Nevin Manimala

J Neurooncol. 2025 Jul 15. doi: 10.1007/s11060-025-05133-7. Online ahead of print.

ABSTRACT

BACKGROUND: Awake craniotomy (AC) has become the standard technique for eloquent region tumor resection. However, concerns remain regarding perioperative seizure and other complications requiring conversion to general anesthesia or operation termination. To prevent such events, antiseizure medications (ASMs) are commonly used but the effectiveness of their combinations is still debated.

MATERIAL AND METHOD: This study is a retrospective cohort study of patients who underwent awake craniotomy for glioma resection. Patients were divided into two groups based on their seizure control medication: Group S (N = 29) received one ASM, while Group D (N = 26) received dual ASM. We conducted a comparative analysis of intraoperative seizure (IOS) and postoperative seizure (POS) rates between the two groups. Additionally, we evaluated the risk factors associated with POS and the 1-month postoperative Karnofsky Performance Scale (1 M-KPS).

RESULT: A total of 55 patients (41.8% female) with a median age of 39.0 (interquartile range [IQR] 33.0-51.0) were included. The rate of IOS was 27.6% in Group S and 11.5% in Group D, with no statistically significant difference (p = 0.14). POS occurred in 24.1% of group S and 7.7% of group D (p = 0.10), demonstrating comparable rates. Moreover, the length of hospital stay (p = 0.61), the length of ICU stay (p = 0.14), postoperative KPS (p = 0.13), and 1 M-KPS (p = 0.22) were comparable between the two cohorts. The occurrence of POS was not associated with adjuvant therapy or the Isocitrate Dehydrogenase 1 (IDH1) mutation. Univariate and multivariate regression models found preoperative KPS and the extent of resection to have a significant association with 1 M-KPS.

CONCLUSION: Adding a second ASM does not have a significant effect on preventing POS and IOS or improving 1 M-KPS. Accordingly, we recommend against the routine use of dual ASM due to their potential for increased adverse events.

PMID:40663311 | DOI:10.1007/s11060-025-05133-7

J Neurooncol. 2025 Jul 15. doi: 10.1007/s11060-025-05134-6. Online ahead of print.

ABSTRACT

OBJECTIVE: Spinal ependymomas are the most common intramedullary spinal cord tumors, with surgical resection being the primary treatment modality. This study aimed to evaluate the prognostic value of preoperative MRI features in predicting motor deficits in patients undergoing surgery for spinal ependymomas.

METHODS: We retrospectively analyzed 71 patients with histopathologically confirmed spinal ependymomas who underwent surgical resection between 2009 and 2021. Preoperative MRI features-including tumor volume, cystic components, syrinx formation, intratumoral hemorrhage, and longitudinal tumor extension-were assessed. Motor strength was recorded pre- and postoperatively. Statistical analysis included univariate comparisons and multivariate logistic regression to identify independent predictors of neurological deficits.

RESULTS: Preoperative motor weakness was significantly associated with syrinx formation (p = 0.012), intratumoral hemorrhage (p = 0.015), and greater tumor length (p = 0.037). Postoperative motor deterioration was significantly correlated with intratumoral hemorrhage (p = 0.025), increased tumor volume (p = 0.007), and longitudinal extension (p = 0.001). In multivariate analysis, the number of vertebral levels involved was the only independent predictor of postoperative motor weakness (OR = 1.737; 95% CI: 1.063-2.838; p = 0.028). No independent predictors were identified for preoperative weakness, although syrinx formation showed a trend toward significance.

CONCLUSION: Preoperative MRI findings-particularly intratumoral hemorrhage, syrinx formation, and longitudinal extension-are associated with motor deficits in spinal ependymomas. However, only longitudinal tumor extension was an independent predictor of postoperative neurological deterioration. These findings highlight the importance of comprehensive radiological assessment in preoperative planning and risk stratification. Small sample size and short-term postoperative assessment represent important limitations of this study.

PMID:40663310 | DOI:10.1007/s11060-025-05134-6

Saudi Dent J. 2025 Jul 15;37(4-6):28. doi: 10.1007/s44445-025-00035-w.

ABSTRACT

This study investigated the color stability and surface roughness of three novel single-shade universal composites after exposure to common staining solutions. A total of 120 specimens (n = 40 per composite) were fabricated from Transcend Universal Composite (TRA), Ecosite One (ECO), and Clearfil Majesty ES-2 Universal (CLA). Specimens were stored at 37 °C in four different staining solutions (artificial saliva, coffee, red wine, matcha tea). Color changes (ΔE₀₀) were assessed at five time points using the eLAB system, and surface roughness (Sa, Sz) was analyzed via 3D laser scanning microscopy. Statistical analysis was performed using a linear mixed model and post-hoc test (Tukey) (p < 0.05). Composite type, staining solution, and exposure duration significantly affected discoloration (p < 0.001). Red wine induced the most pronounced color change (ECO: ΔE₀₀ = 38.9 ± 1.56), while coffee and matcha tea caused similar discoloration (p = 0.164). TRA showed the greatest surface roughness increase; no correlation with color change was observed. The color stability of single-shade composites is influenced by resin matrix composition and staining agent exposure. Tri-modal or nanohybrid composites showed greater color stability than the micro hybrid composite. Surface roughness did not impact discoloration susceptibility.

PMID:40663305 | DOI:10.1007/s44445-025-00035-w

Res Child Adolesc Psychopathol. 2025 Jul 15. doi: 10.1007/s10802-025-01346-6. Online ahead of print.

ABSTRACT

Academic underachievement is often reported in children with attention-deficit/hyperactivity disorder (ADHD). Research shows working memory (WM), and processing speed (PS) have a predictive role in their academic difficulties. Recent evidence suggests both cognitive functions are related, where slower PS underlies WM deficits. This relationship is not accounted for in the current literature on academic underachievement in children with ADHD. In the current study, the role of PS and WM in the association between ADHD symptom severity and academic achievement is investigated in a sample of 504, 6 to 12 years old children diagnosed with ADHD. Academic achievement is assessed across three subjects (mathematics, reading and spelling), by three measurement methods (standardized tests, parent, and teacher ratings). In addition, the role of PS is investigated in the relationship between ADHD symptom severity and WM. Findings show the association between inattention symptom severity and achievement on all three academic subjects is statistically mediated by PS and WM sequentially. For mathematics and spelling performance, PS was a single mediator in this association. Further, PS statistically mediated the relation between inattention symptom severity and WM performance. Hyperactivity/impulsivity symptom severity predicted mathematics performance directly, but none of the indirect effects were significant. The current results show that PS plays an important role in the academic achievement of children with increased inattention symptoms, as well as the WM deficits often reported in this population. These findings have important implications for theoretical accounts of ADHD, as well as academic interventions, currently focusing primarily on WM deficits.

PMID:40663299 | DOI:10.1007/s10802-025-01346-6

Discov Oncol. 2025 Jul 15;16(1):1335. doi: 10.1007/s12672-025-03026-9.

ABSTRACT

BACKGROUND: Abnormal expression of zinc finger (ZNF) proteins is closely associated with tumor proliferation and metastasis. However, due to limited knowledge about ZNF83, we conducted a pan-cancer analysis to explore its shared and distinct roles across various human malignancies.

METHOD: Standardized TCGA pan-cancer data, encompassing clinical details and ZNF83 expression levels, were obtained for in-depth analysis. We assessed the expression landscape of ZNF83, explored its prognostic significance, and examined its relationship with tumor heterogeneity and cellular stemness. Furthermore, immunohistochemical analysis was performed on lung and kidney cancer tissues to support the bioinformatic findings.

RESULTS: ZNF83 expression patterns vary markedly among tumor types, with transcriptomic analysis revealing upregulation in eight malignancies and significant downregulation in twenty-two, compared to adjacent non-cancerous tissues. Notably, ZNF83 levels exhibited robust associations with markers indicative of genomic instability and with indices of tumor stemness across multiple cancer types, suggesting a role in genome maintenance and cellular plasticity. Immunohistochemical staining further substantiated these findings, showing elevated ZNF83 protein levels in renal carcinoma samples, whereas reduced expression was observed in lung adenocarcinoma specimens. In renal cancer, higher ZNF83 expression correlated with poorer overall survival, reinforcing its prognostic value. Although the difference in lung adenocarcinoma was not statistically significant, the expression trend was consistent with transcriptomic observations from the TCGA database.

CONCLUSION: ZNF83 is differentially expressed across cancers and predicts poor prognosis, particularly in renal cell carcinoma, highlighting its utility as a prognostic biomarker.

PMID:40663296 | DOI:10.1007/s12672-025-03026-9

Arch Osteoporos. 2025 Jul 15;20(1):93. doi: 10.1007/s11657-025-01560-1.

ABSTRACT

In hip fracture patients with poor medication adherence, DMAB discontinuation significantly increased the risk of subsequent vertebral and rib fractures. Additionally, higher CCI scores were associated with an increased risk of these fractures. These findings underscore the importance of maintaining treatment adherence to minimize fracture risk in this vulnerable population.

PURPOSE: To assess the risk of major osteoporotic fractures and periprosthetic fractures in hip fracture patients who discontinued denosumab (DMAB) or zoledronic acid (ZOL).

METHODS: Data from the South Korean National Health Insurance Review and Assessment Service were analyzed, focusing on patients aged ≥ 60 years who underwent hip fracture surgery and initiated DMAB or ZOL treatment. Among 20,180 patients, 1737 discontinued DMAB, and 3720 discontinued ZOL. After 1:1 propensity score matching, 3240 patients were included in the final analysis. The DMAB group was stratified into three subgroups based on the cumulative DMAB duration after hip fracture surgery: 1-2, 2-3, and > 3 Y. Discontinuation was defined as a 270-day gap for DMAB or 540-day gap for ZOL last injections. Subsequent osteoporotic fractures after discontinuation were evaluated.

RESULTS: DMAB discontinuation significantly increased the risk of subsequent vertebral fractures (hazard ratio [HR] = 1.81; 95% confidence interval [CI], 1.28-2.56, P = 0.01) and rib fractures (HR = 2.04; 95% CI, 1.27-3.23, P = 0.004) compared to ZOL discontinuation. Higher Charlson Comorbidity Index (CCI) scores were also significantly associated with an increased risk of subsequent vertebral (HR 1.05, 95% CI 1.03-1.09, P = 0.02) and rib fractures (HR 1.12, 95% CI 1.06-1.19, P < 0.01). Although the incidence of hip fractures was lower in DMAB discontinuation group (1 case) than in the ZOL discontinuation group (10 cases), this difference did not reach statistical significance. No significant difference was observed in the risk of other nonvertebral fractures (humerus, wrist, ankle) and periprosthetic fracture between the two groups.

CONCLUSION: This nationwide study, the first to use real-world data, highlighted the significant increase in the risk of vertebral and rib fracture associated with DMAB discontinuation in patients with poor adherence and higher comorbidity burden. Optimizing medication adherence is crucial to minimize the fracture risk in this vulnerable population.

LEVEL OF EVIDENCE: Level III, Prognostic.

PMID:40663295 | DOI:10.1007/s11657-025-01560-1

Endocrine. 2025 Jul 15. doi: 10.1007/s12020-025-04354-0. Online ahead of print.

ABSTRACT

PURPOSE: Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease frequently associated with other autoimmune diseases. This study aims to evaluate the prevalence of additional autoimmunity in adults with T1D and its association with glycemic control, chronic complications, and other comorbidities.

METHODS: We performed a cross-sectional study in adult patients with T1D, followed at the Endocrinology Department of a tertiary hospital, between May 2022 and May 2024. Clinical data collected included glycemic control (HbA1c and continuous glucose monitoring [CGM] parameters), diabetes complications, and other comorbidities. These parameters were compared according to the history of autoimmune diseases. Statistical analysis was performed using parametric and non-parametric tests, ANCOVA and logistic regression models, unadjusted and adjusted for age and sex.

RESULTS: Of the 439 participants (48.8% female and mean age 36.8 ± 14.1 years), 33.8% had at least one autoimmune disease, predominantly Hashimoto’s thyroiditis (28.8%) and celiac disease (3.9%), with higher prevalence in women (p < 0.001). HbA1c (7.7 ± 1.3 vs. 7.8 ± 1.4%, p = 0.53) and CGM-derived parameters, such as glucose management indicator (7.4 ± 0.9 vs. 7.4 ± 0.8%, p = 0.44) and time in range (58.7 ± 18.9 vs. 56.6 ± 16.5%, p = 0.84), were similar in patients with and without autoimmune diseases.

CONCLUSIONS: Over one fourth of patients with T1D had a concomitant autoimmune disease. Our results suggest that the presence of other autoimmune diseases may not preclude the attainment of similar glycemic targets. Given the high risk of autoimmunity in T1D, systematic screening and personalized treatment should be considered. Prospective studies are warranted to explore the long-term implications on metabolic control and cardiovascular outcomes.

PMID:40663292 | DOI:10.1007/s12020-025-04354-0

Clin Rheumatol. 2025 Jul 15. doi: 10.1007/s10067-025-07562-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with idiopathic inflammatory myopathy (IIM) and anti-melanoma differentiation-associated protein 5 (anti-MDA5) antibodies are at significant risk (50-90%) of developing interstitial lung disease (ILD), with a reported mortality rate of 33-60%. Notably, the coexistence of anti-MDA5 and anti-Ro52 antibodies is associated with a more severe ILD prognosis than that of anti-MDA5 antibodies alone. The aim of this study was to investigate the serological characteristics of ILD in patients with IIM who possess anti-MDA5 antibodies, with or without concurrent anti-Ro52 antibodies.

METHODS: We retrospectively collected data from 32 patients diagnosed with anti-MDA5-positive IIM between May 2018 and December 2022. We reviewed these patients’ clinical manifestations, serological parameters, HRCT images and outcomes. We compared the difference between the patients with and without anti-Ro-52 antibodies.

RESULTS: Of the 32 patients with IIM and anti-MDA5 antibodies, 16 tested positive for anti-Ro52 antibodies. Patients positive for both autoantibodies had a higher prevalence of ILD (81.25% vs. 43.75%, p = 0.028), a higher frequency of ground-glass opacity (100% vs. 42.85%, p = 0.002) of HRCT findings, higher C-reactive protein levels (2.9 vs. 1.4 mg/L, p = 0.038), and were older (54.2 vs. 42.1 years, p = 0.021) than those without. Patients who were positive for the coexistence of anti-MDA5 and anti-Ro52 antibodies tended to have a lower survival rate, although this difference was not statistically significant (p = 0.124).

CONCLUSION: Individuals with IIM coexistence of anti-MDA5 and anti-Ro52 antibodies may experience a greater inflammatory response, higher ILD frequency, and poorer prognosis than those without.

KEY POINTS: • The coexistence of anti-MDA5 and anti-Ro52 antibodies in a small cohort of patients with IIM was found to be associated with a higher overall inflammatory features, including the presence of interstitial lung disease. • Coexistence of these antibodies and interstitial lung disease particularly relating to the radiological findings of ground glass opacities can be helpful in providing insights into evaluation and diagnostic pathways for clinicians. • A trend for a lower survival rate was observed for patients with the presence of these two antibodies than anti-MDA5 antibody alone.

PMID:40663261 | DOI:10.1007/s10067-025-07562-1

Langenbecks Arch Surg. 2025 Jul 15;410(1):222. doi: 10.1007/s00423-025-03799-1.

ABSTRACT

BACKGROUND: The impact of anastomotic leakage (AL) on quality of life (QoL) following low anterior resections (LAR) remains a pressing concern, particularly as advancements in surgical techniques and multimodal treatments have resulted in an increasing number of survivors.

METHODS: This study evaluated how AL affected health-related QoL in patients treated at the Department of Surgery, University hospital Mannheim of Heidelberg University from 2010 to 2021, utilizing the LARS score, the EORTC QLQ-C30, and the EORTC QLQ-CR29 questionnaires.

RESULTS: The study included 20 patients in each group, with those having AL matched 1:1 to control subjects without AL, based on criteria such as age, gender, comorbidities, tumor location, and resection degree. Both groups showed impaired QoL in EORTC assessments, with no statistically significant differences except in the abdominal pain scale of EORTC QLQ-CR29, which was higher for AL patients (19.99 ± 22.68 vs. 6.66 ± 17.43; p = 0.03). Comparison of QoL between patients who received neoadjuvant radiotherapy and those who did not, independent of AL, revealed significantly reduced QoL in several scales of both the EORTC QLQ-C30 and QLQ-CR29 assessments. A statistically significant worsening of QoL was observed in the sore skin domain (36.66±34.81 for RT vs. 3.70±11.11 without RT; p = 0.02) of the EORTC QLQ-CR29 among AL patients who received neoadjuvant radiotherapy. AL patients treated with Endoscopic Vacuum Therapy (EVT) showed improved QoL.

CONCLUSIONS: AL alone does not appear to be an independent risk factor for impaired QoL after LAR for rectal cancer. However, the combined effect of AL and neoadjuvant radiotherapy may contribute to worse functional outcomes, significantly impacting QoL. Effective AL management with EVT can help mitigate these effects and improve patient outcomes.

PMID:40663260 | DOI:10.1007/s00423-025-03799-1

Neurosurg Rev. 2025 Jul 15;48(1):567. doi: 10.1007/s10143-025-03686-9.

ABSTRACT

BACKGROUND AND OBJECTIVE: Cerebrospinal fluid leaks or fistulas are a relatively common neurosurgical pathology. Classically, this condition has been managed through an open surgical approach, but endoscopic surgery has emerged as a less invasive alternative with several advantages. Despite this, no meta-analysis has yet directly compared the clinical outcomes of these two management strategies.

METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. The PubMed, Embase, LILACS and Web of Science databases were rigoursly searched. Post-operative repair success rate, risk of recurrence and the risk of presenting any operation-related compilation and the all-cause mortality rate were analyzed. Data were analyzed using a common-effects meta-analysis, and statistical heterogeneity was assessed. The study was registered with PROSPERO (CRD42024606877).

RESULTS: Seven studies comprising 360 patients (140 endoscopic, 220 open) were included. Although the point estimate suggested a higher success rate with endoscopic repair, the difference was not statistically significant OR 1.32 (95% CI 0.55-3.16, I2 = 4.4%). The complication rate was significantly lower in the endoscopic group OR 0.26 (95% CI 0.10-0.67, I2 = 38%) and a leave-one-out analysis excluding the study by Gassner et al. found OR 0.10 (95% CI 0.03-0.32, I2 = 0%). Recurrence of CSF fistulas showed a trend favoring endoscopic repair (OR 0.78, 95% CI 0.42-1.43, I2 = 0%). No mortality was reported.

CONCLUSIONS: Endoscopic CSF fistula repair demonstrates a superior safety profile and is non-inferior in terms of efficacy compared to open surgery. Given the limited number of high-quality studies, further research is needed and larger, well-designed studies are recommended to refine clinical decision-making and optimize patient care.

PMID:40663243 | DOI:10.1007/s10143-025-03686-9