Nevin Manimala

Diabetes Obes Metab. 2025 Jun 11. doi: 10.1111/dom.16497. Online ahead of print.

ABSTRACT

AIMS: Prediabetes is a public health problem, and its prevalence is increasing worldwide. Both genetic factors and lifestyle contribute to the development and progression of prediabetes. The Omentin-1 Val109Asp polymorphism is reported to be associated with insulin resistance and obesity. Moreover, research suggests that vitamin D may help decrease the risk of developing and progressing to type 2 diabetes mellitus. Therefore, this trial aimed to investigate the interaction between vitamin D supplementation and the Omentin-1 gene polymorphism on metabolic factors, omentin-1 levels and obesity values in women with prediabetes.

MATERIALS AND METHODS: This double-blind randomized controlled trial was conducted on 204 women aged 18-65 with prediabetes. After obtaining informed consent, the blood samples of all participants were analysed to determine the Omentin-1 polymorphism (Val109Asp) genotypes. The women were then randomized into intervention (n = 24) and placebo (n = 24) groups (1:1) according to each genotype of the Omentin-1 polymorphism. In total, 96 women were allocated to receive vitamin D (50 000 IU) or a placebo every two weeks for 12 weeks. Anthropometric measures, dietary intake data and physical activity level information were collected at the beginning and after the intervention. Data analyses were performed using IBM SPSS Statistics software.

RESULTS: Vitamin D administration significantly increased serum levels of 25-hydroxyvitamin D (25(OH)D), insulin, HOMA-IR, HOMA-β and QUICKI in both AT and TT genotypes (all, p < 0.001). Moreover, the serum concentration of HDL-C decreased significantly after vitamin D intervention in the AT genotype, but not in the TT genotype (p < 0.001). A significant interaction was also observed between vitamin D intervention and Omentin-1 Val109Asp polymorphism on HDL-C (p = 0.003), waist circumference (WC) (p = 0.026) and waist-to-height ratio (WHthR) (p = 0.035). However, there was no significant interplay between vitamin D and Omentin-1 polymorphism on glycaemic factors, omentin-1 levels and other lipid profiles and anthropometric measures (p ≥ 0.05).

CONCLUSIONS: The findings suggest that the Omentin-1 gene Val109Asp polymorphism may modify the effects of vitamin D intervention on serum HDL-C levels and abdominal obesity in women with prediabetes. Future clinical trials are necessary to clarify the influence of the Omentin-1 gene polymorphism genotype on the effects of vitamin D intervention.

PMID:40497345 | DOI:10.1111/dom.16497

Elife. 2025 Jun 11;13:RP95243. doi: 10.7554/eLife.95243.

ABSTRACT

The brain learns an internal model of the environment through sensory experiences, which is essential for high-level cognitive processes. Recent studies show that spontaneous activity reflects such a learned internal model. Although computational studies have proposed that Hebbian plasticity can learn the switching dynamics of replayed activities, it is still challenging to learn dynamic spontaneous activity that obeys the statistical properties of sensory experience. Here, we propose a pair of biologically plausible plasticity rules for excitatory and inhibitory synapses in a recurrent spiking neural network model to embed stochastic dynamics in spontaneous activity. The proposed synaptic plasticity rule for excitatory synapses seeks to minimize the discrepancy between stimulus-evoked and internally predicted activity, while inhibitory plasticity maintains the excitatory-inhibitory balance. We show that the spontaneous reactivation of cell assemblies follows the transition statistics of the model’s evoked dynamics. We also demonstrate that simulations of our model can replicate recent experimental results of spontaneous activity in songbirds, suggesting that the proposed plasticity rule might underlie the mechanism by which animals learn internal models of the environment.

PMID:40497329 | DOI:10.7554/eLife.95243

BJOG. 2025 Jun 11. doi: 10.1111/1471-0528.18253. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal methods and settings for induction of labour (IOL) in terms of effectiveness, safety, and women’s experience are still not elucidated.

OBJECTIVE: To compare the effectiveness and safety of outpatient versus inpatient cervical ripening settings for IOL.

SEARCH STRATEGY: MEDLINE, Embase, Emcare, CINAHL Plus, Scopus, Cochrane Library, WHO ICTRP and clinicaltrials.gov from inception to July 2024.

SELECTION CRITERIA: Randomised controlled trials, viable singleton gestation, no language restrictions, all the published and unpublished data.

DATA COLLECTION AND ANALYSIS: An individual participant data meta-analysis.

MAIN RESULTS: Eleven out of 18 (61.1%) eligible RCTs shared IPD, totalling 2593 pregnant individuals undergoing IOL (62.2% of all participants in the published RCTs). Among the shared RCTs, four used balloon catheters alone in both groups. Three RCTs compared outpatient balloon catheter with inpatient balloon catheter plus oxytocin. Another three RCTs compared outpatient balloon catheter to inpatient vaginal dinoprostone. One RCT used Dilapan-S in both groups. No trials evaluating outpatient use of vaginal prostaglandins were identified. Vaginal birth (11 RCTs, 2584 women, 67.8% vs. 70.2%, aOR 0.95, 95% CI 0.70; 1.30), composite perinatal outcome (9 RCTs, 2525 women, 11.1% vs. 11.7%, aOR 0.93, 95% CI 0.75; 1.16) and composite maternal (10 RCTs, 2480 women, 14.3% vs. 15.4%, aOR 0.89, 95% CI 0.65; 1.20) outcome did not differ between outpatient and inpatient groups. The outpatient group had a lower risk of acidosis, more epidural analgesia, and more oxytocin. There were no perinatal deaths in either group.

CONCLUSIONS: Overall effectiveness, perinatal and maternal safety are comparable between outpatient setting cervical ripening with a mechanical method and inpatient with any method.

TRIAL REGISTRATION: PROSPERO: CRD42022313183.

PMID:40497299 | DOI:10.1111/1471-0528.18253

Acta Oncol. 2025 Jun 11;64:769-774. doi: 10.2340/1651-226X.2025.43093.

ABSTRACT

BACKGROUND: Early detection of lung cancer with low-dose computed tomography (LDCT) screening can shift diagnoses to early-stage disease and improve survival. However, LDCT has several challenges such as high false positive rate and indefinite cost-effectiveness. We report here secondary and exploratory endpoints of the Low-dose CT screening for lung cancer combined with different smoking cessation approach in Finland (LDCT-SC-FI) study including recruitment channels, LDCT performance, and long-term smoking cessation.

METHODS: In this study, we randomized 200 current smokers with a significant smoking history in 1:1 fashion to receive a smartphone application or standard of care written materials, both for smoking cessation. All underwent LDCT screening at baseline and at 1-year. Participants were recruited through multiple channels, including newspapers, internet advertisements, and healthcare referrals.

RESULTS: Newspaper advertisements were the most effective recruitment method, accounting for 74.5% of participants while minority came through referrals (2.5%). LDCT screening demonstrated uptake of 96.7% for both rounds combined. Six lung cancers were detected with a positive predictive value of 75%. Of the detected lung cancers, five were at stage I and all of these underwent curative intent treatment. Smoking cessation rates at 1-year were higher in the application (18.3%) than in the control arm (12.8%), though the difference was not statistically significant (odds ratio [OR]: 1.53, 95% confidence interval [CI]: 0.69-3.41).

INTERPRETATION: This study suggests that LDCT screening for lung cancer is feasible in Finland. The screening examination uptake was high with both screening rounds, while the positive predictive value for lung cancer detection remained at good level.

PMID:40497290 | DOI:10.2340/1651-226X.2025.43093

J Hand Surg Glob Online. 2025 May 21;7(4):100728. doi: 10.1016/j.jhsg.2025.02.018. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Prior literature has shown that although follow-up radiographs are obtained for approximately two-thirds of nonoperatively treated isolated radial head fractures, they generally do not change management. This study aims to investigate the current practice regarding follow-up radiographs for these injuries and the utility of obtaining these studies.

METHODS: A retrospective review was performed of patients with isolated radial head fractures initially treated nonoperatively at two Level I trauma centers between 2016 and 2020. Patient details, treatment course, and radiographic measurements were recorded. The primary outcome was the acquisition of follow-up radiographs. Secondary outcomes included the number of follow-up radiographs, interval fracture displacement, planned versus unplanned clinic appointments, radiographic union on final follow-up films, change in management based on follow-up radiographs, and nonunion and/or conversion to surgery. Bivariate statistical analysis was performed.

RESULTS: Of 318 patients with 322 isolated radial head fractures initially treated nonoperatively (92% Mason I, 8% Mason II), 217 (67%) had 331 total sets of follow-up radiographs, with a median of 1 set per fracture. Increased articular displacement and Mason II classification were associated with increased number of follow-up radiographs. No patient had a change in management based on follow-up radiographs or documentation of nonunion or conversion to surgery. Median interval fracture displacement was 0 mm. The rate of follow-up radiographs was 11% higher among patients with unplanned clinic visits.

CONCLUSIONS: The incidence of follow-up radiographs for nonoperatively treated isolated radial head fractures has remained similar compared to previous reports, despite prior evidence demonstrating a lack of utility. In our cohort, follow-up radiographs did not change management and interval displacement was minimal, even among patients with unplanned clinic visits. Follow-up radiographs in this clinical scenario are a low-value test, and providers should reconsider the utility of obtaining these studies.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:40497275 | PMC:PMC12148466 | DOI:10.1016/j.jhsg.2025.02.018

J Hand Surg Glob Online. 2025 May 22;7(4):100729. doi: 10.1016/j.jhsg.2025.02.019. eCollection 2025 Jul.

ABSTRACT

PURPOSE: The purpose of this study was to compare the safety and efficacy of the carpal tunnel release surgery in cadaveric specimens, using a newly developed surgical knife incorporating a guide, with and without ultrasound guidance.

METHODS: For this study, 100 fresh frozen human cadaveric hands, free from fractures or surgical antecedents, were used (mean age: 71.3 ± 15.8 years, 60 men and 40 women). The specimens were allocated into two groups of 50 to undergo carpal tunnel release with or without ultrasound guidance, using the knife and guide (KeriKnife, KeriMedical) by four experienced hand surgeons. Donor demographics and operated side were recorded. Following surgery, every surgeon reported the difficulty of cutting the ligament on a scale of 1 (easy) to 5 (difficult), whether the ligament was completely cut, and whether the intervention caused any injuries to the surrounding structures.

RESULTS: There were no differences between the groups in terms of age, sex, weight, or side. Following surgery, the surgeons rated the difficulty similarly between the groups. The ligament was incompletely cut in one (2%) specimen that underwent the surgery with ultrasound, whereas it was incomplete in two (4%) that underwent the surgery without ultrasound, although the difference was not statistically significant. Furthermore, there was one injury in the group without ultrasound.

CONCLUSIONS: The KeriKnife has shown its effectiveness for carpal tunnel release with or without ultrasound control. The only iatrogenic injury happened during the surgical release without ultrasound control.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

PMID:40497274 | PMC:PMC12150071 | DOI:10.1016/j.jhsg.2025.02.019

J Hand Surg Glob Online. 2025 May 21;7(4):100746. doi: 10.1016/j.jhsg.2025.100746. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Glucagon-like peptide-1 receptor agonist (GLP-1RA) use continues to rise because of its efficacy in glycemic control and weight reduction. There are sparse data on the implications of GLP-1RA therapy on surgical outcomes. Given the higher prevalence of carpal tunnel syndrome in patients with diabetes mellitus, obesity, or both, this study evaluated the impact of perioperative GLP-1RA use on both short-term (90-day) and long-term (1-year) postoperative complications in patients undergoing carpal tunnel release (CTR).

METHODS: A retrospective cohort analysis was conducted with the TriNetX research database and identified all patients who underwent CTR at 95 health care organizations between 2004 and 2024. Two cohorts were stratified by perioperative GLP-1RA use and propensity score matched (1:1) to mitigate baseline differences in demographics, comorbidities, and procedural approach. Primary outcomes, including scarring, wound dehiscence, and infection, were evaluated over a 90-day postoperative period, whereas secondary outcomes, including subsequent CTR and median nerve (MN) injury, were assessed at the 1-year follow-up. Cohorts were compared using odds ratios (OR) with 95% confidence intervals (CI).

RESULTS: The query identified 303,360 patients who underwent CTR, including 13,439 on perioperative GLP-1RA therapy. After matching, homogeneous cohorts each consisted of 10,773 patients. At 90 days after surgery, the GLP-1RA cohort had significantly lower odds of wound dehiscence (OR, 0.691; 95% CI, 0.488-0.978) compared with patients not on GLP-1RA therapy. No significant differences were observed in rates of infection (superficial, deep, or unspecified), abscess incision and drainage, or scarring. At 1 year, GLP-1RA patients had lower odds of subsequent CTR (OR, 0.897; 95% CI, 0.839-0.959) and MN injury (OR, 0.399; 95% CI, 0.192-0.832).

CONCLUSIONS: Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. Additionally, GLP-1RA therapy demonstrated lower odds of subsequent CTR and MN injury at the 1-year follow-up. Prospective investigation is warranted to further clarify the impact of GLP-1RA therapy in patients undergoing CTR.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.

PMID:40497273 | PMC:PMC12148469 | DOI:10.1016/j.jhsg.2025.100746

J Hand Surg Glob Online. 2025 May 21;7(4):100721. doi: 10.1016/j.jhsg.2025.03.002. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Carpal tunnel release (CTR) is commonly performed with the patient wide awake using local anesthetic (LA). Although most patients tolerate this type of procedure, there is a possibility of some discomfort or pain. We compared two LA infiltration techniques-subcutaneous infiltration alone (superficial) and subcutaneous infiltration with infiltration into the carpal tunnel (deep)-to determine which provides a better pain experience during CTR.

METHODS: Seventy-four participants (n = 80 cases) were recruited and randomized to either deep or superficial LA infiltration. Thirty-eight received deep LA and 42 superficial LA. Primary outcomes were presence and severity of pain and/or tingling during the LA infiltration and during the procedure. We also examined the severity of pain at 2, 8, and 24 hours after the procedure. Clinical outcomes were assessed with the Boston Carpal Tunnel Questionnaire score at baseline and at 3 months postprocedure. Statistical comparisons were performed using chi-square and analysis of variance tests.

RESULTS: The average age of participants was 63.04 ± 12.92 years (n = 40 females and n = 34 males). In the deep group, 21% experienced pain during LA infiltration compared to 9.5% in the superficial group, whereas 13.2% of the deep group and 11.0% of the superficial group experienced pain during the procedure. Both groups showed a significant improvement in clinical outcomes, measured by the Boston Carpal Tunnel Questionnaire.

CONCLUSIONS: In this randomized clinical trial comparing deep versus superficial LA infiltration techniques for CTR, we found that there was no statistically significant difference in the pain experienced during the administration of the LA or during the procedure. Given these findings, we recommend using superficial infiltration for CTR as it is technically easier and reduces the risk of potential median nerve injury.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Ib.

PMID:40497269 | PMC:PMC12148473 | DOI:10.1016/j.jhsg.2025.03.002

J Hand Surg Glob Online. 2025 May 22;7(4):100737. doi: 10.1016/j.jhsg.2025.100737. eCollection 2025 Jul.

ABSTRACT

PURPOSE: Our aim was to compare the efficacy and safety of the available surgical interventions for trapeziometacarpal joint (TMCJ) arthritis.

METHODS: We conducted a systematic review and network meta-analysis of randomized studies comparing surgical interventions for TMCJ arthritis. Our primary outcome was patient-reported pain, and secondary outcomes were patient-reported functional disability, key pinch strength, and complications. Mean differences (MD) and standardized mean differences (SMD) were calculated for continuous outcomes and odds ratios (OR) for dichotomous outcomes, all with 95% confidence intervals.

RESULTS: Twenty-one randomized studies were included. In pairwise meta-analyses, when simple trapeziectomy was compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI), all pain, functional disability, and key pinch strength were similar (pain visual analogue scale, MD 0.22 points [-0.66 to 0.21]; functional disability, SMD 0.17 [-0.06 to 0.41]; key pinch strength, MD 0.07 kg [-0.22 to 036], P = .64). Compared with trapeziectomy (with or without LRTI), total joint arthroplasty provided similar short-term pain relief (MD 0.20 points [-0.10 to 0.50], moderate certainty of evidence), statistically greater improvement in short-term functional disability (disabilities of the arm, shoulder, and hand), and key pinch strength (function disabilities of the arm, shoulder, and hand, MD 5.24 points [0.72-9.75], low certainty of evidence; key pinch strength, MD 0.92 kg [0.63,-1.21], and moderate certainty of evidence]). Only the difference in key pinch strength exceeded clinical significance. In network meta-analyses, total joint arthroplasty ranked first for all short-term pain, function, and key pinch strength; however, its superiority over other treatments was only significant for key pinch strength. Short-term complications between simple trapeziectomy and trapeziectomy with LRTI, and between trapeziectomy and total joint arthroplasty were similar; however, longer-term data were not available.

CONCLUSIONS: Total joint arthroplasty appears to be at least as effective as trapeziectomy for pain relief and functional disability and may be superior for key pinch strength in the short-term. Until long-term efficacy, complication, and survivorship data arising from high-quality comparative studies become available, its widespread use cannot be recommended.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

PMID:40497265 | PMC:PMC12150098 | DOI:10.1016/j.jhsg.2025.100737

Depress Anxiety. 2025 Jun 3;2025:5130737. doi: 10.1155/da/5130737. eCollection 2025.

ABSTRACT

Objectives: This study was conducted to investigate the personality traits, stress, anxiety, depression levels, fear of childbirth, and affecting factors in Turkish female university students. Materials and Methods: The study was planned as a descriptive and correlational type. The sample consisted of 500 female students who met the research criteria at the Faculty of Health Sciences and Faculty of Education of a university. The data were collected face-to-face using a personal information form, including socio-demographic and pregnancy-birth-related thoughts, the Childbirth Fear-Prior to Pregnancy (CFPP) scale, the Type D Personality Scale (negative affectivity and social inhibition subscales), and the Depression Anxiety Stress Scale-21 (DASS-21). Ethics committee approval and institutional permissions were obtained from the students to conduct the study. In the analysis of the data, the Kolmogorov-Smirnov test, descriptive methods Mann-Whitney U, and the Kruskal-Wallis test were used. Results: 52.8% of the students were from the Faculty of Health Sciences, 48.4% were nursing students, and 30.6% were in their first class of students. The mean CFPP score was 40.14 ± 11.35. The mean score was 12.01 ± 6.79 for negative affectivity, 9.58 ± 6.09 for social inhibition, 6.75 ± 4.05 for stress, 5.28 ± 4.09 for anxiety, and 5.58 ± 4.50 for depression. There was a low level of positive correlation between CFPP and social inhibition subscales (r = 0.113), negative affectivity (r = 0.282), stress (r = 0.241), anxiety (r = 0.231), and depression (r = 0.221 (p = 0.01). The predictor of students’ fear of childbirth prior to pregnancy was negative affectivity. Conclusions: Turkish university students’ fear of childbirth prior to pregnancy was associated with personality traits, depression, anxiety, and stress. It is recommended to identify the depression, anxiety, stress levels, personality traits, and fear of childbirth of female university students in the prepregnancy period, plan information and education, and conduct further research on the fear of childbirth.

PMID:40497255 | PMC:PMC12151619 | DOI:10.1155/da/5130737