Nevin Manimala

J Orthop Surg Res. 2025 Jul 19;20(1):683. doi: 10.1186/s13018-025-06086-3.

ABSTRACT

BACKGROUND: Screw placement in lateral plating of calcaneal fractures presents a challenge due to the proximity of medial neurovascular structures. This study aims to identify high-risk zones, determine appropriate screw lengths, and define optimal fluoroscopic angles to enhance intraoperative visualisation and improve surgical safety.

METHODS: Thirty-three fresh-frozen cadaveric specimens were used. Following a lateral extensile approach, locking screws were inserted through an anatomical plate into seven predefined zones using sleeve-guided drilling, without plate bending or freehand angulation. For each screw, the appropriate length was initially measured, but to facilitate identification during subsequent medial dissection, longer screws were intentionally inserted. Following screw insertion, medial dissection was performed to expose neurovascular and tendinous structures. Distances from each screw were measured at two points: (1) the actual exit point on the medial cortex, and (2) the projected trajectory of the screw. Based on these measurements, risk scores were assigned using a validated scoring system. In a separate step, fluoroscopic angle measurements were conducted. K-wires were placed into the posterior facet and the sustentacular sulcus, and the required cranial and medial angulations of the C-arm relative to the plantar referenced axis were determined for the optimal visualisation of the joint and medial cortex.

RESULTS: Zone 4 (subchondral zone) demonstrated the highest risk, with medial plantar vessels, medial plantar nerve, lateral plantar vessels, and flexor hallucis longus at significant risk, particularly at the projection point. In contrast, Zone 2 inferior and Zones 3 had lower risk scores. The anticipated screw lengths ranged from 35.49 mm to 38.73 mm across different zones. Nearly all distances between screw exit points and projections showed statistically significant differences (p < 0.05), highlighting the importance of screw length. Inter- and intra-observer reliability was good to excellent across all measurements (ICC > 0.75). Fluoroscopic analysis revealed that rotating the C-arm cranially by 34.7° relative to a plantar reference axis optimised posterior facet visualisation, while a combination of 26.09° cranial and 17.79° medial angulation provided the best imaging of the medial cortex at the sustentacular sulcus.

CONCLUSIONS: This study identifies Zone 4 (subchondral zone) as the highest-risk area for neurovascular injury in lateral calcaneal plating and highlights the importance of screw length selection, particularly reconsidering screws exceeding 40 mm, and optimal fluoroscopic visualisation of medial high-risk zones. These findings are crucial for enhancing intraoperative safety in calcaneal fracture fixation.

PMID:40684243 | DOI:10.1186/s13018-025-06086-3

BMC Psychol. 2025 Jul 19;13(1):808. doi: 10.1186/s40359-025-03067-3.

ABSTRACT

BACKGROUND: Entrepreneurial learning is widely recognized as a critical factor in enhancing entrepreneurial performance. However, the specific impact of entrepreneurial learning on the performance of female entrepreneurs and the underlying mechanisms involved remain underexplored. The main purpose of this study is to explore the impact mechanism of entrepreneurial learning on entrepreneurial performance among female entrepreneurs and to reveal the mediating roles of psychological capital and opportunity recognition and development in this relationship.

METHOD: This study employs a quantitative research approach, conducting empirical analysis using survey data from 558 Chinese female entrepreneurs. Utilizing AMOS statistical software, we construct structural equation models to examine the relationship between entrepreneurial learning and business performance among female entrepreneurs.

RESULTS: The findings reveal that: (1) Entrepreneurial learning among female entrepreneurs has a direct and positive impact on entrepreneurial performance, and (2) Psychological capital and opportunity recognition and development serve as key mediators in this relationship.

CONCLUSIONS: Grounded in entrepreneurial learning theory, this study proposes a pathway model that illustrates how female entrepreneurs can leverage entrepreneurial learning to improve their performance. By shedding light on the mechanisms through which entrepreneurial learning influences performance, this study extends the application of entrepreneurial learning theory within the context of female entrepreneurship and provides practical insights for enhancing the entrepreneurial success of female entrepreneurs.

CLINICAL TRIAL REGISTRATION: Not applicable.

PMID:40684238 | DOI:10.1186/s40359-025-03067-3

J Exp Clin Cancer Res. 2025 Jul 19;44(1):214. doi: 10.1186/s13046-025-03473-w.

ABSTRACT

BACKGROUND: Glioblastoma (GBM), the most common and aggressive type of primary brain tumor, engages multiple survival mechanisms, including autophagy. GBM exploits both degradative and secretory autophagy pathways to support tumor growth and limit the efficacy of standard-of-care treatments. We have previously shown that lucanthone, a blood-brain barrier permeable autophagy inhibitor, reduces tumor burden. However, although lucanthone-treated tumors are significantly smaller in size, they are not completely obliterated, suggesting compensatory survival mechanisms. A critical factor for GBM survival is communication with the tumor microenvironment (TME), which can be programmed by glioma cells to support growth and immunosuppression. Plasminogen activator inhibitor-1 (PAI-1), a secreted serine protease inhibitor, has been implicated in the progression of several cancers, including GBM, and has been shown to be modulated by autophagy in other cancers. The role of PAI-1 in GBM, namely its relationship with intracellular autophagy dysregulation and extracellular TME as a mechanism of tumor survival, remains incompletely understood.

METHODS: Murine glioma models were established using intracranial injection of GL261 cells in C57BL/6 mice, followed by autophagy inhibition with intraperitoneal lucanthone and/or PAI-1 inhibition with MDI-2268 chow, and tumors were assessed by immunohistochemistry. In culture, glioma cell lines were challenged with MDI-2268, lucanthone, mitoxantrone, or siRNA-LNPs targeting PAI-1, and assessed by MTT assay, q-RT-PCR, ELISA, invasion assay, immunoblot, and immunocytochemistry. Lysosomal markers and transient transfection with fluorescent vesicular proteins were utilized to evaluate PAI-1 intracellular localization via confocal microscopy. Synergy was analyzed using the HSA model in Combenefit, and statistical analyses included t-tests, ANOVA, and log-rank tests for survival.

RESULTS: Lucanthone treatment increased intracellular PAI-1 and autophagy markers while reducing active extracellular PAI-1. PAI-1 colocalized with lysosomal markers, suggesting impaired secretory autophagy. PAI-1 inhibition reduced glioma cell viability and invasion. Combination therapy with lucanthone and MDI-2268 drastically decreased tumor volume, prolonged survival, and promoted a pro-inflammatory state in the tumor microenvironment.

CONCLUSIONS: Our findings suggest that PAI-1 may be a compensatory survival mechanism in GBM after autophagy inhibition, and that dual targeting of autophagy and PAI-1 disrupts tumor progression and enhances anti-tumor immunity, providing promising evidence for targeting this axis.

PMID:40684232 | DOI:10.1186/s13046-025-03473-w

J Orthop Surg Res. 2025 Jul 19;20(1):679. doi: 10.1186/s13018-025-06074-7.

ABSTRACT

BACKGROUND: Ankylosing spondylitis (AS) often leads to severe thoracolumbar kyphotic deformity, requiring surgical correction. Pedicle subtraction osteotomy (PSO) is the gold standard but carries risks of significant blood loss and neurological complications. Posterior trans-intervertebral osteotomy (PTIO) has emerged as a less invasive alternative, but its comparative efficacy and safety remain unclear. This study aimed to compare radiographic outcomes, surgical parameters, and complications between PTIO and PSO in AS-related kyphosis.

METHODS: A single-center retrospective cohort study included 45 AS patients with thoracolumbar kyphosis (19 PTIO, 26 PSO) who underwent posterior spinal correction. Radiographic parameters (global kyphosis GK, sagittal vertical axis SVA, etc.), surgical data (operative time, blood loss), health-related quality of life (SRS-22), and complications were analyzed. Statistical comparisons were performed using independent t-tests or Mann-Whitney U tests for continuous variables and chi-square/Fisher’s tests for categorical variables.

RESULTS: Both groups achieved significant kyphosis correction, with no differences in postoperative GK (PTIO: 51.4° ± 13.3° vs. PSO: 47.4° ± 13.0°, P > 0.05) or SVA (PTIO: 59.1 ± 50.3 mm vs. PSO: 49.0 ± 47.1 mm, P > 0.05). PTIO showed lower intraoperative blood loss (600.9 ± 264.6 mL vs. 1088.7 ± 287.9 mL, P = 0.009) and fewer neurological complications (5.3% vs. 15.4%, P = 0.003). Health-related quality of life improved similarly in both groups (P > 0.05).

CONCLUSION: PTIO provides comparable radiographic correction to PSO while reducing blood loss and neurological risks. It represents a viable, less invasive alternative for AS-related kyphosis, particularly when anterior column support is achievable. Further studies with long-term follow-up are warranted to validate these findings.

PMID:40684231 | DOI:10.1186/s13018-025-06074-7

Am J Hum Biol. 2025 Jul;37(7):e70096. doi: 10.1002/ajhb.70096.

ABSTRACT

This article considers how to approach sporting injury from the perspective of gender/sex entanglement. Taking the case of anterior cruciate ligament (ACL) injuries, I explore how the gender differences and inequalities that fundamentally shape many sporting environments may contribute to injury in women athletes. I look to Australian Rules football (Aussie Rules)-a male-dominated, high-contact, highly skilled running game and Australia’s largest commercial sport-where, following the launch of a women’s professional league in 2017, a marked gender disparity in ACL injury has been reported. Rather than attribute this reported disparity to essential biological differences between women and men, I consider how gendered practices and disparities may accumulate across the life course of athletes with consequences for the embodied experiences of women and girls. Building on the concept of structural sexism as a key determinant of health, I document gender-related differences and inequalities at the early childhood, youth, and elite levels of Aussie Rules football. Via this case, I contribute to calls for a dynamic, developmental, and fundamentally gendered approach to studies of injury both in and beyond sport.

PMID:40682458 | DOI:10.1002/ajhb.70096

Euro Surveill. 2025 Jul;30(28). doi: 10.2807/1560-7917.ES.2025.30.28.2400723.

ABSTRACT

BACKGROUNDGermany lacks comprehensive studies on the relationship between socioeconomic position (SEP) and antimicrobial resistance (AMR).AIMWe assessed the association between area-level SEP and AMR infection and colonisation in Germany.METHODSIn an ecological study design, we analysed statutory notifications of invasive meticillin-resistant Staphylococcus aureus (MRSA, n = 34,440) in 2010-2019, and colonisations and infections with carbapenem-resistant Acinetobacter spp. (CRA, n = 1,979) and Enterobacterales (CRE, n = 10,825) in 2017-2019. Area-level SEP was measured by the German index of socioeconomic deprivation (GISD), incorporating education, employment and income data. A multilevel Poisson regression analysis estimated the association between AMR incidence and GISD at district level, adjusting for age, sex, notification year and urbanisation degree.RESULTSMedian ages of patients with carbapenem-resistant bacteria were between 66 (CRA colonisation) and 69 years (CRE infection). For MRSA infections, the median age was 74 years. Across each pathogen, approximately two thirds of patients were male. Estimated MRSA incidence was almost five times higher in districts with lowest vs highest area-level SEP (incidence rate ratio, IRR: 4.8; 95% CI: 2.8-8.2). This association was strongest in large cities (IRR: 9.1; 95% CI: 2.7-30.9), and sparsely populated rural districts (IRR: 6.5; 95% CI: 2.8-15.0). Associations of CRA (IRR: 0.6; 95% CI: 0.3-1.2) and CRE (IRR: 0.9; 95% CI: 0.6-1.4) infections with SEP were not statistically significant.CONCLUSIONLower area-level SEP and degree of urbanisation were associated with MRSA incidence, however, no associations were uncovered between SEP and CRA or CRE infections. Further individual-level research could explore if health behaviours, living/working conditions or healthcare access explain the findings. Socioeconomic conditions should be considered for AMR prevention and control.

PMID:40682454 | DOI:10.2807/1560-7917.ES.2025.30.28.2400723

Inquiry. 2025 Jan-Dec;62:469580251356131. doi: 10.1177/00469580251356131. Epub 2025 Jul 19.

ABSTRACT

Few studies assessing stress symptoms are specific to medical education, and even fewer are designed to determine which stressors affect medical students. It was aimed to adapt the Medical Student Stress Factor Scale (MSSF) into Turkish and to provide a valid and reliable tool to determine stress caused by medical education in medical students. Between January and May 2024, 632 medical students participated. The Depression Anxiety Stress Scale-21 (DASS-21), the MSSF, and a sociodemographic data form were used. The MSSF is a 7-point Likert-type scale with 28 items. Although individual item scores range from 1 to 7, the total and subscale scores are calculated by averaging item scores, resulting in an overall score range from 1 to 7. Test-retest, Cronbach α, Davis technique, exploratory and confirmatory factor analyses (EFA and CFA), Pearson correlation, and descriptive analyses were used. The scale’s Cronbach’s alpha was .937, and the Kaiser-Meyer-Olkin (KMO) coefficient was .935. The sphericity results of the Bartlett test were x^² = 9302.227, P < .001. In the CFA analysis, GFI = 0.814, CFI = 0.840, x^²/df = 3.108, and RMSEA = 0.081 were determined. The MSSF total and subscale scores were positively correlated with all DASS-21 subscales (P < .001), supporting the construct validity of the Turkish version of the scale. It was found that the validity and reliability analyses of the Turkish version of the MSSF were satisfactorily met.

PMID:40682447 | DOI:10.1177/00469580251356131

J Clin Endocrinol Metab. 2025 Jul 19:dgaf417. doi: 10.1210/clinem/dgaf417. Online ahead of print.

ABSTRACT

BACKGROUND: Total thyroidectomy requires lifelong levothyroxine (LT4) therapy. Achieving optimal thyroid hormone replacement at the first post-operative follow-up might be harder than it could be expected. Despite various LT4 dose choosing strategies were tested, there is no consensus on the most effective approach to achieve early euthyroidism.

MATERIALS AND METHODS: We performed a systematic review and meta-analysis, including studies published between 2000 and 2024 that reported the proportion of patients achieving euthyroidism at first follow-up after total thyroidectomy. Data from 11 studies comprising 2577 patients were analyzed. LT4 dosing strategies included fixed-dose, weight-based (dose/kg), and individualized algorithm-based methods. Meta-regression and subgroup analyses were used to explore sources of heterogeneity.

RESULTS: The pooled euthyroidism rate at first follow-up was 33.9%, with high heterogeneity across studies (I² = 82.68%). No dosing strategy consistently outperformed others: dose/kg methods achieved 29% euthyroidism, while fixed or algorithm-based approaches achieved 40%, though without statistical significance. Meta-regression analysis did not identify any statistically significant predictor. No significant differences emerged between patients treated for benign or malignant thyroid diseases or between retrospective and prospective study designs.

CONCLUSIONS: Only about one-third of patients achieve euthyroidism at first follow-up after thyroidectomy, regardless of LT4 dosing strategy. The current guidelines recommendation of applying a pro/kg dose may not be adequate, and even personalized algorithms yield inconsistent results. Future prospective studies are needed to refine individualized dosing protocols and identify additional factors influencing LT4 requirements.

PMID:40682434 | DOI:10.1210/clinem/dgaf417

J Geriatr Psychiatry Neurol. 2025 Jul 19:8919887251362470. doi: 10.1177/08919887251362470. Online ahead of print.

ABSTRACT

ObjectiveAnosognosia for memory deficits is frequently observed in patients with Alzheimer’s disease (AD). Despite its relevance, this phenomenon is understudied in individuals with Mild Cognitive Impairment (MCI). People with MCI often struggle to update self-referential beliefs about memory functioning. Nonetheless, findings on error monitoring capacity are mixed and methodologically weak, especially in visuospatial tasks. Here, we investigated online metamemory appraisal for verbal and visuospatial material in patients with MCI due to AD. The potential diagnostic utility of metamemory accuracy was evaluated.MethodsSixteen patients with MCI and 19 healthy controls completed metamemory tasks involving predictions on list and position memory performance. Metamemory accuracy was quantified using the Objective Judgment Discrepancy (OJD) index, the percentage difference between predicted and actual performance. Linear mixed-effects models were used to analyze main effects and interactions.ResultsCompared to controls, patients overestimated their memory performance (P < 0.001, d = 0.51), with greater overestimation in the visuospatial task (P < 0.001, d = 0.57). After adjusting for cognitive functioning, only overestimation in visuospatial memory persisted. Visuospatial OJD correlated significantly with executive and visuospatial abilities (all rho ≥ -0.50, P < 0.05). Clinimetric analyses highlighted visuospatial OJD as a promising marker for diagnostic use (AUC = 0.814, P < 0.001, sensitivity = 0.67, specificity = 0.95).ConclusionOverestimation in verbal memory reflects a statistical artifact consistent with the Dunning-Kruger effect. A selective metacognitive deficit was found in visuospatial memory. Our results support the view of AD as a visuospatial-driven disease and underscore the diagnostic potential of visuospatial metamemory assessments.

PMID:40682426 | DOI:10.1177/08919887251362470

Laryngoscope. 2025 Jul 19. doi: 10.1002/lary.32426. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the role of fine needle aspiration thyroglobulin (FNA-TG) and fine needle aspiration cytokeratin 19 fragment antigen 21-1 (FNA-CYFRA 21-1) in the diagnosis of cervical lymph node metastasis of differentiated thyroid carcinoma (DTC), then analyze whether different neck lymph node compartmentalization affected the cut-off values of FNA-TG and FNA-CYFRA 21-1.

METHODS: One hundred and sixteen lymph nodes with suspicious ultrasound signs between September 2023 and September 2024 were analyzed, and the lymph nodes were classified into central lymph nodes and lateral neck nodes, and all lymph nodes underwent fine needle aspiration cytology (FNAC), FNA-TG, and FNA-CYFRA 21-1 preoperatively. Differences in the levels of FNA-TG and FNA-CYFRA 21-1 in the lateral neck nodes and central lymph nodes were analyzed, and the optimal cut-off values of the two were calculated to further analyze the value of FNAC, FNA-TG, and FNA-CYFRA 21-1 for diagnosis alone and in combination.

RESULTS: In the non-metastatic lymph node group, the difference in FNA-TG levels between the lateral neck zone and the central zone was statistically significant. The levels of FNA-CYFRA 21-1 were not affected by the zoning of the cervical lymph nodes. In the lateral neck region, the area under the diagnostic curve was highest for the combination of the three.

CONCLUSIONS: FNA-CYFRA 21-1 is valuable in DTC cervical lymph node metastasis and can assist in the diagnosis of FNAC and FNA-TG, especially in suspected centralized lymph nodes that are not diagnosed preoperatively.

PMID:40682374 | DOI:10.1002/lary.32426