI in the assessment of (#) ENZIAN classification in patients with deep endometriosis? Findings MRI-based(#)ENZIAN showed high diagnostic values for compartments O, T, A, B, and C. Data on the remaining compartments were insufficient, or the diagnostic accuracy was low. Clinical relevance MRI-based (#) ENZIAN can be used for assessing endometriosis located at the ovaries, tubal ovarian condition, vaginal-rectovaginal space, utero-sacral ligaments, and rectosigmoid. For other compartments, more data are needed and clear definitions might also improve the role of MRI.

PMID:41317188 | DOI:10.1007/s00330-025-12154-3

Clin Oral Investig. 2025 Nov 29;29(12):592. doi: 10.1007/s00784-025-06663-0.

ABSTRACT

OBJECTIVE: To evaluate the effects of concentrated growth factors (CGFs) combined with Bio-Oss bone substitute on the periodontal healing of adjacent teeth following impacted tooth extraction.

METHODS: This single-centre prospective controlled study enrolled 60 patients requiring bilateral impacted mandibular third molar extraction. Patients were randomly allocated to a test group (n = 30; extraction socket filled with CGFs + Bio-Oss and covered with a CGF membrane) or control group (n = 30; natural healing). Primary outcomes included periodontal probing depth (PD) and distal bone height measured by cone beam computed tomography at baseline and 3 and 6 months. Secondary outcomes comprised the visual analogue scale (VAS) pain scores, swelling assessment and dry socket incidence. Statistical analysis was performed using SPSS 26.0, with significance set at P < 0.05.

RESULTS: A total of 60 patients were enrolled in this randomised single-blind clinical trial. The test group showed significantly greater PD reduction (2.41 ± 0.89 vs. 1.52 ± 0.73 mm, P < 0.001) and bone height gain (2.87 ± 1.12 vs. 1.63 ± 0.91 mm, P < 0.001) at 6 months than the control group. The VAS pain scores were significantly lower in the test group at days 3 and 7 (P < 0.001). No cases of dry socket occurred in the test group, compared with three cases (11.1%) in the control group. Multivariate analysis revealed that CGFs + Bio-Oss application was the strongest predictor of bone gain ≥ 2 mm (β = 0.412, P < 0.001).

CONCLUSION: Concentrated growth factors combined with Bio-Oss significantly enhance periodontal healing and bone regeneration at adjacent teeth following impacted tooth extraction while reducing postoperative complications. This combined approach represents a promising strategy for clinical practice.

PMID:41317186 | DOI:10.1007/s00784-025-06663-0

Eur J Orthop Surg Traumatol. 2025 Nov 29;36(1):28. doi: 10.1007/s00590-025-04584-y.

ABSTRACT

INTRODUCTION: We investigated outcomes of patients treated with either locked plating or retrograde intramedullary nailing (IMN) at a single institution and compared outcomes of retrograde IMN to locked plating for periprosthetic distal femur fractures.

METHODS: We reviewed 241 subjects with distal femur fractures around total knee arthroplasty (TKA) treated with locked plating (197) or retrograde IMN (44). Mean age was 77 years, 78% were female, and mean BMI was 32 kg/m². There were 27% Su I, 41% Su II, and 32% Su III fractures. There were 87% primary TKAs and 13% revision TKAs. Mean follow-up was 3 years.

RESULTS: Overall nonunion rate was 10% and 5-year survivorship free of any revision was 81%, with the most common reasons being nonunion (49%), infection (19%), and aseptic TKA loosening (11%). Patients with prior TKA infection (HR 3; p = 0.02), revision TKA (HR 2; p = 0.03), Su III fractures (HR 2.5; p = 0.04) were at increased risk of revision. There was a trend toward higher non-union rate in the locked plating group (11% vs. 2%; p = 0.07). Those with locked plating had higher rates of osteoporosis (70% vs. 52%; p = 0.02), prior revision TKA (16% vs. 2%; p = 0.02), and Su Type III fractures (36% vs.16%, p = 0.047). Five-year survivorship free of any revision for locked plating and retrograde IMN were 80% and 84%, respectively, with no significant difference in revision, reoperation, or non-operative complications.

CONCLUSIONS: Both locked plating and retrograde IMN are viable fixation options for periprosthetic distal femur fractures after TKA. Those treated with locked plating had higher rates of osteoporosis, prior revision TKA, and more distal fractures, but did not demonstrate a significant increased risk for reoperation or revision.

LEVEL OF EVIDENCE: Level III, Retrospective comparative cohort study.

PMID:41317180 | DOI:10.1007/s00590-025-04584-y