Nevin Manimala

Knee Surg Sports Traumatol Arthrosc. 2025 Jul 13. doi: 10.1002/ksa.12795. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.

METHODS: This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.

RESULTS: Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [p = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [p = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [p = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [p = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.

CONCLUSIONS: MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.

LEVEL OF EVIDENCE: Level III, case-control study.

PMID:40652370 | DOI:10.1002/ksa.12795

Ann Otol Rhinol Laryngol. 2025 Jul 12:34894251356306. doi: 10.1177/00034894251356306. Online ahead of print.

ABSTRACT

OBJECTIVE: We evaluated the 5-year graft success rate and incidence of iatrogenic cholesteatoma following endoscopic cartilage-perichondrium sandwich myringoplasty for the repair of large central tympanic membrane perforations.

MATERIALS AND METHODS: This retrospective study included patients with large central perforations who underwent endoscopic cartilage-perichondrium sandwich myringoplasty. Graft integrity and the presence of iatrogenic middle ear cholesteatoma were assessed at a 5-year postoperative follow-up.

RESULTS: In total, 86 patients were included in the final analysis. The mean follow-up duration was 6.4 ± 1.2 years (range, 5-7 years). The graft take rates were 96.5% at 3 months, 94.2% at 6 months, and 93.0% at 5 years postoperatively. At 6 months postoperatively, 2.44% of patients demonstrated no change in hearing, whereas 3.66% experienced a deterioration in conductive hearing. In the remaining 93.90% of patients, the improvement in hearing was statistically significant; the mean air-bone gap decreased from 25.1 ± 4.6 dB preoperatively to 14.9 ± 3.1 dB postoperatively (P < .05). At the 5-year follow-up, high-resolution computed tomography (HRCT) revealed well-pneumatized mastoid and middle ear cavities in 93.02% of patients, eliminating the need for magnetic resonance imaging (MRI). HRCT revealed soft tissue opacities in the mastoid region in 4 patients who had undergone canal wall up mastoidectomy (CWUM) and in 2 patients without CWUM; however, subsequent MRI excluded mastoid cholesteatoma in all 6 cases. Notably, a small graft cholesteatoma was detected in 1 patient (1.16%).

CONCLUSIONS: Five-year imaging follow-up demonstrated that endoscopic cartilage-perichondrium sandwich myringoplasty, performed without removal of the epithelium from the tympanic membrane remnant, achieved a stable graft success rate in the repair of large central perforations. The procedure was associated with a minimal risk of graft cholesteatoma and no observed risk of middle ear cholesteatoma.

PMID:40652319 | DOI:10.1177/00034894251356306

Phys Ther. 2025 Jul 13:pzaf093. doi: 10.1093/ptj/pzaf093. Online ahead of print.

ABSTRACT

IMPORTANCE: Identifying patients most likely to benefit from physical therapy in the hospital could aid physical therapists in optimizing treatment allocation for the purpose of increasing discharge to home.

OBJECTIVE: The aims of this study were to develop and externally validate a predictive model for discharge to home on the basis of physical therapy frequency for patients who were hospitalized.

DESIGN: A predictive model was developed using retrospective cohort data collected between April 2017 and August 2022, with external validation conducted in a separate sample.

SETTING: The setting was a large health system.

PARTICIPANTS: Participants were adult patients who were hospitalized and received physical therapy.

MAIN OUTCOME AND MEASURES: Predictors were extracted from the electronic health record and included demographics, clinical characteristics, and therapist-entered variables such as home set-up and prehospital level of function. Physical therapy frequency was quantified as once daily, defined as ≥5 times per week. The outcome was discharge to home. Variables were included in the final multivariable logistic regression model on the basis of associations with physical therapy frequency and/or outcome and clinical relevance. Calibration and discrimination of the models were assessed.

RESULTS: The development sample included 205,659 adult patient (average age = 72.2 [SD = 14.3] years; 55.3% female) hospitalizations, with 52.5% of patients receiving physical therapy daily and an overall proportion of 67.1% being discharged to home. The final multivariable model included 8 variables, with good calibration and discrimination. Internal validity was established with an optimism-corrected concordance statistic of 0.874 (95% CI = 0.872-0.875). The external sample included 102,311 patient (average age = 67.7 [SD = 16.5] years; 50.9% female) admissions, with 64.5% of patients receiving physical therapy daily and 77.8% being discharged to home. Predictive performance was high (calibration slope = 0.908), and discrimination was good (concordance statistic = 0.851).

CONCLUSIONS AND RELEVANCE: This study developed and externally validated the underlying prediction model for a clinical decision support tool, termed Physical Therapy Frequency Clinical Decision Support Tool (PT-PENCIL), to identify patients most likely to benefit from daily physical therapy to discharge to home. Future work will evaluate the implementation of PT-PENCIL to determine its effect on patient-centered outcomes.

PMID:40652311 | DOI:10.1093/ptj/pzaf093

Sleep. 2025 Jul 13:zsaf194. doi: 10.1093/sleep/zsaf194. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Large muscle group movements during sleep (LMMS) have recently been recognized as a prevalent feature in patients with Restless Legs Syndrome (RLS), yet their autonomic profile remains insufficiently characterized. This study aimed to compare heart rate (HR) changes associated with LMMS to those accompanying short-interval (SILMS), periodic (PLMS), and isolated leg movements (ISOLMS) during non-REM sleep in RLS.

METHODS: Thirty drug-free RLS patients (20 women, mean age 57.6 ± 12.73 years) underwent full-night polysomnography. For each subject, five arousal-associated events per movement type were selected, provided they were isolated by at least 30 seconds of motor/arousal-free sleep. HR changes were analyzed by computing R-R intervals and expressing them as a percentage of baseline, synchronized to movement onset. The area under the curve (AUC, -10 to +20 s), HR change peak, and movement durations were statistically compared using non-parametric tests.

RESULTS: LMMS were significantly longer than other movement types (mean duration: 9.3 s vs. <3.0 s for others) and induced the highest HR response (peak: 129.6%, AUC: 369.3%), followed by SILMS (peak: 125.4%, 266.3%), ISOLMS (peak: 118.2%, 173.4%), and PLMS (peak: 118.5%, 166.9%). SILMS and LMMS were associated with rapid and sustained HR increases, without post-peak bradycardia, while PLMS and ISOLMS showed a modest transient bradycardia following the peak.

CONCLUSIONS: LMMS are associated with strong autonomic activation indicating parasympathetic withdrawal and/or sympathetic activation, distinguishing them from other sleep-related leg movements in RLS. The absence of post-peak bradycardia suggests reduced parasympathetic buffering, potentially reflecting more sustained arousal mechanisms.

PMID:40652310 | DOI:10.1093/sleep/zsaf194

J Burn Care Res. 2025 Jul 13:iraf137. doi: 10.1093/jbcr/iraf137. Online ahead of print.

ABSTRACT

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin (Hb), vaso-occlusive crises, and hemolytic anemia. Hydroxyurea has been proven effective in managing SCD but is associated with non-healing skin ulcers. Additionally, its effects on wound healing in burn patients remain unclear. This study investigates the role of hydroxyurea in mortality, wound infection, wound disruption, and sepsis among SCD patients with burn injuries. Using the TriNetX database, cohorts were identified based on ICD-10 codes for adult patients aged 18 years or older diagnosed with SCD, previous burn injury, and hydroxyurea use. Propensity score matching was performed for demographics (age, sex, race, ethnicity), comorbidities that affect wound healing, and clinical variables (burn severity and SCD severity). Mortality, wound infection, wound disruption, and sepsis were assessed at 30 days, three months, and six months post-burn injury. Statistical methods such as chi-square analysis and risk ratio were used, with a statistical significance at p<.05. Hydroxyurea cohort had significantly higher risk for wound healing outcomes such as wound disruption, wound infection, and recurrent sepsis at each time outcome. However, hydroxyurea cohort had significantly lower risk of mortality compared to control group at each time outcome. This study highlights the need of considering hydroxyurea’s impact on wound healing when developing treatments for SCD patients with burn injury. Further research is needed to investigate its mechanism in wound healing processes and develop safer treatment alternatives.

PMID:40652301 | DOI:10.1093/jbcr/iraf137

J Burn Care Res. 2025 Jul 13:iraf130. doi: 10.1093/jbcr/iraf130. Online ahead of print.

ABSTRACT

Patients with severe burns are more vulnerable to infection, sepsis, and death. With heavy use of antimicrobials, changes in burn wound microbial and antibiotic resistance patterns have been reported; however, the literature remains scarce. This study assessed wound colonization trends in first positive cultures in our burn unit over the last decade. This is a retrospective cohort study including all patients admitted to our burn unit from July 2013 to June 2023. Demographics, total burn surface area (TBSA), injury mechanism and admission information were obtained. Wound culture information including date of positive cultures, type of organisms, and antibiotic susceptibility data was also collected. Patients were stratified based on TBSA as small (<10%), moderate (10-19.9%), and severe burns (≥20%). Descriptive statistics were obtained. Generalized linear models were fit to assess the trends of positive cultures over time for the three TBSA strata. A total of 2755 patients were included; median age was 38 years, 72.2% were male; 74.1%, 15.9%, and 10.1% presented with small, moderate, and severe burns, respectively. Wound cultures on initial presentation were performed in 40.3% of our population with 600 cases having positive first cultures; 84.7% grew Gram positive, 35.7% Gram negative, and 9.7% fungal organisms. Data showed an increase in Gram positive and fungal species over the study period in first positive cultures of severe burn patients. We also found increasing rates of resistance for several antibiotics, including erythromycin, oxacillin, and vancomycin. Future studies are warranted to evaluate changes in microorganism growth throughout the hospital course of severe burn patients.

PMID:40652297 | DOI:10.1093/jbcr/iraf130

J Cannabis Res. 2025 Jul 12;7(1):43. doi: 10.1186/s42238-025-00307-6.

ABSTRACT

INTRODUCTION: The use of medicinal cannabis is increasing worldwide and has applications in managing a wide range of conditions, including neurological, rheumatological, and gastrointestinal diseases. Despite its growing prevalence, there are limited data on patterns of cannabis prescription across varying disease groups and demographic subgroups.

METHODS: This retrospective observational cohort study analysed cannabis usage patterns among 263 patients from the cannabis user clinic at Rabin Medical center (RMC), a tertiary hospital in Israel. To minimise the inclusion of recreational cannabis users, only patients aged 30 years and older were included. Patients were categorised into three groups based on their primary medical condition: neurological (n = 63), rheumatological (n = 106), and gastrointestinal (n = 94). Data collected included: demographic information, cannabis dosage, Tetrahydrocannabinol (THC) content, cultivated variety preference (sativa vs. Indica), and method of consumption (smoking vs. oil). Statistical analyses were conducted using ANOVA, Kruskal-Wallis, chi-square, and t-tests to compare cannabis prescription patterns between disease and demographic groups.

RESULTS: Significant differences in cannabis prescription patterns were observed across disease groups. Patients with gastrointestinal conditions were prescribed the highest mean monthly cannabis dose (22.26 ± 13.60 g), while those with neurological conditions had the highest oil consumption (31.75%). Sex-based differences were notable, with male patients being prescribed significantly higher doses of cannabis (25.48 ± 15.15 g) and higher THC content (14 ± 6.56%) compared to female patients (17.32 ± 9.93 g; THC: 11.39 ± 6.48%).

DISCUSSION: The study highlights variations in cannabis prescription patterns based on both medical conditions and demographic factors. Male patients received higher doses and THC-rich formulations, while patients with gastrointestinal conditions had the highest cannabis prescription overall. These findings suggest the need for individualised cannabis therapy based on patient characteristics and the specific condition being treated.

CONCLUSION: Medicinal cannabis usage patterns vary significantly across disease and demographic groups. Personalised cannabis treatment plans, informed by both clinical and demographic factors, are essential to optimising patient outcomes. Further research is needed to develop more precise guidelines for prescribing medicinal cannabis.

PMID:40652292 | DOI:10.1186/s42238-025-00307-6

BMC Nutr. 2025 Jul 12;11(1):138. doi: 10.1186/s40795-025-01115-0.

ABSTRACT

BACKGROUND: The global prevalence of type 1 diabetes mellitus (T1DM) is steadily increasing, particularly among children and young adults. Health-related myths can significantly influence patients’ dietary behaviors and treatment adherence, thereby compromising disease management and metabolic outcomes.

METHODS: This cross-sectional study included 190 adolescents and young adults with T1DM attending a pediatric endocrinology outpatient clinic. Data on demographics, BMI, HbA1c values, and nutrition-related myths were collected through face-to-face interviews. Statistical analyses, including chi-square tests and Spearman correlation coefficients, were performed using SPSS 22.0 software. Logistic regression analysis was conducted to identify independent predictors of metabolic control status (p < 0.05).

RESULTS: Participants had a mean diabetes duration of 7.5 ± 4.63 years, with a mean HbA1c of 7.9 ± 1.44%. Approximately 27.0% of adolescents and 20.0% of young adults were overweight or obese. Only 29.0% of individuals had good metabolic control (HbA1c <%7), while 71.0% had HbA1c ≥ 7. An increase in diabetes duration was found to elevate the risk of poor metabolic control by 1.107 times, whereas a higher total number of answers was associated with a 0.696-fold decrease in this risk (p < 0.05).

CONCLUSION: Improved knowledge about nutrition myths is associated with better metabolic control among adolescents and young adults with T1DM. Structured education programs tailored to this population may contribute to improved glycemic outcomes. A multidisciplinary team approach is essential to effectively deliver educational content and reinforce evidence-based dietary practices.

PMID:40652289 | DOI:10.1186/s40795-025-01115-0

J Orthop Surg Res. 2025 Jul 12;20(1):644. doi: 10.1186/s13018-025-06054-x.

ABSTRACT

BACKGROUND: Early physical therapy (PT) following ACL reconstruction is widely advocated for optimizing post-operative recovery. However, its impact on functional recovery, proprioception, return-to-sport (RTS) rates, and graft integrity remains debated. This study aims to evaluate whether early PT initiation enhances functional and proprioceptive outcomes without compromising knee stability.

OBJECTIVES: To compare the effects of early (≤ 2 weeks) vs. delayed (≥ 4 weeks) PT initiation on functional recovery, proprioception, RTS success, and graft integrity following ACL reconstruction.

METHODS: A cross-sectional study included 132 participants (n = 66 per group) who were evaluated using standardized assessments, including IKDC scores, quadriceps strength (hand-held dynamometer), knee range of motion (digital inclinometer), proprioception (joint position sense error, Y-Balance Test, and postural stability via force platform), RTS success, and graft integrity (Lachman and Pivot-Shift tests). All outcome measures were assessed between 6 and 12 months post-operatively during routine clinical follow-up, providing a standardized timeframe for evaluating recovery and RTS readiness.

RESULTS: The early PT group demonstrated significantly higher IKDC scores (85.60 ± 6.80 vs. 80.40 ± 7.30, p < 0.001), greater quadriceps strength (2.30 ± 0.40 vs. 2.00 ± 0.50 Nm/kg, p = 0.001), and improved knee ROM (135.20 ± 4.80° vs. 130.80 ± 5.20°, p < 0.001). The proprioceptive function was superior in early PT, with lower JPS error (p < 0.001), higher Y-Balance scores (p = 0.001), and greater postural stability (p < 0.001). RTS rates were higher in the early PT group (78.79% vs. 65.15%), but the difference was not statistically significant (p = 0.121). No significant differences were observed in graft integrity (p = 0.715) or knee stability tests (p > 0.05).

CONCLUSION: Early PT initiation significantly enhances functional recovery and proprioception without increasing the risk of graft failure or knee instability. These findings support the safety and efficacy of early rehabilitation in optimizing post-operative ACL recovery and RTS readiness.

PMID:40652287 | DOI:10.1186/s13018-025-06054-x

BMC Psychol. 2025 Jul 12;13(1):784. doi: 10.1186/s40359-025-03114-z.

ABSTRACT

BACKGROUND: In educational practice, the interaction between students’ learning behaviors and psychological states is crucial. Learning engagement reflects the degree of active participation in learning activities, academic self-efficacy embodies students’ confidence in their own learning abilities, and learning anxiety may affect students’ academic performance and mental health.

PURPOSE: This study aims to break through traditional linear thinking by using Latent Profile Analysis to identify heterogeneous groups of high school students in terms of learning engagement, reveal differences in their learning anxiety and nonlinear characteristics, and validate the differentiated mediating mechanism of academic self-efficacy between learning engagement and anxiety. It fills the theoretical gap from the perspective of group heterogeneity and provides a basis and support for constructing a learning psychological theory model and precise stratified intervention in educational practice.

METHODS: In this study, the method of cluster convenience sampling was adopted. Three ordinary high schools in a city of Hubei Province were selected, and students from six classes in each grade from the first year to the third year of senior high school were sampled as the research subjects. A total of 1,008 original questionnaires were obtained, and 936 valid questionnaires were collected. LPA was employed to identify the potential categories of high school students’ learning engagement and the impact of these categories on learning anxiety. Additionally, the mediating role of academic self-efficacy between different types of learning engagement and learning anxiety was examined based on the classification results. Furthermore, a generalized additive mixed model was used to analyze the linear relationships between different types of learning engagement, academic self-efficacy, and learning anxiety.

RESULTS: Learning engagement can be categorized into four types, among which students with “High Vigor-High Dedication-High Absorption” type exhibit the highest levels of learning anxiety. Academic self-efficacy plays a mediating role between various types of learning engagement and learning anxiety. Moreover, for students with “Medium Vigor-Low Dedication-High Absorption” type, as well as those with “Low Vigor-Medium Dedication-Medium Absorption” type, there exists a non-linear relationship between learning engagement and both academic self-efficacy and learning anxiety.

CONCLUSIONS: This study reveals the heterogeneous characteristics of learning engagement and its differentiated impact on learning anxiety. Furthermore, the study finds that the relationship between learning engagement types and self-efficacy and learning anxiety exhibits a nonlinear characteristic with a turning point, breaking through the traditional assumption of a linear relationship and revealing the possible existence of a ‘threshold effect’ in changes in learning engagement levels.

IMPLICATIONS: This study divides high school students’ learning engagement into four potential categories through LPA, breaking away from traditional single-dimensional or dichotomous research perspectives and providing categorical empirical evidence for learning engagement theory, which fills a gap in the sufficient segmentation of groups with moderate engagement levels.

PMID:40652283 | DOI:10.1186/s40359-025-03114-z