Nevin Manimala

Updates Surg. 2025 Jun 21. doi: 10.1007/s13304-025-02287-x. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the safety, efficacy, and economic outcomes of ambulatory with inpatient gasless trans-axillary endoscopic unilateral thyroidectomy (GTEUT).

METHODS: Data were collected from patients who underwent GTEUT in the day surgery or inpatient wards of Xiangya Hospital, Central South University, between January 1, 2021, and January 1, 2024. All surgeries were performed by the same experienced surgical team, using identical inclusion and exclusion criteria.

RESULTS: A total of 458 patients were included in the study, with 322 in the ambulatory GTEUT group and 136 in the inpatient GTEUT group. The overall incidence of postoperative complications was lower in the ambulatory GTEUT group (7.76%) compared to the inpatient GTEUT group (10.29%), although the difference was not statistically significant. Hospitalization expenses in the ambulatory GTEUT group were reduced by approximately 29% compared to the inpatient group, with a statistically significant difference (p < 0.001). The length of hospital stay was significantly shorter for ambulatory group, who were discharged within 24 h (1.01 ± 0.10 days) compared to the inpatient group (5.76 ± 1.64 days) (p < 0.001). Anxiety and depression levels were higher in the ambulatory GTEUT group compared to the inpatient group, with the difference being statistically significant.

CONCLUSION: Ambulatory GTEUT is a safe alternative to inpatient surgical methods. It offers the advantages of shorter hospital stays and improved economic benefits. However, the mental health of patients undergoing daytime surgeries requires further attention.

PMID:40543009 | DOI:10.1007/s13304-025-02287-x

Rev Endocr Metab Disord. 2025 Jun 21. doi: 10.1007/s11154-025-09981-6. Online ahead of print.

ABSTRACT

Cardiovascular autonomic neuropathy (CAN) is a serious and prevalent complication of diabetes, linked to significant morbidity and mortality. Continuous glucose monitoring systems (CGM) provide a comprehensive and continuous glucose profile, enabling precise assessment of glycemic variability, hypoglycemia, and other key glucose metrics. Despite the increasing use of CGM, the relationship between CGM-derived metrics and CAN risk has yet to be rigorously evaluated. A systematic search of PubMed, Cochrane Library, Web of Science, Medline, and Embase was conducted up to 30 September 2024. Eligible observational studies assessed the association between CGM metrics and CAN in diabetic adults, using ORs with 95% CIs. Heterogeneity was evaluated via Cochrane’s Q and I² statistics, and meta-analysis was performed when at least three studies provided comparable CGM metrics and outcomes. Sixteen studies involving 1,814 participants were included in the systematic review. Among these, four studies each for coefficients of variation (CV) and standard deviation (SD), and five studies for mean amplitude of glycemic excursions (MAGE) provided data suitable for meta-analysis. Higher CV (OR 1.08; 95% CI 1.04-1.12) and SD (OR 1.03; 95% CI 1.01-1.06) were significantly associated with increased CAN risk, whereas MAGE was not significantly associated (OR 1.01; 95% CI 0.99-1.03). Other metrics such as time in range (TIR), time above/below range (TAR/TBR), and low blood glucose index (LBGI) showed inconsistent results across studies and were synthesized narratively. Higher glycemic variability, notably CV and SD, is linked to increased CAN risk in patients with diabetes. Monitoring CGM metrics may aid early detection and management of CAN. Further high-quality longitudinal studies are warranted.

PMID:40543000 | DOI:10.1007/s11154-025-09981-6

Musculoskeletal Care. 2025 Jun;23(2):e70146. doi: 10.1002/msc.70146.

ABSTRACT

The aim of this study is to describe patient experiences with the dietetic service in a multidisciplinary orthopaedic physiotherapy screening clinic for the management of osteoarthritis, specifically nutrition-related indicators of success, such as changes to weight and diet. A retrospective observational medical chart audit was conducted of patients with osteoarthritis within the dietetic clinic over a 12-month period in a large, urban setting in Australia. In total, 38 patients met the inclusion criteria; 68% were female. Patients spent an average of 182 days in dietetics care, with an average of 5 appointments per patient. Approximately one-third (32%) of patients achieved a clinically significant weight loss (> 5% of body weight), 58% had no change in weight, and 11% of patients gained weight (> 5% of body weight). Of patients in the successful weight loss group, 50% had been advised to follow a very low energy diet, compared to 19% in the no weight loss group (p = 0.05). Patients appeared to be increasing their consumption of fruits and vegetables and decreasing their discretionary foods, but changes did not reach statistical significance. We found that the current clinic was resource-intensive, provided varied nutritional treatments, and resulted in some, but limited, success. Findings from this study suggest areas for improvement in clinics that primarily serve patients with osteoarthritis.

PMID:40542998 | DOI:10.1002/msc.70146

Jpn J Ophthalmol. 2025 Jun 21. doi: 10.1007/s10384-025-01214-2. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective cohort compared the cumulative probability of success for glaucoma drainage device (GDD) implantation in pediatric and adult patients.

STUDY DESIGN: This retrospective study enrolled adult and pediatric patients who had received a GDD between January 1, 1985 and December 31, 2017.

METHODS: Kaplan-Meier method was used to estimate the cumulative probability of success in the pediatric and adult patients. Successful intraocular pressure (IOP) control was defined as (i) a 20% reduction from baseline and (ii) IOP>6 and <18. Inadequate IOP control and failure were defined as a violation of these two criteria over two consecutive visits. Cox proportional hazards models enabled assessing the influence of sex, GDD location, and GDD type on IOP control.

RESULTS: A total of 425 adult eyes from 372 individuals and 41 pediatric eyes from 28 individuals were included. The median follow-up time was 55 months for adults and 87 months for children. Superior temporal GDD placement was most employed for both (p=0.16). Adults were more likely to receive a Baerveldt 350 (p=0.04) and children were more likely to receive an Ahmed S2 (p<0.001). Adults and children had a median survival time of 2.99 and 0.82, respectively, and did not have a statistically significant difference in GDD failure rate (p=0.18). Additionally, sex, GDD location, and GDD type did not affect the success rate.

CONCLUSIONS: Children and adults had a similar cumulative probability of success following GDD implantation. This study found that GDD type, GDD location, and glaucoma type did not influence the probability of successful IOP control.

PMID:40542982 | DOI:10.1007/s10384-025-01214-2

J Orthop Traumatol. 2025 Jun 21;26(1):38. doi: 10.1186/s10195-025-00849-8.

ABSTRACT

PURPOSE: To investigate the effect of arthroscopic reduction combined with robot-guided screw placement on Hawkins type II fractures of the talus neck.

METHODS: Clinical data from 42 patients with talus neck Hawkins type II fracture treated in the institution from November 2019 to January 2021 were selected. According to the blind envelope method, 21 patients were enrolled in the study group, and 21 patients were enrolled in the control group. The patients in the study group underwent arthroscopy-assisted reduction combined with orthopedic robot navigation screw placement surgery, while those in the control group underwent open reduction surgery.

RESULTS: All 42 patients were followed up. The patients in the study group were followed up for a mean of 14.76 (range, 12-17) months. No talus avascular necrosis or fracture nonunion were observed. Subtalar arthritis was reported in two cases. Patients in the control group were followed up for an average of 14.52 (ranging from 12 to 17) months, and no talus avascular necrosis or fracture nonunion was found. Incisional infection occurred in one case and subtalar arthritis in three cases. The difference between the two groups was statistically significant (P < 0.05) in the duration from injury to surgery, operation time, blood loss, incision length, and number of guide pin insertions. There was no significant difference between the two groups in ankle joint range of motion, the American Orthopedic Foot and Ankle Society ankle-hindfoot score at the last follow-up, and visual analogue scale of pain before operation and at the last follow-up (P > 0.05).

CONCLUSIONS: The management of Hawkins type II fracture of the talus neck using arthroscopy-assisted reduction combined with robot navigation screw placement yields satisfactory results and represents a viable treatment alternative that warrants consideration.

PMID:40542971 | DOI:10.1186/s10195-025-00849-8

Int Urol Nephrol. 2025 Jun 21. doi: 10.1007/s11255-025-04604-0. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the feasibility and safety of robot-assisted partial nephrectomy (RAPN) to treat large (T2) cystic renal-cell carcinoma.

METHODS: A multinational study was conducted worldwide. Patients with renal tumors larger than 7cm who underwent partial nephrectomy between December 2007 and July 2017 were recruited retrospectively. The patients were divided into solid tumor group (143 cases) and cystic tumor group (28 cases). Baseline parameters, tumor characteristics, perioperative variables, and pathological outcomes were collected.

RESULTS: Between cystic and solid tumors, no statistically significant differences were detected in age, gender, BMI, ASA score, clinical tumor size, laterality, or R.E.N.A.L nephrometry score. Operating time, warm ischemic time, estimated blood loss, complications, histology outcomes, and margin status were comparable. Pathology of 6 cystic tumors came back benign (21.4%). In solid tumors, 6 intraoperative bleeding require transfusion, 1 ureteral damage, and 3 postoperative urinary fistulas were observed. In cystic tumors, conversion to radical nephrectomy happened in one case, because of sticky fat and the risk of cyst rupture. In two cases, postoperative bleeding was treated with embolism. The longest follow-up was 113 months. In cystic group, 1 recurrence or metastasis was observed, while in solid group, 14 cases were observed.

CONCLUSION: RAPN can be safely performed to treat large (T2) cystic renal-cell carcinoma. Patients with cystic renal-cell carcinoma exhibited favorable renal function recovery after robot-assisted partial nephrectomy (RAPN), which maximally preserved normal renal tissue and its function. Further studies are needed to better understand the role of RAPN for these challenging cases.

PMID:40542967 | DOI:10.1007/s11255-025-04604-0

Behav Genet. 2025 Jun 21. doi: 10.1007/s10519-025-10224-2. Online ahead of print.

ABSTRACT

Meta-analyses report small to moderate effect sizes or inconsistent associations (usually around r = -0.10) between wellbeing (WB) and social media use (SMU) and between anxious-depressive symptoms (ADS) and SMU (also around r = 0.10). This study employs the classical twin design, utilizing data from 6492 individuals from the Netherlands Twin Register, including 3369 MZ twins (893 complete twin pairs, 1583 incomplete twin pairs) and 3123 DZ twins (445 complete, 2233 incomplete) to provide insights into the sources of overlap between WB/ADS and SMU. Both hedonic and eudaimonic WB scales were used. SMU was measured by (1) the time spent on different social media platforms (SMU_t), (2) the frequency of posting on social media (SMU_f), and (3) the number of social media accounts individuals have (SMU_n). Our results confirmed the low phenotypic correlations between WB and SMU (between r = -0.09 and 0.04) as well as between ADS and SMU (between r = 0.07 and 0.10). For SMU, heritability estimates between 32 and 72% were obtained. The small but significant phenotypic correlations between WB/ADS and the SMU phenotypes were mainly determined by genetic factors (in the range of 80-90%). For WB and SMU, genetic correlations were between -0.10 and -0.0, and for ADS and SMU genetic correlations were between 0.10 and 0.23. Genetic correlations implied limited but statistically significant sets of genes that affect WB/ADS and SMU levels. Overall, the results indicate that there is evidence that the small associations between WB/ADS and SMU are partly driven by overlapping genetic influences. We encourage researchers and experts to consider more personalized approaches when considering the association between WB and SMU, as well as understanding the reasons for individuals’ observed SMU levels.

PMID:40542957 | DOI:10.1007/s10519-025-10224-2

J Neurooncol. 2025 Jun 21. doi: 10.1007/s11060-025-05105-x. Online ahead of print.

ABSTRACT

PURPOSE: In brain gliomas, non-invasive biomarkers reflecting tumor cellularity would be useful to guide supramarginal resections and to plan stereotactic biopsies. We aim to validate a previously-trained machine learning algorithm that generates cellularity prediction maps (CPM) from multiparametric MRI data to an independent, retrospective external cohort of gliomas undergoing image-guided biopsies, and to compare the performance of CPM and diffusion MRI apparent diffusion coefficient (ADC) in predicting cellularity.

METHODS: A cohort of patients with treatment-naïve or recurrent gliomas were prospectively studied. All patients underwent pre-surgical MRI according to the standardized brain tumor imaging protocol. The surgical sampling site was planned based on image-guided biopsy targets and tissue was stained with hematoxylin-eosin for cell density count. The correlation between MRI-derived CPM values and histological cellularity, and between ADC and histological cellularity, was evaluated both assuming independent observations and accounting for non-independent observations.

RESULTS: Sixty-six samples from twenty-seven patients were collected. Thirteen patients had treatment-naïve tumors and fourteen had recurrent lesions. CPM value accurately predicted histological cellularity in treatment-naïve patients (b = 1.4, R² = 0.2, p = 0.009, rho = 0.41, p = 0.016, RMSE = 1503 cell/mm²), but not in the recurrent sub-cohort. Similarly, ADC values showed a significant association with histological cellularity only in treatment-naive patients (b = 1.3, R² = 0.22, p = 0.007; rho = -0.37, p = 0.03), not statistically different from the CPM correlation. These findings were confirmed with statistical tests accounting for non-independent observations.

CONCLUSION: MRI-derived machine learning generated cellularity prediction maps (CPM) enabled a non-invasive evaluation of tumor cellularity in treatment-naïve glioma patients, although CPM did not clearly outperform ADC alone in this cohort.

PMID:40542949 | DOI:10.1007/s11060-025-05105-x

Anat Sci Int. 2025 Jun 21. doi: 10.1007/s12565-025-00855-0. Online ahead of print.

ABSTRACT

The vertebral artery (VA) supplies almost one-third of the blood flow to the brain, contributing mainly to its posterior circulation. This article provides a comprehensive overview of the different anatomical variations related to the origin, course, and termination of the VA and associated clinical implications. Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literature in Health Sciences (LILACS) as of January 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in VA variant rates were assessed. VA variants were identified that could be separated into three categories: variation in origin, course, and terminal branches. A total of 16 studies met the established selection criteria for the current meta-analysis. VA variations were reported at an overall prevalence of 11% (CI: 7%-15%) and a heterogeneity of 77%. Statistically significantly higher rates were revealed in the following subgroups of the sample: imaging examinations versus cadavers (p = 0.032); right side of the body versus left (p = 0.034); and bilaterally versus unilaterally (p = 0.019). Concerns listed in included studies primarily focused on the possibility of iatrogenic damage during surgical procedures. A few studies also indicated higher rates of VA variants in patients who reported symptoms of recurrent headaches, vertigo, dizziness, and/or syncope. The presence of VA variants is high and can occur in various regions. However, the most important clinical consideration is that individuals with this variant must be constantly monitored since their posterior cerebral circulation could be affected. To avoid iatrogenic damage to the VA, clinicians should employ medical imaging to evaluate its course and branches prior to surgical interventions in the region.

PMID:40542940 | DOI:10.1007/s12565-025-00855-0

Neurosurg Rev. 2025 Jun 21;48(1):524. doi: 10.1007/s10143-025-03674-z.

ABSTRACT

The transpedicular screw placement has been the gold standard for over a decade in treating degenerative diseases of the lumbo-sacral spine related to vertebral instability. The evolution of neuronavigation and robotic surgery has mitigated many perioperative complications such as mispositioning, vascular damage, and nerve structure injuries, leading to enhanced postoperative outcomes, reduced blood loss, and decreased intraoperative radiation exposure. Our study proposes a multicenter comparison between robotic surgery and neuronavigation for treating degenerative diseases of the lumbo-sacral spine. We conducted a retrospective analysis at Papardo Hospital in Messina and Garibaldi Hospital in Catania, examining a consecutive series of 76 patients treated for degenerative diseases of the lumbo-sacral spine between March 2024 and December 2024 using the Excelsius GPS Robot and neuronavigation with the O-arm. We evaluated each procedure based on age, sex, body mass index, number of involved metameres, number of screws placed, operative times, estimated blood loss (EBL), radiation exposure, type of anesthesia, accuracy (using the Gertzbein and Robbins scale), and then compared various pre- and postoperative parameters through univariate statistical analysis. Patients were randomly assigned in a 1:1 ratio using a computer-generated sequence with permuted blocks of variable size (4-6). This ensured balanced allocation and minimized selection bias. A detailed statistical plan has been included: continuous variables were assessed using Student’s t-test or Mann-Whitney U test depending on distribution (Shapiro-Wilk test), while categorical variables were evaluated with Chi-square or Fisher’s exact test as appropriate. 48 out of 76 patients (average age 60.47 years) underwent pedicle screw placement via robotic surgery, and 28 patients (average age 65.92 years) via neuronavigation surgery. Robotic surgery showed comparable results to neuronavigation surgery in terms of blood loss. Additionally, functional outcomes, especially those evaluated with the ODI scale and VAS scale, were similar between the two patient groups. Despite a reported mispositioning rate of 2.2% in neuronavigation surgery, no clinical impact was observed in these specific cases. The surgical procedures included both decompression (laminectomy with partial facetectomy) and fusion in all patients. Operative time was recorded as skin-to-skin time, excluding anesthesia induction and positioning. Patients with prior surgeries at the index level, complex spinal deformities (Cobb angle > 30°), or revision surgeries were excluded from this study. The included diagnoses were degenerative disc disease (RS: 56%, NS: 52%), spinal stenosis (RS: 28%, NS: 31%), spondylolisthesis (RS: 12%, NS: 14%), and traumatic pathology (RS: 4%, NS: 3%). While there was a trend towards greater precision in screw placement with robotic technology, no significant difference was observed compared to neuronavigation with the O-arm. Both technological systems used in instrumented spinal surgery appear safe and effective. However, they present a steep learning curve, and various technical aspects of these systems are continuously reassessed to improve operational efficiency and achieve these objectives.

PMID:40542927 | DOI:10.1007/s10143-025-03674-z