Nevin Manimala

Sci Rep. 2025 Jul 6;15(1):24115. doi: 10.1038/s41598-025-09362-8.

ABSTRACT

The cortical thickness index (CTI) is a radiological measure and correlates with diminishing local bone quality in the proximal femur. The objective of this study was to assess the association between a lower CTI and the occurrence of peri- and postoperative surgical complications. A total of 228 consecutive patients treated with endomedullary nailing for trochanteric fracture (TFx) (AO/OTA 31A1.1-31A2.3) (n = 99) and hemi-/total hip arthroplasty for femoral neck fracture (AO/OTA 31B1-B3) (FNFx) (n = 129) with a mean age of 82 ± 9.9 (50-99) years were retrospectively reviewed. An evaluation of these cases was conducted to ascertain the presence of any surgery-related complications. Eighteen patients (7.9%) undergoing revision surgery were identified. Patient demographics and radiographic measurements of these groups were compared to the cases without complications (n = 210) and statistically analysed. A total of 18 patients (7.9%) with complications who underwent revision surgery were identified. Among the total number of patients, 10 (55.6%) exhibited mechanical complications. The remaining patients underwent a subsequent revision due to infection (n = 4), seroma/hematoma (n = 3), or a running wound (n = 1). The FNFx group exhibited a lack of intraoperative fractures; however, two periprosthetic fractures occurred subsequent to another fall (36 and 59 days postoperatively). A total of five incisions or extractions of the helical blade were identified in the TFx group. The following factors contributed to the necessity for revision: tractus irritation (n = 2), one intraoperative fracture, one running wound, and one seroma. Among all of the variables that were analyzed, including age, body mass index, and hemoglobin level, only the CTI of the affected side in the TFx group was found to be significantly higher in the complications group, as well as the mechanical complications group (0.51 ± 0.09, 0.58 ± 0.05, 0.58 ± 0.05; p = 0.029). Poor local bone quality, as indicated by a low CTI, is not associated with increased complication rates following surgically managed proximal femoral fractures. Instead, the predominant contributors to mechanical complications seem to emanate from alternative factors, such as insufficient fracture reduction and suboptimal blade positioning.

PMID:40619545 | DOI:10.1038/s41598-025-09362-8

J Robot Surg. 2025 Jul 7;19(1):357. doi: 10.1007/s11701-025-02533-9.

ABSTRACT

The recent meta-analysis by Liu et al. comparing postoperative functional complications and quality of life (QoL) between robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) in localized prostate cancer raises important clinical questions but is constrained by methodological and interpretative limitations. Our commentary identifies four key issues: (1) inadequate adjustment for baseline confounding factors such as age, comorbidities, and androgen deprivation therapy exposure; (2) unstandardized aggregation of patient-reported outcome measures (PROMs), impairing statistical comparability; (3) absence of modality-specific stratification within the RT group, which combines external beam and brachytherapy despite differing toxicity profiles; and (4) overinterpretation of functional outcome trends without accounting for follow-up duration and evolving surgical techniques. These issues undermine the validity of the authors’ conclusions regarding RT’s superiority in functional recovery. We argue that future comparative effectiveness research should employ harmonized PROM frameworks, robust causal inference methodologies, and biologically stratified cohort analyses. Our critique underscores the need for precise, individualized assessment in treatment decision-making for localized prostate cancer and supports the broader scientific imperative for methodologically sound patient-centered outcomes research in robotic and radiotherapeutic oncology.

PMID:40619543 | DOI:10.1007/s11701-025-02533-9

Support Care Cancer. 2025 Jul 6;33(7):661. doi: 10.1007/s00520-025-09649-6.

ABSTRACT

PURPOSE: To investigate the clinical characteristics and risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) and to introduce two metrics-equivalent dose (ED) and threshold dose (TD)-as predictive risk assessment tools.

METHODS: In this cross-sectional study, 193 patient records were reviewed from Shahab Dental Clinic and the Oral Medicine Department of Mashhad Dental School (2017-2023). Patients were categorized according to MRONJ stage (0-3) or as “at-risk.” Demographic data, comorbidities, clinical manifestations, and detailed medication profiles were collected. ED for each medication was standardized to the cumulative dose of four years of weekly oral alendronate use (4 × 52 × 70 mg = 14,560 mg). TD was defined as one unit of this ED and served as a cumulative risk cut-off. Statistical analyses included T-tests, ANOVA, and Chi-square tests.

RESULTS: MRONJ was identified in 40.4% of cases, while 59.6% were classified as at-risk. Advanced stages were significantly associated with higher ED, prolonged medication use, and key risk factors, including oncologic diseases, medication type and route of administration, comorbidities, age, and surgical interventions such as extractions and ill-fitting dentures (P < 0.001). The novel metrics demonstrated strong predictive value. ED values were significantly higher in zoledronic acid users compared to denosumab users (2.40 [1.05, 6.00] vs. 1.23 [0.75, 2.37], P < 0.001), and positively correlated with MRONJ severity (R = 0.46, P < 0.001). The odds ratio for MRONJ associated with ED was 1.17 (95% CI: 1.06-1.30).

CONCLUSION: This study offers critical insights into MRONJ risk stratification, highlighting the cumulative impact of medication dose alongside clinical risk factors. The introduction of ED and TD represents a transformative advancement in MRONJ risk prediction, enabling precise prevention strategies and guiding clinical management toward standardized care protocols.

PMID:40619534 | DOI:10.1007/s00520-025-09649-6

Eur Spine J. 2025 Jul 7. doi: 10.1007/s00586-025-09055-w. Online ahead of print.

ABSTRACT

PURPOSE: Spinopelvic fixation surgery is widely used for adult spinal deformity, but its impact on hip joint pathology remains unclear. This study investigates its association with femoroacetabular impingement syndrome (FAIS) using ultrasonography.

METHODS: This retrospective study included 80 patients (160 hips) who underwent spinal fusion for adult spinal deformity. Patients were categorized based on sacroiliac joint fixation into fixation (group F) and non-fixation (group N). Ultrasonography was performed to assess hip morphology, including labral degeneration, cam lesions, and acetabular osteophytes. The Kellgren-Lawrence (KL) grade, and alpha angle were measured on standing radiographs. The anterior impingement test was conducted to evaluate clinical symptoms, and prevalence was statistically compared.

RESULTS: We analyzed 151 hips (26 males, 125 females) with a mean follow-up of 52.7 ± 39.6 months. After excluding 27 hips with advanced hip osteoarthritis (KL grade ≥ 2), labral degeneration (69.5% vs. 37.9%, p = 0.0076) and cam lesions (30.5% vs. 6.9%, p = 0.01) were significantly more prevalent in group F than group N. The mean alpha angle did not significantly differ between two groups at the time of surgery, but significantly greater in group F compared to group N (48.7 ± 3.9° vs. 46.7 ± 4.7°, p = 0.01) at final follow-up.

CONCLUSION: Spinopelvic fixation may contribute to FAIS-related hip abnormalities by increasing mechanical stress. Ultrasonography may aid in early detection of hip joint changes after adult spinal deformity surgery.

PMID:40619521 | DOI:10.1007/s00586-025-09055-w

Sci Rep. 2025 Jul 7;15(1):24158. doi: 10.1038/s41598-025-09458-1.

ABSTRACT

The aim of this research was to evaluate the effects of exercise training on mobility, balance and gait parameters, with a particular emphasis on the timed up and go test (TUG), the Berg Balance Scale (BBS), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT). A systematic search was conducted across several databases, namely Web of Science, Embase, PubMed, and the Cochrane Library for randomized controlled trials (RCTs), to evaluate the effects of exercise interventions on mobility, balance and gait in chronic stroke patients. After rigorous screening, 13 RCTs with both experimental and control groups (193/190 participants) were found eligible for inclusion. The meta-analysis demonstrated significant improvement in the mobility ability, as measured by TUG test after exercise intervention (MD = – 4.81, p < 0.01, 95% CI [- 8.23 to – 1.38]). Furthermore, exercise effectively enhanced the balance ability, as measured by the BBS, among chronic stroke patients (MD = 3.81, p < 0.01, 95% CI [1.98-5.64]). However, no statistically significant impact of exercise training was observed on the 6MWT (SMD = 0.00, p > 0.05, 95% CI [- 0.24 to 0.25]) or 10MWT (SMD = 0.03, p > 0.05, 95% CI [- 0.07 to 0.12]). Exercise training interventions significantly increased mobility and balance scores in chronic stroke patients. However, they had no effect on gait scores. The results of further subgroup analysis show that aerobic training (AT) has a significant effect in enhancing the activity ability index of patients, while resistance training (RT) shows an obvious advantage in improving the balance index evaluated by the Berg Balance Scale (BBS).

PMID:40619517 | DOI:10.1038/s41598-025-09458-1

Sci Rep. 2025 Jul 6;15(1):24149. doi: 10.1038/s41598-025-08741-5.

ABSTRACT

Brucellosis, a prevalent zoonotic disease, induces substantial economic losses in livestock due to reproductive impairments and high mortality rates; it also presents considerable public health concerns worldwide. The current work highlights the potential application of the developed lateral flow immunochromatographic assay (LFIA) in the rapid and accurate detection of Brucella spp., underscoring its significance in disease management and control. The study investigated the purity of the extracted B. abortus smooth lipopolysaccharides-O (S-LPS-O) using high-performance liquid chromatography (HPLC). Moreover, it delved into the development and assessment of a novel diagnostic kit for Brucella using a recombinant protein A-lateral flow assay in comparison to the RBPT, SAT, MRT, I-ELISA as screening tests, also to C-ELISA, CFT as confirmatory tests. HPLC analysis indicated a distinctive absence of impurities in the extracted S-LPS-O, contrasting with the three peaks observed in the commercial LPS chromatogram. Sensitivity, specificity, and accuracy evaluations were performed, with the LFIA demonstrating promising results, showcasing its potential as a reliable diagnostic tool. Statistical analysis of the LFIA, RBPT, SAT, MRT, ELISA, CFT, and PCR results revealed notable sensitivity, specificity, and accuracy rates, affirming the diagnostic efficacy of the LFIA. The novel layout of the LFIA and the purity of extracted S-LPS-O showcased significant progress in the diagnostic capabilities of the developed LFIA. Moreover, the currently developed LFIA introduces a rapid and reliable diagnostic tool, particularly in resource-limited settings, owing to its ease of use and minimal equipment requirements with its competitively obtained results.

PMID:40619514 | DOI:10.1038/s41598-025-08741-5

Sci Rep. 2025 Jul 6;15(1):24103. doi: 10.1038/s41598-025-09807-0.

ABSTRACT

To compare efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in subjects with type 2 diabetes (T2DM). Electronic databases were searched from inception to 2nd October 2024 for randomised controlled trials comparing GLP-1RAs treating T2DM. Bayesian network meta-analyses were conducted to analyze metabolic and safety outcomes. 64 trials comprising of 25,572 participants were identified. Compared to placebo, tirzepatide showed the greatest reduction in HbA1-c (MD: -2.3%) and FPG (MD: -3.1mmol/L); semaglutide was second (HbA1-c: MD: -1.5%; FPG: MD: -2mmol/L); liraglutide was third (HbA1-c: MD: -1.2% FPG: MD: -1.6mmol/L) (P<0.05). All treatments showed no statistically significant differences in BMI, SBP, DBP, TC, HDL-C and LDL-C compared to placebo. Tirzepatide (MD: -9.1 kg), semaglutide (MD: -2.8 kg) and liraglutide (MD: -1.2 kg) (P<0.05) had significant reduction in body weight compared to placebo. GLP-1 RAs had higher risk of gastrointestinal symptoms. Semaglutide increased the risk of hypoglycemia compared to placebo while liraglutide reduced the risk of hypoglycemia compared to traditional antidiabetic drugs. GLP-1RAs improve glycaemic control, with tirzepatide, semaglutide and liraglutide exhibiting the most significant improvements. Tirzepatide is more suitable for treating T2DM with obesity. For individuals with normal weight, both semaglutide and liraglutide are generally more effective for treating T2DM. However, considering the potential for semaglutide to cause hypoglycemia, liraglutide may be the optimal choice for T2DM treatment to minimize the risk of hypoglycemia.

PMID:40619508 | DOI:10.1038/s41598-025-09807-0

Acta Neurol Belg. 2025 Jul 7. doi: 10.1007/s13760-025-02803-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) poses a large burden and cost on the patients, being among the most prevalent causes for emergency department visits. One of the major issues with TBI is the long-term functional outcome of patients, causing disabilities affecting the patient and the surrounding members of society. Several attempts have been made in order to address functional outcomes via means such as pharmacotherapy, physical therapy, and newer methods. In this study, we aimed to conduct a double-blinded, randomized controlled trial with the administration of methylphenidate and amantadine, two drugs proven effective separately in previous studies, to evaluate the functional outcome of patients with blunt TBI.

METHODS: Patients with blunt TBI were randomly assigned into treatment and control groups. Patients in the treatment group received 100 mg of amantadine and 20 mg of methylphenidate twice daily while patients in the control group received similarly shaped placebos. The patients age, gender, GCS, ICU and hospital length of stay and GOSE were evaluated and calculated for evaluation of outcome and initial condition. The main target was GOSE evaluated 6 months after discharge.

RESULTS: A total of 184 patients were included in our study, randomly and equally divided into the treatment and control groups. The mean age of patients was 40.63 ± 17.46, and 84.8% of patients were male. There was no significant difference between the two groups’ age, gender, and initial GCS. Regarding outcome measures, there was no statistical difference between the groups in hospital and ICU length of stay. GOSE was significantly higher in patients in the treatment group (6.22 ± 2.06 vs. 5.37 ± 2.54, p = 0.014).

CONCLUSION: Co-administering methylphenidate and amantadine could help patients with blunt TBI, especially in long-term settings, regarding their functional outcome.

PMID:40619501 | DOI:10.1007/s13760-025-02803-1

Environ Geochem Health. 2025 Jul 6;47(8):300. doi: 10.1007/s10653-025-02624-4.

ABSTRACT

Disordered abandoned mines across the vast grasslands of Inner Mongolia have triggered the widespread dispersion of Potentially Toxic Elements, threatening the integrity of the ecological security barrier within the Yellow River Basin. This study employed multivariate statistical analysis, ecological risk index, geo-accumulation index, Principal Component Analysis, and the Positive Matrix Factorization model to analyze PTEs in agricultural soils surrounding abandoned mines of diverse mineral types. Revealed the unique pollution characteristics of abandoned mines of different mineral types. Metal mines surrounding soils exhibited significant exceedances of As, Cu, Pb, and Ni concentrations (averaging 1.37, 1.94, 1.47, and 1.51 times background values, respectively). Sand and gravel mines Cd and Hg levels were notably elevated (averaging 4.86 and 2.25 times background values). Other mines dominated by enrichment of As and Zn (average concentrations 1.5 and 1.4 times background values). Coal mines showed relatively higher concentrations only for Pb and Zn (averaging 1.48 and 1.38 times background values). Clay mines demonstrated minimal environmental impact in comparison. Pollution and ecological risk assessments identify metal mines and sand and gravel mines as the predominant pollution sources requiring prioritized control of Cd, Cu, Hg, As, Pb, and Ni migration-particularly Cd. Extremely high-risk area concentrated in northwest-eastern sand and gravel mining corridors, where Cd-Hg synergistic pollution posed critical ecological threats. Source analysis via PMF identified mining activities as the primary contributor. The resolved sources and their contributions are mining activities (21.83%), agricultural activities (12.02%), transportation emissions (13.42%), atmospheric deposition (19.90%), and mining activities and natural sources (32.83%). These findings provide novel perspectives and strategies for refining mine pollution remediation and fostering coordinated development with ecological conservation in the Yellow River Basin.

PMID:40619497 | DOI:10.1007/s10653-025-02624-4

Sci Rep. 2025 Jul 6;15(1):24126. doi: 10.1038/s41598-025-09469-y.

ABSTRACT

Musculoskeletal pain is a leading cause of seeking care and imposes an immense economic burden to the healthcare systems. The guidelines recommend physical activity for managing musculoskeletal pain but do not differentiate between occupational and leisure-time physical activity. Research indicates that occupational physical activity may not have similar health benefits as leisure-time physical activity. Thus, we investigated the association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization. At baseline, physical activity data (sitting, standing, light physical activity, moderate-to-vigorous physical activity and time in bed) were collected from 824 blue-collar workers using a thigh-worn accelerometer during work and leisure for up to five days. Musculoskeletal-related primary healthcare utilization (i.e., contacts with general practitioners, physiotherapists and specialists) was retrieved from the Danish National Health Services Registry during a 4-year follow-up from baseline. The association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization was analyzed using a generalized linear model adjusted for potential confounders. During follow-up, 62%, 42% and 10% of the workers had at least one musculoskeletal-related contact to the general practitioner, physiotherapist and specialist, respectively. Leisure-time moderate-to-vigorous physical activity was associated with a decreased risk of a general practitioner contact (RR = 0.78; p value = 0.02), a tendency for a decreased risk of a physiotherapist contact (RR = 0.83; p value = 0.23), but with a tendency for increased risk of a specialist contact (RR = 1.49; p value = 0.20). On the contrary, occupational moderate-to-vigorous physical activity was not associated with a decreased risk of a general practitioner contact (RR = 1.04; p value = 0.75), physiotherapist contact (RR = 1.00; p value = 0.99) or a specialist contact (RR = 1.80; p value = 0.05). Our findings indicate that the domain of physical activity is of importance for musculoskeletal-related primary healthcare utilization. While leisure-time physical activity was associated with a decreased risk of a general practitioner and physiotherapist contact, occupational physical activity was not associated with such benefits.

PMID:40619493 | DOI:10.1038/s41598-025-09469-y